Posterior Nasal Spine Research Articles

Gender-Specific Variations in Greater Palatine Foramen Anatomy: Insights from CBCT Scans in the North Cyprus Population.

BACKGROUND The greater palatine foramen (GPF) is anatomically located distal to the third maxillary molar tooth, midway between the midline of the palate and the dental arch. The GPF contains the major palatine artery, vein, and nerve, traversing the palatine sulcus. This study aimed to evaluate the anatomical position of the GPF in 93 women and 67 men at a single center in Cyprus using cone beam computed tomography (CBCT). MATERIAL AND METHODS A retrospective analysis was conducted on 160 CBCT scans. Measurements of the GPF's horizontal and vertical diameters, distances from GPF to the incisive foramen, posterior nasal spine, anterior nasal spine, and midaxillary suture, and positional relationships to molars were recorded. Statistical analyses compared these measurements between males and females. RESULTS The study included 93 females and 67 males with an average age of 46.6 (±11.6) years. Significant sex differences were observed in most GPF measurements, with males showing larger dimensions such as the anterior nasal spine, posterior nasal spine, mid-maxillary suture, and incisive foramen to the GPF. The GPF was predominantly located in the third molar region (96.25% on the right, 96.9% on the left). The left GPF showed a significantly larger horizontal diameter than the right (P<0.05). CONCLUSIONS There was a significant difference in the average distances from the anterior nasal spine, posterior nasal spine, mid-maxillary suture, and incisive foramen to the GPF, as well as in the size of the GPF, between males and females. Recognizing these variations enhances clinical planning and reduces the risk of complications.

Effects of different expansion appliances and surgical incisions on maxillary expansion: A finite element analysis

PurposeThis study aims to assess the impact of different surgical techniques and three expansion appliances on maxillary expansion in adults using finite element analysis (FEA), with a focus on maxillary displacement and stress on surrounding structures. MethodsSeven different FEA models were created to compare different surgical techniques and three different expansion appliances. Model I represented a bone-supported appliance without surgical assistance. Model II, Model III, and Model IV were surgically assisted rapid palatal expansion (SARPE) models without pterygomaxillary suture disjunction (PMD). Model V, Model VI, and Model VII were SARPE models with PMD. ResultsThe largest displacement at the anterior nasal spine (ANS) was recorded for Model II (2.95 mm). For the posterior nasal spine (PNS), the highest displacement was observed in Models V, VI, VII (2.50 mm), with the lowest in Model III (0.79 mm). Stress analysis revealed the highest stress in Model I, with models featuring PMD displaying nearly zero stress at all anatomical points, highlighting distinct expansion patterns and stress distributions between models with and without PMD. ConclusionSARPE models with PMD demonstrated a parallel expansion of the maxilla with minimal stress, while the miniscrew assisted rapid maxillary expansion (MARPE) model displayed transverse rotation. SARPE models without PMD exhibited a V-shaped expansion pattern. SARPE models with PMD represent an optimal approach for achieving uniform expansion and minimizing stress, with stress levels nearly negligible at all anatomical points in models with PMD.

Evaluation of a Fully Digital, In-House Virtual Surgical Planning Workflow for Bimaxillary Orthognathic Surgery

The advantages of virtual surgical planning (VSP) for orthognathic surgery are clear. Previous studies have evaluated in-house VSP; however, few fully digital, in-house protocols for orthognathic surgery have been studied. The purpose of this study was to evaluate the difference between the virtual surgical plan and actual surgical outcome for orthognathic surgery using a fully digital, in-house VSP workflow. This is a prospective cohort study from September 2020 to November 2022 of patients at the Victoria General Hospital in Halifax, NS, Canada who underwent bimaxillary orthognathic surgery. Patients were excluded if they had previously undergone orthognathic surgery or were diagnosed with a craniofacial syndrome. The primary outcome variables were the mean 3-dimensional (3D) (Euclidean) distance error, as well as mean error and mean absolute error in the transverse (x axis), vertical (y axis), and anterior-posterior (z axis) dimensions. Covariates included age, sex, and surgical sequence (mandible-first or maxilla-first). The primary outcome was tested using Z and t critical value confidence intervals. The P value was set at .05. The 3D distance error for mandible-first and maxilla-first groups was compared using a 2-sample t-test as well as analysis of variance. The study sample included 52 subjects (24 males and 28 females) with a mean age of 27.7 (± 12.1) years. Forty three subjects underwent mandible-first surgery and 9 maxilla-first surgery. The mean absolute distance error was largest in the anterior-posterior dimension for all landmarks (except posterior nasal spine, left condyle, and gonion) and exceeded the threshold for clinical acceptability (2mm) in 16 of 23 landmarks. Additionally, mean distance error in the anterior-posterior dimension was negative for all landmarks, indicating deficient movement in that direction. The effect of surgical sequence on 3D distance error was not statistically significant (P=.37). In general, the largest contributor to mean 3D distance error was deficient movement in the anterior-posterior direction. Otherwise, mean absolute distance error in the vertical and transverse dimensions was clinically acceptable (< 2mm). These findings were felt to be valuable for treatment planning purposes when using a fully digital, in-house VSP workflow.

