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Romeo DJ, Oral KT, Massenburg BB, Ng JJ, Wu M, Sussman JH, Du S, Bartlett SP, Swanson JW, Taylor JA. Nasal Airway Volumes are More Asymmetric in Skeletally Mature Patients With Cleft lip and Palate Than Controls on 3-Dimensional Analysis. J Craniofac Surg 2024:00001665-990000000-01533. [PMID: 38710067 DOI: 10.1097/scs.0000000000010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/08/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND This study assesses nasal airway volumes in skeletally mature patients with CLP and healthy controls and examines the relationship among nasal volumes, cleft laterality, and facial asymmetry. METHODS Computed tomography images from patients with CLP and controls were analyzed using Mimics Version 23.0 (Materialise, Leuven, Belgium). Relationships among nasal airway volume, cleft laterality, and facial asymmetry were compared. RESULTS The 89 patients in this study included 66 (74%) CLP and 23 (17%) controls. Nasal airway volumes in CLP were more asymmetric than controls (26.8±17.5% vs. 17.2±14.4%; P=0.015). In UCLP, the smaller nasal airway was on the cleft side 81% of the time (P<0.001). Maximum airway stenosis was on the cleft side 79% of the time (P<0.001), and maximum stenosis was on the same side as the smaller airway 89% of the time (P<0.001). There was a mild linear relationship between nasal airway asymmetry and maximum stenosis (r=0.247, P=0.023). On 3-dimensional image reconstruction, the septum often bowed convexly into the cleft-sided nasal airway with a caudal deviation towards the noncleft side. Nasal airway asymmetry was not associated with facial midline asymmetry (P>0.05). CONCLUSION The nasal airway is more asymmetric in patients with cleft lip and palate compared with the general population, with the area of maximum stenosis usually occurring on the cleft-sided airway. In patients with unilateral cleft lip and palate, the septum often bows into the cleft side, reducing the size of that nasal airway. Nasal airway asymmetry did not correlate with facial asymmetry.
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Affiliation(s)
- Dominic J Romeo
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, PA
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Diab AMI, Mohammed BBH, Ghoneim MM, Ali MAM, Özdemir S, Shendy MAM, Boufahja F, Ali MMM. Effect of Slow Maxillary Expansion and Alternative Rapid Maxillary Expansion Protocols on Airway Volume in Cleft Palate Cases: A Cone Beam Computed Tomography Based Study. Cureus 2024; 16:e59534. [PMID: 38826953 PMCID: PMC11144024 DOI: 10.7759/cureus.59534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/04/2024] Open
Abstract
A total of 22 patients with cleft palate aged 8 to 12 years were selected and categorized into two groups: the first group was treated with alternate rapid maxillary expansion and constriction (Alt-RAMEC) using an expander with differential opening (EDO) and facemask, while the second group was treated using slow maxillary expansion (SME) using an EDO. Finally, the pharyngeal airway volume in the two groups was compared using cone beam computed tomography (CBCT). CBCT scans were performed before expansion and six months following the expansion. Alveolar crest level, maxillary breadth, nasal cavity width, arch width, inclination of the molar teeth, buccal and palatal alveolar bone thickness, and maxillary alveolar width were all assessed. Paired t-tests (p=0.05) were applied to compare interphase data. The two groups showed a non-significant difference in terms of nasopharyngeal volume (cm3), oropharyngeal volume (cm3), and overall pre- and post-treatment results (p>0.005). Results of comparison of pre- and post-treatment periods in the Alt-RAMEC group revealed a significantly higher cleft volume (cm3) (p=0.001). Results of comparison of pre- and post-treatment periods in the SME group revealed a substantial rise in cleft volume (cm3) (p=0.003). Results from a comparison of the cleft volume (cm3) between the two study groups pre- and post-intervention revealed a non-significant difference (p=0.200 and 0.054, respectively).
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Affiliation(s)
| | | | - Mohamed M Ghoneim
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Sinai University, El-Arish, EGY
| | - Mohamed A M Ali
- Biology, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
| | | | | | - Fehmi Boufahja
- Biology, Imam Muhammad Ibn Saud Islamic University, Riyadh, SAU
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Russel SM, Chiang H, Finlay JB, Shah R, Marcus JR, Jang DW, Abi Hachem R, Goldstein BJ, Frank-Ito DO. Characterizing Olfactory Dysfunction in Patients with Unilateral Cleft Lip Nasal Deformities. Facial Plast Surg Aesthet Med 2023; 25:457-465. [PMID: 37130297 PMCID: PMC10701508 DOI: 10.1089/fpsam.2022.0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Background: Unilateral cleft lip nasal deformity (uCLND) is associated with olfactory dysfunction, but the underlying etiology remains poorly understood. Objective: To investigate the etiology of uCLND-associated olfactory dysfunction using clinical, computational, and histologic assessments. Methods: Inclusion criteria: uCLND patients >16 years undergoing septorhinoplasty. Exclusion criteria: prior septoplasty or rhinoplasty, pregnancy, sinusitis. Measured outcomes: patient-reported scores, rhinomanometry, smell identification and threshold tests, computational fluid dynamics (CFD) airflow simulations, and histologic analysis of olfactory epithelium. Results: Five uCLND subjects were included: 18-23 years, three male and two female, four left-sided cleft and one right-sided cleft. All subjects reported moderate to severe nasal obstruction. Smell identification and threshold tests showed varying degrees of hyposmia. Nasal resistance was higher on the cleft side versus noncleft side measured by rhinomanometry (median 3.85 Pa-s/mL, interquartile range [IQR] = 21.96, versus 0.90 Pa-s/mL, IQR = 5.17) and CFD (median 1.04 Pa-s/mL, IQR = 0.94 vs. 0.11 Pa-s/mL, IQR = 0.12). Unilateral olfaction varied widely and was dependent on unilateral percentage olfactory airflow. Biopsies revealed intact olfactory neuroepithelium. Conclusions: uCLND-associated olfactory dysfunction appears to be primarily conductive in etiology and highly susceptible to variations in nasal anatomy. Clinical Trial Registration number: NCT04150783.
