Original contributionPrenatal diagnosis of cleft palate by three-dimensional ultrasound
Introduction
Facial clefts are the most common of the major congenital craniofacial deformities (Moore 1988). In general, the type of cleft is determined by the location (midline, unilateral or bilateral) and extent (i.e., if the lip alone is affected, the lip and palate are affected, or only the palate is affected) (Nycerg et al. 1995). Some reports indicated the importance of correctly classifying fetal cleft lip or palate because fetal outcome and the presence of additional fetal structural abnormalities are remarkably correlated with the types of clefts Matthews et al 1998, Nycerg et al 1995, Smith et al 1998, Tolarova and Cervenka 1998. Nowdays, prenatal diagnosis of cleft lip by 2-D real-time US is very common when done by a well-trained sonographer. However, prenatal diagnosis of cleft palate remains as a difficult task by 2-D US Babcook et al 1996, Hafner et al 1997, Pretorius et al 1995.
Recently, several reports Devonald et al 1995, Mueller et al 1996, Pretorius et al 1995, Pretorius and Nelson 1995, Ulm et al 1998 used 3-D US in the evaluation of fetal face and head. Yet, no accurate methods of detecting cleft palates were reported. In addition, some investigations attempted to diagnose cleft lip and palate prenatally, using 2-D color Doppler US or transvaginal 2-D sonography Bronshtein et al 1994, Monni et al 1995. Although they achieved a very high accuracy in detecting cleft lip, their methods using 2-D and color Doppler US in diagnosing cleft palate were not only time-consuming, but also unsatisfactory. To date, 3-D US may provide us with a better choice for prenatal diagnosis of cleft palate, if this powerful tool could be properly applied (Pretorius et al. 1995).
For a decade, we have applied 3-D US in maternal-fetal medicine, especially in prenatal diagnosis Chang et al 1997a, Chang et al 1997b, Chang et al 1997c, Chang et al 2000a, Chang et al 2000b, Chang et al 2000c, Chuang et al 2000, Kuo et al 1992, Liang et al 1997a, Liang et al 1997b, Lin et al 1998, Wang et al 1999, Yu et al 2000. In this series, to examine whether 3-D US is a better method for prenatal diagnosis of cleft palate than 2-D US, we analyzed our experience in detecting cleft palate by 3-D US.
Section snippets
Subjects
In this retrospective study, we reviewed our US computer database of prenatal diagnosis of cleft lip and palate in the Antenatal Ultrasound Unit of the National Cheng Kung University Hospital from June 1996 to January 2000. A total of 21 fetuses with facial clefts were scanned by the high-resolution, real-time 2-D and 3-D US. Level II US was performed to find associated anomalies. Our level II US protocol was modified from the recommendation of the American Institute of Ultrasound in Medicine
Results
In Table 1, a total of 21 fetuses with facial clefts were scanned by the above methods to diagnose cleft lip and/or palate. The rates of isolated cleft lip and cleft lip with palate are 47.6% (10 of 21) and 52.4% (11 of 21), respectively (Table 1). Among the 5 fetuses with bilateral cleft lip, 2 (40%) fetuses had cleft palate. The gestational time when a prenatal diagnosis of cleft lip and/or palate was first made ranged between 20 and 34 weeks in our department (mean 25.3 weeks). The maternal
Discussion
Although the advancement of 2-D US, color Doppler mapping and high-resolution transvaginal real-time US have made prenatal diagnosis of cleft lips with or without cleft palate possible, the accurate diagnosis of cleft palate remains as a difficult task for clinical evaluation in daily practice, even in the hands of the best specialists Anderson et al 1995, Gonclaves et al 1994
Color Doppler mapping has been used for cleft palate detection (Monni et al. 1995). The in-and-out flows in the nasal
Acknowledgements
This study was supported in part by grants from National Science Council, Taipei, Taiwan, to Dr. Chiung-Hsin Chang (NSC 89-2314-B006-069, NSC89-2314-B006-115) to Dr. Chen-Hsiang Yu (NSC88-2314-B006-131), and to Dr. Fong-Ming Chang (NSC 89-2314-B006-065, NSC 89-2314-B006-113). The authors are grateful to Hsi-Yao Chen for his advice and to Wen-Chu Chen and Yi-Jen Wang for their assistance.
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