To verify the effect of orthognathic surgery (OS) on nasal dimensions and its correlation with respiratory symptoms in patients operated on over the past 20 years.
Design
Retrospective study.
Setting
Tertiary level craniofacial hospital.
Participants
535 patients with CLP previously repaired, without syndromes, age over 18, who performed OS between 2000 and 2019 and rhinomanometric evaluation pre and post OS.
Interventions
Maxillary advancement isolated and combined with turbinectomy and/or mandibular osteotomy.
Main Outcome Measures
Minimum nasal cross-sectional area (CSA) assessed by posterior (PR) and anterior rhinomanometry (AR), nasopharyngeal cross-sectional area (NCSA) verified by modified AR, and self-perceived respiratory symptoms through a questionnaire.
Results
After OS, there was a significant increase in CSA assessed by PR (p < .001) and AR (p < .001), while there was no significant difference in NCSA (p = 0.319). Regarding respiratory symptoms after OS, 26.3% showed improvement in nasal obstruction, 28.5% in oronasal breathing, 18.5% in snoring, and 5.2% in respiratory obstruction during sleep. However, a weak correlation between increased CSA and improvement of symptoms was observed. In the first decade, lower values of CSA (p < .001) and NCSA (p < .001) were observed compared to the second decade. Both periods showed a significant increase in CSA (p < .001).
Conclusions
Nasal dimensions and breathing symptoms were improved by OS when combined with turbinectomy. Comparing the results of patients operated on between two different decades, patients had more favorable conditions for breathing in the most recent decade of care. However, this was not statistically correlated with the improvement in patient symptoms in this study.
AtaolMErtaşÜ. Evaluation of nasal airflow resistance of operated unilateral cleft lip and palate surgery patients compared with skeletal class III individuals. Int J Pediatr Otorhinolaryngol. 2020;137:110188. doi:https://doi.org/10.1016/j.ijporl.2020.110188
2.
FukushiroAPTrindadeIEK. Nasal airway dimensions of adults with cleft lip and palate: Differences among cleft types. Cleft Palate-Craniofacial J. 2005;42(4):396‐402. doi:https://doi.org/10.1597/03-081.1
3.
WangZWangPZhangY, et al.Nasal airway evaluation after le Fort i osteotomy combined with septoplasty in patients with cleft lip and palate. J Craniofac Surg. 2017;28(1):207‐211. doi:https://doi.org/10.1097/SCS.0000000000003259
4.
ZhangLBaiXLiZ, et al. Improvement of aesthetic and nasal airway in patients with cleft lip nasal deformities: Rhinoplasty with septal cartilage graft and septoplasty. Cleft Palate-Craniofacial J. 2018;55(4):554‐561. doi:https://doi.org/10.1177/1055665617746260
HairfieldWMWarrenDWSeatonDL. Prevalence of mouthbreathing in cleft lip and palate. Cleft Palate J. 1988;25(2):135‐138.
7.
De BragançaMFernandesLGraziela NoronhaA, et al. Symptoms of obstructive sleep apnea, nasal obstruction, and enuresis in children with nonsyndromic cleft lip and palate: A prevalence study. Cleft Palate Craniofac J.56, no. 3(2019): 307‐313. doi:https://doi.org/10.1177/1055665618776074.
8.
CamposLDTrindadeIEKYatabeM, et al. Reduced pharyngeal dimensions and obstructive sleep apnea in adults with cleft lip/palate and Class III malocclusion. Cranio - J Craniomandib Pract. 2021;39(6):484‐490. doi:https://doi.org/10.1080/08869634.2019.1668997
9.
YatesDAllareddyVCaplinJ, et al.An overview of timeline of interventions in the continuum of cleft lip and palate care. Oral Maxillofac Surg Clin North Am. 2020;32(2):177‐186. doi:https://doi.org/10.1016/j.coms.2020.01.001
10.
HathawayRDaskalogiannakisJMercadoA, et al. The americleft study: An inter-center study of treatment outcomes for patients with unilateral cleft lip and palate part 2. Dental arch relationships. Cleft Palate-Craniofacial J. 2011;48(3):244‐251. doi:https://doi.org/10.1597/09-181.1
11.
KloukosDFudalejPSequeira-ByronP, et al.Maxillary distraction osteogenesis versus orthognathic surgery for cleft lip and palate patients. Cochrane Database Syst Rev. 2018;2018(8). doi:https://doi.org/10.1002/14651858.CD010403.pub3
12.
TrindadeIEKYamashitaRPSuguimotoRM, et al.Effects of orthognathic surgery on speech and breathing of subjects with cleft lip and palate: Acoustic and aerodynamic assessment. Cleft Palate-Craniofacial J. 2003;40(1):54‐64. doi:https://doi.org/10.1597/1545-1569(2003)040<0054:EOOSOS>2.0.CO;2
YamashitaRPTrindadeIEK. Long-term effects of pharyngeal flaps on the upper airways of subjects with velopharyngeal insufficiency. Cleft Palate-Craniofacial J. 2008;45(4):364‐370. doi:https://doi.org/10.1597/07-031.1
15.
