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Seixas DR, Trindade IEK, Yamashita RP, Silva ASCD, Araújo BMAM, Maia SÉDS, Fukushiro AP. Effect of Orthognathic Surgery on Breathing in Patients with Cleft lip and Palate: 20-Year Experience at a Tertiary Hospital in Brazil. Cleft Palate Craniofac J 2024; 61:808-817. [PMID: 36517969 DOI: 10.1177/10556656221145311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years. DESIGN Retrospective study. SETTING Tertiary level craniofacial hospital. PARTICIPANTS 535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS. INTERVENTIONS Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy. MAIN OUTCOME MEASURES Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire. RESULTS After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001). CONCLUSIONS Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.
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Affiliation(s)
- Déborah Rocha Seixas
- Postgraduate Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | - Inge Elly Kiemle Trindade
- Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | - Renata Paciello Yamashita
- Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | | | | | - Sergio Éberson da Silva Maia
- Postgraduate Program in Rehabilitation Sciences, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
| | - Ana Paula Fukushiro
- Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, 17012-900, Brazil
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, University of São Paulo, Bauru, SP, 17012-900, Brazil
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Yuan J, An Y. Improvement in nasal airway obstruction after secondary rhinoplasty for cleft lip: A systematic review. J Plast Reconstr Aesthet Surg 2024; 90:130-148. [PMID: 38367410 DOI: 10.1016/j.bjps.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/04/2023] [Accepted: 01/29/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The purpose of the study was to comprehensively review the improvement in nasal airway obstruction after secondary rhinoplasty for cleft lip. METHODS The search was conducted on PubMed, Embase, and Scopus databases for relevant studies published within the past twenty years. Inclusion criteria encompassed patients undergoing secondary rhinoplasty with cleft lip nasal deformity and some evaluation of the nasal outcome. RESULTS A thorough analysis of available studies identified 29 articles that met the inclusion criteria for final assessment. Seven (24.1%) studies were classified as Therapeutic Ⅱ (T II) according to the American Society of Plastic Surgeons level of evidence scale, while the majority were categorized as T III (17.2%), T IV (51.7%), and T V (6.9%). Subjective methods were employed in 21 articles to measure nasal ventilation outcomes, whereas 8 studies utilized objective methods. Overall findings from all included studies consistently indicated an improvement in nasal ventilation post-surgery. CONCLUSIONS Although there is no consensus regarding the impact of secondary rhinoplasty on nasal airway obstruction in cleft lip patients, this review suggests that it can effectively alleviate such obstructions. We conducted an anatomical analysis to investigate the impact of various surgical techniques on nasal ventilation to provide recommendations for postoperative ventilation assessment.
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Affiliation(s)
- Jinfeng Yuan
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China
| | - Yang An
- Department of Plastic Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China.
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Bony Cartilaginous Graft in Unilateral Cleft Lip Rhinoplasty. J Craniofac Surg 2022; 33:2513-2521. [PMID: 35901453 DOI: 10.1097/scs.0000000000008780] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Cleft rhinoplasty is a challenging form of nasal correction of both esthetic and functional deformities. The septal cartilage in many Asian patients are not sufficient and weak. Does a combination of the septal cartilage and the bony septum have both esthetic and functional benefits to secondary unilateral cleft rhinoplasty? PATIENTS AND METHODS Thirty patients with a unilateral cleft lip palate underwent open rhinoplasty from October 2018 to January 2021. After preserving a 10 mm L-strut, the posterior cartilaginous and bony septum were harvested as an integrative unit. The osteocartilaginous graft was used as a caudal septal extension graft and an extended spreader graft. Correcting the asymmetry of the tip and tip projection followed. The intraoperative harvested composite graft was analyzed. Acoustic rhinometry and the 3-dimensional anthropometric measurements of the external nose were assessed before and after surgery. RESULTS The osteocartilaginous unit was much larger than the cartilaginous part of this unit. The mean nasal tip height and the nasolabial angle increased significantly after surgery. The measurement of cross-sectional areas and volumes by acoustic rhinometry revealed that septorhinoplasty provided a significant increase in the function of both nasal cavities. CONCLUSIONS This septal bony cartilaginous graft is effective for cleft lip nasal deformity when correcting the deviated septum, creating a supporting frame to correct the nasal tip asymmetry, improving function.
