Login Register Cart 0
Generic placeholder image

Current Medical Imaging

Editor-in-Chief

ISSN (Print): 1573-4056
ISSN (Online): 1875-6603

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

First-Trimester Evaluation of Cleft Lip and Palate by A Novel Two-Dimensional Sonographic Technique: A Prospective Study

Author(s): Xiuling Li, Guanghui Xiu, Fang Yan, Qingsha Hou, Chun Chen, Xudong Dong* and Huanling Liu*

Volume 19, Issue 3, 2023

Published on: 26 August, 2022

Article ID: e130722206740 Pages: 8

DOI: 10.2174/1573405618666220713103500

Price: $65

Abstract

Objectives: The study aims to evaluate the value of the mandible transection head-side shifting method (MTHSM) by 2-dimensional sonography in the screening of fetal cleft lip and palate (CLP) during the nuchal translucency scans.

Methods: A total of 7,336 fetuses enrolled for first-trimester aneuploidy screening were included in this prospective study. A sequential scanning approach from the mandible transection toward the head was used for the assessment of the palate in the midsagittal, axial, and coronal sections. Observe the continuity of the palatal line, upper alveolar ridge, and primary palate. All fetuses were followed by second-trimester scans and postnatal evaluation.

Results: A total of 18 cases of CLP were identified in the first trimester based on this method. Out of 18, 9 (50.0%) were unilateral CLP, 4 (22.2%) were bilateral CLP, and 5 (27.8%) were median CLP. There were no false-positive results found. Three were missed but confirmed in the second-trimester anomaly scan, including 2 cases of isolated cleft palate (CP) and one of isolated cleft lip (CL). Firsttrimester diagnosis of CLP using MTHSM had a sensitivity of 85.7%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 99.9%.

Conclusion: The mandible transection head-side shifting method is feasible in assessing CLP at the time of routine first-trimester sonographic screening.

Keywords: cleft lip and palate, 2-dimensional sonography, first-trimester, ultrasound screening, prenatal diagnosis, early pregnancy.

