Nasal Floor Width Research Articles

Three-dimensional assessment of the maxilla after modified surgically assisted rapid expansion: a retrospective study.

This retrospective study aims to assess the three-dimensional dentoskeletal effects and median palatal suture opening pattern in patients undergoing modified surgically assisted maxillary rapid expansion (SARME) without pterygoid plate detachment. Twenty-eight patients submitted to modified SARME between 2009 and 2016 were retrospectively evaluated through cone-beam computed tomography (CBCT). Dental and skeletal measurements were taken at three different operative periods (before the expansion - T0; at the end of the activation of the Hyrax device - T1; and six months after the immobilization of the device - T2). Statistical analyses, including ANOVA and Pearson's correlation coefficient, were performed using SPSS software. SARME demonstrated significant transverse maxillary expansion (with an average of 6.05mm) with a greater impact in the anterior region. Dental measurements, including canine and molar distances, exhibited significant changes over the operative periods. Bone measurements (ANS and PNS) presented small but significant alterations, including a slight inferior displacement of ANS during device activation. The nasal floor width increased, followed by a width reduction after immobilization. The median palatal suture predominantly exhibited a Type II (V-shaped) opening. The modified SARME presented a transversal direction increase and a super-lower skeletal displacement, with the anterior region being more affected than the posterior region. There was no change in the anteroposterior direction of the maxilla. Additionally, there was an increase in the linear dental measurements and a decrease in the angular measurement, with a positive correlation between the amount of posterior bone expansion and molar expansion as a result of the treatment in the analyzed period.

Outcomes of Presurgical Nasoalveolar Molding using Modified Nostril Retainers in Patients with Unilateral Cleft Lip and Palate at an Average Follow-up of 2 Years.

Presurgical nasoalveolar molding (PNAM) using a modified nostril retainer is a new treatment approach. This study aimed to evaluate the outcomes of early nasal molding using this approach with an average follow-up of 2 years in patients with severe unilateral cleft lip and palate. This retrospective study included 18 patients with unilateral cleft lip and palate without genetic syndromes who underwent PNAM with modified nostril retainers. The Grayson technique was employed with an intraoral plate to approximate cleft segments. Nasal molding was initiated before reducing the cleft width to 5 mm. Measurements, including alar base height ratio (ABHR), nasal floor width ratio (NFWR), columellar length ratio (CLR), columellar angle (CA), and nostril axis inclination on the cleft and non-cleft sides (NAI-C and NAI-NC, respectively), were calculated from standard photographs taken before PNAM (T1), after PNAM (T2), after an average of 1.81 months post-surgery (T3), and after an average of 2.2 years after T3 (T4). Pairwise comparisons of values at the four time points were conducted. NFWR, CLR, CA, NAI-C and NAI-NC significantly increased after PNAM (p<0.05). However, no significant change was observed in ABHR (p>0.05) from T1 to T2. These outcomes were maintained at T4, and no patient developed a mega nostril. The use of a modified nostril retainer for nasal molding appears to provide stability during the high probability of relapse reported in the literature.

The short- and long-term changes of upper airway and alar in nongrowing patients treated with Mini-Implant Assisted Rapid Palatal Expansion (MARPE): a systematic review and meta-analysis

