Focus on Prenatal Detection of Micrognathia

Antonakopoulos, Nikolaos; Bhide, A.

doi:10.1007/s40556-019-00210-0

Cited by 14 publications

(18 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The ratio of the anteroposterior diameter: transverse diameter of the mandible was calculated. The probe was rotated again, and the mandibular length was measured as the distance between the cartilaginous symphysis menti and the temporomandibular joint 15 (Figure 2). Criteria for prenatal diagnosis of micrognathia at 11 to 13 weeks gestation were an abnormal profile with small mandible, receding chin, and absent mandibular gap in the retro-nasal triangle view.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Zhu

2021

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim To establish reference ranges for fetal mandibular markers in low‐risk singleton pregnancies between 11 and 13 + 6 weeks of gestation in a Chinese population. Methods The inferior facial angle (IFA), transverse, and anteroposterior diameters of the mandible, and mandibular length were measured at 11–13 + 6 weeks of gestation. The utility of these sonographic markers for detecting micrognathia was explored in seven fetuses. Results In healthy fetuses at 11–13 + 6 weeks, there were linear correlations between gestational age and the transverse (Y = −15.615 + 1.987X, r = 0.718, p < 0.001) and anteroposterior (Y = −8.557 + 1.101X, r = 0.581, p < 0.001) diameters of the mandible; mean ratio of the anteroposterior: transverse diameters of the mandible decreased with gestational age (Y = 0.603–0.003X, r = 0.018, p = 0.755); there was a positive correlation between crown rump length and mandibular length (mandible length = 0.861 + 0.137*crown rump length; r = 0.723, p < 0.001); and there was a positive correlation between crown rump length and IFA (r = 0.234, p < 0.05). Reference ranges were: mean ratio of anteroposterior diameter: transverse diameter of the mandible 0.56; mean mandibular length 9.05 mm; and median IFA 66.5°. The values for these mandibular markers in seven cases of fetal micrognathia were outside the normal range. Conclusions Evaluations of fetal mandibular markers during first trimester ultrasound screening may contribute to the early detection and diagnosis of micrognathia. We recommend obtaining a subjective impression of the mandible on the mid‐sagittal view routinely used to measured nuchal translucency, followed by targeted objective measurements on the mid‐sagittal and axial views in suspected cases.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Zhu

2021

J of Obstet and Gynaecol

View full text Add to dashboard Cite

show abstract

“…Detection of fetal abnormalities before birth leads to meticulous neonatal care and reduction of neonatal death [ 1 , 2 ]. Evaluation of the fetal mandible is included in the standard sonographic second trimester anatomical scan; however, currently there are no clear criteria to define ‘abnormal’ in the areas of fetal mandible scan [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…The first is micrognathia, which refers to small size of mandible. The second is retrognathia, which refers to an abnormally posteriorly located mandible compared to the maxilla [ 3 ]. These rare conditions occur in 1 per 1,500 livebirths worldwide [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Previously, prenatal diagnosis of fetal micrognathia and retrognathia was mainly based on the ultrasonographer’s judgement [ 3 , 11 ]. There have been ongoing attempts in recent years to establish specific criteria for diagnosing these conditions, based around 4 main parameters, which were 1) inferior facial angles (IFA) [ 13 , 14 ], 2) jaw index [ 15 ], 3) mandible width/maxilla width ratio (MD/MX ratio) [ 13 ], and 4) mandible length (ML) [ 16 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Reference ranges of fetal mandible measurements: Inferior facial angle, jaw index, mandible width/maxilla width ratio and mandible length in Thai fetuses at 15 to 23 weeks of gestation

