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Asadourian P, Valenti AB, Michalowski A, Truong AY, Borys N, LaValley M, Modi V, Imahiyerobo TA. Estimated Time of Arrival: Impact of Healthcare Disparities on Access to and Outcomes of Multidisciplinary Cleft Lip and Palate Care. Cleft Palate Craniofac J 2024:10556656241259890. [PMID: 39033442 DOI: 10.1177/10556656241259890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
OBJECTIVE To determine the impact of sociodemographic and clinical factors on patient presentation into the cleft care pathway and determine how delayed interventions may affect post-surgical outcomes. DESIGN Retrospective study. SETTING Multidisciplinary craniofacial clinics of two university hospitals. PATIENTS, PARTICIPANT 135 patients with cleft lip and/or palate. INTERVENTIONS Primary cheiloplasty, primary palatoplasty. MAIN OUTCOME MEASURES Age at initial presentation, age at first surgery, lag time, delayed surgery, rate of return to the emergency department (ED), readmission rate, reoperations, and oronasal fistula development. RESULTS Patients referred by OBGYN who underwent cheiloplasty had an earlier age at initial presentation (p < 0.01), earlier age at first surgery (p = 0.01), and a shorter lag time (p < 0.01) compared to children from other referral pathways. African American children had an older age at first surgery (p = 0.01) and a longer lag time (p = 0.02) when compared to non-African American children. Children with syndromes had an older age at first surgery (p < 0.01) and a longer lag time (p < 0.01) than children without syndromes. Patient race, cleft type, and syndromic status increased the odds of receiving delayed surgery. Patients who received delayed palatoplasty returned to the ED at a higher rate than patients who received non-delayed palatoplasty (p = 0.02). CONCLUSIONS Our data suggest that referral source, race, and syndromic status influence the timeliness of cleft care. Surgeons should develop strong referral networks with local OBGYNs and hospitals to allow for an early entry into the cleft care pathway.
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Affiliation(s)
- Paul Asadourian
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Alyssa B Valenti
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Alexandra Michalowski
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Albert Y Truong
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Nell Borys
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Myles LaValley
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Vikash Modi
- Division of Pediatric Otolaryngology-Head & Neck Surgery, Weill Cornell Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
| | - Thomas A Imahiyerobo
- Division of Plastic Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY, USA
- New York Presbyterian Hospital, New York, NY, USA
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Vaillant CL, Bruand M, Corre P. Can a Predetermined Grid and Multidisciplinary Consultation Improve the Description of Cleft lip with or Without Cleft Palate? Cleft Palate Craniofac J 2024; 61:1143-1148. [PMID: 36802821 DOI: 10.1177/10556656231156708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Evaluate the two-dimensional (2D) ultrasound (US) grid and multidisciplinary consultation (maxillofacial surgeon-sonographer) during prenatal US imaging to improve the sensitivity of prenatal description for cleft lip (CL) with or without alveolar cleft (CLA) or +/- cleft palate (CLP). DESIGN Retrospective study of children with CL/P in a tertiary children's Hospital. SETTING Single-center cohort study conducted in a tertiary pediatric Hospital. PATIENTS/PARTICIPANTS Fifty-nine cases of prenatally diagnosed CL +/-CA or CP between January 2009 and December 2017 were analyzed. MAIN OUTCOME MEASURES The correlation was analyzed between prenatal US and postnatal data with regard to eight 2D US criteria (upper lip, alveolar ridge, median maxillary bud, homolateral nostril subsidence, deviated nasal septum, hard palate, tongue movement, nasal cushion flux) in order to propose them in a grid, as well as the presence of the maxillofacial surgeon during the US examination. RESULTS Among the 38 cases included, the results were considered satisfied for 87%. Sixty five percent of the US criteria were described when the final diagnosis was correct (5.2 criteria) versus (vs) 45% (3.6 criteria); [OR = 2.28; IC95% (1.10-4.75) P = .022 < 0.05]. This study also highlighted a more in-depth description when the maxillofacial surgeon was present with 68% of 2D US criteria fulfilled (5.4 criteria) vs 47.5% (3.8) when the sonographer was alone [OR = 2.32; IC95% (1.34-4.06) P < .001]. CONCLUSION This US grid with eight criteria has considerably contributed to a more precise prenatal description. In addition, the systematic multidisciplinary consultation seemed to optimize it and lead to better prenatal information on pathology and postnatal surgical techniques.
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Affiliation(s)
| | - Mariette Bruand
- Department of gynaecology obstetric, CHU Nantes, Nantes cedex, France
| | - Pierre Corre
- Department of stomatology, CHU Nantes, Nantes cedex, France
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Smit JA, Bax CJ, Vermeij-Keers C, Trenning BAH, de Bakker BS, Breugem CC. Decrease in Prevalence of Cleft lip, Alveolus and Palate After Nationwide Introduction of the Second-Trimester Anomaly Scan in the Netherlands. Cleft Palate Craniofac J 2024; 61:930-938. [PMID: 36594216 DOI: 10.1177/10556656221149144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Some studies have suggested that introducing a second-trimester anomaly scan (SAS) leads to increased rates of termination of pregnancy (TOP) in fetuses with orofacial clefts (OFCs). The aim of this study was to evaluate the impact of a nationwide introduction of SAS on the prevalence of live births with OFCs in the Netherlands. DESIGN Retrospective cohort study. SETTING Tertiary setting. POPULATION Included in the study were all patients diagnosed with OFCs as recorded in the "Dutch Association for Cleft Palate Anomalies" database between 1997 and 2019. INTERVENTIONS Patients were divided into three categories: cleft lip with or without alveolus (CL/A), cleft lip, alveolus and palate (CLAP) and cleft palate (CP) based on anatomical landmarks at the first consultation. MAIN OUTCOME MEASURES Prevalence rates of OFCs before and after the nationwide introduction of the SAS on January 1, 2007 were compared. RESULT Overall, 1899 patients were diagnosed with CL/A, 2586 with CLAP and 2927 with CP. The prevalence of clefts before and after introduction of the SAS did not differ (P = 0.85). The prevalence of CL/A decreased (P = 0.04), and that of CLAP decreased (P = 0.01) and that of CP increased (P = 0.02). CONCLUSIONS This study demonstrates a significant decrease in the prevalence of CL/A and CLAP after introduction of the SAS. However, due to an increase in CP, the prevalence of all patients born with OFCs has not changed in the Netherlands between 1997 and 2019.
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Affiliation(s)
- Johannes A Smit
- Amsterdam UMC, location University of Amsterdam, Dept. of Plastic Surgery, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Caroline J Bax
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Christl Vermeij-Keers
- Erasmus MC, Erasmus University Rotterdam, Department of Plastic and Reconstructive Surgery, Doctor Molewaterplein 40, Rotterdam, Netherlands
- Dutch Association for Cleft Palate and Craniofacial Anomalies, Netherlands
| | - Bert A H Trenning
- Erasmus MC, Erasmus University Rotterdam, Department of Plastic and Reconstructive Surgery, Doctor Molewaterplein 40, Rotterdam, Netherlands
- Dutch Association for Cleft Palate and Craniofacial Anomalies, Netherlands
| | - Bernadette S de Bakker
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Dept. of Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC, location University of Amsterdam, Dept. of Medical Biology, Section Clinical Anatomy and Embryology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Corstiaan C Breugem
- Amsterdam UMC, location University of Amsterdam, Dept. of Plastic Surgery, Emma Children's Hospital, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Vibert F, Schmidt G, Löffler K, Gasiorek-Wiens A, Henrich W, Verlohren S. Accuracy of prenatal detection of facial clefts and relation between facial clefts, additional malformations and chromosomal abnormalities: a large referral-center cohort. Arch Gynecol Obstet 2024; 309:1971-1980. [PMID: 37326856 PMCID: PMC11018668 DOI: 10.1007/s00404-023-07084-8] [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: 04/18/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Facial clefts belong to the most common congenital malformations and their prenatal diagnosis is a constant challenge. The aim of this study was to determine the accuracy of prenatal ultrasound in correctly classifying facial clefts. Furthermore, we aimed to specify the distribution of the type of clefts and underlying genetic conditions. METHODS All fetuses seen with suspected facial cleft in the Department of Obstetrics, Charité - Universitätsmedizin Berlin during a period of 23 years (1999-2022) were included in this retrospective study. Clefts were classified according to the classification of Nyberg. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. RESULTS 292 patients were included in the study. The most common type of clefts were unilateral cleft lip and palate (CL-P) (53.6%) and bilateral CL-P (30.6%), followed by CL (8.1%), CP (5.1%) and median CL-P (2.6%). The overall pre- and postnatal concordance rate corresponding to a correct prenatal diagnosis was high, 88.9%, ranging from 73.7% (CL) to 93.7% (unilateral CL-P). Most of the median clefts (95.2%) and CP (93.3%) were associated with other sonographic abnormalities, as well as 52.2% of bilateral CL-P. Chromosomal abnormalities, mostly trisomy 13 and trisomy 18, were observed in in the median CL-P (47.6%), bilateral CL-P (31.1%) and CP (26.7%) groups, in contrast to the CL (9.1%) and unilateral CL-P (12.9%) groups. It was exceptional to have a chromosomal abnormality without additional malformations (4.8%). The mortality rate including one late miscarriage, 5 IUFD's, 74 TOPs and 6 palliative cares at birth was 29.8%, particularly high for median clefts (90.5%). CONCLUSION Prenatal ultrasound exhibited a high accuracy to assess the type of facial clefts with an average rate of 88.9% (73.7%-93.7%) and a concordance rate of up to 93.7%, depending on the type of cleft. The search for additional malformations as well as clarifying underlying genetic conditions is essential. This allows for a targeted counseling of the parents and to best prepare for postnatal care, including surgery by the maxillofacial team.
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Affiliation(s)
- Florence Vibert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Guel Schmidt
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kerstin Löffler
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Adam Gasiorek-Wiens
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Wang B, Zhang Z, Zhao J, Ma Y, Wang Y, Yin N, Song T. Spatiotemporal Evolution of Developing Palate in Mice. J Dent Res 2024; 103:546-554. [PMID: 38619065 PMCID: PMC11145300 DOI: 10.1177/00220345241232317] [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] [Indexed: 04/16/2024] Open
Abstract
The intricate formation of the palate involves a series of complex events, yet its mechanistic basis remains uncertain. To explore major cell populations in the palate and their roles during development, we constructed a spatiotemporal transcription landscape of palatal cells. Palate samples from C57BL/6 J mice at embryonic days 12.5 (E12.5), 14.5 (E14.5), and 16.5 (E16.5) underwent single-cell RNA sequencing (scRNA-seq) to identify distinct cell subsets. In addition, spatial enhanced resolution omics-sequencing (stereo-seq) was used to characterize the spatial distribution of these subsets. Integrating scRNA-seq and stereo-seq with CellTrek annotated mesenchymal and epithelial cellular components of the palate during development. Furthermore, cellular communication networks between these cell subpopulations were analyzed to discover intercellular signaling during palate development. From the analysis of the middle palate, both mesenchymal and epithelial populations were spatially segregated into 3 domains. The middle palate mesenchymal subpopulations were associated with tooth formation, ossification, and tissue remodeling, with initial state cell populations located proximal to the dental lamina. The nasal epithelium of the palatal shelf exhibited richer humoral immune responses than the oral side. Specific enrichment of Tgfβ3 and Pthlh signals in the midline epithelial seam at E14.5 suggested a role in epithelial-mesenchymal transition. In summary, this study provides high-resolution transcriptomic information, contributing to a deeper mechanistic understanding of palate biology and pathophysiology.
