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Fetal Face

UltrasoundMonash Health Obstetric Workshop

Susan Lim

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Introduction:Fetal Face

Orbits

Palate

Mandible

Nose/lips

Nasal bone

Forehead

Ears

Technique

Anatomy

Pathology

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Technique: Set up

Transducers

High frequency curvilinear probe

Low frequency curvilinear probe

3D/4D volume probe

Technique:Axial

Orbits/Lenses

Upper lip

Palate

Mandible

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Technique:Axial

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Technique:Sagittal Profile

Forehead

Nasal bone

Mandible

3D

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Technique:Coronal

Orbits / Lenses

Nose

Lips

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Technique:Coronal

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Technique:Tips Try pushing on the contralateral side to turn baby

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Technique: Tips

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Technique:3D Mid sagittal plane

~30 deg off mid sagittal, chin down

Pocket of fluid in front of face

Avoid limbs / cord

Sweep speed/resolution

Angle (50 – 70 deg.)

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Anatomy:Orbits

Axial / Coronal

Orbits

Globe

Lenses

Vestigial hyaloid artery

Symmetry

Spacing

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Pathology:Orbits

Interocular diameter

Binocular diameter

Rule of 1/3:

Interocular space =

orbit

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Pathology:Orbits Hypotelorism

abnormal closeness of the eyes

Hypertelorism

increased distance between the eyes

Others

Cyclopia

Ethmocephaly

Anopthalmia / micropthalmia

Cataracts

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Pathology:Orbits

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Pathology:Orbits

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Pathology:Orbits Dacrocystoceles

Anatomy:Palate Axial / Coronal

Upper lip

Alveolar ridge

Hard palate

Soft Palate

Uvula

Difficult to see23

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Anatomy:Nose/Lips

Coronal Nose/Lips view

Nose

Nasal Ala

Nares

Central Column

Lips

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Cleft Lip / Palate: Background Incidence – 1:700-1000

Male: Female – 2:1

Left > Right

Associations

Chromosomal abnormalities

Syndromes

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Pathology:Cleft Lip / Palate

Types:

Cleft palate alone (rare)

Cleft lip alone (29%)

Unilateral cleft lip and palate (40%)

Bilateral cleft lip and palate (27%)

Midline cleft lip and palate

Atypical facial clefts

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Pathology:Cleft Lip / Palate

Types:

Cleft palate alone (rare)

Cleft lip alone (29%)

Unilateral cleft lip and palate (40%)

Bilateral cleft lip and palate (27%)

Midline cleft lip and palate

Atypical facial clefts

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Pathology:Cleft Lip / Palate

Types:

Cleft palate alone (rare)

Cleft lip alone (29%)

Unilateral cleft lip and palate (40%)

Bilateral cleft lip and palate (27%)

Midline cleft lip and palate

Atypical facial clefts

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Pathology:Cleft Lip / Palate

Types:

Cleft palate alone (rare)

Cleft lip alone (29%)

Unilateral cleft lip and palate (40%)

Bilateral cleft lip and palate (27%)

Midline cleft lip and palate

Atypical facial clefts

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Pathology:Cleft Lip / Palate

Types:

Cleft palate alone (rare)

Cleft lip alone (29%)

Unilateral cleft lip and palate (40%)

Bilateral cleft lip and palate (27%)

Midline cleft lip and palate

Atypical facial clefts

http://www.sonoworld.com/fetus/page.aspx?id=2316

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Pathology:Cleft Lip

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Pathology:Cleft Lip / Palate

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Pathology:Unilateral Cleft Lip / Palate

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Pathology:Unilateral Cleft Lip / Palate

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Pathology:Unilateral Cleft Lip / Palate

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Pathology:Unilateral Cleft Lip / Palate

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Pathology:Bilateral Cleft Lip / Palate

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Pathology:Bilateral Cleft Lip / Palate

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Pathology:Bilateral Cleft Lip / Palate

Premaxillary protrusion

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Cleft Lip / Palate: Chromosomal

Midline clefts

Aneuploidy

T13 (most common)

T18

Holoprosencephaly

Embryological origins

http://www.sonoworld.com/fetus/page.aspx?id=2817t

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Cleft Lip / Palate:Uvula

Uvula

Equal sign

Wilhelm, L. Borgers, H. The ‘equals sign’: a novel marker in the diagnosis of fetal

isolated cleft palate. Ultrasound Obstet Gynecol 2010. 36:439-444.

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Technique:Mandible Sagittal / Axial / 3D

Jaw Index

AP diameter mandible x100 BPD

<23 - micrognathia

Abnormal:

Micrognathia

Retrognathia

Agnathia / Otocephaly

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Pathology:Micrognathia

Rarely isolated

aneuploidy (most common)

skeletal disorders

syndromes

Polyhydramnios

Delivery

Inferior Facial Angle

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Pathology:Micrognathia

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Technique:Nasal Bone Mid sagittal (profile)

Hyperechogenic line - thick synostosis joining L and R nasal bones

Present / hypoplastic / absent

Length > 2.5th centile

Aneuploidy

LR 6.9

Pathology: Forehead

Mid sagittal (profile) / 3D

Frontal bossing (prominence)

Wormian Bones (3D)

Uncommon

Syndromes; skeletal dysplasias

Cleidocranial Dysplasia

Craniosynostosis

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Frontomaxillary Facial Angle

GA 11 to 13+6

Normal 85 to 75 degrees

Increased in T21

Decreased in spina bifida

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Pathology:Ears

Best assessed using 3D

Assess for:

Size (1/3 BPD)

Position (low set ears)

Absence (anotia)

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Pathology:Less common Masses

Teratoma

(epignathus)

Hamartoma

Skin Tag

Tongue

Macroglossia

Glossoptosis

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Pathology:Less common

Arhinia

Proboscishttp://sonoworld.com/TheFetus/page.aspx?id=2505

Summary:Axial

Orbits/Lenses

Upper lip

Palate

Mandible

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Summary:Sagittal Profile

Forehead

Nasal bone

Mandible

3D

Summary:Coronal

Orbits / Lenses

Nose

Lips

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Summary:Fetal face

Axial, sagittal and coronal imaging

Cleft lip/palate is a common pathology

Practice 3D imaging

Make it a priceless experience

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Acknowledgements

Kate Guskich

Keith VanHaltren

Peter Coombs

Sonographers at Monash

Health