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Affiliation(s)
- Sarah M. Russel
- Department of Otolaryngology/Head & Neck Surgery, University of North Carolina—Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Harry Chiang
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - John B. Finlay
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Medical Scientist Training Program, Duke University School of Medicine, Durham, North Carolina, USA
| | - Reanna Shah
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeffrey R. Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University, Durham, North Carolina, USA
| | - David W. Jang
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Ralph Abi Hachem
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Bradley J. Goldstein
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurobiology, Duke University, Durham, North Carolina, USA
| | - Dennis Onyeka Frank-Ito
- Department of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, North Carolina, USA
- Computational Biology & Bioinformatics PhD Program, Duke University, Durham, North Carolina, USA
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A Novel Classification of Relationship Between Nasal Septum and Inferior Turbinate Associated With Nasal Airway Obstruction in Patients With Unilateral Alveolar Cleft. J Craniofac Surg 2021; 32:496-499. [PMID: 33704968 DOI: 10.1097/scs.0000000000007006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study aims to investigate nasal morphologies associated with nasal airway obstruction in unilateral alveolar cleft patients. METHODS A total of 234 unilateral alveolar cleft cases were performed cone beam computed tomography scans. The digital imaging and communication in medicine data were imported into Simplant Pro software. The radiographic features including nasal septum deviation and inferior turbinate hypertrophy as well as nasal airway volume and sinusitis were analyzed. RESULTS A new radiographic classification of relationship between nasal septum and inferior turbinate (NS-IT) on the cleft side was proposed and three types of NS-IT relationship (type I, II and III) were identified in 234 cases. The statistical analysis revealed that the nasal airway volume on non-cleft side was significantly higher than that on cleft side in each of three types (P < 0.0001), while no difference of nasal airway volume on non-cleft side was found among three types. In addition, the nasal airway volume on non-cleft side in type I and II was significantly higher than that in type III (P < 0.0001). Also, type III presented higher rate of maxillary sinusitis (P = 0.0154) and ethmoid sinusitis on cleft side (P = 0.0490) than type I and II. The other indexes including clinical variances were not significant among three types. CONCLUSIONS Unilateral alveolar cleft patients with type III NS-IT relationship could have nasal airway obstruction and higher rate of maxillary and ethmoid sinusitis on cleft side, which may be taken into account at primary cleft repair and alveolar bone grafting treatment.
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Adults With Unilateral Cleft Lip and Palate Present Reduced Internal Nasal Volumes: Findings of a Three-Dimensional Morphometric Assessment in Cone-Beam Computed Tomography Scans. J Craniofac Surg 2021; 32:e15-e19. [PMID: 33278248 DOI: 10.1097/scs.0000000000006820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The main purpose was to assess and compare nasal cavity (NC) volumes among adults with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) and in noncleft controls (CON), by means of cone-beam computed tomography (CBCT) three-dimensional reconstructions. Forty-five scans of individuals with class III skeletal pattern, matched by age, were gathered in 3 groups: UCLP (n = 15), BCLP (n = 15) and (CON) (n = 15). The NC volume was assessed three-dimensionally, using Dolphin 11.8 software. Descriptive normally distributed data was presented as mean (±SD). Comparisons of NC volume among groups was performed using ANOVA test (P ≤ 0.05). The NC mean volumes corresponded to 14.7(±2.2) cm3 (UCLP), 17.1(±2.2) cm3 (BCLP) and 18.1(±3.8) cm3 (CON), respectively. UCLP individuals presented a significantly reduced NC volume when compared to controls (P = 0.006). No differences were observed between UCLP versus BCLP or BCLP versus CON. The intraclass correlation coefficient suggested a high intra- and inter-examiners agreement (>.075). Individuals with unilateral cleft lip and palate presented reduced NC when compared to individuals without cleft lip and palate. CBCT scans can be considered a highly accurate tool for morphometric assessments of craniofacial structures.
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Automated identification of anatomical anomalies in the hyoid region of cleft lip and palate patients. TRANSLATIONAL RESEARCH IN ANATOMY 2021. [DOI: 10.1016/j.tria.2020.100103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hassegawa CA, Garcia-Usó MA, Yatabe-Ioshida MS, Trindade IEK, Fukushiro AP, Carreira DGG, Trindade-Suedam IK. Internal nasal dimensions of children with unilateral cleft lip and palate and maxillary atresia: comparison between acoustic rhinometry technique and cone-beam computed tomography. Codas 2021; 33:e20200099. [PMID: 34037161 DOI: 10.1590/2317-1782/20202020099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/24/2020] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To compare the nasal cavity geometry of children and teenagers with cleft lip and palate and maxillary atresia by two methods: cone-beam computed tomography, considered the gold standard, and acoustic rhinometry. METHODS Data on cone-beam computed tomography and acoustic rhinometry examinations of 17 children and teenagers with cleft lip and palate and maxillary atresia, previously obtained for orthodontic planning purposes, were evaluated prospectively. Using Dolphin Imaging 11.8 software, the nasal cavity was reconstructed by two evaluators, and the internal nasal volumes were obtained. Using rhinometry, the volumes of regions V1 and V2 were measured. The values of each examination were then compared at a significance level of 5%. RESULTS Statistical analysis showed high intra- and inter-rater reproducibility in the cone-beam computed tomography analysis. The mean internal nasal volumes (± standard deviation) obtained using acoustic rhinometry and cone-beam computed tomography corresponded to 6.6 ± 1.9 cm3 and 8.1 ± 1.5 cm3, respectively. The difference between the examinations was 17.7%, which was considered statistically significant (p = 0.006). CONCLUSION The nasal volumes measured via the two methods were different; that is, they presented discrepancies in the measurements. The gold standard technique identified larger volumes than acoustic rhinometry in the nasal cavity. Therefore, determining which test reflects clinical reality is an essential future step.
