Directional Power Doppler in the midsagittal plane as an aid to the prenatal diagnosis of cleft lip and palate

What does magnetic resonance imaging add to the prenatal ultrasound diagnosis of facial clefts?

“…The prospect of delivering a child with a facial cleft is associated with considerable stress for the parents11. Cleft lip and palate are embryologically distinct processes, varying from a submucous malformation to a complete cleft of the primary and secondary palate, with differing prognoses12. The importance of assessing the degree of extension of a facial cleft and the presence of any associated severe, and possibly lethal, anomalies is obvious and prenatal detection offers the potential for optimal planning of neonatal management13.…”

Value of sagittal color Doppler ultrasonography as a supplementary tool in the differential diagnosis of fetal cleft lip and palate

“…However, detection of a defected palate in a grayscale sonogram is difficult due to acoustic shadowing from the bony alveolar ridge and maxilla [13]. The importance of a sagittal scan, therefore, has been described with a limited view toward detecting “premaxillary protrusion(s)” when bilateral CL with or without CP was suspected in coronal or axial scans.…”

“…Delineating the palatine defect by visualization of the slow amniotic flow through the defect using sagittal CDUS has been tried in some case reports [11-13] to increase the detection rate of CL with or without CP by collecting additional information through sagittal US scans. In this study, we extended the methods to a larger group of high-risk patients.…”

“…Hence, conventional 2-D US is still important as the first-line imaging modality for the prenatal diagnosis of CL and CP. Efforts to enhance the accuracy of 2-D US, including the application of color or power Doppler have been reported [11-13]. A conventional grayscale ultrasound may miss the existence of CP, because acoustic shadowing from the bony alveolar ridge often obscures the palate defect.…”

“…A conventional grayscale ultrasound may miss the existence of CP, because acoustic shadowing from the bony alveolar ridge often obscures the palate defect. Previous communications reported that the color or power Doppler on the sagittal plane can improve the diagnostic accuracy of CP by detecting the slow amniotic fluid flows between the buccal space and the nasal fossa during breathing or swallowing, with representative cases at the level of case reports [11-13]. However, to our knowledge, there have been no previous studies validating the use of color Doppler ultrasonography (CDUS) on the sagittal plane in the diagnosis of CL and CP.…”