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Affiliation(s)
- B. Wang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Z. Zhang
- Center for Ear Reconstruction, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - J. Zhao
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y. Ma
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y. Wang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - N. Yin
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - T. Song
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zhai J, You S, Liang Z, Yu H, Zhu C, Han L. Diagnostic Potential of Complementation of MRI to Prenatal Ultrasound for Detecting Orofacial Clefts in High-Risk Fetuses: A Network Meta-Analysis. Cleft Palate Craniofac J 2024:10556656241231119. [PMID: 38490217 DOI: 10.1177/10556656241231119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVE To compare the complementation of magnetic resonance imaging (MRI) to prenatal ultrasound (US) with prenatal US alone in detecting orofacial clefts in high-risk fetuses. DESIGN A network meta-analysis. SETTING Literature retrieval in PubMed, EMBASE, and Cochrane library, and meta-analysis based on STATA 14.0. PATIENTS Fetuses were at high-risk for orofacial clefts. INTERVENTIONS Prenatal US and the complementation of MRI to prenatal US. MAIN OUTCOME MEASURES The pooled sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic odds ratio (DOR), and area under the curve (AUC). RESULTS Thirteen studies involving 776 patients were included. Direct meta-analysis showed that the complementation of MRI to prenatal US did not differ from prenatal US in detecting orofacial clefts if the type of orofacial clefts was not distinguished. Subgroup analysis showed that the specificity of prenatal US for the detection of isolated cleft palate (CP) was lower than that of the complementation of MRI to prenatal US. Furthermore, network meta-analysis consistently suggested a comparable diagnostic value between prenatal US and the complementation of MRI to prenatal US. Moreover, subgroup analysis showed that the specificity of prenatal US was significantly lower than that of complementation of MRI to prenatal US for the detection of isolated CP. CONCLUSIONS MRI is more accurate than ultrasound in detecting cleft palate. Therefore, MRI should be offered if there is a fetus with a possible or ultrasound diagnosis of cleft palate, especially if the evaluation of cleft palate is deemed unsatisfactory after careful evaluation of the images.
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Affiliation(s)
- Jing Zhai
- Department of Ultrasound, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Shuyan You
- Department of Ultrasound, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Zhonghua Liang
- Department of Radiology, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Haihua Yu
- Department of Fetal Medicine Center, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Chengfeng Zhu
- Department of Radiology, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
| | - Lu Han
- Department of Fetal Medicine Center, Dalian Woman and Child Medical Center (Group), No. 1 Dunhuang Road, Shahekou District, Dalian, Liaoning 116030, China
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7
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Li YY, Tse WT, Kong CW, Wong NKL, Leung TY, Choy KW, To WWK, Cao Y. Prenatal Diagnosis and Pregnancy Outcomes of Fetuses With Orofacial Cleft: A Retrospective Cohort Study in Two Centres in Hong Kong. Cleft Palate Craniofac J 2024; 61:391-399. [PMID: 36128746 DOI: 10.1177/10556656221128436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the local incidence of orofacial cleft (OFC) encountered in fetal morphology scan and prenatal diagnosis, genetic etiology of fetuses with or without other structural abnormalities, and their pregnancy outcomes. DESIGN Retrospective cohort study. SETTING Two maternal fetal medicine units, tertiary hospitals, Hong Kong. PARTICIPANTS All pregnant women with antenatal diagnosis of fetal OFC between January 2016 and December 2020 (N = 66). RESULTS OFC has an incidence of 0.13% among pregnancies in Hong Kong and 28.8% (19/66) were syndromic cleft that exhibited other fetal structural anomalies. There were 55 cases (84.6%) who opted for invasive prenatal diagnostic testing. Genetic defects were identified in 25.8% (17/66) of this cohort, including 14 pathogenic variants. The detection rate in the syndromic cases is 68.4% (13/19) which was significantly higher than 8.5% (4/47) among non-syndromic cases. Aneuploidies would be the most common cause, accounting for 9.1% (6/66). Chromosomal microarray analysis (CMA) provided an incremental diagnostic yield of 6.1% compared to conventional karyotyping. A total of 29 live births including 3 cases of a variant of uncertain significance and 26 cases without genetic abnormalities detected have continued pregnancy to birth. There were 87.5% (21/24) without detectable pathogenic genetic abnormality reported good long-term outcomes. The chance of OFC fetuses having a good long-term outcome was significantly higher if no genomic variant was detected (P < .001). CONCLUSIONS Invasive prenatal tests with CMA should be offered to pregnancies with OFC regardless of the type. It has provided incremental diagnostic yield over conventional karyotyping and helped in prenatal and genetic counseling. A negative result in non-syndromic OFC favors couples to keep the pregnancy.
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Affiliation(s)
- Yan Yu Li
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Wing Ting Tse
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Choi Wah Kong
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - Natalie Kwun Long Wong
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Tak Yeung Leung
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Kwong Wai Choy
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
| | - William Wing Kee To
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong
| | - Ye Cao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong
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8
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Stanton E, Feng J, Kondra K, Sanchez J, Jimenez C, Brown KS, Skiles ML, Urata MM, Chai Y, Hammoudeh JA. A Calvarial Defect Model to Investigate the Osteogenic Potential of Umbilical Cord Stem Cells in Bone Regeneration. Plast Reconstr Surg 2024; 153:637-646. [PMID: 37224290 DOI: 10.1097/prs.0000000000010754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The standard graft material for alveolar cleft repair (ACR) is autogenous iliac crest. A promising alternative potential graft adjunct-newborn human umbilical cord mesenchymal stem cells (h-UCMSCs)-has yet to be explored in vivo. Their capacity for self-renewal, multipotent differentiation, and proliferation allows h-UCMSCs to be harnessed for regenerative medicine. This study sought to evaluate the efficacy of using tissue-derived h-UCMSCs and their osteogenic capabilities to improve ACR in a murine model. METHODS Foxn1 mice were separated into three groups with the following calvarial defects: no treatment (empty defect; n = 6), poly(D,L-lactide-co-glycolide) (PLGA) scaffold ( n = 6), or h-UCMSCs with PLGA ( n = 4). Bilateral 2-mm-diameter parietal bone critical-sized defects were created using a dental drill. Microcomputed tomography (microCT) imaging was performed 1, 2, 3, and 4 weeks postoperatively. The mice were euthanized 4 weeks postoperatively for RNAScope, immunohistochemical, and histological analysis. RESULTS No mice experienced complications during the follow-up period. MicroCT imaging and histological analysis demonstrated that the no-treatment and PLGA-only defects remained patent without significant defect size differences across groups. In contrast, the h-UCMSCs with PLGA group had significantly greater bone fill on microCT and histological analysis. CONCLUSIONS This study demonstrates a successful calvarial defect model for the investigation of h-UCMSC-mediated osteogenesis and bone repair. Evidence reveals that PLGA alone has neither short-term effects on bone formation nor any unwanted side effects, making it an attractive scaffold. Further investigation using h-UCMSCs with PLGA in larger animals is warranted to advance future translation to patients requiring ACR. CLINICAL RELEVANCE STATEMENT The authors' results demonstrate a successful murine calvarial defect model for the investigation of h-UCMSC-mediated osteogenesis and bone repair, and they provide preliminary evidence for the safe and efficacious use of this graft adjunct in alveolar cleft repair.
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Affiliation(s)
- Eloise Stanton
- From the Center for Craniofacial Molecular Biology
- Keck School of Medicine
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Jifan Feng
- From the Center for Craniofacial Molecular Biology
| | - Katelyn Kondra
- Keck School of Medicine
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | | | - Christian Jimenez
- Keck School of Medicine
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Katherine S Brown
- Research and Development, CBR Systems, Inc., a CooperSurgical Company
| | - Matthew L Skiles
- Research and Development, CBR Systems, Inc., a CooperSurgical Company
| | - Mark M Urata
- From the Center for Craniofacial Molecular Biology
- Keck School of Medicine
- Ostrow School of Dentistry, University of Southern California
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
| | - Yang Chai
- From the Center for Craniofacial Molecular Biology
- Ostrow School of Dentistry, University of Southern California
| | - Jeffrey A Hammoudeh
- Keck School of Medicine
- Ostrow School of Dentistry, University of Southern California
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles
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9
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Weissbach T, Lev S, Haimov A, Massarwa A, Shamay I, Plaschkes R, Assa L, Elkan-Miller T, Weisz B, Nardini G, Armon N, Sharon R, Mazaki Tovi S, Kassif E. The Hard Palate Sweep: a multiplanar 2-dimensional sonographic method for the prenatal detection of cleft palate. Am J Obstet Gynecol 2024; 230:356.e1-356.e10. [PMID: 37741531 DOI: 10.1016/j.ajog.2023.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.
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Affiliation(s)
- Tal Weissbach
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shir Lev
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adina Haimov
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abeer Massarwa
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Shamay
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Roni Plaschkes
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Assa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Elkan-Miller
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Nardini
- Department of Plastic Surgery, Sheba Medical Center, Ramat Gan, Israel
| | - Noam Armon
- Department of Plastic and Aesthetic Surgery, Hadassah University Medical Center, Jerusalem, Israel
| | - Roni Sharon
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sheba Medical Center, Ramat Gan, Israel
| | - Shali Mazaki Tovi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Sheba Medical Center, Ramat Gan, Israel
| | - Eran Kassif
- Department of Obstetrics and Gynecology, Institute of Obstetrical and Gynecological Imaging, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Sunal Akturk E, Seker ED, Capkın D, Kutuk MS. Evaluation of Anxiety in Turkish Parents of Newborns with Cleft Palate with or Without Cleft Lip. Cleft Palate Craniofac J 2024; 61:492-497. [PMID: 36594490 DOI: 10.1177/10556656221148903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE (1) To compare anxiety between parents of newborns with cleft lip and palate (CLP), isolated cleft palate (CP), and healthy newborns and (2) to evaluate anxiety between parental dyads within these groups. DESIGN A cross-sectional study. SETTING University Hospital. PARTICIPANTS Surveys were completed by 20 mothers and 20 fathers of newborns with CLP, 21 mothers and 21 fathers of newborns with CP, and 23 mothers and 23 fathers of healthy newborns (controls). MAIN OUTCOME MEASURE The State-Trait Anxiety Inventory (STAI) assessed parental anxiety. Mothers of newborns with a cleft reported on concerns regarding cleft-related issues and facial appearance. RESULTS State and trait anxiety were generally in the moderate range for parents of newborns with a cleft, while control parents had low state anxiety and moderate trait anxiety. Mothers of newborns with CP and CLP had significantly higher state and trait anxiety levels than control mothers (p < .05). Fathers of newborns with CLP had a higher state anxiety level than control fathers. When maternal and paternal anxiety was compared within the groups, only trait anxiety scores were significantly higher in mothers of newborns with CLP than that of fathers (p < .05). More than half of mothers of newborns with a cleft were concerned about their newborn's feeding, speech, and palate. CONCLUSIONS Parents of children with a cleft may need psychological support in the early postnatal period. It is important for neonatal cleft team providers to help reduce parental anxiety and educate families about cleft care, with a focus on feeding.
