3D evaluation of the maxillary sinus volumes in patients with bilateral cleft lip and palate

One of the most common congenital anomalies of the head and neck region is a cleft lip and palate. This retrospective case-control research aimed to compare the maxillary sinus volumes in individuals with bilateral cleft lip and palate (BCLP) to a non-cleft control group. The study comprised 72 participants, including 36 patients with BCLP and 36 gender and age-matched control subjects. All topographies were obtained utilizing Cone Beam Computed Tomography (CBCT) for diagnostic purposes, and 3D Dolphin software was utilized for sinus segmentation. Volumetric measurements were taken in cubic millimeters. No significant differences were found between the sex and age distributions of both groups. Additionally, there was no statistically significant difference observed between the BCLP group and the control group on the right and left sides (p > 0.05). However, the mean maxillary sinus volumes of BCLP patients (8014.26 ± 2841.03 mm3) were significantly lower than those of the healthy control group (11,085.21 ± 3146.12 mm3) (p < 0.05). The findings of this study suggest that clinicians should be aware of the lower maxillary sinus volumes in BCLP patients when planning surgical interventions. The utilization of CBCT and sinus segmentation allowed for precise measurement of maxillary sinus volumes, contributing to the existing literature on anatomical variations in BCLP patients.

Bilateral cleft lip-palate; Cone-beam computed tomography; Maxillary sinus; Volume

[1] Nahas LD, Alzamel O, Dali MY, Alsawah R, Hamsho A, Sulman R, et al. Distribution and risk factors of cleft lip and palate on patients from a sample of Damascus hospitals—a case-control study. Heliyon. 2021; 7: e07957.

[2] Hikosaka M, Nagasao T, Ogata H, Kaneko T, Kishi K. Evaluation of maxillary sinus volume in cleft alveolus patients using 3-dimensional computed tomography. Journal of Craniofacial Surgery. 2013; 24: e23–e26.

[3] Lee Y, Liao Y. Hard palate-repair technique and facial growth in patients with cleft lip and palate: a systematic review. British Journal of Oral and Maxillofacial Surgery. 2013; 51: 851–857.

[4] Srivastav S, Tewari N, Duggal R, Goel S, Rahul M, Mathur VP, et al. Cone-beam computed tomographic assessment of maxillary sinus characteristics in patients with cleft lip and palate: a systematic review and meta-analysis. The Cleft Palate Craniofacial Journal. 2023; 60: 742–751.

[5] Paknahad M, Pourzal A, Mahjoori-Ghasrodashti M, Khojastepour L. Evaluation of maxillary sinus characteristics in patients with cleft lip and palate using cone beam computed tomography. The Cleft Palate-Craniofacial Journal. 2022; 59: 589–594.

[6] Georgievska-Jancheska T. The relationship between the type of cleft and nasal air emission in speech of children with cleft palate or cleft lip and palate. Open Access Macedonian Journal of Medical Sciences. 2019; 7: 352–357.

[7] Friedli L, Kloukos D, Kanavakis G, Halazonetis D, Gkantidis N. The effect of threshold level on bone segmentation of cranial base structures from CT and CBCT images. Scientific Reports. 2020; 10: 7361.

[8] Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. American Journal of Orthodontics and Dentofacial Orthopedics. 2009; 135: 468–479.

[9] Yamashina A, Tanimoto K, Sutthiprapaporn P, Hayakawa Y. The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT. Dentomaxillofacial Radiology. 2008; 37: 245–251.

[10] Wörtche R, Hassfeld S, Lux C, Müssig E, Hensley F, Krempien R, et al. Clinical application of cone beam digital volume tomography in children with cleft lip and palate. Dentomaxillofacial Radiology. 2006; 35: 88–94.

[11] Celikoglu M, Buyuk SK, Sekerci AE, Ucar FI, Cantekin K. Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate. American Journal of Orthodontics and Dentofacial Orthopedics. 2014; 145: 780–786.

[12] Erdur O, Ucar FI, Sekerci AE, Celikoglu M, Buyuk SK. Maxillary sinus volumes of patients with unilateral cleft lip and palate. International Journal of Pediatric Otorhinolaryngology. 2015; 79: 1741–1744.

[13] Celikoglu M, Buyuk SK, Sekerci AE. Assessment of the facial soft tissue thickness of the patients affected by unilateral cleft lip and palate using cone beam computed tomography. Journal of Craniofacial Surgery. 2015; 26: 1647–1651.

[14] Celikoglu M, Ucar FI, Buyuk SK, Celik S, Sekerci AE, Akin M. Evaluation of the mandibular volume and correlating variables in patients affected by unilateral and bilateral cleft lip and palate: a cone-beam computed tomography study. Clinical Oral Investigations. 2016; 20: 1741–1746.

[15] de Rezende Barbosa GL, Pimenta LA, Pretti H, Golden BA, Roberts J, Drake AF. Difference in maxillary sinus volumes of patients with cleft lip and palate. International Journal of Pediatric Otorhinolaryngology. 2014; 78: 2234–2236.

[16] Agarwal R, Parihar A, Mandhani PA, Chandra R. Three-dimensional computed tomographic analysis of the maxilla in unilateral cleft lip and palate. Journal of Craniofacial Surgery. 2012; 23: 1338–1342.

