Original Article

Airway changes in patients with unilateral cleft lip/palate (UCL/P) after

maxillary advancement
Stefan Idsoa; Jared Hollowayb; Pravin Patelc; Linping Zhaod; David Forbese; Dawei Liuf

ABSTRACT

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Objectives: To assess the effect on the retropalatal airway (RPA), retroglossal airway (RGA), and
total airway (TA) volumes and cephalometrics (SNA, SNB, ANB, PP-SN, Occl-SN, N-A, A-TVL, B-
TVL) after maxillary advancement orthognathic surgery in patients with unilateral cleft lip/palate
(UCL/P) using cone-beam computed tomography (CBCT).
Materials and Methods: The CBCT scans of 30 patients (13 males and 17 females, 17–20 years
old) with UCL/P were evaluated at two time points: preoperative (T1) and postoperative (T2). The
interval between T1 and T2 ranged from 9–14 weeks, except for two patients in whom the interval
was 24 weeks. Intraexaminer reliability was measured with an intraclass correlation coefficient test.
A paired t-test was used to compare the airway and cephalometric measurements between T1 and
T2, with a P value of .05 being considered significant.
Results: From T1 to T2, significant increases were found in the volumes of RPA (from 9574 6
4573 to 10,472 6 4767, P ¼ .019), RGA (from 9736 6 5314 to 11,358 6 6588, P ¼ .019), and TA
(from 19,121 6 8480 to 21,750 6 10,078, P ¼ .002). In addition, the RGA (from 385 6 134 to 427
6 165, P ¼ .020) and TA (from 730 6 213 to 772 6 238, P ¼ .016) sagittal area increased
significantly. For minimal cross-sectional area (MCA), only the RPA increased significantly (from
173 6 115 to 272 6 129, P ¼ .002). All cephalometric changes were statistically significant
between T1 and T2 except for SNB.
Conclusions: Maxillary advancement in patients with UCL/P produces statistically significant
increases in the retropalatal (volumetric and MCA), retroglossal (volumetric and sagittal), and total
(volumetric and sagittal) airways based on data from CBCT imaging. (Angle Orthod. 2023;93:727–
735.)
KEY WORDS: Airway; CBCT; Cleft lip/palate; Maxillary advancement; Cephalometrics

INTRODUCTION
a
Graduate Student, Department of Developmental Sciences/
Orthodontics, School of Dentistry, Marquette University, Milwau- Cleft lip and palate (CL/P) is the most common
kee, WI, USA. craniofacial congenital malformation, with an occur-
b
Private Practice, New Richmond, WI, USA. rence of approximately 1 in 1000 infants in the United
c
Professor, Cleft and Craniofacial Center, Shriners Hospitals States.1 A fusion defect limited to the nasal processes
for Children, Reconstructive and Cosmetic Surgery, Craniofacial
Center, University of Illinois, Chicago, IL, USA. is considered a cleft lip (CL), while a cleft palate (CP) is
d
Engineer, Cleft and Craniofacial Center, Shriners Hospitals defined as a fusion defect of the palatal shelves. These
for Children, Reconstructive and Cosmetic Surgery, Craniofacial conditions occur together in approximately 45% of
Center, University of Illinois, Chicago, IL, USA. cases, CP only in 30%, and CL only in 25%.2 The
e
Private Practice, West Dundee, IL, USA.
f
Associate Professor and Program Director, Department of
congenital condition has a multifactorial etiology and
Developmental Sciences/Orthodontics, School of Dentistry, disrupts the function of the stomatognathic system and
Marquette University, Milwaukee, WI, USA. dentofacial esthetics. The characteristic presentations
Corresponding author: Dr Dawei Liu, Department of Develop- of CL/P include a retrognathic and posteriorly inclined
mental Sciences/Orthodontics, Marquette University School of maxilla, greater flattening of the cranial base, a larger
Dentistry, 1801 West Wisconsin Ave, Milwaukee, WI 53233, USA
(e-mail: [email protected]) mandibular plane and gonial angle, larger anterior
facial height, and decreased posterior facial height.3
Accepted: April 2023. Submitted: November 2022.
Published Online: June 15, 2023 The structural abnormalities of the dentofacial
Ó 2023 by The EH Angle Education and Research Foundation, complex in combination with the dysfunction of
Inc. muscles controlling the soft palate place patients with

