Browsing by Subject "cleft lip and palate (CLP)"

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    Molar-Incisor hypomineralization in controls vs CLP with primary or prior to secondary alveolar grafts
    (Office of the Vice Chancellor for Research, 2016-04-08) Allam, E.; Ghoneima, A.; Tholpady, S.; Eckert, G.; Klene, C.; Kula, K.
    Molar incisor hypomineralization (MIH) is a congenital defect of unknown etiology that can affect both esthetics and cariogenic susceptibility. The objective of this study was to determine whether MIH is greater in patients with cleft lip and palate (CLP) who underwent primary alveolar grafting (PAG) as compared to CLP prior to secondary alveolar grafting (SAG) and to controls. A retrospective analysis of intraoral photographs of 13 (10M:3F; 8.9 ± 1.2 yrs) CLP patients who underwent a PAG, 27 (18M:9F;10.0 ± 2.1 yrs) CLP prior to SAG, and 60 (30M:30F; 12.4 ± 1.8 yrs) controls without CLP was performed. Mantel-Haenszel chi-square tests were used to compare the three groups for differences in MIH scores and Wilcoxon Rank Sum tests were used to compare the groups for differences in average MIH scores. A 5% significance level was used for all tests. MIH scores were significantly higher for the PAG and SAG groups compared to the control group (p<0.001). The PAG group had significantly higher incisor MIH (p=0.016) than the SAG group. MIH average scores were significantly higher for the two graft groups compared to the controls (p<0.0001). The PAG group had significantly higher average MIH score and average MIH score for incisors than the SAG group (p=0.03). The results suggest that CLP patients, in general, have significantly greater MIH compared with controls and CLP with PAGs have significantly greater MIH in the incisor region than CLP waiting for SAGs. The increased severity of MIH could be related to the grafting during the time of incisor crown formation.
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    Mucosal Thickening of Maxillary Sinuses of CLP vs non-CLP patients
    (Office of the Vice Chancellor for Research, 2015-04-17) Kula, K.; Starbuck, J.; Hale, L.; Tholpady, S.; Ghoneima, A.
    Objectives: The objective of this retrospective radiographic study was to compare mucosal thickening of maxillary sinuses of patients with cleft lip and palate (CLP) vs. non-CLP. Methods: Following IRB approval, three-dimensional cone beam computerized tomographs (CBCT; i-CAT) of children with unilateral CLP and children without CLP (age and gender matched; 8-14yoa; n=15ea) were selected randomly from pre-existing orthodontic records. Following reliability studies, one investigator segmented both sinuses from each CBCT using Dolphin-3D Imaging software. The sinuses were separated coronally into .4mm slices anterioposteriorly. Bony sinuses and airspaces were outlined manually on each slice. Software calculated total sinus and airspace area. Areas were summed and multiplied by slice thickness to determine volume. Mucosal thickening was the difference between total sinus and airspace volumes. Percent mucosal thickening was calculated. Since no significant differences existed between cleft (left) and noncleft (right) sides of either patient group (p>.05), sinuses for each group were pooled (n=30 ea). Significant differences in total sinus, airspace, mucosal thickening volumes and % mucosal thickening were determined using paired t-tests, accepting p<0.05 as significant. Principal Component Analysis (PCA) scatterplots were used to determine patterns of multivariate variation based on group, age, and sex. MANOVA was used to confirm PCA findings. Reliability was determined using Intraclass Correlations (ICC). Results: Reliability was excellent (ICC>0.99). The CLP total sinus and airspace volume were significantly smaller and mucosal thickening and % mucosal thickening were significantly greater than non-CLP sinuses (all p<.024). PCA showed that 89.6% of sample variance was explained by PC axis 1 and 2 (group and age). Age group 8-9yrs showed more separation with 13-14yrs than with 10-12yrs. MANOVA confirmed a significant effect of sample (p=.001) and age (p=.007).
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    A Three-Dimensional Analysis of Maxillary Sinus Congestion in Unilateral Cleft Lip and Palate
    (Office of the Vice Chancellor for Research, 2014-04-11) Hale, Lindsay; Starbuck, John M.; Ghoneima, Ahmed A.; Kula, Katherine S.
    Cleft lip and palate (CLP) perturbs osseous and soft-tissue development of the nasolabial regions, often resulting in chronic maxillary sinusitis and mucosal thickening (MT) of the maxillary sinus. This preliminary study quantifies maxillary sinus MT in children with surgically repaired unilateral CLP. We hypothesize that maxillary sinus MT is increased in children with CLP relative to controls. We define "MT" as the difference between the entire maxillary sinus volume and airspace volume. Cone beam computed tomography (CBCT) images of 8-14 yr. old age- and sex-matched unilateral CLP patients (n = 10) and controls (n = 10) were obtained (IRB approval # 1210009813). Both maxillary sinus and airspace surface areas (SAs) were measured on each individual CBCT slice in coronal view. SA measurements were summed and multiplied by voxel size (0.4mm) to obtain a volume. Paired t-tests determined whether maxillary sinus volume, air volume, MT (i.e. maxillary sinus volume – airspace volume), and percentage of MT (i.e. MT/maxillary size x 100) differed. A p-value of ≤ 0.05 was considered significant. Intra-class correlation assessed reliability and was high (0.99). Significant differences were found for several measurements: Maxillary airspace (non-cleft side vs. right side control p-value = 0.002; cleft-side vs. left side control p-value = 0.004), MT (cleft-side vs. left side p-value = 0.009), and percentage of MT (non-cleft side vs. right side control p-value = 0.002, cleft-side vs. left side control p-value = 0.002). Maxillary airspace was decreased by 30% (non-cleft side) and by 33% (cleft side). Percentage of average MT was 40% (non-cleft side) and 42% (cleft side) of CLP patients, but only 9% (left and right side) in controls. Surgically repaired CLP patients exhibit decreased maxillary airspace and increased MT relative to controls. CLP deformities are associated with MT. 3D imaging is useful for quantitatively evaluating MT of the maxillary sinus.