Art-1-Jamilian
ORTHODONTICS www.stomaeduj.com
Original Articles
MAXILLARY SINUS VOLUME IN CLEFT LIP
AND PALATE PATIENTS WITH AND WITHOUT
AN ORONASAL FISTULA USING CBCT
1a 2b 1c 1d 1e*
Bita Kiaee , Ladan Hafezi , Mahshid Karani , Faezeh Amiri , Abdolreza Jamilian
¹Department of Orthodontic, Dental School, Tehran University of Medical Sciences, Tehran, Iran
²Maxillofacial Radiology Department, Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
a
DDS, MS, Assistant Professor; e-mail: dr.bitakia@gmail.com; ORCIDiD: https://orcid.org/0000-0002-9117-3593
b
DDS, MS, Assistant Professor; e-mail: Lhafezzi@yahoo.com; ORCIDiD: https://orcid.org/0000-0002-1727-2665
c
DDS; e-mail: dr.mahkm96@gmail.com; ORCIDiD: https://orcid.org/0000-0002-8586-3846
d
DDS; e-mail: dr.faezehamiri1989@gmail.com; ORCIDiD: https://orcid.org/ 0000-0003-0184-3061
e
DDS, MS, Professor; e-mail: info@jamilian.net; ORCIDiD: https://orcid.org/0000-0002-8841-0447
ABSTRACT https://doi.org/10.25241/stomaeduj.2021.8(3).art.1
Introduction Formation of oronasal fistula is a common complication after surgical closure of cleft lip and
palate (CLP). This study aimed to compare the maxillary sinus volume in 9-12-year-old CLP patients with and
without an oronasal fistula who had undergone surgical closure of the cleft at 1 year of age, using cone-
beam computed tomography (CBCT).
Methodology This descriptive, cross-sectional, analytical study was conducted on CBCT scans of 50 patients
with unilateral CLP who were between 9-12 years and had undergone surgical closure of the cleft at 1
year of age in two groups with and without an oronasal fistula (n=50). The patients were selected among
those presenting to a private orthodontic office between 2001-2009 and already had CBCT scans taken for
orthodontic treatment. The 3D CBCT scans were reconstructed with Mimics software, and the volume of the
maxillary sinuses was measured on the images. Data were compared using t-test.
Results The maxillary sinus volume was significantly smaller in patients with oronasal fistula compared with
those without it (9510.7±492 mm3 vs. 10278.2±512 mm3, P<0.000). The maxillary sinus of the affected side
was smaller than that of the unaffected side in both groups of patients with and without an oronasal fistula
(P<0.05).
Conclusion IImmature patients with unilateral CLP and oronasal fistula have a smaller maxillary sinus than
unilateral CLP patients without an oronasal fistula, and may be at higher risk of respiratory infections.
KEYWORDS
Cone-Beam Computed Tomography; Orofacial Cleft; Fistula; Maxillary Sinus.
1. INTRODUCTION Development of an oronasal fistula indicates failure
of the surgical closure of the palate to obstruct the
The failed fusion of the medial nasal and maxillary communication between the oral and the nasal
processes would result in the occurrence of cleft cavity.
lip while failed fusion of the palatine prominences According to the classification by Pittsburg, seven
would lead to the formation of a cleft palate [1,2]. types of fistula are present [8], which can be
Cleft lip and palate (CLP) has a prevalence of 1 per symptomatic or asymptomatic. Symptomatic fistula
500 live births [3]. Surgical management of CLP was can cause several complications such as leakage
first performed approximately 150 years ago [4]. At of foods and drinks from the oral cavity into the
present, CLP patients often undergo surgery before nasal cavity, bad odor, rhinitis, impaired hearing,
the 1st year of age. However, an oronasal fistula may hypernasality, infection, and speech problems
develop postoperatively due to the infection of the [7,9,10].
palate or tension of the flap, and cause problems CLP patients often suffer from decreased maxillary
for the patient [5]. The oronasal fistula is a common sinus volume and significant esthetic impairments
complication of surgical management of CLP with a due to the maxillary deficiency at the midface, where
prevalence rate of 9-50%. The rate of recurrence of the maxillary sinuses are located. These patients
the fistula after surgery is as high as 35-70% [6,7]. often develop recurrent sinusitis for no clear reason.