DOI: 10.2319/110722-764.1 727 Angle Orthodontist, Vol 93, No 6, 2023

728 IDSO, HOLLOWAY, PATEL, ZHAO, FORBES, LIU

CL/P at high risk for sleep-disordered breathing.4 patients with additional orthognathic surgeries (ie,
Patients from this population have been shown to bilateral sagittal split osteotomy and genioplasty).
have more complaints of respiratory difficulties and Presurgical and postsurgical orthodontic treatment
snoring during sleep compared with control popula- was provided by various providers, although a team
tions.5,6 Other studies reported that patients who of experienced surgeons at Shriners Hospitals for
experience CL/P had an increased frequency of Children, Chicago, was responsible for all maxillary
hypopnea and mouth breathing during sleep.7,8 Respi- advancement operations.
ratory difficulties increase the risk for hypertension, A power analysis for a one-tailed paired-samples t-
excessive sleepiness during the daytime, and cardio- test indicated that the minimum sample size to yield a
vascular and cerebrovascular diseases.9 For these statistical power of at least .8 with an alpha of .05 and a

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reasons, the study of the pharyngeal airway space medium effect size (d ¼ 0.5) was 30 (G*power,
(PAS) in patients affected by CL/P has the potential to Düsseldorf, Germany).
improve patient treatment outcomes.
Patients with CL/P often require correction of various Data Collection
forms of malocclusion, especially a Class III skeletal
malocclusion due to maxillary deficiency. Treatment The CBCT scans of 30 patients (13 males and 17
involves a combination of orthodontics and orthog- females, 17–20 years old) were evaluated at two time
nathic surgery to achieve optimal results. After points: preoperative (T1) and postoperative (T2). The
presurgical orthodontics is complete, a Le Fort I interval between T1 and T2 ranged from 9–14 weeks,
osteotomy with advancement of the maxilla is com- except for two patients in whom the interval was 24
monly indicated. Orthognathic surgery not only im- weeks. All CBCT scan images were previously
proves occlusion and facial balance but can also obtained for surgical planning and treatment outcome
provide the further benefit of enlarging the patient’s purposes using an i-CAT Next Generation scanner
airway. However, the literature is limited regarding the (Imaging Science International Inc., Hatfield, Penn). All
effects on the airway after single jaw surgery in this scans were taken using the following clinical protocol;
patient population. Yatabe-Ioshida et al.10 reported an field of view at least 16 3 13 cm, exposure time of 26.9
upper airway increase in patients with CL/P after seconds, 120-kV tube voltage, 5-mA tube current, and
orthognathic surgery using cone-beam computed a 0.3-mm3 voxel size.
tomography (CBCT) scan data. However, only nine The CBCT image files were exported in Digital
subjects were included in the CL/P group, and two Imaging and Communication in Medicine format into
different surgical procedures were involved: maxillary Dolphin Imaging software version 11.95 Premium
advancement and mandibular setback together and (Dolphin Imaging & Management Solutions, Chatsworth,
maxillary advancement only. To further study the Calif). Each three-dimensional (3D) image was spatially
effects of maxillary advancement surgery on the airway oriented in Dolphin through a standardized protocol. The
in UCL/P patients, the effects of maxillary advance- axial plane was positioned coincidently with the Frankfort
ment surgery on the retropalatal airway (RPA), retro- horizontal plane (FP), and then the midsagittal plane was
glossal airway (RGA), total airway (TA) volumes, and aligned perpendicular to the FP while passing through
cephalometrics (SNA, SNB, ANB, PP-SN, Occl-SN, N- nasion. In patients with an asymmetry, the orientation
A, A-TVL, B-TVL) were assessed in patients with UCL/ was set so that these planes were as close to the original
P using data from CBCT scans. The null hypothesis plane orientation as possible.11 Once the image was
was that there would be no statistically significant properly oriented, a lateral cephalometric image at the
change for each of the parameters of airway and midsagittal plane was created using the ‘‘Build X-Rays’’
cephalometrics in this study. tool in Dolphin. The lateral cephalogram for each time
point was traced using the ‘‘Digitize’’ tool and the
MATERIALS AND METHODS following angles: SNA, SNB, ANB, palatal plane–SN
(PP-SN), occlusal plane–SN (Occl-SN). Distances nasi-
Study Design on–A point (N-A), A-true vertical line (A-TVL), and B-true
This retrospective study protected the rights of vertical line (B-TVL), were recorded (Figures 1 and 2).
human subjects and was approved by the Marquette For A-TVL and B-TVL distances, when the A or B point
University Institutional Review Board for research was distal/posterior to TVL, the distance value was
under the jurisdiction of the university (HR-3485). The defined as negative, while it was positive when the point
inclusion criteria were patients with unilateral cleft lip was mesial/anterior to TVL.
and palate (UCL/P), skeletal Class III malocclusion, To evaluate the volume (mm3) of the RPA, RGA, and
treated with a Le Fort I maxillary advancement only, TA (Figures 3 and 4), the Dolphin sinus/airway tool was
and perioperative CBCT scans. Exclusion criteria were used to outline the areas of interest and calculate the

