Cephalometric and three-dimensional assessment of superior posterior airway space after maxillomandibular advancement

The purpose of this study was to quantify cephalometric and three-dimensional alterations of the posterior airway space of patients who underwent maxillomandibular advancement surgery. 20 patients treated by maxillomandibular advancement were selected. The minimal postoperative period was 6 months. The treated patients underwent cone-beam computed tomography at 3 distinct time intervals, preoperative (T1), immediate postoperative period up to 15 days after surgery (T2), and late postoperative period at least 6 months after surgery. The results showed that the maxillomandibular advancement promoted an increase in the posterior airway space in each patient in all the analyses performed, with a statistically significant difference between T2 and T1, and between T3 and T1, p<0.05. There was a statistical difference between T2 and T3 in the analysis of area and volume, which means that the airway space became narrower after 6 months compared with the immediate postoperative period. The maxillomandibular advancement procedure allowed great linear area and volume increase in posterior airway space in the immediate and late postoperative periods, but there was partial loss of the increased space after 6 months. The linear analysis of airway space has limited results when compared with analysis of area and volume.     

同期咽后壁组织瓣转移修复后大龄腭裂患者语音改善效果的评价

目的探讨咽后壁瓣转移修复术对大龄腭裂患者语音效果的影响。方法选择2006年8月～2008年8月就诊于青岛大学医学院附属医院口腔颌面外科的大龄腭裂患者37例,20例采用两瓣法关闭裂隙并同期行咽后壁瓣转移修复术;17例单纯关闭裂隙。比较手术前后腭咽闭合不全率（RVPI）,单元音[i]三个共振峰频率,辅音[ka]、[pa]、[si]、[qi]冲直条和擦音乱纹及语音清晰度变化,并与健康儿童20例对照。结果所有患者均达到临床Ⅰ期愈合,两手术组术后RVPI均显著降低,语音也有不同程度改善,且关闭裂隙同期行咽后壁瓣转移修复术组明显优于单纯关闭裂隙组。结论大龄腭裂患者同期行腭裂修复术和咽后壁瓣转移修复术能显著改善患者的腭咽闭合功能,可作为大龄腭裂患者常规术式。     

不完全性腭裂修复术后患者替牙期的颅面特征初探

目的比较不完全性腭裂患者修复术后与健康儿童替牙期颅面形态的差别，进一步了解不完全性腭裂患者的颅面特征。方法选择20例不完全性腭裂修复术后，处于替牙期的患者作为腭裂组，年龄7～11岁；选择年龄、性别匹配的非腭裂健康儿童35名作为对照组。对两组研究对象的头颅侧位X线片进行X线头影测量对比分析。结果腭裂组全颅底长、上颌长、下颌有效长度分别为86．48mm、44．79mm、65．45mm，对照组分别为91．27mm、48．84mm、70．49mm，差异均有统计学意义（P〈0．001）。结论不完全性腭裂患者颅面部发育不足，呈Ⅲ类骨面型。     

Cephalometric outcome of two types of palatoplasty in complete unilateral cleft lip and palate

In complete unilateral cleft lip and palate (CLP), a vomerplasty is assumed to improve midfacial growth because of the reduction in scarring in the growth-sensitive areas of the palate. Our aim, therefore, was to evaluate maxillofacial morphology after a modified Langenbeck technique or a vomerplasty in children with complete unilateral CLP who were operated on by a single surgeon. As part of a one-stage closure of complete unilateral CLP done during the first year of life, the technique for repair of the hard palate repair differed between the two groups. In the modified group (n = 37, mean age 11 years) a modified von Langenbeck technique was used that resulted in denudation of the bony surface on the non-cleft side only. In the vomerplasty group (n = 37, mean age 11 years) a vomerplasty was used to cover the palatal bone. Lateral cephalograms from both groups were compared using the Eurocleft protocol. Fourteen angular variables were measured and 2 ratios calculated. Skeletal morphology in the groups was comparable. Maxillary incisor inclination (ILs/NL angle) and interincisal angle (ILs/ILi) were better after vomerplasty (p = 0.001 and 0.04, respectively) but soft tissue facial convexity (gs-prn-pgs) was less good after vomerplasty (p = 0.009). However, there was no difference between the groups in the other variable that reflected facial convexity (gs-sn-pgs) (p = 0.22). Modification of the palatoplasty had a limited effect on skeletal morphology in preadolescent children, but it resulted in better inclination of the maxillary incisors.     

Cephalometric analysis of maxillofacial morphology in unoperated cleft palate patients.

