Three-dimensional cone beam computed tomography evaluation of maxillary sinus volume and craniofacial asymmetry in unilateral and bilateral cleft lip and palate patients

Introduction: Orofacial clefts, including cleft lip with or without cleft palate (CLP) and isolated cleft palate (CP), are common congenital deformities affecting midfacial structures and craniofacial symmetry with possible mandibular involvement. Radiological assessment is crucial for surgical and orthodontic planning. This study evaluated maxillary sinus volume (MSV) and craniofacial asymmetry in individuals with unilateral and bilateral CLP compared with noncleft controls. Materials and Methods: This retrospective study utilized cone beam computed tomography records of 60 subjects aged 15–22 years, including 40 individuals with cleft lip and palate and 20 age- and sex-matched noncleft controls. Linear asymmetry parameters were assessed using CS 9300 imaging software Carestream CS 9300 3D system (Carestream Health, Inc., Atlanta, Georgia, USA) whereas volumetric measurements of the maxillary sinus were performed using Dolphin Imaging software (Dolphin 3D software version 11.9.07.24 (Patterson Dental Holdings, Inc., New York, USA). Intergroup comparisons were performed using one-way analysis of variance followed by Tukey’s post hoc test, with significance set at P < 0.05. Results: Significant differences were observed across multiple linear parameters (DNAH, DMOH, DMAV, DNAV, DJUV, and DMOV; all P < 0.001), reflecting asymmetries in the nasal region, maxillary dentoalveolar area, and mandibular region. In addition, the smallest MSV was observed in bilateral cleft lip and palate (BCLP) subjects, showing significant differences in overall group comparison ( P = 0.004). Conclusion: Craniofacial asymmetry was most pronounced in unilateral cleft lip and palate subjects, followed by bilateral cleft cases, and was least in noncleft controls. Reduced MSV was observed in BCLP patients, highlighting the impact of cleft severity on midfacial structures.