Module 11 : Fetal Face and Neck Pathology Flashcards
(90 cards)
1
Q
when does face development begin and end
A
- starts 5 weeks LMP
- completed 10 weeks LMP
2
Q
what does the face develop from
A
- 5 main facial processes that move together and fuse
3
Q
what are the 5 main facial processes
A
- 1 frontonasal process
- 2 maxillary prominences
- 2 mandibular prominences
4
Q
how does the frontal nasal process move
A
- starts superior in head and moves inferiorly
5
Q
what 5 things does the frontonasal process form
A
- mid forehead
- nose
- CENTRAL UPPER LIP
- central maxilla
- anterior pallate
6
Q
how do the maxillary prominences move
A
- starts lateral then move medial
7
Q
what 4 things does the maxillary prominences form
A
- cheeks
- LATERAL UPPER LIP
- maxilla
- posterior/ secondary palate
8
Q
how do the mandibular prominences move
A
- start lateral and inferior then move medially
9
Q
what does the mandibular prominences form
A
- form the mandible
10
Q
where does the nose being to develop and where does it move to
A
- nose starts above the orbits as 2 widely spread nasal placodes
- move medially and inferiorly
11
Q
what are placodes
A
- areas of ectoderm tissue which form the sense organs
+ auditory, olfactory, vision
12
Q
where do the eyes being to develop and where do they move to.
A
- eyes start lateral
- move medial
13
Q
where do the ears begin to develop and where do they move to
A
- start below the mandible
- move laterally and upward
14
Q
area facial anomalies uncommon or common
A
- very common
15
Q
what other abnormality usually occur with facial anomaly
A
- polyhydramnios occurs with most cases due to swallowing affected
16
Q
what chromosomal abnormality is most commonly associated with facial anomalies
A
- trisomy 13 is highest
17
Q
what maternal related factors can affect development of face
A
- drugs
- alcohol
- codeine
- valium
- anti-epileptic drugs
18
Q
in what view do we assess the fetal orbits
A
- axial (BPD) through face
19
Q
what do three things do we asses when looking at orbits
A
- orbital size
- lens on eyes
- binocular distance
20
Q
in what view do we view nose/lips
A
- tangential coronal of nose lip
21
Q
what 3 things are we looking for when we do the nose lip picture
A
- want soft tissue of the nose and lip rather than bone
- assess for intact upper lip
- presence of 2 nostrils
22
Q
where do we take the profile picture of baby
A
- directly over midline sagittal of face
23
Q
what 3 things are we looking for with the profile image of baby
A
- prominence of chin and forehead
- protruding tongue or a flattened nose
- asses for the nasal bone
24
Q
what would the presence of a nasal bone look like on baby
A
- equal “=” sign between skin and bone
25
why is 3D imaging done with facial anomalies
- some surgeons like to see it for the extent of anomaly and to help parents get a better idea of what to expect on delivery
26
what is the normal distance between the orbits
- should be separated by the distance of one orbital globe
27
what orbital measurement can be used to date pregnancy when BPD cannot be used
- outer orbital distance OOD
| - but does not communicate directly in mm to weeks
28
what are the 2 measurements of the orbits
- OOD = outer orbital distance
| - IOD = inner orbital distance
29
what are 7 orbital anomalies
- anopthalmia
- micropthalmia
- hypertelorism
- hypotelorism
- cyclopia
- ethmocephaly
- cebocephaly
30
what is anopthalmia
- congenital absence or sever hypoplasia of the eyes
31
what chromosomal abnormality is most commonly associated with anopthalmia
- trisomy 13
32
what is microphthalmia and what chromosomal abnormality is associated with it
- small eyes
| - trisomy 13
33
what is hypertelorism
- widely spread eyes
34
what is hypertelorism most commonly caused by
- due to mass blocking anterior migrate (encephalocele)
35
what is the less likely cause of hypertelorism
- craniosyostoses
36
what is hypotelorism and what chromosomal abnormality is it most commonly seen
- eyes close together
| - trisomy 13
37
what is cycolpia and what chromosomal abnormality is it associated with
- fusion of eyes into one orbit
- typically with a supraorbital proboscis
- trisomy 13
38
what is ethmocephaly
- 2 closely spaced but separate eyes with a supraorbital probiscis
39
what is cebocephaly
- 2 closely spaced but separate eyes with a centrally placed nosed with only one blind ended nostril
40
what is a proboscis
- tuft of tissue usually above the eyes
| - absence of a normal nose
41
5 patterns or cleft and palate
- cleft lip alone
- unilateral cleft lip and palate
- bilateral cleft lip and palate
- midline cleft lip and palate
