Three-Dimensional Palatal Morphology and Obstructive Sleep Apnea Severity in Children with Unilateral Cleft Lip and Palate: A CBCT Study.

Background/Objectives: Obstructive sleep apnea (OSA) is highly prevalent in children with unilateral cleft lip and palate (UCLP) due to maxillary retrusion and upper airway compromise. While palatal morphology may influence pediatric OSA, three-dimensional (3D) evaluations in this population remain limited. This study evaluated palatal dimensions and maxillary widths in UCLP children with and without OSA using cone-beam computed tomography (CBCT) and examined their associations with OSA severity (apnea-hypopnea index, AHI). Methods: Forty CBCT scans of Thai children with non-syndromic UCLP (mean age 8.98 ± 1.99 years) were analyzed. Participants were categorized into OSA (n = 20; AHI ≥ 1) and non-OSA (n = 20; AHI < 1) groups. Reconstructed palatal structures were measured for surface area, volume, height, and transverse maxillary widths. Group differences were assessed using independent t-tests, and associations with AHI were examined via Pearson's correlation and linear regression (p < 0.05). Results: Children with OSA exhibited significantly reduced palatal surface area, volume, height, and buccal alveolar crest width compared with those without OSA (p < 0.05). Other transverse widths showed no significant intergroup differences. Linear regression identified palatal volume as the only variable independently associated with AHI (β = -0.631, p < 0.001). Conclusions: Children with UCLP and OSA exhibit significantly constricted palatal morphology. Among the measured parameters, reduced three-dimensional palatal volume was the only variable independently associated with increased OSA severity in this sample. Thus, CBCT-based palatal volume assessment may serve as a preliminary screening parameter to help identify OSA risk within multidisciplinary cleft care, though further validation is needed.