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Affiliation(s)
- Caroline Akemi Hassegawa
- Programa de Pós-graduação, Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil
| | | | - Marília Sakayo Yatabe-Ioshida
- Departemento de Ortodontia e Odontopediatria, School of Dentistry, University of Michigan - UM - Ann Arbor (MI), USA
| | - Inge Elly Kiemle Trindade
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo - FOB USP - Bauru (SP), Brasil
| | - Ana Paula Fukushiro
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru, Universidade de São Paulo - FOB USP - Bauru (SP), Brasil
| | - Daniela Gamba Garib Carreira
- Setor de Ortodontia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Ortodontia, Faculdade de Odontologia de Bauru - FOB USP - Bauru (SP), Brasil
| | - Ivy Kiemle Trindade-Suedam
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo - HRAC USP - Bauru (SP), Brasil.,Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo - FOB USP - Bauru (SP), Brasil
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Li H, Martin HL, Marcus JR, Frank-Ito DO. Analysis of nasal air conditioning in subjects with unilateral cleft lip nasal deformity. Respir Physiol Neurobiol 2021; 291:103694. [PMID: 34020065 DOI: 10.1016/j.resp.2021.103694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/22/2021] [Accepted: 05/16/2021] [Indexed: 11/15/2022]
Abstract
This study evaluated the impact of unilateral cleft lip nasal deformity (uCLND) on the ability of the nasal passages to warm and humidify inspired environmental air using computational fluid dynamics (CFD) modeling. Nasal air conditioning was simulated at resting inspiration in ten individuals with uCLND and seven individuals with normal anatomy. The overall heat and water transfer through nasal mucosa was significantly greater (p = 0.02 for both heat and moisture fluxes) on the non-cleft side than on the cleft side. Unilateral median and interquartile range (IQR) for heat flux (W/m2) was 190.3 (IQR 59.9) on the non-cleft side, 160.9 (IQR 105.0) on the cleft side, and 170.7 (IQR 87.8) for normal subjects. For moisture flux (mg/(s·m2), they were 357.4 (IQR 112.9), 298.7 (IQR 200.3) and 320.8 (IQR 173.0), respectively. Significant differences of SAHF50 between cleft side of uCLND and normal existed except for anterior region. Nevertheless, air conditioning ability in subjects with uCLND was generally comparable to that of normal subjects.
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Affiliation(s)
- Hang Li
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Jeffrey R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University Medical Center, Durham, NC, USA
| | - Dennis O Frank-Ito
- Department of Head and Neck Surgery and Communication Sciences, Duke University Medical Center, Durham, NC, USA; Computational Biology & Bioinformatics PhD Program, Duke University, Durham, NC, USA; Thomas Lord Department of Mechanical Engineering and Materials Science, Duke University Pratt School of Engineering, Durham, NC, USA.
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Awuapara S, Liñan C, Solis G, Meneses A, Lagravère M. Evaluation of the nasal septum and depth of palatal arch in different facial vertical patterns: A Cone-Beam Computed Tomography Study. Int Orthod 2021; 19:228-234. [PMID: 33836972 DOI: 10.1016/j.ortho.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the nasal septum and the depth of posterior palatal arch in the different facial vertical patterns using cone-beam computed tomography (CBCT). MATERIALS AND METHODS A total of 143 CBCTs were analysed (53 normodivergents, 26 hypodivergents, and 64 hyperdivergents) using the software Real Scan 2.2. On the coronal view, the following measurements were taken, palatal interalveolar length (PIL), palatal arch depth (PAD), maxillopalatal arch angle (MPAA), septal vertical length (SVL), deviated septal length (DSL), and deviated septal curve angle (DSCA). Using the program Stata v16.0, we obtained the mean, standard deviation and median values. The identification of significant differences between facial biotypes was performed using the one-way ANOVA test and H of Kruskal-Wallis test, considering a significance level of 0.05. RESULTS The hypodivergent group got the highest PIL and MPAA (49.6mm and 118.1° respectively), with statistically significant differences (P<0.05) between this group and the hyperdivergent group. Statistically significant differences were found by gender for the SNMeGo, PFH, AFH, and the relationship between the facial heights, where the males had the highest values. Additionally, PIL and SVL also had the highest values for males (48.8mm and 63.6mm respectively). CONCLUSIONS Patients presenting with greater hyperdivergence have shorter interalveolar distances and smaller maxillopalatal arch angles.
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Affiliation(s)
- Shereen Awuapara
- Universidad Peruana Cayetano Heredia, Faculty of Stomatology, Lima, Peru
| | - Carlos Liñan
- Universidad Peruana Cayetano Heredia, Faculty of Stomatology, Lima, Peru
| | - Gilmer Solis
- Universidad Peruana Cayetano Heredia, Faculty of Science and Philosophy, Department of Statistics, Demography, Humanities and Social Sciences, Lima, Peru
| | - Abraham Meneses
- Universidad Peruana Cayetano Heredia, Faculty of Stomatology, Lima, Peru
| | - Manuel Lagravère
- School of Dentistry University of Alberta, Faculty of Medicine and Dentistry, Orthodontic Graduate Program, ECHA 5-524, 11405 - 87th avenue, T6G 1C9 Edmonton, Alberta, Canada.
