title: Airway Obstruction and the Unilateral Cleft Lip and Palate Deformity: Contributions by the Bony Septum.
abstract: BACKGROUND
  Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT).
  
  
  METHODS
  A 2-year retrospective review of all subjects with unilateral CLP who underwent CBCT imaging (n = 22) and age-matched controls (n = 9) who underwent CT imaging was conducted. Control CT scans were used to determine the segment of nasal septum comprised almost entirely of bone. The CBCT of the nasal airway was assessed using Dolphin software to determine the contribution of the bony septum to septal deviation and airway obstruction.
  
  
  RESULTS
  The nasal septum posterior to the midpoint between anterior and posterior nasal spine is comprised of 96% bone. The nasal airway associated with this posterior bony segment was 43.1% (P < 0.001) larger by volume on the non-cleft side in patients with unilateral CLP. The average septal deviation within the posterior bony segment was 5.4 mm, accounting for 74.4% of the maximal deviation within the nasal airway. The average airway stenosis within the posterior bony nasal airway was 0.45 mm (0-2.2 mm).
  
  
  CONCLUSIONS
  In patients with unilateral CLP, the bony nasal septum can demonstrate significant deviation and airway stenosis. Surgeons should consider a bony septoplasty in their treatment algorithm in unilateral CLP patients who have reached skeletal maturity.
authors.affiliation: From the *Division of Plastic Surgery, Department of Surgery, Indiana University; †Department of Orthodontics and Orofacial Genetics, Indiana University School of Dentistry; ‡Department of Surgery, Indiana University, Indianapolis, IN; and §Department of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Friel
authors.forename: John M
authors.initials: JM
authors.lastname: Starbuck
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Ghoneima
authors.forename: Kariuki
authors.initials: K
authors.lastname: Murage
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Kula
authors.forename: Sunil
authors.initials: S
authors.lastname: Tholpady
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Havlik
authors.forename: Roberto L
authors.initials: RL
authors.lastname: Flores
mesh_terms: D000293:Adolescent; D000402:Airway Obstruction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D002648:Child; D002971:Cleft Lip / Q000150:complications* / Q000601:surgery; D002972:Cleft Palate / Q000150:complications* / Q000601:surgery; D054893:Cone-Beam Computed Tomography; D006801:Humans; D021621:Imaging, Three-Dimensional; D009300:Nasal Septum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D009667:Nose Deformities, Acquired / Q000150:complications* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D012225:Rhinoplasty; D014057:Tomography, X-Ray Computed