Two-Dimensional Analysis of the Size of Nasopharynx and Adenoids in Non-Syndromic Unilateral Cleft Lip and Palate Patients Using Lateral Cephalograms
Abstract
Objectives: Cleft lip and palate (CLP) is the most common congenital anomaly of the head and neck region. The upper airway in CLP patients is affected by retarded maxillary growth. Small size of the nasopharynx can also lead to mouth breathing. This study aimed to compare the size of nasopharynx and adenoids in non-syndromic unilateral CLP (NSUCLP) patients and healthy controls two-dimensionally on lateral cephalograms.
Materials and Methods: This retrospective study was performed on 30 children with NSUCLP (mean age of 11.3 years) and 30 sex- and age-matched healthy controls with class I skeletal relationship. The bony boundaries of the nasopharynx, nasopharyngeal airway and adenoids were outlined on lateral cephalograms and their surface area was calculated and compared between the two groups. The percentage of nasopharynx occupied by the adenoids was calculated for each individual and compared between the two groups using independent t-test.
Results: Size of nasopharynx in NSUCLP children was significantly smaller than that in healthy controls (P=0.0001). Size of adenoids was significantly larger in NSUCLP children (P=0.0001). Size of nasopharyngeal airway was smaller in NSUCLP patients than controls (P=0.0001). Percentage of nasopharynx occupied by the adenoids was significantly greater in NSUCLP patients (P=0.0001).
Conclusions: The size of nasopharynx is smaller while the size of adenoids is larger in NSUCLP children compared to healthy controls; this can lead to mouth breathing and velopharyngeal incompetence.
- Shapira Y, Lubit E, Kuftinec MM, Borell G. The distribution of clefts of the primary and secondary palates by sex, type, and location. Angle Orthod. 1999 Dec;69(6):523-8.
- Tanaka SA, Mahabir RC, Jupiter DC, Menezes JM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg. 2012 Mar;129(3):511e-518e.
- Mossey P. Global strategies to reduce the healthcare burden of craniofacial anomalies. Br Dent J. 2003 Nov;195(10):613.
- Bugaighis I, O’higgins P, Tiddeman B, Mattick C, Ben Ali O, Hobson R. Three-dimensional geometric morphometrics applied to the study of children with cleft lip and/or palate from the North East of England. Eur J Orthod. 2010 Oct;32(5):514-21.
- Kirjavainen M, Kirjavainen T. Upper airway dimensions in Class II malocclusion: effects of headgear treatment. Angle Orthod. 2007 Nov;77(6):1046-53.
- El H, Palomo JM. Measuring the airway in 3 dimensions: a reliability and accuracy study. Am J Orthod Dentofacial Orthop. 2010 Apr;137(4 Suppl):S50.e1-9.
- Jena AK, Singh SP, Utreja AK. Sagittal mandibular
development effects on the dimensions of the awake pharyngeal airway passage. Angle Orthod. 2010 Nov;80(6):1061-7.
- Taylor M, Hans MG, Strohl KP, Nelson S, Holly Broadbent B. Soft tissue growth of the oropharynx. Angle Orthod. 1996 Oct;66(5):393-400.
- Handelman CS, Osborne G. Growth of the nasopharynx and adenoid development from one to eighteen years. Angle Orthod. 1976 Jul;46(3):243-59.
- Linder-Aronson S. Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl. 1970;265:1-132.
- Linder-Aronson S, Woodside D, Lundströ A. Mandibular growth direction following adenoidectomy. Am J Orthod Dentofac Orthop. 1986 Apr;89(4):273-84.
- Friede H, Johanson B. Adolescent facial morphology of early bone-grafted cleft lip and palate patients. Scand J Plast Reconstr Surg. 1982;16(1):41-53.
- Oosterkamp BC, Remmelink HJ, Pruim GJ, Hoekema A, Dijkstra PU. Craniofacial, craniocervical, and pharyngeal morphology in bilateral cleft lip and palate and obstructive sleep apnea patients. Cleft Palate Craniofac J. 2007 Jan;44(1):1-7.
- MacLean JE, Hayward P, Fitzgerald DA, Waters K. Cleft lip and/or palate and breathing during sleep. Sleep Med Rev. 2009 Oct;13(5):345-54.
