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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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Loureiro NB, Marzano-Rodrigues MN, Trindade-Suedam IK, D Aquino A, Trindade SHK. Assessment of Internal Nasal Dimensions of Individuals With Cleft Lip and Palate and Obstructive Sleep Apnea Syndrome by Computed Tomography. Cleft Palate Craniofac J 2024; 61:574-583. [PMID: 36330652 DOI: 10.1177/10556656221133606] [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
To evaluate nasal cavity (NC) dimensions of individuals with cleft lip and/or palate (CL/P), obstructive sleep apnea (OSA), and primary snoring, by tomographic image analysis, compared to individuals with OSA without CL/P (N-CL/P). Cross-sectional and retrospective. Tertiary referral center. Patients were divided into 2 groups: (G1) CL/P + OSA or primary snoring, n = 11; (G2) N-CL/P + OSA, n = 13. NC tomographic images were reconstructed using ITK-SNAP software, and measurements were obtained from these three-dimensional models using SpaceClaim software. Total NC volumes, right and left NC volumes, and volumes of the nostril to the nasal valve (V1) and from the nasal valve to the superior limit of the nasopharynx (V2), cross-sectional areas, and perimeters. NC volumes (total, right, and left sides), V1, and V2, though smaller in the CL/P + OSA, did not differ significantly from the N-CL/P + OSA. Cross-sectional areas and perimeters of the superior limit of the nasopharynx, in the CL/P + OSA, presented significantly higher values compared to the N-CL/P + OSA (P ≤ .05). The internal nasal dimensions of patients with CL/P do not seem to be part of the etiopathogenesis, nor constitute a risk factor for OSA with greater severity, in this special group of patients.
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Affiliation(s)
- Natalia Bortotti Loureiro
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Maria Noel Marzano-Rodrigues
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Ivy Kiemle Trindade-Suedam
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Alessandro D Aquino
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
| | - Sergio Henrique Kiemle Trindade
- Sleep Studies Unit/Laboratory of Physiology/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
- Otolaryngology Section/Hospital for Rehabilitation of Craniofacial Anomalies - HRAC, University of São Paulo, Brazil
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Campos LD, Trindade IEK, Trindade SHK, Pimenta LAF, Kimbell J, Drake A, Marzano-Rodrigues MN, Trindade-Suedam IK. Effects of 3D Airway Geometry on the Airflow of Adults with Cleft Lip and Palate and Obstructive Sleep Apnea: A Functional Imaging Study. Sleep Sci 2023; 16:e430-e438. [PMID: 38197022 PMCID: PMC10773502 DOI: 10.1055/s-0043-1776868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 02/09/2023] [Indexed: 01/11/2024] Open
Abstract
Objective Individuals with cleft lip and palate (CLP) are at a high risk of developing obstructive sleep apnea (OSA). Hypothetically, the severity of OSA might be associated with the morphology of the upper airway (UAW) and the characteristics of the airflow. Thus, the present study aimed to assess and compare, in adults with CLP and skeletal class-III discrepancy, with or without OSA, simulations of airflow resistance and pressure according to the geometrical characteristics of the UAW and cephalometric parameters. Materials and Methods According to the results of type-I polysomnography tests, the sample ( n = 21) was allocated in 2 groups: 1) without OSA (N-OSA; n = 6); and 2) with OSA (OSA; n = 15). Cephalometric measurements were performed on the cone-beam computed tomography (CBCT) scans of the groups. After three-dimensional (3D) reconstructions, the volume (V) and minimal cross-sectional area (mCSA) of the UAW were generated. Computational fluid dynamics (CFD) simulations were used to assess key airflow characteristics. The results were presented at a significance level of 5%. Results The UAW pressure values and airway resistance did not differ between the groups, but there was a tendency for more negative pressures (26%) and greater resistance (19%) in the OSA group. Volume and mCSA showed a moderate negative correlation with resistance and pressure. The more inferior the hyoid bone, the more negative the pressures generated on the pharyngeal walls. Conclusion The position of the hyoid bone and the geometry of the UAW (V and mCSA) exerted effects on the airway-airflow resistance and pressure. However, key airflow characteristics did not differ among subjects with CLP, were they affected or not by OSA.
