Focus on Prenatal Detection of Micrognathia

Antonakopoulos, Nikolaos; Bhide, A.

doi:10.1007/s40556-019-00210-0

Cited by 20 publications

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“…The ratio of the anteroposterior diameter: transverse diameter of the mandible was calculated. The probe was rotated again, and the mandibular length was measured as the distance between the cartilaginous symphysis menti and the temporomandibular joint 15 (Figure 2). Criteria for prenatal diagnosis of micrognathia at 11 to 13 weeks gestation were an abnormal profile with small mandible, receding chin, and absent mandibular gap in the retro-nasal triangle view.…”

Section: Methodsmentioning

confidence: 99%

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Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Zhu

2021

J of Obstet and Gynaecol

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Aim To establish reference ranges for fetal mandibular markers in low‐risk singleton pregnancies between 11 and 13 + 6 weeks of gestation in a Chinese population. Methods The inferior facial angle (IFA), transverse, and anteroposterior diameters of the mandible, and mandibular length were measured at 11–13 + 6 weeks of gestation. The utility of these sonographic markers for detecting micrognathia was explored in seven fetuses. Results In healthy fetuses at 11–13 + 6 weeks, there were linear correlations between gestational age and the transverse (Y = −15.615 + 1.987X, r = 0.718, p < 0.001) and anteroposterior (Y = −8.557 + 1.101X, r = 0.581, p < 0.001) diameters of the mandible; mean ratio of the anteroposterior: transverse diameters of the mandible decreased with gestational age (Y = 0.603–0.003X, r = 0.018, p = 0.755); there was a positive correlation between crown rump length and mandibular length (mandible length = 0.861 + 0.137*crown rump length; r = 0.723, p < 0.001); and there was a positive correlation between crown rump length and IFA (r = 0.234, p < 0.05). Reference ranges were: mean ratio of anteroposterior diameter: transverse diameter of the mandible 0.56; mean mandibular length 9.05 mm; and median IFA 66.5°. The values for these mandibular markers in seven cases of fetal micrognathia were outside the normal range. Conclusions Evaluations of fetal mandibular markers during first trimester ultrasound screening may contribute to the early detection and diagnosis of micrognathia. We recommend obtaining a subjective impression of the mandible on the mid‐sagittal view routinely used to measured nuchal translucency, followed by targeted objective measurements on the mid‐sagittal and axial views in suspected cases.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Zhu

2021

J of Obstet and Gynaecol

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“…Detection of fetal abnormalities before birth leads to meticulous neonatal care and reduction of neonatal death [ 1 , 2 ]. Evaluation of the fetal mandible is included in the standard sonographic second trimester anatomical scan; however, currently there are no clear criteria to define ‘abnormal’ in the areas of fetal mandible scan [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The first is micrognathia, which refers to small size of mandible. The second is retrognathia, which refers to an abnormally posteriorly located mandible compared to the maxilla [ 3 ]. These rare conditions occur in 1 per 1,500 livebirths worldwide [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previously, prenatal diagnosis of fetal micrognathia and retrognathia was mainly based on the ultrasonographer’s judgement [ 3 , 11 ]. There have been ongoing attempts in recent years to establish specific criteria for diagnosing these conditions, based around 4 main parameters, which were 1) inferior facial angles (IFA) [ 13 , 14 ], 2) jaw index [ 15 ], 3) mandible width/maxilla width ratio (MD/MX ratio) [ 13 ], and 4) mandible length (ML) [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Reference ranges of fetal mandible measurements: Inferior facial angle, jaw index, mandible width/maxilla width ratio and mandible length in Thai fetuses at 15 to 23 weeks of gestation