- Drake AF, Davis JU, Warren DW. Nasal airway size in cleft and noncleft children. Laryngoscope. 1993 Aug;103(8):915-7.
- Hairfield WM, Warren DW, Seaton DL. Prevalence of mouth breathing in cleft lip and palate. Cleft Palate J. 1988 Apr;25(2):135-8.
- Warren DW, Hairfield WM, Dalston ET, Sidman JD, Pillsbury HC. Effects of cleft lip and palate on the nasal airway in children. Arch Otolaryngol Head Neck Surg. 1988 Sep;114(9):987-92.
- Imamura N, Ono T, Hiyama S, Ishiwata Y, Kuroda T. Comparison of the sizes of adenoidal tissues and upper airways of subjects with and without cleft lip and palate. m J Orthod Dentofacial Orthop. 2002 Aug;122(2):189-94.
- Osborne GS, Pruzansky S, Koepp-Baker H. Upper cervical spine anomalies and osseous nasopharyngeal depth. J Speech Lang Hear Res. 1971 Mar;14(1):14-22.
- Ren Y-F, Isberg A, Henningsson G. Interactive influence of a pharyngeal flap and an adenoid on maxillofacial growth in cleft lip and palate patients. Cleft Palate Craniofac J. 1993 Mar;30(2):144-9.
- van Cauwenberge PB, Bellussi L, Maw AR, Paradise JL, Solow B. The adenoid as a key factor in upper airway infections. Int J Pediatr Otorhinolaryngol. 1995 Jun;32 Suppl:S71-80.
- Wada T, Satoh K, Tachimura T, Tatsuta U. Comparison of nasopharyngeal growth between patients with clefts and noncleft controls. Cleft Palate Craniofac J. 1997 Sep;34(5):405-9.
- Rose E, Staats R, Thissen U, Otten JE, Schmelzeisen R, Jonas I. Sleep-related obstructive disordered breathing in cleft palate patients after palatoplasty. Plast Reconstr Surg 2002 Aug;110(2):392-6.
- Wu JT, Huang GF, Huang CS, Noordhoff MS. Nasopharyngoscopic evaluation and cephalometric analysis of velopharynx in normal and cleft palate patients. Ann Plast Surg. 1996 Feb;36(2):117-22.
- Grewal N, Godhane AV. Lateral cephalometry: A simple and economical clinical guide for assessment of nasopharyngeal free airway space in mouth breathers. Contemp Clin Dent. 2010 Apr;1(2):66-9.
- Mason KN, Perry JL. Relationship between age and diagnosis on volumetric and linear velopharyngeal measures in the cleft and noncleft populations. J Craniofac Surg. 2016 Jul;27(5):1340-5.
- Woo AS. Velopharyngeal dysfunction. Semin Plast Surg. 2012 Nov;26(4):170-7.
- Kassem F, Ebner Y, Nageris B, Watted N, DeRowe A, Nachmani A. Cephalometric findings among children with velopharyngeal dysfunction following adenoidectomy-A retrospective study. Clin Otolaryngol. 2017 Dec;42(6):1289-94.
- Mason RM, Warren DW. Adenoid involution and developing hypernasality in cleft palate. J Speech Hear Disord. 1980 Nov;45(4):469-80.
- Celikoglu M, Buyuk SK, Sekerci AE, Ucar FI, Cantekin K. Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by nilateral cleft lip and palate. Am J Orthod Dentofac Orthop. 2014 Jun;145(6):780-6.
- MacLean JE, Fitzsimons D, Fitzgerald D, Waters K. Comparison of clinical symptoms and severity of sleep-disordered breathing in children with and without cleft lip and/or palate. Cleft Palate Craniofac J. 2017 Sep;54(5):523-9.
- Kemaloğlu Y, Kobayashi T, Nakajima T. Analysis of the craniofacial skeleton in cleft children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 1999 Jan;47(1):57-69.
- Cosman B, Falk AS. Pharyngeal flap augmentation. Plast Reconstr Surg. 1975 Feb;55(2):149-55.
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Issue | Vol 15, No 3 (2018) | |
Section | Original Article | |
Keywords | ||
Cleft Lip Cleft Palate Nasopharynx Adenoids Cephalometry |
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