ObjectiveThis study aims to assess the short- and long-term changes in the upper airway and alar width after mini-implant -assisted rapid palatal expansion (MARPE) in nongrowing patients.MethodsFive electronic databases (PubMed, Scopus, Embase, Web of Science, and Cochrane Library) were searched up to 2 August, 2023 based on the PICOS principles. The main outcomes were classified into three groups: 1) nasal cavity changes, 2) upper airway changes and 3) alar changes. The mean difference (MD) and 95% confidence intervals (CI) were used to assess these changes. Heterogeneity tests, subgroup analyses, sensitivity analyses, and publication bias were also analyzed.ResultOverall, 22 articles were included for data analysis. Nasal cavity width (WMD: 2.05 mm; 95% CI: 1.10, 3.00) and nasal floor width (WMD: 2.13 mm; 95% CI: 1.16, 3.11) increased significantly. While palatopharyngeal volume (WMD: 0.29 cm3, 95% CI: -0.44, 1.01), glossopharyngeal volume (WMD: 0.30 cm3, 95% CI: -0.29, 0.89) and hypopharyngeal volume (WMD: -0.90 cm3; 95% CI: -1.86, 0.06) remained unchanged, nasal cavity volume (WMD: 1.24 cm3, 95% CI: 0.68, 1.81), nasopharyngeal volume (MD: 0.75 cm3, 95% CI: 0.44, 1.06), oropharyngeal volume (WMD: 0.61 cm3, 95% CI: 0.35, 0.87), and total volume of the upper airway (WMD: 1.67 cm3, 95% CI: 0.68, 2.66) increased significantly. Alar width (WMD: 1.47 mm; 95% CI: 0.40, 2.55) and alar base width (WMD: 1.54 mm; 95% CI: 1.21, 1.87) also increased.ConclusionMARPE can increase nasal cavity width, nasal cavity volume, nasopharyngeal volume and oropharyngeal volume for nongrowing patients, but has no significant effect on hypopharyngeal volume. In addition, the alar width also increased. However, the studies included in this meta-analysis were mainly retrospective, nonrandomized and small in number, so the findings should be interpreted with caution and high-quality RCTs need to be studied.

What changes in maxillary morphology from distraction osteogenesis maxillary expansion (DOME) correlate with subjective and objective OSA measures?

To correlate skeletal and airway measures on imaging with polysomnographic and self-reported measures after distraction osteogenesis maxillary expansion (DOME), in the effort to identify clinically relevant sites of expansion to guide treatment for adult patients withobstructive sleep apnea(OSA). This is a retrospective study reviewing subjects who underwent DOME and had the complete set of the following data: peri-treatment cone-beam computed tomography (CBCT) scans, polysomnography (PSG), Epworth Sleepiness Scale (ESS), and nasal obstruction symptom (NOSE) scores. Of 132 subjects who underwent DOME, 35 met inclusion criteria (71% men, mean age 27.7 ± 6.5years, mean BMI 26.0 ± 6.4kg/m2)and were enrolled in the study.There was a significant reduction in the NOSE score from 11.4 ± 5.5 to 3.6 ± 3.1, in the ESS score from 12.0 ± 4.6 to 7.1 ± 4.7, and in the apnea-hypopnea index (AHI) from 17.1 ± 15.8 to 7.01 ± 6.2 (p < 0.0001), after DOME. Nasal floor width at the nasopalatine canal level showed a statistically significant correlation with AHI reduction (p < .0001). DOME is significantly associated with reduction of nasal obstruction, sleepiness, and severity of OSA. The findings suggest that expansion at the anterior third of the bony nasal passage, specifically where the nasopalatine canal is located predicts its clinical efficacy. This site may be a useful target anatomically via imaging.

Feasibility of distraction osteogenesis maxillary expansion in patients with persistent nasal obstruction after septoplasty.

Distraction osteogenesis maxillary expansion (DOME) is an emerging surgical concept for obstructive sleep apnea patients with a high-arched and narrow hard palate presenting with nasal obstruction. Herein we demonstrate the feasibility of DOME in the treatment of patients with persistent nasal obstruction after primary septoplasty. A total of 32 consecutive patients with persistent nasal obstruction after septoplasty who underwent DOME were enrolled in this study. The efficacy of DOME in treating persistent nasal obstruction in septoplasty failure patients was evaluated using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale. Pre- and postoperative computed tomography (CT) scans were performed to measure the change of nasal floor width after surgery. NOSE score improved significantly from 13.62±4.74 to 5.15±3.50 (p<0.001) after DOME. The postoperative CT scan showed a significant increase of the nasal floor width from 22.4±4.21 to 28.06±4.52 (p<0.01). No patient had major complications such as wound infection, oronasal fistula, sinusitis, loss of incisor teeth, or malunion. We found that DOME appears to improve persistent nasal obstruction after septoplasty in patients with a narrow and high-arched hard palate.

