• Enrico Vezzetti Politecnico di Torino
  • Domenico Speranza Università degli Studi di Cassino e del Lazio Meridionale
  • Federica Marcolin Politecnico di Torino
  • Giulia Fracastoro Politecnico di Torino




cleft lip, dysmorphisms, landmarking, syndrome diagnosis, 3D ultrasound


The aim of this work is to automatically diagnose and formalize prenatal cleft lip with representative key points and identify the type of defect (unilateral, bilateral, right, or left) in three-dimensional ultrasonography (3D US). Geometry has been used as a framework for describing facial shapes and curvatures. Then, descriptors coming from this field are employed for identifying the typical key points of the defect and its dimensions. The descriptive accuracy of these descriptors has allowed us to automatically extract reference points, quantitative distances, labial profiles, and to provide information about facial asymmetry. Eighteen foetal faces, ten of healthy foetuses and eight with different types of cleft lips, have been obtained through a Voluson system and used for testing the algorithm. Cleft lip has been diagnosed and correctly characterized in all cases. Transverse and cranio-caudal length of the cleft have been computed and upper lip profile has been automatically extract to have a visual quantification of the overall labial defect. The asymmetry information obtained is consistent with the defect. This algorithm has been designed to support practitioners in identifying and classifying cleft lips. The gained results have shown that geometry might be a proper tool for describing faces and for diagnosis.

Author Biographies

Enrico Vezzetti, Politecnico di Torino

Department of Management and Production Engineering

Domenico Speranza, Università degli Studi di Cassino e del Lazio Meridionale

Dipartimento di Ingegneria Civile e Meccanica

Federica Marcolin, Politecnico di Torino

Department of Management and Production Engineering

Giulia Fracastoro, Politecnico di Torino

Department of Management and Production Engineering


Bäumler, M., Faure, J.M., Bigorre, M., Bäumler-Patris, C., Boulot, P., Demattei, C., Captier, G., 2011. Accuracy of prenatal three-dimensional ultrasound in the diagnosis of cleft hard palate when cleft lip is present. Ultrasound Obstet Gynecol 38, 440–444.

Calignano, F., and Vezzetti, E., 2010. Soft tissue diagnosis in maxillofacial surgery: a preliminary study on three-dimensional face geometrical features-based analysis. Aesthetic plastic surgery 34(2), 200-211.

Campbell, S., Lees, C., Moscoso, G., and Hall, P., 2005. Ultrasound antenatal diagnosis of cleft palate by a new technique: the 3D ‘reverse face’ view. Ultrasound Obstet Gynecol 25, 12-18.

Carlson, D.E., 2000. Opinion ― The ultrasound evaluation of cleft lip and palate―a clear winner for 3D. Ultrasound Obstet Gynecol 16, 299-301.

Demircioglu, M., Kangesu, L., Ismail, A., Lake, E., Hughes, J., Wright, S., and Sommerlad, B.C., 2008. Increasing accuracy of antenatal ultrasound diagnosis of cleft lip with or without cleft palate, in cases referred to the North Thames London Region. Ultrasound Obstet Gynecol 31, 647–651.

Gindes, l., Weissmann-Brenner, A., Zajicek, M., Weisz, B., Shrim, A., Geffen, K.T., Mendes, D., Kuint, J., Berkenstadt, M., and Achiron, R., 2013. Three-dimensional ultrasound demonstration of the fetal palate in high-risk patients: the accuracy of prenatal visualization. Prenatal Diagnosis 33, 436–441.

Grandjean, H., Larroque, D., Levi, S., 1999. The performance of routine ultrasonographic screening of pregnancies in the Eurofetus Study. Am J Obstet Gynecol 181(2), 446-54.

Hata, T., Yonehara, T., Aoki, S., Manabe, A., Hata, K., and Miyazaki, K., 1998. Three-Dimensional Sonographic Visualization of the Fetal Face. American Journal of Roentgenology 170(February), 481-483.

Luck, C. A., 1992. Value of routine ultrasound scanning at 19 weeks: a four year study of 8849 deliveries. BMJ 304(6840): 1474-8.

Johnson, D.D., Pretorius, D.H., Budorick, N.E., Jones, M.C., Lou, K.V., James, G.M., and Nelson, T.R., 2000. Fetal Lip and Primary Palate: Three-dimensional versus Two-dimensional US. Radiology 217(1), 236–239.

Jones, M.C., 1993. Facial clefting. Etiology and developmental pathogenesis. Clin Plast Surg 20(4): 599-606.

Lee, W., Kirk, J.S., Shaheen, K.W., Romero, R., Hodges, A.N., and Comstock, C.H., 2000. Fetal cleft lip and palate detection by three-dimensional ultrasonography. Ultrasound Obstet Gynecol 16, 314-320.

Maarse, W., Bergé, S.J., Pistorius, L., Van Barneveld, T., Kon, M., Breugem, C., Mink van der Molen, A.B., 2010. Diagnostic accuracy of transabdominal ultrasound in detecting prenatal cleft lip and palate: a systematic review. Ultrasound Obstet Gynecol 35, 495–502.

Mailáth-Pokorny, M., Worda, C., Krampl-Bettelheim, E., Watzinger, F., Brugger, P.C., and Prayers, D., 2010. What does magnetic resonance imaging add to the prenatal ultrasound diagnosis of facial clefts?. Ultrasound Obstet Gynecol 36, 445–451.

