22/05/2023 at 9:02 pm #49938Sara QuixleyParticipant
Do you have any tips and tricks for fetal uvula/soft palate and hard palate assessment?
My colleagues and I have been trying to get uvula view lately, ooooo it’s so tricky…
It’ll be great if you can make a video to share your tips and tricks!
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23/05/2023 at 4:41 pm #49984Stephen BirdKeymaster
Yes, these clefts are really tricky.
If there is a cleft lip I think it is pretty simple, but when the cleft involves the hard palate or the soft palate and not the lip, that is where I think it is really tough.
The articles you have attached are really great articles which I have enjoyed previously and have not read any better explanations.
With the uvula, you have read there is a sagittal and an axial technique described.
Personally I find the sagittal technique really hard, but fortunately I find the axial technique quite simple.
If you start from a standard BPD plane and then scan axially directly down towards the babies neck without changing the angle of the transducer you will see the petrous temporal bones appear as well as the orbits. At this pointy I magnify the image to keep the orbits and the anterior half of the brain as you are really only interested in the airway and the palate / lips of the baby from this point on. This maximises your image quality. Then keep scanning down and as you exit the orbits you enter the palate area and you will see the arch shaped maxilla with the “bat” shaped palate. Just posterior to the “bat” you sill see the airway and it will be black as it is full of liquor. At this point you should see the “equal sign” of the uvula, just posterior to the “bat”. As you are in a perfect “BPD axial” plane you hit the uvula at the perfect angle to get the two specular reflections of the “equal sign”. If the baby is swallowing or breathing you might find when you get to the level you are expecting to see the uvula there is in fact no airway seen behind the “bat” palate and this is quite common. Just stay there for a few seconds and you will see the airway open again with liquor and you should be looking at a nice uvula.
I think of the uvula as being the very anterior part of the soft palate so you should have no liquor extending anterior the uvula or the expected uvula position. If you have an anechoic cleft extending anterior from this position I would be concerned.
I can’t help you with the sagittal technique as I am crap at it !
But in the first trimester remember when you are doing nuchal translucency scans or 1st trimester morphology assessment to look at the hard palate. It is a dense, bright, continuous line of bone. You see it well when you have the perfect nuchal translucency or nasal bone image, you just have to remind your eyes to look at it carefully and not be sidetracked by your beautiful nuchal or nasal bone image and miss the obvious hole.
I will talk to some of my colleagues and see if I can dredge up enough cases to put together a presentation on clefts.
I think it would be a popular topic and certainly one I would enjoy writing and recording,
23/05/2023 at 8:14 pm #49996Sara QuixleyParticipant
Thanks again for your excellent explanation! I can’t wait to try it out tomorrow 😃 you make it sound simple and doable. Would you mind if I share your this with my colleagues?
Thank you very much!
23/05/2023 at 9:15 pm #49998Stephen BirdKeymaster
Please share it with everyone interested,
If you ever work out the sagittal technique please let me know!
Please let your colleagues know they can read it first hand along with everything else via this website.
As I am presenting at the ASA conference this weekend they can use a coupon code: asa2023
This is currently active and will give them a discount.
Please let me know how you go with the technique I have described.
The nice thing about the axial technique is everything is done in a pure axial plane which all sonographers are very used to scanning in.
If you are going to ASA in Brisbane please come and say hi,
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