OPEN ACCESS This is an Open Access article under the CC BY-NC 4.0 license.
Peer-Reviewed Article
Citation: Kiaee B, Hafezi L, Karani M, Amiri F, Jamilian A. Maxillary sinus volume in cleft lip and palate patients with and without an oronasal fistula using
CBCT Stoma Edu J. 2021;8(3):157-162.
Received: July 15, 2021; Revised: July 23, 2021; Accepted: July 27, 2021; Published: August 03, 2021
*Corresponding author: Abdolreza Jamilian, DDS,MS
Department of Orthodontics, Dental School, Cranio Maxillofacial Research Center, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
Tel: +982122011892; Fax: +982122052228; e-mail: info@jamilian.net
Copyright: © 2021 the Editorial Council for the Stomatology Edu Journal.
Stoma Edu J. 2021;8(3): 157-162 pISSN 2360-2406; eISSN 2502-0285 157
Kiaee B, et al.
www.stomaeduj.com
Also, they have smaller sinuses due to a different (on sagittal CBCT scans). The CVS of each patient
Original Articles
developmental process during the embryonic stage, was determined by two examiners after reaching a
surgical scars, recurrence of fistula, leakage of foods consensus.
and liquids into the nasal cavity, frequent infections, The exclusion criteria were history of previous
and different pattern of air circulation in the nose and orthodontic treatment, orthognathic surgery,
sinuses [1,8,11-14]. trauma, syndromes, frequent colds (more than 6
Several studies have been conducted on CLP patients times in 1 year), medication intake at the time of
using 2D lateral cephalometry, which has high CBCT, inflammatory diseases of the upper airways at
diagnostic accuracy for clinical applications, despite the time of CBCT, and systemic conditions.
simplicity and low cost [15-20]. However, cone- All CBCT images had been obtained in standard
beam computed tomography (CBCT) has become upright position with maximum intercuspation.
increasingly popular in the recent years due to its Also, all images had been taken with NewTom 5G
higher accuracy at a comparable cost. CBCT scanner (NEWTOM | CEFLA S.C., Imola, Italy)
Controversy exists regarding the maxillary sinus with a total scanning time of 14-18 s, 3.4 s exposure
volume in CLP patients such that some studies time, and 0.3 mm3 voxel size. Three-dimensional
reported a significantly smaller volume of the reconstruction of images was performed according
maxillary sinuses in CLP patients compared with to the Demirtas method [11].
normal individuals [15,21-23] while some others After standardization of images, the maxillary sinus
found no significant difference in this respect volume was quantified. For this purpose, first the
[8,11,24-26]. Considering the existing controversy in skeletal borders adjacent to the sinus structure were
this respect, and the gap of information regarding the were traced.
maxillary sinus volume in patients who developed
an oronasal fistula after surgery compared with
those who did not, this study aimed to compare the
maxillary sinus volume in 9-12-year-old CLP patients
with and without an oronasal fistula who had
undergone the surgical closure of the cleft at 1 year
of age using CBCT. The null hypothesis was that no
significant difference would be found in the maxillary
sinus volume between CLP patients with and without
oronasal fistula.
2. MATERIALS AND METHODS
This descriptive, cross-sectional, analytical study was
conducted on 50 unilateral CLP patients between
9-12 years who had undergone surgical closure
of the cleft at 1 year of age in two groups with and
without oronasal fistula (n=50). The patients were
selected from among those presenting to a private
orthodontic office in Tehran between 2010-2019 and
who already had CBCT scans taken for orthodontic
treatment. The study was approved by the ethics
committee of School of Dentistry (IR.IAU.DENTAL.
REC.1399.19).
