Facial Mass



Facial Mass


Roya Sohaey, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Premaxillary Protrusion



    • Cleft Lip, Palate


  • Proboscis


Less Common



  • Epignathus


  • Frontal Encephalocele


Rare but Important



  • Preauricular Tags


  • Orbital Tumors


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Routine views of fetal face



    • Profile



      • Nasal bone assessment


      • Rule out micrognathia


    • Orbit



      • Axial and coronal views


      • Note distance between eyes


    • Nose and lip assessment



      • Coronal soft tissue view


  • 3D ultrasound technique



    • Acquisition best from profile view


    • Need fluid in front of face


    • Soft tissue rendered views



      • Assess eyes, nose and lips on one image


    • Bone rendered views



      • Bony palate


      • Sutures


  • 4D ultrasound



    • 3D in real time = 4D


    • Static 3D has better resolution


  • MR



    • Better delineation of extension of masses


    • Best for associated subtle brain anomalies


Helpful Clues for Common Diagnoses



  • Premaxillary Protrusion



    • From bilateral cleft lip, palate



      • Bilateral cleft palate leaves midline “island” of dysplastic maxillary tissue


      • Axial palate view shows defects best


      • Profile view shows mass-like structure


      • 3D shows mass under nose


    • May be seen with unilateral cleft lip/palate



      • Large cleft palate defect


      • Alveolar ridge anteriorly displaced


      • Palate protuberance on profile view


      • 3D shows morphology best


    • Cleft lip, palate (CL/CP) classification



      • Type 1: Unilateral CL only


      • Type 2: Unilateral CL/CP


      • Type 3: Bilateral CL/CP


      • Type 4: Midline CL/CP


  • Proboscis



    • Tube-like soft tissue midface structure



      • Proboscis instead of normal nose


      • Superior to eyes or between eyes


      • May lie flush with forehead


    • Orbit anomalies with proboscis



      • Cyclopia


      • Hypotelorism


    • Holoprosencephaly association



      • Alobar


      • Semilobar


    • Aneuploidy



      • Trisomy 13 most common


      • Trisomy 18


Helpful Clues for Less Common Diagnoses



  • Epignathus



    • Teratoma



      • Arises from oral or nasal cavity


      • Calcification in 50% (diagnostic)


    • Large, fungating oral mass



      • Fills oral cavity then emanates from mouth and/or nose


    • Can have intracranial extension



      • Transsphenoidal extension


      • Extra-axial mass


    • Polyhydramnios from impaired swallowing


    • MR



      • Helpful in determining extent of mass


      • Can identify fat within lesion


  • Frontal Encephalocele



    • Skull defect in frontoethmoidal region with herniation of intracranial structures



      • Skin-covered


    • Nasofrontal



      • Between frontal and nasal bones


    • Nasoethmoidal



      • Between nasal bones and nasal cartilage


    • Nasoorbital



      • Through medial orbital defect


    • Associated with other midline anomalies



      • Hypertelorism


      • Corpus callosum anomalies


      • Heterotopia


      • Interhemispheric lipoma



    • Most common in Southeast Asia



      • 1:1,000


    • Better prognosis than occipital or parietal encephaloceles


Helpful Clues for Rare Diagnoses

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Aug 10, 2016 | Posted by in OBSTETRICS | Comments Off on Facial Mass

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