The Hard Palate Sweep: a multiplanar 2-dimensional sonographic method for the prenatal detection of cleft palate.

BACKGROUND: Prenatal diagnosis of cleft palate is challenging. Numerous 2-dimensional and 3-dimensional methods have been proposed to assess the integrity of the fetal palate, yet detection rates remain relatively low. We propose the "Hard Palate Sweep," a novel 2-dimensional method that enables clear demonstration of the entire fetal palate throughout pregnancy, in a single sweep, avoiding acoustic shadows cast by surrounding bones. OBJECTIVE: This study aimed to assess the feasibility and performance of the Hard Palate Sweep, performed throughout pregnancy. STUDY DESIGN: This was a prospective cross-sectional study performed between 2018 and 2022 in pregnant patients referred for a routine or targeted anomaly scan between 13 and 40 weeks of gestation. The presence or absence of a cleft palate was determined using the "Hard Palate Sweep." This was compared with the postnatal palate integrity assessment. Test feasibility and performance indices, including sensitivity, specificity, and positive and negative predictive values were calculated. Offline clips were reviewed by 2 investigators for the assessment of inter- and intraoperator agreement, using Cohen's kappa formula. The study protocol was approved by the institutional ethics committee. All participating patients were informed and provided consent. RESULTS: A total of 676 fetuses were included in the study. The Hard Palate Sweep was successfully performed in all cases, and 19 cases were determined to have a cleft palate. Of these, 13 cases were excluded because postmortem confirmation was not performed, leaving 663 cases available for analysis. Six cases determined to have a cleft palate were confirmed postnatally. In 655 of 657 cases prenatally determined to have an intact palate, this was confirmed postnatally. In the 2 remaining cases, rare forms of cleft palate were diagnosed postnatally, rendering 75% sensitivity, 100% specificity, 100% positive predictive value, and 99.7% negative predictive value for the Hard Palate Sweep (P<.001). There was complete intra- and interoperator agreement (kappa=1; P<.0001). CONCLUSION: The Hard Palate Sweep is a feasible and accurate method for prenatally detecting a cleft palate. It was successfully performed in all attempted cases between 13 and 40 weeks of gestation. This method is reproducible, offering high sensitivity and specificity. Implemented routinely, the Hard Palate Sweep is expected to increase the prenatal detection of cleft palate.

Occurrence and characteristics of head cysts in children.

BACKGROUND: Lumps arising in the head and neck constitute an important diagnostic category in children. As malignancy in this age group is relatively rare, lumps that are not due to inflammatory or infective causes often prove to be cysts. Correct diagnoses of the different subcutaneous lumps are often missed because of the lack of recognition or uncertainty with management. OBJECTIVES: The purpose of this study was to review the characteristics of most common pediatric cysts appearing in the head. METHODS: A retrospective study was designed to review all the children treated for a cyst in the head during the 12-year period from 1995 to 2007. Study patients had a preoperative diagnosis of a cyst in the head, were younger than 11 years at the time of the diagnosis, and had received a surgical treatment for the condition. The pathological specimens were revised with an expert dermatopathologist, and the clinical data were statistically analyzed. RESULTS: Of the 90 cysts, 53 were dermoid cysts (58.88%), 16 were diagnosed as pilomatrixomas (17.77%), 5 cysts were diagnosed as branchial cysts (5.55%), and 12 were diagnosed as epidermal cyst (13.33%). Male gender and younger age were significantly associated with correct diagnosis of dermoid cysts (P <.05). CONCLUSIONS: Ninety-five percent of the cysts fell in 1 of the 4 following categories: dermoid cyst, pilomatrixoma, epidermal cyst, and branchial arch cyst. Dermoid cysts were the most common facial cysts (60%). Correct preoperative diagnosis was more accurate in cases of dermoid and branchial cysts.