[1]
Vyas T, Gupta P, Kumar S, Gupta R, Gupta T, Singh HP. Cleft of lip and palate: A review. J Family Med Prim Care 2020; 9(6): 2621-5.
[http://dx.doi.org/10.4103/jfmpc.jfmpc_472_20] [PMID: 32984097]
[2]
Allam E, Windson J, Stone C. Cleft lip and palate: Etiology, epidemiology, preventive and intervention strategies. Anat Physiol 2014; 4: 1-6.
[3]
Setó-Salvia N, Stanier P. Genetics of cleft lip and/or cleft palate: Association with other common anomalies. Eur J Med Genet 2014; 57(8): 381-93.
[http://dx.doi.org/10.1016/j.ejmg.2014.04.003] [PMID: 24768816]
[4]
Dvivedi J, Dvivedi S. A clinical and demographic profile of the cleft lip and palate in Sub-Himalayan India: A hospital-based study. Indian J Plast Surg 2012; 45(1): 115-20.
[http://dx.doi.org/10.4103/0970-0358.96602] [PMID: 22754165]
[5]
Faure JM, Mousty E, Bigorre M, et al. Prenatal ultrasound diagnosis of cleft palate without cleft lip, the new ultrasound semiology. Prenat Diagn 2020; 40(11): 1447-58.
[http://dx.doi.org/10.1002/pd.5794] [PMID: 32673416]
[6]
Lakshmy SR, Rose N, Masilamani P, Umapathy S, Ziyaulla T. Absent ‘superimposed-line’ sign: Novel marker in early diagnosis of cleft of fetal secondary palate. Ultrasound Obstet Gynecol 2020; 56(6): 906-15.
[http://dx.doi.org/10.1002/uog.21931] [PMID: 31763719]
[7]
Chaoui R, Orosz G, Heling KS, Sarut-Lopez A, Nicolaides KH. Maxillary gap at 11-13 weeks’ gestation: Marker of cleft lip and palate. Ultrasound Obstet Gynecol 2015; 46(6): 665-9.
[http://dx.doi.org/10.1002/uog.15675] [PMID: 26277990]
[8]
Sepulveda W, Wong AE, Martinez-Ten P, Perez-Pedregosa J. Retronasal triangle: A sonographic landmark for the screening of cleft palate in the first trimester. Ultrasound Obstet Gynecol 2010; 35(1): 7-13.
[http://dx.doi.org/10.1002/uog.7484] [PMID: 20014330]
[9]
Sepulveda W, Cafici D, Bartholomew J, Wong AE, Martinez-Ten P. First-trimester assessment of the fetal palate: A novel application of the Volume NT algorithm. J Ultrasound Med 2012; 31(9): 1443-8.
[http://dx.doi.org/10.7863/jum.2012.31.9.1443] [PMID: 22922625]
[10]
Martinez-Ten P, Adiego B, Illescas T, Bermejo C, Wong AE, Sepulveda W. First-trimester diagnosis of cleft lip and palate using three-dimensional ultrasound. Ultrasound Obstet Gynecol 2012; 40(1): 40-6.
[http://dx.doi.org/10.1002/uog.10139] [PMID: 22081485]
[11]
Salomon LJ, Alfirevic Z, Bilardo CM, et al. ISUOG practice guidelines: Performance of first-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol 2013; 41(1): 102-13.
[http://dx.doi.org/10.1002/uog.12342] [PMID: 23280739]
[12]
Som PM, Naidich TP. Illustrated review of the embryology and development of the facial region, part 1: Early face and lateral nasal cavities. AJNR Am J Neuroradiol 2013; 34(12): 2233-40.
[http://dx.doi.org/10.3174/ajnr.A3415] [PMID: 23493891]
[13]
Yoon H, Chung IS, Seol EY, Park BY, Park HW. Development of the lip and palate in staged human embryos and early fetuses. Yonsei Med J 2000; 41(4): 477-84.
[http://dx.doi.org/10.3349/ymj.2000.41.4.477] [PMID: 10992809]
[14]
Li WJ, Wang XQ, Yan RL, Xiang JW. Clinical significance of first-trimester screening of the retronasal triangle for identification of primary cleft palate. Fetal Diagn Ther 2015; 38(2): 135-41.
[http://dx.doi.org/10.1159/000369797] [PMID: 25613219]
[15]
De Robertis V, Rembouskos G, Fanelli T, Votino C, Volpe P. Cleft palate with or without cleft lip: the role of retronasal triangle view and maxillary gap at 11-14 weeks. Fetal Diagn Ther 2019; 46(6): 353-9.
[http://dx.doi.org/10.1159/000496842] [PMID: 30852571]
[16]
Lachmann R, Schilling U, Brückmann D, Weichert A, Brückmann A. Isolated cleft lip and palate: Maxillary gap sign and palatino-maxillary diameter at 11-13 weeks. Fetal Diagn Ther 2018; 44(4): 241-6.
[http://dx.doi.org/10.1159/000481773] [PMID: 29073631]
[17]
Lakshmy SR, Deepa S, Rose N, Mookan S, Agnees J. First-trimester sonographic evaluation of palatine clefts: A novel diagnostic approach. J Ultrasound Med 2017; 36(7): 1397-414.
[http://dx.doi.org/10.7863/ultra.16.05084] [PMID: 28417474]
[18]
Rossi AC, Prefumo F. Accuracy of ultrasonography at 11-14 weeks of gestation for detection of fetal structural anomalies: A systematic review. Obstet Gynecol 2013; 122(6): 1160-7.
[http://dx.doi.org/10.1097/AOG.0000000000000015] [PMID: 24201688]
[19]
Ramos GA, Romine LE, Gindes L, et al. Evaluation of the fetal secondary palate by 3-dimensional ultrasonography. J Ultrasound Med 2010; 29(3): 357-64.
[http://dx.doi.org/10.7863/jum.2010.29.3.357] [PMID: 20194932]
[20]
Faure JM, Captier G, Bäumler M, Boulot P. Sonographic assessment of normal fetal palate using three-dimensional imaging: A new technique. Ultrasound Obstet Gynecol 2007; 29(2): 159-65.
[http://dx.doi.org/10.1002/uog.3870] [PMID: 17252526]
[21]
Maarse W, Bergé SJ, Pistorius L, et al. Diagnostic accuracy of transabdominal ultrasound in detecting prenatal cleft lip and palate: A systematic review. Ultrasound Obstet Gynecol 2010; 35(4): 495-502.
[http://dx.doi.org/10.1002/uog.7472] [PMID: 20235140]
[22]
Offerdal K, Jebens N, Syvertsen T, Blaas H-GK, Johansen OJ, Eik-Nes SH. Prenatal ultrasound detection of facial clefts: A prospective study of 49,314 deliveries in a non-selected population in Norway. Ultrasound Obstet Gynecol 2008; 31(6): 639-46.
[http://dx.doi.org/10.1002/uog.5280] [PMID: 18381773]
[23]
Martínez Ten P, Pérez Pedregosa J, Santacruz B, Adiego B, Barrón E, Sepúlveda W. Three-dimensional ultrasound diagnosis of cleft palate: ‘Reverse face’, ‘flipped face’ or ‘oblique face’--which method is best? Ultrasound Obstet Gynecol 2009; 33(4): 399-406.
[http://dx.doi.org/10.1002/uog.6257] [PMID: 19109803]
[24]
Frisova V, Cojocaru L, Turan S. A new two-dimensional sonographic approach to the assessment of the fetal hard and soft palates. J Clin Ultrasound 2021; 49(1): 8-11.
[http://dx.doi.org/10.1002/jcu.22928] [PMID: 32989822]

Rights & Permissions Print Cite
Article Metrics
3
© 2024 Bentham Science Publishers | Privacy Policy