Prenatal ultrasound diagnosis of cleft palate without cleft lip, the new ultrasound semiology

Abstract

Objectives: The aim of this study was to define the prenatal ultrasound semiology of cleft palate without cleft lip using 3D visualization of the fetal palate. Methods: A prospective longitudinal study was performed in our University Hospital Center from 2011 to 2018. The fetal secondary palate was studied in 3D, starting with 2D axial transverse ultrasound view. We defined a cleft palate as a disruption of the horizontal plate of the palatine bone of the secondary palate. Prenatal findings were correlated to anatomic postnatal examinations performed by a paediatric plastic surgeon. Results: Forty-three cases of cleft palate without cleft lip were prenatally diagnosed, of whom 34 were associated with malformations. We defined four types of disruptive appearances: isolated nonvisualization of the posterior nasal spine; partialdisruption or cleft velum; complete disappearance or V-shaped cleft palate; and complete disappearance or U-shaped cleft palate. The adjusted kappa coefficient, between prenatal and postnatal evaluation, was 0.88 (95% CI: 0.79-0.97), corresponding to an excellent agreement. Conclusions: Using a strictly axial transverse ultrasound view, visualization of the secondary fetal palate enables to diagnose a cleft palate without cleft lip. This method offers a prenatal anatomic classification of cleft palate with a high level of concordance to postnatal findings.

Estudo para detecção de fissuras labiopalatinas no pré-natal: revisão de literatura e relato de caso/ Study for crack detection prenatal labiopalatins: literature review and case report

“…No que diz respeito à identificação das fissuras labiopalatinas vale salientar que a ultrassonografia é altamente eficiente, uma vez que mostra imagens em tempo real, além de oferecer uma alternativa barata e segura para visualizar o feto indiretamente, sem nenhum risco aparente para mãe e para o feto (BERGGREN et al, 2012;PILU;HOFFMANNOVA et al, 2018;FAURE et al, 2020).…”

“…Há alguns fatores desfavoráveis que limitam a precisão diagnóstica por meio da ultrassonografia como: sombreamento ósseo, dificuldade em identificação nas mães obesas, posição fetal desfavorável, oligodramnia, sombra acústica, e idade gestacional avançada (SOMMERLAD, et al, 2010;FUCHS et al, 2018;FAURE, et al, 2020).…”

“…O melhor período para visualização destas fissuras é após o primeiro trimestre de gestação (SOMMERLAD et al, 2010;RAMOS. et al, 2010;WANG et al 2011;FUCHS et al, 2018;FAURE, et al, 2020).…”

Applications of Advanced Ultrasound Technology in Obstetrics

“…Compared to 2D ultrasound alone, combined approach of 2D and 3D ultrasound with multiplanar/multi-slice analysis can improve the detection or exclusion of cleft palate in fetuses with cleft lip [ 50 ] ( Figure 10 ). Although 3D ultrasound is less sensitive for the detection of isolated cleft palate, a recent study showed that an accurate evaluation of palate requires 3D ultrasound examination with volume acquisition in a strictly axial transverse view of the palate [ 16 ]. The use of 3D ultrasound multiplanar analysis and 3D rendering view can facilitate the display of mid-sagittal plane of the fetal face and thus improve the accuracy of measurements of the mandible and the detection of micrognathia [ 51 ].…”

“…High-resolution ultrasonography allows the clear visualization of facial profile, lens, nostrils, lips, maxilla, and ears (Figure 3a-d, Video S3a,b). Recently, a new sonographic sign, the 'superimposed line' sign, is suggested for evaluation of the secondary palate by assessment of the vomeromaxillary junction in the midsagittal view of the palate [16] (Figure 3a). Larynx and its movement can be assessed by prenatal ultrasound (Figure 4 and V S4).…”