Morphology of C1 - C3 vertebrae in patients with unoperated nonsyndromic cleft palate - a retrospective CBCT study

Oana Mihalache^1,3, Yllka Deçolli¹, Ana Elena Sîrghe¹, Danisia Haba^1,2

¹Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania - ²Imaging Center ”Medimagis”, Iasi, Romania - ³Radiology Department, Regional Psychiatry Institute, Iasi, Romania

Introduction: Palate cleft is one of the most frequent craniofacial abnormalities, also reported in association with other anomalies or malformations, with possible involvement of cervical vertebrae. Cervical vertebrae anomalies are important to know in trauma and in the case of surgical treatment - screw procedures. The aim of this study is to investigate the C1-C3 morphology and possible anomalies in patients with unoperated nonsyndromic palate cleft compared to a control group of patients without palate. We used a newer 3D imaging technique, rarely used for vertebral diagnosis. 

Materials and methods: The overjet group with palate cleft consisted of 20 patients (4-22 years): 5 females and 15 males. The control group consisted of 20 patients (6-29 years): 8 females and 12 males. We retrospectively reviewed the CBCT images of the patients and examined the C1-C3 vertebrae. 

Results: Anomalies or anatomical variants were found in 80% of the palate cleft group, compared to 35% of the control group. Atlantoaxial rotatory fixation was found in 65% of the cleft group and in 10% of the control group. Other anomalies encountered were incomplete transverse foramen, unfused vertebral arches, ossiculum terminal, dens bicornis, and deviated spinous process. 

Conclusion: Our study confirmes a higher occurrence of cervical vertebrae anomalies among patients with palate cleft. Our findings support the results reported by the other authors but also report other anomalies less discussed and occult to 2D imaging. Although the etiology of atlantoaxial rotatory fixation is still unknown, our study showed a high incidence among patients with unoperated palate cleft.