The sample size was calculated to be 25 for each
group according to the results of a pilot study on 10
patients from each group considering α=0.05, β=0.2,
mean maxillary sinus volume of 10671 mm3 and
10081 mm3 in the two groups and standard deviation
of 715 mm3 using two-sample t-test, assuming equal
variances in PASS 15.
The CBCT scans of unilateral CLP patients between
9-12 years who had undergone surgical closure of the
cleft at 1 year of age were retrieved from the archives
of a private orthodontic office from 2010-2019 by
convenience sampling, and assigned to two groups
with and without oronasal fistula.
The inclusion criteria were age between 9-12 years,
history of surgical closure of the cleft before 1 year Figure 1. Quantification of the maxillary sinus volume on axial,
of age, and cervical vertebral stage (CVS) 2 or 3 sagittal and coronal CBCT sections using the Mimics software.
158 Stoma Edu J. 2021;8(3): 157-162 pISSN 2360-2406; eISSN 2502-0285
Maxillary Sinus Volume in Cleft Lip and Palate
www.stomaeduj.com
Original Articles
Figure 2. Identifying the maxillary sinus at the cleft
and non-cleft sides.
Next, the sinus area between the bones and the area 4. DISCUSSION
between the infundibulum and the uncinate process This study compared the maxillary sinus volume
was measured (Figs 1 and 2). Then, a 3D model was in 9-12-year-old CLP patients with and without
prepared to assess the sinus volume. After image oronasal fistula who had undergone surgical closure
reconstruction and standardization of orientation of the cleft at 1 year of age using CBCT. The null
in axial, coronal and sagittal planes, the Mimics hypothesis was that no significant difference would
software suite-20 (Materialise, 3001 Leuven, Belgium) be found in the maxillary sinus volume between
was used for the measurements. CLP patients with and without oronasal fistula. The
The data were analyzed by SPSS version 22 using results showed that the maxillary sinus volume was
t-test. All measurements were repeated on 20 significantly smaller in patients with oronasal fistula
randomly selected CBCT scans after a 2-week interval compared with those without it. Also, the maxillary
by another examiner, and the reliability of the sinus volume in the cleft side was significantly smaller
measurements was ensured by test-retest reliability. than that in the non-cleft side in both groups. Thus,
Since R was found to be >0.8, the results were found the null hypothesis of the study was rejected. The
to be adequately reliable. smaller size of the maxillary sinus at the cleft side
can be due to different developmental processes
3. RESULTS
during the embryonic stage, maxillary deficiency,
surgical scars, recurrence of fistula, leakage of
This study evaluated 50 patients including 25 with
foods and liquids into the nasal cavity and frequent
and 25 without oronasal fistula. The group with
infections, and different patterns of air circulation
oronasal fistula included 17 females (66%) and 8
in the nose and sinuses. The present results were
males (34%) with a mean age of 10±1 years. Of all,
30 patients (80%) were in CVS II (15 from each group) in agreement with those of Demirtas et al [11]. Our
and 10 (20%) were in CVS III (5 from each group). The methodology was also similar to that of Demirtas
control groups were matched with the test group in et al, [11] although they did not assess the effect
terms of age, CVS and gender. of the presence of oronasal fistula on the maxillary
Table 1 presents the mean maxillary sinus volume in sinus volume; however, they assessed patients
the two groups of patients. As shown, the maxillary with a mean age of 13.5 years while we evaluated
sinus volume at the cleft side of patients with patients between 9-12 years. The assessment of
oronasal fistula was significantly lower than that at patients in this age range was an advantage since
the cleft side of patients without fistula (P<0.000). evidence shows airway growth and development in
The maxillary sinus volume at the non-cleft side of two periods of 6-9 and 12-15 years, with an interval
patients with oronasal fistula was also significantly between 9-12 years [27]. Also, CBCT images are not
lower than that at the non-cleft side of patients often obtained from patients younger than 9 years
without fistula (P<0.000). The maxillary sinus volume of age (CBCT is often first requested for grafting
at the cleft side was significantly smaller than that prior to canine eruption). Moreover, the soft tissue
at the non-cleft side in patients with (P<0.000) and becomes more stable after 9 years of age. Erdura
without (P<0.000) oronasal fistula. et al. [8] evaluated the maxillary sinus volume of
Table 1. Mean maxillary sinus volume in the two groups of patients with and without oronasal fistula.
