Width of the nasopharynx and related anatomic structures in normal and unoperated cleft palate children

Abstract Laminagraphy, a body-sectioning radiographic technique, was utilized in this study to evaluate objectively the lateral dimensions of the osseous nasopharyngeal and related areas. One hundred forty-two children under 3 years of age were examined radiographically. The sample included ninety-one unoperated cleft cases and fifty-one noncleft palate cases. Both cleft palate and normal subjects were grouped with respect to age: Age Group I (0 to 1 year of age), Age Group II (1 to 2 years of age), and Age Group III (2 to 3 years of age). The cleft population was grouped according to four types of cleft: Type I, posterior clefts; Type II, unilateral clefts; Type III, bilateral clefts; and Type IV, alveolar clefts. Bihamular measurements appear to indicate that a tendency toward a leveling off in nasopharyngeal width occurs during the second year of life. All cleft types (with the exception of Type IV, alveolar) show wider nasopharyngeal dimensions than were observed in normal subjects. Statistically, the significance of these mean differences exceeded the 1 per cent level of confidence. Cleft Types I, II, and III were remarkably uniform in mean bihamular measurement, irrespective of type. A leveling off in birotundal width similar to that noted in bihamular measurements, was observed in the normal children and in the cleft palate cases during the second year of life. When all cleft types and age groups were combined and compared with the total normal population, no significant difference in birotundal measurements was evident. This finding was in striking contrast to the marked differences observed in biohamular measurements. Analysis of the angular inclination of the pterygoid plates revealed that asymmetry regarding right and left inclination of the pterygoid plates was noted in normal and cleft cases; a greater asymmetry was evident in cleft cases. Normal and cleft mean angulation for specific age groups indicated a progressive decrease in inclination with increment in age. The angulation of the medial pterygoid plates was greater in all cleft types. In an effort to determine whether aberrations appeared in other bones, measurements of the zygomatic arch and the first permanent maxillary molars were made. A leveling off process for both measurements was noticed at about 2 years of age in cleft palate victims and normal children. No difference in bizygomatic measurements was demonstrated between individual types of clefts or between cleft palate and normal subjects. The abnormal width in cleft cases that was obvious in bihamular measurement was not revealed in the bizygomatic measures. The means of the bimaxillary measurements of the cleft subjects, irrespective of types, were always greater than those in the normal subjects. A uniformly high statistical correlation between bihamular and bimaxillary measurements was obtained. Normal subjects most frequently presented a vomer that was perpendicular to the cranial base, and with little variation. The vomer inclination of the cleft subjects, differing noticeably from the normal, tended to differentiate clefts into types. Unilateral clefts showed the greatest degree of deviation from the perpendicular. A slight degree of variation in inclination of the palatal plates was observed in the normal population. In contrast, the cleft samples demonstrated great variability and a more frequent occurrence of inverse relationship or inclination of the palatal plates toward the floor of the mouth.