Postsurgical Volumetric Airway Changes in Class III Patients Receiving Bimaxillary Orthognathic Surgery.

The purpose of the present study was to investigate the pharyngeal airway space (PAS) changes in class III patients receiving bimaxillary orthognathic surgery and correlate the PAS volume and minimum axial section changes with the magnitude of the surgical movement. This research involved a retrospective sample composed of 38 patients with class III skeletal occlusions. Three-dimensional measurements of the PAS volume and minimum axial section were conducted. Cephalometric points were used to verify the extent of jaw-hyoid bone movement. No significant differences were found between pre and postoperative total PAS volume (P = 0.280), nasopharyngeal volume (P = 0.545), oropharyngeal volume (P = 0.297), and minimum axial section (P = 0.568). Anterior movement of point A and posterior nasal spine were significantly associated with an increase in total PAS volume, oropharyngeal volume, and minimum axial section (P < 0.05). However, the posterior movement of menton was significantly associated with a decrease in total PAS volume, oropharyngeal volume, and minimum axial section (P < 0.05). The results of the present study indicated that PAS is not negatively affected by bimaxillary surgery in class III patients. However, the planning of class III patients who are prone to the development of airway problems should be done carefully.

Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: a single-centre retrospective study.

This study assessed the dental and skeletal effects of pure bone-borne, non-surgical maxillary expansion, using a modified force-controlled polycyclic protocol. Records of 17 adult patients, mean age 24.1 years; range 18-39 years, who had undergone maxillary expansion using a bone-borne Quad-expander (with 4 mini-screws), were analysed. In all patients, 0.17mm/day of expansion was completed for 1 week, followed by a cyclic protocol of expansion of forward and backward turns until the force needed to turn the expander was below 400 cN, assessed weekly. After this, expansion continued at a rate of 0.17mm/day until the desired amount of expansion was achieved. Cone beam computer tomography scans were taken pre- and post-expansion. The mid-palatal suture was successfully opened in 100% of patients included in this study. Axially, the amount of skeletal opening at the posterior nasal spine was 61% of the anterior nasal spine. Expansion was pyramidal in the coronal plane. Significant increases at the dental and skeletal levels were achieved, with changes at the skeletal level reaching 73%. The alveolar bone angle increased more than the angular changes at the molars and premolars. This is a retrospective study with short-term results. The Quad-expander, with a force-controlled polycyclic expansion protocol, effectively produced a significant increase in maxillary width in skeletally mature subjects in the short term.

MORPHOLOGICAL EVALUATION OF INCISIVE FORAMEN ACCORDING TO AGE, GENDER AND EDENTULOUS STATUS

Objective: Evaluation of the change in incisive foramen (IF) diameter and localization according to age, gender, edentulous status and other anatomical landmarks by cone beam computed tomography (CBCT). Method: 162 patients (81 females, 81 males, mean age 41.1+_15.2) were included in the study. IF diameter, distance between IF and the greater palatine foramen (GPF) and distance between IF and the most posterior of the median palatine bone (PNS: posterior nasal spine) were measured. The measurement values of the patients were compared with the Independent t-test according to gender and dental status. The relationship between age and measurements was examined with the Pearson correlation test. Results: The mean IF diameter of the patients was 3.78±0.95 mm. The mean IF diameter (P.&amp;lt;001), the distance between the right GPF and the IF (P.=023) and the distance between the IF and the PNS (P.=039) of the dentate patients were found to be significantly lower than the edentulous patients. Conclusion: The IF diameter and the IF - GPF distance were found to be lower in dentulous patients than in edentulous patients. It was determined that the IF diameter and the IF - GPF distance increased with age. Keywords: Incisive foramen, greater palatine foramen, CBCT

