Value of sagittal color Doppler ultrasonography as a supplementary tool in the differential diagnosis of fetal cleft lip and palate

Abstract

PurposeThe purpose of this study was to evaluate the feasibility and usefulness of sagittal color Doppler ultrasonography (CDUS) for the diagnosis of fetal cleft lip (CL) and cleft palate (CP).MethodsWe performed targeted ultrasonography on 25 fetuses with CL and CP, taking coronal and axial images of the upper lip and maxillary alveolar arch in each case. The existence of defects in and malalignment of the alveolus on the axial image, hard palate defects on the midsagittal image, and flow-through defects on CDUS taken during fetal breathing or swallowing were assessed. We compared the ultrasonography findings with postnatal findings in all fetuses.ResultsAlveolar defects were detected in 16 out of 17 cases with CP and four out of eight cases with CL. Alveolar malalignment and hard palate defects were detected in 11 out of 17 cases and 14 out of 17 cases with CP, respectively, but not detected in any cases with CL. Communicating flow through the palate defect was detected in 11 out of 17 cases of CL with CP. The accuracy of detection in axial scans of an alveolar defect and malalignment was 80% and 76%, respectively. Accuracy of detection of in mid-sagittal images of hard palate defect and flow was 80% and 86%, respectively. The overall diagnostic accuracy of combined axial and sagittal images with sagittal CDUS was 92%.ConclusionSagittal CDUS of the fetal hard palate is a feasible method to directly reveal hard palate bony defects and flow through defects, which may have additional value in the differential diagnosis of fetal CL and CP.

Prenatal diagnosis of cleft lip and cleft lip palate – a case series

“…Moreover, very recent data suggest that during the 11-13 gestational weeks a scan, in the mid-sagittal view of the fetal head, face and brain, certain measurable abnormalities, such as a smaller palatino-maxillary diameter can raise the suspicion of an underlying CLP [33]. Nevertheless, the diagnosis of orofacial clefts during the 1 st trimester of pregnancy has been rarely reported until now [34][35][36], but it was recently proved that sagittal color Doppler ultrasonography can also be useful especially in the detection of fetal hard palate clefts [37]. Regarding the soft palate, the absence of 'the equals sign' at 2D ultrasound was proved to be associated with CLP and is an indication for supplementary examination of this part of the palate in a median sagittal section [16].…”