Objectives: To describe an observation in relation to diagnosis of hard palate cleft by visualisation the fetal tongue entering the ethmoid sinus in close approximation to the nasal septum. Methods: We reviewed 11 cases where it was possible to diagnose prenatal cleft palate on 2D ultrasound. Cases were considered to have a cleft in the hard palate if the tongue was seen moving next to or abutting the nasal septum in transverse view (figure). All cases also had 3D reverse rendering technique. Results: In 11 women referred with a possible diagnosis of facial cleft, the technique yielded a positive result. In these cases, there was complete concordance with 3D reverse face views and postnatal follow up. Conclusions: Visualising the tongue abutting the nasal septum in the transverse view indicates strongly the presence of the cleft in the hard palate as the tongue would not otherwise be visualised in the same plane as the septum. As the tongue may appear indistinct in a frozen image, the technique can only be considered to give a positive result if the tongue is seen moving next to the nasal septum in the transverse view. It may be a useful additional modality in the diagnosis of hard palate cleft in 2D. We do not yet have sufficient cases where the technique gave a negative result in order to determine its value in excluding cleft of hard palate.
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