This study was designed to investigate maxillofacial morphology in adolescents and adults with unrepaired cleft palate, with or without cleft lip. Twenty-two Chinese patients with unilateral cleft lip and palate (the UCLP group), and 21 Chinese with cleft palate (the CP group) were cephalometrically evaluated and classified into the five ranges established from the means and standard deviations for matched normal Chinese populations. Many subjects in both UCLP and CP groups showed an intrinsic maxillary retrusion and a steeper mandible. The others had nearly normal maxillofacial morphology. The tendency for maxillary retrusion and a steeper mandible became increasingly remarkable with age. In the long axis of upper incisors in subjects with permanent dentition, there were no UCLP subjects with labial inclination, whereas three CP subjects exhibited labial inclination.     

Dental arch relationships after two-flap palatoplasty in Taiwanese patients with unilateral cleft lip and palate

The authors evaluated the dental arch relationships of patients with unilateral cleft lip and palate treated with two-flap palatoplasty at the Chang Gung Craniofacial Center, Taipei, Taiwan, and compared them with the 6 centers from the Eurocleft study. Intraoral dental photographs of 60 consecutively treated Taiwanese patients with complete unilateral cleft lip and palate were used. The dental arch relationships were rated with the Goslon yardstick and compared with the Goslon outcome of the 6 center Eurocleft study. The strength of agreement of rating was assessed with quadratic-weighted kappa statistics. Inter- and intra-examiner agreements were high. 75% of patients were classified into poor or very poor categories, and the mean Goslon score was 3.92. These results showed no significant difference with Eurocleft center D, which had relatively poor treatment outcome. These data suggest that intraoral dental photographs provide a reliable method for rating dental arch relationships. Dental arch relationships in patients with unilateral cleft lip and palate at Chang Gung Craniofacial Center were unfavorable. This seemed to be attributable to the surgical procedures and racial differences in craniofacial morphology.     

头颅定位测量对大年龄未手术腭裂患者上颌骨发育的研究分析

目的研究分析大年龄未手术腭裂患者上颌骨发育的情况。方法运用电脑图象测试系统，对３７名未手术的大年龄腭裂患者头颅定位Ｘ片进行测量分析，并与２０名正常成人对照。结果大年龄未手术患者上颌骨前后发育受限，而垂直向发育与正常成人无显著性差异。结论腭裂畸形本身可影响上颌骨的发育     

Cephalometric and three-dimensional assessment of the posterior airway space and imaging software reliability analysis before and after orthognathic surgery

PurposeThis study aimed to compare the reliability of three different imaging software programs for measuring the PAS and concurrently to investigate the morphological changes in oropharyngeal structures in mandibular prognathic patients before and after orthognathic surgery by using 2D and 3D analyzing technique.Material and methodsThe study consists of 11 randomly chosen patients (8 females and 3 males) who underwent maxillomandibular treatment for correction of Class III anteroposterior mandibular prognathism at the University Hospital in Zurich. A set of standardized LCR and CBCT-scans were obtained from each subject preoperatively (T0), 3 months after surgery (T1) and 3 months to 2 years postoperatively (T2). Morphological changes in the posterior airway space (PAS) were evaluated longitudinally by two different observers with three different imaging software programs (OsiriX^® 64-bit, Switzerland; Mimics^®, Belgium; BrainLab^®, Germany) and manually by analyzing cephalometric X-rays.ResultsA significant increase in the upper airway dimensions before and after surgery occurred in all measured cases. All other cephalometric distances showed no statistically significant alterations. Measuring the volume of the PAS showed no significant changes in all cases. All three software programs showed similar outputs in both cephalometric analysis and 3D measuring technique.ConclusionA 3D design of the posterior airway seems to be far more reliable and precise phrasing of a statement of postoperative gradients than conventional radiography and is additionally higher compared to the corresponding manual method. In case of Class III mandibular prognathism treatment with bilateral split osteotomy of the mandible and simultaneous maxillary advancement, the negative effects of PAS volume decrease may be reduced and might prevent a developing OSAS.     

Acoustic airway profiles in unilateral cleft palate patients.

