Anterior facial Masses
· Premaxillary protrusion- The abnormality may occur with complete cleft lip and palate and is usually seen with other types of facial clefting. Sonographicallv the PMP may be more obvious than the underlying cleft and may be an important clue to diagnosis.
· Probsces in holoprosencephaly- A proboscis may be sited above a single median orbit (cyclopia) or as a fleshy primitive nose with a single nostril but normally sited. The fetus may have two orbits, have hypotelorism with associated probosces and an absent nose(cebocephaly.) Midline facial clefring has also been recorded. Significant association with chromosome abnormality.
· Teratoma- Teratomas (other than epignathus may occur on the facial surface and in common with other teratomas present as a complex mass on sonography with some cyst elements. They may calcify.
· Anterior encephalocele/ meningocele- These represent either herniation of meninges through a calvarial defect (cranial meningocele) or the herniation of brain and meninges (true encephalocele). The majority occurs in the occipital midline but 13% occur in the frontal midline. Absence of brain tissue within a cranial meningocele is an important favourable prognostic sign.
Anterior encephalocele/ meningocele
· Enlarged protruding tongue- This may be associated with a tumor such as a teratoma or may occur as part of an organomegaly syndrome (Beckwith—Wiede mann). Beckwith—Wiedemann syndrome is associated with omphalocele, macroglossia gigantism, pancreatic hyperplasia and PH. There is an increased incidence of Wilms’ tumors and hepatoblastomas.
Enlarged protruding tongue
· Hemangioma- Hemangiomas can occur anywhere in the body. They may present as mixed or solid masses. Actual flow or pulsations help to identify their origin. Duplex Dopper may be diagnostic.
· Epignathus- This is a benign teratomatous tumor arising from the sphenoid, nose, pharynx, tongue or jaw. The sonographic appearances are those of a lobular complex mass, primarily solid but with some cystic components. They may contain calcification.
· Exophthalmos- This has been reported in association with Crouzon’s syndrome (craniofacial dysostosis); other features of the syndrome include a deformed skull, mandibular prognathism, small maxilla, ocular hypertelorism and hydrocephalus.
· • Dacryocystocele - A lacrimal duct cyst which can be identified as a small hypoechoic mass inferomedial to the orbit. They do not have a mass effect on the orbit and most resolve spontaneously after birth.
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