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

Abstract

PurposeMaxillary 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 methodsThis 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. ResultsA 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). ConclusionPatients 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.