Type:
Educational Exhibit
Keywords:
Foetus, Education, Ultrasound, Foetal imaging, Eyes, Ear / Nose / Throat
Authors:
M. Kapanigowda1, A. Makam2, P. Jhawar1, U. Gunakala1, M. Jayadevappa1, N. Perothayil1, R. Jadiya3; 1Bengaluru/IN, 2Bangalore/IN, 3bangalore, ka/IN
DOI:
10.26044/ecr2019/C-3187
Findings and procedure details
Systematic approach: Normal planes.
A routine approach to fetal face includes evaluation of face in all 3 planes- axial,
coronal and sagittal.
1. Axial plane:
- Serious of transverse images of the face obtained craniocaudally to examine various structures like forehead,
nose,
orbits,
lips,
anterior palate and mandible (Fig 1).
- It helps in diagnosing many conditions like hyper/hypotelorism,
microphthalmia,
cataract,
the extension of the cleft lip into the alveolar ridge and anterior palate,
asymmetry of face.
2. Coronal plane:
- Modified coronal view helps to assess the integrity of face and lips; also to look for the extension of the cleft lip to alveolar ridges and anterior palate.
- It also helps in the assessment of orbits,
eyelids,
and nose (Fig 2 and 3).
- Observing the chin at the level or just behind the lower lips rules out retrognathia.
3. Sagittal plane:
- Useful in the assessment of normal facial profile (Fig 4).
- Parasagittal views to look for ears.
- Colour Doppler evaluation during the opening of mouth helps to diagnose cleft palate and isolated cleft palate (Fig 5).
4. Others:
- 3D & 4D helps in gross evaluation of facial anatomy (Fig 6 & 7).
- It’s complementary to the regular 2D evaluation.
Facial anomalies:
Facial anomalies are sub-classified according to the individual structural abnormalities.
Classification of facial anomalies:
Orbits:
- Hypertelorism
- Hypotelorism
- Microphthalmia/ anophthalmia
- Manophthamia
- Cyclopia
- Cataract
Nose:
- Arrinia
- Probosis
- Nasal cleft
- Chonal atresia
- Nasal tumours – Dermoid cyst,
Glioma,
Encephalocele,
Teratoma
- Broad/Short nasal bridge
Ear:
- Anotia
- Microtia
- Synotia
- Hypoplastic ear
- Dysplastic ear
- Low set ear
Mouth:
- Cleft lip/palate
- Agnathia
- Micrognathia
- Retrognathia
- Micro/macroglossia
- Micro/ macrostomia
- Tumors- Ranula,
teratoma
ORBIT:
Microphthalmia (small eyes):
- Defined as the total axial length of the globe is >2 standard deviation for that age (Fig 7 & 8).
- It’s associated with aneuploidy (Trisomy 13) and non-aneuploidic syndromes (Aicardi syndrome,
Fraser syndrome,
Fryns syndrome,
Goldenhar syndrome,
Treacher Collins syndrome).
EARS:
Low set ears:
- Depressed or abnormally low positioning of the pinna by two or more standard deviation below the population average (Fig 9).
- It’s associated with aneuploidy (trisomy 13) and non-aneuploidic syndromes (Fetal valproate syndrome,
Freeman Sheldon syndrome,
Fryn syndrome,
Noonan syndrome and potter sequence).
MOUTH:
Cleft lip and palate:
- Cleft is congenital malformation characterized by partial or complete clefting of the upper lip,
with or without clefting of the alveolar ridge or the hard palate or soft palate.
- Most frequent craniofacial anomalies.
- Compromises to 13% of all the anomalies and incidence is 1.4 per 1000 births.
- 25% cleft lip,
25% cleft palate and 50% cleft lip & palate.
- Clefting is unilateral in 75% of the cases (left>right).
- Associated with many genetic syndromes (isolated cleft palate is associated with more syndromes than other varieties).
Cases:
- Isolated cleft lip (Fig 10)
- Unilateral cleft lip with extension into alveolar ridge (Fig 11).
- Unilateral cleft lip with extension into hard palate and soft palate with bifid uvula (Fig 12).
- Bilateral cleft lip and palate (Fig 13).
- Cleft lip and palate extending into orbit (Fig 14).
- Colour demonstration of cleft palate (Fig 15).
Micrognthia:
- The abnormal shape and arrested development of the mandible (Fig 16).
- Micrognathia: Undersized mandible.
- Retrognathia: Reporitioned mandible.
- In severe cases,
the chin is absent in profile view.
- Jaw index and inferior facial angle are used in less severe cases.