Effect of Cleft Width on the Outcome of Presurgical Nasoalveolar Molding in Patients With Unilateral Cleft Lip and Palate.

The purpose of this study was to investigate the short-term effects of presurgical nasoalveolar molding (PNAM) according to cleft width (CW) in patients with unilateral cleft lip and palate (UCLP). In this retrospective study, 32 newborns with nonsyndromic UCLP treated with PNAM were allocated to 2 groups based on CW (group A, CW ≤5 mm; and group B, CW >5 mm). The following measurements were carried out using standardized photographs taken before and after PNAM therapy (before primary lip surgery): nostril axis inclination of healthy (NAI-NC) and cleft sides (NAI-C), columellar angle (CA), nasal base inclination (NBI), nasal floor width ratio (NFWR), alar base height ratio (ABHR), and columellar length ratio. Before PNAM therapy, there were significant differences between the 2 groups with respect to NAI-C, NBI, NFWR, and ABHR, indicating greater deformation of the nose in group B. After PNAM therapy, CA, NAI-C, NAI-NC, NFWR, and columellar length ratio were significantly improved in both the groups, whereas NBI and ABHR significantly worsened in group B. The improvement in CA, NAI-C, and NFWR was significantly greater in group B. Although a larger CW had some negative effects on the outcome of PNAM, it was found to be advantageous for nasal symmetry, if initiated as early as possible. Nevertheless, it is important to consider those aspects of the nasolabial area that are involved in the perception of symmetry when evaluating the effect of CW on PNAM outcomes in UCLP.

Reliability of Measurements on Plaster and Digital Models of Patients with a Cleft Lip and Palate.

The purpose of this study was to determine (1) the more and less reliable measurements/methods and (2) the influence of knowledge and skill on the inter-examiner, intra-examiner, and inter-method reliability of nasolabial measurements on plaster casts and three dimensional (3D) stereophotogrammetric images of casts in infants with an unrepaired unilateral cleft lip and palate (UUCLP). Preoperative extraoral plaster casts from 42 patients with UUCLP were measured with a digital caliper, and the image acquisition of casts was performed with the 3dMDface stereophotogrammetry system (3dMD, Atlanta, GA). Two examiners (one postgraduate student, one lecturer) evaluated 19 nasolabial measurements in two separate sessions. Intra-rater, inter-rater, and inter-method reliability was lower in measurements of nasal, philtral, and nasal floor width. Almost all of the interclass correlation coefficients (ICC) for measurements performed by the lecturer were above 0.75, whereas the intra-examiner reliability of some measurements performed by the postgraduate student showed low ICC (<0.75). Measurements of curving slopes, such as nasal width, of small dimensions, such as nostril floor width, and deformity-affected anatomic parts, such as philtrum width, presented a low reliability. Measurements on 3D images showed a higher reliability compared to plaster model measurements performed by the postgraduate student. Therefore, it may be recommended to use 3D digital images of infants with CLP for nasolabial measurements especially if performed in postgraduate settings.

The Upper Airway Nasal Complex: Structural Contribution to Persistent Nasal Obstruction.

