Sonographic evaluation of fetal face is a part of anatomic survey in mid pregnancy However , little is required; b/c according to american institute of ultrasound in modern practice guidelines, only visualization of fetal upper lip is mandatory during anatomy survey. 3D & 4D images are more informatory in cases where fetal face is hard to evaluate in 2D scan due to fetal position.

1. Fetal Head & Neck
USG
Presented by
Dr Vrishit Saraswat

2. Embryology & Development
FACE
5 main tissue buds (prominences)
F
n nn n
maxill
ary
maxill
ary
mandibular mandibular
F

3. • Development of face occurs from 4th to 8th
gestational week
• At 4th wk (FOur)-
Five (round) openings starts
to form.
a) 2 nasal placodes on frontal prominences
b) 2 optic fissures and optic discs posterolaterally
c) In stomodeum , buccopharyngeal membrane
starts to fenestrate.

4. • At 5th wk
a) Nasal pits in nasal placodes
b) Lens vesicle invaginate in optic disc
c) Caudal end of medial nasal prominence fuses
with maxillary prominences.

5. • At 6th wk
a) 6 auricular buds fuse to form auricle & if any
defect occurs in this process, will lead to
auricular pits.
b) Medial and lateral nasal prominences fuse
c) Maxillary prominence form upper jaw
d) Both medial nasal prominence fuse in
midline
e) Optic fissure fuses.
6

6. • By 7th wk
a) Tip of nose in profile for the first time
b) Pinna of ear takes complete shape
c) Nose and philtrum are formed
d) Eye lids become prominent
• By 8th wk
2mm
o o

8. NECK
• At 4th wk, laryngotracheal grove forms along
flour of primitive mouth.
• The margins of grove evaginate to form
diverticula, which fuses later.
• The distal end of tube form lung buds
• The proximal end form laryngeal structures
like vestibule & vocal cords
• The muscles of larynx are formed by 4th and
6th pharyngeal arches.
Cont….

9. • The lymphatic system develops as lymphatic
sacs at 4th to 6th wks which then drain into
subclavian and jugular veins.
• Abnormal connection b/w lymphatic sacs and
veins , in which they drain into, contributes to
NT.

10. Normal Fetal Face on USG
• Sonographic evaluation of fetal face is a part
of anatomic survey in mid pregnancy
• However , little is required; b/c according to
american institute of ultrasound in modern
practice guidelines, only visualization of fetal
upper lip is mandatory during anatomy survey.
• 3D & 4D images are more informatory in cases
where fetal face is hard to evaluate in 2D scan
due to fetal position.

11. Sagittal face profile
• Shows nasal bone , lip, chin and forhead.
Axial view
• Informatory to verify if both eye lobes are
present, are normal & at normal distance
apart.
Axial View
• of maxilla and alveolar ridge can be obtained
to look for primary palate and tongue.
• Secondary palate is difficult to visualize
sometimes .

15. ABNORMALITIES OF HEAD
Shape Abnormality
1. Dolicocephalic – MC, commonly seen
with breach presentation., oligohydroamnios
& premature closure of sagittal suture.
2. Brachycephalic – 2nd MC, seen with
premature closure of coronal sutures.
3. Lemon shaped – Chiari II malformation.

16. 4 Strawberry Shaped – Tri 18
5 Clover leaf shaped –Thanatophoric Dys.

18. Pancraniosynostosis

19. Craniosynostosis
• Abnormal fusion of sutures leading to
abnormal head shapes
• It is related to abnormal molecular signaling
by fibroblast growth factors (FGFs) leading to
premature closure.
• 85% cases are isolated
• 15% are associated with following syndromes
Cont…..

20. 1. A- Apert Syndrome
2. B- Beare Steven Syn.
3. AB- Antley Bixler Syn.
4. C – Carpenter Syn
Crouzon Syn
&
Thanatophoric Dysplasia
• Besides just the shape, additional problems
occure , like - ICT, proptosis, visual loss,
dental malformation & IQ.

21. Wormian Bone
Extra occification centre in fontanalle, i.e. extra
bone with in sutures.
Associated anomalies – HOT-P
1. H- cong Hypothyroidism
2. O- Ost. Imperfecta
3. T- Tri 18, 21
4. P- Progeria

23. Forehead Abnormalities
Frontal Bossing
Acromegaly, Achondroplasia
Thanatophoric dysplasia
Crouzon Syndrome
Pfieffer Syndrome
Frontal bone sloping
Microcephaly
Wolf Hirschhorn syndrome(4p-
del)
sloping

24. Orbit Anomalies
• Hypotelorism- Hypotelorism refers to an
abnormal decrease in distance between any
two organs although some authors use the
term synonymously with
orbital hypotelorism meaning an abnormal
decrease in the distance between the two
eyes (the eyes appear too close together).

25. • Associations- Holoprosencephaly ,
Microcephaly, Tri-13,18,21, 5p-del,

26. • Hypertelorism- Hypertelorism is an
abnormally increased distance between two
organs or bodily parts, usually referring to an
increased distance between the orbits (eyes),
or orbital hypertelorism. In this condition the
distance between the inner eye corners as
well as the distance between the pupils is
greater than normal.

29. • TABLE 33-1. NORMAL ORBITAL DIAMETERS IN THE FETUS
• GESTATIONAL AGE
• (wk)
• Inner Diameters (mm) Outer Diameters (mm)
• 5th %ile 50th %ile 95th %ile 5th %ile 50th %ile 95th %ile
• 13 4 7 10 12 16 20
14 5 8 11 14 18 22
• 15 5 8 11 17 21 25
• 16 6 9 12 19 23 27
• 17 7 10 13 21 25 29
• 18 8 11 14 24 27 31
• 19 8 11 14 26 30 34
• 20 9 12 15 28 32 36
• 21 10 13 16 30 34 38
• 22 10 13 16 32 36 40

30. Congenital Cataract
• On USG – rounded echogenic mass in anterior
portion of globe
• Asso- Congenital Rubella & Toxoplasma
Tri-13,18,21, Congenital icthyosis
X-linked Cataract (Hutterite Syndrome)
Marfan Syndrome
Walker wasburg Syndrome(typII
Lissen.)”HARD_E”

32. Coloboma
Results from incomplete closure of optic fissure.
Can effect any structure from eyelid to optic
nerve or retina.
Usg will show visualization of focal buldge in
posterior aspect of globe
Association – CHARGE Syndrome
retina
cor
nea
L
E
N
S

35. Dacrocystocoele
• Results from obstruction of nasolacrimal ducts
• On Usg- cystic mass , antero-infermedially to
orbit with no mass effect on globe.
• PTR- Nasolacrimal duct canalize in III trim, so
diagnosis should be made afet 30 wks of
gestation.
• Any lesion with mass effect inferomedially to
globe should be suspected as either
1. Teratoma-solid or mixed cystic-solid , with or
without calcification
2. Hemangiomas- echogenic with increased
vascular flow.

38. Ear Abnormalities
Low set ears
•Horizontal line from
inner canthus joins the
helix. If helix is below
this arbitary line,
diagnosis will be
LOW-SET EARS.
Noonan Syndrome
Klipple-weil Syndrome
Microtia
•Small ears , 66%
associated with
syndromes amd
aneuplodies
Otocephaly
•Union of ears in front
of neck
•Bcoz of failure of
ascent of auricles
during development.
•This FATAL anomaly
associated with
microstomia &
agnathia.

42. To be continued
Thank You…..