fetal face ultrasound - clinical ultrasound · fetal face ultrasound monash health obstetric...
TRANSCRIPT
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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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