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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: 3] [Impact Index Per Article: 1.0] [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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Faco R, Yatabe M, Cevidanes LHS, Timmerman H, De Clerck HJ, Garib D. Bone-anchored maxillary protraction in unilateral cleft lip and palate: a cephalometric appraisal. Eur J Orthod 2020; 41:537-543. [PMID: 30865780 DOI: 10.1093/ejo/cjz005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the cephalometric outcome of bone-anchored maxillary protraction (BAMP) in individuals with unilateral complete cleft lip and palate (UCLP). MATERIAL AND METHODS The experimental group (EG) comprised 23 individuals (17 males and 6 females) with UCLP and a mean age of 11.7 years. At least 6 months after secondary alveolar bone grafting, Bollard miniplates were installed in the posterior region of the maxilla and in the anterior region of the mandible. Class III elastics were recommended to be worn for 24 hours/day for a mean time of 18 months. Cone beam computed tomography (CBCT) was obtained before (T1) and after treatment (T2). The control group (CG) consisted of 23 individuals with UCLP matched by initial age and gender with the EG and without any orthopaedic or surgical intervention performed between T1 and T2. The interval between T1 and T2 observations was 18 months for both groups. Twenty-one cephalometric variables were analysed. Intra- and intergroup comparisons were performed using paired and independent t-tests, respectively (P < 0.05). RESULTS BAMP caused a greater maxillary protrusion (SNA) and a greater decrease of Class III maxillomandibular discrepancy (ANB and Wits appraisal) compared with the CG. BAMP also caused a counterclockwise rotation of the occlusal plane (Occ Plane to FH) and an improvement in the molar relationship compared with controls. CONCLUSIONS BAMP therapy demonstrated a significant orthopaedic maxillary protraction and an improvement in the Class III skeletal pattern in UCLP.
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Affiliation(s)
- Renato Faco
- Department of Maxillofacial Surgery, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Lucia H S Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | - Hugo J De Clerck
- Department of Orthodontics, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Daniela Garib
- Department of Orthodontics, Bauru Dental School, Hospital of Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
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Are reduced internal nasal dimensions a risk factor for obstructive sleep apnea syndrome? Braz J Otorhinolaryngol 2020; 88:399-405. [PMID: 32868224 PMCID: PMC9422546 DOI: 10.1016/j.bjorl.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/04/2020] [Accepted: 06/28/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction Obstructive sleep apnea syndrome is a high-prevalence disorder found in the population. Studies have shown a possible association between nasal obstruction and obstructive sleep apnea syndrome, but the existence of a association between the degree of nasal obstruction and obstructive sleep apnea syndrome severity has not yet been proven. Objective To evaluate the internal nasal dimensions of adults with primary snoring and obstructive sleep apnea syndrome by acoustic rhinometry and to correlate the findings with obstructive sleep apnea severity. Methods Twenty-one male Caucasian subjects with complaints of snoring and/or respiratory pauses during sleep, aged between 18 and 60 years of age, were evaluated. After clinical evaluation, otorhinolaryngological examination and flexible nasopharyngolaryngoscopy, all patients underwent type III polysomnography. The participants were divided into two groups according to symptom severity: group 1, primary snoring and/or mild obstructive sleep apnea syndrome(n = 9) and group 2, moderate/severe obstructive sleep apnea syndrome (n = 12). Internal nasal dimensions were measured by acoustic rhinometry, analyzing minimum cross sectional area (CSA) and three nasal segment volumes. Results The respiratory event index corresponded to 8.1 ± 4.0 in group 1 and 47.5 ± 19.1 in group 2. In group 1, the cross-sectional areas values, in cm2, corresponded to: CSA 1 = 1.1 ± 0.4; CSA 2 = 2.1 ± 0.9; CSA 3 = 3.5 ± 1.8 and, in group 2: CSA 1 = 1.2 ± 0.3, CSA 2 = 2.0 ± 0.5; CSA 3 = 2.8 ± 0.7. In group 1, volumes (V), in cm3, corresponded to: V1 = 3.5 ± 1.0; V2 = 9.3 ± 5.0; V3 = 40.2 ± 21.5 and in group 2 a: V1 = 3.6 ± 0.5; V2 = 7.6 ± 1.5; V3 = 31.5 ± 6.7. Cross-sectional area and volume did not differ between groups. Conclusion There were no significant differences in the cross-sectional areas and nasal volumes between individuals with primary snoring-mild obstructive sleep apnea syndrome and moderate-severe obstructive sleep apnea syndrome. Differently to the raised hypothesis, our results suggest that there is no association between internal nasal dimensions and severity of obstructive sleep apnea syndrome.
