Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion

Objective: To compare the prevalence of increased risk of obstructive sleep apnea (OSA) in children with and without cleft lip and/or palate using a previously validated questionnaire and to examine the clinical and demographic variables that may lead to increased OSA risk. Design: Prospective, cross-sectional study. Participants: One hundred fifty-five cleft lip palate and 155 noncleft children between 2 and 18 years old. Interventions: The Pediatric Sleep Questionnaire (PSQ): Sleep Related Breathing Disorder Scale was used for screening of increased OSA risk. Age, body mass index (BMI), gender, breast-feeding, and bottle-feeding durations were recorded for all patients. Cleft type, lip and palate operation times, nasoalveolar molding, or nutrition plaque usage was documented for the cleft lip palate group. Pearson χ2 or Fisher exact test was used for the evaluation of the qualitative variables and independent samples t test or Mann Whitney U test for quantitative variables. P < .05 was accepted as statistically significant. Results: The mean ages were 7.52 ± 3.91 and 7.50 ± 3.89 years for cleft lip palate and control groups, respectively. No significant differences were observed between the groups for age, gender, or BMI. Breast-feeding duration was significantly higher, and bottle-feeding duration was lower in the control group ( P < .05). Mean PSQ score was significantly higher in cleft lip palate group (0.18 ± 0.12) than in control group (0.13 ± 0.1, P < .001); and prevalence of increased OSA risk was significantly higher in patients with both cleft lip and palate ( P = .020). Conclusions: Positive OSA screening ratio of children with cleft lip and palate (12.2%) was significantly higher than the controls (4.5%).

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Importance of orthodontic intervention of the Class III malocclusion in mixed dentition

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.25.5.057-065.bbo ◽

2020 ◽

Vol 25 (5) ◽

pp. 57-65

Author(s):

Dennyson Brito Holder da Silva ◽

Ariane Salgado Gonzaga

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Environmental Factors ◽

Sleep Apnea Syndrome ◽

Mixed Dentition ◽

Class Iii ◽

Class Iii Malocclusion ◽

Obstructive Sleep ◽

Tongue Position ◽

Apnea Syndrome

ABSTRACT Introduction: Supervising the development of occlusion, managing problems during the transition from mixed to permanent dentition, as well as controlling environmental factors that contribute to establishing malocclusion, are important actions to achieve a Class I occlusion with facial balance. Among these problems, the malocclusions associated with dysfunctions such as mouth breathing or obstructive sleep apnea syndrome (OSAS), atypical swallowing and abnormal tongue position, open bites, crossbites and maxillomandibular discrepancies, and especially the Class III malocclusion can be listed. Objective: The purpose of this article is to present and discuss the main aspects relevant to the benefits of performing the treatment of Class III malocclusion in patients with growth.

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Treating Velopharyngeal Inadequacy Using Bilateral Buccal Flap Revision Palatoplasty

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig5-2019-0005 ◽

2019 ◽

Vol 4 (5) ◽

pp. 878-892

Author(s):

Joseph A. Napoli ◽

Linda D. Vallino

Keyword(s):

Systematic Review ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

A Priori ◽

Sufficient Evidence ◽

Obstructive Sleep ◽

Before And After ◽

Buccal Flap

Purpose The 2 most commonly used operations to treat velopharyngeal inadequacy (VPI) are superiorly based pharyngeal flap and sphincter pharyngoplasty, both of which may result in hyponasal speech and airway obstruction. The purpose of this article is to (a) describe the bilateral buccal flap revision palatoplasty (BBFRP) as an alternative technique to manage VPI while minimizing these risks and (b) conduct a systematic review of the evidence of BBFRP on speech and other clinical outcomes. A report comparing the speech of a child with hypernasality before and after BBFRP is presented. Method A review of databases was conducted for studies of buccal flaps to treat VPI. Using the principles of a systematic review, the articles were read, and data were abstracted for study characteristics that were developed a priori. With respect to the case report, speech and instrumental data from a child with repaired cleft lip and palate and hypernasal speech were collected and analyzed before and after surgery. Results Eight articles were included in the analysis. The results were positive, and the evidence is in favor of BBFRP in improving velopharyngeal function, while minimizing the risk of hyponasal speech and obstructive sleep apnea. Before surgery, the child's speech was characterized by moderate hypernasality, and after surgery, it was judged to be within normal limits. Conclusion Based on clinical experience and results from the systematic review, there is sufficient evidence that the buccal flap is effective in improving resonance and minimizing obstructive sleep apnea. We recommend BBFRP as another approach in selected patients to manage VPI. Supplemental Material https://doi.org/10.23641/asha.9919352

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Screening for obstructive sleep apnea in children with syndromic cleft lip and/or palate

Journal of Plastic Reconstructive & Aesthetic Surgery ◽

10.1016/j.bjps.2014.07.026 ◽

2014 ◽

Vol 67 (11) ◽

pp. 1475-1480 ◽

Cited By ~ 15

Author(s):

Jason Silvestre ◽

Youssef Tahiri ◽

J. Thomas Paliga ◽

Jesse A. Taylor

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Lip ◽

Obstructive Sleep

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Incidence of positive screening for obstructive sleep apnea in patients with isolated cleft lip and/or palate

Plastic Surgery ◽

10.1177/229255031402200404 ◽

2014 ◽

Vol 22 (4) ◽

pp. 259-263 ◽

Cited By ~ 6

Author(s):

