Cervical Vertebral Maturation Method for Cleft Palate Patients

Objective: Cervical vertebral maturation (CVM) method has been widely used to assess the skeletal maturation of growing patients. However, it has not been examined if the CVM method can be applied to cleft patients who are frequently observed to have cervical vertebral anomalies due to altered bone remodeling. Thus, the objective of this study was to examine if the cervical vertebral parameters obtained using clinical cone beam computed tomography (CBCT) for the cleft patients are comparable with those for non-cleft control patients.

Method: IRB approval was obtained for analysis of CBCT exams of 5 patients (1 male and 4 females, mean 20.1 yrs) who were treated for the cleft lip and palate and 5 non-cleft control patients (1 male and 4 females, mean 19.08 yrs) who were gender and age matched with the cleft patient group. C2 and C3 vertebrae were digitally isolated from the 3D CBCT image. Total 3D volume and height of each vertebra were measured. Mean and standard deviation (SD) and coefficient of variation (COV) of degree of bone mineralization (DBM) were obtained using CT attenuation histogram. ANOVA was used to compare the parameters between the two groups. In addition, the concavity of cleft group was compared with that in the previous CVM study that included 30 healthy people.    

Result: All parameters examined were not significantly different between the two groups (p>0.236). The concavity (2.06±0.2 mm) of current cleft group was measured within the range of that (2.2±0.5 mm) in the previous study.

Conclusion: There were no significant difference in vertebral structure, DBM parameters that account for activity of bone remodeling, and concavity between the cleft and non-cleft group suggesting the CVM method is likely applicable to measure oral bone maturity of the cleft patients. The current concavity results were confirmed by comparison with the previous observation.