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Ribeiro ADA, Smith FJ, Nary Filho H, Trindade IEK, Tonello C, Trindade-Suedam IK. Three-Dimensional Upper Airway Assessment in Treacher Collins Syndrome. Cleft Palate Craniofac J 2019; 57:371-377. [DOI: 10.1177/1055665619885555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: The purpose of this investigation was to assess the pharyngeal dimensions and the craniofacial morphology of individuals with Treacher Collins syndrome (TCS) when compared to vertical skeletal class II individuals. It is our hypothesis that the upper airways of individuals with TCS are reduced in view of the skeletal pattern and the maxillomandibular dysmorphologies. Materials and Methods: Cone-beam computed tomography scans of 26 individuals had the pharyngeal volume (V) and minimal cross-sectional area (mCSA) evaluated. Study group (TCS) was formed by 13 scans of patients with TCS (7 males and 6 females; 20.2 ± 4.7 years). Control group (CG) assembled 13 scans of nonaffected individuals with the same type of skeletal pattern (2 males and 11 females; 26.6 ± 5.4 years). Cephalometric data of maxillomandibular position, maxillomandibular dimensions, and growth pattern were assessed. Statistical analysis ( P ≤ .05) included Student t test and Pearson correlation coefficient. Results: Although reduced, pharyngeal V and mCSA of TCS were not statistically different from the CG. On both groups, mCSA was mostly at the oropharyngeal level. Individuals with TCS presented retrognathic chin, reduced maxillomandibular dimensions, and increased clockwise rotation of the palatal plane. Maxillary and mandibular lengths were correlated with pharyngeal V and mCSA. Conclusions: The pharyngeal dimensions of individuals with TCS are impacted by the micrognathia and retrognathia. In association with the skeletal pattern, the reduction of the airways, although not statistically significant, may explain the increased prevalence of airways disorder in this syndrome.
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Affiliation(s)
- Alexandre de Almeida Ribeiro
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
| | - Francis Joel Smith
- Anschutz Medical Campus Bookstore, University of Colorado at Denver, CO, USA
| | | | - Inge E. K. Trindade
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
| | - Cristiano Tonello
- School of Dentistry, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
| | - Ivy K. Trindade-Suedam
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Brazil
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Campos LD, Trindade IEK, Yatabe M, Trindade SHK, Pimenta LA, Kimbell J, Drake AF, Trindade-Suedam IK. Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion. Cranio 2019; 39:484-490. [DOI: 10.1080/08869634.2019.1668997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Leticia Dominguez Campos
- Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, SP, Brazil
| | - Inge Elly Kiemle Trindade
- Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, SP, Brazil
| | - Marilia Yatabe
- Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, MI, USA
| | | | - Luiz Andre Pimenta
- Craniofacial Center and Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Kimbell
- Department of Otolaryngology/Head and Neck Surgery (A.F.D.), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amelia F. Drake
- Craniofacial Center, Department of Otolaryngology/Head and Neck Surgery (A.F.D.), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ivy Kiemle Trindade-Suedam
- Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru, SP, Brazil
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Ivy Kiemle TS, Thiago FL, Letícia DC, Renato Yassutaka FY, Hugo Nary F, Inge Elly KT. Tomographic Pharyngeal Dimensions in Individuals with Unilateral Cleft Lip/Palate and Class III Malocclusion are Reduced When Compared with Controls. Cleft Palate Craniofac J 2017; 54:502-508. [DOI: 10.1597/15-124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The objective of this study was to three-dimensionally evaluate the pharyngeal dimensions of individuals with complete nonsyndromic unilateral cleft lip and palate (UCLP) using cone beam computed tomography. Design This was a cross-sectional prospective study. Setting The study took place at the Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru-SP, Brazil. Patients and Participants The control group (CON) consisted