Dentoperiodontal and skeletal changes induced by miniscrew-assisted rapid maxillary expansion (C-expander) treatment in adults: A retrospective clinical trial

The objective of this study was to evaluate the dental periodontal and skeletal response to ≥5 mm of expansion width achieved by C-expander treatment with posterior miniscrews placed between the first and second molars in adults. A total of 28 patients aged 21.91 ± 3.20 years with maxillary transverse deficiency underwent C-expander treatment. Anterior miniscrews were positioned between the first and second premolars, whereas posterior miniscrews were positioned between the first and second molars. Cone-beam computed tomography records were obtained before expansion and 3 months after expansion. The dental periodontal and skeletal changes for all patients were recorded. The C-expander treatment expanded the palatal suture with slight buccal alveolar bone inclination. An increase in the nasal cavity width and a greater increase in the maxillary base bone width were observed after maxillary expansion. The expansion at the posterior nasal spine (3.78 mm) was approximately 85.7% of that at the anterior nasal spine (4.41 mm). No significant buccal dehiscence occurred after expansion, whereas the mesiobuccal alveolar bone thickness of the first molars was decreased at the 8 mm level with respect to the cementoenamel junction. The first molar showed decreased inclination (right, -0.45°; left, -0.38°, P>0.05), whereas the expansion at the apical level was less than that at the crown level. Age and the skeletal/dental expansion ratio had no discernible relationship. Miniscrew-assisted C-expander treatment can be effective for adults with maxillary transverse deficiency. Rearward placement of the miniscrews may create an approximately parallel expansion. Most maxillary expansion was derived from skeletal expansion with slight alveolar bone buccal inclination.

CBCT Analysis of Oropharynx Airway Volume.

The study was performed to analyze the oropharynx airway and examine the influence of age and gender on the oropharynx volume configuration using cone beam computed tomography. This study examined the cone beam computed tomographic images of 51 patients 25 male and 26 females, group matched for age and gender. The oropharynx airway volume and area between the posterior nasal spine and top of the epiglottis were measured and compared. The statistical measurements of 51 cone beam computed tomography images showed a nonsignificant difference found between male and female regarding the age (the mean age for female 40.15y. and for male32.72y). Male subjects had greater oropharynx volume, a high significant difference ( P =0.005) in oropharynx volume between the 3 age groups. A significant difference was found between the smallest age group with the larger age groups. The study data revealed that the changes in measurements of oropharynx airway are age-dependent in addition to gender effect.

Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study.

Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion. This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4/2021 to 4/2022. Patients completed pre- and post-operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter-molar distance (IMD), and anterior nasal spine (ANS). The cohort (N = 20) was middle-aged (39 ± 11 years), predominantly male (80%), and overweight (BMI 28 ± 4 kg/m2 ). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography-confirmed obstructive sleep apnea (OSA). Full anterior-posterior separation of the mid-palatal suture line was evident on all post-operative CT scans, with mean expansion at the PNS of 3.6 ± 1.3 mm, IMD of 6.1 ± 1.6 mm and ANS of 7.0 ± 1.6 mm (p < 0.001). Following surgery, mean NOSE scores improved from 57 ± 23 to 14 ± 13 (p < 0.001). One patient required maxillary antrostomy for post-operative sinusitis. 2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency. 4 Laryngoscope, 134:1970-1977, 2024.