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Affiliation(s)
- Ezgi Sunal Akturk
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Elif Dilara Seker
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Duygu Capkın
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Mehmet Serdar Kutuk
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, 34093, Turkey
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11
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Wang B, Xu M, Zhao J, Yin N, Wang Y, Song T. Single-cell Transcriptomics Reveals Activation of Macrophages in All-trans Retinoic Acid (atRA)-induced Cleft Palate. J Craniofac Surg 2024; 35:177-184. [PMID: 38049149 DOI: 10.1097/scs.0000000000009782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/22/2023] [Indexed: 12/06/2023] Open
Abstract
Cleft palate is among the most common birth defects with an impact on swallowing and speaking and is difficult to diagnose with ultrasound during pregnancy. In this study, we systematically capture the cellular composition of all-trans retinoic acid (atRA)-exposed and normal embryonic gestation 16.5 days mouse palate by the single-cell RNA sequencing technique. The authors identified 14 major cell types with the largest proportion of fibroblasts. The proportion of myeloid cells in atRA-exposed palate was markedly higher than those in the normal palate tissue, especially M1-like macrophages and monocytes. The upregulated genes of the different expression genes between atRA-exposed palate and normal palate tissue were linked to the biological processes of leukocyte chemotaxis and migration. Protein TLR2, CXCR4, THBS1, MRC1, transcription factor encoding genes Cebpb, Fos, Jun, Rela, and signaling pathway IL-17 and phagosome were found to be significantly involved in these processes. Subsequently, cellular communication network analysis suggested that myeloid-centered cell interactions SELL, SELPLG, MIF, CXCL, ANNEXIN, THBS, and NECTIN were significantly more activated in atRA-exposed palate. Overall, we delineate the single-cell landscape of atRA-induced cleft palate, revealing the effects of overexposure to atRA during palate tissue development and providing insights for the diagnosis of cleft palate.
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Affiliation(s)
- Binqing Wang
- Center for Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Parham MJ, Simpson AE, Moreno TA, Maricevich RS. Updates in Cleft Care. Semin Plast Surg 2023; 37:240-252. [PMID: 38098682 PMCID: PMC10718659 DOI: 10.1055/s-0043-1776733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Cleft lip and/or palate is a congenital malformation with a wide range of presentations, and its effective treatment necessitates sustained, comprehensive care across an affected child's life. Early diagnosis, ideally through prenatal imaging or immediately postbirth, is paramount. Access to longitudinal care and long-term follow-up with a multidisciplinary approach, led by the recommendations of the American Cleft Palate Association, is the best way to ensure optimal outcomes. Multiple specialties including plastic surgery, otolaryngology, speech therapy, orthodontists, psychologists, and audiologists all may be indicated in the care of the child. Primary repair of the lip, nose, and palate are generally conducted during infancy. Postoperative care demands meticulous oversight to detect potential complications. If necessary, revisional surgeries should be performed before the child begin primary school. As the child matures, secondary procedures like alveolar bone grafting and orthognathic surgery may be requisite. The landscape of cleft care has undergone significant transformation since early surgical correction, with treatment plans now tailored to the specific type and severity of the cleft. The purpose of this text is to outline the current standards of care in children born with cleft lip and/or palate and to highlight ongoing advancements in the field.
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Affiliation(s)
- Matthew J. Parham
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Arren E. Simpson
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Tanir A. Moreno
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
| | - Renata S. Maricevich
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
- Division of Plastic Surgery, Texas Children's Hospital, Houston, Texas
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13
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Moreira T, Dias M, Von Hafe M, Curval AR, Ramalho C, Maia AM, Moura CP. Orofacial clefts: Reflections on prenatal diagnosis and family history based on a series of cases of a tertiary children hospital. Congenit Anom (Kyoto) 2023; 63:195-199. [PMID: 37653578 DOI: 10.1111/cga.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
Prenatal diagnosis of orofacial clefts allows adequate counseling and planning for prenatal care and delivery. In 2001, two-dimensional ultrasound screening became universally used in Portugal by government guidelines, and after 2007 more advanced ultrasound became available. This study aimed to describe the prevalence of family history in patients with orofacial clefts and analyze prenatal diagnosis in patients born before 2001, between 2001 and 2007 and after 2007. Retrospective analysis of a cohort of patients with orofacial clefts followed by the trans-disciplinary team of a tertiary hospital. A total of 672 OFCs were identified: 40.9% isolated cleft palate, 38.1% cleft lip and palate, 19.7% cleft lip and 1.3% atypical cleft; 57.1% were male. The prevalence of family history was 26.0% of which 30.9% had a recognizable syndrome. Of those born before 2001, 13.7% had prenatal diagnosis; of those born between 2001 and 2007, 32.6% orofacial clefts were diagnosed in utero; and in children born after 2007, prenatal diagnosis increased to 47.1%. In our study, about one-fourth of children had a positive family history. Since the implementation of universal ultrasound screening in Portugal, more orofacial clefts were identified in utero (42.5% vs. 13.7%; p < 0.05) and after the availability of advanced ultrasound, prenatal diagnosis increased to 47.1% (vs. 20.4% before 2007; p < 0.05). Of all orofacial clefts diagnosed prenatally, ultrasound revealed more accuracy for the diagnosis of cleft lip and palate (65.4%) and cleft lip (24.8%). Cleft palate is the most difficult to detect in utero (9.3%). Prenatal ultrasound screening in Portugal has technically evolved with consequent better diagnostic accuracy for the identification of orofacial clefts, allowing better parenteral counseling.
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Affiliation(s)
- Tatiana Moreira
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Margarida Dias
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Madalena Von Hafe
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Rita Curval
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Ramalho
- Transdisciplinary Team of Cleft Lip and Palate, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Gynaecology-Obstetrics and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Human Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Maria Maia
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Transdisciplinary Team of Cleft Lip and Palate, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Gynaecology-Obstetrics and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carla Pinto Moura
- Transdisciplinary Team of Cleft Lip and Palate, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Human Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, Porto, Portugal
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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14
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Rubio E, Mantilla-Rivas E, Manrique M, Fan KL, Blask A, Rada EM, Bulas D, White MA, Rogers GF, Oh AK. Alveolar Cleft Size on Prenatal Two-Dimensional Ultrasonography Predicts Cleft of the Secondary Palate in Unilateral Cleft Lip. Plast Reconstr Surg 2023; 152:895e-899e. [PMID: 36940150 DOI: 10.1097/prs.0000000000010437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
SUMMARY Prenatal diagnosis of cleft palate (CP) is challenging. The current study's objective was to investigate whether prenatal alveolar cleft width is associated with the likelihood of a cleft of the secondary palate in unilateral cleft lip (CL). The authors reviewed two-dimensional ultrasound (US) images in fetuses with unilateral CL from January of 2012 to February of 2016. Images of the fetal face were obtained with a linear and/or curved probe in the axial and coronal planes. Measurements of the alveolar ridge gap were taken by the senior radiologist. Postnatal phenotype findings were compared with prenatal findings. Thirty patients with unilateral CL met inclusion criteria; average gestational age was 26.67 ± 5.11 weeks (range, 20.71 to 36.57 weeks). Ten fetuses were found to have an intact alveolar ridge by prenatal US; postnatal examination confirmed intact secondary palate in all. Small alveolar defects (<4 mm) were noted in three fetuses; postnatal examination documented CP in a single patient. CP was confirmed in 15 of the remaining 17 fetuses who had alveolar cleft width greater than 4 mm. An alveolar defect of greater than or equal to 4 mm on prenatal US was associated with greater likelihood of a cleft of the secondary palate [c 2 (2, n = 30) = 20.23; P < 0.001]. In the setting of unilateral CL, prenatal US documentation of alveolar defects greater than or equal to 4 mm are highly predictive of the presence of a cleft of the secondary palate. Conversely, an intact alveolar ridge is associated with an intact secondary palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.
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Affiliation(s)
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences
| | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences
| | - Kenneth L Fan
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences
| | | | - Erin M Rada
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences
| | | | - Marney A White
- Department of Social and Behavioral Sciences, Yale University School of Public Health
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, George Washington University School of Medicine and Health Sciences
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15
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Wright R, Gomez A, Zimmer VA, Toussaint N, Khanal B, Matthew J, Skelton E, Kainz B, Rueckert D, Hajnal JV, Schnabel JA. Fast fetal head compounding from multi-view 3D ultrasound. Med Image Anal 2023; 89:102793. [PMID: 37482034 DOI: 10.1016/j.media.2023.102793] [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: 03/18/2022] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 07/25/2023]
Abstract
The diagnostic value of ultrasound images may be limited by the presence of artefacts, notably acoustic shadows, lack of contrast and localised signal dropout. Some of these artefacts are dependent on probe orientation and scan technique, with each image giving a distinct, partial view of the imaged anatomy. In this work, we propose a novel method to fuse the partially imaged fetal head anatomy, acquired from numerous views, into a single coherent 3D volume of the full anatomy. Firstly, a stream of freehand 3D US images is acquired using a single probe, capturing as many different views of the head as possible. The imaged anatomy at each time-point is then independently aligned to a canonical pose using a recurrent spatial transformer network, making our approach robust to fast fetal and probe motion. Secondly, images are fused by averaging only the most consistent and salient features from all images, producing a more detailed compounding, while minimising artefacts. We evaluated our method quantitatively and qualitatively, using image quality metrics and expert ratings, yielding state of the art performance in terms of image quality and robustness to misalignments. Being online, fast and fully automated, our method shows promise for clinical use and deployment as a real-time tool in the fetal screening clinic, where it may enable unparallelled insight into the shape and structure of the face, skull and brain.
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Affiliation(s)
- Robert Wright
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
| | - Alberto Gomez
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Veronika A Zimmer
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Department of Informatics, Technische Universität München, Germany
| | | | - Bishesh Khanal
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Nepal Applied Mathematics and Informatics Institute for Research (NAAMII), Nepal
| | - Jacqueline Matthew
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK
| | - Emily Skelton
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; School of Health Sciences, City, University of London, London, UK
| | | | - Daniel Rueckert
- Department of Computing, Imperial College London, UK; School of Medicine and Department of Informatics, Technische Universität München, Germany
| | - Joseph V Hajnal
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK.
| | - Julia A Schnabel
- School of Biomedical Engineering & Imaging Sciences, King's College London, UK; Department of Informatics, Technische Universität München, Germany; Helmholtz Zentrum München - German Research Center for Environmental Health, Germany.
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16
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Ludorf KL, Benjamin RH, Canfield MA, Swartz MD, Agopian AJ. Prediction of Preterm Birth among Infants with Orofacial Cleft Defects. Cleft Palate Craniofac J 2023:10556656231198945. [PMID: 37671412 DOI: 10.1177/10556656231198945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVE To develop risk prediction models for preterm birth among infants with orofacial clefts. DESIGN Data from the Texas Birth Defects Registry for infants with orofacial clefts born between 1999-2014 were used to develop preterm birth predictive models. Logistic regression was used to consider maternal and infant characteristics, and internal validation of the final model was performed using bootstrapping methods. The area under the curve (AUC) statistic was generated to assess model performance, and separate predictive models were built and validated for infants with cleft lip and cleft palate alone. Several secondary analyses were conducted among subgroups of interest. SETTING State-wide, population-based Registry data. PATIENTS/PARTICIPANTS 6774 infants with orofacial clefts born in Texas between 1999-2014. MAIN OUTCOME MEASURE(S) Preterm birth among infants with orofacial clefts. RESULTS The final predictive model performed modestly, with an optimism-corrected AUC of 0.67 among all infants with orofacial clefts. The optimism-corrected models for cleft lip (with or without cleft palate) and cleft palate alone had similar predictive capability, with AUCs of 0.66 and 0.67, respectively. Secondary analyses had similar results, but the model among infants with delivery prior to 32 weeks demonstrated higher optimism-corrected predictive capability (AUC = 0.74). CONCLUSIONS This study provides a first step towards predicting preterm birth risk among infants with orofacial clefts. Identifying pregnancies affected by orofacial clefts at the highest risk for preterm birth may lead to new avenues for improving outcomes among these infants.
