The evaluation of the craniofacial region is a multistep process. First, sonographic skill and expertise are required to ascertain these often subtle abnormalities. Next, precise measurements must be obtained in appropriate and reproducible planes. Finally, a thorough search for other related fetal anomalies is essential. Exciting breakthroughs in our understanding of underlying courses and mechanisms can now guide the practitioner not only in deciding whether or not to pursue invasive testing, but which tests to order, particularly if molecular diagnosis may be required. Complementary advances in ultrasound technology, prenatal diagnosis, and genetic research will have the potential to enhance the accuracy of our counseling, management, and overall care of our patients.