CBCT-Based 3D Assessment of Maxillary Sinus and Pharyngeal Airway in Unilateral Cleft Lip and Palate

Cleft lip and palate (CLP) is one of the most common congenital craniofacial anomalies, often associated with structural variations in the maxillary sinus and pharyngeal airway. These alterations may predispose individuals to complications such as sinusitis and obstructive sleep apnea. While previous studies have investigated these structures, most relied on two-dimensional imaging, which has inherent limitations for evaluating three-dimensional structures. Moreover, the maxillary sinus and airway have rarely been evaluated together in a unified three-dimensional framework, despite their close developmental relationship. Cone Beam Computed Tomography (CBCT) offers improved three-dimensional assessment. This study aimed to evaluate maxillary sinus and pharyngeal airway volumes in individuals with unilateral CLP (UCLP) using CBCT and compare findings with a matched control group. This retrospective study analyzed CBCT images of 30 individuals with UCLP and 30 age- and sex-matched healthy controls (ages 12–20). Images were processed using ITK-SNAP software. Maxillary sinuses were segmented bilaterally, and pharyngeal airway volumes were defined using standardized anatomical landmarks. Volume measurements were obtained using a semi-automatic method, and statistical analyses were performed via SPSS. The UCLP group showed a significantly lower left maxillary sinus volume compared to controls (p = 0.011), while right sinus volumes were not significantly different. Pharyngeal airway volumes were lower in the UCLP group but not statistically significant (p > 0.05). No significant differences were observed based on cleft side, sex, or age within either group. This study revealed a unilateral reduction in left maxillary sinus volume in UCLP patients, while other volumetric differences were not statistically significant. Despite limited statistical variation, the known anatomical deviations in UCLP may increase susceptibility to respiratory and sinus pathologies. However, this volumetric evaluation was limited by the absence of functional or dynamic assessment of airway performance. CBCT provides a reliable modality for detailed volume analysis. Future studies should incorporate larger, multicenter samples and dynamic assessments to further clarify functional implications and guide clinical decision-making.