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Liao M, Wang L, Shang N, Hu X, He B, Liu X, Xiang G, Zhong W. Ultrasound measurements of fetal facial profile markers and their associations with congenital malformations during early pregnancy. BMC Pregnancy Childbirth 2023; 23:772. [PMID: 37925422 PMCID: PMC10625258 DOI: 10.1186/s12884-023-06067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 10/13/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Fetal facial profile could be measured during the early pregnancy. Its abnormalities might be associated with certain congenital malformations. We aimed to study the associations between fetal facial profile measurements with crown-rump length and congenital malformations (cleft lip and palate, micrognathia, and open spina bifida) during early pregnancy. METHODS We performed a prospective cross-sectional study between June 2019 and April 2022. Pregnant women at a gestational age between 11-13+ 6 weeks were enrolled. Two sonographers performed fetal facial profile measurements independently. The associations between these measurements with crown-rump length and congenital malformations were evaluated. RESULTS There were 406 and 25 fetuses without or with congenital malformations, respectively. Two sonographers showed satisfactory inter- and intra-observer agreements and reproducibility. The maxillary gap was only observed in 7.6% of normal fetuses, whereas all cleft lip and palate fetuses had a maxillary gap ≥ 0.8 mm. The crown-rump length was negatively correlated with frontomaxillary facial angle, inferior facial angle, and profile line distance but positively correlated with maxilla-nasion-mandible angle, facial maxillary angle, frontal space distance, and palatine maxillary diameter. These measurements showed various significant changes with different congenital malformations. CONCLUSIONS Measurements of fetal facial profile in early pregnancy were feasible with satisfactory reproducibility. These measurements correlated with crown-rump length and showed significant differences with certain fetal congenital malformations.
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Affiliation(s)
- Minyan Liao
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Limin Wang
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Ning Shang
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China.
| | - Xueyi Hu
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Bingjia He
- Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510260, China
| | - Xiangjiao Liu
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Guanghua Xiang
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
| | - Wei Zhong
- Guangdong Women and Children Hospital, 521 Xing-nan Avenue Pan-Yu, Guangzhou, 510499, China
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Ji C, Liu K, Yang X, Cao Y, Cao X, Pan Q, Yang Z, Sun L, Yin L, Deng X, Ni D. A novel artificial intelligence model for fetal facial profile marker measurement during the first trimester. BMC Pregnancy Childbirth 2023; 23:718. [PMID: 37817098 PMCID: PMC10563312 DOI: 10.1186/s12884-023-06046-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND To study the validity of an artificial intelligence (AI) model for measuring fetal facial profile markers, and to evaluate the clinical value of the AI model for identifying fetal abnormalities during the first trimester. METHODS This retrospective study used two-dimensional mid-sagittal fetal profile images taken during singleton pregnancies at 11-13+ 6 weeks of gestation. We measured the facial profile markers, including inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial-maxillary angle (FMA), frontal space (FS) distance, and profile line (PL) distance using AI and manual measurements. Semantic segmentation and landmark localization were used to develop an AI model to measure the selected markers and evaluate the diagnostic value for fetal abnormalities. The consistency between AI and manual measurements was compared using intraclass correlation coefficients (ICC). The diagnostic value of facial markers measured using the AI model during fetal abnormality screening was evaluated using receiver operating characteristic (ROC) curves. RESULTS A total of 2372 normal fetuses and 37 with abnormalities were observed, including 18 with trisomy 21, 7 with trisomy 18, and 12 with CLP. Among them, 1872 normal fetuses were used for AI model training and validation, and the remaining 500 normal fetuses and all fetuses with abnormalities were used for clinical testing. The ICCs (95%CI) of the IFA, MNM angle, FMA, FS distance, and PL distance between the AI and manual measurement for the 500 normal fetuses were 0.812 (0.780-0.840), 0.760 (0.720-0.795), 0.766 (0.727-0.800), 0.807 (0.775-0.836), and 0.798 (0.764-0.828), respectively. IFA clinically significantly identified trisomy 21 and trisomy 18, with areas under the ROC curve (AUC) of 0.686 (95%CI, 0.585-0.788) and 0.729 (95%CI, 0.621-0.837), respectively. FMA effectively predicted trisomy 18, with an AUC of 0.904 (95%CI, 0.842-0.966). MNM angle and FS distance exhibited good predictive value in CLP, with AUCs of 0.738 (95%CI, 0.573-0.902) and 0.677 (95%CI, 0.494-0.859), respectively. CONCLUSIONS The consistency of fetal facial profile marker measurements between the AI and manual measurement was good during the first trimester. The AI model is a convenient and effective tool for the early screen for fetal trisomy 21, trisomy 18, and CLP, which can be generalized to first-trimester scanning (FTS).
