The aim of this study was to analyze craniofacial, craniocervical, and pharyngeal morphology in surgically treated bilateral cleft lip and palate (BCLP) men, untreated men with obstructive sleep apnea (OSA), and a reference group of men.
Subjects and methods:
Lateral cephalograms were obtained of 27 male BCLP patients (mean age 29.0 ± 8.3 years), 27 untreated male OSA patients (mean age 38.6 ± 5.3 years), and 27 male controls serving as a reference group (mean age 30.8 ± 9.2 years). Tracings were made, and 26 variables representing craniofacial, craniocervical, and pharyngeal dimensions were obtained using Viewbox 3.1.1.6. software. The groups were compared using a one-way analysis of variance.
Results:
Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients was similar except for a significantly more retrusive maxilla in the BCLP group. Compared to the reference group, the BCLP and OSA groups had significantly larger craniocervical angulations, smaller depth of the oropharynx at the tip of the velum, and a more inferiorly positioned hyoid bone. Significantly larger vertical dimensions were found in the BCLP group compared to the reference group.
Conclusions:
Craniofacial, craniocervical, and pharyngeal morphology of BCLP and OSA patients demonstrate substantial similarities except for a significantly more retrusive maxilla in the BCLP group. It is suggested that airway obstruction and postural adaptation to the obstruction may possibly be related to the aberrant craniofacial, craniocervical, and pharyngeal morphology in OSA and in BCLP patients.
American Academy of Sleep Medicine.Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force.Sleep.1999; 22: 667–689.
BaikU.B.SuzukiM.IkedaK.SugawaraJ.MitaniH.Relationship between cephalometric characteristics and obstructive sites in obstructive sleep apnea syndrome.Angle Orthod.2002; 72: 124–134.
4.
BardachJ.MorrisH.L.OlinW.H.GrayS.D.JonesD.L.KellyK.M.ShawW.C.SembG.Results of multidisciplinary management of bilateral cleft lip and palate at the Iowa Cleft Palate Center.Plast Reconstr Surg.1992; 89: 419–432.
5.
BehfeltK.Linder-AronsonS.McWilliamJ.NeanderP.Laage-HellmanJ.Cranio-facial morphology in children with and without enlarged tonsils.Eur J Orthod.1990a; 12: 233–243.
6.
BehfeltK.Linder-AronsonS.NeanderP.Posture of the head, the hyoid bone and the tongue in children with and without large tonsils.Eur J Orthod.1990b; 12: 458–467.
7.
BisharaS.E.de ArrendondoR.S.ValesH.P.JacobsenJ.R.Dentofacial relationships in persons with unoperated clefts: comparisons between three cleft types.Am J Orthod.1985; 87: 481–507.
8.
BisharaS.E.KrauseC.J.OlinW.H.WestonD.NessJ.V.FellingC.Facial and dental relationships of individuals with unoperated clefts of the lip and/or palate.Cleft Palate J.1976; 13: 238–252.
9.
BisharaS.E.OlinW.H.KrauseC.J.Cephalometric findings in two cases with unrepaired bilateral cleft lip and palate.Cleft Palate J.1978; 15: 233–238.
10.
Boo-ChaiK.The unoperated adult bilateral cleft of the lip and palate.Br J Plast Surg.1971; 24: 250–257.
11.
DahlE.Craniofacial morphology in congenital clefts of the lip and palate. An x-ray cephalometric study of young adult males.Acta Odontol Scand.1970; 28 (Suppl) 57: 11–20.
12.
da Silva FilhoO.G.Carvalho LaurisR.C.Capelozza FilhoL.SembG.Craniofacial morphology in adult patients with unoperated complete bilateral cleft lip and palate.Cleft Palate Craniofac J.1998; 35: 111–119.
13.
FukushiroA.P.TrindadeI.E.Nasal airway dimensions of adults with cleft lip and palate: differences among cleft types.Cleft Palate Craniofac J.2005; 42: 396–402.
14.
HairfieldW.M.WarrenD.W.Dimensions of the cleft nasal airway in adults: a comparison with subjects without cleft.Cleft Palate J.1989; 26: 9–13.
15.
HairfieldW.M.WarrenD.W.SeatonD.L.Prevalence of mouth breathing in cleft lip and palate.Cleft Palate J.1988; 25: 135–138.
16.