- facial defects with amniotic band
42
in what two chromosomal abnormalities is clefting most common
- trisomy 13 most common
| - trisomy 18
43
is cleft palate easy to see on ultrasound
- no
44
what other anomaly will be seen with cleating and why
- polyhradmnios and small stomach
| - due to swallowing defects
45
what normal structure can be commonly confused with cleft lip
the philtrum
46
What is median cleft face
- cleft in the middle of the nose
47
What causes median cleft face
- nasal and maxillary structures fail to fuse
48
What chromosomal abnormality is often associated with median cleft face
- trisomy 13
49
Is cleft palate easier to diagnose on ultrasound than cleft lip
- much more difficult
50
Where should we look to assess for cleft palate
- look in transverse around the tooth buds
51
What is macroglossia
- abnormally large protruding tongue beyond the lips
52
What 2 chromosomal abnormalities is macroglossia associated with
- trisomy 21
| - beckwith-wiedemann syndrome
53
What 5 anomalies is beckwith-wiedamann syndrome associated with
- macroglossia
- macrosomia (LGA)
- omphalocele
- renal hyperplasia or renal dysplasia
- increased risk of Wilms tumor and hepatoblastoma
54
What will produce a Doppler signal when using color around teh area of the tongue
- baby breathingi
55
What is micrognathia
- small chin
56
What is retrognathia
- receded
| - posteriorly displaced chin
57
What is frontal bossing
- very large protruding forehead
| - goes past the line
58
What chromosomal abnormality is low are small ears associated with
- trisomy 21, 18, 13
59
When does fetal thyroid begin to function
- 12 weeks
60
What two disorders of the thyroid can a fetus have and how would they change the thyroid
- hyperthyroidism
- hypothyroidism
- both would enlarge the thyroid
61
What maternal disease can cause hyperthyroid in fetus
- maternal Graves’ disease
62
Can a neck mass be identified on ultrasound how will the mass affect the fetal position
- yes
| - fetal neck could be hyperextended
63
What other anomaly may result from a neck mass
- polyhydramnious from obstruction
64
What three things can fetal thyroid destruction lead to
- IUGR
- oligohydramnios
- tachycardia
65
How do you treat thyroid disorders in fetus
- thyroid medication administered to mother
66
What complications can occur with the umbilical cord
- nuchal cord
67
What is a nuchal cord
- umbilical cord looped 2 or more times around the neck and tight
- common reason for unexplained/sudden death in uterus
68
What is the best view to assess for nuchal cord
- transverse
69
What is a cystic hygroma
- septated nuchal fluid
| - multilocular lymphatic fluid lined by lymphatic endothelial
70
What is the cause of cystic hygroma
- arise due to a failure of the lymphatic system to develop a communication to the venous systems of the neck
71
Are all cystic hygromas lymphatic in origin
- no
72
What other disorder usually accompanies cystic hygroma
- hydrops
73
What is the prognosis of cystic hygroma
- poor prognosis
74
What chromosomal abnormality is cystic hygroma most commonly associated with
- turners syndrome
75
Ultrasound appearance of cystic hygroma
- hypoechoic fluid collection with random septations
| - seen as early as 10 weeks but should not be mistaken with normal nuchal translucency
76
What is the DDx of cystic hygroma
- posterior encephalocele howerever brain , skull, and spine normal with a cystic hygroma
77
When is the nuchal lucency seen on ultrasound
- seen between 11w-13w6 d gestation
78
What is the usually normal measurement for nuchal lucency
- <3mm
| * VERY DEPENDANT ON MATERNAL AGE
79
What is an increased nuchal lucency asasociated with
- aneuploidy and other fetal abnormalities
80
Steps for doing nuchal lucency
- magnify/zoom fetal head and chest
- perfect midline sag plane
- natural flexion of the spine
- decrease dynamic range
- measure on to on
81
When is nuchal fold assessed and what is it associated with
- 16-24 weeks
| - Down syndrome
82
What is thickening of nuchal fold caused by
- subcutaneous edema
83
What plane is used to assess the nuchal fold
- transverse axial
84
What landmarks must be on teh image for nuchal fold
- posterior fossa
| - CSP
85
When do we stop measuring nuchal fold and why
- after 24 weeks
| - ibigger baby more skin
86
What kind of tissue are teratomas composed of
- 3 germ cell layers
87
Can teratomas obstruct swallowing and what would it cause
- yes
| - polyhydramnious
88
What complication can teratomas cause
- dystocia
89
What is dystocia
- difficult labor or birth
90
Teratomas on ultrasound
- solid mass
| - if larger hyperextending of fetal neck will result