[17] Aras I, Olmez S, Dogan S. Comparative evaluation of nasopharyngeal airways of unilateral cleft lip and palate patients using three-dimensional and two-dimensional methods. The Cleft Palate-Craniofacial Journal. 2012; 49: 75–81.

[18] Farzal Z, Walsh J, Lopes de Rezende Barbosa G, Zdanski CJ, Davis SD, Superfine R, et al. Volumetric nasal cavity analysis in children with unilateral and bilateral cleft lip and palate. The Laryngoscope. 2016; 126: 1475–1480.

[19] Houston WJB. The analysis of errors in orthodontic measurements. American Journal of Orthodontics. 1983; 83: 382–390.

[20] Bardach J, Morris HL. Multidisciplinary management of cleft lip and palate. Pa WB Saunders Co: Philadelphia. 1990.

[21] Suzuki H, Yamaguchi T, Furukawa M. Maxillary sinus development and sinusitis in patients with cleft lip and palate. Auris Nasus Larynx. 2000; 27: 253–256.

[22] Bajoria A, Sarkar S, Sinha P. Evaluation of odontogenic maxillary sinusitis with cone beam computed tomography: a retrospective study with review of literature. Journal of International Society of Preventive and Community Dentistry. 2019; 9: 194.

[23] Schneiderman ED, Xu H, Salyer KE. Characterization of the maxillary complex in unilateral cleft lip and palate using cone-beam computed tomography. Journal of Craniofacial Surgery. 2009; 20: 1699–1710.

[24] Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2008; 106: 106–114.

[25] Kihara E, Chindia M, Ocholla T, Parker M. Clinical significance of pathological and anatomical findings in cone beam CT scans of the maxillary sinus. Open Journal of Stomatology. 2014; 04: 285–290.

[26] Zhang J, Liu L, Yang L, Wang J, Tan X, Huang D. Diagnosis of odontogenic maxillary sinusitis by cone-beam computed tomography: a critical review. Journal of Endodontics. 2023; 49: 1445–1456.

[27] Ma RR. Three dimensional analysis of CT image on naso-maxillary complex in cleft lip and palate patients. Journal of the Japan Stomatological Society. 1994; 61: 492–511. (In Japanese)

[28] Deeb R, Malani PN, Gil B, Jafari-Khouzani K, Soltanian-Zadeh H, Patel S, et al. Three-dimensional volumetric measurements and analysis of the maxillary sinus. American Journal of Rhinology & Allergy. 2011; 25: 152–156.

[29] Suzuki H. Rhinologic computed tomographic evaluation in patients with cleft lip and palate. Archives of Otolaryngology-Head & Neck Surgery. 1999; 125: 1000.

[30] Salib R, Chaudri S, Rockley T. Sinusitis in the hypoplastic maxillary antrum: the crucial role of radiology in diagnosis and management. The Journal of Laryngology & Otology. 2001; 115: 676–678.

[31] Darsey DM, English JD, Kau CH, Ellis RK, Akyalcin S. Does hyrax expansion therapy affect maxillary sinus volume? A cone-beam computed tomography report. Imaging Science in Dentistry. 2012; 42: 83.

[32] Pangrazio-Kulbersh V, Wine P, Haughey M, Pajtas B, Kaczynski R. Cone beam computed tomography evaluation of changes in the naso-maxillary complex associated with two types of maxillary expanders. The Angle Orthodontist. 2012; 82: 448–457.

[33] Erdur EA, Yıldırım M, Karatas RMC, Akin M. Effects of symmetric and asymmetric rapid maxillary expansion treatments on pharyngeal airway and sinus volume. The Angle Orthodontist. 2020; 90: 425–431.

[34] Bhat N, Thakur K, Bhardwaj N, Nandan H, Rawat A, Lathwal A. Cleft lip and palate: a review. Annals of Medical and Health Science Research. 2020; 10: 927–930.

[35] Saatci B, Ataç MS. Alveolar Grafting of the Hard Palate in Patients with Cleft Lip and Palate: A Review. Gazi Medical Journal. 2021; 32: 330–336.

[36] Halıcıoğlu K, Koçal M. Alveolar Bone Grafting In Patients With Cleft Lip and Palate. Atatürk Üniversitesi Diş Hekimliği Fakültesi Dergisi. 2016; 26: 153–168.

[37] Demirtas O, Kalabalik F, Dane A, Aktan AM, Ciftci E, Tarim E. Does unilateral cleft lip and palate affect the maxillary sinus volume? The Cleft Palate-Craniofacial Journal. 2018; 55: 168–172.

[38] Yılmaz S, Amuk M. Evaluation of the maxillary sinus volume and surface area in patients with unilateral lip and palate cleft using cone beam computed tomography. Current Research in Dental Sciences. 2021; 31: 1–7.

[39] Rodrigues ML, Francisco I, Caramelo F, Figueiredo JP, Vale F. A retrospective and tridimensional study of the maxillary sinus in patients with cleft lip and palate. American Journal of Orthodontics and Dentofacial Orthopedics. 2021; 159: e17–e24.

[40] Yassaei S, Ezodini F, Shiri A, Nasr N. Maxillary sinus volume in patients with unilateral cleft lip and palate by CBCT. Journal of Craniofacial Surgery. 2023; 34: e641–e644.

[41] Tunç H, Ünsal G. Comparison of the paranasal sinus features of paediatric patients with and without cleft palate: a CBCT study. To be published in The Cleft Palate Craniofacial Journal. 2023. [Preprint].