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Upper airway in children with unilateral cleft lip and palate evaluated with computational fluid dynamics

Tomonori Iwasaki1, Hokuto Suga1, Ayaka Minami-Yanagisawa1

  • 1Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima-City, Japan.

American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics
|August 4, 2019
PubMed

Insights

Children with unilateral cleft lip and palate (UCLP) have significantly higher nasal and pharyngeal airway resistance. This study used computational fluid dynamics to reveal upper airway obstruction in UCLP patients, impacting breathing and sleep quality.

Area of Science:

  • Pediatric Otolaryngology
  • Respiratory Physiology
  • Computational Fluid Dynamics

Background:

  • Children with unilateral cleft lip and palate (UCLP) often experience snoring and mouth breathing, indicative of potential obstructive sleep apnea.
  • The precise impact of UCLP on upper airway ventilation remains incompletely understood.
  • This study investigates upper airway ventilation in children with UCLP using advanced computational methods.

Purpose of the Study:

  • To evaluate and compare upper airway ventilation conditions in children with and without UCLP.
  • To quantify nasal resistance and airway pressure differences between the groups.
  • To elucidate the contribution of nasal and pharyngeal factors to upper airway obstruction in UCLP.

Main Methods:

  • Cone-beam computed tomography (CBCT) scans were acquired for 21 children with UCLP and 25 controls.
  • Computational fluid dynamics (CFD) analysis was performed on CBCT data to assess nasal resistance and airway ventilation.
  • Statistical comparison between groups utilized Mann-Whitney U tests and Student t tests.

Main Results:

  • The UCLP group exhibited significantly higher nasal resistance (0.97 Pa/cm³/s) compared to controls (0.26 Pa/cm³/s; P < 0.001).
  • Maximal upper airway pressure was markedly elevated in the UCLP group (335.02 Pa) versus controls (67.57 Pa; P < 0.001).
  • Pharyngeal airway pressure was also significantly higher in children with UCLP (140.46 Pa) than in the control group (15.92 Pa; P < 0.02).

Conclusions:

  • Upper airway obstruction in children with UCLP is a multifactorial issue.
  • Both nasal and pharyngeal airway abnormalities contribute to breathing difficulties.
  • Findings highlight the need for comprehensive assessment of the entire upper airway in UCLP management.
Abstract

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