To determine the contribution of the nasal floor and hard palate morphology to nasal obstruction for nonresponders to prior intranasal surgery. Retrospective case-control study. Tertiary academic center. Institutional review board-approved, retrospective institutional database analysis was obtained of a cohort of 575 patients who presented with nasal obstruction over a 21-year period. Of the patients, 89 met inclusion criteria: 52 were placed into the experimental group, defined as having persistent nasal obstruction following endoscopic sinus surgery (ESS), septoplasty, nasal valve repair, and/or turbinoplasty using validated subjective questionnaires, and 37 were placed into the control group, defined as having resolution of subjective nasal obstruction. Computed tomography imaging was presented to 3 blinded experts, who measured numerous nasal airway and hard palate morphology parameters, including anterior nasal floor width, anterior maxillary angle, maxilla width, anterior nasal floor width, and palatal vault height. Standard demographic information, comorbidities, perioperative 22-item Sinonasal Outcome Test (SNOT-22), and follow-up time were also assessed. Wilcox rank sum analysis or t test was performed where appropriate. Follow-up ranged from 2 to 36 months following surgical intervention. Several skeletal characteristics within the upper airway were significantly associated with persistent nasal obstruction, including acute maxillary angle (P = .035), narrow maxillary width (P = .006), and high arched palate (P = .004). Persistent nasal obstruction may be seen in patients with narrow, high arched hard palate despite prior nasal surgical intervention and may benefit from additional skeletal remodeling procedures such as maxillary expansion.

Skeletal changes following surgically assisted rapid maxillary expansion (SARME).

Surgically assisted rapid maxillary expansion (SARME) is a common treatment technique in the correction of maxillary transverse deficiency. The purpose of this study was to evaluate nasal and palatal skeletal changes following SARME using Cone Beam Computed Tomography (CBCT) and posterior anterior (PA) cephalograms. In this retrospective study, the radiographic images obtained from 14 patients with transverse maxillary deficiency before treatment and 6 months after SARME operations were evaluated. The changes in nasal bone width and palatal bone width were measured on CBCT. The changes in basal maxillary width, nasal cavity width and angular measurements were evaluated on PA cephalograms. Nasal floor width was measured at the levels of upper first premolar teeth and molar teeth which significantly increased following SARME (p=0.005 and 0.017 respectively). Palatal bone width between first premolar teeth and molar teeth also significantly increased (p=0.003 and 0.002 respectively). Basal maxillary width (p=0.026), nasal cavity width (p=0.024) and other angular measurements also significantly increased (p<0.05). Nasal and palatal skeletal transverse dimensions increased following SARME. Due to the enlargement of the nasal floor and nasal cavity, it is likely to improve air pass through the nose.

Rapid Maxillary Expansion and Naso-PharyngealAirway A Three Dimensional Assessment

The two dimensional plain cephalometric radiographs were widely used to assess the post-rapidmaxillary expansion (RME) effect on the naso-pharyngeal airway. However,volumetric changes inthe airway need proper assessment. The aim of this study was to assess the linear and volumetricchanges in the airway pre and post orthodontic RME using cone beam computed tomography(CBCT). A sample of 12 participants (8 males, 4 females with mean age 14+1.3) who needed RMEfor the management of posterior crossbite due to transverse maxillary deficiency was used in thisstudy. CBCT scans were acquired pre and post maxillary expansion. Linear and angular measurementswere calculated in addition to the volumetric measurements were obtained. There was astatistically significant increase in inter-molar width and molar tipping. The nasal cavity showedstatistically significant increase in the width of the nasal floor and the lateral nasal width. There wasalso statistical significant increase in naso and oropharygeal airway measurements post-expansion.RME using hyrax appliance increased the nasal floor width, nasal lateral width and the airway volumeat the naso and oropharyngeal level

Digital evaluation of nasal changes induced by rapid maxillary expansion with different anchorage and appliance design