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An anatomical composite nasal lining subunit technique in primary cleft nose correction. JPRAS Open 2021; 28:72-76. [PMID: 33855147 PMCID: PMC8027686 DOI: 10.1016/j.jpra.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/26/2021] [Indexed: 11/26/2022] Open
Abstract
Current primary cleft nose correction techniques are associated with a significant rate of long term alar collapse. The nasal lining on the cleft side has been observed to be distorted and deficient. Nasal endoscopy was used to map the two dimensional topography of the anterior nasal airway lining in a normal and patient with unilateral cleft lip. The vestibular nasal subunit was noted to have a triple structural overlap (Lateral crus, valve and vestibule units). A nasal lining subunit based surgical strategy was designed, based on the subunit principle. The lateral crural tethering was released and differential repositioning of the cartilage/lining complex performed. The difference in domal height between the cleft and non-cleft sides was translated into a superior and medial advancement of the cartilage/lining composite subunit. The valve sub-unit defect was resurfaced with a vermilion full thickness graft, taken at the time of primary cleft lip repair. Primary septal relocation was performed and no percutaneous cartilage sutures were done. Pre and post-operative anthropometry measurements were obtained, and repeated at follow up. Complete nasal correction was seen in the unilateral cleft lip patient and was noted to be stable at 1 year follow-up. A novel nasal cartilage/lining subunit topographical map is proposed and forms the basis for a surgical strategy addressing comprehensive correction of the unilateral cleft nasal deformity.
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Sleep-Disordered Breathing and Airway Assessment Using Polysomnography in Pediatric Patients With Craniofacial Disorders. J Craniofac Surg 2020; 31:720-726. [PMID: 32049904 DOI: 10.1097/scs.0000000000006249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Children with cleft and craniofacial conditions commonly present with concurrent airway anomalies, which often manifest as sleep disordered breathing. Craniofacial surgeons and members of the multidisciplinary team involved in the care of these patients should appreciate and understand the scope of airway pathology as well as the proper means of airway assessment. This review article details the prevalence and assessment of sleep disordered breathing in patients with craniofacial anomalies, with emphasis on indications, limitations, and interpretation of polysomnography.
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Ramanathan M, Ramesh P, Aggarwal N, Parameswaran A, Sailer HF, George AE. Evaluation of airflow characteristics before and after septoplasty in unilateral cleft patients with a deviated nasal septum: a computational fluid dynamics study. Int J Oral Maxillofac Surg 2020; 50:451-456. [PMID: 32861556 DOI: 10.1016/j.ijom.2020.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 06/01/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate changes in airflow characteristics before and after septoplasty in unilateral cleft lip and palate (UCLP) patients using computational fluid dynamics (CFD) models. The study was designed as a prospective cohort study involving pre- and postoperative computed tomography data from 12 UCLP patients with a deviated nasal septum who underwent septoplasty. CFD analysis of nasal airflow was conducted to study changes in velocity, pressure, volume, nasal resistance, and wall shear stress of the nasal domain before and after surgery. The study results demonstrated a statistically significant difference in pressure drop after septoplasty: median 116.10Pa (interquartile range (IQR) 749.02Pa) preoperative compared with 43.39Pa (IQR 349.01Pa) postoperative (P= 0.004). Maximum wall shear stress was found to be approximately three times lower after septoplasty: median 6.15 Pa (IQR 1908.62 Pa) preoperative versus median 2.51 Pa (IQR 540.06 Pa) postoperative (P=0.002). Changes in nasal resistance were also found to be statistically significant: median 460.59 Pa·s/l (IQR 1946.99 Pa·s/l) preoperative versus median 166.61 Pa·s/l (IQR 694.08 Pa·s/l) postoperative (P=0.04). These values demonstrate significant changes in flow dynamics after surgery indicative of a more uniform airflow pattern and stabilization of the nasal mucosa.
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Affiliation(s)
- M Ramanathan
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, India
| | - P Ramesh
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, India
| | - N Aggarwal
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, India.
| | - A Parameswaran
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, India
| | - H F Sailer
- Klinik Professor Sailer, Zurich, Switzerland
| | - A E George
- Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, India
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Effect of maxillary expansion and protraction on the oropharyngeal airway in individuals with non-syndromic cleft palate with or without cleft lip. PLoS One 2019; 14:e0213328. [PMID: 31361754 PMCID: PMC6667113 DOI: 10.1371/journal.pone.0213328] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 07/15/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction The aim of this study was to evaluate three dimensionally the effect of the combined maxillary expansion and protraction treatment on oropharyngeal airway in children with non-syndromic cleft palate with or without cleft lip (CP/L). Methods CBCT data of 18 preadolescent individuals (ages, 8.4 ± 1.7 years) with CP/L, who underwent Phase I orthodontic maxillary expansion with protraction, were compared before and after treatment. The average length of treatment was 24.1± 7.6 months. The airway volume and minimal cross-sectional area (MCA) were determined using 3DMD Vultus imaging software with cross-sectional areas calculated for each 2-mm over the entire length of the airway. A control group of 8 preadolescent individuals (ages, 8.7 ± 2.6 years) with CP/L was used for comparison. Results There was a statistically significant increase in pharyngeal airway volume after phase I orthodontic treatment in both groups, however, there was no statistically significant change in minimal cross-sectional area in neither study nor control group. Conclusion The findings showed that maxillary expansion and protraction did not have a significant effect on increasing oropharyngeal volume and MCA in patients with CP/L.
