Normal fetal salivary glands at 14-16 weeks of gestation as observed by transvaginal ultrasound imaging

First-Trimester Nonvisualization of the Parotid Gland and Aneuploidy in Fetuses With Increased Nuchal Translucency: A Prospective Cohort Study

OBJECTIVES

Aplasia and hypoplasia of the major salivary glands, particularly the parotid glands, were reported to be associated with trisomy 21. This study aimed to evaluate the value of first-trimester nonvisualization of the parotid gland in a high-risk population of fetuses with increased nuchal translucency (NT).

METHODS

A single-center prospective observational cohort study was conducted. The feasibility of imaging the parotid gland was assessed in 100 sequential cases of routine low-risk NT scans. In a 2-dimensional image in an axial plane at the level of the fetal mandible, the parotid glands appear as bilateral hyperechoic round areas. Cases referred for counseling for an NT measured above the 95th percentile for gestational age were evaluated for visualization of the parotid glands. Prenatal findings were correlated with fetal genetic analysis results.

RESULTS

Forty-two cases with increased NT constituted the final study group. Within the group with nonvisualization of the parotid gland, genetic testing revealed 9 cases of trisomy 21, 3 cases of trisomy 18, and 1 case of monosomy X. The sensitivity and specificity of nonvisualization of the parotid gland as a predictor of aneuploidy were 76% and 80%, respectively. The positive likelihood ratio, negative likelihood ratio, and relative risk were 3.82 (95% confidence interval [CI], 1.67-8.74), 0.29 (95% CI, 0.12-0.71), and 4.33 (95% CI, 1.69-11.09; P < .01). The negative predictive value was 95.14%.

CONCLUSIONS

First-trimester nonvisualization of the parotid gland may constitute a potential method for detection of aneuploid fetuses within a high-risk population.

Congenital absence of salivary glands in Down syndrome

BACKGROUND

Children with Down syndrome have different saliva composition compared to normal children. The presence or absence of the salivary glands has not been previously reported.

OBJECTIVE

To examine the presence or absence of the salivary glands in children with Down syndrome.

METHODS

15 children with Down syndrome underwent an ultrasound examination of the salivary glands. The control group consisted of 31 healthy children. The areas of the parotid and submandibular glands on both sides were scanned in an attempt to demonstrate all four glands. The result was reported as 'present' or 'absent'.

RESULTS

In four children out of 15 with Down syndrome, one or more salivary glands were absent (26.7%), while in the controls all salivary glands were present. The difference between the groups was statistically significant (p=0.008). There was no significant difference between the groups regarding age and sex.

CONCLUSIONS

At least one salivary gland is undetected by ultrasound in some children with Down syndrome.