of 23 noncleft adults with class III malocclusion, and the cleft group (UCLP) consisted of 22 individuals with UCLP and class III malocclusion. Two subgroups of individuals with class III malocclusion as a result of maxillary retrusion with (UCLP'; n = 19) and without (CON'; n = 8) clefts were also assessed. Interventions Pharyngeal volume, pharyngeal minimal cross-sectional area (CSA), location of CSA, pharyngeal length, sella-nasion-A point angle (SNA), sella-nasion-B point angle (SNB), and A point-nasion-B point angle (ANB), and body mass index were assessed using Dolphin software. Main Outcome Measure The pharyngeal dimensions of UCLP individuals are smaller when compared with controls. Results Mean pharyngeal volume (standard deviation) for the UCLP patients (20.8 [3.9] cm3) and the UCLP’ patients (20.3 [3.9] cm3) were significantly decreased when compared with the CON (28.2 [10.0] cm3) and CON’ patients (29.1 [10.2] cm3), respectively. No differences were found in the pharyngeal minimal CSA, ANB, or pharyngeal length values between groups (CON versus UCLP and CON’ versus UCLP'). CSAs were located mostly at the oropharynx, except in the UCLP’ patients, which were mainly at the hypopharynx. Mean SNA in the UCLP (76.4° [4.6°]) and UCLP’ groups (75.1 [3.1°]) were significantly smaller than those in the CON (82.8° [4.1°]) and CON’ groups (78.6° [1.2°]). SNB values were statistically smaller only for the comparison of CON versus UCLP patients. Conclusion The pharynx of individuals with UCLP and class III malocclusion is volumetrically smaller than that of individuals with class III malocclusion and no clefts.
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Affiliation(s)
- Trindade-Suedam Ivy Kiemle
- Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Freire Lima Thiago
- Oral and Maxillofacial Surgeon, Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Dominguez Campos Letícia
- Physical Therapist and PhD student, Postgraduate Program in Rehabilitation Science, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Faria Yaedú Renato Yassutaka
- Department of Stomatology, Bauru School of Dentistry and Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
| | - Filho Hugo Nary
- Oral and Maxillofacial Surgeon, Brånemark Institute Bauru, Professor, University of Sacred Heart, Bauru, SP, Brazil
| | - Kiemle Trindade Inge Elly
- Full Professor, Department of Biological Sciences, Bauru School of Dentistry and Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil
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Melo ACCD, Gomes ADOC, Cunha DAD, Lima SJH, Lima WRP, Cunha RAD, Silva HJD. Mudança nas áreas nasais em crianças com respiração oral após a limpeza e massagem nasal. Codas 2016; 28:770-777. [DOI: 10.1590/2317-1782/20162015172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/05/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMO A avaliação e quantificação das possíveis alterações da cavidade nasal são necessárias para o auxílio diagnóstico e tratamento de crianças que respiram predominantemente pela boca. O modo respiratório oral pode desencadear distúrbios da fala, deformidades da face, mau posicionamento dos dentes, postura corporal inadequada e alterações no sistema respiratório. Objetivo analisar as mudanças ocorridas na geometria das cavidades nasais, antes e depois da limpeza nasal por meio da aeração nasal e da rinometria acústica em crianças com respiração oral. Método Foram selecionadas 20 crianças com idade entre quatro e 12 anos. A coleta foi realizada no Laboratório Multifuncional do Departamento de Fonoaudiologia da Universidade Federal de Pernambuco. Foi aplicado o Índice de Identificação dos Sinais e Sintomas da Respiração Oral; marcação da aeração nasal por meio do espelho milimetrado de Altmann e o exame da geometria nasal por Rinometria Acústica. Depois da limpeza e massagem nasal com o soro fisiológico, foram realizados os mesmos procedimentos. Resultados Observaram-se mudanças significantes nas áreas relativas ao fluxo aéreo nasal em ambos os lados, após limpeza e massagem nasais. Quanto à geometria nasal, aferida por meio da rinometria acústica, o efeito da limpeza e massagem nasal mostrou-se discreto, quando feita a comparação entre as narinas. Conclusão As medidas de aeração nasal mostraram sensibilidade à técnica de limpeza e massagem e as medidas da geometria nasal confirmaram seu efeito sobre a fisiologia respiratória.