HeidbuchelK.L.Kuijpers-JagtmanA.M.FreihoferH.P.Facial growth in patients with bilateral cleft lip and palate: a cephalometric study.Cleft Palate Craniofac J.1994; 31: 210–216.
17.
HeliovaaraA.HaapanenM.L.HukkiJ.RantaR.Long-term effect of pharyngeal flap surgery on craniofacial and nasopharyngeal morphology in patients with cleft palate.Acta Odontol Scand.2003; 61: 159–163.
18.
HellsingE.L'EtrangeP.Changes in lip pressure following extension and flexion of the head at changed mode of breathing.Am J Orthod.1987; 91: 286–294.
19.
HirschbergJ.RehakG.Flap surgery: experience with 1,030 operations and cephalometric investigation.Folia Phoniatr Logop.1997; 49: 201–208.
20.
HoekemaA.HovingaB.StegengaB.de BontL.G.M.Craniofacial morphology and obstructive sleep apnea: a cephalometric analysis.J Oral Rehabil.2003; 30: 690–696.
21.
HudsonD.A.GrobbelaarA.O.FernandesD.B.LentinR.Treatment of velopharyngeal incompetence by the Furlow Z-plasty.Ann Plast Surg.1995; 34: 23–26.
22.
HuggareJ.A.Laine-AlavaM.T.Nasorespiratory function and head posture.Am J Orthod Dentofacial Orthop.1997; 112: 507–511.
23.
IkedaK.OguraM.OshimaT.SuzukiH.HiganoS.TakahashiS.KurosawaH.HidaW.MatsuokaH.TakasakaT.Quantitative assessment of the pharyngeal airway by dynamic magnetic resonance imaging in obstructive sleep apnea syndrome.Ann Otol Rhinol Laryngol.2001; 110: 183–189.
24.
IsbergA.RenY.F.HenningssonG.McWilliamJ.Facial growth after pharyngeal flap surgery in cleft palate patients: a five-year longitudinal study.Scand J Plast Reconstr Surg Hand Surg.1993; 27: 119–126.
25.
KadukW.M.GrabowskiR.GrundlachK.K.H.Position of the hyoid bone in cleft lip, alveolus, and palate: variation of normal anatomy or sign accompanying the malformation?Cleft Palate Craniofac J.2003; 40: 1–5.
26.
KolliasI.K.KrogstadO.Adult craniocervical and pharyngeal changes—a longitudinal cephalometric study between 22 and 42 years of age. Part I: morphological craniocervical and hyoid bone changes.Eur J Orthod.1999; 21: 333–344.
LiaoY.F.ChuangM.L.ChenP.K.T.ChenN.H.YunC.HuangC.S.Incidence and severity of obstructive sleep apnea following pharyngeal flap surgery in patients with cleft palate.Cleft Palate Craniofac J.2002; 39: 312–316.
29.
Linder-AronsonS.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.
30.
Linder-AronsonS.Respiratory function in relation to facial morphology and the dentition.Br J Orthod.1979; 6: 59–71.
31.
LissonA.HankeI.TränkmannJ.Vertical changes in patients with complete unilateral and bilateral cleft lip, alveolus and palate.J Orofac Orthop.2004; 65: 246–258.
32.
LongE.J.McNamaraJ.A.Facial growth following pharyngeal flap surgery: skeletal assessment on serial lateral cephalometric radiographs.Am J Orthod.1985; 87: 187–196.
33.
LoweA.A.OzbekM.M.MiyamotoK.PoeE.K.FleethamJ.A.Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis.Angle Orthod.1997; 67: 143–153.
34.
LuiH.WarrenD.W.DrakeA.F.DavisJ.U.Is nasal airway size a marker for susceptibility toward clefting?Cleft Palate Craniofac J.1992; 29: 336–339.
35.
MaltaisF.CarrierG.CormierY.SeriesF.Cephalometric measurements in snorers, non-snorers, and patients with sleep apnoea.Thorax.1991; 46: 419–423.
36.
OrrW.C.LevineN.S.BuchananR.T.Effect of cleft palate repair and pharyngeal flap surgery on upper airway obstruction during sleep.Plast Reconstr Surg.1987; 80: 226–232.
37.
Ortiz-MonasterioS.SerranoA.BarreraG.Rodriguez-HoffmanH.VingerrasE.A study of untreated adult cleft palate patients.Plast Reconstr Surg.1966; 38: 36–41.
