Cervical Vertebral Bone Mineral Density Distribution of Cleft Patients

Objective: Assessment of skeletal maturation begins at a young age for the cleft patient to facilitate treatment. Cervical vertebral maturation (CVM) method has been used to assess skeletal maturity. Active bone remodeling associated with the skeletal maturation likely alters bone mineral density (BMD) distribution. However, the current 2D image based CVM method is limited to provide detailed information for the BMD distribution. The objective of this study was to examine whether age-dependent changes of the cervical vertebral BMD distribution are different between cleft patients and non-cleft control patients using clinical cone beam computed tomography (CBCT) images.

Method: Following IRB approval, CBCT images were obtained from 14 patients (6 males and 8 females) who were treated for the cleft lip and palate, and 14 control patients (6 males and 8 females) who were gender and age (14 to 32 yrs) matched with the cleft patient group. Bodies of cervical vertebrae (C2 and C3) were digitally isolated from the 3D CBCT images. The gray level (equivalent to BMD) histograms were obtained from each patient. Mean and standard deviation (SD), and coefficient of variation (COV=SD/mean) of the gray level in each of the vertebral bodies were assessed. Correlations between the BMD parameters and patients’ ages were tested for the control and cleft patient groups.

Result: Significant negative correlations of age with SD and COV were found for the cleft group (p<0.024) while no significant correlations were observed with other BMD parameters for the cleft and control groups (p>0.243). 

Conclusion: The variability (SD and COV) of BMD could increase resulting from active bone remodeling. Cleft patients are frequently observed to have cervical vertebral anomalies that may involve the active bone remodeling. The current results indicate that cervical vertebral bone remodeling for cleft patients decreases with age.