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[Correlation between antenatal ultrasound and postnatal diagnosis in cleft lip or palate: A retrospective study of 44
V Dochez1, P Corre2, A-S Riteau1
1Service de gynécologie-obstétrique, CHU de Nantes, quai 38, boulevard Jean-Monnet, 44093 Nantes cedex, France.
Insights
Prenatal screening for cleft palate has improved, with 85.2% accuracy in identifying primary and secondary clefts. However, diagnosing isolated secondary cleft palate remains challenging, even with 3D ultrasound.
Area of Science:
- Medical Imaging
- Pediatric Surgery
- Craniofacial Anomalies
Background:
- Maxillofacial developmental anomalies occur in 1 in 700 births.
- Approximately 30% of isolated primary cleft palate or secondary cleft palate diagnoses are confirmed postnatally.
- Accurate antenatal diagnosis is crucial for effective management.
Purpose of the Study:
- To compare antenatal ultrasound data with postnatal surgical diagnoses of cleft palate.
- To evaluate the diagnostic accuracy of ultrasound in identifying primary and secondary cleft palate.
- To assess the impact of 3D ultrasound on screening performance.
Main Methods:
- Retrospective observational study of children with cleft palate born between December 2009 and January 2014.
- Exclusion of newborns with associated anomalies.
- Comparison of antenatal ultrasound reports with postnatal surgical descriptions.
Main Results:
- 41 children were included; 27 were screened.
- Ultrasound and clinical diagnosis matched in 85.2% of cases (23/27).
- Prenatal diagnosis accuracy was 90.5% for primary cleft palate but only 42.1% for secondary cleft palate, particularly in Pierre-Robin sequence.
Conclusions:
- Antenatal screening for cleft palate shows increasing sensitivity, reaching 85.2% in this series.
- Diagnosis of isolated secondary cleft palate remains difficult.
- 2D ultrasound appears sufficient for screening; 3D ultrasound offers better visualization for parents.
Objectives:
Anomalies of the maxillofacial development concern 1 for 700 births. About 30% of prenatal diagnoses of isolated primary cleft palate or associated with a cleft of secondary palate will be corrected in postnatal. This retrospective observational study was designed to compare the antenatal data and postnatal diagnosis regarding a series of clefts.
Materials And Methods:
All children born between 1 December 2009 and 31 January 2014 in a prenatal diagnostic reference center and having a cleft palate were included. Newborns with an abnormality associated with the cleft were excluded. A comparison was made between the data in the antenatal ultrasound reports and postnatal those described by the surgeon during surgery.
Results:
Forty-four children were included and three infants were excluded due to associated anomalies. Of those 41 children, 27 children have been screened. Ultrasound and clinical diagnosis was the same for 23 cases (85.2%) and inaccurate for 4 patients (14.8%). In case of primary cleft palate prenatal diagnosis was performed to 19 cases of 21 (90.5%), but only 8 of 20 if only secondary cleft palate (42.1%) including 7 with a Pierre-Robin sequence.
Discussion:
Antenatal screening sensitivity of primary and secondary cleft palate increase in recent years with a rate of 85.2% in our series. By contrast, diagnosis of isolated secondary cleft palate seems to be more difficult and 3D ultrasound does not always improve screening performance.
Conclusion:
Ultrasound 2D seem sufficient for screening of primary and secondary cleft palate. The 3D ultrasound may be useful for a better representation of the cleft for future parents. The same language concerning the classification of the clefts facilitates harmonization of reporting and understanding between professionals. The presence of the maxillofacial surgeon ultrasound room would allow the sonographer to direct its ultrasound accurately or improve its learning curve.
