Improving cleft palate/cleft lip antenatal diagnosis by 3-dimensional sonography: the "flipped face" view

Three-dimensional sonography has enhanced the diagnosis of congenital anomalies in the early stages of pregnancy. Both cleft lip and palate remain a diagnostic challenge for the sonographer because of the variable size of the defects as well as their location. Recently, a technique described by Campbell et al (Ultrasound Obstet Gynecol 2003; 22:552-554, 2005; 25:12-18) demonstrated an improved method called the "reverse face" view, which appears to assist in the diagnosis of clefts involving the palate.

The fetal face was initially examined with the fetus in the supine position. Using 3-dimensional sonography, a static volume was acquired. Following acquisition of the volume, it was rotated 90 degrees so that the cut plane was directed in a plane from the chin to the nose. The volume cut plane was then scrolled from the chin to the nose to examine in sequential order the lower lip, mandible, and alveolar ridge; tongue; upper lip, maxilla, and alveolar ridge; and hard and soft palates.

This approach identified the full length and width of the structures of the mouth and palates and allows the examiner to identify normal anatomy as well as clefts of the hard and soft palates.

The fetal hard and soft palates of the mouth can be accessed using a new technique, which we call the "flipped face" maneuver, when an adequate volume of the face can be obtained.