Quantitative Assessment of the Pharyngeal Recess Morphometry in Anatolian Population Using 3D Models Generated from Multidetector Computed Tomography Images

Aim: It was aimed to analyze the detailed morphometry of the pharyngeal recess (PR) using three-dimensional (3D) models reconstructed from multidetector computed tomography (MDCT) images.&#x0D; Material and Methods: This study was a retrospective analysis and performed on MDCT images of 97 patients (43 males, 54 females). 3D models of the PR were reconstructed using 3D Slicer software, enabling morphometric measurements according to established protocols. Measurements included PR depths, distances between the posterior nasal spine and torus levatorius (PNS-TL), distances between right and left TL (RTL-LTL) distances between the PNS and posterior wall of the nasopharynx (PNS-PWN), the angle (α) between the centerline of the PR and the sagittal plane. The morphologies of the PR classified into three types.&#x0D; Results: The average measurements for the parameters were as follows: PR depth - 10.42 mm, distance between PNS and TL - 10.40 mm, distance between RTL and LTL - 19.13 mm, distance between PNS and PWN - 19.92 mm, and the angle (α) - 53.65°. The prevalence of PR types was 20.62%, 47.42% and 31.96% for type 1, type 2 and type 3, respectively.&#x0D; Conclusion: Variations in reported measurements of the pharyngeal recess can be attributed to imaging techniques, patient positioning, anatomical differences, and sample sizes. The use of 3D models generated from MDCT datasets offers a high-resolution and comprehensive approach to understanding the PR's morphometry and spatial relationships, enabling accurate measurements and advancing our knowledge of this anatomical region.

Gearing Effect in Clockwise Rotational Orthognathic Surgery.

The standard procedure for managing skeletal class III malocclusion is maxillary advancement with mandibular setback. Occlusal plane-altering orthognathic surgery, such as jaw rotation, is useful as well. Although clockwise jaw rotation is a common procedure, its mechanism has not been well investigated. With this study, the authors aim to introduce the gearing effect to correct class III malocclusion in Asians by maxillary posterior impaction using clockwise rotation without advancing the maxilla. Patients with class III correction with clockwise rotation of the maxillomandibular complex without maxillary advancement were included; those who underwent genioplasty were excluded. Various facial skeletal cephalometric landmarks were measured using artificial intelligence-based cephalometric analysis software. The gearing effect was determined by dividing the lower anterior facial height (LAFH) in relatively short and long groups compared with those in the anterior nasal spine to posterior nasal spine length. In a total of 29 patients, the amount of menton setback between group 1 ( n = 15; short LAFH) and group 2 ( n = 14; long LAFH) was 1.67 ± 0.66 and 2.74 ± 0.99 mm per 1 mm of posterior nasal spine impaction, respectively ( P = 0.002), and 1.58 (interquartile range, 0.78) and 1.95 (interquartile range, 1.05) mm per 1 degree of clockwise rotation of the palatal angle, respectively ( P = 0.007). The convexity of the A point was improved without any significant change in the sella-nasion-A point angle before and after surgery. This article addresses the scientific evidence regarding the impact of clockwise rotational orthognathic surgery based on the gearing effect. The mandibular setback turned out to be more effective in patients with a long LAFH. Risk, II.

Three-Dimensional Evaluation of Alveolar Cleft Volume and Nasomaxillary Form in Patients with Unilateral Cleft Lip and Palate.

To evaluate the alveolar cleft volume (ACV) and to study its correlation with the nasomaxillary form in patients with unilateral cleft lip and palate (UCLP). Retrospective study. University Academic Hospital. 30 patients with UCLP and 30 non-cleft patients. Cone beam computed tomography (CBCT) scans. The Maxillary sinus volume (MSV) and Nasal cavity volume (NCV) were significantly reduced on the affected side in patients with UCLP (P < .001) and also in the cleft group when compared to the noncleft group (P < .01). The septal deviation measured at anterior, mid and posterior nasal spine were increased in the UCLP group significantly when compared to the non-cleft group (P < .01) and maximum deviation was seen at the mid-level. The mean ACV was found to be 0.587 + 0.396 cm3.The nasomaxillary complex was affected in UCLP patients irrespective of cleft size and a statistically significant correlation of ACV was found with septal height only (r value = -0.508). Parameters like septal height, anterior and middle maxillary width were significantly reduced (P < .01) in the cleft group when compared to the non-cleft group. The patients with UCLP showed significant differences among various parameters within the nasomaxillary complex when compared to the control group. Within the cleft group, the MSV and NCV were significantly decreased on the cleft side and also a significant negative correlation of ACV was found with septal height only.