Maxillary sinus volume Sinus volume at the Cinus volume at the
cleft side non-cleft side P value
Oronasal fistula Mean± std. deviation Mean± std. deviation
Present (n=5) 9510.78±492 10282.8±483 p<0.0001
Absent (n=5) 10278.2±512 10932.9±554 p<0.0001
FP value Fp<0.0001 Fp<0.0001
Stoma Edu J. 2021;8(3): 157-162 pISSN 2360-2406; eISSN 2502-0285 159
Original Articles
Kiaee B, et al.
www.stomaeduj.com
unilateral CLP patients of approximately 13 years operated by different surgeons at 1 year of age, and
of age. They found no significant difference in the different techniques had been used for cleft closure,
maxillary sinus volume between the cleft and non- which could have different effects. Due to the small
cleft sides, which was different from the present number of patients, they could not be standardized
results, and may be attributed to the different age
in this respect. Future studies should address this
range of patients. Hikosaka et al. [18] measured the
maxillary sinus volume in patients with CLP. They topic and preferably enroll patients operated by the
assessed the computed tomography (CT) scans of same surgeon and with the same surgical technique
109 CLP and 100 non-CLP patients and found no for cleft closure. Moreover, the effects of the surgical
significant difference between the two groups, which technique and time of surgery on the recurrence
was in contrast to our findings. Also, they found no of the fistula are important topics that need to be
significant difference in the maxillary sinus volume scrutinized in further studies.
of the cleft and non-cleft sides, which was different
from the present results. The difference between
the two studies may be due to the use of different 5. CONCLUSION
imaging modalities (CBCT vs. CT). Also, they did not
specify the patients’ age. Agarwal et al. [16] evaluated Immature patients with unilateral CLP and oronasal
the differences in maxillary sinuses of the cleft and fistula have a smaller maxillary sinus than unilateral
non-cleft sides. They made the measurements on CLP patients without an oronasal fistula, and may
the maxilla using a combination of reconstructed
be at higher risk of respiratory infections. Also, the
axial, coronal and lateral CT images. The maxillary
sinus volume was calculated on 3D reconstructed maxillary sinus at the cleft side is smaller than that at
images. They found significant reduction of length, the non-cleft side in unilateral CLP patients.
width, height, depth and volume of the maxillary
sinus at the cleft side, which supported the present ACKNOWLEDGMENTS
results. However, they did not mention the patients’ None.
age range.
The assessment of patients between 9-12 years was
AUTHOR CONTRIBUTIONS
a strength of this study since this age range is ideal
AJ: Study concept and design; critical revision of the manuscript
for assessment of the size of maxillary sinuses [27].
The use of CBCT was another strength of this study for important intellectual content; administrative, technical, and
since it provides highly accurate data regarding material support; study supervision. LH: Acquisition of data.
the dimensions of anatomical structures, and has BK, AJ: Analysis and interpretation of data. FA: Drafting of the
high measurement accuracy. Also, the effect of manuscript. MK: Statistical analysis.
the presence of the fistula on the maxillary sinus
dimensions was evaluated in this study, which has FUNDING
not been addressed before.
This research did not receive any specific grant from funding
Not evaluating bilateral CLP patients and small
agencies in the public, commercial, or not-for-profit sectors.
sample size were among the limitations of this study.
Future studies with a larger sample size are required
on bilateral CLP patients. Another limitation was COMPETING INTERESTS
that, patients evaluated in this study had been The authors declare that they have no competing interests.
REFERENCES
1. Jamilian A, Lucchese A, Darnahal A, et al. Cleft sidedness and 6. Costello BJ, Edwards SP, Clemens M. Fetal diagnosis and
congenitally missing teeth in patients with cleft lip and palate treatment of craniomaxillofacial anomalies. J Oral Maxillofac Surg.
patients. Prog Orthod. 2016;17:14. doi: 10.1186/s40510-016- 2008 Oct;66(10):1985-1995. doi: 10.1016/j.joms.2008.01.042.
