5 fetal face ultrasound dr ahmed esawy Fetal face Skin tag EAR AND FACE APPENDIX Beckwith Wiedemann syndrome HYPOTELERISM HYPERTELERISM Facial anomalies with holoprosencephaly Lacrimal duct cysts. Macroglossia Lymphangioma of the tongue Cleft Palate and Cleft Lip Cleft lip and palate Microphthalmia Micrognathia Micrognathia associated with a Dandy-Walker variant.

1. Dr/AHMED ESAWY

2. Dr. Ahmed Esawy
MBBS M.Sc
MD
Dr/AHMED ESAWY

3. Fetal face by 3D,4D
Dr/AHMED ESAWY

4. Fetal face by 3D,4D
Dr/AHMED ESAWY

5. FETAL FACE IN 1ST HALF OF PREGNANCY 10TH
,12TH ,14TH .18TH PREGNANCY
Dr/AHMED ESAWY

6. FETAL FACE IN 2ND HALF OF
PREGNANCY
Dr/AHMED ESAWY

7. DEVELOPMENT OF NASOLACRIMAL GROOVE
13TH WEEKS FETUS,7TH WEEK EMBRYO
Dr/AHMED ESAWY

8. Open eyelids in 2nd half pregnancy
Dr/AHMED ESAWY

9. BLINKING,YAWING,GRIMACING,TONGUE
EXPULSION,MOUTHING,SWALLOWING
Dr/AHMED ESAWY

10. Dr/AHMED ESAWY
Three-dimensional ultrasound
image of a normal fetal face
(24 weeks of gestation).

11. Dr/AHMED ESAWY
(a) Normal profile of fetal lips
(L) in the second trimester;
(b) profile of fetal lips
showing the upper lips (L)
with a large cleft (C)
present.

12. Dr/AHMED ESAWY

13. PATHOLOGICAL CHANGES IN FETAL FACE
STRUCTURES
Dr/AHMED ESAWY

14. • Orbits Axial view
• Proptosis
• Hypertelorism, hypotelorism (orbital spacing)
• Facial cleft
• Nose and lip Sagittal profile
• Coronal view
• Axial view
• Proboscis
• Micrognathia
• Facial mass
• Spina bifida
Dr/AHMED ESAWY

15. NORMAL SONOGRAPHIC ANATOMY
Dr/AHMED ESAWY

16. Dr/AHMED ESAWY

17. A combination of sagittal and coronal sections allows a detailed
evaluation of the fetal face from early gestation
The fetal face 2D sonography of the fetal face
CRESTA ALVEOLAR
POSTERIOR PALADAR DURO
VELO DEL PALADAR
UVUL
A
LABIO SUPERIOR
Dr/AHMED ESAWY

18. 3D sonography of fetal face
:3D ultrasound is an ideal tool for the evaluation of the fetal face
Dr/AHMED ESAWY

19. 3D ultrasound of the fetal skull
The bones that form the fetal skull and the interposed sutures and fontanelles
are visualized using an application of 3D ultrasound
Dr/AHMED ESAWY

20. 3D tomography of fetal face
3D tomography of fetal face
Dr/AHMED ESAWY

21. Lateral cleft of the fetal face
Lateral cleft of the fetal face
Dr/AHMED ESAWY

22. Skin tag
Legend:Skin tag
Dr/AHMED ESAWY

23. EAR AND FACE APPENDIX
Dr/AHMED ESAWY

24. Beckwith Wiedemann syndrome
:Beckwith Wiedemann syndrome is a rare congenital anomaly characterized
by overgrowth and different patterns of anomalies including mostly omphalocele,
macrosomia, macroglossia and placental dysplasia
Dr/AHMED ESAWY

25. ORBITAL DEFECTS
Hypotelorism (stenopia):
Hypotelorism (decreased interorbital distance)
Dr/AHMED ESAWY

26. Dr/AHMED ESAWY
HYPERTELERISMHYPOTELERISM

27. Facial anomalies with holoprosencephaly
Facial anomalies with holoprosencephaly
Dr/AHMED ESAWY

28. • the fetal eyeballs
visualized.
• The fetal lens of the
eyes are visualized
as minute echogenic
rings in the orbit.
Real time
Dr/AHMED ESAWY

29. • Another set of ultrasound
images of the normal fetal lenses
are seen above. This fetus is 21
weeks gestational age. The
presence of the lens rules out
anopthalmia (absence of the
eyeballs).
Dr/AHMED ESAWY