Changes in alveolar bone width around maxillary implants, as determined through cone beam computed tomography based on bony landmarks: A preliminary study.

This study aimed to investigate changes in alveolar bone width around dental implants and identify the anterior nasal spine (ANS), posterior nasal spine (PNS), and floor of the nasal cavity that can be used as reference landmarks for standardizing the orientation of different cone-beam computed tomography (CBCT) scans. We enrolled two groups that comprised 30 implants. Two CBCT scans from the same patient after implant surgery in the first group were obtained to determine differences in the relative distance and angle between the ANS and apex of the dental implant. Then we compared the second group of patients' presurgical and postsurgical CBCT images to evaluate changes in alveolar bone width after dental implant surgery by the aforementioned bony landmarks. In the first group, no statistically significant differences were detected in the mean distance between the ANS, PNS and implant tip in different directions. In the second group, bone width increased at 1 mm (p = 0.020) and decreased at 4 mm (p < 0.001) and 7 mm (p < 0.001) below the alveolar bone crest after implant surgery. Within the limitations of the present study, the ANS, PNS, and floor of the nasal cavity can be useful in standardizing the orientation of CBCT scans and alveolar bone remodeling after implant surgery varied depending on the height and direction from the alveolar bone crest based on the three landmarks.

Upper airway modifications after weight loss: a systematic review.

Weight loss is one of the most often prescribed treatments to reduce the level of sleep apnea severity; however, objective assessment of airway alterations after loss of weight has only been studied in the last decades. This study aimed at evaluating alterations after weight loss reported in the literature. A literature review was performed in the medical databases: PubMed, Web of Science, Scopus and Embase. A total of 681 articles were found in the databases and after evaluation only 10 studies were selected for data extraction. Most studies observed an increase of the area in the retropalatal region; some indicating that this increase occurred mostly in the lateral pharyngeal region. Studies with volumetric reconstruction showed a significant reduction in parapharyngeal fat deposits, lateral wall and tongue fat, and volumetric reduction in all soft tissues of the pharynx, pterygoid and genioglossus muscles. Studies evaluating craniofacial bone structures showed a reduction in the airway height by bringing the hyoid closer to the posterior nasal spine and a reduction in the distance from the hyoid to the chin. There is a limited number of studies with a good level of scientific evidence evaluating changes in the upper airways after weight loss and how these changes impact obstructive sleep apnea. The studies included in this review indicate that weight loss increases the airways space by reducing the volume of the parapharyngeal structures, particularly at the retropalatal site, where there is an apparent gain in the lateral area of the airway and hyoid relocation.

Transverse Maxillary Deficiency Predicts Increased Upper Airway Collapsibility during Drug-Induced Sleep Endoscopy.

To examine the relationship between craniofacial skeletal anatomy and objective measures of pharyngeal collapse obtained during drug-induced sleep endoscopy. We hypothesized that transverse maxillary deficiency and an increased pharyngeal length will be associated with higher levels of pharyngeal collapsibility. Cross-sectional analysis in a prospective cohort. University Hospital. A cross-sectional analysis was conducted in a cohort of consecutive patients from the positive airway pressure(PAP) alternatives clinic who underwent computed tomography (CT) analysis and drug-induced sleep endoscopy for characterization of upper airway collapsibility. PAP titration was used to determine pharyngeal critical pressure (PCRIT ) and pharyngeal opening pressure (PhOP). CT metrics included: Transverse maxillary dimensions (interpremolar and intermolar distances) and pharyngeal length (posterior nasal spine to hyoid distance). The cohort (n = 103) of severe obstructive sleep apnea (Apnea and Hipopnea Index 32.1 ± 21.3 events/h) was predominantly male (71.8%), Caucasian (81.6%), middle-aged (54.4 ± 14.3 years), and obese (body mass index[BMI] = 30.0 ± 4.9 kg/m2 ). Reduced transverse maxillary dimensions were associated with higher PCRIT (intermolar distance: β [95% confidence interval, CI] = -.25 [-0.14, -0.36] cmH2 O/mm; p = .03) and PhOP (Interpremolar distance: β = -.25 [-0.14, -0.36] cmH2 O/mm; p = .02). Longer pharyngeal length was also associated with higher PCRIT (β = .11 [0.08, 0.14] cmH2 O/mm, p = .04) and PhOP (β [95% CI] = .06 [0.03, 0.09] cmH2 O/mm, p = .04). These associations persisted after adjustments for sex, age, height, and BMI. Our results further the concept that skeletal restriction in the transverse dimension and hyoid descent areassociated with elevations in pharyngeal collapsibility during sleep, suggesting a role of transverse deficiency in the pathogenesis of airway obstruction.