OBJECTIVE: This study investigates the nasal airway in unilateral cleft palate patients by means of a noninvasive, objective diagnostic method that provides topographic information about the airway profile. DESIGN: A consecutive sample of patients was measured. SETTING: Cleft palate rehabilitation center of the University of Mainz, Germany. PATIENTS: Forty-nine subjects were investigated: 34 full-grown patients with complete unilateral cleft lip and palate and 15 controls with subjective normal nasal patency. INTERVENTION: A transnasal series of three acoustic measurements of nasal volume was performed per nostril; measurements were taken both before and after decongestion with 0.3 mg xylometazoline per nostril. Minimum cross-sectional area, nasal volume, and decongestion capacity were calculated for both the cleft side and the contralateral side and for both nasal sides in controls. RESULTS: Pathologic obstructions (<0.4 cm2) were detected on the cleft side in 75% of patients but were detected in only 15% of patients on the contralateral side (p < .001). The valve area of the cleft side (0.32 +/- 0.2 cm2) yielded significantly (p < .001) lower cross-sectional values compared with the contralateral side (0.56 +/- 0.1 cm2). Total nasal volume was determined to be 35% smaller on the cleft side (p < .001). Significantly higher decongestion capacity was verified on the cleft side, thus indicating mucosal hypertrophy. CONCLUSION: Despite a wide range of interindividual variability, we recognized a characteristic "descending W" airway pattern in cleft palate patients. Acoustic rhinometry seems to be a powerful tool for acquiring topographic information about the individual airway profile. It has proven helpful in visualizing the location and amount of pathologic obstructions, rendering it especially useful for preoperative investigation and quality control in corrective cleft nose surgery.     

Cephalometric pharyngeal changes after Le Fort I osteotomy in patients with unilateral cleft lip and palate

Pharyngeal changes after Le Fort I osteotomy were evaluated cephalometrically in 37 patients (27 M, 10 F; mean age 23.8 years) with unilateral cleft lip and palate (UCLP). Seven patients had previously undergone velopharyngeal (VPP) flap surgery to improve speech. One year postoperatively the patients without previous VPP showed a significant change (55%-85% of the surgical change) in the upper and lower sagittal depth of the nasopharyngeal airway, but not in the depth of oropharyngeal airway, length of soft palate, or position of hyoid bone. No significant changes were observed between 6 months and 1 year postoperatively. Mean surgical horizontal advancement was 4.7 mm and the mean vertical lengthening 4.7 mm anteriorly and 1 mm posteriorly. There was a correlation between the amount of horizontal advancement and the amount of change in the nasopharyngeal airway. The patients with previous VPP showed significant postoperative change (85% of the surgical change) only in the lower nasopharyngeal airway, although their surgical advancement was similar to that without previous VPP. Patients with previous VPP showed significantly smaller depths of upper nasopharyngeal airway postoperatively than the patients without previous VPP. Five patients (13%) needed VPP after the osteotomy. There was no difference in the nasopharyngeal airway in the patients with VPP after the osteotomy when compared to those without, but they seemed to have shortest maxillary lengths and largest mean surgical changes vertically both anteriorly (5.5 mm) and posteriorly (2.3 mm). Moderate maxillary advancement in UCLP patients results in significant changes in the nasopharyngeal airway.     

Cephalometric pharyngeal changes after Le Fort I osteotomy in patients with unilateral cleft lip and palate

Pharyngeal changes after Le Fort I osteotomy were evaluated cephalometrically in 37 patients (27 M, 10 F; mean age 23.8 years) with unilateral cleft lip and palate (UCLP). Seven patients had previously undergone velopharyngeal (VPP) flap surgery to improve speech. One year postoperatively the patients without previous VPP showed a significant change (55%-85% of the surgical change) in the upper and lower sagittal depth of the nasopharyngeal airway, but not in the depth of oropharyngeal airway, length of soft palate, or position of hyoid bone. No significant changes were observed between 6 months and 1 year postoperatively. Mean surgical horizontal advancement was 4.7 mm and the mean vertical lengthening 4.7 mm anteriorly and 1 mm posteriorly. There was a correlation between the amount of horizontal advancement and the amount of change in the nasopharyngeal airway. The patients with previous VPP showed significant postoperative change (85% of the surgical change) only in the lower nasopharyngeal airway, although their surgical advancement was similar to that without previous VPP. Patients with previous VPP showed significantly smaller depths of upper nasopharyngeal airway postoperatively than the patients without previous VPP. Five patients (13%) needed VPP after the osteotomy. There was no difference in the nasopharyngeal airway in the patients with VPP after the osteotomy when compared to those without, but they seemed to have shortest maxillary lengths and largest mean surgical changes vertically both anteriorly (5.5 mm) and posteriorly (2.3 mm). Moderate maxillary advancement in UCLP patients results in significant changes in the nasopharyngeal airway.     

