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Gilboa Y, Achiron R, Kivilevitch Z, Hochberg A, Bardin R, Zalel Y, Perlman S. Imaging of the Fetal Zygomatic Bone: A Key Role in Prenatal Diagnosis of First Branchial Arch Syndrome. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2165-2172. [PMID: 32378755 DOI: 10.1002/jum.15325] [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: 01/20/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES First arch syndromes are congenital defects caused by failure of neural crest cells to migrate into the first branchial arch. First arch syndrome is classified into 2 main clinical manifestations: Treacher Collins syndrome, characterized by bilateral underdevelopment of the zygomatic bones; and Pierre Robin sequence. The aim of this study was to describe the feasibility of visualization of the fetal zygomatic bone and assess its application in cases referred for features suggestive of first arch syndrome. METHODS A prospective cohort study was conducted. The feasibility of visualization of the zygomatic bone was performed in 50 sequential fetuses with a normal anatomic scan between 12 and 24 weeks' gestation using 3-dimensional sonography. Following this, cases referred for targeted scans for suspected first branchial arch syndrome were assessed for the presence or absence of the zygomatic bones. RESULTS Visualization of the fetal zygomatic bone was feasible in all low-risk cases. Cases referred for targeted scans included 11 isolated cases of micrognathia or retrognathia, 3 cases of microtia, and 3 cases of auricular or facial vestiges. Within this group, the zygomatic bones were visualized in all but 2 cases. No associated extrafacial malformations were detected; therefore, this phenotype was consistent with Treacher Collins syndrome. CONCLUSIONS Prenatal imaging of the zygomatic bones offers a clinically based sonographic approach to cases referred for features suggestive of first arch syndrome and enables differentiation between the 2 main clinical manifestations: Treacher Collins syndrome and Pierre Robin sequence.
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Affiliation(s)
- Yinon Gilboa
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Reuven Achiron
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Zvi Kivilevitch
- Prenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Alyssa Hochberg
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Ron Bardin
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Yaron Zalel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
| | - Sharon Perlman
- Ultrasound Unit, Helen Schneider Women's Hospital, Rabin Medical Center, Petach Tikva, Israel
- Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel
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Xu BQ, Zhen L, Li DZ. First-trimester detection of micrognathia as a presentation of mandibulofacial dysostosis with microcephaly. J OBSTET GYNAECOL 2020; 41:821-823. [PMID: 32799722 DOI: 10.1080/01443615.2020.1785410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Bi-Qiu Xu
- Prenatal Diagnosis Center, Hu Zhong Hospital, Huadu District Maternal and Neonatal Healthcare Hospital of Guangzhou, Guangzhou, Guangdong, China
| | - Li Zhen
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
| | - Dong-Zhi Li
- Prenatal Diagnostic Center, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, China
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Fayoux P, Daniel SJ, Allen G, Balakrishnan K, Boudewyns A, Cheng A, De Alarcon A, Goel D, Hart CK, Leboulanger N, Lee G, Moreddu E, Muntz H, Rahbar R, Nicollas R, Rogers-Vizena CR, Russell J, Rutter MJ, Smith RJH, Wyatt M, Zalzal G, Resnick CM. International Pediatric ORL Group (IPOG) Robin Sequence consensus recommendations. Int J Pediatr Otorhinolaryngol 2020; 130:109855. [PMID: 31896499 DOI: 10.1016/j.ijporl.2019.109855] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To provide recommendations for the comprehensive management of airway obstruction in patients with Robin Sequence. METHODS Expert opinion by the members of the International Pediatric Otolaryngology Group (IPOG). RESULTS The consensus statement provides recommendations for medical specialists who manage infants with Robin Sequence including: evaluation and treatment considerations for commonly debated issues in post-natal airway obstruction, assessment of antenatal obstruction and perinatal airway management. CONCLUSION Consensus recommendations are aimed at improving management of airway obstruction in patients with Robin Sequence.
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Affiliation(s)
- Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Jeanne de Flandre Hospital, CHU Lille, Université de Lille, Lille, France.
