Does Differential Maxillary Expansion Prior to Alveolar Cleft Bone Grafting Affect Nasal Width?

Abstract

Objective Determine the effects of differential maxillary expansion on nasal width in patients with unilateral cleft lip and alveolus with or without cleft of the secondary palate (UCLA ± P). Design Retrospective radiographic study. Setting Institutional. Participants Forty patients with UCLA ± P who had alveolar bone grafting (ABG) between 2015 and 2020 and available preexpansion and postexpansion cone beam computed tomography (CBCT) scans. Twenty patients with UCLA ± P who underwent ABG without expansion were included as controls. Main Outcome Measure Percent change in width at the nasal pyriform, inferior turbinates, and alar base on cleft and noncleft sides. Results The study included 40 patients (24 males, mean age 9.6 years) and 20 controls (10 males, mean age 10.1 years). After maxillary expansion, there was an increase in width on the cleft and noncleft sides compared to nonexpanded controls at nasal pyriform (10.9% cleft side, P ≤ 0.001 and 4.3% noncleft side, P ≤ .001), inferior turbinate (8.7%, P ≤ .001 and 4.5%, P = .01), and alar base (6.7%, P = <.001 and 0.8% P = .54). The increase in width was greater on the cleft side than the noncleft side at the nasal pyriform (7.1%, P ≤ .001), inferior turbinate (4.3%, P ≤ .001), and alar base (7.0%, P ≤ 0.001) in the expansion group. There was good to excellent intra-rater and inter-rater agreement for measurements. Conclusion Patients with UCLA ± P who undergo differential maxillary expansion before ABG exhibit greater nasal widening on the cleft side.

Rhinoplasty in Patients with Cleft Lip Nasal Deformity: Correcting the Alar Base

“…At least one study showed widening of the nasal width with maxillary expansion compared with patients who underwent ABG without expansion. 7 This expansion may work in the patient benefit with a narrow cleft side but, more often, may worsen the asymmetry with those with an already wide alar base.…”