Nasal airway impairment: the oral response in cleft palate patients

Evaluation of the Change in Halitosis with the Improvement in Oral Health in Cleft Lip and Palate Patients

AIM

This study aimed to assess the effects of hygiene education on periodontal health and mouth/nasal halitosis in patients with cleft.

MATERIALS AND METHODS

39 patients with cleft who were accepted for orthodontic treatment divided into two groups as with (Group1; n = 24) and without braces (Group2; n = 15). Plaque Index (PI), Gingival Index (GI), and Tongue coating Index (TCI) values were recorded. The BANA test microbiological kit, was used to determine the amount of anaerobic bacteria. Values of volatile sulfur components (VSC) for the measurement of oral and nasal halitosis were measured with a Halimeter device. After the initial measurements, oral hygiene instructions were given to eliminate the plaque production on teeth, periodontal structure, tongue and palate. All measurements were repeated 4 weeks after the hygiene instructions. Wilcoxon and Mann-Whitney U test were used for statistical analysis.

RESULTS

In both groups, the PI, GI, values were significantly decreased (P < .05). Tongue coating area, thickness and TCI were significantly reduced (P < .05). Oral halitosis values decreased significantly (P < .05). The PI values decreased significantly more in the Group 1 (P < .05). Non significant difference was detected in nasal halitosis in both groups. In unilateral cleft lip and palate cases cases (n = 23), no significant difference was found in nasal halitosis values between the cleft and the healthy sides (P > 0.05).

CONCLUSION

In patients with clet cases, periodontal health was improved and oral halitosis was reduced by the given hygiene education; brushing the teeth, especially the tongue and palate. However, hygiene education did not have a significant effect on nasal halitosis. Key Words: Cleft lip and palate, Halitosis, BANA test, Periodontal index.

Evaluation of Oral and Nasal Odor in Patients with and without Cleft Lip and Palate: Preliminary Report

Objective

To evaluate oral and nasal halitosis parameters in patients with and without clefts.

Design

Randomized and prospective study. Patients with and without clefts were evaluated as to oral and nasal halitosis.

Setting

University of São Paulo, Bauru Dental School and Hospital for Rehabilitation of Craniofacial Anomalies, Bauru, Brazil.

Patients

Twelve patients with clefts and 12 without clefts were evaluated, and no exclusion criteria were followed.

Interventions

Nasal and oral halitosis were measured with the use of a portable sulfide monitor during a single visit.

Results

One hundred percent of the patients with clefts had altered values for volatile sulfur compounds. Only 33.3% of the patients without clefts had at least one strong value for nasal halimeter measurements, and 58.3% of these patients showed alteration in the nasal values. Statistical evaluation, made using the Mann-Whitney U test, classifying the nasal halimeter values as normal, weak, and strong, showing a statistical significant group difference (p = .003). There was no significant difference in the oral halimeter values between the two groups.

Conclusions

Patients with cleft lip and palate had a tendency to present higher values for the nasal halimeter measurements, when compared with patients without clefts.

Nasopharyngeal Airway Volume for Different GOSLON Scores in Patients with Unilateral Cleft Lip and Palate

Objective

The aim of this study is to evaluate the nasopharyngeal airway volumes of patients with unilateral cleft lip and palate (UCLP) with different GOSLON scores.

Methods

The study sample consisted of 34 patients with UCLP and 20 controls with no cleft history. In the UCLP group, three experienced examiners used the GOSLON Yardstick to rate dental arch relationships, and the sample was divided into three groups as GOSLON 2 (G2) (n = 13), GOSLON 3 (G3) (n = 10), and GOSLON 4 (G4) (n = 11). Airway volumes were constructed using three-dimensional computed tomography data and divided into four compartments named the nasal airway, and superior, middle, and inferior pharyngeal airways.

Results

No statistically significant difference was detected among G2, G3, and G4 between the constitutive airway departments of the nasopharyngeal region. However, nasal airway volumes were significantly higher in the control group when compared with the UCLP group.

Discussion

Although there was no correlation among the investigated parameters, it is also a fact that airway capacities display a great variability among patients when investigated three dimensionally.

Conclusion

Although the severity of GOSLON scores might predetermine the extent of which the airways are affected from the cleft, a larger sample size is needed in future studies.

Oral and nasal malodor in patients with and without cleft lip and palate who had undergone orthodontic therapy

OBJECTIVE

To compare oral and nasal malodor in patients with and without cleft lip and palate (CLP) who had undergone orthodontic therapy.

SETTING

University of Cumhuriyet, Sivas, Turkey.

PATIENTS

The study included 33 patients. Group 1 was composed of 11 patients with CLP. Measurements were taken while they were undergoing treatment with orthodontic fixed appliances. Group 2 included 11 individuals without CLP; measurements were taken during fixed orthodontic therapy. Group 3 consisted of 11 individuals without CLP who did not receive orthodontic therapy.

