Does Differential Maxillary Expansion Prior to Alveolar Cleft Bone Grafting Affect Nasal Width?

Area of Science:

• Craniofacial surgery
• Orthodontics
• Plastic surgery

Background:

• Unilateral cleft lip and alveolus (UCLA±P) often results in nasal asymmetry.
• Maxillary hypoplasia is a common characteristic in patients with UCLA±P.
• Nasal width is a critical aesthetic and functional concern in these patients.

Purpose of the Study:

• To evaluate the impact of differential maxillary expansion on nasal width in patients with UCLA±P.
• To compare nasal width changes between cleft and noncleft sides following expansion.
• To assess the efficacy of maxillary expansion as an adjunct to alveolar bone grafting (ABG).

Main Methods:

• Retrospective radiographic study utilizing cone beam computed tomography (CBCT) scans.
• Inclusion of 40 patients with UCLA±P who underwent maxillary expansion and ABG.
• Comparison with 20 control patients with UCLA±P who underwent ABG without expansion.

Main Results:

• Maxillary expansion led to significant increases in nasal width at the nasal pyriform, inferior turbinates, and alar base on both cleft and noncleft sides.
• The increase in width was notably greater on the cleft side compared to the noncleft side at all measured nasal structures.
• Measurements demonstrated good to excellent intra-rater and inter-rater reliability.

Conclusions:

• Differential maxillary expansion is an effective method for increasing nasal width in patients with UCLA±P.
• The treatment promotes more substantial nasal widening on the cleft side, aiding in facial symmetry.
• This approach should be considered prior to alveolar bone grafting in managing nasal deformities associated with UCLA±P.