0127-z. Epub 2016 May 9. PMID: 27135068; PMCID: PMC4864872. PMID: 18848093.
Full text links CrossRef PubMed Google Scholar Scopus WoS Full text links CrossRef PubMed Google Scholar Scopus WoS
2. Lawson W, Patel ZM, Lin FY. The development and pathologic 7. Sadhu P. Oronasal fistula in cleft palate surgery. Indian J Plast
processes that influence maxillary sinus pneumatization. Anat Surg. 2009 Oct;42 Suppl(Suppl):S123-S128. doi: 10.4103/0970-
Rec (Hoboken). 2008;291(11):1554-1563. doi: 10.1002/ar.20774. 0358.57203. PMID: 19884667; PMCID: PMC2825081.
PMID: 18951496. CrossRef Google Scholar
Full text links CrossRef PubMed Google Scholar Scopus WoS 8. Erdur O, Ucar FI, Sekerci AE, et al. Maxillary sinus volumes
3. Jamilian A, Nayeri F, Babayan A. Incidence of cleft lip and of patients with unilateral cleft lip and palate. Int J Pediatr
palate in Tehran. J Indian Soc Pedod Prev Dent. 2007;25(4):174-176. Otorhinolaryngol. 2015 Oct;79(10):1741-1744. doi: 10.1016/j.
doi: 10.4103/0970-4388.37013. PMID: 18007103. ijporl.2015.08.003. Epub 2015 Aug 8. PMID: 26292906.
PubMed Google Scholar Scopus Full text links PubMed Google Scholar Scopus WoS
4. Salihu S, Krasniqi B, Sejfija O, et al. Analysis of potential 9. Jamilian A, Showkatbakhsh R, Behnaz M, et al. Tooth-borne
oral cleft risk factors in the Kosovo population. Int Surg. distraction osteogenesis versus conventional Le Fort I in maxilla-
2014;99(2):161-165. doi: 10.9738/INTSURG-D-13-00089.1. PMID: ry advancement of cleft lip and palate patients. Minerva Stomatol.
24670027; PMCID: PMC3968843. 2018 Jun;67(3):117-124. doi: 10.23736/S0026-4970.18.04121-3.
Full text links CrossRef PubMed Google Scholar Scopus WoS Epub 2018 Jan 31. PMID: 29388417.
5. Tessier P. Anatomical classification facial, cranio-facial and Full text links CrossRef PubMed Google Scholar Scopus WoS
latero-facial clefts. J Maxillofac Surg. 1976 Jun;4(2):69-92. doi: 10. Tahmasbi S, Jamilian A, Showkatbakhsh R, et al. Cephalo-
10.1016/s0301-0503(76)80013-6. PMID: 820824. metric changes in nasopharyngeal area after anterior maxillary
PubMed Google Scholar Scopus segmental distraction versus Le Fort I osteotomy in patients with
160 Stoma Edu J. 2021;8(3):157-162 pISSN 2360-2406; eISSN 2502-0285
Maxillary Sinus Volume in Cleft Lip and Palate
www.stomaeduj.com
cleft lip and palate. Eur J Dent. 2018 Jul-Sep;12(3):393-397. doi: 19. Ishikawa Y, Kawano M, Honjo I, Amitani R. The cause of nasal
Original Articles
10.4103/ejd.ejd_374_17. PMID: 30147405; PMCID: PMC6089043. sinusitis in patients with cleft palate. Arch Otolaryngol Head Neck
Full text links CrossRef PubMed Google Scholar Scopus Surg. 1989 Apr;115(4):442-446. doi: 10.1001/