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Affiliation(s)
- Katherine L Ludorf
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Renata H Benjamin
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX, USA
| | - Michael D Swartz
- Department of Biostatistics, UTHealth School of Public Health, Houston, TX, USA
| | - A J Agopian
- Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX, USA
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17
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Pérez-González A, Lavielle-Sotomayor P, López-Rodríguez L, Pérez-Días ME, Vega-Hernández D, Domínguez JN, Clark P. Characterization of 554 Mexican Patients With Nonsyndromic Cleft Lip and Palate: Descriptive Study. J Craniofac Surg 2023; 34:1776-1779. [PMID: 37276332 DOI: 10.1097/scs.0000000000009455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 06/07/2023] Open
Abstract
Orofacial clefts are one of the most common birth defects and the most common craniofacial malformation worldwide. The most common orofacial clefts (OFCs) are congenital cleft lip with or without cleft palate (CL ± P) and isolated cleft palate (CP). The incidence of OFCs varies depending on region and ethnicity; however, it affects approximately 1 in 600 newborns worldwide. In most cases, CL ± P and CP are multifactorial congenital malformations, where both exogenous and genetic factors play an important role. The objective of this study was to describe the frequency of potential risk factors associated with the development of CL ± P and CP in Mexican population. Patients were referred for multisystemic treatment, from private and public institutions in different regions of the country (center, north, and south). Sociodemographic information, prenatal and parental history were obtained through direct interviews with the patients or the patients' mothers in the case of underaged patients. Referred patients were invited to participate in the study. No interventions were applied for this study. The relationship between these factors and the prevalence of CL ± P and CP was studied. A total of 554 patients were included, the majority with CLP (30% to 7%), statistically significant differences were found for folic acid ( P = 0.02) consumption. Familial aggregation did not reach statistical significance for first-degree family members ( P = 0.34) but was significant for second-degree family members ( P = 0.007). More risk factors associated with CL ± P and CP may still be unknown, prompting more epidemiological research and research in other little-studied areas, such as; specific genetic factors in Mexican population.
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Affiliation(s)
- Araceli Pérez-González
- Department of Reconstructive Plastic Surgery, Mexican Charity for Children with Cleft Lip and Palate, ABC Medical Center
| | | | | | - Maria E Pérez-Días
- Department of Reconstructive Plastic Surgery, Fundación Mexicana para Niños con Labio y Paladar Hendido AC
| | - Daniela Vega-Hernández
- Faculty of Medicine, Monterrey Institute of Technology and Higher Education, Campus Ciudad de México (ITESM)
| | | | - Patricia Clark
- Department of Clinical Epidemiology, Children's Hospital of Mexico "Federico Gómez", Ciudad de México, México
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18
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Thompson RL, Thorson HL, Chinnadurai S, Tibesar RJ, Roby BB. Prenatal Consultation Outcomes for Infants With Cleft Lip With and Without Cleft Palate. Cleft Palate Craniofac J 2023; 60:1071-1077. [PMID: 35437035 DOI: 10.1177/10556656221093174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
To assess the clinical impacts of prenatal consultation with a multidisciplinary cleft team on infants with cleft lip with or without cleft palate (CL ± P). Retrospective cases series. Tertiary pediatric hospital. Infants with CL ± P whose mothers received prenatal consultation with a pediatric otolaryngology team from June 2005 to December 2019 were identified. A random sample of infants with CL ± P without prenatal consultation from June 2005 to December 2019 was also identified. The primary outcomes were the length of hospitalization during the first 12 weeks of life, timing of surgical repair, length of postsurgical hospitalization, and number of unplanned clinic visits and phone calls for feeding evaluation. Time to cleft lip repair differed significantly between the 2 groups with repair performed at 13.4 (±0.9) weeks for the prenatal consultation group (n = 73) and 15.3 (±2.1) weeks for the control group (n = 80), (P < .05). If hospitalization was required for feeding difficulties during the first 12 weeks of life, length of stay was 4.9 (± 1.7) days for infants with prenatal consultation and 11.5 (± 7.2) days for control infants (P < .05). Unplanned clinic visits with a speech-language pathologist (SLP) for feeding difficulties were needed for 2.7% of prenatal consultation infants and 11.3% of control infants (P < .05). Prenatal consultation regarding CL ± P resulted in infants with decreased duration of early hospitalizations, earlier cleft lip repair, and decreased engagement with the SLP feeding clinic for feeding difficulties when compared with infants without prenatal consultation.
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Affiliation(s)
| | - Heidi L Thorson
- Minnesota Perinatal Physicians, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Sivakumar Chinnadurai
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota Department of Otolaryngology Head and Neck Surgery, Minneapolis, MN, USA
| | - Robert J Tibesar
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota Department of Otolaryngology Head and Neck Surgery, Minneapolis, MN, USA
| | - Brianne B Roby
- Department of ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA
- University of Minnesota Department of Otolaryngology Head and Neck Surgery, Minneapolis, MN, USA
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19
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Guichoud Y, El Ezzi O, de Buys Roessingh A. Cleft Lip and Palate Antenatal Diagnosis: A Swiss University Center Performance Analysis. Diagnostics (Basel) 2023; 13:2479. [PMID: 37568842 PMCID: PMC10416856 DOI: 10.3390/diagnostics13152479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/22/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Precision of cleft lip and/or palate antenatal diagnosis plays a significant role in counselling, neonatal care, surgical strategies and psychological support of the family. This study aims to measure the accuracy of antenatal diagnosis in our institution and the detection rate of cleft lip and/or palate on routine morphologic ultrasonography. In this retrospective observational study, we compared antenatal and postnatal diagnosis of 233 patients followed in our unit. We classified our patients according to the Kernahan and Stark's classification system: Group 1: facial cleft including labial and labio-maxillary clefts; Group 2: facial cleft including total, subtotal and submucous palatal clefts; Group 3: labio-maxillary-palatal clefts. Out of 233 patients, 104 were antenatally diagnosed with a facial cleft, i.e., an overall detection rate of 44.6%. The diagnosis was confirmed at birth in 65 of these patients, i.e., an overall accuracy of 62.5%. Of the 67 children (29.2%) in Group 1, the screening detection rate was 58.2% with an antenatal diagnostic accuracy of 48.7%. Of the 97 children (41.6%) in Group 2, the screening detection rate was 2% with an antenatal diagnostic accuracy of 50%. Of the 69 children (29.6%) in Group 3, the screening detection rate was 91.3% with an antenatal diagnostic accuracy of 71.4%. Our study demonstrates a relatively poor diagnostic accuracy in prenatal ultrasound, where the diagnosis was inaccurate in one third to one half of patients. It showed great variability in the screening detection rate depending on the diagnostic group observed, as well as a low rate of detection of palatal clefts.
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Affiliation(s)
| | | | - Anthony de Buys Roessingh
- Service de Chirurgie de l’Enfant et de l’Adolescent, Département Femme Mère Enfant, Lausanne University Hospital, 1011 Lausanne, Switzerland
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20
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Wiechers C, Poets C, Hoopmann M, Kagan KO. Fetal Profile Markers for the Detection of Robin Sequence in Fetuses with Retrognathia. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:299-306. [PMID: 34852370 DOI: 10.1055/a-1659-2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine whether the prefrontal space ratio (PSFR), inferior facial (IFA) and maxilla-nasion-mandible angle (MNM), and the fetal profile line (FPL) are helpful in identifying fetuses with Robin sequence (RS) in cases with isolated retrognathia, and thus better predict the likelihood of immediate need for postnatal respiratory support. METHODS This was a retrospective matched case-control study of fetuses/infants with isolated retrognathia with or without RS receiving pre- and postnatal treatment at the University Hospital of Tübingen, Germany between 2008 and 2020. The PFSR, IFA, MNM, and FPL were measured in affected and normal fetuses according to standardized protocols. Cases were stratified into isolated retrognathia and RS. RESULTS 21 (n=7 isolated retrognathia, n=14 RS) affected fetuses and 252 normal fetuses were included. Their median gestational age at ultrasound examination was 23.6 and 24.1 weeks, respectively. In fetuses with isolated retrognathia and RS, the PSFR, IFA, and FPL were significantly different from the normal population. At a false-positive rate of 5%, the detection rate was 76.2% for the PFSR, 85.7% for the IFA, and 90.5% for both parameters combined. However, all parameters failed to distinguish between isolated retrognathia and RS. CONCLUSION PSFR and IFA are simple markers for identifying retrognathia prenatally. However, they are not helpful for the detection of RS in fetuses with isolated retrognathia. Therefore, delivery should take place in a center experienced with RS and potentially life-threatening airway obstruction immediately after birth.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Poets
- Department of Neonatology, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
- Interdisciplinary Center for Craniofacial Malformations, University Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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21
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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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22
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Tonni G, Peixoto AB, Werner H, Grisolia G, Ruano R, Sepulveda F, Sepulveda W, Araujo Júnior E. Ultrasound and fetal magnetic resonance imaging: Clinical performance in the prenatal diagnosis of orofacial clefts and mandibular abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:346-361. [PMID: 36785498 DOI: 10.1002/jcu.23403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/12/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Cleft lip, with or without cleft palate, is the most common congenital craniofacial anomaly and the second most common birth defect worldwide. Micrognathia is a rare facial malformation characterized by small, underdeveloped mandible and frequently associated with retrognathia. Second- and third-trimester prenatal ultrasound is the standard modality for screening and identification of fetal orofacial abnormalities, with a detection rate in the low-risk population ranging from 0% to 73% for all types of cleft. The prenatal ultrasonography detection can also be performed during the first trimester of pregnancy. Given the potential limitations of obstetric ultrasound for examining the fetal face, such as suboptimal fetal position, shadowing from the surrounding bones, reduce amniotic fluid around the face, interposition of fetal limbs, umbilical cord and placenta, and maternal habitus/abdominal scars, the use of adjunct imaging modalities can enhance prenatal diagnosis of craniofacial anomalies in at-risk pregnancies. Fetal magnetic resonance imaging (MRI) is a potentially useful second-line investigation for the prenatal diagnosis of orofacial malformations with a pooled sensitivity of 97%. In this review, we discuss the role of ultrasound and fetal MRI in the prenatal assessment of abnormalities of the upper lip, palate, and mandible.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Centre, Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Alberto Borges Peixoto
- Department of Obstetrics and Gynecology, Federal University of Triângulo Mineiro (UFTM), Uberaba, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Clínica de Diagnóstico por Imagem (CDPI - DASA), Rio de Janeiro, Brazil
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, ASST Mantova, Mantova, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, UH Jackson Fetal Care, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Francisco Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
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23
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Vardhan H, Verma M. Prenatal management in clefts. JOURNAL OF CLEFT LIP PALATE AND CRANIOFACIAL ANOMALIES 2023. [DOI: 10.4103/jclpca.jclpca_26_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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24
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Gai S, Wang L, Zheng W. Comparison of prenatal ultrasound with MRI in the evaluation and prediction of fetal orofacial clefts. BMC Med Imaging 2022; 22:213. [PMID: 36471263 PMCID: PMC9720929 DOI: 10.1186/s12880-022-00929-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 11/05/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Orofacial clefts (OFCs) are common craniofacial abnormalities. This study aimed to compare the diagnostic and predictive values of prenatal ultrasonography (US) and magnetic resonance imaging (MRI). METHODS We reviewed the newborn physical examinations or fetal autopsy data with OFCs. Between January 2013 and December 2018, the diagnoses resulting from prenatal US and MRI examination were compared retrospectively with the postpartum diagnoses. The diagnostic prediction of prenatal imaging was then determined. RESULTS 334 infants were identified with OFCs by either newborn physical exam or stillborn autopsy. For detection of OFCs by US, the total accuracy (ACC), true positive rate (TPR), true negative rate (TNR), positive predictive value (PPV), and negative predictive value (NPV) were 99.9% (111,178/110,286), 81.9% (230/281), 99.9% (109,948/110,005), 80.1% (230/287), and 99.9% (109,948/109,999), respectively. For MRI, the ACC, TPR, TNR, PPV, and NPV were 99.8% (4,125/4,132), 89.8% (44/49), 99.9% (4,081/4,083), 95.7% (44/46), and 99.9% (4,081/4,086), respectively. When we compared the predictive values between prenatal US and MRI, there were significant differences in the PPV of OFCs (P < 0.05), NPV of OFCs (P < 0.05), TPR of CLO (P < 0.001), PPV of CLP (P < 0.05), and TPR of CPO (P < 0.05). CONCLUSION Our results suggest that prenatal US could be effective for diagnosing and ruling out fetal OFCs. Diagnostic confidence is significantly improved when fetal MRI is used to assess fetal OFCs as an adjunct to US examination.