TrindadeIEKBertierCESampaio-TeixeiraACM. Objective assessment of internal nasal dimensions and speech resonance in individuals with repaired unilateral cleft lip and palate after rhinoseptoplasty. J Craniofac Surg. 2009;20(2):308‐314. doi:https://doi.org/10.1097/SCS.0b013e3181992287
16.
ChangCSWallaceCGHsiaoYC, et al. Airway changes after cleft orthognathic surgery evaluated by three-dimensional computed tomography and overnight polysomnographic study. Sci Rep. 2017;7(1):1‐9. doi:https://doi.org/10.1038/s41598-017-12251-4
17.
World Health Organization (WHO). Global strategies to reduce the health-care burden of craniofacial anomalies: report of WHO meetings on International Collaborative Research on Craniofacial Anomalies, Geneva, Switzerland, 5-8 November 2000; Park City, utah, USA, 24-26 May 2001. In: World Health. 2002:1–148.
HairfieldWMWarrenDW. Dimensions of the cleft nasal airway in adults: A comparison with subjects without cleft. Cleft Palate J. 1989;26(1):9‐13.
25.
SampaioACMTrindadeIEKGenaroKF, et al.Dimensões das vias aéreas na respiração de repouso: áreas nasal e nasofaríngea. In: Livro de Resumos Do I Encontro Cientıíico Da Pós-Graduação Do HPRLLP–USP. 1997:31.
26.
de AraújoLLda SilvaASCAraújoBMAM, et al.Nasopharyngeal dimensions in normal individuals: Normative data. Codas. 2016;28(4):403‐408. doi:https://doi.org/10.1590/2317-1782/20162015020
27.
de Souza FreitasJAde AlmeidaALPFSoaresS, et al. Rehabilitative treatment of cleft lip and palate: Experience of the hospital for rehabilitation of craniofacial anomalies/USP (HRAC/USP) - part 4: Oral rehabilitation. J Appl Oral Sci. 2013;21(3):284‐292. doi:https://doi.org/10.1590/1679-775720130127.
28.
Trindade-SuedamIKCastilhoRLSampaio-TeixeiraACM, et al. Rapid maxillary expansion increases internal nasal dimensions of children with bilateral cleft lip and palate. Cleft Palate Craniofac J. 2016;53(3):272‐277. doi:https://doi.org/10.1597/14-244
29.
PiriläTTikantoJ. Unilateral and bilateral effects of nasal septum surgery demonstrated with acoustic rhinometry, rhinomanometry, and subjective assessment. Am J Rhinol. 2001;15(2):127‐133. doi:https://doi.org/10.2500/105065801781543664
30.
DilaverEAkKBSuzenM, et al.Evaluation of internal nasal valve using computed tomography after le Fort i osteotomy: A cross-sectional study from a tertiary center. Haseki Tip Bul. 2021;59(5):400‐404. doi:https://doi.org/10.4274/haseki.galenos.2021.7386
31.
GötzfriedHFMasingH. On the improvement of nasal breathing following mid-face osteotomies, and possible reasons for the phenomenon. J Maxillofac Surg. 1984;12(1):29‐32. doi:https://doi.org/10.1016/S0301-0503(84)80206-4
32.
SantiagoTMMouraLBGabrielliMAC, et al.Volumetric and cephalometric evaluation of the upper airway of class III patients submitted to maxillary advancement. Rev Odontol da UNESP. 2016;45(6):356‐361. doi:https://doi.org/10.1590/1807-2577.05816
33.
Yatabe-IoshidaMSCamposLDYaeduRY, et al.Upper airway 3D changes of patients with cleft lip and palate after orthognathic surgery. Cleft Palate Craniofac J. 2019;56(3):314‐320. doi:https://doi.org/10.1177/1055665618778622
34.
ParkSBKimYISonWS, et al.Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with Class III skeletal deformities: Bimaxillary surgery and mandibular setback surgery. Int J Oral Maxillofac Surg. 2012;41(1):87‐93. doi:https://doi.org/10.1016/J.IJOM.2011.09.008
35.
GonçalesESDuarteMAHPalmieriC, et al.Retrospective analysis of the effects of orthognathic surgery on the pharyngeal airway space. J Oral Maxillofac Surg. 2014;72(11):2227‐2240. doi:https://doi.org/10.1016/J.JOMS.2014.04.006
MarsonATessitoreASakanoE, et al.Effectiveness of speech and language therapy and brief intervention proposal in mouth breathers. Rev CEFAC. 2012;14(6):1153‐1166. doi:https://doi.org/10.1590/s1516-18462012005000054