BackgroundScientific evidence showed that rapid maxillary expansion (RME) affects naso-maxillary complex, increasing nasal width and volume. This study aimed to evaluate nasal changes induced by rapid maxillary expansion with different anchorage and appliance design by using low dose and cone beam computed tomography.MethodsA total of 44 patients (20 males, mean age 8y 8 m ± 1y 2 m; 24 females mean age 8y 2 m ± 1y 4 m) were included in the investigation and divided into three groups according to the appliance: Hyrax-type expander anchored to permanent teeth, modified Hyrax-type expander anchored to deciduous teeth, modified Haas-type expander anchored to deciduous teeth. Maxillary expansion was performed until overcorrection and the expander was passively kept in situ for 7 months at least. All patients had three-dimensional imaging before expansion (T0) and after the retention period (T1). Nasal floor width, nasal wall width, maxillary inter-molar width were measured by means of Mimics software. The paired sample t-test was employed to assess the significance of the differences between the time points; the analysis of variance test (ANOVA) was used to compare differences between groups.ResultsThe statistical analysis revealed significant differences between T0 and T1 for each recorded measurement in each group; no significant differences were found by comparing groups.ConclusionsRapid maxillary expansion produces a significant skeletal transverse expansion of nasal region in growing patients. No significant differences in nasal effects are expected when the appliance is anchored onto deciduous teeth, with or without the palatal acrylic coverage.

Effects of lateral osteotomy on surgically assisted rapid maxillary expansion

This study aimed to assess the potential effects of two different osteotomy designs of the maxillary lateral wall on dental and skeletal changes after surgically assisted rapid maxillary expansion (SARME). Thirty adult patients were divided into two groups according to the lateral osteotomy design: group 1 (n=16) underwent lateral osteotomy performed in a horizontal straight fashion, and group 2 (n=14) underwent lateral osteotomy performed in parallel to the occlusal plane with a step at the zygomatic buttress. Cone beam computed tomography scans were obtained preoperatively (T1), immediately after expansion (T2), and 6 months after expansion (T3). Mixed analysis of variance (ANOVA) was used for the statistical analysis. The results showed no significant interaction effect between groups and time points. Therefore, maxillary expansion was effective in both groups. Statistically significant increases in all dental and skeletal measurements were observed immediately after expansion (P<0.001). Relapse of the nasal floor width, tipping of the supporting teeth, and an increase in root distance in molars occurred at T3 (P<0.05). In summary, the maxillary lateral osteotomy design did not influence the results of SARME, which occurred mainly through the inclination of maxillary segments.

Short-term skeletal and dental changes following bone-borne versus tooth-borne surgically assisted rapid maxillary expansion: A randomized clinical trial study

AimTo evaluate and compare the short-term (post-retention) skeletal and dental changes following bone-borne and tooth-borne surgically assisted rapid maxillary expansion (SARME) using cone beam computed tomography (CBCT). Subjects and methodsIn this randomized clinical study, 30 patients with transverse maxillary deficiency underwent either tooth-borne (n = 15) or bone-borne (n = 15) SARME. Before treatment and immediately after the consolidation period, CBCT was obtained and the nasal floor width, interdental root distance, palatal bone width and interdental cusp distance were measured at first premolar and first molar regions of maxilla. ResultsTwenty eight patients completed the study protocol. In both tooth-borne (n = 13) and bone-borne (n = 15) groups the highest degree of expansion occurred in the dental arch, followed by palatal bone, and nasal floor (V-shaped widening in coronal dimension). The amount and pattern of expansion was comparable between anterior and posterior maxillary regions in each group (parallel posteroanterior expansion) and between the two groups. ConclusionDental and skeletal effects of tooth-borne and bone-borne devices were comparable. The overall complication rate was negligible. Selection of an expansion device should be based on each individual patient's requirements. Future long-term clinical trial studies to evaluate the stability and relapse of these two techniques are recommended.

