Objective Diagnosis of Micrognathia in the Fetus

Paladini, D.; Morra, T.; Teodoro, A.; Lamberti, A.; Tremolaterra, Fortunato; Martinelli, Pasquale

doi:10.1097/00006250-199903000-00014

Cited by 17 publications

(9 citation statements)

References 9 publications

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“…Paladini et al and Mermans et al showed that the Jaw Index is a reliable instrument to assess the objective size of the lower jaw in newborns [ 51 , 52 ]. In this study, patients with RS showed a significantly increased index connected with a smaller mandibula and an increased overjet.…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy

Effert

Uhlig²,

Wiechers³

et al. 2023

JCM

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Background: To assess the long-term functional orthodontic outcome of the Tübingen palatal plate (TPP) in children with Robin sequence (RS) in comparison to age- and sex-matched healthy controls. Methods: Between 09/2019 and 10/2020, we performed orthodontic assessments in 41 children at our Department of Orthodontics. Included were patients with RS (17 non-syndromic; four syndromic) and healthy controls (n = 22, average age in both groups 9.9 y). Facial analyses of 2D images, digital study casts and cephalometric measurements were made. Results: The orthodontic examinations showed no statistically significant group differences regarding functional extraoral, intraoral and pharyngeal parameters, or in skeletal patterns. The relationship between the upper and lower incisors was significantly increased (overjet 4 (2–10) vs. 3 (0–9) mm; p = 0.01) with a significant deficit in the lower face proportions (Jaw Index 4.15 (1.9–9.6) vs. 2.98 (0–9); p = 0.02; Facial convexity angle 157 (149–173) vs. 159 (149–170); p = 0.01). Conclusion: Children with RS treated with the TPP showed normal long-term functional orthodontic outcomes, thanks to the functional adaption of the stomatognathic system. However, soft tissue growth did not completely match skeletal growth, resulting in a more convex facial profile.

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Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy

Effert

Uhlig²,

Wiechers³

et al. 2023

JCM

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“…Ultrasound measurements of the fetal face were reviewed and assessed for features previously reported to be associated with diagnosis of micrognathia and the need for intubation within 24 h. Specifically, we evaluated available imaging for a jaw index lower than 24 (5th percentile, a highly sensitive value 22,23 associated with need for intubation within 24 h of life 3,6,7,23,24 ), an inferior facial angle of less than 50° (which has been reported as 100% sensitive with a positive predictive value for diagnosis of micrognathia of 75%), 3,22 a frontal nasomental angle measurement of less than or equal to 140° (which is considered diagnostic for micrognathia), and severely decreased frontal nasomental angles between 100 and 134° (which is associated with more severe cases) 22,25 . Details regarding calculations of these facial measurements are well‐described in the literature 7,22,23,25 …”

Section: Methodsmentioning

confidence: 99%

“…22,25 Details regarding calculations of these facial measurements are well-described in the literature. 7,22,23,25 Other nonspecific findings on imaging that supported the prenatal diagnosis included any of the following: airway narrowing at the level of the oropharynx, polyhydramnios, abnormal appearance of fetal swallowing, or abnormal size of the gastric bubble. 3,7 There was no statistical power analysis conducted prior to the study.…”

Section: Introductionmentioning

confidence: 99%

Immediate postdelivery airway management of neonates with prenatally diagnosed micrognathia: A retrospective observational study

Berger,

Nelson,

Staben

et al. 2023

Pediatric Anesthesia

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IntroductionMicrognathic neonates are at risk for upper airway obstruction, and many require intubation in the delivery room. Ex‐utero intrapartum treatment is one technique for managing airway obstruction but poses substantial maternal risks. Procedure requiring a second team in the operating room is an alternative approach to secure the obstructed airway while minimizing maternal risk.The aim of this study was to describe the patient characteristics, airway management, and outcomes for micrognathic neonates and their mothers undergoing a procedure requiring a second team in the operating room at a single quaternary care children's hospital.MethodsThis was a retrospective descriptive study. Subjects had prenatally diagnosed micrognathia and underwent procedure requiring a second team in the operating room between 2009 and 2021. Collected data included infant characteristics, delivery room airway management, critical events, and medications. Follow‐up data included genetic testing and subsequent procedures within 90 days. Maternal data included type of anesthetic, blood loss, and incidence of transfusion.ResultsFourteen deliveries were performed via procedure requiring a second team in the operating room during the study period. 85.7% were male, and 50% had a genetic syndrome. Spontaneous respiratory efforts were observed in 93%. Twelve patients (85.7%) required an endotracheal tube or tracheostomy. Management approaches varied. Medications were primarily a combination of atropine, ketamine, and dexmedetomidine. Oxygen desaturation was common, and three patients experienced bradycardia. There were no periprocedural deaths. Follow‐up at 90 days revealed that 78% of patients underwent at least one additional procedure, and one patient died due to an unrelated cause.All mothers underwent cesarean deliveries under neuraxial anesthesia. Median blood loss was 700 mL [IQR 700 mL, 800 mL]. Only one mother required a blood transfusion for pre‐procedural placental abruption.DiscussionProcedure requiring a second team in the operating room is a safe and effective approach to manage airway obstruction in micrognathic neonates while minimizing maternal morbidity.ConclusionsThough shown to be safe and effective, more data are needed to support the use of procedure requiring a second team in the operating room as an alternative to ex‐utero intrapartum treatment for micrognathia outside of highly specialized maternal–fetal centers.

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“…5. Mandibular length-Mandibular length adjusted for gestational age or fetal biometry (like femur length), seems to be another sensitive and reliable prenatal method for assessment of fetal jaw development [5,6,9,12]. Specific charts provide mean values and 95% intervals for mandibular length according gestational age or femur length [13].…”

Section: Diagnostic Indicesmentioning

confidence: 99%

Untitled

2019

Journal of Fetal Medicine

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Fetal micrognathia involves abnormal or arrested development of the fetal mandible. Till recently, the prenatal diagnosis was subjective, based on the evaluation of the fetal profile and assessment of the relationship between the maxilla and the mandible. Recently objective sonographic methods have been utilized for diagnosing micrognathia such as the inferior facial angle, the jaw index, the frontal nasomental angle, the mandible width/maxilla width ratio and the mandibular length. Another useful sonographic sign, the mandibular gap in the retronasal triangle view, increases the accuracy of the diagnosis early in the first trimester. 3D sonographic views can add to the diagnosis and prenatal MRI is a useful adjunct to ultrasound in cases of limited acoustic window, maternal obesity, oligohydramnios and anterior spine position. The identification of micrognathia should prompt karyotyping and sonographic investigation for other abnormalities. The outcome of fetuses with this seemingly isolated finding is more guarded than one would intuitively believe, and the parents should be counseled accordingly. Postnatal complications including mild to severe upper airway obstruction leading to respiratory distress, feeding difficulties and mild to severe long-term developmental delay are common. One should be careful in pronouncing a fetus having 'micrognathia', especially on subjective evaluation, as this term implies that the fetus is abnormal with presence of significant pathology. There is no 'gold standard' for a definitive diagnosis of micrognathia on post-natal evaluation. Using a combination of objective sonographic markers as well as follow-up ultrasound assessments can significantly reduce the risk of a false diagnosis. Follow-up scans should be arranged, and neonatal service should be alerted in cases of ongoing pregnancies.

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Objective Diagnosis of Micrognathia in the Fetus

Cited by 17 publications

References 9 publications

Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy

Prospective Evaluation of Children with Robin Sequence following Tübingen Palatal Plate Therapy

Immediate postdelivery airway management of neonates with prenatally diagnosed micrognathia: A retrospective observational study

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