For patient, her family, and her support system, imaging of fetal face is one of most anticipated parts of ultrasound exam

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  Studies have shown that seeing fetal face improves bonding experiences

3D ultrasound is additive to show both normal and abnormal anatomy

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  With single 3D view, like photograph, everyone can immediately recognize face

Much of face and neck anatomy routinely seen in midgestation can also be seen at time of nuchal translucency screening

Right and left upper lip, maxilla, and nostrils start as separated plates of tissue (placodes)

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  Placodes migrate medially and fuse

  
  
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  Failure to fuse leads to cleft lip, cleft palate, nose deformities, and midface hypoplasia

Bony palate has separate front portion (primary palate) and paired side and back portions (secondary palate) that also have to migrate together and fuse

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  Failure to fuse leads to bony and soft tissue cleft palate

Jaw growth, ear development, and posterior soft tissue palate development occur together and are linked

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  If mandible is small, ears are often low set

  
  
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  Extremely small mandible is almost always associated with soft tissue palate defect

  
  
  
  
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    Very hard to see with ultrasound

    
    
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    Soft tissue palate is more easily seen with fetal MR

  
  

Nose and lips view

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  Technique: Angle transducer to obtain coronal view of nose and mouth (snout view)

  
  
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  Structures seen

  
  
  
  
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    Intact upper lip

    
    
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    Normal rounded nares and nostrils

  
  
  
  
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  Pitfalls

  
  
  
  
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    If including bony maxilla, then too far back

  
  

Profile view

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  Technique: Angle transducer exactly midline and sagittal

  
  
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  Structures seen

  
  
  
  
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    Full nasal bone, forehead, maxilla, mandible

  
  
  
  
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  Pitfalls

  
  
  
  
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    Erroneous short or absent nasal bone because angle of beam is “shooting” down length of nose

    
    
    
    
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      Take image when fetal neck position is neutral (not looking straight up)

      
      
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      Ultrasound beam should be near 90⁰ to nasal bone

    
    
    
    
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    Short nasal bone because not true sagittal

    
    
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    Fetal head is tucked down so chin looks small

  
  

Orbits (eyes)

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  Technique: Axial view through orbits

  
  
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  Structures seen: Orbits, lens of eyes

  
  
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  Pitfalls

  
  
  
  
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    Central hyaloid canal/artery (thin line extending from lens to dorsal orbit) not to be confused with anomaly

    
    
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    Off-axis view may make one orbit look small

  
  

Nuchal fold (measure 16-20 weeks)

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  Technique: Standard angulated (< 15⁰) view through posterior fossa includes neck skin

  
  
  
  
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    Measure from outer skull to skin/fluid interface

  
  
  
  
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  Structures seen

  
  
  
  
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    Nuchal skin (should be < 6 mm)

    
    
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    Additional posterior fossa structures include cerebellum, vermis, cisterna magna

  
  
  
  
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  Pitfalls

  
  
  
  
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    Overangulation causes false thickened nuchal fold (measuring too much of lower neck skin)

    
    
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    Including skull in measurement

  
  

Maxilla

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  Sagittal view: Box-like and without disruption

  
  
  
  
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    Any disruption > 2 mm suggests cleft palate

    
    
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    Appearance of flattened midface is abnormal

    
    
    
    
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      Measure maxilla-nasion-mandible angle (MNM)

    
    

  
  
  
  
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  Axial view: Show curved intact anterior maxilla

Mandible

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  Sagittal view: Frontal margin only slightly behind maxilla front margin

  
  
  
  
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    Measure MNM angle if profile is abnormal

  
  
  
  
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  Axial view: Measure jaw index if mandible is small

Ears

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  Coronal, sagittal, 3D views best to show ear position

  
  
  
  
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    Top of ear at medial eye level

  
  
  
  
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  Normal ear length is ~ 1/3 biparietal diameter

Thyroid

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  Axial view: At level of maximum diameter of gland

  
  
  
  
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    Fluid-filled central airway and peripheral neck vessels flank thyroid gland

  
  
  
  
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  Measure thyroid circumference: Compare to published normative data

Multiplanar capacity allows for evaluation of normal anatomy in challenging fetal position cases

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  Example: Coronal view of face is obtainable but profile is not because of fetal position

  
  
  
  
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    Obtain 3D volume in coronal plane and manipulate images in orthogonal planes to get good profile view

  
  

Better evaluation of facial anomalies

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  Cleft lip/palate

  
  
  
  
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    Soft tissue views show extent of defect to family and maxillofacial team

    
    
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    Palate defects seen best with multiplanar views and bone rendered views

  
  
  
  
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  Ear anomalies seen best with 3D

  
  
  
  
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    Helix anomalies, deficient ear

    
    
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    Ear position on face

  
  
  
  
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  Complex face anomalies and facial characteristics associated with syndromes

  
  
  
  
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    More easily identified with photograph-like 3D images than with multiple 2D views in different planes