11. Demirtas O, Kalabalik F, Dane A, et al. Does unilateral cleft lip archotol.1989.01860280040014. PMID: 2923687.
and palate affect the maxillary sinus volume? Cleft Palate Cranio- Full text links PubMed Google Scholar Scopus WoS
fac J. 2018 Feb;55(2):168-172. doi: 10.1177/1055665617726991. 20. Ishikawa Y, Amitani R. Nasal and paranasal sinus disease in
Epub 2017 Dec 14. PMID: 29351024. patients with congenital velopharyngeal insufficiency. Arch
Full text links CrossRef PubMed Google Scholar Otolaryngol Head Neck Surg. 1994 Aug;120(8):861-865. doi:
12. Jamilian A, Jamilian M, Darnahal A, et al. Hypodontia and 10.1001/archotol.1994.01880320063014. PMID: 8049050.
supernumerary and impacted teeth in children with Full text links CrossRef PubMed Google Scholar Scopus WoS
various types of clefts. Am J Orthod Dentofacial Orthop. 2015 21. Robinson HE, Zerlin GK, Passy V. Maxillary sinus development
Feb;147(2):221-225. doi: 10.1016/j.ajodo.2014.10.024. PMID: in patients with cleft palates as compared to those with normal
25636556. palates. Laryngoscope. 1982 Feb;92(2):183-187. doi: 10.1002/
Full text links CrossRef PubMed Google Scholar Scopus WoS lary.1982.92.2.183. PMID: 7162315.
13. Jamilian A, Showkatbakhsh R, Boushehry MB. The effect of Full text links CrossRef PubMed Google Scholar Scopus WoS
tongue appliance on the nasomaxillary complex in growing 22. Jamilian A, Sarkarat F, Jafari M, et al. Family history and risk
cleft lip and palate patients. J Indian Soc Pedod Prev Dent. factors for cleft lip and palate patients and their associated
2006 Sep;24(3):136-139. doi: 10.4103/0970-4388.27893. PMID: anomalies. Stomatologija. 2017;19(3):78-83. PMID: 29339670.
17065780. Full text links PubMed Google Scholar Scopus
CrossRef PubMed Google Scholar Scopus 23. Suzuki H, Yamaguchi T, Furukawa M. Maxillary sinus
14. Showkatbakhsh R, Pourdanesh F, Jamilian A, et al. Hyrax ap- development and sinusitis in patients with cleft lip and palate.
plication as a tooth-borne distractor for maxillary advancement. Auris Nasus Larynx. 2000 Jul;27(3):253-256. doi: 10.1016/s0385-
J Craniofac Surg. 2011 Jul;22(4):1361-1366. doi: 10.1097/SCS. 8146(99)00066-8. PMID: 10808114.
0b013e31821c93d8. PMID: 21772186. Full text links CrossRef PubMed Google Scholar Scopus
Full text links CrossRef PubMed Google Scholar Scopus WoS 24. Smith TD, Siegel MI, Mooney MP, et al. Formation and
15. Lopes de Rezende Barbosa G, Pimenta LA, Pretti H, et al. enlargement of the paranasal sinuses in normal and cleft
Difference in maxillary sinus volumes of patients with cleft lip lip and palate human fetuses. Cleft Palate Craniofac J. 1997
and palate. Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2234- Nov;34(6):483-489. doi: 10.1597/1545-1569_1997_034_0483_
2236. doi: 10.1016/j.ijporl.2014.10.019. Epub 2014 Oct 25. PMID: faeotp_2.3.co_2. PMID: 9431465.
25458166. Full text links CrossRef PubMed Google Scholar WoS
Full text links PubMed Google Scholar Scopus WoS 25. Schneiderman ED, Xu H, Salyer KE. Characterization of the
16. Agarwal R, Parihar A, Mandhani PA, Chandra R. Three-dimen- maxillary complex in unilateral cleft lip and palate using cone-
sional computed tomographic analysis of the maxilla in unilateral beam computed tomography: a preliminary study. J Craniofac
cleft lip and palate: implications for rhinoplasty. J Craniofac Surg. Surg. 2009 Sep;20 Suppl 2:1699-1710. doi: 10.1097/SCS.0b013e-