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Dentino KM, Sierra-Vasquez D, Padwa BL. Inferior Turbinate Asymmetry Is a Feature of the Unilateral Complete Cleft Lip and Palate Nasal Deformity. J Oral Maxillofac Surg 2015; 74:797-803. [PMID: 26604048 DOI: 10.1016/j.joms.2015.09.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 09/27/2015] [Accepted: 09/28/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients with unilateral complete cleft lip and palate (UCLP) have a characteristic bilateral septal deformity, and septal deviation can be associated with turbinate hyperplasia, leading to paradoxical nasal obstruction. The purpose of the present study was to measure and compare the bony and mucosal dimensions of the inferior turbinate on the cleft and non-cleft sides in patients with UCLP. PATIENTS AND METHODS We implemented a retrospective cohort study of patients with UCLP who had undergone computed tomography (CT) scan between 2002 to 2013. Subjects who had undergone nasal revision, septoplasty, turbinectomy, or Le Fort I osteotomy before the imaging date were excluded. The primary predictor variable was the subject side (cleft vs noncleft side), and the primary outcome variable was the turbinate cross-sectional area. The secondary predictor variables included the site of measurement along the sagittal axis of the turbinate (anterior, middle, posterior) and tissue type (turbinate whole, bone, mucosa). The Wilcoxon signed rank test for paired samples compared the turbinate dimensions on the cleft and noncleft sides, with statistical significance set at P ≤ .05. RESULTS The sample included 53 patients (32 females and 21 males). The inferior turbinates were measured bilaterally on CT images obtained at a mean age of 12.2 ± 0.8 years. The inferior turbinate on the noncleft side was significantly larger in both bone and mucosa (P = .003). This relationship did not change when controlling for age and gender. CONCLUSIONS The results of the present study have confirmed bony and mucosal enlargement of the inferior turbinate on the noncleft side in patients with UCLP. This might contribute to bilateral nasal obstruction and should be considered during treatment planning for nasopharyngeal and orthognathic surgery.
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Affiliation(s)
- Kelley M Dentino
- Clinical Research Fellow, Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Bonnie L Padwa
- Associate Professor, Harvard School of Dental Medicine, Oral Surgeon in Chief, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
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Gurlen SO, Aras I, Dogan S. Nasopharyngeal Airway Volume for Different GOSLON Scores in Patients with Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2015; 52:e176-9. [DOI: 10.1597/14-119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
| | - I. Aras
- Ege University, School of Dentistry, Department of Orthodontics, Izmir, Turkey
| | - S. Dogan
- Ege University, School of Dentistry, Department of Orthodontics, Izmir, Turkey
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Trindade-Suedam IK, Castilho RL, Sampaio-Teixeira ACM, Araújo BMAM, Fukushiro AP, Campos LD, Trindade IEK. Rapid Maxillary Expansion Increases Internal Nasal Dimensions of Children With Bilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2015; 53:272-7. [PMID: 25591126 DOI: 10.1597/14-244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The transverse maxillary deficiency frequently observed in patients with cleft lip and palate (CLP) is usually treated by rapid maxillary expansion (RME). Considering that RME causes a significant increase of the internal nasal dimensions in children with unilateral CLP (UCLP), this study aimed to characterize the internal nasal geometry of children with bilateral CLP (BCLP) and transverse maxillary deficiency using acoustic rhinometry. The study also aimed to analyze changes caused by RME. DESIGN Cross-sectional prospective study. SETTING Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. PARTICIPANTS Fifteen children with repaired BCLP of both genders, aged 8 to 15 years, referred for RME, were prospectively analyzed. INTERVENTIONS Subjects underwent acoustic rhinometry before the expander installation and after the active phase of expansion. Cross-sectional areas (CSA) and volumes (V) of the nasal valve regions (CSA1 and V1) and turbinates (CSA2, CSA3, and V2), were measured after nasal decongestion. MAIN OUTCOME MEASURES In the majority of the subjects, an increase of internal nasal dimensions was observed. RESULTS Percent changes of CSA1, CSA2, CSA3, V1, and V2 were: +25%, +11%, +9%, 20%, and +12%, respectively. Differences were significant for all variables studied, except CSA3 (P < .05). CONCLUSIONS RME promotes an increase in the internal nasal dimensions of children with BCLP, suggesting that RME is capable of substantially improving nasal patency in this population.
