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Absent 'superimposed-line' sign: novel marker in early diagnosis of cleft of fetal secondary palate.
Ultrasound Obstet Gynecol. 2020 12; 56(6):906-915.UO

Abstract

OBJECTIVES

To describe a novel sign, the 'superimposed-line' sign, for early diagnosis of cleft of the fetal secondary palate on two-dimensional imaging of the vomeromaxillary junction in the midsagittal view.

METHODS

This was a prospective evaluation of the superimposed-line sign using two-dimensional sonography (midsagittal view) in 9576 singleton fetuses referred for routine screening between 12 and 20 weeks of gestation. In this view, the vomer bone appears as a line superimposed on the distal two-thirds of the maxillary line, as the vomer fuses with the secondary palate in the midline. If there is a midline cleft of the secondary palate, the line formed by the palate is absent and hence only the vomer bone is visualized, creating a single line instead of the normal superimposed double line. Multiplanar three-dimensional (3D) views were assessed in cases in which the superimposed-line sign was absent.

RESULTS

The superimposed line was absent in 17 fetuses with a cleft of the secondary palate that was confirmed by 3D evaluation. Of these, 13 had defects involving the premaxilla and four had an isolated cleft of the secondary palate. Postnatal confirmation was available in all cases. The sign was useful in ruling out cleft of the fetal secondary palate in 32 high-risk cases with a family history of cleft palate. The superimposed-line sign had a sensitivity of 89.5% in detecting cleft of the secondary palate.

CONCLUSIONS

The superimposed-line sign is a new sonographic marker for evaluation of cleft of the fetal secondary palate; documentation of this sign proves the presence of both the palate and vomer in the midline. This marker can be demonstrated clearly in the late first trimester, allowing early diagnosis of secondary palatine cleft. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Authors+Show Affiliations

Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India.Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India.Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India.Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India.Shri Lakshmi Clinic and Scan Centre, Department of Fetal Medicine, N.C.R. Complex, Kaveripattinam, Krishnagiri, Tamil Nadu, India.

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

31763719

Citation

Lakshmy, S R., et al. "Absent 'superimposed-line' Sign: Novel Marker in Early Diagnosis of Cleft of Fetal Secondary Palate." Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, vol. 56, no. 6, 2020, pp. 906-915.
Lakshmy SR, Rose N, Masilamani P, et al. Absent 'superimposed-line' sign: novel marker in early diagnosis of cleft of fetal secondary palate. Ultrasound Obstet Gynecol. 2020;56(6):906-915.
Lakshmy, S. R., Rose, N., Masilamani, P., Umapathy, S., & Ziyaulla, T. (2020). Absent 'superimposed-line' sign: novel marker in early diagnosis of cleft of fetal secondary palate. Ultrasound in Obstetrics & Gynecology : the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology, 56(6), 906-915. https://doi.org/10.1002/uog.21931
Lakshmy SR, et al. Absent 'superimposed-line' Sign: Novel Marker in Early Diagnosis of Cleft of Fetal Secondary Palate. Ultrasound Obstet Gynecol. 2020;56(6):906-915. PubMed PMID: 31763719.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Absent 'superimposed-line' sign: novel marker in early diagnosis of cleft of fetal secondary palate. AU - Lakshmy,S R, AU - Rose,N, AU - Masilamani,P, AU - Umapathy,S, AU - Ziyaulla,T, PY - 2019/02/09/received PY - 2019/10/25/revised PY - 2019/11/12/accepted PY - 2019/11/26/pubmed PY - 2021/12/1/medline PY - 2019/11/26/entrez KW - 2D ultrasound KW - 3D ultrasound KW - cleft lip and palate KW - cleft palate KW - screening KW - secondary palate KW - superimposed line SP - 906 EP - 915 JF - Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology JO - Ultrasound Obstet Gynecol VL - 56 IS - 6 N2 - OBJECTIVES: To describe a novel sign, the 'superimposed-line' sign, for early diagnosis of cleft of the fetal secondary palate on two-dimensional imaging of the vomeromaxillary junction in the midsagittal view. METHODS: This was a prospective evaluation of the superimposed-line sign using two-dimensional sonography (midsagittal view) in 9576 singleton fetuses referred for routine screening between 12 and 20 weeks of gestation. In this view, the vomer bone appears as a line superimposed on the distal two-thirds of the maxillary line, as the vomer fuses with the secondary palate in the midline. If there is a midline cleft of the secondary palate, the line formed by the palate is absent and hence only the vomer bone is visualized, creating a single line instead of the normal superimposed double line. Multiplanar three-dimensional (3D) views were assessed in cases in which the superimposed-line sign was absent. RESULTS: The superimposed line was absent in 17 fetuses with a cleft of the secondary palate that was confirmed by 3D evaluation. Of these, 13 had defects involving the premaxilla and four had an isolated cleft of the secondary palate. Postnatal confirmation was available in all cases. The sign was useful in ruling out cleft of the fetal secondary palate in 32 high-risk cases with a family history of cleft palate. The superimposed-line sign had a sensitivity of 89.5% in detecting cleft of the secondary palate. CONCLUSIONS: The superimposed-line sign is a new sonographic marker for evaluation of cleft of the fetal secondary palate; documentation of this sign proves the presence of both the palate and vomer in the midline. This marker can be demonstrated clearly in the late first trimester, allowing early diagnosis of secondary palatine cleft. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd. SN - 1469-0705 UR - https://www.unboundmedicine.com/medline/citation/31763719/Absent_'superimposed_line'_sign:_novel_marker_in_early_diagnosis_of_cleft_of_fetal_secondary_palate_ L2 - https://doi.org/10.1002/uog.21931 DB - PRIME DP - Unbound Medicine ER -