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Computational Analysis of the Mature Unilateral Cleft Lip Nasal Deformity on Nasal Patency. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2244. [PMID: 31333968 PMCID: PMC6571342 DOI: 10.1097/gox.0000000000002244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/08/2019] [Indexed: 01/15/2023]
Abstract
Background Nasal airway obstruction (NAO) due to nasal anatomic deformities is known to be more common among cleft patients than the general population, yet information is lacking regarding severity and variability of cleft-associated nasal obstruction relative to other conditions causing NAO. This preliminary study compares differences in NAO experienced by unilateral cleft lip nasal deformity (uCLND) subjects with noncleft subjects experiencing NAO. Methods Computational modeling techniques based on patient-specific computed tomography images were used to quantify the nasal airway anatomy and airflow dynamics in 21 subjects: 5 healthy normal subjects; 8 noncleft NAO subjects; and 8 uCLND subjects. Outcomes reported include Nasal Obstruction Symptom Evaluation (NOSE) scores, cross-sectional area, and nasal resistance. Results uCLND subjects had significantly larger cross-sectional area differences between the left and right nasal cavities at multiple cross sections compared with normal and NAO subjects. Median and interquartile range (IQR) NOSE scores between NAO and uCLND were 75 (IQR = 22.5) and 67.5 (IQR = 30), respectively. Airflow partition difference between both cavities were: median = 9.4%, IQR = 10.9% (normal); median = 31.9%, IQR = 25.0% (NAO); and median = 29.9%, IQR = 44.1% (uCLND). Median nasal resistance difference between left and right nasal cavities were 0.01 pa.s/ml (IQR = 0.03 pa.s/ml) for normal, 0.09 pa.s/ml (IQR = 0.16 pa.s/ml) for NAO and 0.08 pa.s/ml (IQR = 0.25 pa.s/ml) for uCLND subjects. Conclusions uCLND subjects demonstrated significant asymmetry between both sides of the nasal cavity. Furthermore, there exists substantial disproportionality in flow partition difference and resistance difference between cleft and noncleft sides among uCLND subjects, suggesting that both sides may be dysfunctional.
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15
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Iwasaki T, Yanagisawa-Minami A, Suga H, Shirazawa Y, Tsujii T, Yamamoto Y, Ban Y, Sato-Hashiguchi M, Sato H, Kanomi R, Yamasaki Y. Rapid maxillary expansion effects of nasal airway in children with cleft lip and palate using computational fluid dynamics. Orthod Craniofac Res 2019; 22:201-207. [PMID: 30912603 DOI: 10.1111/ocr.12311] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/06/2019] [Accepted: 03/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Rapid maxillary expansion (RME) improves nasal airway ventilation in non-cleft palate children. Children with unilateral cleft lip and palate (UCLP) may have nasal obstruction and experience an increased risk of obstructive sleep apnoea. The effect of RME in UCLP children is unclear. This retrospective study evaluated RME-induced changes in ventilation parameters in children with UCLP using computational fluid dynamics. SETTING AND SAMPLE POPULATION Nineteen patients (10 boys, mean age 10.7 years) who required RME had cone-beam computed tomography images taken before and after RME. Twenty control participants (11 boys, mean age 11.1 years) received regular orthodontic treatment. METHODS Nasal airway ventilation parameters (air pressure, air velocity and airflow rate) were analysed via computational fluid dynamics, and nasal cross-sectional area (CSA) was measured. RESULTS Maximum pressure, velocity and nasal resistance were significantly reduced by RME in the UCLP group. Air flow rate and CSA on the cleft side significantly were increased by RME in the UCLP group. CONCLUSIONS In children with UCLP, increasing the quantity of airflow and CSA on the cleft side by RME substantially improved nasal ventilation.
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Affiliation(s)
- Tomonori Iwasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Ayaka Yanagisawa-Minami
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hokuto Suga
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yoshito Shirazawa
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Toshiya Tsujii
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuushi Yamamoto
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Yuusuke Ban
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Makiko Sato-Hashiguchi
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | - Hideo Sato
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
| | | | - Youichi Yamasaki
- Department of Pediatric Dentistry, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan
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16
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Takahashi M, Yamaguchi T, Lee MK, Suzuki Y, Adel M, Tomita D, Nakawaki T, Yoshida H, Hikita Y, Furuhata M, Tsuneoka M, Nagahama R, Marazita ML, Weinberg SM, Maki K. Three-dimensional assessment of the pharyngeal airway in Japanese preschoolers with orofacial clefts. Laryngoscope 2019; 130:533-540. [PMID: 30977521 DOI: 10.1002/lary.27957] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/15/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Individuals with orofacial clefts often experience respiratory problems because of nasopharyngeal abnormalities. Pharyngeal airway morphology is thought to differ among the various cleft types. We measured three-dimensional (3D) airway volume using cone-beam computed tomography (CBCT) analysis to evaluate and compare pharyngeal airways in Japanese preschoolers with and without orofacial clefts. STUDY DESIGN Retrospective case-control study. METHODS We enrolled 83 subjects (37 boys, 46 girls; mean age = 4.66 ± 0.56 years) with nonsyndromic orofacial clefts and 16 noncleft healthy subjects (seven boys, nine girls; mean age = 5.30 ± 0.52 years) as controls. The subjects were divided into five groups. Four groups were based on the cleft type: isolated cleft palate, unilateral cleft lip and alveolus), unilateral cleft lip and palate, and bilateral cleft lip and palate. The fifth group included the noncleft controls. All subjects were examined with CBCT, and the 3D airway volume was measured. We analyzed group differences statistically using analysis of covariance with the Bonferroni post hoc pairwise comparison tests for the corrected means. RESULTS Compared with the noncleft group, each cleft group exhibited significantly decreased total and nasal airway volumes and increased superior and inferior pharyngeal airway volumes. The differences were all statistically significant. CONCLUSIONS Our findings suggest that anatomical differences exist in pharyngeal airway volumes among various cleft groups and in those without a cleft. LEVEL OF EVIDENCE 3b Laryngoscope, 130:533-540, 2020.