INTERVENTION

Oral malodor, nasal malodor, Gingival Index, Plaque Index, and probing depths were evaluated in each group.

RESULTS

Plaque Index, Gingival Index, and probing depths showed no significant differences between groups 1 and 2. In contrast, oral malodor was significantly different between the two groups (p < .05). Groups 2 and 3 showed differences in gingival and plaque indices but not in probing depths and oral malodor. All healthy nostrils in Group 1, Group 2, and Group 3 were significantly different from affected nostrils in the CLP patients. There was significant malodor in affected nostrils when compared with nonaffected nostrils in group 1 (p < .05).

CONCLUSION

Oral malodor was increased in patients with CLP. Nasal malodor level was also higher in affected nostrils of the CLP patients compared to nostrils of healthy subjects.

Septopalatal protraction for correction of nasal septal deformity in cleft palate infants

OBJECTIVE

It is proposed to test the practicality of septopalatal protraction in the unilateral cleft palate infant for purposes of straightening the nasal septum and thus relieving nasal airflow obstruction and its detrimental sequelae.

METHODS

Alternate infants affected with complete unilateral palatal clefts had septopalatal protraction for a period of 6 to 8 weeks (protraction group; n = 4). Septal deviation was measured by a standardized technique that used computed tomography scans. The remaining infants had no protraction and served as controls (nonprotraction group; n = 5). Septal deviation was measured in the nonprotraction group from palatoseptal dental molds.

RESULTS

A total of 9 patients were studied. All patients in the nonprotraction group had worsening of nasal septal deviation over a period of 8 weeks compared with the protraction group, which had complete nasal septal straightening. Differences in septal angle deviation between the protraction group and nonprotraction group at the end of the study were statistically significant (P < or = 0.01) as measured by the paired Student t test.

CONCLUSIONS

Septopalatal protraction in the newborn appears to provide a means for correcting nasal septal deviation in complete unilateral cleft palate infants. Septopalatal protraction in the newborn is relatively easy and safe.

Evaluation of oral and nasal halitosis parameters in patients with repaired cleft lip and/or palate

OBJECTIVE

The objective of this study was to investigate the relationship between halitosis parameters in patients with and without cleft lip and/or palate.

STUDY DESIGN

Forty-two subjects were examined. They were divided into group I, postgraduate students of Bauru Dental School (FOB); and group II, individuals with repaired cleft lip and/or palate. The concentration of volatile sulfur compounds (VSC) was assessed with a portable sulfide monitor and the values were correlated to the salivary flow rate and weight of tongue coating.

RESULTS

There was a relationship between the presence of tongue coating and VSC levels, as well as between salivary flow rate and VSC levels in group II. The same group also revealed a significant correlation between weight of tongue coating and salivary flow rate. There were no significant differences between groups as regards the Halimeter oral measurement.

CONCLUSIONS

Individuals with repaired cleft lip and/or palate can have the same VSC levels as subjects without clefts.

Dyspnea following experimentally induced increased nasal airway resistance

Nasal resistance (NRZ) values for healthy adults range from 1.0 to 3.5 cm H2O/L/sec. Some oral breathing tends to occur at values above 3.5. The purpose of the present study was to determine at what level of NRZ individuals sense that nasal breathing is difficult. A diaphragm was used to add four different resistance loads in random to 15 adult subjects. These loads were 5,8, and 15 cm H2O/L/sec and a value 40% above the individual's normal NRZ. Loads were added under four conditions: normal breathing, fixed flow rate, fixed breathing rate, and fixed flow and breathing rate. The pressure-flow technique was used to measure NRZ under all conditions. The study revealed that the sensation of breathing difficulty occurred at a median resistance of 5 cm H2O/L/sec and, as subjects were constrained to maintain fixed flow and breathing rates, the magnitude of RZ, at which the sensation of dyspnea was noted, decreased. The values observed in this study support previous findings suggesting that individuals switch to some oral breathing to maintain an adequate level of upper airway resistance at values between 3.5 and 4.5 cm H2O/L/sec. The findings also show that individuals attempt to minimize increases in airway resistance by modifying breathing behaviors.

Perceptual and respiratory responses to added nasal airway resistance loads in older adults

The purpose of the present study was to assess breathing behavior under various nasal resistance load conditions and, in particular, to determine whether respiratory responses to added nasal resistance loads occur before the threshold perception of an added load. The participants were 40 older adults who ranged in age from 59 to 82 years. Nasal airflow and resistance were measured with the pressure-flow technique, which was modified to create calibrated resistance loads. Statistical analyses revealed a significant decrease in airflow rate and volume during load conditions both before perceptual detection and at detection of increased resistance in comparison to a "no load" condition. No differences in respiratory behaviors were found between the load condition just before perceptual detection of an increased resistance load and the load condition at detection. The present findings suggest that physiologic responses to changes in the airway environment apparently occur even before there is perceptual recognition that the environment has changed.