30. Hypotelorism with
associated brain
abnormalities.
Dr/AHMED ESAWY

31. Lacrimal duct
cysts.
Dr/AHMED ESAWY

32. Macroglossia.
Dr/AHMED ESAWY

33. Lymphangioma of
the tongue.
Dr/AHMED ESAWY

34. • Hypotelorism, proboscis, with
Holoprosencephaly and overriding of aorta in
fetus
• Trisomy-13 and Trisomy-18 are the common
chromosomal disorders found in such cases.
(OR= Orbits)
Dr/AHMED ESAWY

35. both orbits are very
close to each other
proboscis
The presence of hypotelorism and proboscis is called ethmocephaly
Dr/AHMED ESAWY

36. small fleshy projection above the eyes in the
region of the forehead
Dr/AHMED ESAWY

37. overriding of aorta
Dr/AHMED ESAWY

38. Dr/AHMED ESAWY

39. Cleft Palate and Cleft Lip
• 13% of all congenital anomalies in US
• 50% Lateral clefting
– Lip and Palate
• 25% Lip alone
• 25% Palate alone
• 25% Bilateral
• 60% have additional anomalies
– Polydactyly
– Congenital Heart Dz
– Trisomy 21
Dr/AHMED ESAWY

40. Cleft Palate and Cleft Lip cont…
• US Dx:
– Groove extends
• Nostril thru lip
• Median Cleft Lip
– Assoc w/
Holoprosencephaly
– < 0.7%
– US:
• Wide centralized defect
– Upper Lip
– Palate
Dr/AHMED ESAWY

41. FACIAL
CLEFT
Dr/AHMED ESAWY

42. Dr/AHMED ESAWY

43. Sagittal section of a 24 weeks fetus. The soft palate is between the arrows. The vomer
bone is outlined. From “Prenatal ultrasound examination of the secondary palate
Dr/AHMED ESAWY

44. Cleft Lip
• 2nd most common congenital malformation
• Estimated to be 1:700 live births
• 50% both lip and palate are defective
• Can be caused by both genetic and environmental
factors
• 97% of the time it is an isolated finding
• Occurs shortly after 3rd week of gestation when the
grooves that separate the structures that form the
primitive oral cavity persist, they would normally be
obliterated by normal growth.
• Most commonly seen is a unilateral cleft
Dr/AHMED ESAWY

45. • Upper lip defect on nose/mouth view
Ultrasound Findings
Dr/AHMED ESAWY

46. Dr/AHMED ESAWY

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49. Dr/AHMED ESAWY

50. Cleft lip and palate
Dr/AHMED ESAWY

51. SMALL CLEFT LIP
Dr/AHMED ESAWY

52. • isolated cleft lip
anomaly.
Dr/AHMED ESAWY

53. Dr/AHMED ESAWY

54. Cleft lip and
palate.
Dr/AHMED ESAWY

55. Upper lip defect on nose/mouth view
Ultrasound Findings
Dr/AHMED ESAWY

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62. The fetal palate
Legend:3D ultrasound allows the visualization of the fetal palate
Dr/AHMED ESAWY

63. Varieties of fetal facial clefts
:Varieties of fetal facial clefts
Dr/AHMED ESAWY

64. Isolated cleft lip
Legend:Isolated cleft lip
Dr/AHMED ESAWY

65. Cleft lip and palate
Legend:Cleft lip and palate
Dr/AHMED ESAWY

66. Bilateral cleft lip and palate
:Bilateral cleft lip and palate
Dr/AHMED ESAWY

67. MICROGNATHIA
• Micrognathia is characterized by mandibular
hypoplasia causing a receding chin
Dr/AHMED ESAWY

68. Microphthalmia is defined as a decreased size of
the eyeball and anophthalmia refers to the
absence of the eye
Dr/AHMED ESAWY

69. Micrognathia associated with a Dandy-
Walker variant.
Dr/AHMED ESAWY

70. Micrognathia
Legend: Micrognathia
Dr/AHMED ESAWY

71. Micrognathia associated with a Dandy-
Walker variant.
Dr/AHMED ESAWY

72. • Normal nasal bone ossification at 12 weeks gestation.
Transabdominal US image of the fetal facial profile shows
ossification of the nasal bone (NB).
Dr/AHMED ESAWY

73. • Absent nasal bone
ossification at 12 weeks
gestation in a fetus with
trisomy 21.
Transabdominal US image
of the fetal facial profile
shows no ossification in
the expected location of
the nasal bone (NB).
Dr/AHMED ESAWY

74. Absent nasal bone
Dr/AHMED ESAWY

75. present nasal bone
Dr/AHMED ESAWY