Influence of the Furlow palatoplasty for patients with submucous cleft palate on facial growth

The purpose of this study was to investigate the facial growth in patients with submucous cleft palate operated on using the Furlow palatoplasty. A total of 30 patients with submucous cleft palate underwent Furlow palatoplasty from 1993 to 1998. The mean follow-up period was 4 years and 3 months. Twenty-five of 30 patients were followed up. Mid-facial growth was measured using lateral cephalograms in 18 patients whose age was greater than 8 years. The parameters obtained in the lateral cephalogram were compared with those of a healthy population in Korea. Eleven (61.1%) of 18 patients observed were within the clinical normal range for the age group for the parameter of the span between the anterior nasal spine and posterior nasal spine, 6 patients (33.3%) were over the range, and 1 patient (5.6%) was below the range. For the sella-nasion-subspinale angle, 55.6% of patients were within the clinical normal range, 27.8% were over the range, and 16.6% were below the range. For the sella-nasion-supramentale angle, 55.6% of patients were within the clinical normal range, 22.2% were over the range, and 22.2% were below the range. For the sella-nasion-subspinale-sella-nasion-supramentale angle, 72.2% of patients were within the clinical normal range, 27.8% were over the range, and none were below the range. For the span between the basion and posterior nasal spine, 50.0% of patients were within the clinical normal range, 27.8% were over the range, and 22.2% were below the range. In conclusion, our results suggest that the Furlow palatoplasty is a useful procedure as an initial treatment of submucous cleft palate and that this technique has a less harmful effect on facial growth because there is no excessive surgical intervention on the hard palate and alveolar process.     

Cephalometric analysis in submucous cleft palate: comparison of cephalometric data obtained from submucous cleft palate patients with velopharyngeal competence and incompetence.

OBJECTIVE: The purpose of this study was to investigate the relationship between craniofacial and nasopharyngeal morphology and velopharyngeal function in submucous cleft palate. DESIGN AND PATIENTS: Fifty-two lateral cephalometric radiographs of 46 submucous cleft palate (SMCP) patients with velopharyngeal competence (24 patients) and incompetence (22 patients) at 4 and 7 years of age were studied. The patients had not received any surgical or orthodontic treatment prior to cephalography being performed. RESULTS: Significant differences were found between cephalometric variables (N-Ba, N-S-Ba angle) in children with velopharyngeal competence and incompetence. However, the results of our study showed that cephalometric data alone are not useful for predicting velopharyngeal function and can not serve as an absolute prognostic indicator. CONCLUSION;There are many factors that can influence velopharyngeal function in SMCP patients. Cephalometric data did not demonstrate a strong relationship to velopharyngeal function.     

Cephalometric study of posterior airway space in patients affected by Class II occlusion and treated with orthognathic surgery.

The posterior airway space (PAS) is delimited by hard and soft tissues with anomalies that may produce alterations in volume. In patients with severe hypoplasia of the middle and lower third of the face, a decrease in volume of the PAS is present, producing a polysyndromic condition that ranges from snoring to obstructive sleep apnea syndrome (OSAS). The aim of this report is to define PAS variations via a cephalometric study in patients affected by class II occlusion and treated with orthognathic surgery. The authors studied 44 patients affected by class II occlusion who underwent surgery to correct the maxillomandibular malformation. The patient cohort was classified according to the type of surgery performed: Le Fort I osteotomy with or without a sagittal split osteotomy. To evaluate PAS variation, cephalometric analyses were performed by pre- and postoperative lateral teleradiography. This study showed an increase in PAS volume, especially at the hypopharynx and the lower part of the oropharynx, when the sagittal split osteotomy was performed and/or the maxilla was moved anteriorly and/or superiorly. A decrease of PAS can be seen in downward and/or backward maxillary movements. In conclusion, cephalometric studies of hard and soft tissues (such as tongue, pharynx, soft palate, etc.) should be performed in all patients affected by maxillomandibular malformation. This approach may provide data for the diagnosis of respiratory pathologies that vary from snoring to OSAS.     

Cephalometric soft tissue profile in unilateral cleft lip and palate patients

Soft tissue profile analysis from cephalometric radiographs is recognized as an important part of the assessment of treatment outcome in cleft lip and palate (CLP), and has previously been found to discriminate between groups better than conventional hard tissue cephalometric analysis. Cephalometric radiographs of 182 12-14-year-old children from the UK with complete unilateral cleft lip and palate (UCLP) were available for this investigation, which aimed to describe the cephalometric soft tissue findings for this group of UK children. Seven soft tissue profile angular variables were measured using Dentofacial Planner Plus (DFP). Thirty films were re-measured two weeks later to assess the reliability of the method, which was acceptable for most of the variables, although use of landmarks related to the lips increased error. Mean nasolabial angle (97.44 degrees), facial convexity (138.02 degrees), and soft tissue ANB (2.99 degrees) compared unfavourably with previously reported data. These findings support the data given in the Clinical Standards Advisory Group study. Soft tissue profile assessment from cephalometric radiographs has acceptable reliability. The results of treatment show poor outcome in the UK compared with published data.     

