Paranasal echogenic mass: sonographic sign of bilateral complete cleft lip and palate before 20 menstrual weeks.

A paranasal echogenic mass identified at ultrasound performed during the second trimester was the initial and primary clue to the presence of bilateral complete cleft lip and palate in four fetuses. Referral had been for dating purposes in three cases and because of high maternal serum alpha-fetoprotein level in one. Genetic amniocentesis revealed deletion of the 15th chromosome in one case. The clefts were small and difficult to visualize; the finding of the echogenic mass (representing a premaxillary protrusion) therefore added confidence to the diagnosis.