OP23.06: Prenatal diagnosis and prognosis of the unilateral cleft lip and palate ( UCLP ): interest of the three‐dimensional axial view

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To define the prenatal sonographic criteria for UCLP according to a new postnatal prognostic classification. Delestan postnatal UCLP classification is defined by the maxillary cast visualised at birth. It includes four groups (1 to 4) one of which one, group 3, is associated with a poor surgical prognosis (width cleft, short lower maxillary bone, and curvilinear nasal septum (NS)). Every case of fetal UCLP between 2006 and 2011 in Montpellier Hospital Center was reviewed. 3D axial plane images and multiplanar rendering images were extracted and interpreted both by an independent sonographer (operator 1) and maxillofacial surgeon (operator 2) in order to asses inter and intra-observer variability. The evaluation criteria were based on the symmetry of the palate, the shape of the NS and the measurement of the septal deviation (in degrees). Then, a biometric analysis was undertaken according to the different classes. 16 fetuses were included in the study with a median gestational age at 3D acquisition of 28 weeks (22 to 34 weeks). The reliability was moderate. The mean normalised width of cleft was for operator 1 (group 2: 7.2 mm+/−3.4, group 3: 12 mm+/−2.2, group 4: 11.4 mm+/−1.9) and for the operator 2 (group 2: 7.6 mm+/−2.6, group 3: 13.1 mm+/−2.3, group 4: 10.2 mm+/−3.1). The mean septal deviation for operator 1 was: group 2: 10.9°+/−6, group 3: 20.8°+/−1.4, group 4: 14.2°+/−2; and for the operator 2 was: group 2: 8.6°+/−7.2, group 3: 20.5°+/−2.3, group 4: 15.7°+/−3.3. This study enabled us to apply postnatal classification to prenatal images: group 1 (harmonious form, alveolar notch and rectilinear septum), group 2 (harmonious form, rectilinear septum and width cleft < 10 mm), group 3 (dysharmonious form, curvilinear septum, large cleft and septal deviation) and group 4 (dysharmonious form, rectilinear septum, small septal deviation and large cleft). This method also enabled us to build a diagnostic organogram with the classification that could be used for parents during prenatal counselling.

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