Fetal Face And Neck Flashcards
(128 cards)
1
Q
What re some abnormalities of the fetal face? 6
A
- Cleft lip
- Cleft palate
- Micrognathia
- Neck
- Nuchal translucency
- Nuchal fold
2
Q
Fetal face embryology starts when? When is it finished?
A
5 weeks LMP and is complete 10 weeks LMP
3
Q
What develops during fetal face embryology ? 3
A
Develops from five main facial processes that move together and fuse
1. 1 Frontonasal process
2. 2 Maxillary prominence
3. 2 Mandibular prominences
4
Q
The frontonasal process starts where? And moves where? What does it form? 5
A
Starts superior and moves Inferiorly to form
1. Mid forehead
2. Nose
3. Central upper lip
4. Central maxilla
5. Anterior palate
5
Q
Maxillary prominence move medially to form what? 4
A
- Checks
- Lateral upper lip
- Maxilla
- Hard palate
6
Q
In terms of formation, the nose starts where and migrates how?
A
The nose starts above the orbits as 2 widely spread nasal placodes that move medially Inferiorly
7
Q
What are placodes?
A
Areas of ectoderm tissues which form the sense organs - auditory, olfactory, or vision
8
Q
The eyes start where and move how?
A
Laterally and move medially
9
Q
The ears start where and move where?
A
Ears start below the mandible and move laterally upward
10
Q
What is the occurrence rate of facial anomalies?
A
1/600 births
11
Q
How common are facial anomalies?
A
Common
12
Q
Polyhydraminos occurs with how many facial anomalies?
A
60% of the facial anomalies
13
Q
How often does other non -facial anomalies occur due to chromosomal abnormalities?
A
50%
14
Q
What increases the risk of development of the face? 3
A
Drugs such as
1. Alcohol
2. Codeine
3. Valium
15
Q
What doe we see with axial view of the face? why? 3
A
- Orbits
- Lens of the eye
- To assess binocular distance
16
Q
What’s the nose/lip shot?
A
Tangential coronal of nose lip
17
Q
What are some tips for Nose/lip? 3 (What do we need to assess?)
A
- Make sure you have the soft tissue of the nose and lip rather than bone
- Assess for intact upper lip
- Assess for the presence of 2 nostrils
18
Q
How do we get a profile image?
A
Ultrasound beam directly over the midline of the face
19
Q
What are some things that we should see with the profile view? 3
A
- Chin should be off of chest
- Should see nasal bone and maxilla
- Midline structures of the brain (Corpos callosum)
20
Q
What are some things we assess with the profile view? 3
A
- Prominence of the chin and forehead
- Protruding tongue or flattened nose
- Nasal bone
21
Q
What is a benefit of 3D imaging for parents/
A
Gives parents an idea of what to expect at delivery
22
Q
How can 3D imaging be used for in terms of detection?
A
For better detecting facial anomalies after 2D
23
Q
Orbits should be separated by a distance of how much?
A
Orbit globe (1 eyeball)
24
Q
Outer orbital distances can be used to do what?
A
Date the pregnancy when the BPD can not be obtained. Low head.
25
What is anophthalmia?
Congenital absence or severe hypoplasia of the eyes
26
What do we need to look for to confirm anophhtalmia?
Look for lens
27
Who is most affected by anophthalmia? (demographic)
T13 babies
28
What is Microphthalmia?
Small eyes
29
What do we need to diagnose microphthalmia?
Interocular measurments
30
Who is affected by microphthalmia?
T13 babies
31
What is hypertelorism?
Widely spread eyes
32
Hypertelorism is most commonly due to what?
Mass blocking anterior migration
33
Hypertelorism is less commonly due to what?
Craniosynostoses
34
What is hypotelorism?
eyes close together
35
What kind of measurement do we have with hypotelorism?
Binocular measurement
36
Who is affected by hypotelorism?
T13 babies
37
What is cyclonic?
Fusion of eyes into one orbit
38
What is cyclonic typically seen with?
With nose as supraorbitial proboscis?
39
Who is affected by cyclopia?
13
40
What is ethmocephaly?
2 closely spaced but separate eyes with supraorbital proboscis
41
What is cebocephaly?
2 closely spaced by separate eyes with a central placed nose with only one blind needed nostril
42
What is a proboscis?
Tuft of tissue, usually above the eyes.
43
What is seen with proboscis?
Absence of a normal nose
44
What are five patterns of cleft lip and palate? One extra. 6
1. Cleft lip alone
2. Unilateral cleft lip and palate
3. Bilateral cleft lip and palate
4. Midline cleft lip and palate
5. Cleft palate alone
6. Facial defects associated with amniotic bands
45
What is the occurrence rate of clefting with T18?
40%
46
What is the occurrence rate of clefting in t13?
60%
47
Isolated cleft palate is more likely to be associated with what?
Additional anomalies
48
How easy is it to see cleft palate on u/s?
Difficult
49
Polyhydraminos and small stomach are often seen because of what?
clefting defect which can disturb fetal swallowing
50
If you are having a difficult time catching the soft tissue, what do we need to do?
Look very carefully, this baby may have bilateral cleft lip
51
When looking for a cleft lip we need to be careful not to do what?
Confuse not to confuse philtrum with cleft lip
52
Where is the median cleft face located?
Middle of the nose
53
What is medial cleft face?
Nasal and maxillary structures fail to fuse, also cleft nose.
54
Which is more difficult to see, Cleft palate or Cleft lip?
Cleft palate
55
What is the view we need to use to catch cleft palate?
