Pathogenesis of cleft palate in Robin sequence: Observations from prenatal MRI

Publication date: Available online 16 October 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Cory M. Resnick, Judy A. Estroff, Tessa D. Kooiman, Carly E. Calabrese, Maarten J. Koudstaal, Bonnie L. Padwa
PurposeThe etiology of the palatal cleft in Robin sequence (RS) is unknown. The purpose of this study was to assess position of the fetal tongue on prenatal magnetic resonance imaging (MRI) and to suggest a potential relationship between tongue position and development of the cleft palate seen in the majority patients with RS.MethodsThis is a retrospective case-control study including fetuses with prenatal MRIs performed in our center from 2002-2017. Inclusion criteria were: (1) prenatal MRI of adequate quality, (2) live-born infant, and (3) postnatal diagnosis of Robin sequence ("Robin" group) or cleft lip and palate ("CLP" group). Subjects with postnatal RS without a palatal cleft were excluded. A control group with normal facial morphology was gestational-age matched. The outcome variable was tongue position on fetal MRI described as: within the cleft, along the floor-of-mouth, other, or indeterminate.Results122 subjects with mean gestational age at MRI of 25.8±4.9 weeks were included: Robin, n=21 (17%), CLP, n=47 (39%), control, n=54 (44%). The tongue was visualized within the palatal cleft in 76.2% of the Robin group and 4.3% of the CLP group. The tongue was found along the floor-of-mouth (normal position) in the remainder of the Robin and CLP groups, and in 100% of the control group.ConclusionThese findings suggest a relationship between in-utero tongue position and the development of a cleft palate in RS.



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