Maxillary gap at 11–13 weeks’ gestation: Marker of cleft lip and palate

Abstract

Objective: To describe a new sign of cleft lip and palate (CLP), the maxillary gap, which is visible in the mid‐sagittal plane of the fetal face used routinely for measurement of nuchal translucency thickness. Methods: This was a retrospective study of stored images of the mid‐sagittal view of the fetal face at 11–13 weeks' gestation in 86 cases of CLP and 86 normal controls. The images were examined to determine if a maxillary gap was present, in which case its size was measured. Results: In 37 (43.0%) cases of CLP the defect was isolated and in 49 (57.0%) there were additional fetal defects. In the isolated CLP group, the diagnosis of facial cleft was made in the first trimester in nine (24.3%) cases and in the second trimester in 28 (75.7%). In the group with additional defects, the diagnosis of facial cleft was made in the first trimester in 46 (93.9%) cases and in the second trimester in three (6.1%). A maxillary gap was observed in 96% of cases of CLP with additional defects, in 65% of those with isolated CLP and in 7% of normal fetuses. There was a large gap (>1.5 mm) or complete absence of signals from the maxilla in the midline in 69% of cases of CLP with additional defects, in 35% of those with isolated CLP and in none of the normal controls. Conclusions: The maxillary gap is a new simple marker of possible CLP, which could increase the detection rate of CLP, especially in isolated cases. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.