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Affiliation(s)
- Masahiro Takahashi
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Tetsutaro Yamaguchi
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Myoung K Lee
- Department of Oral Biology, Center for Craniofacial and Dental Genetics, Pittsburgh, Pennsylvania, U.S.A
| | - Yoko Suzuki
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Mohamed Adel
- Department of Orthodontics, Suez Canal University, Ismailia, Egypt
| | - Daisuke Tomita
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Takatoshi Nakawaki
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Hiroshi Yoshida
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Yu Hikita
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Mayu Furuhata
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Misato Tsuneoka
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Ryo Nagahama
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
| | - Mary L Marazita
- Department of Oral Biology, Center for Craniofacial and Dental Genetics, Pittsburgh, Pennsylvania, U.S.A.,Department of Human Genetics, Graduate School of Public Health, Clinical and Translational Science Institute, Pittsburgh, Pennsylvania, U.S.A.,Department of Human Genetics, Clinical and Translational Science Institute, Pittsburgh, Pennsylvania, U.S.A.,Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Seth M Weinberg
- Department of Oral Biology, Center for Craniofacial and Dental Genetics, Pittsburgh, Pennsylvania, U.S.A.,Department of Human Genetics, Graduate School of Public Health, Clinical and Translational Science Institute, Pittsburgh, Pennsylvania, U.S.A.,Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Koutaro Maki
- Department of Orthodontics, School of Dentistry, Showa University, Tokyo, Japan
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17
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Zimmerman JN, Lee J, Pliska BT. Reliability of upper pharyngeal airway assessment using dental CBCT: a systematic review. Eur J Orthod 2018; 39:489-496. [PMID: 27999121 DOI: 10.1093/ejo/cjw079] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Upper airway analysis is an often-cited use of cone beam computed tomography (CBCT) imaging in orthodontics. However, the reliability of this process in a clinical setting is largely unknown. Objective Our objective was to systematically review the literature to evaluate the reliability of upper pharyngeal airway assessment using dental CBCT. Search methods MEDLINE, EMBASE, Web of Science, and Google Scholar were searched through June 2015. Selection criteria Human studies that measured reliability of upper airway assessment in patients using CBCT as part of the study protocol were considered. Data collection and analysis The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was followed. Data were collected on overall study characteristics and measurements, CBCT unit and machine settings used, and examination characteristics of the included studies. Methodological quality of the included studies was evaluated. Results Forty-two studies were evaluated, representing the CBCT scans of 956 patients. Studies included a wide variety of patients and CBCT machines with various scan settings. Only five studies were deemed high quality. The available evidence indicates that under specific restricted conditions there is moderate to excellent intra- and inter-examiner reliability. Airway volume demonstrated greater intra- and inter-examiner reliability than did minimum cross-sectional area. However, significant methodological limitations of the current literature, most importantly a lack of manual orientation of the images and selection of threshold sensitivity in study protocols, suggest that reliability has not been adequately established. Conclusions The current literature reports moderate to excellent reliability, with airway volume having higher reliability than minimum cross-sectional area. However, only limited aspects of the process of airway analysis have been evaluated, indicating that further research is required to adequately establish the reliability of upper pharyngeal airway assessment of patients using dental CBCT. Registration None.
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Affiliation(s)
- Jason N Zimmerman
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janson Lee
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benjamin T Pliska
- Division of Orthodontics, Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Ahmad Y, Starbuck JM. Disruption of symmetry: A quantitative assessment of facial skeleton anatomy in children born with unilateral cleft lip and palate. Clin Anat 2018; 31:1129-1136. [DOI: 10.1002/ca.23277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 08/20/2018] [Accepted: 09/07/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Yaser Ahmad
- Department of Biomedical SciencesUniversity of Central Florida Orlando Florida 32816
| | - John M. Starbuck
- Department of AnthropologyUniversity of Central Florida Orlando Florida 32816
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19
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Reply: Objective Assessment of the Unilateral Cleft Lip Nasal Deformity Using Three-Dimensional Stereophotogrammetry: Severity and Outcome. Plast Reconstr Surg 2018; 142:421e. [PMID: 29965915 DOI: 10.1097/prs.0000000000004666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Zhang C, Miller SF, Roosenboom J, Wehby GL, Moreno Uribe LM, Hecht JT, Deleyiannis FWB, Christensen K, Marazita ML, Weinberg SM. Soft tissue nasal asymmetry as an indicator of orofacial cleft predisposition. Am J Med Genet A 2018; 176:1296-1303. [PMID: 29663709 DOI: 10.1002/ajmg.a.38688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/04/2018] [Accepted: 03/05/2018] [Indexed: 12/23/2022]
Abstract
The biological relatives of offspring with nonsyndromic orofacial clefts have been shown to exhibit distinctive facial features, including excess asymmetry, which are hypothesized to indicate the presence of genetic risk factors. The significance of excess soft tissue nasal asymmetry in at-risk relatives is unclear and was examined in the present study. Our sample included 164 unaffected parents from families with a history of orofacial clefting and 243 adult controls. Geometric morphometric methods were used to analyze the coordinates of 15 nasal landmarks collected from three-dimensional facial surface images. Following generalized Procrustes analysis, Procrustes ANOVA and MANOVA tests were applied to determine the type and magnitude of nasal asymmetry present in each group. Group differences in mean nasal asymmetry were also assessed via permutation testing. We found that nasal asymmetry in both parents and controls was directional in nature, although the magnitude of the asymmetry was greater in parents. This was confirmed with permutation testing, where the mean nasal asymmetry was significantly different (p < .0001) between parents and controls. The asymmetry was greatest for midline structures and the nostrils. When subsets of parents were subsequently analyzed and compared (parents with bilateral vs. unilateral offspring; parents with left vs. right unilateral offspring), each group showed a similar pattern of asymmetry and could not be distinguished statistically. Thus, the side of the unilateral cleft (right vs. left) in offspring was not associated with the direction of the nasal asymmetry in parents.