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AIRWAY CHANGES AFTER MAXILLARY ADVANCEMENT 729

for the RPA, RGA, and TA—in other words, the area of
greatest PAS constriction.

Statistical Analysis
The measurements of the RPA, RGA, TA volumes,
and cephalometrics (SNA, SNB, ANB, PP-SN, Occl-
SN, N-A, A-TVL, B-TVL) were analyzed using a paired
t-test to compare between T1 and T2. SPSS statistical
software (SPSS Statistics 28.0.0.0, IBM, Armonk, NY)
was used for all statistical analyses. Data were

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expressed as means 6 standard deviations, with a P
value of .05 considered significant. In addition, one
patient was randomly selected to be reevaluated by the
same investigator. Each measurement was performed
Figure 1. Construction of the true vertical line (TVL) from nasion
three times at 1-week intervals to evaluate intra-
perpendicular to the Frankfort plane. examiner reliability using the intraclass correlation
coefficient test (Table 1).
airway space and respective minimum cross-sectional
areas (MCAs). First, the boundaries were traced using RESULTS
a protocol outlined by Chang et al.12 The superior Cephalometric Measurements
border of the PAS, in this study, was the variable TA
and was defined as the line connecting the posterior Significant changes were observed in all measured
cephalometric measurements except for SNB (Table
nasal spine to basion. The inferior border of the PAS
2). Increased values were found in the PP-SN, SNA,
was defined as a horizontal line passing through the
ANB, Occl-SN, N-A, and B-TVL measurements. A
most superior point of the epiglottis. The PAS was
point in reference to TVL moved significantly anteriorly
divided into the superior portion (the RPA) and the (from 3.9 6 5.0 to 1.5 6 5.3, P ¼ .000), indicating the
inferior portion (the RGA). The line differentiating these A point moved anteriorly about 5.4 mm on average
segments was defined as a horizontal line through the after maxillary advancement. The cephalometric mea-
most posteroinferior point of the soft palate. surements showing the largest and most significant
Within the defined boundaries, a seed point was changes were SNA (from 74.6 6 5.5 to 80.3 6 5.4, P ¼
placed with a standardized threshold value of 55 .000), ANB (from 0.6 6 15.3 to 2.6 6 2.3, P ¼ .000),
Hounsfield units. The MCA was the smallest cross- and A-TVL (from 3.9 6 5.0 to 1.5 6 5.3, P ¼ .000;
sectional area of each segment, in square millimeters, Figure 5).