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Affiliation(s)
- Shuangshuang Gai
- grid.13402.340000 0004 1759 700XDepartment of Ultrasound, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Rd No.88, Hangzhou, 310029 Zhejiang People’s Republic of China ,grid.13402.340000 0004 1759 700XDepartment of Ultrasound, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No.1, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Lixiu Wang
- grid.13402.340000 0004 1759 700XDepartment of Ultrasound, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No.1, Hangzhou, 310006 Zhejiang People’s Republic of China
| | - Weizeng Zheng
- grid.13402.340000 0004 1759 700XDepartment of Radiology, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No.1, Hangzhou, 310006 Zhejiang People’s Republic of China
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25
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Song S, Wang J, Wang L, Wu Q. Visualisation of the fetal uvula on three-dimensional ultrasonography. Aust N Z J Obstet Gynaecol 2022; 62:E6-E8. [PMID: 35723530 DOI: 10.1111/ajo.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Shijing Song
- Department ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.,Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Jingjing Wang
- Department ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.,Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Li Wang
- Department ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.,Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Qingqing Wu
- Department ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.,Beijing Maternal and Child Health Care Hospital, Beijing, China
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26
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Frederick R, Hogan AC, Seabolt N, Stocks RMS. An Ideal Multidisciplinary Cleft Lip and Cleft Palate Care Team. Oral Dis 2022; 28:1412-1417. [DOI: 10.1111/odi.14213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Robert Frederick
- Department of Otolaryngology College of Medicine University of Tennessee Health Science Center 910 Madison Avenue Ste 430 Memphis TN 38163 USA
| | - Amy Claire Hogan
- LeBonheur Children’s Inpatient Rehabilitation Services 848 Adams Avenue Memphis TN 38103 USA
| | - Natalie Seabolt
- College of Nursing University of Tennessee 874 Union Avenue Memphis TN 38163 USA
| | - Rose Mary S. Stocks
- Department of Otolaryngology College of Medicine University of Tennessee Health Science Center 910 Madison Avenue Ste 430 Memphis TN 38163 USA
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27
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Huang W, He Q, Li M, Ding Y, Liang W, Li W, Lin J, Zhao H, Chen F. Two rare variants reveal the significance of Grainyhead‐like 3 Arginine 391 underlying non‐syndromic cleft palate only. Oral Dis 2022; 29:1632-1643. [PMID: 35189007 DOI: 10.1111/odi.14164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/07/2022] [Accepted: 02/12/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Non-syndromic cleft palate only (NSCPO) is one of the most common craniofacial birth defects with largely undetermined genetic etiology. It has been established that Grainyhead-like 3 (GRHL3) plays an essential role in the pathogenesis of NSCPO. This study aimed to identify and verify the first-reported GRHL3 variant underlying NSCPO among the Chinese cohort. METHODS We performed whole-exome sequencing (WES) on a Chinese NSCPO patient and identified a rare variant of GRHL3 (p.Arg391His). A validated deleterious variant p.Arg391Cys was introduced as a positive control. Zebrafish embryos injection, reporter assays, live-cell imaging, and RNA sequencing were conducted to test the pathogenicity of the variants. RESULTS Zebrafish embryos microinjection demonstrated that overexpression of the variants could disrupt the normal development of zebrafish embryos. Reporter assays showed that Arg391His disturbed transcriptional activity of GRHL3 and exerted a dominant-negative effect. Interestingly, Arg391His and Arg391Cys displayed distinct nuclear localization patterns from that of wild-type GRHL3 in live-cell imaging. Bulk RNA sequencing suggested that the two variants changed the pattern of gene expression. CONCLUSIONS In aggregate, this study identified and characterized a rare GRHL3 variant in NSCPO, revealing the critical role of Arginine 391 in GRHL3. Our findings will help facilitate understanding and genetic counseling of NSCPO.
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Affiliation(s)
- Wenbin Huang
- Department of Orthodontics Peking University School and Hospital of Stomatology 100081 Beijing China
- National Center of Stomatology National Clinical Research Center for Oral Diseases National Engineering Laboratory for Digital and Material Technology of Stomatology Beijing Key Laboratory for Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials 100081 Beijing China
| | - Qing He
- Department of Physiology and Pathophysiology School of Basic Medical Sciences Xi’an Jiaotong University Health Science Center 710061 Xi’an, Shaanxi China
| | - Mingzhao Li
- Department of Orthodontics Peking University School and Hospital of Stomatology 100081 Beijing China
- National Center of Stomatology National Clinical Research Center for Oral Diseases National Engineering Laboratory for Digital and Material Technology of Stomatology Beijing Key Laboratory for Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials 100081 Beijing China
| | - Yi Ding
- Department of Physiology and Pathophysiology School of Basic Medical Sciences Xi’an Jiaotong University Health Science Center 710061 Xi’an, Shaanxi China
| | - Wei Liang
- Department of Orthodontics Peking University School and Hospital of Stomatology 100081 Beijing China
- National Center of Stomatology National Clinical Research Center for Oral Diseases National Engineering Laboratory for Digital and Material Technology of Stomatology Beijing Key Laboratory for Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials 100081 Beijing China
| | - Weiran Li
- Department of Orthodontics Peking University School and Hospital of Stomatology 100081 Beijing China
- National Center of Stomatology National Clinical Research Center for Oral Diseases National Engineering Laboratory for Digital and Material Technology of Stomatology Beijing Key Laboratory for Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials 100081 Beijing China
| | - Jiuxiang Lin
- Department of Orthodontics Peking University School and Hospital of Stomatology 100081 Beijing China
- National Center of Stomatology National Clinical Research Center for Oral Diseases National Engineering Laboratory for Digital and Material Technology of Stomatology Beijing Key Laboratory for Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials 100081 Beijing China
| | - Huaxiang Zhao
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research College of Stomatology Xi’an Jiaotong University 710004 Xi'an, Shaanxi China
- Department of Orthodontics College of Stomatology Xi’an Jiaotong University 710004 Xi’an, Shaanxi China
| | - Feng Chen
- Central laboratory Peking University School and Hospital of Stomatology 100081 Beijing China
- National Center of Stomatology National Clinical Research Center for Oral Diseases National Engineering Laboratory for Digital and Material Technology of Stomatology Beijing Key Laboratory for Digital Stomatology, Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health, NMPA Key Laboratory for Dental Materials 100081 Beijing China
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28
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Emodi O, Capucha T, Shilo D, Ohayon C, Ginini JG, Ginsberg Y, Aizenbud D, Rachmiel A. Trends in cleft palate incidence in the era of obstetric sonography and early detection. J Matern Fetal Neonatal Med 2022; 35:9350-9355. [PMID: 35129039 DOI: 10.1080/14767058.2022.2032635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The effect of improvement in prenatal identification of cleft lip or palate (CL/P) on termination of pregnancy (TOP) worldwide is scarcely reported. Our aim was to assess changes in the prevalence of cleft palate attributed to the high access and availability of prenatal advanced screening and pregnancy termination in Israel. METHODS A retrospective study was conducted on CL/P patients which were treated in our institute and born between January 2000 and December 2018. Clinical and demographic data were extracted from medical records. Data on TOP were collected based on accessible information from the Ministry of Health. Cleft palate severity was evaluated using the Veau Classification. RESULTS The study was conducted on 258 patients. Higher incidence of Veau II and III was evident throughout the examined period (2000-2018). However, when evaluating the incidence per year, we found that the incidence of severe cases (Veau III and IV) decreased every year showing a major decline of 60% in the last decade, whereas mild cases (Veau type I and II) demonstrated a marked increase of 90%. Regarding the incidence of abortions in Israel, a decrease of 30% was observed in the last two decades, meanwhile a substantial increase was detected in the rate of abortions related to physical malformations of the fetus. Additionally, the number of late terminations due to physical malformations significantly increased in the last decade. CONCLUSIONS Significant decrease was observed in the incidence of severe cleft palate cases in the last decade. Concurrently, we found a substantial increase in percentage of abortions performed due to physical malformations. We suggest that these changes might be attributed to the accessibility of advanced prenatal screening and pregnancy termination in Israel under the social healthcare system.
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Affiliation(s)
- Omri Emodi
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Tal Capucha
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Dekel Shilo
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Chaim Ohayon
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Jiriys George Ginini
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yuval Ginsberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.,Division of Gynecology and Obstetrics, Rambam Health Care Campus, Haifa, Israel
| | - Dror Aizenbud
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,Department of Orthodontics and Craniofacial Anomalies, Rambam Health Care Campus, Haifa, Israel
| | - Adi Rachmiel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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29
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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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30
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Ji C, Yang Z, Yin L, Deng X, Pan Q, Lu B, Zhang J, Jiang W, Jiang X. The application of three-dimensional ultrasound with reformatting technique in the diagnosis of fetal cleft lip/palate. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:307-314. [PMID: 33665816 DOI: 10.1002/jcu.22994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/22/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the clinical value of three-dimensional ultrasound (3D-US) with reformatting technique in the diagnosis of fetal cleft lip/palate (CL/P), especially those involving the secondary palate. METHODS A total of 113 fetuses suspected with cleft lip (CL) on two-dimensional ultrasound (2D-US) were further evaluated by 2D-US and 3D-US with reformatting technique, in order to clarify the type of oral cleft. Lesions were classified as cleft lip (CL), cleft lip and alveolus (CLA), and cleft lip and palate (CLP) (including primary and secondary palate). All fetuses were followed until birth or termination of pregnancy. The diagnostic accuracies of 2D-US and 3D-US with reformatting technology were compared. RESULTS Both 2D-US and 3D-US with reformatting successfully detected CLs in the final 103 participants. Among these, 29, 25, and 49 cases were confirmed to have CL, CLA, and CLP, respectively. CL, CLA, and CLP were diagnosed by 2D-US in 34, 66, and 3 cases, respectively, and by 3D-US with reformatting technology in 31, 27, and 45 cases, respectively. The sensitivities of 2D-US and 3D-US with reformatting technology in the diagnosis of CLA were 80% (20/25) and 92.0% (23/25), respectively, and the difference was not statistically significant. For CLP, however, the sensitivities were 6.1% (3/49) and 91.8% (45/49), respectively (P < .001). CONCLUSIONS Both 2D-US and 3D-US with reformatting technique have high diagnostic accuracy for CL and CLA. However, 3D-US has a much higher diagnostic accuracy for CLP.