咽后壁瓣断蒂对腭咽闭合影响的探讨

目的 探讨咽后壁瓣成形术后腭咽闭合功能不全(velopharyngeal insufficiency,VPI)及其并发症阻塞性睡眠呼吸暂停低通气综合征(OSAHS)治疗中咽后壁瓣断蒂的作用.方法 1993至2008年于北京大学口腔医学院·口腔医院唇腭裂治疗中心接受咽后壁瓣断蒂术患者20例(不完全腭裂11例、完全性唇腭裂9例),20例断蒂术前均行鼻咽纤维镜、头颅定位侧位X线片检查及语音录音,对有OSAHS主述者行睡眠呼吸监测.全部患者术后48 h后进行语音评价.术中单纯断蒂14例,断蒂后重新改变咽成形术式6例.结果 ①14例成形术后语音改善不明显,仍存在过高鼻音,咽后壁瓣断蒂术后语音改善明显;②3例成形术后虽发音正常但出现呼吸道阻塞症状,断蒂术后呼吸睡眠状况改善,语音仍正常;③3例成形术后发音正常,因正颌手术的麻醉需要断蒂,断蒂后的语音无明显改变.结论 咽后壁瓣成形术后出现OSAHS或仍存在VPI,需手术断蒂或其他类型咽成形术治疗;断蒂的时间应在咽后壁瓣成形术半年后.     

腭裂术后语音障碍患儿的语音清晰度及言语康复治疗效果分析

目的:探讨腭裂(cleft palate,CP)术后嗓音障碍(voice disorder,VD)患儿的语音特点及言语康复治疗效果.方法:选取我院2018年1月—2018年12月收治的40例行CP修复术的患儿,所有患儿均在CP修复术后1个月接受言语康复治疗,对比言语康复治疗前后/a/音声学特点参数和临床疗效.结果:腭裂修补术后,患儿经言语康复治疗后,其发/a/音时的基频(F0)值,与治疗前差异无统计学意义(t=0.661,P>0.05);言语康复后,谐噪比(harmonic-noise ratio,HNR)值明显大于治疗前,标准化噪声能量(normalized noise energy,NNE)、振幅微扰(Shimmer)、基频微扰(Jit-ter)值明显小于治疗前(t=1.690、3.974、2.287、24.558,P<0.05);言语康复治疗前,重度VD患儿语音清晰度(phonetic intelligibility,PI)明显低于轻度患儿(F=3.452,P<0.05),治疗后,不同程度术后VD患儿PI值均显著提升,组间对比,差异无统计学意义(F=1.153,P>0.05).CP术后重、中、轻度VD患儿临床治疗有效率分别为88.89％、100.00％、100.00％.结论:CP修复术后常存在VD,言语康复治疗可有效提升CP患儿嗓音音质;临床应重视腭裂术后的VD训练.     

Craniofacial morphology in isolated cleft palate prior to palatoplasty

Roentgencephalometry was used in a study of 30 boys and 30 girls with isolated cleft palate prior to palatoplasty. Their ages ranged from 3.5 to 4.5 years. These patients were compared with a control series and with a group of 20 boys with unilateral cleft lip and palate, examined similarly prior to palatoplasty. The isolated cleft palate (CP) group showed four basic differences from the control group: a shortening of maxillary depth and mandibular length (body and ramus), a reduction of the posterior height of the upper face, and a marked widening of the nasal cavity. In contrast to the unilateral cleft lip and palate group the CP group failed to demonstrate a shortening of the anterior height of the upper face or an elongation of the lower face. There was also no indication of a posterior displacement of the upper jaw, of a dentoalveolar retroinclination of the maxilla, or of an increase of the interocular distance. The observed shortening of both jaws in the CP group might be of importance in understanding the pathogenesis of isolated cleft palate. Unilateral cleft lip and palate was not associated with a reduction of the depth of the upper jaw, although the observed shortening of the lower jaw and of the posterior height of the upper face and the widening of the nasal cavity were similar to those seen in isolated cleft palate.