Figure 2. Using the ‘‘Build X-Rays’’ tool in Dolphin imaging software, lateral cephalograms were generated for each patient at T1 and T2 to
measure SNA, SNB, ANB, PP-SN, and Occl-SN angles and N-A vertical and point A and B to TVL distances.

Angle Orthodontist, Vol 93, No 6, 2023

730 IDSO, HOLLOWAY, PATEL, ZHAO, FORBES, LIU

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Figure 3. Construction of the retropalatal airway in the sagittal view (from basion to PNS and the inferior point of the soft palate).

PAS Volume sagittal dimensions. Cakirer et al.13 analyzed the

sagittal airway changes after maxillary advancement
The volumetric changes increased significantly in
in patients with UCL/P. The study found significant
each studied area: RPA (from 9574 6 4573 to 10,472
increases in the nasopharyngeal airway and no
6 4767, P ¼ .019), RGA (from 9736 6 5314 to 11,358
changes in the oropharyngeal airway. In another study
6 6588, P ¼ .019), and TA (from 19,121 6 8480 to
involving patients with UCL/P, Baez et al.14 also
21,750 6 10,078, P ¼ .002) (Figure 6). For the
observed increases in the upper airway after maxillary
corresponding MCAs, only the RPAm increased
advancement. However, in those studies, radiographic
significantly (from 173 6 115 to 272 6 129, P ¼
assessment was performed using lateral cephalo-
.002), and the RGAm and TAm had no or inconse-
grams. Lateral cephalograms are limited in the fact
quential changes. In the sagittal plane, the area in mm2
that they produce a static, two-dimensional (2D) image
of the RGAs (from 385 6 134 to 427 6 165, P ¼ .020)
that cannot satisfactorily portray the 3D volumetric
and TAs (from 730 6 213 to 772 6 238, P ¼ .016)
airway space.15 Major et al.16 found a weak correlation
showed significant changes, and the RPAs had no
between linear 2D measurements and identifying
increase (Table 3).
airway restrictions. The study suggested that 2D
cephalograms should be used only as a screening
DISCUSSION
tool for airway obstruction. The Baez et al.14 study also
Several studies already observed that a Le Fort I recommended future research in patients with UCL/P
osteotomy with maxillary advancement created an to analyze airway changes using the airway volume
increase in the nasopharyngeal and upper airway capabilities of cone-beam technology.

Figure 4. Construction of the retroglossal airway in the sagittal view (from a horizontal line through the inferior point of the soft palate to a
horizontal line through the superior point of epiglottis).

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AIRWAY CHANGES AFTER MAXILLARY ADVANCEMENT 731

Table 1. Intrarater Reliability Dataa

Retropalatal Airway Retroglossal Airway Total Volume
Volume, Sagittal, MCA, Volume, Sagittal, MCA, Volume, Sagittal, MCA,
Assessment Scan mm3 mm2 mm2 mm3 mm2 mm2 mm3 mm2 mm2
1 T1 15,038 568 201 3930 177 93 18,074 729 95
T2 15,599 451 349 6881 268 81 22,439 732 81
2 T1 14,530 525 201 3686 162 109 17,564 711 109
T2 15,746 454 354 6887 267 95 23,185 759 95
3 T1 14,213 514 201 4141 182 114 17,932 723 114
T2 16,073 449 342 6908 257 111 22,209 696 104
a
MCA indicates minimal cross-sectional area; T1, presurgical cone-beam computed tomography scan; T2, postsurgical cone-beam computed

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tomography scan.