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Affiliation(s)
- Charles Zhang
- Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven F Miller
- Department of Anatomy, Midwestern University, Downers Grove, Illinois
| | - Jasmien Roosenboom
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, Iowa
| | | | - Jacqueline T Hecht
- Department of Pediatrics, University of Texas McGovern Medical Center, Houston, Texas
| | | | - Kaare Christensen
- Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Seth M Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
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21
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Massie JP, Runyan CM, Stern MJ, Alperovich M, Rickert SM, Shetye PR, Staffenberg DA, Flores RL. Nasal Septal Anatomy in Skeletally Mature Patients With Cleft Lip and Palate. JAMA FACIAL PLAST SU 2017; 18:347-53. [PMID: 27227513 DOI: 10.1001/jamafacial.2016.0404] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Septal deviation commonly occurs in patients with cleft lip and palate (CLP); however, the contribution of the cartilaginous and bony septum to airway obstruction in skeletally mature patients is poorly understood. OBJECTIVES To describe the internal nasal airway anatomy of skeletally mature patients with CLP and to determine the contributors to airway obstruction. DESIGN, SETTING, AND PARTICIPANTS This single-center retrospective review included patients undergoing cone-beam computed tomography (CBCT) from November 1, 2011, to July 6, 2015, at the cleft lip and palate division of a major academic tertiary referral center. Patients met inclusion criteria for the study if they were at least 15 years old at the time of CBCT, and images were used only if they were obtained before Le Fort I osteotomy and/or formal septorhinoplasty. Twenty-four skeletally mature patients with CLP and 16 age-matched control individuals were identified for the study. MAIN OUTCOMES AND MEASURES Septal deviation and airway stenosis were measured in the following 3 coronal sections: at the cartilaginous septum (anterior nasal spine), bony septum (posterior nasal spine), and midpoint between the anterior and posterior nasal spine. The perpendicular plate of the ethmoid bone and vomer displacement were measured as angles from the vertical plane at the coronal section of maximal septal deviation. The site of maximal septal deviation was identified. RESULTS Among the 40 study participants, 26 were male. The mean (SD) age was 21 (5) and 23 (6) years for patients with CLP and controls, respectively. Septal deviation in patients with CLP was significantly worse than that of controls at the anterior nasal spine (2.1 [0.5] vs 0.8 [0.2] mm; P < .05) and posterior nasal spine (2.9 [0.5] vs 1.0 [0.3] mm; P < .01) and most severe at the midpoint (mean [SD], 4.4 [0.6] vs 2.1 [0.3] mm; P < .01). The point of maximal septal deviation occurred in the bony posterior half of the nasal airway in 27 of 40 patients (68%). The CLP bony angular deviation from the vertical plane was significant in the CLP group compared with the control group (perpendicular plate of the ethmoid bone, 14° [2°] vs 8° [1°]; vomer, 34° [5°] vs 13° [2°]; P < .05 for both), and vomer deviation was significantly associated with anterior nasal airway stenosis (r = -0.61; P < .01). CONCLUSIONS AND RELEVANCE Skeletally mature patients with CLP have significant septal deviation involving bone and cartilage. Resection of the bony and cartilaginous septum should be considered at the time of definitive cleft rhinoplasty. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Jonathan P Massie
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Christopher M Runyan
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Marleigh J Stern
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Michael Alperovich
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Scott M Rickert
- Department of Otolaryngology, New York University Langone Medical Center, New York, New York
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, New York
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22
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Choi SH, Jung SN, Cha JY, Hu KS, Kim KD, Baik HS, Hwang CJ. Changes in the craniofacial complex and alveolar bone height of young adults: Applications to dental medicine. Clin Anat 2016; 29:1011-1017. [PMID: 27560155 DOI: 10.1002/ca.22772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 08/12/2016] [Accepted: 08/22/2016] [Indexed: 12/27/2022]
Abstract
The few studies on craniofacial complex changes in adults have reported contradictory findings. The aim of this study was to radiographically evaluate changes in the craniofacial complex and alveolar bone height of young adults over a 4-year period. This prospective study included 82 young adults (62 men; mean age, 19.0 ± 0.8 years; 20 women; mean age, 18.8 ± 0.9 years). Three radiographic examinations were performed longitudinally: the first (T0) was conducted at the start of the study, the second (T1) was conducted 2 years later, and the third (T2) was conducted at the end of the study period. As part of these examinations, lateral cephalograms, maxillary and mandibular anterior periapical radiographs, and bilateral posterior bitewing radiographs were obtained. During the 4-year follow-up period, all linear cephalometric measurements were significantly greater in men than in women. The amount of increase in the anterior facial height between T1 and T2 was lower in women than in men (P = 0.029). The rate of uprighting of the upper incisors was lower in men than in women over time (P = 0.020). The apex of the nose moved inferiorly between T0 and T2 (P = 0.006). The average overall change in the alveolar bone height was 0.27 mm and the yearly change was 0.07 mm over the 4-year period (P< 0.001). Significant changes in the skeletal, dental, and soft tissue, as well as, natural changes in alveolar bone, occur in young adults over time. Clin. Anat. 29:1011-1017, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Sung-Hwan Choi
- Department of Orthodontics, The Institute of Cranio-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Si-Nae Jung
- Department of Orthodontics, The Institute of Cranio-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jung-Yul Cha
- Department of Orthodontics, The Institute of Cranio-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kyung-Seok Hu
- Division of Anatomy and Developmental Biology, Department of Oral Biology, Human Identification Research Institution, BK21 PLUS Project, College of Dentistry, Yonsei University, Seoul, Korea
| | - Kee-Deog Kim
- Department of Advanced General Dentistry, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyoung-Seon Baik
- Department of Orthodontics, The Institute of Cranio-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Korea
| | - Chung-Ju Hwang
- Department of Orthodontics, The Institute of Cranio-Facial Deformity, College of Dentistry, Yonsei University, Seoul, Korea.
