Predictors of Velopharyngeal Dysfunction in Individuals With Cleft Palate Following Surgical Maxillary Advancement: Clinical and Tomographic Assessments

Objective: To investigate whether morphofunctional velopharyngeal aspects may be considered predictors of appearance or worsening of hypernasality in patients with cleft palate after surgical maxillary advancement (MA). Design: Prospective. Setting: National referral center for cleft lip and palate rehabilitation. Participants: Fifty-two patients with repaired cleft palate, skeletal class III malocclusion, and normal speech resonance completed speech audio recordings and cone-beam computed tomography examination before (T1) and, on average, 14 months after (T2) MA. Interventions: Hypernasality was rated by 3 experienced speech-language pathologists using a 4-point scale and morphofunctional aspects on a 3-point scale. Cone-beam computed tomography image measurements were performed using Amira and Dolphin 3D software. For each velopharyngeal morphofunctional aspect analyzed, patients were compared according to the absence (G1) and presence (G2) of postoperative hypernasality. Main Outcome Measures: Comparison of hypernasality scores between T1 and T2 and association between hypernasality and each velopharyngeal morphofunctional aspect. Results: Significant difference was observed between T1 and T2 for hypernasality ( P = .031) and between G1 and G2 ( P = .015) for velar mobility, with significant association between this variable and hypernasality on T2 ( P = .041). Conclusions: Levator veli palatini mobility influenced the appearance of hypernasality after MA.

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Upper airway assessment using four different maxillary expanders in cleft patients: A cone-beam computed tomography study

The Angle Orthodontist ◽

10.2319/032015-174.1 ◽

2015 ◽

Vol 86 (4) ◽

pp. 617-624 ◽

Cited By ~ 6

Author(s):

Carolina Morsani Mordente ◽

Juan Martin Palomo ◽

Martinho Campolina Rebello Horta ◽

Bernardo Quiroga Souki ◽

Dauro Douglas Oliveira ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Cone Beam ◽

Nasal Passage ◽

Maxillary Expansion ◽

Computed Tomography Images ◽

Intergroup Comparison ◽

Significant Difference

ABSTRACTObjective: To evaluate the anterior and posterior maxillary width, the nasal passage volume, the oropharyngeal minimum axial area, and volume changes in unilateral cleft lip and palate patients treated with one of the following four expanders: Hyrax, Fan-Type, inverted mini-hyrax supported on the first permanent molars (iMini-M), or inverted mini-hyrax supported on the first premolars (iMini-B).Materials and Methods: A total of 40 patients with transverse maxillary deficiency who were submitted for rapid maxillary expansion were divided in four groups according to type of expander used. Cone-beam computed tomography images were taken before and 3 months after expansion. One-way analysis of variance was used to analyze the differences among the groups, and paired t-tests were used to evaluate the changes in each group.Results: All groups showed a significant increase in the anterior maxillary width, with no intergroup differences. The iMini-B was the only group that did not show a significant increase in the posterior maxillary width. The intergroup comparison demonstrated differences among all groups except between Hyrax and iMini-M, which showed the greatest posterior expansions. The intragroup analysis showed a significant increase in the nasal passage volume in hyrax and inverted mini-hyrax on the molar groups, but the intergroup comparison revealed a significant difference only between Fan-Type and inverted mini-hyrax on the molars. None of the expanders caused significant changes in the oropharyngeal measurements.Conclusions: Only the Hyrax and inverted mini-hyrax on the molar expanders effectively increased the nasal passage volume, and none of the expanders evaluated in this study modified the oropharyngeal airway.

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Cone-Beam Computed Tomography Evaluation of Skeletal Deformities and Pharyngeal Airway in Chinese Han Individuals With Nonsyndromic Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665619860700 ◽

2019 ◽

Vol 57 (1) ◽

pp. 65-72 ◽

Cited By ~ 1

Author(s):

Yuan Zhang ◽

Yuhua Wang ◽

Yaoyuan Zhang ◽

Sheng Li ◽

Lin Wang ◽

...