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Affiliation(s)
- Chunya Ji
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Zhong Yang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Linliang Yin
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Xuedong Deng
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Qi Pan
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Bing Lu
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Jun Zhang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Wei Jiang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
| | - Xiaoli Jiang
- Center for Medical Ultrasound, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China
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31
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Sileo FG, Finarelli A, Contu G, Lugli L, Dipace V, Ballarini M, Guidi C, Facchinetti F, Bertucci E. Ultrasound screening for fetal anomalies in a single center: diagnostic performances twenty years after the Eurofetus Study. J Matern Fetal Neonatal Med 2021; 35:6312-6319. [PMID: 33910476 DOI: 10.1080/14767058.2021.1911994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To establish the accuracy of ultrasound in detecting fetal anomalies looking at the concordance between prenatal and postnatal diagnosis. MATERIALS AND METHODS Retrospective analysis of concordance between prenatal and postnatal/autoptic diagnosis of fetuses with congenital abnormalities. Data are from a single center (Policlinico di Modena); all fetuses included were born between 2017 and 2018 and with a follow-up of at least 6 months. We included all deliveries (including perinatal deaths) and termination of pregnancy (TOP) for fetal indication. We calculated sensibility, sensitivity, Positive and Negative Likelihood Ratio, positive and negative predictive value of ultrasound. RESULTS During the study period 5920 deliveries, including perinatal deaths, and 28 TOP for fetal indication were registered at our center. The prevalence of congenital malformations was 2.6% (153/5920). At least one ultrasound was performed in our center in 1250 women delivering in our unit. All 28 TOP had the anomaly scan performed in our center. Among the total 1278 women scanned in our unit, there were 128 (10%) suspicious scans. In 5/128 (3.9%) cases we diagnosed a false alarm; in 8/128 (6.2%) cases an evolutive malformation with in-utero regression. The prenatal diagnosis was confirmed in 77 (60.2%) cases at birth and in 28/128 (21.9%) at postmortem analysis while there were 10/128 false positive (7.8%). Among the 153 congenital malformations diagnosed at birth, the anomaly scan was performed in our Prenatal Medicine Unit in 92 (60.1%) fetuses. Among these, there were 15 false negatives (9.8%) while in 77/92 (83.7%) the malformation at birth agreed with the sonographic diagnosis. Sensitivity and specificity of ultrasound were 87.5% (IC95 80.2-92.8%) and 99.1% (IC95 98.4-99.6%) respectively with a Positive Likelihood Ratio and Negative Likelihood Ratio of 101.3 (IC95 54.5-188.5) and 0.13 (IC95 0.08-0.2); Positive Predictive Value and Negative Predictive Value were 91.3% (IC95 85-95.1%) and 98.7(IC95 98-99.2%). CONCLUSION Anomaly scan in pregnancy allows the diagnosis of congenital malformations with a sensibility of 87.5% and specificity of 99.1%. The main limitations of this study are its retrospective design and that it was conducted in a single referral center.
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Affiliation(s)
- Filomena G Sileo
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Finarelli
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Giannina Contu
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Licia Lugli
- Neonatology and Paediatric Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenza Dipace
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Michela Ballarini
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Cristina Guidi
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Emma Bertucci
- Prenatal Medicine Unit, Obstetrics and Gynaecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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Lesieur E, Degardin N, Develay-Morice JE, Quarello E. [Ultrasound scan of a fetus with facial cleft must be done from the lip to the uvula: What's new?]. ACTA ACUST UNITED AC 2021; 49:767-781. [PMID: 33766791 DOI: 10.1016/j.gofs.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Indexed: 10/21/2022]
Abstract
Facial cleft are the most frequent craniofacial anomalies with an incidence of one for 1000 births, all births combined, and require specialized multidisciplinary care. Since 2005, the systematic realization of two ultrasound views (nose-lip and profile) is recommended for the exploration of the fetal face in the 2nd trimester of pregnancy. Application of these recommendations should allow screening of the majority of cleft lip and palate. However, cleft palates, without labiomaxillary involvement, are currently largely underdiagnosed at prenatal ultrasound, although they can be associated with a syndromic diagnosis in up to 30% of cases. The aim of this work is to describe, from embryology to surgical consultation, the complete ultrasound examination of a fetus with a classic facial cleft.
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Affiliation(s)
- E Lesieur
- Screening and Diagnosis Unit, Department of Obstetrics and Gynecology, Saint-Joseph Hospital, 26, boulevard de Louvain, 13008 Marseille, France.
| | - N Degardin
- Department of Pediatric Plastic Surgery, Public Assistance Hospital of Marseille, University Hospital Center Timone, 278, rue Saint-Pierre, 13005 Marseille, France
| | - J-E Develay-Morice
- Department of Gynecology and Obstetrics, Gynepole, Assistance Publique-Hôpitaux de Marseille, chemin des Bourrely, 13015 Marseille, France
| | - E Quarello
- Screening and Diagnosis Unit, Department of Obstetrics and Gynecology, Saint-Joseph Hospital, 26, boulevard de Louvain, 13008 Marseille, France; IMAGE2 Center, 6, rue Rocca, 13008 Marseille, France
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Wiechers C, Thjen T, Koos B, Reinert S, Poets CF. Treatment of infants with craniofacial malformations. Arch Dis Child Fetal Neonatal Ed 2021; 106:104-109. [PMID: 32409560 DOI: 10.1136/archdischild-2019-317890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/29/2020] [Indexed: 11/04/2022]
Abstract
Infants with craniofacial malformations (CFMs) are at increased risk of various clinical problems, including respiratory and feeding disorders, the result of which may be long-lasting. An improvement in clinical care can be achieved by prenatal diagnosis and interdisciplinary birth preparation. Feeding problems may particularly be stressful for the family and require a team approach involving nursing staff, speech therapists and nutritional specialists to anticipate, avoid and treat sequelae such as failure to thrive or recurrent aspirations. Special techniques (eg, optimisation of breast feeding, alternative feeding methods or manual orofacial therapy) may be used individually to improve feeding competence; supplemental nutrition via a nasogastric or gastrostomy tube may be temporarily necessary to ensure adequate weight gain. The high prevalence of respiratory disorders in infants with craniofacial abnormalities requires anticipation and screening to prevent growth failure and neurological deficits. Treatment of upper airway obstruction varies widely, strategies can be divided into non-surgical and surgical, and in those aimed at widening the pharyngeal space (eg, prone position, palatal plates, craniofacial surgery) and those bridging the narrow upper airway (eg, nasopharyngeal airway, modified palatal plate, pneumatic airway stenting, tracheostomy). The complex management of an infant with CFM should be performed by a multidisciplinary team to offer specialised support and care for affected families.
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Affiliation(s)
- Cornelia Wiechers
- Department of Neonatology, Tuebingen University Hospital, Tuebingen, Germany.,Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany
| | - Tabea Thjen
- Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Physical Therapy Centre, Tuebingen University Hospital, Tuebingen, Germany
| | - Bernd Koos
- Department of Orthodontics, University of Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Siegmar Reinert
- Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany.,Department of Craniofacial Surgery, Tuebingen University Hospital, Tuebingen, Germany
| | - Christian F Poets
- Interdisciplinary Centre for Cleft Palate and Craniofacial Malformations, Tuebingen University Hospital, Tuebingen, Germany .,Department of Neonatology, University of Tuebingen, Tuebingen, Germany
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Frisova V, Cojocaru L, Turan S. A new two-dimensional sonographic approach to the assessment of the fetal hard and soft palates. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:8-11. [PMID: 32989822 DOI: 10.1002/jcu.22928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/15/2020] [Accepted: 09/07/2020] [Indexed: 06/11/2023]
Abstract
Facial clefts are among the most common congenital defects. Ultrasound (US) imaging of secondary fetal palate, especially the detection of isolated defects, remains challenging. Currently described two-dimensional (2D) and three-dimensional methods are technically demanding and impractical for application during routine fetal anatomy evaluation. As an adjunct method, magnetic resonance imaging can provide additional information but has its limitations. We present a novel 2D US approach using axial and sagittal planes to evaluate the fetal palate and demonstrate the main differences between an intact palate, isolated cleft palate, and a cleft lip with cleft palate.
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Affiliation(s)
- Veronika Frisova
- Profema-Fetal Medicine Centre, Prague, Czech Republic
- Department of Obstetrics and Gynaecology, Faculty Hospital, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Liviu Cojocaru
- Department of Obstetrics, Gynaecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shifa Turan
- Department of Obstetrics, Gynaecology & Reproductive Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Kruse T, Neuschulz J, Wilhelm L, Ritgen J, Braumann B. Prenatal Diagnosis of Robin Sequence: Sensitivity, Specificity, and Clinical Relevance of an Index for Micrognathia. Cleft Palate Craniofac J 2020; 58:1012-1019. [PMID: 33228397 DOI: 10.1177/1055665620972297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Micrognathia in connection with glossoptosis (called Robin sequence) may lead to life-threatening respiratory problems immediately after birth. An objective detection during prenatal routine ultrasound sonography is possible using an index that relates fetal lower jaw length to femur length or gestational age. The aim of this study was to test the method's sensitivity and specificity and to discuss its predictive power concerning neonatal respiratory insufficiency. DESIGN Patients with subjectively identified suspicious signs in the sagittal profile view were included in the study: Two-dimensional serial ultrasound scans of their fetal mandible were used to measure the lower jaw lengths and compare them to predicted values according to an index, derived from 313 healthy fetuses. Follow-up data provided additional information on the clinical appearance of the newborns. RESULTS The index showed a high sensitivity: 15 of the 16 cases with a micrognathia were correctly diagnosed (sensitivity of 93.75%). Follow-up data showed that newborns with similar index values differed in terms of their upper airway obstruction and treatment need. CONCLUSION Fetal mandibular micrognathia can be objectively evaluated with the help of the index. The method allows an early detection of micrognathia, which helps to take the necessary steps for proper treatment of potential life-threatening respiratory impairment. Observations ranging outside the prediction interval could prompt the ultrasonographer to check for other associated malformations.
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Affiliation(s)
- Teresa Kruse
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Julia Neuschulz
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
| | - Lucas Wilhelm
- Practice for Prenatal Diagnostics and Fetal Echocardiography, Frankfurt, Germany
| | - Jochen Ritgen
- Practice for Prenatal Medicine and Genetics, Cologne, Germany
| | - Bert Braumann
- 14309Department of Orthodontics, University of Cologne, Cologne, Germany.,Center for Rare Diseases Cologne, University of Cologne, Cologne, Germany
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Sato Y, Yoshioka E, Saijo Y, Miyamoto T, Sengoku K, Azuma H, Tanahashi Y, Ito Y, Kobayashi S, Minatoya M, Bamai YA, Yamazaki K, Ito S, Miyashita C, Araki A, Kishi R. Trajectories of the Psychological Status of Mothers of Infants With Nonsyndromic Orofacial Clefts: A Prospective Cohort Study From the Japan Environment and Children's Study. Cleft Palate Craniofac J 2020; 58:369-377. [PMID: 32844663 DOI: 10.1177/1055665620951399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study examined psychological status trajectories of mothers of infants with nonsyndromic orofacial clefts in Japan. DESIGN Prospective cohort study. SETTING Data from the Japan Environment and Children's Study. PARTICIPANTS Infants with a nonsyndromic cleft (N = 148) including cleft lip and palate (CLP; n = 72), cleft lip (CL; n = 46), and cleft palate (CP; n = 30). The control group included unaffected infants (N = 84 454). MAIN OUTCOME MEASURES At 15 weeks and 27 weeks of pregnancy and 12 months after birth, the Kessler Psychological Distress Scale (clinical cutoff ≥5) was used. At 1 month and 6 months after birth, the Edinburgh Postnatal Depression Scale (clinical cutoff ≥9) was used. RESULTS Prenatal diagnosis rates were unavailable. Mothers of infants with CLP had higher psychological distress than controls at 27 weeks of pregnancy (prevalence ratio [PR] = 1.36, 95% CI: 1.06-1.74) and postnatal depression at 1 month after birth (PR = 2.21, 95% CI: 1.53-3.19). Mothers of infants with CP showed heightened psychological distress at 27 weeks of pregnancy (PR = 1.62, 95% CI: 1.21-2.17) and postnatal depression 6 months after birth (PR = 1.86, 95% CI: 1.01-3.43). There was no significant association between CL and maternal psychological status. At 12 months after birth, no differences in distress were found between mothers of infants with a cleft and controls. CONCLUSIONS Mothers of infants with orofacial clefts may need psychosocial support, particularly during pregnancy and the first year after birth.