2012 Sep;23(5):1338-1342. doi: 10.1097/SCS.0b013e31826466d8. 3181b3eddf. PMID: 19816335.
PMID: 22948621. Full text links CrossRef PubMed Google Scholar Scopus WoS
Full text links PubMed Google Scholar Scopus WoS 26. Guijarro-Martinez R, Swennen GR. Cone-beam computerized
17. Francis P, Raman R, Korula P, Korah I. Pneumatization of the tomography imaging and analysis of the upper airway: a
paranasal sinuses (maxillary and frontal) in cleft lip and palate. systematic review of the literature. Int J Oral Maxillofac Surg. 2011
Arch Otolaryngol Head Neck Surg. 1990 Aug;116(8):920-922. doi: Nov;40(11):1227-1237. doi: 10.1016/j.ijom.2011.06.017. Epub
10.1001/archotol.1990.01870080042012. PMID: 2378718. 2011 Jul 20. PMID: 21764260.
Full text links PubMed Google Scholar WoS Full text links PubMed Google Scholar Scopus WoS
18. Hikosaka M, Nagasao T, Ogata H, et al. Evaluation of maxillary 27. Taylor M, Hans MG, Strohl KP, et al. Soft tissue growth
sinus volume in cleft alveolus patients using 3-dimensional of the oropharynx. Angle Orthod. 1996;66(5):393-400. doi:
computed tomography. J Craniofac Surg. 2013 Jan;24(1):e23-e26. 10.1043/0003-3219(1996)066<0393:STGOTO>2.3.CO;2. PMID:
doi: 10.1097/SCS.0b013e318267bdf3. PMID: 23348325. 8893109.
Full text links CrossRef PubMed Google Scholar Scopus WoS Full text links PubMed Google Scholar Scopus WoS
Bita KIAEE
DDS, MSc, Assistant Professor
Department of Orthodontics
Dental School
Tehran University of Medical Sciences
Tehran, Iran
CV
Dr. Kiaee received her DDS (2013) and MSc in Orthodontics (2017) from Tehran University in Tehran, Iran. Since 2017, she has
been working as an Assistant Professor at the Department of Orthodontics within the Faculty of Dentistry of Tehran University.
Her research areas of interest are mostly clinical projects.
Stoma Edu J. 2021;8(3):157-162 pISSN 2360-2406; eISSN 2502-0285 161
Kiaee B, et al.
www.stomaeduj.com
Questions
Original Articles
1. Which item was among the exclusion criteria stated in this article?
qa. History of surgical closure of the cleft before 1 year of age;
qb. Orthognathic surgery;
qc. Cervical vertebral stage (CVS) 2 or 3;
qd. Age between 9-12 years.
2. Which statement is NOT TRUE based on the findings of this article?
qa. The maxillary sinus volume at the cleft side of patients with oronasal fistula was significantly lower than
that at the cleft side of patients without fistula;
qb. The maxillary sinus volume at the non-cleft side of patients with oronasal fistula was significantly lower
than that at the non-cleft side of patients without fistula;
qc. The maxillary sinus volume at the cleft side was significantly smaller than that at the non-cleft side in
patients with and without oronasal fistula;
qd. The maxillary sinus volume at the cleft side of patients without oronasal fistula was significantly lower
than that at the cleft side of patients with fistula.
3. Which of the following statements is True based on the findings of this article?
qa. Immature patients with unilateral CLP and oronasal fistula have a smaller maxillary sinus than unilateral
CLP patients without an oronasal fistula;
qb. Immature patients with unilateral CLP and oronasal fistula may be at lower risk of respiratory infections;
qc. The maxillary sinus at the non-cleft side is smaller than that at the cleft side in unilateral CLP patients;
qd. Adult patients with bilateral CLP and oronasal fistula have a smaller maxillary sinus than unilateral CLP
patients without an oronasal fistula.
4. Which one is the prevalence of cleft lip and palate patients based on the present study?
qa. 1 per 700 live births;
qb. 1 per 1000 live births;
qc. 1 per 500 live births;
qd. 2.3 per 1000 live births.
162 Stoma Edu J. 2021;8(3): 157-162 pISSN 2360-2406; eISSN 2502-0285