A prospective CBCT study of upper airway changes after rapid maxillary expansion

ObjectiveThe aim of this prospective study was to investigate the upper airway changes after rapid maxillary expansion utilizing CBCT. Methods16 children (10 male, 6 female) with a mean age of 12.73±1.73 years underwent RME as part of their comprehensive orthodontic treatment with4,6-banded hyrax expanders. The screws were activated 2 turns a day. Depending on the expansion amount (2.7–6.3mm), the activation period ranged from 2 to 3 weeks. CBCT images were taken immediately before (T1) and three months after expansion (T2) in upright position, with patients’ heads kept in consistent position. All CBCT data were processed with the software EZ3D2009. After orienting the CBCT images, a set of linear, area and volumetric parameters of the upper airway were measured and calculated. Student paired t test and one-way ANOVA were applied. The significance level of P<0.0033 was used according to the Bonferroni correction. ResultsAfter expansion, with molar-to-molar width increasing 4.4±1.3mm and molars tipping 6.2±6.2°, the nasal floor width and nasal lateral width increased 1.6, 1.5, and 1.6mm and 1.3, 1.7, and 1.4mm from the anterior to the posterior part, respectively. And there was no difference among the anterior, median and posterior part. The lower nasal volume increased 1348.5mm3 with the percentage change being 8.1%. The pharyngeal airway showed no positive change. ConclusionRME can expand the nasal cavity and the expansion pattern may follow the parallel opening configuration. However, the influence on the pharyngeal airway is limited.

Effects of orthopedic maxillary expansion on nasal cavity size in growing subjects: A low dose computer tomography clinical trial

ObjectiveThe aim of this retrospective clinical trial was to evaluate the effects of rapid maxillary expansion on skeletal nasal cavity size in growing subjects by use of low dose computer tomography. MethodsEight Caucasian children (three male; five female) with a mean age of 9.7 years (SD±1.41) were the final sample of this research that underwent palatal expansion as a first phase of orthodontic treatment. The maxillary expander was banded to the upper first molars and was activated according a rapid maxillary expansion protocol. Low-dose computer tomography examinations of maxilla and of the low portion of nasal cavity were performed before inserting the maxillary expander (T0) and at the end of retention (T1), 7 months later. A low-dose computer tomography protocol was applied during the exams. Image processing was achieved in 3 steps: reslicing; dental and skeletal measurements; skeletal nasal volume computing. A set of reproducible skeletal and dental landmarks were located in the coronal passing through the first upper right molar furcation. Using the landmarks, a set of transverse linear measurements were identified to estimate maximum nasal width and nasal floor width. To compute the nasal volume the lower portion of the nasal cavity was set as region of interest. Nasal volume was calculated using a set of coronal slices. In each coronal slice, the cortical bone of the nasal cavity was identified and selected with a segmentation technique. Dependent t-tests were used to evaluate changes due to expansion. For all tests, a significance level of P<0.05 was used. ResultsRapid maxillary expansion produced significant increases of linear transverse skeletal measurements, these increments were bigger in the lower portion of the nasal cavities: nasal floor width (+3.15mm; SD±0.99), maximum nasal width (+2.47mm; SD±0.99). Rapid maxillary expansion produced significant increment of the total nasal volume (+1.27cm3±SD 0.65). The anterior volume increase was 0.58cm3 while the posterior one was 0.69cm3. ConclusionIn growing subjects RME is able to significantly enlarge the dimension of nasal cavity. The increment is bigger in the lower part of the nose and equally distributed between the anterior e the posterior part of the nasal cavity.

Facial Anthropometric Analysis of the Javanese Female

Facial Anthropometric Analysis of the Javanese Female

Editor's Summary, Q & A, Reviewer's Critique: Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography

