SA4 - Does Maxillary Expansion for Alveolar Cleft Bone Grafting Affect Nasal Width More on the Cleft Side?

On-demand

Figure 1. Measurements take at the pyriform rim at the widest part of the pyriform and at the height of the inferior turbinate

Table 1. Dimensional changes on the side of the cleft

Table 2. Dimensional changes on the side without cleft

Oral Abstract Presenter(s)

Joseph Zoida, BS

Dental Student
Harvard School of Dental Medicine
Boston, Massachusetts

Disclosure: Nothing to disclose.

Co-Author(s)

Mark Green, DDS, MD

Instructor
Boston Children's Hospital
Boston, Massachusetts

Disclosure: Nothing to disclose.
Bonnie L. Padwa, DMD, MD

Professor
Boston Children's Hospital
Boston, Massachusetts

Disclosure: Nothing to disclose.

Abstract:

Purpose: Maxillary expansion is often required in patients with cleft lip and alveolus/palate prior to alveolar cleft bone grafting (ABG) to align maxillary segments and provide space for closure of an oronasal fistula (ONF). There is limited information on how maxillary expansion affects the nasal skeleton in patients with unilateral cleft lip and alveolus/palate (UCLA/P). The purpose of this study was to compare changes in width between the cleft and non-cleft sides after maxillary expansion at the widest part of the nasal pyriform and at the level of the inferior turbinates.

Patients and methods: This is a retrospective case series of patients with UCLA/P who had maxillary expansion prior to alveolar bone grafting by the author (BLP) at Boston Children’s Hospital from 2015 through 2020. Patients were included if they had maxillary expansion prior to ABG and had CBCT before and after expansion. Linear measurements at the widest aspect of the nasal pyriform and the most superior position of the inferior turbinate were recorded for both the cleft and non-cleft sides. Patients were excluded if they did not have maxillary expansion, if the CBCT data did not include all relevant landmarks, or the scans were greater than 4 years apart. Twenty patients with UCLP who underwent ABG without expansion during the same time period were used as a control group. A paired sample T-test was used to compare the cleft vs. the non-cleft side in the expansion group. The same test was used to compare the non-expanded control group to those who underwent maxillary expansion.

Results: A total of 119 patients with UCLA/P had maxillary expansion prior to ABG, but only 41 (61.0% male, mean age at ABG 10.1 years) had adequate pre- and post-expansion CBCT and were included in the study. Patients with UCLA/P who underwent maxillary expansion showed greater increase in width at the nasal pyriform and inferior turbinate levels on the cleft side compared to the non-cleft side (P < .001). When compared to the non-expanded control group of patients with UCLA/P, the percent increase at the nasal pyriform and inferior turbinate on both the cleft and non-cleft sides were statistically greater for those who underwent maxillary expansion (P < .001, P = .01 at inferior turbinate on the non-cleft side).

Conclusion: Patients with UCLA/P who undergo maxillary expansion prior to alveolar bone grafting have greater dimensional change of the anterior nasal skeleton on the side of the cleft.

References:
1. Veloso NC, Mordente CM, de Sousa AA, Palomo JM, Yatabe M, Oliveira DD, Souki BQ, Andrade I: Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate. Angle Orthod 90(5):672-679, 2020
2. Figueiredo DS, Bartolomeo FU, Romualdo CR, Palomo JM, Horta MC, Andrade I Jr, Oliveira DD: Dentoskeletal effects of 3 maxillary expanders in patients with clefts: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 146(1):73-81, 2014