Radiological assessment of the nasal cavity and nasopharynx in children with congenital cleft lip and palate

Objective: to assess the anatomical features of the nasal cavity and nasopharynx in children with congenital clefts using radiography and computed tomography.

 Material and methods: sixty children aged 3 to 14 years with congenital cleft lip and palate were examined. The patients were divided into two groups: children with a complete cleft and children with an incomplete cleft. Methods included clinical, imaging evaluation (plain radiography of the paranasal sinuses, CT of the nose and nasopharynx), and statistical analysis.

Results: analysis of radiographic and tomographic data revealed pronounced anatomical changes in children with a complete cleft: reduced nasal cavity volume, narrowing of the nasal passages, choanal deformity, and mucosal thickening. In the group with an incomplete cleft, the changes were less pronounced, although local deformities and partial adenoid hypertrophy were observed. The frequency of inflammatory processes, including rhinosinusitis, adenoiditis, and otitis, was significantly higher in children with a complete cleft compared to those with an incomplete cleft. This indicator was 65% versus 40%, indicating a direct relationship between the severity of anatomical defects and the frequency of inflammatory changes. The results confirm that anatomical alterations in the nasal cavity and nasopharynx in children with congenital clefts are a risk factor for chronic inflammatory processes.

Conclusion: based on the findings, the following practical recommendations were developed: ENT examination with radiography and CT when necessary; early diagnosis and treatment of inflammatory processes; prevention of middle ear complications; preoperative preparation with mandatory management of ENT infectious foci; and the use of radiography and CT in dynamics to predict complications and adjust follow-up. 

1. Agranovich V.I. Adenotomy in the prevention of exudative otitis media in children. XVII Congress of Otorhinolaryngologists of the Russian Federation. Nizhny Novgorod; 2006:415. (In Russ.)

2. Amanullaev R.A. Improvement of medical rehabilitation of children with congenital cleft lip and palate in the Republic of Uzbekistan. Abstract of dissertation for Doctor of Medical Sciences. Tashkent; 2005:38. (In Russ.)

3. Makhkamova N.E., Mirazizov K.D. Condition of the larynx in children with congenital cleft lip and palate. Vestnik Otorinolaringologii. 2007;(5):23–25. (In Russ.)

4. Sarafanova M.E., Prityko A.G. Middle ear condition in children with congenital cleft lip and palate at different stages of childhood. Quantum Satis. 2017;(1):48–50. (In Russ.)

5. Starikova N.V., Nadtochiy A.G., Ageeva M.I. Prenatal diagnosis of cleft palate based on structural features and tongue function. Stomatologiya. 2013;(1):70–75. (In Russ.)

6. Ubaydullaev M.B. Treatment of patients with congenital and acquired anatomical and functional disorders of the nasomaxillary complex. Dissertation for Doctor of Medical Sciences. Tashkent; 2001:220. (In Russ.)

7. Karnitsky A.V., Mardanov A.E., Stepanova Yu.V., Alexandrova L.I. Modern approaches to diagnosis and treatment of congenital cleft lip and palate. Russian Dentistry. 2017;10(2):35–42. (In Russ.)

8. Inoyatov A.Sh. The prevalence and clinical features of congenital cleft lip and palate in Central Asia. Journal of Craniofacial Surgery. 2020;31(5):1321–1325.

9. Hong M., Li X., Wang Y. Epidemiology and genetics of cleft lip and palate: a review. Frontiers in Pediatrics. 2017;5:205–213.

10. Blinder Zh.A., Felton M. Surgical correction and postoperative management of cleft lip and palate in children. Plastic and Reconstructive Surgery. 2015;135(3):750–758.

11. Kuijpers M.A., Pazera A., Admiraal R.J., Bergé S.J., Vissink A., Pazera P. Maxillary sinus volume and pneumatization in children with cleft lip and palate. European Archives of Oto-Rhino-Laryngology. 2014;271(4):935–940.

12. Singla S., Utreja A., Singh S.P., Lou W., Suri S. Asymmetry of maxillary sinuses in unilateral cleft lip and palate: radiological study. Cleft Palate Journal. 2014;51(6):682–689.