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23
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A Multivariate Analysis of Unilateral Cleft Lip and Palate Facial Skeletal Morphology. J Craniofac Surg 2016; 26:1673-8. [PMID: 26163844 DOI: 10.1097/scs.0000000000001836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Unilateral cleft lip and palate (UCLP) occurs when the maxillary and nasal facial prominences fail to fuse correctly during development, resulting in a palatal cleft and clefted soft and hard tissues of the dentoalveolus. The UCLP deformity may compromise an individual's ability to eat, chew, and speak. In this retrospective cross-sectional study, cone beam computed tomography (CBCT) images of 7-17-year-old individuals born with UCLP (n = 24) and age- and sex-matched controls (n = 24) were assessed. Coordinate values of three-dimensional anatomical landmarks (n = 32) were recorded from each CBCT image. Data were evaluated using principal coordinates analysis (PCOORD) and Euclidean distance matrix analysis (EDMA). Approximately 40% of morphometric variation is captured by PCOORD axes 1-3, and the negative and positive ends of each axis are associated with specific patterns of morphological differences. Approximately 36% of facial skeletal measures significantly differ by confidence interval testing (α = 0.10) between samples. Although significant form differences occur across the facial skeleton, strong patterns of morphological differences were localized to the lateral and superioinferior aspects of the nasal aperture, particularly on the clefted side of the face. The UCLP deformity strongly influences facial skeletal morphology of the midface and oronasal facial regions, and to a lesser extent the upper and lower facial skeletons. The pattern of strong morphological differences in the oronasal region combined with differences across the facial complex suggests that craniofacial bones are integrated and covary, despite influences from the congenital cleft.
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24
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Farzal Z, Walsh J, Lopes de Rezende Barbosa G, Zdanski CJ, Davis SD, Superfine R, Pimenta LA, Kimbell JS, Drake AF. Volumetric nasal cavity analysis in children with unilateral and bilateral cleft lip and palate. Laryngoscope 2015; 126:1475-80. [PMID: 26267849 DOI: 10.1002/lary.25543] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/09/2015] [Accepted: 07/06/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS Children with cleft lip and palate (CLP) often suffer from nasal obstruction that may be related to effects on nasal volume. The objective of this study was to compare side:side volume ratios and nasal volume in patients with unilateral (UCLP) and bilateral (BCLP) clefts with age-matched controls. STUDY DESIGN Retrospective case-control study using three-dimensional (3D) nasal airway reconstructions. METHODS We analyzed 20 subjects (age range = 7-12 years) with UCLP and BCLP from a regional craniofacial center who underwent cone beam computed tomography (CT) prior to alveolar grafting. Ten multislice CT images from age-matched controls were also analyzed. Mimics software (Materialise, Plymouth, MI) was used to create 3D reconstructions of the main nasal cavity and compute total and side-specific nasal volumes. Subjects imaged during active nasal cycling phases were excluded. RESULTS There was no statistically significant difference in affected:unaffected side volume ratios in UCLP (P = .48) or left:right ratios in BCLP (P = .25) when compared to left:right ratios in controls. Mean overall nasal volumes were 9,932 ± 1,807, 7,097 ± 2,596, and 6,715 ± 2,115 mm(3) for control, UCLP, and BCLP patients, respectively, with statistically significant volume decreases for both UCLP and BCLP subjects from controls (P < .05). CONCLUSIONS This is the first study to analyze total nasal volumes in BCLP patients. Overall nasal volume is compromised in UCLP and BCLP by approximately 30%. Additionally, our finding of no major difference in side:side ratios in UCLP and BCLP compared to controls conflicts with pre-existing literature, likely due to exclusion of actively cycling scans and our measurement of the functional nasal cavity. LEVEL OF EVIDENCE 3b. Laryngoscope, 126:1475-1480, 2016.
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Affiliation(s)
- Zainab Farzal
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Jonathan Walsh
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | | | - Carlton J Zdanski
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Stephanie D Davis
- Department of Pediatrics, Section of Pediatric Pulmonology, Allergy, and Sleep Medicine, Riley Children's Hospital, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A
| | - Richard Superfine
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Luiz A Pimenta
- University of North Carolina Craniofacial Center, Chapel Hill, North Carolina, U.S.A
| | - Julia S Kimbell
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A
| | - Amelia Fischer Drake
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, U.S.A.,University of North Carolina Craniofacial Center, Chapel Hill, North Carolina, U.S.A
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25
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Starbuck JM, Ghoneima A, Kula K. Bilateral cleft lip and palate: A morphometric analysis of facial skeletal form using cone beam computed tomography. Clin Anat 2015; 28:584-92. [DOI: 10.1002/ca.22530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 02/02/2015] [Accepted: 02/04/2015] [Indexed: 12/20/2022]
Affiliation(s)
- John M. Starbuck
- Department of Orthodontics and Oral Facial Genetics, School of DentistryIndiana UniversityIndianapolis Indiana
- Department of Sociology and AnthropologyIndiana University NorthwestGary Indiana
- Department of AnthropologyUniversity of Central FloridaOrlando Florida
| | - Ahmed Ghoneima
- Department of Orthodontics and Oral Facial Genetics, School of DentistryIndiana UniversityIndianapolis Indiana
| | - Katherine Kula
- Department of Orthodontics and Oral Facial Genetics, School of DentistryIndiana UniversityIndianapolis Indiana
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