Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimester

Sepúlveda, Waldo; Wong, Amy E.; Martínez-Ten, Pilar; Pérez-Pedregosa, Javier

doi:10.1002/uog.7484

Cited by 114 publications

(128 citation statements)

References 20 publications

(13 reference statements)

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“…The retronasal triangle view was recently described as a firsttrimester technique for the sonographic screening of cleft palate. 11 By displaying the primary palate and the frontal processes of the maxilla in the same plane, a characteristic echogenic triangle-shaped structure behind the fetal nose is clearly shown. We noticed that the nasal bones were easily identified in this plane, allowing the opportunity of identifying the nasal bone during the first-trimester scan.…”

Section: Discussionmentioning

confidence: 99%

“…10 We have recently described a new technique to evaluate the midface using the coronal plane at the level where the primary palate and frontal processes of the maxilla are simultaneously visualized, which we have named the retronasal triangle view. 11 This technique aims to screen for orofacial clefting in the first trimester. During the routine evaluation of this area in healthy fetuses, it became evident that the nasal bones can also be visualized at the upper tip of the triangle, suggesting that this technique could also be useful for visualizing both nasal bones in a single view (Figure 1).…”

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confidence: 99%

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First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

Martínez-Ten¹,

Adiego²,

Pérez-Pedregosa³

et al. 2010

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate a new sonographic technique for identifying the nasal bones using the retronasal triangle view, ie, the coronal plane at which the palate and frontal processes of the maxilla are simultaneously visualized. Methods. Three-dimensional (3D) volumes were acquired from women undergoing first-trimester sonographic screening for aneuploidy by 2 accredited operators. Those data sets in which the fetal face was clearly identified were selected for offline analysis by 2 other observers who were unaware of the sonographic or clinical findings. The nasal bones were classified as both present, only 1 present (right or left), or absent according to the presence or absence of 2 small paired echogenic linear structures at the upper tip of the retronasal triangle as determined by 3D navigation in the coronal plane and compared to those findings obtained by 3D navigation in the sagittal plane. Additional 3D data sets involving a subset of 4 first-trimester fetuses with trisomy 21 and absent nasal bones were also analyzed retrospectively and included randomly in the study group. Results. A total of 110 3D data sets were analyzed, of which 86% were obtained transabdominally and 14% transvaginally. The quality of nasal bone identification was classified subjectively by the observers as good in 67% of cases, fair in 29%, and poor in 4%. The nasal bones were classified as at least 1 present in 106 of the cases (96%) and absent in 4 (4%), with complete agreement between observers in both the sagittal and coronal planes (κ = 1). Discrimination between the right and left nasal bones was possible in 89% and 93% for observer A and in 96% and 96% for observer B by assessing the sagittal and coronal views, respectively (right nasal bone: κ = 0.90 [95% confidence interval (CI), 0.79-1]; left nasal bone: κ = 0.85 [95% CI, 0.60-0.99]). The nasal bones were not identified at the level of the retronasal triangle view in any of the fetuses with trisomy 21 and absent nasal bones. Conclusions. This study shows that the nasal bones can be confidently identified as paired echogenic structures located at the upper tip of the retronasal triangle. This coronal view of the fetal face offers the possibility of screening for the presence or absence of the nasal bones in the first trimester, especially when the standard midsagittal views of the fetal face are suboptimal because of fetal or maternal factors. Because both nasal bones can be evaluated simultaneously in the coronal plane, the retronasal triangle view may be advantageous over the conventional midsagittal view assessment, in which only 1 of the 2 nasal bones is evaluated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

Martínez-Ten¹,

Adiego²,

Pérez-Pedregosa³

et al. 2010

Journal of Ultrasound in Medicine

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“…25 Various authors have reported, complete fetal anatomy survey was achieved between 82%-98% depending on the protocol and gestational age at the time of scan. 26 The strength of the study includes the completeness of data, usage of good ultrasound machine for better visualization, the checklist for visualization of structures was based on ISUOG protocol for uniformity and standardization, and all the scans for the study were done by a single experienced radiologist with the same machine.…”