| | - Sam J Daniel
- Department of Otolaryngology, Head and Neck Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Gregory Allen
- Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA
| | | | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Belgium
| | - Alan Cheng
- Department of Pediatric Otolaryngology, The Sydney Children's Hospital Network-Westmead Campus, The University of Sydney, Sydney, NSW, Australia
| | - Alessandro De Alarcon
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Dimple Goel
- Neonatal Intensive Care Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Catherine K Hart
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Nicolas Leboulanger
- Pediatric ENT Department, Hôpital Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
| | - Gi Lee
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | - Eric Moreddu
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille Université, Marseille, France
| | - Harlan Muntz
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, UT, USA
| | - Reza Rahbar
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | - Richard Nicollas
- Department of Pediatric Otolaryngology Head and Neck Surgery, La Timone Children's Hospital, Aix-Marseille Université, Marseille, France
| | | | - John Russell
- Department of Otorhinolaryngology, Our Lady's Children's Hospital, Dublin, Ireland
| | - Michael J Rutter
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Richard J H Smith
- Department of Otolaryngology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA
| | - Michelle Wyatt
- Department of Paediatric Otolaryngology, Great Ormond Street Hospital, London, UK
| | - George Zalzal
- Department of Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Cory M Resnick
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
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Nguyen JQN, Calabrese CE, Heaphy KJ, Koudstaal MJ, Estroff JA, Resnick CM. Can Robin Sequence Be Predicted From Prenatal Ultrasonography? J Oral Maxillofac Surg 2019; 78:612-618. [PMID: 31758942 DOI: 10.1016/j.joms.2019.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/24/2019] [Accepted: 10/15/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE Prenatal diagnosis of Robin sequence (RS) could promote safe delivery and improve perinatal care. The purpose of this study was to evaluate the correlation between prenatal ultrasonography (US) and magnetic resonance imaging (MRI) studies for assessing micrognathia to determine if US alone can be used to reliably screen for RS. MATERIALS AND METHODS This was a retrospective case-control study of fetuses evaluated in the Advanced Fetal Care Center at Boston Children's Hospital from 2002 to 2017. To be included, 1) prenatal MRI and US must have been performed during the same visit, 2) the infant must have been live-born, and 3) the diagnosis must have been confirmed postnatally. Patients with images of inadequate quality for analysis were excluded. Patients were divided into 4 groups based on postnatal diagnosis: 1) RS (micrognathia, glossoptosis, and airway obstruction) (RS group), 2) micrognathia without RS (micrognathia group), 3) cleft lip and palate (CLP) without micrognathia (CLP group), and 4) gestational age-matched controls with normal craniofacial morphology (control group). The inferior facial angle (IFA) was measured using both imaging modalities and compared. Receiver operating characteristic curves were applied to identify a threshold for the diagnosis of RS from US. The sensitivity, specificity, positive predictive value, negative predictive value, and odds ratio were calculated. RESULTS A total of 94 patients were included (mean gestational age at imaging, 24.9 ± 5.2 weeks), with 25 in the RS group (26.6%), 29 in the micrognathia group (30.9%), 23 in the CLP group (24.5%), and 17 in the control group (18.1%). The IFA was significantly smaller in the RS group than in all other groups on both US and MRI (P < .001). A moderate correlation was found between IFA measurements on US and MRI (intraclass correlation coefficient, 0.729). An IFA threshold on US of 45.5° maximized sensitivity (84%) and specificity (81%) for the diagnosis of RS. CONCLUSIONS We suggest incorporating the IFA into routine prenatal US and referring patients for confirmatory MRI when the US IFA is lower than 45.5°.
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Affiliation(s)
| | - Carly E Calabrese
- Clinical Research Specialist, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
| | - Kathryn J Heaphy
- Pediatric Radiology Fellow, Department of Radiology, Boston Children's Hospital, Boston, MA
| | - Maarten J Koudstaal
- Assistant Professor of Oral and Maxillofacial Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands; and Research Associate, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA
| | - Judy A Estroff
- Associate Professor of Radiology, Harvard Medical School, Boston, MA; and Director of Fetal-Neonatal Imaging, Department of Radiology, Advanced Fetal Care Center, Boston Children's Hospital, Boston, MA
| | - Cory M Resnick
- Assistant Professor of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA; and Oral and Maxillofacial Surgeon, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
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Mouthon L, Busa T, Bretelle F, Karmous-Benailly H, Missirian C, Philip N, Sigaudy S. Prenatal diagnosis of micrognathia in 41 fetuses: Retrospective analysis of outcome and genetic etiologies. Am J Med Genet A 2019; 179:2365-2373. [PMID: 31509347 DOI: 10.1002/ajmg.a.61359] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/20/2019] [Accepted: 08/23/2019] [Indexed: 12/20/2022]
Abstract
Fetal micrognathia can be detected early in pregnancy. Prognosis of micrognathia depends on the risk of respiratory distress at birth and on the long-term risk of intellectual disability. The purpose of this study was to evaluate the long-term prognosis of fetuses with prenatal diagnosis of micrognathia by estimating the prevalence and the severity of confirmed genetic diagnosis in our cohort. Our retrospective study included 41 fetuses with prenatal diagnosis of micrognathia referred to the multidisciplinary centers for prenatal diagnosis in Nice and Marseille, France, between 2006 and 2016. Fetal micrognathia was associated with cleft palate in 27 cases. A genetic cause was confirmed in 21 cases (67%). A chromosomal abnormality was present in 12 cases, including three copy-number variations diagnosed by array CGH. Monogenic disorders were identified in nine cases, most often after birth. Fetuses with family history of micrognathia or Pierre Robin sequence had a favorable outcome. Prognosis was good for the fetuses without associated findings and normal chromosomal analysis, with the exception of one case with a postnatal diagnosis of mandibulofacial dysostosis with microcephaly. Prognostic was poor for the fetuses with additional ultrasound anomalies, as only 5 out of 28 children had a good outcome. Prenatal diagnosis of micrognathia is an indicator of a possible fetal pathology justifying multidisciplinary management. Our study confirms the necessity of performing prenatal array CGH. Use of high-throughput gene sequencing in prenatal period could improve diagnostic performance, prenatal counseling, and adequate postnatal care.
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Affiliation(s)
- Linda Mouthon
- GH La Pitié Salpêtrière-Charles Foix, Medical Genetics, Paris, France
| | - Tiffany Busa
- Hôpital de la Timone, Medical Genetics, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Florence Bretelle
- Hôpital de la Timone, Prenatal diagnosis, Marseille, Provence-Alpes-Côte d'Azur, France
| | | | - Chantal Missirian
- Hôpital de la Timone, Cytogenetics, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Nicole Philip
- Hôpital de la Timone, Medical Genetics, Marseille, Provence-Alpes-Côte d'Azur, France.,Hôpital de la Timone, Prenatal diagnosis, Marseille, Provence-Alpes-Côte d'Azur, France
| | - Sabine Sigaudy
- Hôpital de la Timone, Medical Genetics, Marseille, Provence-Alpes-Côte d'Azur, France.,Hôpital de la Timone, Prenatal diagnosis, Marseille, Provence-Alpes-Côte d'Azur, France
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