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Affiliation(s)
- Leticia Dominguez Campos
- Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil
| | - Inge Elly Kiemle Trindade
- Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Biological Sciences, School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil
| | - Sergio Henrique Kiemle Trindade
- Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil
- Department of Pediatric Dentistry, Orthodontics and Public Health, School of Medicine, Universidade de São Paulo, Bauru, SP, Brazil
| | - Luiz André Freire Pimenta
- Department of Biological Sciences, School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil
| | - Julia Kimbell
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Amelia Drake
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Maria Noel Marzano-Rodrigues
- Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil
| | - Ivy Kiemle Trindade-Suedam
- Laboratory of Physiology, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Biological Sciences, School of Dentistry, Universidade de São Paulo, Bauru, SP, Brazil
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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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Melo ACCD, Gomes ADOC, Cunha DAD, Almeida WRPL, Lima SJH, Cunha RAD, Silva HJD. Comparison between rhinometric variables and nasal airing in children with mouth breathing. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/202123414020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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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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Gorucu-Coskuner H, Atik E, Akarsu-Guven B, Aksu M. Comparison of Transverse Craniofacial Dimensions Between Growing Individuals With Unilateral Cleft Lip and Palate and Age-and Sex-Matched Noncleft Controls. Cleft Palate Craniofac J 2020; 57:1308-1313. [PMID: 32462928 DOI: 10.1177/1055665620927584] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study aimed to assess the transverse craniofacial dimensions of patients (age, 7-14 years) with unilateral cleft lip and palate (UCLP), compare these dimensions with those of noncleft individuals, and identify the correlations between the nasal and maxillary transverse widths of patients with UCLP. DESIGN A cross-sectional study. PARTICIPANTS Eighty patients operated on for complete UCLP (UCLP group; 35 girls, 45 boys; median age: 10.7 [7.9-14] years) and 80 age- and sex-matched noncleft individuals (control group; 35 girls, 45 boys; median age: 10.7 [7.3-14] years). INTERVENTIONS Interorbital, bizygomatic, nasal, maxillary skeletal, maxillary molar, mandibular molar, and antegonial width measurements were performed using posteroanterior cephalometric radiographs. Intergroup comparisons were conducted by using the independent samples t-test and Mann-Whitney U test. Correlation between the variables was examined using Pearson correlation analysis. RESULTS The bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths in the UCLP group were significantly less than those in the control group (P < .05). A positive correlation was found between the maxillary skeletal and nasal widths (r = 0.550, P < .001) and between the maxillary molar and nasal widths (r = 0.560, P < .001). CONCLUSIONS In individuals with UCLP, the bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths were significantly less than those in noncleft individuals. As the maxillary skeletal and dental widths presented a positive correlation with the nasal width, a decrease in nasal width must be considered when maxillary constriction is noted.
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Affiliation(s)
- Hande Gorucu-Coskuner
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
| | - Ezgi Atik
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
| | - Bengisu Akarsu-Guven
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
| | - Muge Aksu
- Department of Orthodontics, Faculty of Dentistry, 37515Hacettepe University, Ankara, Turkey
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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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Rocha JÍTD, Lima AMJD, Silva HJD, Gomes ADOC, Vitorino PA, Clímaco DCS, Cunha DAD. Comparison of nasal geometry among adults with obstructive sleep apnea: a preliminary study. REVISTA CEFAC 2019. [DOI: 10.1590/1982-0216/201921610719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to compare nasal geometry between two groups of patients with different degrees of obstructive sleep apnea and to correlate apnea-hypopnea index, apnea severity and degree of daytime sleepiness with nasal areas and volume. Methods: a total of 20 adults (15 women and 5 men, mean age of 52.0±11.4 years old) without nasal obstruction were submitted to polysomnography. The subjects were divided into two groups: a) 10 individuals without apnea or with mild-grade apnea; b) 10 with moderate or severe apnea. Nasal geometry was evaluated by acoustic rhinometry. The volume, comprising the distance from the nasal valve to the posterior part of the middle nasal turbinate, and the three sectional areas corresponding to nasal valve, anterior part of the inferior nasal turbinate and posterior part of the inferior nasal turbinate, were considered. The Shapiro-Wilk, Mann-Whitney, Student’s t tests for independent samples and Spearman’s correlation coefficient were used for the analysis, with a significance level lower than 5%. Results: group 2 presented lower values in the area corresponding to the nasal valve (on the right), and higher values in the nasal turbinate areas. There was no correlation between the drowsiness scale and nasal areas and volumes. Conclusion: the area of the nasal valve was unilaterally smaller in the group with moderate and severe apnea. There was no correlation between volumes and nasal areas and excessive daytime sleepiness.
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Fernandes MDBL, Salgueiro AGNS, Bighetti EJB, Trindade-Suedam IK, Trindade IEK. Symptoms of Obstructive Sleep Apnea, Nasal Obstruction, and Enuresis in Children With Nonsyndromic Cleft Lip and Palate: A Prevalence Study. Cleft Palate Craniofac J 2018; 56:307-313. [PMID: 29775557 DOI: 10.1177/1055665618776074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To estimate the prevalence of symptoms of obstructive sleep apnea (OSA), nasal obstruction, and enuresis in children with nonsyndromic unilateral cleft lip and palate. DESIGN Prospective cross-sectional study. SETTING Referral care center. PARTICIPANTS One hundred seventy-four children aged 6 to 12 years of both genders. INTERVENTIONS Symptoms of OSA and nasal obstruction were investigated by analysis of scores obtained by the Sleep Disturbance Scale for Children (SDSC) and Congestion Quantifier (CQ-5). Enuresis was considered as present when urinary loss was reported during sleep (at least 1 episode/month, last 3 months). To characterize the enuresis as mono- or polysymptomatic, symptoms of dysfunction of the lower urinary tract (DLUT) were investigated by the Dysfunctional Voiding Scoring System (DVSS). Statistical analysis was performed at a 5% level of significance. RESULTS Positive SDSC scores for OSA were observed in 60 (34%) children; positive CQ-5 scores for nasal obstruction in 45 (26%), positive DVSS scores for DLUT in 30 (17%), and enuresis was reported by 29 (17%), being categorized as primary in 66% and polysymptomatic in 72% of the children. Compared to the pediatric population, OSA, nasal obstruction, and enuresis prevalence ratios were up to 7 (95% confidence interval [CI] 5-9), 2 (95% CI 2-3), and 3 times (95% CI 2-5) higher, respectively. There was a positive/moderate correlation between symptoms of OSA and nasal obstruction ( P = .0001). No correlation was seen between symptoms of OSA and enuresis. CONCLUSIONS Children with nonsyndromic cleft lip and palate have high prevalence of nasal obstruction and enuresis and are at risk of OSA.