Booncharoen

Sawaddisan²,

Suwanrath³

et al. 2022

PLoS ONE

View full text Add to dashboard Cite

Objectives To determine the normal distribution of 1) inferior facial angles (IFA), 2) jaw index, 3) mandible width/maxilla width ratio (MD/MX ratio), and 4) mandible length (ML) in second trimester Thai fetuses. Methods A prospective study was performed between April 1 and October 31, 2020, at the Maternal-Fetal Medicine Unit of Songklanagarind Hospital. Transabdominal ultrasonography was performed on Thai singleton pregnant women at 150/7 to 236/7 weeks of gestation to measure IFA, jaw index, MD/MX ratio and ML. All women received standard antenatal care and were followed up until delivery. The exclusion criteria were multifetal gestation, congenital anomaly, chromosomal abnormality, fetal growth restriction, abnormal amniotic fluid volume, suspected abnormality of fetal mandible, maxilla or jaws based on the proposed criteria from previous studies and suspected neonatal structural or genetic abnormalities postnatally. Quantile regression was used to estimate changes in the median, 5th and 95th percentiles of each parameter across gestational ages and to generate formulas for predicting the 5th percentile value for each parameter. Results The results of 291 women were analyzed. Scatter plots and reference ranges of each parameter were generated. IFA, jaw index and ML values significantly increased, while the MD/MX ratio value significantly decreased, with increasing gestational age. The formulas calculated for predicting the 5th percentile value for each parameter were IFA = 55.12 + 0.045*(GA in days—136) jaw index = 37.272 + 0.01693*(GA in days—136) MD/MX ratio = exp(0.027–0.00110*(GA in days—136)) ML = 20.83 + 0.243*(GA in days—136). Conclusions The reference ranges and formulas to calculate the 5th percentile values of mandible parameters in Thai fetuses were developed. Trial registration This study has been reviewed and approved by the Thai Clinical Trials Registry with identification number TCTR20210602003.

show abstract

Changing indications and antenatal prognostic factors for ex‐utero intrapartum treatment procedures

Porter

Trivedi

Márquez³

et al. 2022

Prenatal Diagnosis

View full text Add to dashboard Cite

Objective: In cases of suspected neonatal airway obstruction, the ex-utero intrapartum treatment (EXIT) procedure is used to secure the airway while a fetus remains on placental circulation. We report indications and outcomes from all EXIT procedures at a tertiary obstetric unit between 1997 and 2020.Method: Retrospective cohort study with data collected from maternal and neonatal medical records.Results: Indications for EXIT procedures were micrognathia (n = 7), lymphatic malformations (n = 5), cervical teratomas (n = 4), goiters (n = 2), and intra-oral epulis (n = 1). Infants with a fetal teratoma were delivered earliest due to 75% presenting with preterm premature rupture of membranes or preterm labor. Low birth weight was found in 75% of these neonates; they did not survive 1 year.Intubation at EXIT occurred for 58% (n = 11) of babies, and six neonates required a tracheostomy. In four cases of fetal micrognathia, the inferior facial angle (IFA) was noted to be <5th centile. All but one micrognathia case had polyhydramnios. Of the total cohort, 75% of neonates were alive at 1 year. Conclusion:Risks for neonatal demise with EXIT include fetal teratoma, low birth weight, and prematurity. Micrognathia has become an increasingly valid indication for the procedure. The combination of polyhydramnios and IFA <5% correlates well with severe airway obstruction and suggests consideration of EXIT. Key points What's already known about this topic?� Ex-utero Intrapartum Treatment (EXIT) remains a potentially life-saving procedure for fetuses with airway obstruction. Indications for EXIT have broadened over the past 20 years. What does the study add?� Fetal teratoma, low birth weight, and prematurity should inform prenatal counseling as predictors for fetal and neonatal mortality.� To improve multidisciplinary management, all neonates with suspected fetal airway obstruction should have ultrasound and MRI imaging.� Micrognathia is now a common indication for EXIT. In cases of micrognathia, inferior facial angle (IFA) <5% in conjunction with polyhydramnios appears predictive of a difficult airway.

show abstract

Focus on Prenatal Detection of Micrognathia

Cited by 14 publications

References 19 publications

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Ultrasonographic study of fetal mandibular markers during the first trimester in a Chinese population

Reference ranges of fetal mandible measurements: Inferior facial angle, jaw index, mandible width/maxilla width ratio and mandible length in Thai fetuses at 15 to 23 weeks of gestation

Changing indications and antenatal prognostic factors for ex‐utero intrapartum treatment procedures

Contact Info

Product

Resources

About