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Trindade IEK, Gomes ADOC, Fernandes MDBL, Trindade SHK, Silva Filho OGD. Nasal Airway Dimensions of Children With Repaired Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2014; 52:512-6. [PMID: 25210862 DOI: 10.1597/14-103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To measure cross-sectional areas of the main nasal constrictions as a function of the distance into the nose in children with repaired unilateral cleft lip and palate, as compared with children without cleft, by acoustic rhinometry. DESIGN Prospective analysis. SETTING Craniofacial anomalies hospital. PARTICIPANTS A total of 39 children with repaired unilateral cleft lip and palate and 34 healthy controls without cleft, of both genders, aged 6 to 9 years. Interventions/Variables : Nasal cross-sectional areas measured at the three main deflections of the rhinogram (CSA1, CSA2, CSA3) and distances from the nares (dCSA1, dCSA2, dCSA3) were assessed by means of an Eccovision Acoustic Rhinometer, before and after nasal decongestion. Differences were analyzed at a significance level of 5%. RESULTS At the cleft side, mean CSA1, CSA2, and CSA3 values ± standard deviation obtained before nasal decongestion were 0.17 ± 0.12, 0.29 ± 0.20, and 0.40 ± 0.28 cm(2), respectively, and dCSA1, dCSA2, and dCSA3 values ± standard deviation were 2.02 ± 0.40, 3.74 ± 0.51, and 5.50 ± 0.44 cm, respectively. At the noncleft side, these were 0.33 ± 0.11, 0.65 ± 0.28, and 0.90 ± 0.43 cm(2), respectively, and 1.69 ± 0.48, 3.67 ± 0.53, and 5.60 ± 0.70 cm, respectively. Increased cross-sectional area means were seen after nasal decongestion in the control and cleft groups. Mean cross-sectional area values at the cleft side were significantly smaller than noncleft side and control values, and the mean dCSA1 value was smaller at the noncleft side before and after decongestion. CONCLUSIONS Objective assessment of internal nasal dimensions has shown that children with unilateral cleft lip and palate have a significant impairment of nasal patency due to the reduced cross-sectional areas seen at the cleft side.
