Three-Dimensional Upper Airway and Craniofacial Morphology Across Pubertal Stages and Skeletal Relationships in Unilateral Cleft Lip and Palate

ObjectiveTo compare the upper airway and craniofacial morphology between patients with nonsyndromic unilateral complete cleft lip and palate (UCLP) and skeletal Class I controls across different pubertal stages.DesignRetrospective study.SettingCleft Care Center and Orthodontic department, Khon Kaen University, Thailand.Patients, Participants: About 45 patients with UCLP and 45 matched controls (ages 8-18), categorized into prepubertal and postpubertal stages.InterventionsCone-beam computed tomography (CBCT) scans were acquired with participants seated upright.Main Outcome Measure(s)Upper airway volumes, minimum cross-sectional area (MCA), and craniofacial morphology were measured using Dolphin imaging software.ResultsPrepubertally, the UCLP group had significantly smaller oropharyngeal airway volume and total pharyngeal airway volume (TAV), reduced MCA, decreased SNA and ANB, and higher hyoid position relative to the Frankfort horizontal plane (Hy-FH) than controls. Postpubertally, OAV and TAV remained significantly smaller, with further reductions in SNA, SNB, ANB, Co-A, and Co-Gn. Compared with prepubertal subjects, postpubertal patients with UCLP showed significantly larger airway dimensions, whereas controls showed significant increases only in nasal cavity volume (NC) and TAV. In the UCLP group, OAV correlated moderately with N-Me and weakly with SNB, S-Go, and Hy-FH.ConclusionsPatients with UCLP exhibit persistent maxillary retrusion, a skeletal Class III tendency, and an inferiorly positioned hyoid bone. Despite significant pubertal expansion, airway dimensions remain consistently smaller than controls. Moreover, vertical and sagittal jaw relationships, as well as hyoid position, are only partial contributors to these airway limitations.