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Affiliation(s)
- Chunya Ji
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Kai Liu
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
| | - Xin Yang
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
| | - Yan Cao
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China
- Shenzhen RayShape Medical Technology Co., Ltd, Shenzhen, Guangdong, China
| | - Xiaoju Cao
- Center for Reproduction and Genetics, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Qi Pan
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhong Yang
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Lingling Sun
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, Suzhou Municipal Hospital, Gusu School, The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing Medical University, Suzhou, Jiangsu, China.
| | - Dong Ni
- National-Regional Key Technology Engineering Laboratory for Medical Ultrasound, School of Biomedical Engineering, Health Science Center, Shenzhen University, Xueyuan Blvd, Nanshan, Shenzhen, Guangdong, China.
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Minor K, Chueh J. Understanding the distinction between cleft lip and cleft palate: a critical step for successful prenatal detection. Curr Opin Obstet Gynecol 2023; 35:113-126. [PMID: 36912278 DOI: 10.1097/gco.0000000000000852] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW Orofacial clefts (OCs) are among the most common congenital anomalies, however, prenatal detection of cleft palate without cleft lip (CP) remains low. CP is associated with a higher risk of associated structural anomalies, recurrence risk and genetic aberrations. There is opportunity to optimize prenatal diagnosis, counseling and diagnostic genetic testing for OCs. RECENT FINDINGS Improving prenatal diagnosis of CP requires understanding that embryologically, the secondary palate develops from the 6th to the 10th week and fuses with the primary palate by the 12th week. Multiple first, second and third trimester 2D ultrasonographic markers for OCs have been described including the maxillary gap, frontal space, maxilla-nasion-mandible angle, retronasal triangle, palatino-maxillary diameter, equal sign, nonvisualization or gap in the soft to hard palate interface and loss of the superimposed line. We discuss the technique, evidence and limitations of each. SUMMARY Prenatal detection of OC can be optimized by employing 2D sonographic markers. Prenatal detection of CP may be improved by recognizing its high association with retrognathia/micrognathia.
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Affiliation(s)
- Kathleen Minor
- Division of Maternal-Fetal Medicine & Obstetrics, Department of Obstetrics and Gynecology, School of Medicine, Stanford University, Stanford, California, USA
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Zhou X, Ji C, Sun L, Yin L, Deng X, Pan Q, Zhang J, Yang Z, Zheng C, Ling C, Shi L, Wu Y. Clinical value of fetal facial profile markers during the first trimester. BMC Pregnancy Childbirth 2022; 22:738. [PMID: 36184592 PMCID: PMC9526988 DOI: 10.1186/s12884-022-05028-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives To study the correlations between facial profile markers and crown-lump length (CRL) in a Chinese population, and to evaluate the clinical value of these markers for abnormal fetuses during the first trimester (11 to 13+6 gestational weeks). Methods The facial profile markers were as followings: inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA), frontal space (FS) distance and profile line (PL) distance. These markers were measured in facial mid-sagittal section through ViewPoint 6 software. The diagnostic value of these markers for abnormal fetuses was assessed by receiver operating characteristic (ROC) curves. Results According to the first-trimester scanning (FTS) and follow-up, 31 fetuses were enrolled in the abnormal group, including 14 cases of trisomy 21, 7 cases of trisomy 18, 10 cases with cleft lip and palate (CLP), and 1000 normal fetuses were selected. Among the normal fetuses, the IFA, FS distance and PL distance had negative correlations with CRL. The MNM angle and FMA had positive correlations with CRL. The mean IFA values for fetuses with trisomy 21 and trisomy 18 were 74.11° (standard deviation (SD) 7.48) and 69.88° (SD 7.08), respectively, which were significantly smaller than the normal fetuses (p = 0.013; p = 0.003). The mean MNM angle of fetuses with trisomy 18 and CLP were 6.98° (SD 2.61) and 9.41° (SD 2.57), respectively, which were significantly greater than the normal fetuses (p = 0.005; p < 0.001). The mean FMA values of trisomy 18 fetuses were 63.95° (SD 4.77), which was significantly smaller than the normal fetuses (p < 0.001). The mean FS distance of CLP fetuses was -0.22 mm (SD 1.38), which was significantly smaller than the normal fetuses (p < 0.001). The mean PL distance of trisomy 21, trisomy 18 and CLP fetuses were 2.89 mm (SD 0.41), 2.91 mm (SD 0.56) and 2.71 mm (SD 0.37), respectively. The difference with the normal fetuses had no statistical significance (p = 0.56; p = 0.607; p = 0.54). Conclusions Fetal facial profile markers had excellent correlations with CRL during the first trimester. IFA had certain clinical significance in detecting trisomy 21. FMA, IFA and MNM angle were reliable indicators for screening trisomy 18. The abnormal MNM angle and FS distance could be used as sensitive indicators for CLP. However, PL distance was not the best markers for trisomy 21, trisomy 18 and CLP. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05028-9.