Booncharoen

Sawaddisan²,

Suwanrath³

et al. 2022

PLoS ONE

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Objectives To determine the normal distribution of 1) inferior facial angles (IFA), 2) jaw index, 3) mandible width/maxilla width ratio (MD/MX ratio), and 4) mandible length (ML) in second trimester Thai fetuses. Methods A prospective study was performed between April 1 and October 31, 2020, at the Maternal-Fetal Medicine Unit of Songklanagarind Hospital. Transabdominal ultrasonography was performed on Thai singleton pregnant women at 150/7 to 236/7 weeks of gestation to measure IFA, jaw index, MD/MX ratio and ML. All women received standard antenatal care and were followed up until delivery. The exclusion criteria were multifetal gestation, congenital anomaly, chromosomal abnormality, fetal growth restriction, abnormal amniotic fluid volume, suspected abnormality of fetal mandible, maxilla or jaws based on the proposed criteria from previous studies and suspected neonatal structural or genetic abnormalities postnatally. Quantile regression was used to estimate changes in the median, 5th and 95th percentiles of each parameter across gestational ages and to generate formulas for predicting the 5th percentile value for each parameter. Results The results of 291 women were analyzed. Scatter plots and reference ranges of each parameter were generated. IFA, jaw index and ML values significantly increased, while the MD/MX ratio value significantly decreased, with increasing gestational age. The formulas calculated for predicting the 5th percentile value for each parameter were IFA = 55.12 + 0.045*(GA in days—136) jaw index = 37.272 + 0.01693*(GA in days—136) MD/MX ratio = exp(0.027–0.00110*(GA in days—136)) ML = 20.83 + 0.243*(GA in days—136). Conclusions The reference ranges and formulas to calculate the 5th percentile values of mandible parameters in Thai fetuses were developed. Trial registration This study has been reviewed and approved by the Thai Clinical Trials Registry with identification number TCTR20210602003.

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Perinatal Airway Management Mandibular Anomalies: A National Inpatient Cohort Analysis

Puricelli,

Barr,

Ellefson

et al. 2024

The Laryngoscope

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ObjectiveTo characterize incidence of mandibular anomalies (MAs) and compare gestational age, airway interventions, and complications among individuals with MA phenotypes (isolated retrognathia, isolated micrognathia, syndromic micrognathia, micrognathia plus cleft palate/cleft lip and palate, agnathia/micrognathia plus cervical auricle/otocephaly, and agnathia/micrognathia plus microstomia) and unaffected individuals.MethodsThe Healthcare Cost and Utilization Project Kids' Inpatient Database was used to collect data over a 20‐year period beginning in 2000. Interventions were classified as perinatal when performed on day of life (DOL) 0 or 1 and subsequent when performed during the birth hospitalization after DOL 1. Hypoxic complications included cardiac arrest, birth asphyxia, hypoxic–ischemic encephalopathy, anoxic brain damage, intraventricular hemorrhage or cerebral infarction. Descriptive statistics are reported, and the Rao‐Scott chi‐square test compared groups.ResultsMAs affected 119 per 100,000 birth visits. Preterm delivery was more frequent for all MA phenotypes. Individuals with MA phenotypes are more likely to require medical attention (airway intervention on DOL 0 or 1 OR no airway intervention received but patient sustained hypoxic complication/mortality): 16.2%–70.7% vs. 3.8%, p < 0.01. Despite receipt of airway interventions at a higher rate, collectively individuals with MAs who received an airway intervention on DOL 0 or 1 have a mildly elevated risk of hypoxic complication or mortality (32.4% vs. 26.4%, p < 0.01).ConclusionsPreterm birth is more common, however, does not account for the elevated rate of airway intervention. Individuals with MAs require higher rates of medical attention, and current airway management paradigms are insufficient to prevent complications and mortality.Level of EvidenceIII Laryngoscope, 2024

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Focus on Prenatal Detection of Micrognathia

Cited by 20 publications

References 19 publications

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Reference ranges of fetal mandible measurements: Inferior facial angle, jaw index, mandible width/maxilla width ratio and mandible length in Thai fetuses at 15 to 23 weeks of gestation

Perinatal Airway Management Mandibular Anomalies: A National Inpatient Cohort Analysis

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