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Cone Beam ◽

Skeletal Deformities ◽

Pharyngeal Airway ◽

Face Height ◽

Computed Tomography Images ◽

Significant Difference

Objective: This study examined the relationships between skeletal deformities and the pharyngeal airway of patients with nonsyndromic unilateral cleft lip and palate (UCLP). Design: Retrospective study. Setting: Orthodontics and Oral and Maxillofacial Surgery Departments in the Affiliated Hospital of Stomatology, Nanjing Medical University, China. Patients, Participants: The sample comprised 30 nonsyndromic UCLP patients and 30 healthy controls. Each group has 23 males and 7 females. Interventions: All cone-beam computed tomography images were obtained with the participant in the standard supine position and asked to bite with intercuspal position without swallowing or moving their heads and tongues during scanning. Main Outcome Measure(s): SNA, SNB, ANB, anterior cranial base, Wits appraisal, maxillary length (PTM-ANS || FH), maxillary position (S-PTM || FH), mandibular length (Go-Pog || MP), FMA, posterior face height, anterior face height, Posterior-Anterior face height, lower face height, pharyngeal airway volumes, and areas were evaluated by Dolphin imaging software. Results: The UCLP group showed significantly decreased SNA, SNB, ANB, PTM-ANS || FH, S-PTM || FH, P-A Face Height compared with the controls. However, the airway volumes and areas showed no significant difference between 2 groups. The total airway volume and minimum cross-sectional area in UCLP patients were related to the Go-Pog || MP and FMA. Conclusions: Patients with UCLP have both the maxillary and mandibular deficiencies in the sagittal dimension. Both the sagittal and vertical relationships of the jaw might affect the airway volume and area. However, no significant difference was detected in airway volume and area in UCLP patients when compared with the controls.

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Three-Dimensional Assessment of Cervical Vertebrae Anomalies in Patients With Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620980226 ◽

2020 ◽

pp. 105566562098022

Author(s):

Gabriella L. de Rezende Barbosa ◽

Luiz A. Pimenta ◽

Donald A. Tyndall ◽

Trishul V. Allareddy ◽

Saulo L. Sousa Melo

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Cervical Vertebrae ◽

Cone Beam ◽

Os Odontoideum ◽

Posterior Arch ◽

Computed Tomography Images ◽

Significant Difference

Objective: To evaluate the occurrence of cervical vertebrae anomalies (CVA) in patients with unilateral (UCLP) and bilateral cleft lip and palate (BCLP) using cone beam computed tomography (CBCT) examinations. Design: Retrospective assessment of CBCT images. Descriptive statistics were calculated. Fisher exact test or χ2 test was performed to evaluate the differences among each CVA between sex and type of cleft. Setting: School of Dentistry. Participants: One hundred fifty-one patients with cleft lip and palate (103 UCLP/48 BCLP). Interventions: No relevant intervention. Main Outcome Measures: Cone beam computed tomography images were assessed for the presence or absence of 12 most commonly observed CVA: spina bifida, dehiscence, cleft of the posterior arch, cleft of the anterior arch, fusion between cervical vertebrae, block fusion, occipitalization, narrowing of the intervertebral space, posterior ponticle, os odontoideum, ossiculum terminale, and subdental cartilaginous remnants. Results: The presence of subdental cartilaginous remnants was the most frequently observed alteration—found in 81.45% of the sample—and it was the only CVA with statistically significant frequencies in the individuals with BCLP. Considering only the other CVA, 22.51% presented 1 and 5.29% presented 2 or more CVA. Conclusions: Patients with cleft lip and palate may present an overall high incidence of CVAs. However, when comparing the distribution of the CVAs among sex and types of cleft, the only significant difference noted was a higher incidence of subdental cartilaginous remnants among patients with BCLP.

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Alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients using cone-beam computed tomography evaluation

Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie ◽

10.1007/s00056-020-00276-w ◽

2021 ◽

Author(s):

Marcin Stasiak ◽

Anna Wojtaszek-Słomińska ◽

Bogna Racka-Pilszak

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Cleft Lip ◽

Cleft Lip And Palate ◽

Alveolar Bone ◽

Contralateral Side ◽

Cone Beam ◽

Rank Test ◽

Cross Sectional ◽

Alveolar Bone Grafting

Abstract Purpose The aims of this retrospective cross-sectional study were to measure and compare labial and palatal alveolar bone heights of maxillary central incisors in unilateral cleft lip and palate patients, following STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Patients and methods The study group consisted of 21 patients with a mean age of 16 years. High-resolution cone-beam computed tomography was performed at least one year after secondary alveolar bone grafting. The experimental side was the cleft side and the contralateral side without congenital cleft was the control. Measurements were performed on incisors’ midsagittal cross-sections. The Wilcoxon signed-rank test was used for intergroup comparisons. Results The labial and palatal distances between alveolar bone crests and cementoenamel junctions were significantly greater on the cleft side than on the noncleft side. Mean differences were 0.75 and 1.41 mm, respectively. The prevalence of dehiscences at the cleft side maxillary central incisors was 52% on the labial surface and 43% on the palatal surface. In the controls, it was 19% and 14%, respectively. Conclusion The cleft-adjacent maxillary central incisors had more apically displaced alveolar bone crests on the labial and palatal sides of the roots than the controls. Higher prevalence of dehiscences was found on the cleft side. Bone margin differences predispose to gingival height differences of the central incisors. These differences could increase the demands of patients to obtain more esthetic treatment results with orthodontic extrusion and periodontal intervention on the cleft side.

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