Analysis of Skeletal and Airway Changes Following Anterior Maxillary Distraction in Cleft Patients: A CBCT Study

Aim: This study aimed to evaluate the skeletal, soft tissue, and airway changes following anterior maxillary distraction in cleft lip and palate (CLP) patients using cone-beam computed tomography (CBCT). The objective was to assess the impact of distraction osteogenesis on pharyngeal airway volume, maxillary sinus dimensions, and facial aesthetics. Methods: Thirty patients, aged 12–18, with maxillary hypoplasia secondary to CLP, underwent anterior maxillary distraction using a tooth-borne modified Hyrax appliance. Preoperative and postoperative CBCT scans were obtained and analyzed for changes in nasopharyngeal and oropharyngeal volumes, maxillary sinus dimensions, and cephalometric parameters. Hard tissue changes included ANB angle, PNS-ANS distance, and U1 to A-Pog measurements, while soft tissue assessment focused on upper lip length, protrusion, and position relative to E-line and S-line. Statistical analysis was conducted using paired t-test, with a significance level of P<0.05. Results: Significant improvements were observed in nasopharyngeal volume (2.66 cm³ to 4.84 cm³, P<0.001) and total pharyngeal volume (12.97 cm³ to 15.64 cm³, P<0.001), indicating enhanced airway patency. The ANB angle increased from -3.60° to 2.60° (P<0.001), confirming skeletal advancement. Maxillary sinus volumes increased bilaterally (P<0.001), and soft tissue changes showed improved lip support and projection. Conclusion: AMD using a modified Hyrax appliance significantly enhanced airway function, skeletal structure, and facial aesthetics in CLP patients. CBCT proved valuable in quantifying these changes. This study reinforces the clinical effectiveness of distraction osteogenesis for maxillary advancement and airway improvement, providing both functional and aesthetic benefits.