To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry.
Materials and Methods:
Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22).
Results:
The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft (P value <.001) and noncleft side (P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 (P value <.05).
Conclusions:
Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.
ArasIOlmezSDoganS. 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(6):e75–e81.
2.
AstaniSAYilmazHNNevzatogluSDemirkayaAAcarZA. Evaluation of airway volume in cleft lip and palate following nasoalveolar molding. J Craniofac Surg. 2018;29(8):2143–2147.
3.
CakmakOCelikHCankurtaranMOzluogluLN. Effects of anatomical variations of the nasal cavity on acoustic rhinometry measurements: a model study. Am J Rhinol. 2005;19:262–268.
4.
CelikogluMBuyukSKSekerciAEUcarFICantekinK. Three dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop. 2014;145(6):780–786.
5.
DastidarPNumminenJHeinonenTRyyminPRautiainenMLaasonenE. Nasal airway volumetric measurement using segmented HRCT images and acoustic rhinometry. Am J Rhinol. 1999;13(2):97–103.
6.
DelaireJ. Theoretical principles and technique of functional closure of the lip and nasal aperture. J Maxillofac Surg. 1978;6(2):109–116.
7.
DiwakarRSidhuMSJainSGroverSPrabhakarM. Three-dimensional evaluation of pharyngeal airway in complete unilateral cleft individuals and normally growing individuals using cone beam computed tomography. Cleft Palate Craniofac J. 2015;52(3):346–351.
8.
DrakeAFDavisJUWarrenDW. Nasal airway size in cleft and non cleft children. Laryngoscope. 1993;103(8):915–917.
9.
FergusonKAOnoTLoweAAKeenanSPFleethamJA. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996;109(5):1269–1275.
10.
FredbergJJWohlMEGlassGMDorkinHL. Airway area by acoustic reflections measured at the mouth. J Appl Physiol. 1980;48(5):749–758.
11.
GraysonBHCuttingCWoodR. Preoperative columella lengthening in bilateral cleft-lip and palate. Plast Reconstr Surg. 1993;92(7):1422–1423.
12.
GraysonBHMaullD. Nasoalveolar molding for infants born with clefts of the lip, alveolus, and palate. Semin Plast Surg. 2005;19(04):294–301.
13.
GrymerLFHilbergOPedersenOFRasmussenTR. Acoustic rhinometry: values from adults with subjective normal nasal patency. Rhinology. 1991;29(1):35–47.
14.
HaavistoLESipilaJI. Acoustic rhinometry in children: some practical aspects and influence of age and body surface area on results. Am J Rhinol. 2008;22(4):416–419.
15.
HosseiniHRKaklamanosEGAthanasiouAE. Treatment outcomes of pre-surgical infant orthopedics in patients with non-syndromic cleft lip and/or palate: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017;12(7):e0181768.
16.
IbrahimK. Normal standard curve for acoustic pharyngometry. Otolaryngol Head Neck Surg. 2001;124(3):323–330.
17.
KamalI. Test–retest validity of acoustic pharyngometry measurements. Otolaryngol Head Neck Surg. 2004;130(2):223–228.
18.
KumarSJayanBBansalAK. Acoustic pharyngometry: an objective assessment tool for determining pharyngeal airway. J Dent Special. 2015;3(1):102–108.
19.
KunkelMWahlmannUWagnerW. Acoustic airway profiles in unilateral cleft palate patients. Cleft Palate Craniofac J. 1999;36(5):434–440.
20.
MacLeanJEHaywardPFitzgeraldDAWatersK. Cleft lip and/or palate and breathing during sleep. Sleep Med Rev. 2009;13(5):345–354.
21.
MakiKInouNTakanishiAMillerAJ. Computer-assisted simulations in orthodontic diagnosis and the application of a new cone beam X-ray computed tomography. Orthod Craniofac Res. 2003;6(suppl 1):95–101.
22.
MarshallIMaranNJMartinSJanMARimmingtonJEBestJJ. Acoustic reflectometry for airway measurements in man: implementation and validation. Physiol Meas. 1993;14:157–169.
23.
MassieJPBruckmanKRifkinWJRunyanCMShetyePRGraysonBFloresRL. The effect of nasoalveolar molding on nasal airway anatomy: a 9-year follow up of patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2018;55(4):596–601.
24.
NigroCENigroJFVoegelsRLMionOMelloJFJr. Acoustic rhinometry: anatomic correlation of the first two notches found in the nasal echogram. Rev Bras Otorrinolaringol. 2005;71(2):149–154.
25.
OosterkampBCRemmelinkHJPruimGJHoekemaADijkstraPU. Craniofacial, craniocervical, and pharyngeal morphology in bilateral cleft lip and palate and obstructive sleep apnea patients. Cleft Palate Craniofac J. 2007;44(1):1–7.
26.
PapadopoulosMAKoumpridouENVakalisMLPapageorgiouSN. Effectiveness of pre-surgical infant orthopedic treatment for cleft lip and palate patients: a systematic review and meta-analysis. Orthod Craniofac Res. 2012;15(4):207–236.
27.
PrimentaLAde Rezende BarbosaGLPrettiHEmodiOvan AalstJRossouwPETyndallDADrakeAF. Three-dimensional evaluation of nasopharyngeal airways of unilateral cleft lip and palate patients. Laryngoscope. 2014;125(3):736–739.
TaylorMHansMGStrohlKPNelsonSBroadbentBH. Soft tissue growth of the oropharynx. Angle Orthod. 1996;66(5):393–400.
30.
ThrontonJBNimerSHowrdPS. The incidence, classification, etiology and embryology of oral clefts. Semin Orthod. 1996;2(3):162–168.
31.
UrzoADLawsonVGVassalKP. Airway area by acoustic response measurements and computerized tomography. Am Rev Respir Dis. 1987;125:392–398.
32.
UzelAAlparsianZN. Long-term effects of presurgical infant orthopedics in patients with cleft lip and palate: a systematic review. Cleft Palate Craniofac J. 2011;48(5):587–595.
33.
YilmazRBNCakanDGNoyanA. Comparison of oxygen saturation during impression taking before and after presurgical orthopaedic therapy in babies with cleft lip and palate. Cleft Palate Craniofac J. 2017;54(5):582–587.
34.
YoshiharaMTerajimaMYanagitaN. Three-dimensional analysis of the pharyngeal airway morphology in growing Japanese girls with and without cleft lip and palate. Am J Orthod Dentofacial Orthop. 2012;141(suppl 4):S92–S101.