Manganaro, L., Tomei, A., Fierro, F., Di Maurizio, M., Sollazzo, P., Sergi, M.E., Vinci, V., Bernardo, S., Irimia, D., Cascone, P., and Marini, M., 2011. Fetal MRI as a complement to US in the evaluation of cleft lip and palate. Radiol med 116, 1134–1148.

Martinez-Ten, P., Adiego, B., Illescas, T., Bermejo, C., Wong, A.E., and Sepulveda W. 2012. First-trimester diagnosis of cleft lip and palate using three-dimensional ultrasound. Ultrasound Obstet Gynecol 40, 40–46.

Mittermayer, C. and Lee, A., 2003. Picture of the Month ― Three-dimensional ultrasonographic imaging of cleft lip: the winners are the parents. Ultrasound in Obstetrics and Gynecology 21, 628-629.

Offerdal, K., Jebens, N., Syvertsen, T., Blaas, H.G., Johansen, O.J., Eik-Nes, S.H., 2008. Prenatal ultrasound detection of facial clefts: a prospective study of 49,314 deliveries in a non-selected population in Norway. Ultrasound Obstet Gynecol 31(6): 639-46.

Platt, L.D., DeVore, G.R., and Pretorius, D.H., 2006. Improving Cleft Palate/Cleft Lip Antenatal Diagnosis by 3-Dimensional Sonography ― The “Flipped Face” View. J Ultrasound Med 25, 1423–1430.

Pretorius, D.H., House, M., Nelson, T.R., and Hollenbach, K.A., 1995. Evaluation of Normal and Abnormal Lips in Fetuses: Comparison Between Three- and Two-Dimensional Sonography. American Journal of Roentgenology 165(5), 1233-1237.

Riccabona, M., Pretorius, D.H., Nelson, T.R., Johnson, D., and Budorick, N.E., 1997. Three-Dimensional Ultrasound: Display Modalities in Obstetrics. J Clin Ultrasound 25(4), 157–167.

Roelfsema, N.M., Hop, W.C.J., Van Adrichem, L.N.A., and Wladimiroff, J.W., 2007. Craniofacial variability index determined by three-dimensional ultrasound in isolated vs. syndromal fetal cleft lip/palate. Ultrasound Obstet Gynecol 29, 265–270.

Rotten, D. and Levaillant, J.M., 2004. Two- and three-dimensional sonographic assessment of the fetal face. 1. A systematic analysis of the normal face. Ultrasound Obstet Gynecol 23, 224-231.

Sepulveda, W., Wong, A.E., Martinez-Ten, P., and Perez- Pedregosa, J., 2010. Retronasal triangle: a sonographic landmark for the screening of cleft palate in the first trimester. Ultrasound Obstet Gynecol 35, 7–13.

Tonni, G. and Lituania, M., 2012. OmniView Algorithm ― A Novel 3-Dimensional Sonographic Technique in the Study of the Fetal Hard and Soft Palates. J Ultrasound Med 31, 313–318.

Tonni, G. and Lituania, M., 2013. Arthrogryposis multiplex congenita-like syndrome associated with median cleft lip and palates: First prenatally detected case. Congenital Anomalies 53, 137–140.

Vezzetti, E., and Marcolin, F., 2012. 3D human face description: landmarks measures and geometrical features. Image and Vision Computing 30(10), 698-712.

Vezzetti, E., and Marcolin, F., 2012. Geometrical descriptors for human face morphological analysis and recognition. Robotics and Autonomous Systems 60(6), 928-939.

Vezzetti, E., and Marcolin, F., 2012. Geometry-based 3D face morphology analysis: soft-tissue landmark formalization. Multimedia Tools and Applications 68(3), 895-929.

Vezzetti, E., and Marcolin, F., 2014. 3D Landmarking in Multiexpression Face Analysis: A Preliminary Study on Eyebrows and Mouth. Aesthetic Plastic Surgery 38(4), 796-811.

Vezzetti, E., Calignano, F., Moos, S., 2010. Computer-aided morphological analysis for maxillo-facial diagnostic: a preliminary study. Journal of Plastic, Reconstructive & Aesthetic Surgery 63(2), 218-226.

Vezzetti, E., Marcolin, F., Fracastoro, G., 2014. 3D face recognition: An automatic strategy based on geometrical descriptors and landmarks. Robotics and Autonomous Systems 62(12), 1768-1776.

Vezzetti, E., Marcolin, F., Stola, V., 2013. 3D Human Face Soft Tissues Landmarking Method: An Advanced Approach. Computers in Industry 64(9), 1326–1354.

Vezzetti, E., Moos, S., Marcolin, F., 2011. Three-Dimensional Human Face Analysis: Soft Tissue Morphometry. Proceedings of the InterSymp 2011. Baden-Baden, Germany.

Vezzetti, E., Moos, S., Marcolin, F., Stola, V., 2012. A pose-independent method for 3D face landmark formalization. Computer Methods and Programs in Biomedicine 198(3), 1078-1096.

Vezzetti, E., Speranza, D., Marcolin, F., Fracastoro, G. 2014. Exploiting 3D Ultrasound for Fetal Diagnosis Purpose through Facial Landmarking. Image Analysis & Stereology 33(3), 167-188.




How to Cite

Vezzetti, E., Speranza, D., Marcolin, F., & Fracastoro, G. (2015). DIAGNOSING CLEFT LIP PATHOLOGY IN 3D ULTRASOUND: A LANDMARKING-BASED APPROACH. Image Analysis and Stereology, 35(1), 53–65. https://doi.org/10.5566/ias.1339



Original Research Paper

Most read articles by the same author(s)