The usefulness of cone beam computed tomography according to age in cleft lip and palate

Abstract

The current study aimed to evaluate the usefulness of cone beam computed tomography (CBCT) examination in cleft children and adolescents, the age of the first CBCT exposure, and the criteria that justified the first CBCT exposure. A number of 229 non-syndromic cleft subjects aged between 0-22 years receiving treatment in the same specialized surgical center in orofacial cleft treatment were studied. A cleft group of 64 cleft lip and palate (CLP) children with at least one CBCT exposure was identified based on CBCT records. Parameters related to diagnosis and treatment planning in cleft deformity were considered dental anomalies and bone morphology changes. The examiners assessed whether the treatment option was necessary, not necessary, or could not be evaluated at the age of CBCT exposure. A number of thirty-nine unilateral clefts and fifteen bilateral clefts were identified. Posterior palatal cleft was present in six children (mean age: 15.03±5.55 years; male/female ratio: 1/0.8). Alveolar bone morphology changes were found in 90.58% of cases; jaw relationship changes in 71.82%; nasal fossa morphology changes in 74.99%; airway obstruction in 49.98% and maxillary asymmetry in 87.48%. Orthodontic planning was necessary for 85.93% of CLP patients, and orthognathic surgery in 39.05%. The usefulness of CBCT in patients with CLP varied with age, with reduced value for the evaluation of impaction and root resorption under the age of ten.

Keywords: 2D – Two-dimensional; 3D – Three-dimensional; CBCT – Cone beam computed tomography; CLP – Cleft lip and palate; FOV – Field of view; RME – Rapid maxillary expansion; SD – Standard deviation; child; cleft lip and palate; cone beam computed tomography; kV – Kilovolt; mAs – Milliampere-seconds.

Figure 1

A – Panoramic reformatted image on CBCT examination shows a left CLP with dental anomalies: hypodontia with the absence of first upper right premolar, impacted upper canines with a follicular cyst at the right upper canine and lateral left incisor in the cleft area; mesioversion of the upper lateral right incisor. B – axial CBCT image shows the absence of the upper second right premolar and the position of the teeth in the maxillary jaw, with midline shift; the crown of the lateral left incisor is prominent in the cleft area (A-anterior; P-posterior; R-right; L-left). C – coronal CBCT image shows the dimension of bone defect and the teeth position related to the palate cleft.