Normal fetal face and neck
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1 Normal fetal face and neck Maria A. Calvo-Garcia, MD. Associate Professor of Radiology Cincinnati Children s Hospital Medical Center Cincinnati, Ohio
2 Disclosure I have no disclosures
3 Goals & objectives Become familiar with the anatomic assessment of the fetal face / neck Refresh some basic Embryology Understand frequent associations of malformations Guide search patterns
4 Background on facial abnormalities Important themselves May also indicate an underlying problem Chromosome abnormality Syndromic conditions
5 Background on facial abnormalities Assessment of the face is always included in all standard fetal anatomic surveys If you found other anomalies recheck the face And conversely, if you see facial anomalies look for other systemic defects
6 US facial survey 2D US: Images of the fetal face can be accomplished in coronal,sagittal and axial planes
7 US facial survey 2D US: Images of the fetal face can be accomplished in coronal,sagittal and axial planes
8 US facial survey 2D US: Images of the fetal face can be accomplished in coronal,sagittal and axial planes
9 US facial survey Auricles Position Shape Size (subjective / normograms for fetal ear dimensions
10 US facial / neck survey
11 US facial survey
12 US facial survey
13 US facial and neck survey Fetal MRI frequently in search for additional information CNS Airway Helping in challenging cases Help counseling / planning delivery / neonatal treatment
14 Evaluation of the orbits
15 Fetal MRI assessment Bony orbits IOD / BOD 32w GA fetus
16 Fetal MRI assessment Bony orbits IOD / BOD 32w GA fetus
17 Fetal MRI assessment Bony orbits IOD / BOD Intraorbital content Globe (OD) Lens 32w GA fetus
18 Evaluation of the orbits Evaluation of the ears
19 Fetal MRI assessment Sagittal image of the auricle on SSFP sequence Sagittal image of the auricle on SSFP sequence. (29 weeks gestation) auricles, external auditory canals, fluid filled middle ear and inner ear structures (29 weeks gestation) A
20 Fetal MRI assessment Absent bilateral auricles (anotia) + External Auditory Canals (aural atresia) Normal bilateral ears + External Auditory Canals
21 Evaluation of the orbits Evaluation of the ears Evaluation of the mid / lower face
22 Basic Embryology 1 st and 2 nd branchial arches are involved in the development of the ear (1 st arch also in the face) Hypoplasias and abnormal development Otomandibular dysplasias (AKA branchial arch syndromes)
23 Basic Embryology The face results from the development of five buds (frontonasal process and 1 st branchial arch. Frontonasal process 1 st branchial arch If the processes do not mold together: facial cleft, at that boundary
24 Basic Embryology The ear starts forming in the lower neck (6 th week). With the development of the mandible, the ears ascend
25 Basic Embryology Mandibular hypoplasia would lead to impaired ascent (Ear malposition): Micrognathia + Low set - ears
26 Mandibular index calculation Paladini D, et al Obstet Gynecol : : AP mandible length / BPD x100 ( 21% or < is significant micrognathia) index: AP mandible length/ BPDx100= if <21% is significant micrognathia
27 Mandibular index calculation Paladini D, et al Obstet Gynecol : : jaw index: AP mandible length/ BPDx100= if <21% is significant micrognathia
28 Normal anatomy
29 Normal anatomy Facial cleft
30 Normal anatomy Cleft palate, intact lip
31 Evaluation of the orbits Evaluation of the ears Evaluation of the mid / lower face Evaluation of the airway
32 Fetal MRI assessment
33 Cervical teratoma
34 LT Choanal atresia CHARGE association Nasopharyngeal mass Congenital salivary gland anlage tumor
35 Anatomic Search Pattern in the presence of a facial anomaly Look for other facial defects: Orbital Clefts Hypoplasias [face, ear, eyes], (branchial arch syndrome?) Look for brain malformations Other systemic malformations? (Genetic / chromosomal?) Airway
36 Thank You!
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