It is important to note that the CBCT scans used for in a way, reflects the complex nature of airway
this research were performed as part of the standard of changes in response to maxillary advancement.
care for patients undergoing orthognathic surgery. The minimum cross-sectional airway had a signifi-
Since its introduction into dentistry in 1997, CBCT cant change in the RPA. The MCA of the RGA and TA
has become an increasingly important source of 3D was essentially unaffected by maxillary advancement.
volumetric information for orthodontic diagnosis, surgi- This suggested that the MCA of the PAS in most
cal treatment planning, and research.17 However, it is patients was located in the area defined as the RGA. A
important to ensure that the additional information similar study also found an increase in the lower airway
garnered from CBCT is able to meaningfully aid in MCA after orthognathic surgery (Yamashita et al.11),
diagnosis, treatment planning, or for assessing pro- although that group used data from combination
gress during treatment.18 Kapila and Nervina19 con- surgeries (maxillary advancement and mandibular
firmed that CBCT was indicated for CL/P and setback, maxillomandibular advancement).
orthognathic surgery patients, as the CBCT data are Predictably, significant changes were found in all
likely to improve patient outcomes. Another benefit of measured cephalometric measurements except for
CBCT is that lateral cephalograms and panoramic SNB. SNB represents the relative anteroposterior
radiographs can be generated from the scan and used position of the mandible to the cranial base. The lack
for traditional purposes, including cephalometric trac- of significant change in SNB was expected since the
ing. Cephalometric analysis allows for a quantitative surgical operation was performed only on the maxilla.
Therefore, the only appreciable change was observed
assessment of the extent of the dentofacial deformity
in data focused on the upper jaw.
and provides valuable surgical planning information.20
An interesting finding was that the B-TVL (distance
Using the 3D power of CBCT, the current study
in millimeters from the B point perpendicular to the true
found significant changes in airway volume, sagittal
vertical line) was increased after maxillary advance-
area, and MCA after maxillary advancement. For the
ment. This may have been because the maxilla was
volume measurements, the RPA (P ¼ .019), RGA (P ¼
moved downward during advancement, which was
.019), and TA (P ¼ .002) increased significantly. These also reflected in the palatal plane to SN angle and the
findings were in agreement with another CBCT study occlusal plane to angle increases, leading to a
conducted by Yatabe-Ioshida et al.,10 which reported clockwise rotation of the mandible.
an upper airway increase in patients with CL/P after In analyzing pre- and postoperative CBCT images,
orthognathic surgery. However, only nine subjects we investigated the effects of single jaw surgery
were included in the CL/P group, and two different maxillary advancement on airway and cephalometric
surgical procedures were involved: maxillary advance- measurements in patients with UCL/P. The results
ment and mandibular setback together, and maxillary were largely expected. Significant increases in the
advancement only. RPA, RGA, and TA volume were observed, along with
The sagittal airway area showed significant increas- significant changes in most cephalometric measure-
es in the RGAs and TAs and no increase in the RPAs. ments. This research showed that performing a Le Fort
The sagittal airway changes (RPAs, RGAs, TAs) were I maxillary advancement in patients with UCL/P can
the smallest compared with the other dimensional improve PAS. However, because of the nature of the
changes measured. It seems that maxillary advance- unilateral cleft, further studies are needed to answer
ment moves the maxilla forward skeletally, but the whether the airway responses to maxillary advance-
effect on the airway is in the volume increase rather ment are symmetrical or asymmetrical, as well as for
than the sagittal dimension of the airway. This finding, long-term follow-up.

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732 IDSO, HOLLOWAY, PATEL, ZHAO, FORBES, LIU