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Affiliation(s)
| | | | - Eliete Janaína Bueno Bighetti
- 1 Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of Sao Paulo, Bauru-SP, Brazil
| | - Ivy Kiemle Trindade-Suedam
- 2 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
| | - Inge Elly Kiemle Trindade
- 2 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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Ertaş Ü, Ataol M. Evaluation of Nasal Airway Volume of Operated Unilateral Cleft Lip and Palate Patients Compared With Skeletal Class III Individuals. Cleft Palate Craniofac J 2018; 56:15-20. [PMID: 29738291 DOI: 10.1177/1055665618774024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cleft lip and palate (CLP) patients have various problems with nasal anatomy beyond just oronasal separation. The alar base, concha, and septum are over impressed in these individuals. Additionally, skeletal class III deformity is seen. These conditions may limit nasal function. In our study, 15 unilateral patients with CLP older than 15 years (10 females, 5 males; mean age: 19.13) who had received surgery were included as the study group, and 15 participants with noncleft skeletal class III deformities were included as the control group (10 females, 5 males; mean age: 19.20). The individuals' nasal airway volumes (total/cleft side/noncleft side/control/ nasal passages) were examined and compared statistically. The results showed that the study group had significantly higher values in terms of total airway volume ( P < .05). Additionally, there were significant differences between the cleft side and noncleft side volumes, between the cleft side volumes and the volumes of the control group participants, and between the noncleft side volumes and the volumes of the control group participants ( P < .05). There was no difference between the groups in terms of nasopharyngeal ( P = .39) and nasal passage volumes ( P = .73). The results show there are some problems regarding nasal airway volume in patients with CLP, even when lip, palate, and alveolar cleft operations have been performed. The aim of this study was to evaluate differentiation of nasal airway volumes between unilateral patients with CLP and individuals with noncleft skeletal class III serving as the control group.
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Affiliation(s)
- Ümit Ertaş
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
| | - Mert Ataol
- 1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ataturk University, Erzurum, Turkey
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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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Araújo LLD, Silva ASCD, Araújo BMAM, Yamashita RP, Trindade IEK, Fukushiro AP. Nasopharyngeal dimensions in normal individuals: normative data. Codas 2016; 28:403-8. [PMID: 27652921 DOI: 10.1590/2317-1782/20162015020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/24/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To establish normative values of minimum cross-sectional nasopharyngeal area in individuals without craniofacial anomalies at different age ranges. MATERIAL AND METHOD Ninety-six individuals of both genders, without craniofacial anomalies, and with normal body mass index and neck circumference were evaluated. Participants were divided into 4 age groups: children, aged 6 to 10 years (G1); adolescents, aged 11 to 17 years (G2); young adults, 18 to 39 years (G3), and middle-aged adults, 40 to 59 years (G4). Minimum cross-sectional nasopharyngeal area (nasopharyngeal area - NPA) was assessed by means of modified anterior rhinomanometry (pressure-flow technique) using a PERCI-SARS system (version 3.50 - Microtronics Corp.). RESULTS Mean±SD values of NPA were 1.025±0.054cm2, 1.055±0.081cm2, 1.050±0.083cm2, and 1.054±0.081cm2, respectively for groups G1, G2, G3, and G4, showing that there were no differences between the four age groups. CONCLUSION Normative data of NPA were established for individuals without craniofacial anomalies from different age ranges, and they may be used as reference values in the clinical routine and for future studies regarding nasopharyngeal obstruction diagnosis, particularly in cases of craniofacial anomalies.
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Affiliation(s)
- Laryssa Lopes de Araújo
- Programa de Pós-graduação em Ciências da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | | | - Bruna Mara Adorno Marmontel Araújo
- Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Renata Paciello Yamashita
- Programa de Pós-graduação em Ciências da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Inge Elly Kiemle Trindade
- Programa de Pós-graduação em Ciências da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil
| | - Ana Paula Fukushiro
- Programa de Pós-graduação em Ciências da Reabilitação, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Laboratório de Fisiologia, Hospital de Reabilitação de Anomalias Craniofaciais - HRAC, Universidade de São Paulo - USP - Bauru (SP), Brasil.,Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru - FOB, Universidade de São Paulo - USP - Bauru (SP), Brasil
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