Comparison study of the Le Fort I osteotomy using 2- and 4-plate fixation.

This study was conducted to evaluate the postsurgical stability of Le Fort I osteotomy using zygomatic buttress internal fixation alone with no piriform aperture internal fixation. Patients with maxillary retrognathia and mandibular prognathism underwent the Le Fort I osteotomy with a bilateral sagittal split ramus osteotomy. In group I, fixation was accomplished using titanium plate and screws placed at the piriform aperture and the zygomatic buttress (4 plates). In group II, fixation was accomplished using titanium plate and screws placed at the zygomatic buttress (2 plates). Lateral cephalometric radiographs were taken preoperatively (T1), immediately after surgery (T2), and at 6 months to 1 year (T3) to evaluate skeletal movement. In total, 32 patients were included in this study. None of the patients had wound infection, dehiscence, bone fragment instability, and long-term malocclusion. Regarding point A and the posterior nasal spine (PNS), vertical and horizontal relapse in groups I and II did not differ significantly. In most hospitals, the maxilla was fixed using four plates (piriform aperture and zygomatic buttress); however, within the limitations of the study, the choice of the number of plates for osteosynthesis following Le Fort I osteotomy and repositioning of the maxilla can be left to the discretion of the surgeon without putting the patients at risk for increased relapse by careful intraoperative management.

Effects of different distractor positions on the formation of expansion, stress and displacement patterns in surgically assisted rapid maxillary expansion without pterygomaxillary disjunction: a finite element analysis study

Skeletal orthopedic expansion of maxilla is accepted as a reliable method for the treatment of transverse maxillar deficiency in growing patients. The aim of the study was to evaluate the effects of different palatal distractor positions on the expansion, stress and displacement patterns of the structures of craniofacial complex in surgical assisted rapid maxillary expansion without pterygomaxillary disjunction (PTMD) with the help of finite element analysis(FEA). Four facial skeleton models with different distractor positions (first premolar, second premolar, first molar, second molar regions) were created. In all finite element models median and lateral osteotomies were performed, without PTMD. Stress distribution was evaluated after 5 mm activation of the transpalatal distraction in all models using the nonlinear solution method in FEA. Unilateral displacement(mm) and stress distribution(MPa) were measured in three directions (x, y, and z axes) of craniofacial and maxillofacial structures in the symmetrical finite element models. In all models, the unilateral transverse displacements of the anterior teeth were greater than those of the posterior teeth, and the greatest displacement was at the central incisor level. The greatest displacement values at the central incisor level, at the anterior nasal spine(ANS) and at the posterior nasal spine(PNS) levels was measured in Model-IV, III, II and I, respectively. Mean elemental stress(von Mises stress) in the medial pterygoid plate, screw and lateral pterygoid plate regions from highest to lowest was measured in Model-IV, III, II and I, respectively. The maxilla performed outward rotation and tipping movement in all models during the expansion period. Among the distractor positions, the second molar region was found to be the most advantageous one in terms of expansion pattern. Considering the patient’s anatomy and clinical conditions, placing the palatal distractor as posteriorly as possible will result in more effective maxillary expansion.

Comparison of velopharyngeal morphology of two palatoplasty techniques in patients with hard and soft cleft palate.