Table 2. Cephalometric Mesurementsa

Cephalometric Data
Patient Scan PP-SN SNA SNB ANB Occl-SN N-A, mm A-TVL, mm B-TVL, mm
1 T1 18.5 76.5 74.6 1.9 18.6 61.6 1.3 1.0
T2 17.8 75.7 74.4 1.3 17.6 58.1 2.1 1.5
2 T1 14.5 77.6 81.7 4.1 17.9 55.4 2.3 4.5
T2 11.4 85.1 86.3 1.2 12.3 61.6 0.4 0.7
3 T1 5.4 81.9 85.6 3.7 20.8 52.7 3.9 13.5
T2 8.6 87.0 83.0 4.1 22.8 53.8 11.6 14.0
4 T1 5.6 82.0 86.2 4.1 9.1 51.1 3.0 10.5
T2 8.0 89.5 85.3 4.2 10.8 65.4 8.4 6.7
5 T1 9.8 78.3 78.0 0.3 12.9 51.8 0.6 1.7

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T2 17.4 81.9 77.8 4.2 17.9 53.8 2.1 2.9
6 T1 14.6 76.7 77.6 0.9 17.4 61.7 1.5 0.5
T2 19.1 82.2 78.2 3.9 18.5 64.4 4.1 0.5
7 T1 1.1 71.3 81.9 10.6 8.7 62.4 11.8 1.0
T2 4.2 80.0 80.5 0.5 8.9 47.8 5.2 6.1
8 T1 8.1 69.1 73.5 4.5 6.4 57.1 11.5 10.7
T2 16.5 73.5 72.5 1.0 15.1 63.2 6.0 9.7
9 T1 5.9 86.4 83.3 3.1 11.8 60.2 4.1 0.9
T2 2.6 89.3 83.7 5.6 18.6 63.0 4.9 0.4
10 T1 8.6 77.2 77.8 0.6 12.0 65.5 0.9 2.1
T2 11.3 76.7 73.5 3.2 16.4 66.8 1.9 1.9
11 T1 13.6 72.1 70.7 1.4 23.6 67.6 8.3 16.6
T2 15.1 80.0 75.3 4.7 23.9 68.9 3.0 13.5
12 T1 12.5 83.9 87.1 3.2 6.4 51.9 5.5 13.8
T2 10.7 89.7 88.0 1.6 2.3 49.2 10.6 16.3
13 T1 5.0 73.5 74.0 0.4 17.3 58.6 6.9 11.7
T2 4.4 79.1 74.0 5.1 21.6 61.8 2.4 13.3
14 T1 14.5 69.2 75.2 6.0 23.3 56.7 4.3 2.9
T2 20.3 80.8 78.2 2.6 21.6 59.6 7.6 3.9
15 T1 7.5 75.3 78.4 3.1 15.3 56.0 3.1 0.3
T2 9.2 79.1 78.5 0.6 20.2 50.5 2.0 1.5
16 T1 6.0 71.4 81.0 9.6 1.2 56.5 9.2 0.4
T2 12.0 75.0 79.0 4.0 6.8 54.1 2.7 0.9
17 T1 23.6 73.3 77.2 3.9 22.0 61.2 4.5 0.7
T2 21.5 80.5 75.2 5.3 26.4 67.0 5.9 3.0
18 T1 9.9 77.0 77.6 0.6 17.2 49.8 1.6 0.6
T2 16.2 80.2 78.2 2.0 23.1 53.7 4.5 0.7
19 T1 15.0 67.9 74.8 6.9 29.5 52.5 0.1 9.4
T2 10.6 74.8 72.8 2.0 31.2 53.2 10.6 13.3
20 T1 7.0 67.8 70.9 3.1 15.3 55.1 10.3 12.5
T2 14.3 72.2 70.7 1.4 22.7 57.4 7.0 12.6
21 T1 18.5 71.1 75.3 4.3 23.1 54.6 10.9 13.8
T2 14.7 71.9 69.5 2.3 29.0 56.5 5.0 12.7
22 T1 4.8 77.4 84.6 7.2 9.2 50.0 6.9 1.7
T2 10.0 81.5 81.6 0.2 14.0 56.6 4.3 5.7
23 T1 3.9 78.4 81.7 3.3 13.1 52.8 2.9 0.2
T2 10.8 81.0 78.7 2.4 17.8 55.3 1.5 2.3
24 T1 20.6 67.3 71.3 3.9 29.2 60.1 12.0 12.3
T2 17.4 74.2 71.5 2.7 29.9 65.7 4.5 11.3
25 T1 8.5 81.8 80.7 1.1 18.2 59.2 0.7 3.5
T2 11.9 86.9 80.0 7.0 16.7 64.5 5.0 4.8
26 T1 12.4 77.3 78.5 1.2 16.3 54.7 2.4 0.9
T2 14.9 84.7 79.2 5.5 19.5 57.3 3.9 0.2
27 T1 3.7 73.6 77.2 3.6 20.0 52.6 4.1 2.1
T2 14.0 81.0 76.0 4.9 17.8 56.8 1.2 6.4
28 T1 14.1 68.0 68.0 77.0 9.0 54.5 8.1 0.8
T2 15.4 78.8 77.2 1.6 23.7 62.2 0.9 1.5
29 T1 21.1 64.7 67.0 2.3 28.3 71.8 7.3 5.8
T2 19.2 69.5 67.1 2.4 26.3 66.5 4.6 13.7
30 T1 8.4 72.0 81.4 9.4 11.2 62.9 5.2 7.6
T2 7.8 86.0 82.5 3.5 17.6 69.4 6.1 2.8
Mean T1 10.7 74.6 77.9 0.6 15.4 57.1 3.9 1.8
SD 6.0 5.5 5.3 1.5 8.5 5.4 5.0 7.5
Mean T2 12.5 80.3 77.6 2.6 19.0 59.5 1.5 3.2
SD 6.0 5.4 5.0 2.3 6.6 6.0 5.4 7.6
a
T1 indicates presurgical cone-beam computed tomography scan; T2, postsurgical cone-beam computed tomography scan.

