Maxillary Sinus Congestion in Children with Cleft Lip/Palate vs. Controls

Methods: With IRB approval, three-dimensional cone beam computerized tomographs (3D CBCT) of children 8-14 yoa with unilateral CL/P and surgical lip repair (n=12) and controls (age and gender matched; n=12) were selected randomly from pre-existing orthodontic records.  Following reliability studies, one investigator segmented the right and left sinuses from each CBCT using Dolphin 3D Imaging Software (v11.5).  Each sequential coronal section (0.4 mm thickness) was manually measured by outlining the maxillary sinus bone boundaries and the airspace on each slice.  The software calculated the total cross-sectional surface area of the bony maxillary sinus and air space of each slice.  Total area was summed and multiplied by the slice thickness (voxel size - 0.4mm) to determine volume.  Congestion was defined as the difference between sinus total and air volumes.  Significant differences in total, air, and congestion volumes between the groups were determined using paired t-tests, accepting p < 0.05 as significant.  Reliability was determined using Intraclass Correlations (ICC).

Results: Reliability was excellent (ICC > 0.99).  Although the CL/P sinus total volume on both sides was smaller than controls, the differences were not significant.  Mean air volume in the cleft-side sinus (12336mm³) was significantly smaller and mean congestion volume (7435mm³) significantly greater than the controls (24109mm³and 3213mm³, respectively).  CL/P noncleft side mean sinus air volume (13493mm³) was significantly smaller than the controls (23505mm³) whereas CL/P mean congestion volume (5605mm³) was significantly greater than controls (3082mm³). 

Conclusion: Preliminary results suggest that children with CL/P have more maxillary sinus congestion compared with same age and gender controls. Patients with CL/P should be evaluated for clinical signs of maxillary sinus congestion.