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Pimenta LA, de Rezende Barbosa GL, Pretti H, Emodi O, van Aalst J, Rossouw PE, Tyndall DA, Drake AF. Three-dimensional evaluation of nasopharyngeal airways of unilateral cleft lip and palate patients. Laryngoscope 2014; 125:736-9. [DOI: 10.1002/lary.24895] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/14/2014] [Accepted: 07/29/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Luiz A. Pimenta
- Department of Dental Ecology; School of Dentistry; University of North Carolina at Chapel Hill
| | | | - Henrique Pretti
- Department of Orthodontics; School of Dentistry, Federal University of Minas Gerais; Belo Horizonte Minas Gerais Brazil
| | | | - John van Aalst
- Division of Plastic and Reconstructive Surgery; School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina U.S.A
| | - Paul E. Rossouw
- Department of Orthodontics; School of Dentistry; University of North Carolina at Chapel Hill
| | - Donald A. Tyndall
- Department of Diagnostic Sciences; School of Dentistry; University of North Carolina at Chapel Hill
| | - Amelia F. Drake
- Department of Otolaryngology/Head and Neck Surgery; School of Medicine; University of North Carolina at Chapel Hill; Chapel Hill North Carolina U.S.A
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Freitas JADS, Trindade-Suedam IK, Garib DG, Neves LTD, Almeida ALPFD, Yaedu RYF, Oliveira TM, Soares S, Lauris RDCMC, Yamashita RP, Trindade Jr AS, Trindade IEK, Pinto JHN. Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology. J Appl Oral Sci 2013; 21:383-90. [DOI: 10.1590/1678-775720130290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 05/02/2013] [Indexed: 11/22/2022] Open
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Morén S, Mani M, Lundberg K, Holmström M. Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate. J Plast Surg Hand Surg 2013; 47:383-9. [PMID: 23639332 DOI: 10.3109/2000656x.2013.771583] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.
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Aras I, Olmez S, Dogan S. Comparative Evaluation of Nasopharyngeal Airways of Unilateral Cleft Lip and Palate Patients Using Three-Dimensional and Two-Dimensional Methods. Cleft Palate Craniofac J 2012; 49:e75-81. [DOI: 10.1597/12-004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim Comparison of nasopharyngeal airway dimensions among UCLP patients and the control group. Materials and Methods Computed tomography imaging data and cephalometric films of 20 patients with UCLP and 20 controls were acquired prior to treatment. Three-dimensional (3D) reconstructions of nasal, superior, middle, and inferior pharyngeal airways were carried out from dicom data, and volumes of these compartments were calculated. Nasal width and superior, middle, and inferior nasopharyngeal areas were calculated from cephalometric films. Results The only statistically significant difference among the cleft and noncleft patients was detected in nasal volume ( p < .01). Upper and middle pharyngeal airway areas were found to display significant larger areas in the noncleft group on cephalometric appraisal. Nonsignificantly larger nasal widths were measured in the cleft group. Discussion and Conclusion Evaluation of the nasopharyngeal airways of cleft and noncleft patients was done, resulting in only the nasal region showing statistically significant difference. Our results showed significantly lower nasal volume measurements of cleft patients when compared with the healthy individuals (p < .01). This inadequacy can be interpreted as an outcome of the deficiency. The controversy among results of cephalometric appraisal and 3D imaging can be associated with superimpositions, density, and contrast inadequacies and obscured landmarks. When 2D data are compared with 3D data, the former can be insufficient and therefore deceiving. Consequently, although the radiation dose of 3D imaging systems is greater, they have the advantage of superior diagnostic outputs.
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Affiliation(s)
- Isil Aras
- Ege University, Faculty of Dentistry, Department of Orthodontics, Izmir, Turkey
| | - Sultan Olmez
- Ege University, Faculty of Dentistry, Department of Orthodontics, Izmir, Turkey
| | - Servet Dogan
- Ege University, Faculty of Dentistry, Department of Orthodontics, Izmir, Turkey
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Gerek M, Durmaz A, Aydin U, Birkent H, Hidir Y, Tosun F. Relationship between nasal valve changes and nasalance of the voice. Otolaryngol Head Neck Surg 2012; 147:98-101. [PMID: 22354854 DOI: 10.1177/0194599812438846] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE It is well known that the nasal cavity and paranasal sinuses affect the acoustic characteristics of the voice as resonators. Any expansion in nasal valve area, the narrowest segment of the nasal cavity, affects the nasal resistance and therefore has the potential to alter the nasalance. The aim of this study was to investigate the effect of nasal valve changes on nasalance of the voice by using an external nasal dilator strip that widens the nasal valve area. STUDY DESIGN Before-and-after study. SETTING Tertiary university hospital. SUBJECTS AND METHODS Healthy volunteer subjects who had no nasal or voice-related complaints were enrolled in the study. All subjects underwent acoustic rhinometry and nasometry before and while wearing a commercially available external nasal dilator strip. The data with and without the nasal strip were compared. RESULTS Twenty-five subjects were enrolled in the study. After the application of nasal strips, statistically significant increases were observed in the minimal cross-sectional area of the nasal valve. However, there were no significant changes in the nasalance measurements. CONCLUSION Despite increasing the nasal valve area, application of the nasal strips did not cause any significant change in nasalance scores in healthy subjects, showing no relationship between the nasal valve and nasalance of the voice.