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Figure 5. Cephalometric changes in patients with unilateral cleft lip/palate after maxillary advancement. Note: PP-SN, SNA, SNB, ANB, and Occl-
SN are angles (degree) and N-A, A-TVL, and B-TVL are distances (mm). * P , .05; ** P , .01; *** P , .001.

CONCLUSIONS  Based on the data, the null hypotheses were

rejected. Maxillary advancement produces statisti-
 Maxillary advancement single jaw surgery success- cally significant increases in the retropalatal (volu-
fully corrects the midface deficiency in UCL/P metric and MCA), retroglossal (volumetric and
patients. sagittal), and total (volumetric and sagittal) airways.

Figure 6. Airway changes in patients with unilateral cleft lip/palate after maxillary advancement. m indicates minimal cross-sectional area; RGA,
retroglossal airway; RPA, retropalatal airway; s, sagittal; TA, total airway; v, volume. * P , .05; ** P , .01; *** P , .001.

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734 IDSO, HOLLOWAY, PATEL, ZHAO, FORBES, LIU

Table 3. Airway Mesurementsa

Retropalatal Airway Retroglossal Airway Total Volume
Patient Scan Volume, mm 3
Sagittal, mm 2
MCA, mm 2
Volume, mm 3
Sagittal, mm 2
MCA, mm 2
Volume, mm 3
Sagittal, mm2 MCA (mm2)
1 T1 19,525 543 333 31,404 738 1,021 50,252 1267 351
T2 19,688 454 411 31,919 749 349 51,877 1243 411
2 T1 13,482 498 231 13,035 521 174 26,109 988 189
T2 16,073 649 271 8820 407 110 24,695 1046 239
3 T1 11,909 470 130 6894 331 87 18,904 773 300
T2 11,904 440 290 7169 353 57 19,086 776 140
4 T1 19,950 564 109 12,209 372 309 32,235 953 309
T2 20,218 501 461 23,663 617 132 43,149 1115 235
5 T1 5658 247 135 5483 370 54 11,100 618 54