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Affiliation(s)
- Xiaofeng Zhou
- Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China
| | - Chunya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Lingling Sun
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China.
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China.
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Jun Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Chenhan Zheng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Chen Ling
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, No. 26 Daoqian Street, Suzhou, 215002, Jiangsu, China
| | - Liping Shi
- Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China
| | - Yanqing Wu
- Department of Ultrasound, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, No. 6 Huanghe Street, Changshu, 215500, Jiangsu, China
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Wiechers C, Kagan KO. Fetal markers for the detection of infants with craniofacial malformation. Semin Fetal Neonatal Med 2021; 26:101291. [PMID: 34593337 DOI: 10.1016/j.siny.2021.101291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Facial clefts and Robin sequence (RS) share the timing of the diagnosis during the course of pregnancy, their association with genetic diseases and the subsequent management following the initial diagnosis. If a suspicion of a facial cleft or RS is made, a detailed anatomical examination of the fetus should be carried out to identify further anomalies. This may also involve genetic testing including a microarray or an exome analysis. Interdisciplinary counseling, including pre- and postnatal experts with sufficient experience in the management of such neonates, should be involved in this counseling. Parents should be informed about disease-specific therapeutic options and postnatal outcome. Delivery should take place in a center with experience in craniofacial malformations where clinicians are prepared for potentially life-threatening airway obstruction immediately after birth.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Hospital, Eberhard Karls University, Calwerstraße 7, Tübingen, 72076, Germany; Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University, Tübingen, Germany.
| | - Karl Oliver Kagan
- Department of Gynecology and Obstetrics, University Hospital, Eberhard Karls University, Calwerstraße 7, Tübingen, 72076, Germany.
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Lakshmy SR, Rose N, Masilamani P, Umapathy S, Ziyaulla T. Absent 'superimposed-line' sign: novel marker in early diagnosis of cleft of fetal secondary palate. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 56:906-915. [PMID: 31763719 DOI: 10.1002/uog.21931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 10/25/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To describe a novel sign, the 'superimposed-line' sign, for early diagnosis of cleft of the fetal secondary palate on two-dimensional imaging of the vomeromaxillary junction in the midsagittal view. METHODS This was a prospective evaluation of the superimposed-line sign using two-dimensional sonography (midsagittal view) in 9576 singleton fetuses referred for routine screening between 12 and 20 weeks of gestation. In this view, the vomer bone appears as a line superimposed on the distal two-thirds of the maxillary line, as the vomer fuses with the secondary palate in the midline. If there is a midline cleft of the secondary palate, the line formed by the palate is absent and hence only the vomer bone is visualized, creating a single line instead of the normal superimposed double line. Multiplanar three-dimensional (3D) views were assessed in cases in which the superimposed-line sign was absent. RESULTS The superimposed line was absent in 17 fetuses with a cleft of the secondary palate that was confirmed by 3D evaluation. Of these, 13 had defects involving the premaxilla and four had an isolated cleft of the secondary palate. Postnatal confirmation was available in all cases. The sign was useful in ruling out cleft of the fetal secondary palate in 32 high-risk cases with a family history of cleft palate. The superimposed-line sign had a sensitivity of 89.5% in detecting cleft of the secondary palate. CONCLUSIONS The superimposed-line sign is a new sonographic marker for evaluation of cleft of the fetal secondary palate; documentation of this sign proves the presence of both the palate and vomer in the midline. This marker can be demonstrated clearly in the late first trimester, allowing early diagnosis of secondary palatine cleft. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- S R Lakshmy
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - N Rose
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - P Masilamani
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - S Umapathy
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
