First-Trimester Diagnosis of Fetal Epignathus With 2-and 3-Dimensional Sonography

Epignathus is a teratoma that arises from the base of the skull and is located in the oral cavity It usually involves the posterior nasopharynx, hard palate, or sphenoid bone and occurs with a reported incidence ranging between 1 per 35,000 to 1 per 200,000 live births.(1) Most cases are isolated, and only rarely has it been associated with an abnormal chromosomal milieu.(2,3) The prenatal diagnosis of fetal epignathus has been reported infrequently since the first report by Kang et al(4) more than 30 years ago. In all reported cases, the diagnosis was made in the second(5-7) or third(8-10) trimester, which in most countries precludes patients from having the option of pregnancy termination. Advancements in sonographic imaging with the addition of 3-dimensional (3D) volume rendering now allow for an early and accurate diagnosis, which is key for expert counseling and an informed decision. We report prenatal diagnosis of fetal epignathus in the first trimester and the incorporation of 3D sonography in the evaluation to further improve counseling.