Three-dimensional analysis of the upper airways of patients with cleft palate and maxillomandibular discrepancy

Author(s)

Thiago Freire Lima

• Document type: Master's Dissertation
• Press: Bauru.
• Institution: Universidade de São Paulo (USP). Faculdade de Odontologia de Bauru (FOB/SDB)
• Defense date: 2015-03-02

Examining board members

Ivy Kiemle Trindade Suedam; Daniela Gamba Garib Carreira; Luiz Andre Freire Pimenta

• Advisor: Ivy Kiemle Trindade Suedam

Abstract

Objective: Cleft lip and palate (CLP) is the most prevalent congenital malformation in humans. Primary plastic surgeries, which main objective is to repair the anatomy and the function of the lip and palate, paradoxically, impair maxillary growth and, consequently, impact negatively on the nasal morphophysiology, leading to deformities such as septal deviation and turbinate hypertrophy. These changes reduce the internal nasal dimensions and increase the resistance to respiratory airflow. The aim of the present study was to evaluate three-dimensionally the pharyngeal airway space of individuals with complete unilateral cleft lip and palate by means of cone beam computed tomography. Materials and Methods: Two groups were evaluated: 1) Control group (CoG): 30 CT scans of individuals without CLP + Angle class III malocclusion, and 2) Cleft group (ClG): 30 CT scans of individuals with CLP + Angle class III malocclusion. Two trained and calibrated examiners assessed the images, in two different moments, by means of Dolphin Imaging 11.0 software. Mean values of pharyngeal volumes (V) and minimal cross-sectional areas (CSA) obtained by examiner 1 were considered for analysis. Intra and inter-examiner reproducibility were assessed by Intraclass correlation coeficiente test. The significance of differences between groups was evaluated by Student \"t\" test for independent samples. The correlation between variables was assessed using Pearson\'s correlation coefficient. P values <0.05 were considered significant. Results: Mean values of V (mm3) for the ClG (20,9±5,0) were significantly lower than for the CoG (26,9±9,6) (p=0,004). Although not statistically significant, individuals from the ClG presented with lower ASMs (158,6±99,1) than the CG individuals (188.8±110,2). A strong positive correlation was observed between the ASM and V variables in both groups (p <0.001) and a strong negative correlation was observed between the variables ASM and age, only for the ClG (p = 0.017). Conclusion: The pharynx of the patients with complete unilateral cleft lip and palate and with Angle Class III malocclusion is volumetrically smaller than that of individuals without cleft lip and palate and with the same type of skeletal discrepancy. This result suggests a greater chance for pharyngeal collapsibility in individuals with cleft lip and palate and, consequently, a greater risk for obstructive sleep apnea in this population. (AU)

• FAPESP's process: 13/24524-9 - THREE-DIMENSIONAL ANALYSIS OF UPPER AIRWAYS IN PATIENTS WITH CLEFT LIP AND PALATE AND MAXILLOMANDIBULAR DISCREPANCY
• Grantee: Thiago Freire Lima
• Support Opportunities: Scholarships in Brazil - Master