Anatomy and growth of the fetal soft palate: a cadaveric study to improve its ultrasonographic observation. Captier Guillaume,Faure Jean-Michel,Baümler Marcel,Bonnel François,Daures Jean-Pierre The Cleft palate-craniofacial journal : official publication of the American Cleft Palate-Craniofacial Association OBJECTIVE:To determine the anatomy of the soft and hard palate during fetal growth in order to improve its ultrasonographic prenatal visualization. DESIGN:Anatomic study in human formalin-fixed fetus. METHODS:The heads of 18 second and third trimester fetuses were studied in the median sagittal plan. Measurements of the soft palate, the velopharynx, the root of the tongue, and the oral floor were taken. The hard palate/soft palate angle and the anterior cranial base/soft palate angle were measured. RESULTS:The growth of the hard palate was linear, and the growth of the soft palate was polynomial (second order) during the period studied. The hard palate/soft palate angle was 150.33 degrees +/- 7.62 and 150.20 degrees +/- 6.67 in the second and third trimester, respectively. The anterior position of the soft palate in relation to the anterior cranial base was 48.8 degrees +/- 3.13 in the second trimester and 52.26 degrees +/- 3.31 in the third trimester. Its posterior position was 89.66 degrees +/- 5.51 in the second trimester and 92.97 degrees +/- 4.01 in the third trimester. Throughout the fetal period, the soft palate moved downward relative to the clivus and cervical spine. CONCLUSIONS:Despite the nonlinear growth and downward displacement of the soft palate during fetal life, its position remains stable. These results may be useful to explore the fetal soft palate using 2D and 3D ultrasonography and to improve the prenatal diagnosis of isolated cleft palate. 10.1597/07-044.1

Analysis of Fetal Palate to Assist Pre-natal Ultrasound. Shastry Anjali,Ravindranath Yogitha,Ravindranath Roopa Journal of clinical and diagnostic research : JCDR INTRODUCTION:Cleft palate is one of the major facial congenital malformation in newborns. Pre-natal detection of this malformation is limited to detection of clefting of hard palate but isolated soft palate clefting still remains challenge for sonologists. As Indian literature is limited present study was attempted to provide dimensions and position of fetal palate by digitized images. AIM:To study dimensions, position and differences in parameters between second and third trimester fetuses. MATERIALS AND METHODS:Median sagittal section of 32 formalin fixed fetuses was selected from the Department of Anatomy, St John's Medical College, Bangalore, Karnataka, India. Anatomical landmarks-The Nasion (N), Sellaturcica (S), Anterior Nasal Spine (ANS), Posterior Nasal Spine (PNS), tip of Uvula (U) were marked on sections. Length of hard palate (from ANS to PNS), Length of soft palate (from PNS to U), Hard palate/soft palate angle was defined. The anterior position of soft palate and its posterior position in relation to anterior cranial base were marked as N-S-PNS and N-S-U angle, respectively. The measurements were acquired directly from the digitized images using ImageJ software. Statistical analysis was done using SPSS 16. RESULTS:The mean values of ANS-PNS and PNS-U were 23.59±3.69mm and 14.39±2.70mm, respectively. The mean values of hard palate/soft palate angle, N-S-PNS and N-S-U angle were 144.720±11.11,51.150±9.09 and 93.370±9.58, respectively. Significant difference was noted between trimesters for length of hard and soft palate but not for palatal angles. CONCLUSION:During Pre-natal assessment of cleft palate, it is important for sonologist to keep in mind that the dimensions of palate proportionately increased in last two trimesters while the position remains constant. 10.7860/JCDR/2016/21170.8709

Diagnosis of fetal isolated cleft palate using assessment of the posterior hard palate angle. Ultrasound (Leeds, England) Objective:The study aims to evaluate the role of the posterior hard palate angle in the prenatal diagnosis of cleft palate. Study Design:Stored images of the axial transverse view of the fetal secondary palate, obtained at three-level obstetric ultrasounds, were used to evaluate the posterior border of the hard palate. The study population comprised 63 consecutive pregnancies of unaffected cases and 17 pregnancies suspected for a cleft palate without cleft lip, including 7 cases of cleft palate, 4 cases of high-arched palate, and 6 false-positive cases. Results:The posterior angle of the hard palate was significantly larger in the cleft palate group than in the healthy controls and false-positive cases: 227° (±51°) vs 160° (±16°), < 0.0001; and 173° ± 18°, < 0.0001, respectively. Regression analysis revealed that reflex angle remained an independent risk factor for cleft palate (odds ratio, 58.67 (95% confidence interval 10-341)). The sensitivity and specificity of the posterior angle assessment were 73% and 96%, respectively. Conclusions:The posterior hard palate angle could be an ultrasound marker of cleft palate without a cleft lip. 10.1177/1742271X241260220