A Morphological and Volumetric Airway Analysis of Patients with Mandibulofacial Abnormalities Using Cone Beam Computed Tomography

Introduction: The type and severity of mandibulofacial abnormalities affects the size and shape of the pharynx as patients affected by these conditions often have complaints of snoring and respiratory difficulties during sleep. Purpose: The objectives of this study were to evaluate the volume and morphology of nasopharyngeal, oropharyngeal, hypopharyngeal and the total airway of patients affected by mandibulofacial abnormalities (unilateral cleft lip and palate [UCLP], and craniometaphyseal dysplasia [CMD]) and to compare them with a matched control group without any mandibulofacial abnormalities. Methods: Cone-beam computed tomography (CBCT) records of 80 patients (30 UCLP and 10 CMD along with 40 age and gender-matched controls) were collected. Volumetric analysis was performed using image segmentation features in MIMICS 15.0 (Materialise, Levuen, Belgium) to evaluate the nasopharyngeal, oropharyngeal, hypopharyngeal and total airway volumes, as well as the airway morphology. Minimum cross-sectional area was determined using InVivo Dental 5.3 (Anatomage, San Jose, California). Statistical analysis with SPSS 22.0 (IBM, Armonk, NY) was done to evaluate inter- and intra-operator reliability by using Cronbach\u27s alpha and paired t-test. Results: Patients affected by UCLP had statistically significant smaller naso-, hypopharyngeal and total airway volumes, smaller minimum cross-section area, and a more circularly shaped oropharynx when compared with the controls. The CMD group presented the same airway shape as UCLP patients and statistically significant smaller volumes of all pharyngeal regions as well as total airway and minimum cross-section area when compared with the controls. Conclusion: Individuals with UCLP and CMD had a different pharyngeal airway shape and smaller pharyngeal volumes compared to the controls. These individuals have more susceptibility of developing sleep related breathing disorders. This information is pivotal for the clinician in defining the best possible treatment choice for each patient, thus avoiding procedures that could further compromise the airway