TRX around tooth buds
56
It is very easy to create cleft palate if you are doing what?
Scanning in the oral cavity or ethmoid sinuses
57
What is marcroglossia?
Abnormally large protruding tongue beyond the lips
58
What chromosomal anomaly is macroglossia assocaited with?
T21
59
What S/S of Beckwith- wiedemann syndrome? 4
1. Macroglossia
2. Macrosomia
3. Omphalocele
4. Renal hyperplasia or renal dysplasia
60
Beckwith-wiedemann syndrome has an increased risk of developing what? 2
1. Wilms tumor
2. Hepatoblastoma
61
What is Micrognathia?
Mandibular hypoplasia
62
What are some features we see with Micrognathia? 2
1. Lower jaw smaller than usual
2. Small chin
63
If the ears are placed low or small, it can be associated with what? 3
1. T21
2. T18
3. T13
64
Fetal thyroid starts to function @ how many weeks?
12 weeks
65
Can the fetus have hyperthyroidism and hypothyroidism?
Yes
66
Hyperthyroidism and hypothyroidism does what to the thyroid?
Enlarges it
67
Maternal Graves’ disease can cause what?
Hyperthyroid in fetus
68
Can we see a neck mass on u/s?
Yes
69
A mass in the fetal neck may cause what?
Fetal neck to hyperextend
70
What can happen as a result of a fetal mass in the neck? (s/s)
Polyhydraminos
71
Fetal thyroid dysfunction can lead to what? 3
1. IUGR
2. Oligiohydramnios
3. **Tachycardia**
72
Treatment of the thyroid can be done when?
In utero with thyroid medication administered to the mother
73
What is a nuchal cord?
Umbilical cord looped 2 or more times around neck
74
What is cystic hygroma?
Septated nuchal fluid
75
Cystic hygroma usually consists of what?
Multiocular lymphatic fluid lined by lymphatic endothelium
76
Cystic hygroma is thought to arise due to what?
Failure of the lymphatic system to develop a communication to the Venous system of the neck
77
Not all cystic hygromas have what kind of origin?
Lymphatic
78
Cystic hygromas are often accompanied by what? 2
1. Hydrops
2. Cardiac abnormalities
79
>60% of fetuses with cystic hygromas have what?
Chromosomal abnormalities
80
What are some chromosomal anomalies that are associated with cystic hygroma? 3
1. Turner’s syndrome
2. Down’s syndrome
3. Noonan Syndrome
81
What is a non chromosomal syndrome that is a associated with cystic hygroma?
Fetal alcohol syndrome
82
When can cystic hygroma be seen as?
Postmortem effect
83
What does cystic hygroma look like on u/s?
Hypoechoic fluid collection with random septations
84
How early can cystic hygromas be seen on u/s?
10 weeks but should not be mistaken with nuchal translucency
85
What is the DDX of cystic hygroma?
Posterior encephalocele, however, the brain, skull, and spine are normal with cystic hygroma
86
When is nuchal translucency seen?
Between 11w - 13w 6d gestation
87
What is the CRL of nuchal translucency values?
45- 84mm
88
What is the normal values of nuchal translucency?
Depends on the maternal age
89
What is nuchal translucency used for?
Screening for increasing or decreasing first of chromosomal abnormalities
90
Increased nuchal translucency is associated with what?
Aneuploidy and other fetal abnormalities
91
When is nuchal fold thickening assessed?
Between 16-22 weeks as port of a routine 2nd trimester detailed assessment
92
What is nuchal fold thickening due to?
Subcutaneous edema
93
What is considered abnormal for nuchal fold thickening?
>6mm
94
What has a high association with nuchal fold thickening?
T21
95
42% of fetus with Down syndrome have a thick what?
Nuchal fold
96
What does a teratoma look like?
Solid/ complex mass
97
If the teratoma is large what happens to the fetal neck?
Hyperextension
98
Label
99
Label
100
What does this image represent?
The migration of the nose, eyes and ears
101
Which plane is used to assess the nuchal fold?
BPD
102
What are some landmarks we see when we look for a nuchal fold?
CSP, Falx, peduncles
103
Teratomas may obstruct swelling causing what?
Polyhydraminos
104
What is the views being identified?
1. Nose bone
2. Maxilla
105
What does this profile image focus on?
1. Assessing the prominence of the chin and forehead
2. Assess from protruding tongue or a flattened nose
3. Assess for nasal bone
106
What does this image represent?
Hypoplastic nasal bone
107
What does this image represent?
Hypoplastic nasal bone
108
What does this image represent?
Retronasal triangle
109
What does this image represent?
No nasal bone
110
What does this image represent?
Coronal face
111
What does this image represent?
Orbital measurements
112
What does this image represent?
Normal vs IOD abnormal
113
What does this image represent?
Hypotelorism
114
What does this image represent?
Ethmocephaly vs cebocephaly
115
Label
116
What does this image represent?
Normal nose/ lip and cleft lip
117
What does this image represent?
Bilateral cleft lip
118
What does this image represent?
Median cleft face
119
What does this image represent?
Beckwith - wiedemann syndrome
120
What does this image represent?
Tongue mass
121
What does this image represent?
Micrognathia vs retrognathia
122
What does this image represent?
Frontal bossing
123
What does this image represent?
1. Normal
2. Pseudo low set ears
3. True low set ears
124
What does this image represent?
Nuchal cord
125
What does this image represent?
Nuchal cord
126
What does this image represent?
Normal vs abnormal lymphatic drainage
127
What does this image represent?
Nuchal translucency
128
What does this image represent?
Nuchal fold