Section: 20mentioning

confidence: 99%

A prospective study to evaluate the efficacy of 11-13+6 weeks anatomy scan in detecting fetal structural anomalies compared to traditional 18-22 weeks scan

Elamaran

Daniel

George

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Congenital anomalies are one of the leading causes of infant mortality. Traditional TIFFA scan done at 18-22 weeks leads to delay in diagnosis, referral and management. With high resolution ultrasound and TVS probe, normal and abnormal fetal anatomy could be visualized in early gestation with good accuracy. Objective of present study was to evaluate the efficacy of 11-13+6 weeks anatomy scan in detecting fetal structural anomalies compared to traditional 18 -22weeks scan and in visualizing the complete normal fetal anatomyMethods: An Observational study of 300 antenatal patients at Jubilee Mission Medical College for 1 year (Jan-Dec2014) was done. The scan was performed at 11-13+6 weeks by TAS first, if a full fetal anatomy survey not achieved, TVS added. A mid-trimester fetal anatomy scan was then performed in patients who had not dropped out, miscarried or undergone pregnancy termination at 18-22weeks.Results: The incidence of anomalies in our study was 3.67% -11 cases; 9 detected at 11-13+6 weeks, 2 were newly detected at 18-22 weeks. At 11-13+6 weeks anatomy scan, the detection rate of anomalies was 81.8% and complete fetal anatomy survey was achieved in 92%. Heart and kidneys were not properly visualized in 4% and 12.7%, at 11‐13+6 weeks compared with 0.7% and 0% at 18‐22 weeks.Conclusions: The 11-13+6 weeks anatomy scan is an important diagnostic tool which is underutilized and should be offered to all women as a routine standard of antenatal care. However as fetal anomalies can present at varying gestational age, standard 18-22 weeks anatomy scan cannot be abandoned.

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“…Facial landmarks such as tragus, nasion, gnathion, glabella, subnasion, and others were employed to extract sixteen craniofacial measurements for the evaluation of after-birth abnormal/regular orofacial development. Although none of the foetuses evaluated in their study was affected by cleft lip, Sepulveda et al (2010) proposed a novel sonographic landmark typical of the first trimester, the 'retronasal triangle', to be adopted for the early screening of CP. This landmark has been termed this way because coronal plane displays three easily identifiable echogenic lines: the two maxilla frontal processes and the primary palate.…”

Section: Introductionmentioning

confidence: 99%

Diagnosing Cleft Lip Pathology in 3d Ultrasound: A Landmarking-Based Approach

et al. 2015

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The aim of this work is to automatically diagnose and formalize prenatal cleft lip with representative key points and identify the type of defect (unilateral, bilateral, right, or left) in three-dimensional ultrasonography (3D US). Geometry has been used as a framework for describing facial shapes and curvatures. Then, descriptors coming from this field are employed for identifying the typical key points of the defect and its dimensions. The descriptive accuracy of these descriptors has allowed us to automatically extract reference points, quantitative distances, labial profiles, and to provide information about facial asymmetry. Eighteen foetal faces, ten of healthy foetuses and eight with different types of cleft lips, have been obtained through a Voluson system and used for testing the algorithm. Cleft lip has been diagnosed and correctly characterized in all cases. Transverse and cranio-caudal length of the cleft have been computed and upper lip profile has been automatically extract to have a visual quantification of the overall labial defect. The asymmetry information obtained is consistent with the defect. This algorithm has been designed to support practitioners in identifying and classifying cleft lips. The gained results have shown that geometry might be a proper tool for describing faces and for diagnosis.

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Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimester

Abstract: Objectives To describe a new first-trimester sonographic landmark, the retronasal triangle, which may be useful in the early screening for cleft palate. Methods

Cited by 114 publications

References 20 publications

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

First-Trimester Assessment of the Nasal Bones Using the Retronasal Triangle View

A prospective study to evaluate the efficacy of 11-13+6 weeks anatomy scan in detecting fetal structural anomalies compared to traditional 18-22 weeks scan

Diagnosing Cleft Lip Pathology in 3d Ultrasound: A Landmarking-Based Approach

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