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T2 5232 205 145 4812 311 59 9958 518 46
6 T1 18,921 650 127 10,622 346 68 29,255 977 225
T2 22,672 645 364 16,817 414 117 38,840 1041 129
7 T1 5930 191 71 8390 368 137 13,772 539 137
T2 9680 286 489 12,188 458 201 21,223 723 201
8 T1 15,038 568 201 3930 177 93 18,074 729 95
T2 15,599 451 349 6881 268 81 22,439 732 81
9 T1 8194 332 104 10,222 441 240 18,598 771 229
T2 9260 333 308 12,254 460 298 22,309 817 298
10 T1 13,338 476 409 12,242 538 279 22,459 917 279
T2 12,829 449 214 20,532 808 258 34,341 1219 258
11 T1 6899 311 259 15,208 579 292 22,921 903 259
T2 5977 325 245 15,599 625 283 22,784 966 253
12 T1 3691 79 34 7139 319 230 10,959 457 110
T2 8979 192 140 3425 181 205 12,103 383 140
13 T1 9821 359 76 11,719 537 62 20,922 875 62
T2 10,331 279 344 17,785 630 352 27,966 912 352
14 T1 6335 246 166 4932 237 105 10,991 479 105
T2 8509 331 334 4407 217 110 13,206 559 110
15 T1 9395 327 384 7462 343 89 17,870 721 89
T2 8035 231 165 11,937 434 103 20,450 685 103
16 T1 10,987 429 196 10,918 559 207 22,949 1,033 207
T2 10,885 379 519 12,174 555 229 23,350 955 229
17 T1 5135 262 190 8824 443 210 13,629 684 190
T2 3297 275 102 4884 438 71 7762 624 84
18 T1 4185 127 29 4519 212 161 9590 397 144
T2 6948 239 162 4337 184 71 11,292 407 71
19 T1 8063 235 236 10,348 272 39 18,354 507 39
T2 5539 172 233 8678 279 558 14,415 462 69
20 T1 2507 122 43 6607 344 146 8268 421 30
T2 4088 164 112 9183 344 217 12,875 545 126
21 T1 6535 218 20 3711 151 53 10,318 346 24
T2 6785 202 32 3676 153 36 11,776 398 36
22 T1 6298 224 78 9494 391 140 16,105 627 140
T2 8165 287 255 10,178 378 94 18,267 661 94
23 T1 9838 287 63 7463 331 29 17,759 653 97
T2 10,765 389 174 7474 328 95 18,853 745 95
24 T1 9817 311 333 16,767 522 317 26,636 844 317
T2 10,947 336 195 18,906 555 140 29,724 882 140
25 T1 9271 440 114 2636 216 91 11,040 624 91
T2 12,098 495 388 7703 360 147 18,802 702 147
26 T1 11,504 390 150 7702 312 426 19,248 706 411
T2 11,715 421 356 8260 335 328 19,730 745 328
27 T1 9997 348 350 12,297 461 318 22,216 795 318
T2 10,975 321 496 17,959 576 476 29,199 908 476
28 T1 11,728 406 318 11,279 472 347 22,597 858 319
T2 12,330 466 317 9158 429 245 20,323 836 245
29 T1 9424 347 267 9036 276 245 18,349 617 241
T2 6314 251 149 9870 382 249 14,721 557 147
30 T1 3834 305 41 9,596 396 167 12,155 808 42
T2 8320 428 147 10,092 594 86 16,989 994 86
Mean T1 9574 344 173 9736 386 205 19,121 730 180
SD 4573 141 115 5314 134 187 8480 213 111
Mean T2 10,472 353 272 11,358 427 192 21,750 772 179
SD 4676 128 129 6588 165 129 10,078 238 111
a
MCA indicates minimal cross-sectional area; T1, presurgical cone-beam computed tomography scan; T2, postsurgical cone-beam computed
tomography scan.

Angle Orthodontist, Vol 93, No 6, 2023

AIRWAY CHANGES AFTER MAXILLARY ADVANCEMENT 735

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Angle Orthodontist, Vol 93, No 6, 2023