The Impact of Training on the Detection of Facial Clefts

Abstract

The incidence of facial clefting is approximately one in 750 live births, broadly similar to that of the live birth incidence of Down's syndrome. There is considerable variation within the UK in the prenatal detection of facial clefts by ultrasound, with sensitivities varying from 17.5 to 75%. Evaluation of published guidelines for sonographers aimed at improving their knowledge of facial clefting has demonstrated a positive response to their usefulness in the workplace. The preliminary results of a 2-year study assessing the longer-term impact of the guidelines show an increase in the prenatal detection of facial clefts. The face should be imaged in coronal, transverse and sagittal planes to exclude clefting of the upper lip or alveolus. The necessary views are easily learnt by sonographers already experienced in routine anomaly screening. Although clefting of the palate may be identified, the normal palate cannot normally be adequately imaged. Parents should be made aware that examining the face using these techniques will not, therefore, exclude an isolated cleft palate. Departments should be encouraged to incorporate adequate evaluation of the face into their routine anomaly protocols in order that the prenatal detection of facial clefts may be improved.