Mandibular Measurements at the 20-week Anatomy Ultrasound as a Prenatal Diagnostic Predictor of Pierre-Robin Sequence
Raeesa Islam, BS, University of Pittsburgh School of Medicine
Madeleine Bruce, BA, UPMC Children's Hospital of Pittsburgh
Erin Anstadt MD, Department of Plastic Surgery at UPMC
Miles J. Pfaff, MD MHS, UPMC Children's Hospital of Pittsburgh
Timothy Canavan MD, Department of Ob/Gyn/RS, Division of ultrasound at UPMC
Jesse Goldstein MD, UPMC Children's Hospital of Pittsburgh
University of Pittsburgh School of Medicine
Presenter: Raeesa Islam
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. The program director is responsible for making a statement within the confines of the box below specific to how much of the work on this project represents the original work of the resident. All authors/submitters of each abstract should discuss this with their respective program director for accurate submission of information as well as the program director's approval for inclusion of his/her electronic signature.
Director Name: Jesse Goldstein, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: Pierre-Robin Sequence (PRS) is characterized by micrognathia, glossoptosis, and upper airway obstruction. This study aimed to evaluate 20-week fetal ultrasounds to determine if specific facial measurements could predict PRS diagnosis and disease severity to facilitate delivery team preparation for an airway emergency.
Methods: A retrospective case-control study of 53 patients with PRS and gender-matched controls was performed. Medical records were reviewed for respiratory and surgical interventions. Three parameters to assess micrognathia were measured on mid-sagittal profile ultrasound images: facial nasomental angle (FNMA), facial-maxillary angle (FMA), and alveolar overjet. FMA <66°and FNMA <136° signify micrognathia. One-tailed t-test was performed, p≤0.05 was considered statistically significant, mean ± standard deviation was reported.
Patients with PRS demonstrated significantly smaller FNMA compared to the control group (129.0 ± 8.3 vs.137.5 ± 3.2, respectively; p<.001), as well as a significantly smaller FMA (63.0 ± 9.5 vs. 74.6 ± 6.0; p<.001). The PRS group also demonstrated significantly larger overjet compared to the control group (3.9 ± 1.4 vs. 2.2 ± 0.8, respectively, p<.001). As respiratory support needs increased, median FMA decreased and alveolar overjet increased. Surgical patients tended to have smaller FNMAs and greater overjet compared to nonsurgical patients.
Conclusions: Mandibular features on 20-week anatomy ultrasounds can be measured to predict PRS and prepare for respiratory intervention at delivery to minimize hypoxia at birth. Alveolar overjet, previously not described in prenatal ultrasound literature but routinely assessed on neonatal clinical evaluation, is measurable and has utility in prenatal diagnosis, as do FMA and FNMA.
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