Jason Silvestre ◽

Youssef Tahiri ◽

J Thomas Paliga ◽

Jesse A Taylor

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Cleft Lip ◽

Obstructive Sleep

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Tomographic Pharyngeal Dimensions in Individuals with Unilateral Cleft Lip/Palate and Class III Malocclusion are Reduced When Compared with Controls

The Cleft Palate-Craniofacial Journal ◽

10.1597/15-124 ◽

2017 ◽

Vol 54 (5) ◽

pp. 502-508 ◽

Cited By ~ 6

Author(s):

Trindade-Suedam Ivy Kiemle ◽

Freire Lima Thiago ◽

Dominguez Campos Letícia ◽

Faria Yaedú Renato Yassutaka ◽

Filho Hugo Nary ◽

...

Keyword(s):

Cleft Lip ◽

Outcome Measure ◽

Cleft Lip And Palate ◽

Cone Beam ◽

Control Group ◽

Craniofacial Anomalies ◽

Class Iii ◽

Class Iii Malocclusion ◽

Cross Sectional ◽

Cleft Lip Palate

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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Systematic head and neck physical examination as a predictor of obstructive sleep apnea in class III obese patients

Brazilian Journal of Medical and Biological Research ◽

10.1590/s0100-879x2008001200008 ◽

2008 ◽

Vol 41 (12) ◽

pp. 1093-1097 ◽

Cited By ~ 20

Author(s):

F.L. Martinho ◽

R.P. Tangerina ◽

S.M.G.T. Moura ◽

L.C. Gregório ◽

S. Tufik ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Physical Examination ◽

Head And Neck ◽

Obese Patients ◽

Class Iii ◽

Obstructive Sleep

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Prevalence and Risk Factors for Obstructive Sleep Apnea Syndrome Among Children and Adolescents with Cleft lip and Palate: A Survey Study in Hong Kong

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211068306 ◽

2021 ◽

pp. 105566562110683

Author(s):

A. C. H. Ho ◽

F. Savoldi ◽

R. W. K. Wong ◽

S. C. Fung ◽

S. K. Y. Li ◽

...

Keyword(s):

Risk Factors ◽

Obstructive Sleep Apnea ◽

Hong Kong ◽

Sleep Apnea ◽

Children And Adolescents ◽

Cleft Lip ◽

Sleep Apnea Syndrome ◽

Survey Study ◽

Obstructive Sleep ◽

Secondary Palate

Objective To investigate the prevalence of obstructive sleep apnea syndrome (OSAS) risk and related risk factors among children and adolescents of Hong Kong with cleft lip and/or palate (CL/P). Design Retrospective survey study adopting three questionnaires, obstructive sleep apnea-18 (OSA-18), pediatric sleep questionnaire-22 (PSQ-22), and modified Epworth Sleepiness Scale (ESS). Settings Multicenter study in two public hospitals. Patients A total of 351 Chinese children and adolescents with non-syndromic CL/P (6-18-year-old, 57% males) visited between September 2017 and November 2019, with primary palatal repair surgery done before 3-year-old. Main Outcome Measure Positive OSAS risk was determined based on cut-off ≥60 for OSA-18, ≥8 for PSQ-22, and >8 for ESS. Age, sex, overweight presence, cleft type, embryonic secondary palate involvement, palatal repair surgery, palatal revision surgery, and orthodontic treatment were analyzed as possible risk factors. Results A total of 9.5% of patients had positive OSAS risk based on OSA-18, 13.6% based on PSQ-22, and 13.2% according to ESS. A higher prevalence of patients with positive OSAS risk was of younger age (OSA-18, p = .034), had cleft involving embryonic secondary palate (PSQ-22, p = .009), and history of fixed orthodontic treatment (ESS, p = .002). The regression model identified only involvement of embryonic secondary palate as a risk factor (PSQ-22, odds ratio = 3.7, p = .015). Conclusions OSAS risk among children and adolescents of Hong Kong with CL/P was 9.5% to 13.6%. Patients at higher risk were those with cleft involving embryonic secondary palate. OSAS risk assessment may be influenced by different aspects of the disease spectrum, and a multimodal approach should be considered for such assessment.

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Septoplasty for Obstructive Sleep Apnea in Infants after Cleft Lip Repair

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1996_033_0473_sfosai_2.3.co_2 ◽

1996 ◽

Vol 33 (6) ◽

pp. 473-476 ◽

Cited By ~ 8

Author(s):

Gary D. Josephson ◽

Jamie Levine ◽

Court B. Cutting

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nasal Septum ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Septal Deviation ◽

Facial Growth ◽

Deviated Nasal Septum ◽

Obstructive Sleep ◽

Cleft Lip Repair

A neonate with a unilateral cleft lip and palate usually presents with a deviated nasal septum due to the asymmetric bony base associated with cleft palate. Prior to repair, the facial cleft offers a wide open breathing passage despite the septal deviation. Cleft lips are traditionally repaired in neonates at about 3 months of age. These patients usually do not present with significant symptoms of nasal obstruction following repair, except in unusual cases. Severe septal deviation may cause obstructive sleep apnea. Repair of septal deformities in children is controversial due to the potential alteration of facial growth. We present two patients with documented obstructive sleep apnea that began after cleft lip repair. Conservative surgical correction of the septal deviation resulted in relief of the sleep apnea.

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