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Affiliation(s)
- Mustafa Gerek
- Department of Otolaryngology-Head & Neck Surgery, Gulhane Military Medical School, Ankara, Turkey.
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Palandi BBN, Guedes ZCF. Aspectos da fala de indivíduos com fissura palatina e labial, corrigida em diferentes idades. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: comparar indivíduos com fissura labiopalatina que realizaram correção cirúrgica em diferentes idades e verificar quais os fatores intervenientes mais importantes nas alterações da fala. MÉTODOS: a amostra é composta por 29 indivíduos que nasceram com fissura labiopalatina e foram submetidos à correção cirúrgica em diferentes idades, sem outros comprometimentos associados (neurológicos, físicos, psicológicos, etc). Estes indivíduos foram avaliados sem se levar em consideração a etiologia e o tipo de malformação encontrado. Sendo que 13 do sexo masculino e 16 do sexo feminino possuem idades variando de seis a 13 anos de idade. Os indivíduos são do ambulatório de Distúrbios da Comunicação Humana de uma Universidade Pública Federal e do ambulatório de Cirurgia Plástica de um Hospital Público que ainda não entraram em terapia fonoaudiológica. A fala, desses indivíduos, foi avaliada pelo Teste de Fonologia (capítulo 1 do ABFW, Teste de Linguagem Infantil), e por meio da nomeação foi analisada a fala dos indivíduos. A nomeação foi feita com figuras simples que foram mostradas a eles. RESULTADOS: os resultados do presente estudo quanto ao sexo e o tipo de fissura da amostra não apresentaram resultados estatisticamente significantes. Entretanto, a época tardia em que ocorreu a cirurgia reparadora interferiu de forma negativa para emissão de fala desses pacientes. CONCLUSÕES: com base nos resultados obtidos da análise da fala de indivíduos com fissura labiopalatina, pode-se concluir que um fator interveniente importante para a sua fala é a idade em que é realizada a cirurgia corretiva.
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Effects of orthopedic rapid maxillary expansion on internal nasal dimensions in children with cleft lip and palate assessed by acoustic rhinometry. J Craniofac Surg 2010; 21:306-11. [PMID: 20186095 DOI: 10.1097/scs.0b013e3181cf5f5f] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The objective of the current study was to characterize the internal nasal dimensions of children with repaired cleft lip and palate and transverse maxillary deficiency, using acoustic rhinometry and analyze the changes caused by rapid maxillary expansion (RME). A convenience sampling of 19 cleft lip and palate individuals, aged 14 to 18 years, of both sexes, previously submitted to primary surgeries and referred for RME were analyzed prospectively at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil. All patients underwent acoustic rhinometry before installation of the expansor and at 30 and 180 days after the active expansion phase. Nasal cross-sectional areas and volumes corresponding to the nasal valve (CSA1 and V1) and the turbinates (CSA2, CSA3, and V2) regions were determined before and after nasal decongestion. Rapid maxillary expansion led to a statistically significant increase (P < 0.05) in mean CSA1, CSA2, V1, and V2 (without nasal decongestion) and in CSA1 and V1 (with decongestion) in the group as a whole. Individual data analysis showed that 58% of the patients responded positively to RME, with an average increase in CSA1 of 26% (with decongestion), whereas 37% of the patients had no significant change. Only 1 patient (5%) showed a decrease. The findings contribute toward the characterization of nasal deformities determined by the cleft and demonstrate the positive effect RME had on nasal morphophysiology in a significant number of the patients who underwent this procedure.
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