The study aims to compare the velopharyngeal morphology of hard and soft cleft palate (HSCP) patients after Furlow and Sommerlad palatoplasty. A total of 51 patients (20 cases in Furlow palatoplasty group, 16 cases in Sommerlad palatoplasty group and 15 normal children in the control group) were included in our study. Velopharyngeal function and speech outcomes of patients with HSCP who had either Furlow palatoplasty or Sommerlad palatoplasty for cleft palate repair were evaluated by perceptual speech assessment (PSA), lateral cephalometric radiographs and nasopharyngoscopy. To assess velopharyngeal morphology of patients treated with two techqiques, we analyzed measurements such as velar length, pharyngeal depth, and the Adequate ratio (the ratio of velar length to pharyngeal depth). Furthermore, skeletal landmarks including cranial base, cervical vertebrae, posterior nasal spine which were defined as the pharyngeal triangle were measured. Finally, the position of the point U relative to the pharyngeal triangle were compared. Velopharyngeal closure (VPC) rate in Furlow palatoplasty group accounted for 90%, while that in Sommerlad palatoplasty group was 81.3%. PSA of the former group was significantly better than that of the latter group (P < 0.05). Velar length, pharyngeal depth and the Adequate ratio (1.37 ± 0.14 vs. 1.41 ± 0.15) were comparable between the Furlow group and control group (P > 0.05), while Sommerlad group had a shorter velar length, deeper pharyngeal depth and a smaller Adequate ratio (1.20 ± 0.18) compared to the above two groups (P < 0.05). Furhermore, the point U of Sommerlad group in the pharyngeal triangle was higher than that of the other two groups. In the treatment modality of patients with HSCP, both Furlow palatoplasty and Sommerlad palatoplasty seem to be effective. Furlow palatoplasty appears to have velopharyngeal morphology similar to normal control group., while Sommerlad group shows a shorter velar length, deeper pharyngeal depth and a smaller Adequate ratio.

Nasopharynx evaluation in children of unilateral cleft palate patients and normal with cone beam computed tomography.

This study aimed to examine the morphological characteristics of the nasopharynx in unilateral Cleft lip/palate (CL/P) children and non-cleft children using cone beam computed tomography (CBCT). A retrospective study consisted of 54 patients, of which 27 patients were unilateral CL/P, remaining 27 patients have no CL/P. Eustachian tubes orifice (ET), Rosenmuller fossa (RF) depth, presence of pharyngeal bursa (PB), the distance of posterior nasal spine (PNS)-pharynx posterior wall were quantitatively evaluated. The main effect of the CL/P groups was found to be effective on RF depth-right (p < 0.001) and RF depth-left (p < 0.001). The interaction effect of gender and CL/P groups was not influential on measurements. The cleft-side main effect was found to be effective on RF depth-left (p < 0.001) and RF depth-right (p = 0002). There was no statistically significant relationship between CL/P groups and the presence of bursa pharyngea. Because it is the most common site of nasopharyngeal carcinoma (NPC), the anatomy of the nasopharynx should be well known in the early diagnosis of NPC.

Comparison of 3 different bone-borne type expansion appliances used in surgically-assisted rapid palatal expansion: A finite element analysis

This study aimed to compare the effects of 3 different bone-borne type expansion appliances used in the surgically-assisted rapid palatal expansion (SARPE) by finite element analysis. Three different miniscrew-supported palatal expansion appliances were modeled. Median and lateral osteotomies were performed without pterygomaxillary suture separation. Model I consisted of a palatal expander with 2 miniscrews placed 4 mm far from the midpalatal suture. In model II, 2 miniscrews were located at the alveolar ridge between the first molar and the second premolar. In model III, 4 miniscrews were placed as a combination of the first and second models. Stress distributions and amount of displacements were evaluated with Ansys software (version 19.2; Ansys, Canonsburg, Pa) for 5-mm expansion in a symmetrical finite element analysis model to reflect the clinical situation. SARPE simulation using miniscrew-assisted maxillary expanders for all models showed a rotation and tipping of the maxilla. The largest displacement was found for the anterior part of the palate in model II and the posterior part in model III. Although a wedge-shaped expansion pattern was observed in all models, this form was more prominent in model II. The highest stress value (0.91 MPa) was measured in model I, and the lowest value (0.004 MPa) was measured in model II for the anterior nasal spine region. The highest stress value (0.51 MPa) was measured in model III, and the lowest value (0.12 MPa) was measured in model II for the posterior nasal spine region. The lowest stress values were measured in model II for all the craniofacial and maxillofacial structures. Among the models, the lowest stress distribution conditions for craniofacial and maxillofacial structures were found in model II. The largest displacement was found at the incisors and anterior part of the maxilla for model II. The greatest displacement was found at the posterior region for model III.