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Mandibular Measurements at the 20-week Anatomy Ultrasound as a Prenatal Predictor of the Severity of Respiratory and Surgical Interventions Associated with Pierre-Robin Sequence
Raeesa Islam, BS, University of Pittsburgh School of Medicine
Erin Anstadt MD, Department of Plastic Surgery at UPMC
Timothy Canavan MD, Department of Obstetrics and Gynecology, UPMC
Jesse Goldstein MD, Department of Plastic Surgery at UPMC
University of Pittsburgh School of Medicine
2020-02-05
Presenter: Raeesa Islam
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Jesse Goldstein, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Prenatal diagnosis of Pierre-Robin Sequence (PRS) facilitates delivery team preparation for airway emergencies. 20-week ultrasounds screen facial features, allowing evaluation of maxilla-mandibular relationships. This study evaluates 20-week ultrasounds of PRS infants to determine if facial measurements could predict PRS disease severity.
Methods: A retrospective review of PRS patients was performed. Respiratory and surgical interventions were scored for severity. Mid-sagittal images of ultrasounds were measured for 3 parameters of micrognathia: facial-maxillary angle (FMA), facial-nasomental angle (FNMA), and alveolar overjet.
Results: Of 40 PRS patients, 53% had FMAs below 66°, suggesting micrognathia (range:47-84°, mean:64.08°). For FNMA, 83% were below 136°, suggesting micrognathia (range:104-154°, mean:130.9°). Mean alveolar overjet was 3.7mm (range:2-7mm).
As respiratory support needs increased, median FMA decreased and alveolar overjet increased. For respiratory independent patients, median FMA was 67° (IQR=61°-73.5°) while the CPAP/NC group had a median FMA of 62° (IQR=56°-66°) and the intubated group had a median FMA of 63° (IQR=54.25°-66°). Median alveolar overjet for patients without respiratory support was 2.95mm, CPAP/NC patients was 4.3mm, and intubated patients was 4.0mm.
There was no statistically significant difference in mean measurements between surgical and nonsurgical patients. However, surgical patients tended to have smaller FNMAs and greater overjet compared to nonsurgical patients; median FNMA was 127° versus 132°, and median overjet was 2.8 versus 4.15 mm, respectively.
Conclusions: While many patients had normal FMA, majority had abnormally acute FNMA. Alveolar overjet, previously unmentioned in ultrasound literature but routinely assessed on neonatal clinical evaluation, is measurable and may have utility in prenatal diagnosis.