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Affiliation(s)
- Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Toshinobu Miyamoto
- Department of Obstetrics and Gynecology, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Kazuo Sengoku
- Department of Obstetrics and Gynecology, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Tanahashi
- Department of Pediatrics, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiya Ito
- Faculty of Nursing, 38325Japanese Red Cross Hokkaido College of Nursing, Hokkaido, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Machiko Minatoya
- Faculty of Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Yu Ait Bamai
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Sachiko Ito
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Atsuko Araki
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
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Bozkurt AP, Aras I. Cleft Lip and Palate YouTube Videos: Content Usefulness and Sentiment Analysis. Cleft Palate Craniofac J 2020; 58:362-368. [DOI: 10.1177/1055665620948722] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective: This study aimed to describe the content of YouTube videos about cleft lip and palate (CLP) and to describe the sentiment analysis of related comments. Design: Retrospective, YouTube video, and sentiment analysis. Methods: YouTube videos (N = 112) about CLP were examined, including demographics and ratings of quality and usefulness. Comments on CLP (N = 205) were classified by content, and measured from negative (−5) to positive (+5) with a sentiment analysis program. Results: Videos were uploaded most often by universities and hospitals (25%) and health information sites (22%). Most videos were educational (49.1%) or described patient experiences (48.2%). The most frequent video topics were terminology, CLP treatment, and prenatal diagnosis information. Based on the comprehensiveness of CLP topics covered, videos were generally rated by authors as moderately useful (31.5%) or very useful (35.7%). Comments were mostly made by people with CLP (79%), and the median sentiment scores were +3, and −2 for positive and negative sentiments, respectively. General content categories were positive comments (24.8%), provided information about themselves (24.4%), negative comments (19.5%), comments on usefulness of video (17.6%), or advice (9.3%). While 36.1% of comments noted no difficulties, the remaining comments included difficulties with surgery pain (13.2%), psychological state (12.2%), embarrassment (11.7%), physical appearance (10.2%), long term therapy (9.8%), and speech problems (6.8%). Conclusions: Although useful and educational YouTube videos were available, the variability of content quality suggests that caution be used in relying on videos for information and that experts in CLP treatment should be consulted.
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Affiliation(s)
| | - Isıl Aras
- School of Orthodontics Brooks Rehabilitation College of Healthcare Sciences, Jacksonville University, FL, USA
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38
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Ko H, Chang TY, Lussier EC, Olisova K, Sung CY, Chen PKT, Li WC, Yang TY, Wang RX. Multidisciplinary team approach to the prenatal management of orofacial clefts: a single center cohort study in Taiwan. Sci Rep 2020; 10:13916. [PMID: 32811868 PMCID: PMC7435174 DOI: 10.1038/s41598-020-70906-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/03/2020] [Indexed: 11/09/2022] Open
Abstract
Advances in ultrasound fetal diagnostics and treatment have created a dilemma for doctors and parents: choosing whether to continue with a pregnancy as well as choosing between various treatment options. A multidisciplinary approach has been widely accepted in the management of other prenatally diagnosed anomalies and has shown superior results compared to routine care. We present a retrospective cohort of patients prenatally diagnosed with orofacial clefts who were offered consultation by an expert multidisciplinary team, including: a fetal medicine specialist, an obstetrician, a plastic surgeon, and a case managing nurse. We analyzed factors influencing parents' decision to utilize a consultation service, as well as their decision about pregnancy continuation. Our results suggest that the presence of other anomalies and maternal age heavily influenced the decision about the uptake of consultations. If consulted by the team, parents tended to continue with the pregnancy, even when accounting for fetal gender and maternal age. On the other hand, having a consultation had varying effects depending on the cleft type. The findings suggest that multidisciplinary consultations may be an efficient approach in managing pregnancies complicated by orofacial cleft anomalies; which may help in preventing unnecessary pregnancy terminations and developing a sufficient postnatal care plan.
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Affiliation(s)
| | | | | | | | | | | | - Wen-Chu Li
- Puli Christian Hospital, Puli Township, Taiwan
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Faure JM, Mousty E, Bigorre M, Wells C, Boulot P, Captier G, Fuchs F. Prenatal ultrasound diagnosis of cleft palate without cleft lip, the new ultrasound semiology. Prenat Diagn 2020; 40:1447-1458. [PMID: 32673416 DOI: 10.1002/pd.5794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 07/01/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The aim of this study was to define the prenatal ultrasound semiology of cleft palate without cleft lip using 3D visualization of the fetal palate. METHODS A prospective longitudinal study was performed in our University Hospital Center from 2011 to 2018. The fetal secondary palate was studied in 3D, starting with 2D axial transverse ultrasound view. We defined a cleft palate as a disruption of the horizontal plate of the palatine bone of the secondary palate. Prenatal findings were correlated to anatomic postnatal examinations performed by a paediatric plastic surgeon. RESULTS Forty-three cases of cleft palate without cleft lip were prenatally diagnosed, of whom 34 were associated with malformations. We defined four types of disruptive appearances: isolated nonvisualization of the posterior nasal spine; partial-disruption or cleft velum; complete disappearance or V-shaped cleft palate; and complete disappearance or U-shaped cleft palate. The adjusted kappa coefficient, between prenatal and postnatal evaluation, was 0.88 (95% CI: 0.79-0.97), corresponding to an excellent agreement. CONCLUSIONS Using a strictly axial transverse ultrasound view, visualization of the secondary fetal palate enables to diagnose a cleft palate without cleft lip. This method offers a prenatal anatomic classification of cleft palate with a high level of concordance to postnatal findings.
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Affiliation(s)
- Jean Michel Faure
- Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France
| | - Eve Mousty
- Department of Obstetrics and Gynecology, University Hospital Center, Nîmes, France
| | - Michèle Bigorre
- Department of Plastic Pediatric and Craniofacial Surgery, University Hospital Center, Montpellier, France
| | - Constance Wells
- Department of Genetic, University Hospital Center, Montpellier, France
| | - Pierre Boulot
- Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France
| | - Guillaume Captier
- Department of Plastic Pediatric and Craniofacial Surgery, University Hospital Center, Montpellier, France
| | - Florent Fuchs
- Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France.,Inserm, Center for Research in Epidemiology and Population Health (CESP), Villejuif, France.,EA2415, Epidemiologic Biostatistic and Clinical Research Laboratory, University of Montpellier, Montpellier, France
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A Comparison of Early Versus Late Prenatal Magnetic Resonance Imaging in the Diagnosis of Cleft Palate. Ann Plast Surg 2020; 82:S242-S246. [PMID: 30855394 DOI: 10.1097/sap.0000000000001881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prenatal ultrasound is the standard modality to screen for fetal craniofacial malformations, but can be limited by sonographer experience, oligohydramnios, and maternal obesity. Fetal magnetic resonance imaging (MRI) can be used as an adjunct to ultrasound, but there is a paucity of literature on its performance. The objective of this study was to examine the accuracy of fetal MRI for prenatal diagnosis of craniofacial abnormalities in an at-risk patient population and to determine if accuracy is maintained before and after 24 weeks gestational age (GA). METHODS This was a retrospective review of a single-center fetal MRI database including cases from March 2011 to November 2018. All cases were referred for MRI due to a suspected orofacial cleft or micrognathia upon screening ultrasound. Magnetic resonance imaging was performed and interpreted by dedicated fetal MRI radiologists. Prenatal findings were correlated with postnatal anatomy. RESULTS Sixty-one cases were identified. Ten were lost to follow-up and 9 underwent termination of pregnancy. Among the remaining 42 cases, MRI possessed a sensitivity of 91.7% and negative predictive value (NPV) of 90% for prenatal diagnosis of cleft palate. When performed at early GA, fetal MRI (n = 20) demonstrated sensitivity and NPV of 100% for cleft palate diagnosis. For cleft lip, MRI had 93.1% sensitivity and 86.7% NPV without significant decrease in accuracy at early GA. For micrognathia, MRI demonstrated 100% sensitivity and NPV overall, as well as at early and late gestational ages. CONCLUSIONS Fetal MRI is an accurate method for prenatal diagnosis of cleft palate, cleft lip, and micrognathia. Furthermore, it remains highly accurate even when performed before 24 weeks GA. We advocate the use of fetal MRI as an adjunct imaging modality to standard ultrasound for the evaluation of suspected fetal craniofacial anomalies to provide complete and accurate counseling to prospective parents and facilitate the planning of appropriate postnatal care.
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Oliver JD, Turner EC, Halpern LR, Jia S, Schneider P, D'Souza RN. Molecular Diagnostics and In Utero Therapeutics for Orofacial Clefts. J Dent Res 2020; 99:1221-1227. [PMID: 32609569 DOI: 10.1177/0022034520936245] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Orofacial clefts and their management impose a substantial burden on patients, on their families, and on the health system. Under the current standard of care, affected patients are subjected to a lifelong journey of corrective surgeries and multidisciplinary management to replace bone and soft tissues, as well as restore esthetics and physiologic functions while restoring self-esteem and psychological health. Hence, a better understanding of the dynamic interplay of molecular signaling pathways at critical phases of palate development is necessary to pioneer novel prenatal interventions. Such pathways include transforming growth factor-β (Tgfβ), sonic hedgehog (Shh), wingless-integrated site (Wnt)/β-catenin, bone morphogenetic protein (Bmp), and fibroblast growth factor (Fgf) and its associated receptors, among others. Here, we summarize commonly used surgical methods used to correct cleft defects postnatally. We also review the advances made in prenatal diagnostics of clefts through imaging and genomics and the various in utero surgical corrections that have been attempted thus far. An overview of how key mediators of signaling that drive palatogenesis are emphasized in the context of the framework and rationale for the development and testing of therapeutics in animal model systems and in humans is provided. The pros and cons of in utero therapies that can potentially restore molecular homeostasis needed for the proper growth and fusion of palatal shelves are presented. The theme advanced throughout this review is the need to develop preclinical molecular therapies that could ultimately be translated into human trials that can correct orofacial clefts at earlier stages of development.
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Affiliation(s)
- J D Oliver
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA.,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, USA
| | - E C Turner
- University of Western Australia Dental School, Perth, Western Australia
| | - L R Halpern
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA
| | - S Jia
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA
| | - P Schneider
- Department of Biochemistry, University of Lausanne, Epalinges, Switzerland
| | - R N D'Souza
- School of Medicine and School of Dentistry, University of Utah Health, Salt Lake City, UT, USA.,Department of Biomedical Engineering, College of Engineering, University of Utah, Salt Lake City, UT, USA.,University of Utah, Departments of Neurobiology and Anatomy, Pathology, and Surgery, Salt Lake City, UT, USA
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42
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Undetected anomalies in foetuses with a prenatal diagnosis of isolated cleft. Int J Oral Maxillofac Surg 2020; 49:1576-1583. [PMID: 32546322 DOI: 10.1016/j.ijom.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 11/22/2022]
Abstract
The aim of this study was to determine the rate of undetected additional anomalies following a prenatal diagnosis of isolated oral cleft. Data of all infants with a prenatal diagnosis of isolated oral cleft born between 2000 and 2015 were studied retrospectively. Additional anomalies detected after birth were categorized as minor or major and included structural and chromosomal anomalies. Isolated clefts of the lip (CL), lip and alveolus (CLA) and lip, alveolus, and palate (CLAP) were diagnosed prenatally in 176 live-born infants. The type of cleft was more extensive after birth in 34/176 (19.3%) and less extensive in 16/176 (9.1%) newborns. Additional anomalies were diagnosed in 24 infants (13.6%), of which 12 (6.8%) were categorized as major. The latter included two submicroscopic chromosome anomalies and two gene mutations. Postnatal additional anomalies occurred more frequently in CLA and CLAP than in CL, and more in bilateral than in unilateral clefts. Major anomalies are still found in infants with a prenatal diagnosis of an isolated oral cleft. The prevalence of additional anomalies seems to be related to the type and bilaterality of the cleft, and this should be considered during prenatal counselling.