The purpose of this study was to use cone-beam computed tomography to quantitatively evaluate skeletal expansion and alveolar tipping of the maxilla at the maxillary canine (C1), first premolar (P1), second premolar (P2), and first molar (M1) after rapid maxillary expansion (RME). The transverse effects to the maxillary suture, nasal width, and maxillary sinus were also assessed.Thirty consecutive patients (17 boys, 13 girls; mean age, 13.8 +/- 1.7 years) who required RME with Hyrax appliances as part of their comprehensive orthodontic treatment were studied. Measurements before and after RME of palatal and buccal maxillary widths, palatal alveolar angle, nasal width, nasal floor width, and maxillary sinus width at C1, P1, P2, and M1 were compared by using Wilcoxon signed rank, Kruskal-Wallis, and Wilcoxon rank sum tests. Pearson correlation analyses were also performed (* = .05).Skeletal expansion of the maxilla had a triangular pattern with a wider base in the anterior region, accounting for 55% of total expansion at P1, 45% at P2, and 38% at M1. Alveolar bending or tipping accounted for 6% of total expansion at P1, 9% at P2, and 13% at M1. The remaining orthodontic (dental tipping) portions of total expansion were 39% at P1, 46% at P2, and 49% at M1. RME produces a statistically significant increase in nasal width and a decrease in maxillary sinus width (P <0.0001). Retention time showed a significant negative correlation to the change in palatal maxillary width at C1, P2, and M1 (P <0.05), the rate of appliance expansion had a significant correlation with palatal maxillary expansion at P1 and P2 (P <0.05), and age had no statistically significant association with any parameter (P >0.05).

Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography

Introduction: The purpose of this study was to use cone-beam computed tomography to quantitatively evaluate skeletal expansion and alveolar tipping of the maxilla at the maxillary canine (C1), first premolar (P1), second premolar (P2), and first molar (M1) after rapid maxillary expansion (RME). The transverse effects to the maxillary suture, nasal width, and maxillary sinus were also assessed. Methods: Thirty consecutive patients (17 boys, 13 girls; mean age, 13.8 ± 1.7 years) who required RME with Hyrax appliances as part of their comprehensive orthodontic treatment were studied. Measurements before and after RME of palatal and buccal maxillary widths, palatal alveolar angle, nasal width, nasal floor width, and maxillary sinus width at C1, P1, P2, and M1 were compared by using Wilcoxon signed rank, Kruskal-Wallis, and Wilcoxon rank sum tests. Pearson correlation analyses were also performed (α = .05). Results and Conclusions: Skeletal expansion of the maxilla had a triangular pattern with a wider base in the anterior region, accounting for 55% of total expansion at P1, 45% at P2, and 38% at M1. Alveolar bending or tipping accounted for 6% of total expansion at P1, 9% at P2, and 13% at M1. The remaining orthodontic (dental tipping) portions of total expansion were 39% at P1, 46% at P2, and 49% at M1. RME produces a statistically significant increase in nasal width and a decrease in maxillary sinus width ( P P P P >0.05).

An anthropometric analysis of indices of severity in the unilateral cleft lip.

The aim of this study was to analyze the relationships among three key anthropometric parameters in the unilateral cleft lip to determine the correlations, if any, among these indices of severity. Using a standardized anthropometric documentation protocol, preoperative measurements of 125 unilateral cleft lips (103 complete and 22 incomplete) were performed under general anesthesia by a single surgeon at the time of primary lip repair at the age of 3 months. The following key measurements were analyzed statistically: (1) the philtral height difference (PHD) between the cleft and noncleft sides, (2) the nasal floor width difference (NFWD) between the cleft and noncleft sides, and (3) the cleft width (CW). The mean values of all three indices were greater in the complete group versus the incomplete group. These differences were statistically significant. Linear relationships were obtained between NFWD and GAP, between PHD and GAP, and between PHD and NFWD in the complete group. In contrast, the relationships between PHD and GAP, and between PHD and NFWD were nonlinear in the incomplete group. These findings suggest that there was a strong correlation between the transverse and vertical tissue deficiencies in the complete cleft lip. In incomplete clefts, however, this correlation did not exist. In other words, the incomplete cleft lip can be associated with a severely short philtrum even in the presence of a relatively mild transverse tissue deficit. Therefore, it is not necessarily easier to repair an incomplete cleft lip in terms of the correction of the vertical tissue deficiency.