| | - T Ziyaulla
- Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India
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Lakshmy SR, Rose N, Masilamani P, Umapathy S, Ziyaulla T. First Trimester Ultrasound Evaluation of the Cleft Palate: Midsagittal, Axial or Coronal View-Which View is Best? JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-020-00262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Median Facial Cleft. Am J Obstet Gynecol 2019; 221:B22-B24. [PMID: 31679592 DOI: 10.1016/j.ajog.2019.08.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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De Robertis V, Rembouskos G, Fanelli T, Votino C, Volpe P. Cleft Palate with or without Cleft Lip: The Role of Retronasal Triangle View and Maxillary Gap at 11-14 Weeks. Fetal Diagn Ther 2019; 46:353-359. [PMID: 30852571 DOI: 10.1159/000496842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the presence of maxillary gap (MG) and abnormal retronasal triangle (RT) as markers of cleft palate (CP) with and without cleft lip in the first trimester and to assess their association with the type of orofacial cleft (OC). METHODS The RT and the mid-sagittal view of the face were evaluated retrospectively by two operators in 26 fetuses with OC and in 80 normal controls to detect abnormal RT and/or MG. The agreement between operators was calculated. RESULTS Amongst the 26 fetuses, there were 15 cases of bilateral, 6 cases of unilateral, and 4 cases of median cleft lip and palate, and 1 case of CP alone. The MG was observed in 18 cases by operator 1 and in 17 cases by operator 2; an abnormal RT was detected in 21 cases by operator 1 and in 22 cases by operator 2. Great agreement between operators was obtained. In controls, MG or abnormal RT was suspected in 6 and 2-4% of cases, respectively. CONCLUSIONS RT seems to be more sensitive compared to MG; however, the latter showed an additional diagnostic ability when the secondary palate was involved. Both approaches in combination could be useful in detecting OC in the first trimester.
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Affiliation(s)
| | | | - Tiziana Fanelli
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Carmela Votino
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
| | - Paolo Volpe
- Fetal Medicine Unit, Di Venere and Sarcone Hospitals, Bari, Italy
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Bilateral Cleft Lip and Palate, With Facial Dysplasia: Interdisciplinary Treatment and Long-Term Follow-Up. J Craniofac Surg 2018; 29:1441-1444. [PMID: 30015740 DOI: 10.1097/scs.0000000000004756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Bilateral complete clefts represent the result of an incomplete fusion with all the morphologic components present. It is well known that patients with bilateral cleft lip and palate have typical characteristics such as insufficient medial face development with an orthodontic class III tendency, flat nose and short columella with abnormal nasolabial angle, bilateral oronasal fistulas, alterations in the number and position of the lateral incisors, and agenesis or supernumerary teeth. Successfully solving these cases, results in a difficult challenge and studies showing extended follow-up are not frequent. Bilateral complete clefts, including medial facial dysplasia, are a rare condition, not only difficult to be included in any classification but also of complex solution. These patients require multiple surgical procedures throughout life, and long-term results are often still far from ideal. Due to surgical intervention and diminished intrinsic growth potential, surgical results may change from initially good into a progressively disappointing outcome. However, if the ideal timing and type of surgery are known, in combination with the intrinsic growth potential, these results could be ameliorated. A patient with complete bilateral cleft, presenting hypoplasia of philtrum and premaxilla, flat nose with rudimentary columella and septum, is reported. A description of her interdisciplinary treatment and long-term outcome with an adequate and stable result was observed. Being the intrinsic growth restriction mainly localized in the central mid-face, a protocol oriented to stimulate facial development during growth period could be essential to reduce the number of surgical procedures and prevent sequels. Early referral to a specialized center is mandatory to achieve a correct treatment and result.
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Principles of first trimester screening in the age of non-invasive prenatal diagnosis: screening for other major defects and pregnancy complications. Arch Gynecol Obstet 2017; 296:635-643. [DOI: 10.1007/s00404-017-4460-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 07/05/2017] [Indexed: 01/19/2023]
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