The Fetal Face and Neck part 4

Branchial cleft cyst

A cystic defect that arises from the primitive branchial apparatus.

tongue

Abnormal positioning of the ____ may be indicative of a mass of the oral cavity, an obstructive process, or macroglossia.

Yes

Can neck masses represent life-threatening disorders?

100%

Cystic hygroma with fetal hydrops carries ____% mortality

hydramnios; stomach

Esophagus may be obstructed with large goiter and hyperextended fetal neck, resulting in ____ and a small or absent ______.

lymphatic tissue (cavities); hydrops or death

Fetal Cystic Hygroma: The abnormal collection of lymph fluid causes distention of the ________, which may lead to fetal ____ or ____.

swallowing; hydramnios

In fetuses with epignathus, _____ may be impaired, resulting in _____

Teratoma

Is usually unilateral and located anteriorly; May have complex sonographic patterns

Complete bilateral cleft lip and palate

Large gap in upper lip on modified coronal view; nose is flattened and widened; a premaxillary mass may be present

Cystic Hygroma Colli

Most common neck mass

meningomyelocele, hemangiomas, teratomas, goiter, sarcoma, and metastatic adenopathy

Other types of neck masses

bony shadowing

Sonographically, visualization of the hard and soft palates remains a diagnostic challenge because of considerable ________.

Normal behavioral patterns of the fetus

Swallowing Protrusion and retrusion of the tongue Hiccoughing

3D and 4D

The addition of ____ and ____ reconstruction may complement the 2D assessment of facial anomalies, in particular facial clefts.

systemic; coronal and axial

The sonographer need to use a _______ approach in the ____ and ___ planes.

False. Neck masses are usually LARGE and OBVIOUS because their presences CAUSES distortion of the neck contour.

True or False. Neck masses are usually small and not obvious because their presences does not cause distortion of the neck contour.

True

True or False. Whenever maternal thyroid disease present, fetal thyroid should be evaluated

septum; septations

Typically, a dense midline ____ divides the hygroma, with _____ noted within the dilated lymph sacs.

Questions for the Sonographer Evaluating a Fetal Neck Mass

What is the position of the mass (anterior, posterior, lateral, or midline)? Is it a unilateral or bilateral lesion? Is a nuchal ligament present? What are the Doppler properties? (Hemangiomas have arterial and venous characteristics.) Is there polyhydramnios? Is heart failure or hydrops present? Are there coexisting anomalies? Is there hyperextension, which may suggest neck mass or iniencephaly (fusion of occiput to spine)?

hypothyroid or hyperthyroid

When goiter suspected, fetus may be either ____ or ____

20%

___% of cystic hygroma involve the axillae (atypical cystical hygroma).

Color

____ Doppler may help differentiate mass from atypical hygromas or other more cystic masses.

70%; posterior; bilaterally

____% of Cystic Hygroma involve the neck (usually arising from the _____ aspect of the neck, and ______).

50%

____% of cystic hygroma are associated with chromosomal abnormalities

Large; posterolateral

_____ fetal cystic hygromas have a typical sonographic appearance. They appear as bilateral large cystic masses at the _____ borders of the neck that in severe cases may surround the neck and head and upper trunk.

Webbing of the neck and swelling; Turner Syndrome (45X)

_________ is seen after birth due to Fetal Cystic Hygroma, and frequently seen with neonates with ______ syndrome.

Epignathus

is a teratoma located in the oropharynx. (Complex mass)

Fetal Cystic Hygroma

results from a malformation of the lymphatic system that leads to single or multiloculated lymph-filled cavities around the neck

Fetal goiter (thyromegaly)

usually appears as a symmetrical (bilobed), solid, and homogeneous mass, arising from the anterior fetal neck in the region of the fetal thyroid gland.