PruzanskyS.FriedeH.Two sisters with unoperated bilateral cleft lip and palate, age 6 and 4 years.Br J Plast Surg.1975; 28: 251–258.
40.
RoseE.StaatsR.ThissenU.OttenJ.E.SchmelzeisenR.JonasI.Sleep-related obstructive disordered breathing in cleft palate patients after palatoplasty.Plast Reconstr Surg.2002; 110: 392–396.
41.
RoseE.ThissenU.OttenJ.E.JonasI.Cephalometric assessment of the posterior airway space in patients with cleft palate after palatoplasty.Cleft Palate Craniofac J.2003; 40: 498–503.
42.
RosensteinS.W.GrasseschiM.DadoD.V.A long-term retrospective outcome assessment of facial growth, secondary surgical need, and maxillary lateral incisor status in a surgical-orthodontic protocol for complete clefts.Plast Reconstr Surg.2003; 111: 1–13.
43.
RosenthalW.Zur Frage der Gaumenplastik.ZblChir.1924; 30: 1621–1627.
44.
SembG.A study of facial growth in patients with bilateral cleft lip and palate treated by the Oslo CLP Team.Cleft Palate Craniofac J.1991; 28: 22–39.
45.
ShprintzenR.J.Pharyngeal flap surgery and the pediatric upper airway.Int Anesthesiol Clin.1988; 26: 79–88.
SiroisM.Caouette-LabergeL.SpierS.LaroqueY.EgerszegiE.P.Sleep apnea following a pharyngeal flap: a feared complication.Plast Reconstr Surg.1994; 93: 943–947.
48.
SolowB.KreiborgS.Soft-tissue stretching: a possible control factor in craniofacial morphogenesis.Scand J Dent Res.1977; 85: 505–507.
49.
SolowB.OvesenJ.NielsenP.W.WildschiodtzG.TallgrenA.Head posture in obstructive sleep apnea.Eur J Orthod.1993; 15: 107–114.
50.
SolowB.Siersbaek-NielsenS.GreveE.Airway adequacy, head posture, and craniofacial morphology.Am J Orthod.1984; 86: 214–223.
51.
SolowB.SkovS.OvesenJ.NorupP.W.WildschiodtzG.Airway dimensions and head posture in obstructive sleep apnea.Eur J Orthod.1996; 18: 571–579.
52.
SolowB.TallgrenA.Natural head position in standing subjects.Acta Odontol Scand.1971; 29: 591–607.
53.
SubtelnyJ.D.Effect of diseases of tonsils and adenoids on dentofacial morphology.Ann Otol Rhinol Laryngol.1975; 84(Suppl 19): 50–54.
54.
TangugsornV.SkatvedtO.KrogstadO.LybergT.Obstructive sleep apnea: a cephalometric study. Part I. Cervico-craniofacial skeletal morphology.Eur J Orthod.1995a; 17: 45–56.
55.
TangugsornV.SkatvedtO.KrogstadO.LybergT.Obstructive sleep apnea: a cephalometric study. Part II. Uvulo-glossopharyngeal morphology.Eur J Orthod.1995b; 17: 57–67.
56.
VargervikK.Growth characteristics of the premaxilla and orthodontic treatment principles in bilateral cleft lip and palate.Cleft Palate J.1983; 20: 289–302.
57.
WarrenD.W.HairfieldW.M.DaltonE.T.The relationship between nasal airway size and nasal-oral breathing in cleft lip and palate.Cleft Palate J.1990; 27: 46–51.
58.
WellsM.D.VuT.A.LuceE.A.Incidence and sequelae of nocturnal respiratory obstruction following posterior pharyngeal flap operation.Ann Plast Surg.1999; 43: 252–257.
59.
WongM.L.SandhamA.AngP.K.WongD.C.TanW.C.HuggareJ.Craniofacial morphology, head posture, and nasal respiratory resistance in obstructive sleep apnoea: an inter-ethnic comparison.Eur J Orthod.2005; 27: 91–97.
60.
ZúñigaC.MirallesR.CarvajalR.RaveraM.J.ContrerasP.CavadaG.Comparative study between children with and without cleft lip and cleft palate. Part 1: cephalometric analysis.Cleft Palate Craniofac J.2000; 37: 281–285.
