NAM Therapy-Evidence-Based Results.

Many orthodontists working on patients with cleft lip and palate (CLP) have shown great enthusiasm for presurgical infant orthopedics (PSIO) to improve surgical outcomes with minimal intervention. Even though every clinician aims to use the best treatment modality for their patients, PSIO effects can be confounded by surgical type and timing of the primary repair, as is discussed in many studies. In such cases, one should be cautious when evaluating the particular outcomes for patients with CLP since it is difficult to differentiate the sole effect of an individual surgical or orthodontic intervention. As with any treatment methodology, nasoalveolar molding (NAM) has both benefits and limitations. Commonly cited concerns with NAM, and PSIO in general, include increased cost, increased burden of care, and a negative impact on maxillary growth. However, NAM cannot be deemed as having apparent long-term negative or positive effects on skeletal or soft tissue facial growth, based on previous studies. A review of the literature suggests that NAM does not alter skeletal facial growth when compared with the samples that did not receive PSIO. Nevertheless, the published studies on NAM show evidence of benefits to the patient, caregivers, the surgeon, and society. These benefits include documented reduction in severity of the cleft deformity prior to surgery and as a consequence improved surgical outcomes, reduced burden of care on the care givers, reduction in the need for revision surgery, and consequent reduced overall cost of care to the patient and society.

Relation between orthodontic malocculusion and maxillary sinus volume.

BACKGROUND: This study aimed to determine maxillary sinus volume (MSV) in different skeletal malocclusion classes and the correlation between MSV and craniofacial morphology on Cone Beam Computed Tomography (CBCT). MATERIALS AND METHODS: The study was performed retrospectively on CBCT images of individuals aged 12-24 years. A total of 129 patients (70 females, 59 males) with a normal vertical growth pattern (27° ≤ SNGoMe ≤ 38°) were divided into three groups according to malocclusion. Group 1 consisted of Class I (1 ≤ ANB ≤ 4) (n = 46) patients, Group 2 consisted of Class II (ANB > 4) (n = 47) patients, and Group 3 consisted of Class III (ANB < 1) (n = 36) patients. Four angular (SNA, SNB, ANB, SNGoMe) and linear (S-N, ANS-PNS, S-Ar, N-ANS) parameters were measured to evaluate craniofacial morphology. Right and left MSV were measured using Dolphin 11.0 (Dolphin Imaging, Chatsworth, CA, USA) Imaging software. Pearson's correlation analysis was performed to assess statistical correlation. RESULTS: MSV was larger in males than females (male AMSV = 14244.1 ± 4735.8, female AMSV = 12778.2 ± 4606.9 p = 0.011) in the general population, but just the Class II group showed this (male AMSV = 16089.6 ± 4330.4, female AMSV= 12705.9 ± 3210.2, p = 0.008). RMSV and LMSV were similar (female p = 0.181 male p = 0.097), and MSV showed no significant differences between the different malocclusion classes in both sex (female p = 0.315, male p = 0.118). In the Class III group, SNB was positively correlated with RMSV (r = 416, p = 0.012). MSV showed significant positive correlation with N-ANS in all groups (Class I r = 0.359, p = 0.014, Class II r = 0.336, p = 0.021, Cl III r = 0.387, p = 0.02). In the Class II and Cl III groups, there is a statistically significant correlation between MSV and the S-N parameter (Class II r = 0.304, p = 0.038, Class III r = 0.412, p = 0.013). ANS-PNS parameter was measured at the lowest statistically significant level (female 43.1 ± 3.9a, p < 0.001, male 43.1 ± 4.3a, p < 0.001) in the Class III group but no correlation was found with MSV. Only Class II group showed a weak positive correlation between MSV and ANS-PNS (r = 0.314, p = 0.032). CONCLUSIONS: There was no difference regarding MSV between malocclusion classes. Class II males exhibit significantly larger MSV compared to females. There is a correlation between MSV and SNB, S-N, N-ANS and ANS-PNS parameters for various orthodontic skeletal patterns. Further studies are needed to understand the relationship between MSV and different skeletal structures.