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CLINICAL IMAGE Table of Contents  
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Ultrasonography diagnosis of cleft lip and palate – Nyberg classification type II

 Department of Radiology, St. John's Hospital, Bengaluru, Karnataka, India

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Date of Submission14-Jan-2022
Date of Decision22-Apr-2022
Date of Acceptance04-May-2022
Date of Web Publication06-Jun-2022

How to cite this URL:
Reddy R. Ultrasonography diagnosis of cleft lip and palate – Nyberg classification type II. Apollo Med [Epub ahead of print] [cited 2022 Sep 27]. Available from: https://apollomedicine.org/preprintarticle.asp?id=346703

  Description Top

A 30-year-old primigravida from a rural background presented to the hospital at 22 weeks gestation and was referred for anomaly scan. The patient is from low socioeconomic strata and has no complaints with folic acid supplementation during pregnancy. Longitudinal ultrasonography revealed complete clefting of the lip and palate on the left, while the contralateral side was unremarkable [Figure 1]. Normal appearance of nose–mouth view has been shown for comparison [Figure 2]. Ultrasonography revealed normal fetal movements and fetal heart sounds. However, fetal parameters were within normal limits. The amniotic fluid index was increased at 14 cm. An ultrasonography diagnosis of the unilateral left-sided cleft lip and palate (Nyberg classification Type II) was made, and the parents were offered counseling regarding the same. After 3 days, the baby was referred to the department of plastic surgery for advice and further management.
Figure 1: Longitudinal ultrasonography image of the face demonstrating complete clefting of lip (arrow) and palate on the left (Nyberg classification Type II)

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Figure 2: Longitudinal ultrasonography image of the face demonstrating normal nose (yellow arrow) and mouth (green arrow) view with absent clefting

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  Discussion Top

Cleft lip and palate constitutes the most common and prevalent congenital facial anomaly encountered on the second trimester antenatal scans, with an incidence of 1 in 700–1000 live births.[1] Postnatal sequelae of the cleft lip and palate include aberrant speech, defective hearing, and impaired psychosocial well-being. The distribution of the described cleft types includes isolated cleft lip (15%), isolated cleft palate (40%), and combined cleft lip and palate (45%).[2] There are several dentofacial sequelae associated with cleft lip and palate, which include hearing loss, supernumerary teeth, velopharyngeal insufficiency, and oronasal fistulae. A combination of cleft palate and micrognathia may be identified as Pierre Robin sequence.[3] Antenatal detection of the cleft lip and palate is precisely made on two- and three-dimensional ultrasonography. The distribution of cleft types is commonly unilateral and noted on the left side. The Nyberg 1995 antenatal ultrasound classification system has five types and correlates well with the severity of the defect.[4] However, isolated cleft palate has high propensity to be missed on antenatal ultrasound scans and is not included in the Nyberg classification. Prenatal detection of the cleft lip and palate requires imaging in the “mid-sagittal” and “anterior coronal nose–mouth view.” Following the identification of facial cleft, imaging is performed in the axial, coronal, and sagittal orthogonal planes to further characterize the anatomical defect. Correction of the cleft deformity at proper age group is imperative for achieving functional rehabilitation and esthetic well-being.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Crockett DJ, Goudy SL. Cleft lip and palate. Facial Plast Surg Clin North Am 2014;22:573-86.  Back to cited text no. 1
Vyas T, Gupta P, Kumar S, Gupta R, Gupta T, Singh HP. Cleft of lip and palate: A review. J Family Med Prim Care 2020;9:2621-5.  Back to cited text no. 2
  [Full text]  
Gangopadhyay N, Mendonca DA, Woo AS. Pierre robin sequence. Semin Plast Surg 2012;26:76-82.  Back to cited text no. 3
Abramson ZR, Peacock ZS, Cohen HL, Choudhri AF. Radiology of cleft lip and palate: Imaging for the prenatal period and throughout life. Radiographics 2015;35:2053-63.  Back to cited text no. 4

Correspondence Address:
Ravikanth Reddy,
Department of Radiology, St. John's Hospital, Bengaluru - 560 034, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/am.am_9_22


  [Figure 1], [Figure 2]


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