| Cleft lip and palate is one of the most common diseases in our country's birth defects.It is found that most patients with cleft lip and palate are accompanied by sleep problems and snoring symptoms,which will seriously affect the quality of sleep of them with the emergence of blood oxygen saturation decline,daytime sleepiness,inattention and other issues.For children it would interfere with the children's normal growth and development,affect the formation of cardiopulmonary function,and may even lead to death.So concerning about the airway condition of the cleft lip and palate patients is necessary.The lateral cephalogram is one of the commonly used methods of assessing the airway,but because it is a two-dimensional imaging technology,there are some problems in clinical applications such as difficult to confirm some signs,the three-dimensional structure of the airway cannot be reflected and so on.With the development of cone beam CT and three-dimensional reconstruction techniques,CBCT has been increasingly used to assess the patient's upper airway and it has been demonstrated that the result of CBCT is credible.In this paper,CBCT and Dolphin software were used to study the upper airway and craniofacial three-dimensional morphology of patients with compelet cleft lip and palate and patients with class ? and ? malocclusion.The aim of this study was to help clinicians to have more comprehensive understanding of the airway and craniofacial morphology of patients with cleft lip and palate and providing some guidance for clinical work.Part I:Three-dimensional study of upper airway and craniofacial morphology in patients with unilateral cleft lipOBJECTIVE:Using CBCT to compare the upper airway and craniofacial morphology of patients with right/left complete cleft lip palate,Class I malocclusion and Class III malocclusion,and to provide some reference for clinic work.Methods:108 patients were select from the Department of Orthodontics,Wuhan University Stomatology Hospital and were divided into the 4 groups:patients with left side complete cleft lip and palate(CLP-L),right side complete cleft lip and palate(CLP-R),Class I and III malocclusion.The volume of the nasopharyngeal airway,upper segment of oropharyngeal airway,lower segment of oropharyngeal airway and total airway volume and 28 craniofacial morphological indexes such as SNA,SNB and ANB were measured.Differences were measured by student t test.Results:(1)The total volume,nasopharyngeal volume,oropharyngeal volume and upper segment of oropharyngeal volume in the CLP-L group were significantly smaller than those in the Class I group(P<0.05),but there was no significant statistical difference between the CLP-L group and the Class III group(P>0.05).No difference was found between the CLP-L and CLP-R groups although the mean value of volume was smaller for CLP-L.(P>0.05).The airway volume and three cross sections areas of the Class I group were larger than those of the Class III group,but the difference was only found in the palatal plane area(P<0.05).(2)The length of maxillary and mandible,the length of mandibular ramus,SNA and ANB in the left complete cleft lip and palate group were smaller than those in the I group.Except for the above indexes,the Y-axis angle and SNB of the CLP-L group were also smllar than the Class III group(P<0.05).The results of the CLP-R were similar to the CLP-L.Conclusion:The airway volume of patients with unilateral cleft lip and palate is significantly smaller than that of patients with Class I malocclusion,and the maxillary and mandibular growth were insufficient.The maxillary and mandibular dysplasia may be relative to the smaller volumn of the airway.Orthodontists should pay attention to the airway conditions of cleft lip and palate patients and try to stimulate the growth of the maxilla.Part II:Three-dimensional study of upper airway and craniofacial morphology in patients with bilateral complete cleft lip and palateOBJECTIVE:To compare the airway and craniofacial morphology of bilateral cleft lip and palate with Class I malocclusion by CBCT,and to provide some reference for clinical work.Methods:54 patients were selected from the Department of Orthodontics,Wuhan University Stomatology Hospital and were divided into the 2 groups:patients with bilateral complete cleft lip and palate(CLP-B)and Class I malocclusion.The volume of the nasopharyngeal airway,upper segment of oropharyngeal airway,lower segment of oropharyngeal airway and total airway volume and 28 craniofacial morphological indexes such as SNA,SNB and ANB were measured.Differences were measured by student t test.Results:The total airway volume,oropharyngeal volume,oropharyngeal volume,oropharyngeal volume,epiglottis area,epiglottis length,palatal plane length and soft palate plane of the CLP-B group were significantly smaller than those in the Class I group(P<0.05)At the same time,the length of the anterior skull base,the mandibular ramus,the effective length of the mandible were smaller and the position of the tongue was higher than that of the control group(P<0.05).Conclusion:The airway volume of patients with bilateral cleft lip and palate was smaller than that of patients with Class I malocclusion.The mandibular development was insufficient.The airway narrow was more significant in the coronal plane.This suggests that orthodontists should pay attention to the airway status of patients with bilateral cleft lip and palate and the three-dimensional morphology analyze should be used.Part III:Analysis of airway and craniofacial morphology in patients with unilateral cleft lip and palate and bilateral cleft lip and palateOBJECTIVE:To compare the airway and craniofacial morphology between patients with unilateral cleft lip and palate and bilateral cleft lip and palate and to help clinicians get more fully understand of the patient's airway condition.Methods:81 patients were select from the Department of Orthodontics,Wuhan University Stomatology Hospital and were divided into the 3 groups:patients with left side complete cleft lip and palate(CLP-L),right side complete cleft lip and palate(CLP-R),and bilateral complete cleft lip and palate(CLP-B).The volume of the nasopharyngeal airway,upper segment of oropharyngeal airway,lower segment of oropharyngeal airway and total airway volume and 28 craniofacial morphological indexes such as SNA,SNB and ANB were measured.Differences were measured by student t test.Results:The total airway volume,oropharyngeal volume,upper and lower segments of oropharyngeal volume and oropharyngeal volume in CLP-B were smaller than those in CLP-L and CLP-R,but the difference were not significant(P>0.05).The length of soft palate in CLP-B was significantly smaller than that in CLP-L and CLP-R(P<0.05).Conclusion:The difference of airway volume between unilateral and bilateral cleft lip and palate was not obvious.The possible reason is that the sample size is not enough.The velopharyngeal closure function of patients with bilateral cleft lip and palate may be worse than that of unilateral cleft lip and palate.In the future,expanding the sample size should be done,and doctors should pay more attention to the surgery method and strengthen training to help restore the velopharyngeal closure function of patients with bilateral cleft lip and palate... |
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