Effects of Orthopedic Rapid Maxillary Expansion on Internal Nasal Dimensions in Children With Cleft Lip and Palate Assessed by Acoustic Rhinometry

Abstract

The objective of the current study was to characterize the internal nasal dimensions of children with repaired cleft lip and palate and transverse maxillary deficiency, using acoustic rhinometry and analyze the changes caused by rapid maxillary expansion (RME). A convenience sampling of 19 cleft lip and palate individuals, aged 14 to 18 years, of both sexes, previously submitted to primary surgeries and referred for RME were analyzed prospectively at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, São Paulo, Brazil. All patients underwent acoustic rhinometry before installation of the expansor and at 30 and 180 days after the active expansion phase. Nasal cross-sectional areas and volumes corresponding to the nasal valve (CSA1 and V1) and the turbinates (CSA2, CSA3, and V2) regions were determined before and after nasal decongestion. Rapid maxillary expansion led to a statistically significant increase (P < 0.05) in mean CSA1, CSA2, V1, and V2 (without nasal decongestion) and in CSA1 and V1 (with decongestion) in the group as a whole. Individual data analysis showed that 58% of the patients responded positively to RME, with an average increase in CSA1 of 26% (with decongestion), whereas 37% of the patients had no significant change. Only 1 patient (5%) showed a decrease. The findings contribute toward the characterization of nasal deformities determined by the cleft and demonstrate the positive effect RME had on nasal morphophysiology in a significant number of the patients who underwent this procedure.

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

“…When the examinations were performed at rest, the subjects were asked to maintain the mouth closed, without swallowing or moving the tongue during data acquisition, to avoid interference from breathing and swallowing on the quality of rhinograms. Care was also taken to avoid deformation to the nostril and thus to the nasal valve during the procedure 7,16,18 .…”

Nasal Airway Dimensions of Children with Repaired Unilateral Cleft Lip and Palate

“…However, findings on adults are not applicable to children because nasal airflow resistance changes with age (Saito and Nishihata, 1981). In this regard, previous publications focused only on adolescents with UCLP (Trindade et al, 2010) or on mixed groups of children and adults with UCLP (Kunkel et al, 1997;HuempfnerHierl et al, 2009;Trindade et al, 2009). This study evaluated cross-sectional areas of the main nasal constrictions and their specific sites in children with repaired UCLP, at the cleft and noncleft sides, as compared with control children, by acoustic rhinometry.…”

Efeitos da expansão rápida da maxila sobre as dimensões internas nasais de crianças com fissura labiopalatina bilateral: avaliação por rinometria acústica

“…Os resultados evidenciam que as áreas seccionais e os volumes nasais médios de pacientes com fissura transforame incisivo bilateral são equivalentes, ou ligeiramente maiores, que os aferido em estudo prévio do nosso grupo (Trindade et al 2010), em pacientes com fissura unilateral. Estes dados vão de encontro aos obtidos por Warren et al (1988) que observaram que crianças com fissura bilateral apresentam o "melhor nariz", ou seja, o nariz mais permeável, na avaliação por rinomanometria, para o que pode ter contribuído o alongamento de columela feito nesta faixa etária.…”

“…Adicionalmente, observou-se que as áreas e volumes nasais dos pacientes com fissura bilateral, da presente amostra, são ligeiramente maiores que as de pacientes com fissura unilateral, de estudo prévio (Trindade et al 2010), e, que em ambos os grupos houve aumento significativo das dimensões internas nasais após ERM, em parcela significativa da população estudada. Contudo, este aumento se mostrou consideravelmente maior nos pacientes com fissura transforame incisivo bilateral, exceto na região correspondente à AST 3 .…”

“…A avaliação rinométrica foi realizada com a mesma metodologia utilizada em estudo anterior do Laboratório de Fisiologia do HRAC-USP, em que se avaliou o efeito da ERM em pacientes com fissura transforame incisivo unilateral (Trindade et al 2010).…”