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43
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Hens K, Hens G. Pregnancy Termination in the Case of an Orofacial Cleft: An Investigation of the Concept of Reproductive Autonomy. Cleft Palate Craniofac J 2020; 57:1134-1139. [PMID: 32495649 DOI: 10.1177/1055665620929775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe ethical approaches to the issue of pregnancy termination after prenatal detection of cleft lip ± palate. RESULTS Gynecologists and cleft surgeons are sometimes confronted with the demand for a pregnancy termination after ultrasound detection of an isolated cleft lip/cleft palate. In this article, we discuss different ethical theories and principles that can be applied to the dilemma at hand. We formulate recommendations that will respect the right to autonomy of the pregnant woman and at the same time acknowledge that a termination of pregnancy for a cleft lip may in most cases not be the best option. CONCLUSION The recognition of each person's right to reproductive autonomy also entails that clinicians should make sure that prospective parents are provided with up-to-date and relevant clinical information.
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Affiliation(s)
- Kristien Hens
- Department of Philosophy, University of Antwerp, Antwerpen, Belgium.,Institute of Philosophy, KU Leuven, Leuven, Belgium
| | - Greet Hens
- Department of Neurosciences, KU Leuven, Leuven, Belgium
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van der Hoek-Snieders HEM, van den Heuvel AJML, van Os-Medendorp H, Kamalski DMA. Diagnostic accuracy of fetal MRI to detect cleft palate: a meta-analysis. Eur J Pediatr 2020; 179:29-38. [PMID: 31797081 PMCID: PMC6942582 DOI: 10.1007/s00431-019-03500-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/17/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
This systematic review aims to determine the diagnostic accuracy of fetal MRI for detecting cleft palate in fetuses at risk for orofacial clefts. Pubmed, Embase, and CINAHL were searched systematically. A diagnostic study was included if it performed MRI (index test) and postnatal examination (reference test) in fetuses at risk for orofacial clefts. Methodological quality was assessed using the QUADAS-2. A meta-analysis was performed with a random-effects model, calculating the pooled sensitivity, specificity, and area under the curve. The search resulted in eight studies (334 fetuses) to be included: four prospective and four retrospective studies. The applicability concern was low. There was, however, a risk of selection and information bias. All studies showed that MRI well predicted the chance of cleft palate. The sensitivity results were homogeneous, but heterogeneity was assumed regarding the specificity estimate (Cochrane's Q test: p = 0.00). The pooled sensitivity was 0.97 (95% CI 0.93-0.99); the pooled specificity was 0.94 (0.89-0.97). The area under the curve was 0.98 (95% CI 0.98-0.99).Conclusion: This meta-analysis shows that MRI has an excellent sensitivity and good to excellent specificity for diagnosing cleft palate in fetuses at risk for orofacial clefts. Future research should assess applicability for clinical care.What is Known:• Using ultrasound for prenatal detection of cleft palate leads to misdiagnosis frequently.• MRI could potentially improve the prenatal detection rate of cleft palate.What is New:• Eight studies describe the diagnostic accuracy of MRI for detecting cleft palate.• Combined results show excellent sensitivity and good to excellent specificity.
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Affiliation(s)
| | | | - Harmieke van Os-Medendorp
- Clinical Health Sciences, Faculty of Medicine, Utrecht University, Utrecht, The Netherlands ,Department of Dermatology/Allergology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Digna M. A. Kamalski
- Department of Otorhinolaryngology Head and Neck Surgery, University Medical Centre Utrecht, Heidelberglaan 100, G05.129, 3584 CX Utrecht, The Netherlands
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Brusilov M, Wolman I, Ashwal E, Malinger G, Birnbaum R. Ultrasound imaging of the fetal secondary palate: Methodological description of a two-dimensional approach and a case series. Prenat Diagn 2019; 38:1049-1054. [PMID: 30402910 DOI: 10.1002/pd.5385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/31/2018] [Accepted: 11/01/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The study aims to describe our two-dimensional (2D) ultrasound approach to visualize the fetal secondary palate and plot its growth curve and to describe and demonstrate its clinical implementation. METHODS This is a two parts retrospective study. First, we measured the antero-posterior length of the bony secondary palate, from the soft to hard palate interface (SHPI) line to the alveolar ridge, blindly by two operators during routine scans of low-risk fetuses, and plot a longitudinal growth curve. In the second part, we describe four cases of prenatal diagnosis of secondary palate cleft. RESULTS Sixty-eight fetuses were included: 14 to 15 weeks (n = 20), 21 to 24 weeks (n = 32), and 29 to 35 weeks (n = 16). The bony secondary palate elongates along gestation from a mean of 5.3 mm (+/-0.46 mm) at 14 to 15 weeks to 15.9 mm (+/-1.7 mm) at 29 to 35 weeks. We found high intraobserver and interobserver correlation between measurements. All four cases diagnosed by this approach were confirmed postnatally. CONCLUSIONS The SHPI, representing the normally developed secondary bony palate, can be imaged in the fetus by direct 2D ultrasound as early as 14 weeks. A gap within or nonvisualization of the SHPI is highly suggestive for a secondary palate cleft.
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Affiliation(s)
- Michael Brusilov
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igal Wolman
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Ashwal
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gustavo Malinger
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Roee Birnbaum
- OB-GYN Ultrasound Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Tian M, Xiao L, Jian N, Wei X, Liu S, Zhao H, Li G, Zhang S, Liang W, Lin N, Lin X. Accurate diagnosis of fetal cleft lip/palate by typical signs of magnetic resonance imaging. Prenat Diagn 2019; 39:883-889. [PMID: 31169321 DOI: 10.1002/pd.5499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/13/2019] [Accepted: 05/26/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aims to evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing orofacial clefts and proposes specific signs for determining the type of cleft. METHODS Pregnant women in whom fetal facial malformations are suspected by ultrasonography (US) underwent 1.5 T MRI. The accuracy of the prenatal US and MRI diagnosis was compared with the postnatal findings. RESULTS A total of 71 fetuses were included in the final analysis, which comprised of 35 cases of isolated cleft lip, six cases of cleft lip and alveolus, 21 cases of cleft lip and palate, four cases of isolated cleft palate, and five normal fetuses. MRI was more sensitive than US (MRI 100%, US 77.5%; Fisher's exact test: MRI vs US P=0.000). The accuracy of MRI for all types was 100%. Specific signs (Inverted T, L/anti-L, U, and "Notch" signs) were proposed, indicating the normal hard, unilateral cleft, bilateral cleft, and cleft soft palates, respectively, which can facilitate the identification of different types of cleft palates. CONCLUSION MRI can accurately diagnose the type of cleft based on typical signs, which can serve as a definite diagnostic modality and an effective supplement of US.
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Affiliation(s)
- Mimi Tian
- School of Medicine, Shandong University, Jinan, China
| | - Lianxiang Xiao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Nan Jian
- School of Medicine, Shandong University, Jinan, China.,CT Department, Heze Municipal Hospital, Heze, China
| | - Xinhong Wei
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Shuwei Liu
- Shandong Provincial Key Laboratory of Mental Disorders, Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Jinan, China
| | - Hui Zhao
- Department of Imaging, Shandong Provincial Western Hospital, Jinan, China
| | - Guan Li
- College of Radiology, Taishan Medical University, Tai'an, China
| | - Shuai Zhang
- School of Medicine, Shandong University, Jinan, China
| | - Wenjia Liang
- Shandong Provincial Key Laboratory of Mental Disorders, Research Center for Sectional and Imaging Anatomy, Shandong University School of Medicine, Jinan, China
| | - Nan Lin
- School of Medicine, Shandong University, Jinan, China
| | - Xiangtao Lin
- School of Medicine, Shandong University, Jinan, China.,Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
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Schreurs M, Suttorp CM, Mutsaers HAM, Kuijpers-Jagtman AM, Von den Hoff JW, Ongkosuwito EM, Carvajal Monroy PL, Wagener FADTG. Tissue engineering strategies combining molecular targets against inflammation and fibrosis, and umbilical cord blood stem cells to improve hampered muscle and skin regeneration following cleft repair. Med Res Rev 2019; 40:9-26. [PMID: 31104334 PMCID: PMC6972684 DOI: 10.1002/med.21594] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/17/2019] [Accepted: 04/19/2019] [Indexed: 12/18/2022]
Abstract
Cleft lip with or without cleft palate is a congenital deformity that occurs in about 1 of 700 newborns, affecting the dentition, bone, skin, muscles and mucosa in the orofacial region. A cleft can give rise to problems with maxillofacial growth, dental development, speech, and eating, and can also cause hearing impairment. Surgical repair of the lip may lead to impaired regeneration of muscle and skin, fibrosis, and scar formation. This may result in hampered facial growth and dental development affecting oral function and lip and nose esthetics. Therefore, secondary surgery to correct the scar is often indicated. We will discuss the molecular and cellular pathways involved in facial and lip myogenesis, muscle anatomy in the normal and cleft lip, and complications following surgery. The aim of this review is to outline a novel molecular and cellular strategy to improve musculature and skin regeneration and to reduce scar formation following cleft repair. Orofacial clefting can be diagnosed in the fetus through prenatal ultrasound screening and allows planning for the harvesting of umbilical cord blood stem cells upon birth. Tissue engineering techniques using these cord blood stem cells and molecular targeting of inflammation and fibrosis during surgery may promote tissue regeneration. We expect that this novel strategy improves both muscle and skin regeneration, resulting in better function and esthetics after cleft repair.
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Affiliation(s)
- Michaël Schreurs
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Maarten Suttorp
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | | | - Johannes W Von den Hoff
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edwin M Ongkosuwito
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Paola L Carvajal Monroy
- Department of Oral & Maxillofacial Surgery, Special Dental Care and Orthodontics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Frank A D T G Wagener
- Department of Dentistry, Section of Orthodontics and Craniofacial Biology, Radboud University Medical Centre, Nijmegen, The Netherlands.,Radboud Institute for Molecular Life Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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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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Kurjak A, Spalldi-Barišić L, Sibinčić S, Porović S, Tinjić S, Stanojević M. Fetal syndromes: Diagnosis and management using 3D-4D sonography. SCRIPTA MEDICA 2019. [DOI: 10.5937/scriptamed50-21107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Abstract
Orofacial clefts are common congenital malformations with genetic and environmental risk factors. In the perinatal period, feeding and nutrition can be a challenge and the need for specialized feeders is common. Lip taping and nasoalveolar molding are early interventions that can be used to preoperatively modify cleft defects to enhance surgical outcomes. Multiple techniques are available for repair of orofacial clefts and choice of technique depends on cleft extent and surgeon preference. After definitive repair, children remain at increased risk for middle ear disease, velopharyngeal dysfunction, and malocclusion and require ongoing follow-up with a multidisciplinary team.
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