Comparison of two imaging softwares for three-dimensional analysis of pharyngeal airway volume in unilateral cleft lip and palate patients versus normal control

Objectives: The pharyngeal space encompasses airway structures extending from the plica vocalis to its nasal and oral openings, serving critical functions in air conduction and regulation while protecting against external irritants. Variations in dentoskeletal growth can obstruct the upper airway, promoting mouth breathing and leading to altered craniofacial growth, malocclusion, and potentially severe conditions such as obstructive sleep apnea syndrome (OSAS). This study aimed to compare the pharyngeal airway volume in unilateral cleft lip and palate (UCLP) patients versus normal controls using cone-beam computed tomography (CBCT), and to evaluate the accuracy and efficiency of two CBCT imaging software programs—OnDemand 3D and NTT software—for three-dimensional airway analysis. Methods: CBCT scans were obtained from patients diagnosed with unilateral cleft lip and palate (study group) and age-matched individuals without craniofacial abnormalities (control group). Pharyngeal airway volumes were measured using both OnDemand 3D and NTT software. Each scan was standardized for head orientation and segmentation boundaries before analysis. Airway segmentation protocols were applied consistently across both software platforms. Measurements of total airway volume and minimum cross-sectional area were compared between the two software and across groups. Statistical analyses were conducted to assess inter-software agreement and differences in airway parameters between UCLP and control subjects. Results: Preliminary findings indicated that unilateral cleft lip and palate patients exhibited significantly reduced pharyngeal airway volumes compared to normal controls. Both software programs demonstrated strong correlation and consistency in measurement outcomes; however, OnDemand 3D provided faster segmentation and better visualization of volumetric boundaries, while NTT software yielded slightly higher precision in defining cross-sectional areas. Conclusions: Three-dimensional assessment using CBCT provides a reliable method for evaluating airway morphology in UCLP patients. Despite minor differences in computational precision, both OnDemand 3D and NTT software proved valid for volumetric airway analysis. The study underscores the importance of standardized 3D imaging in diagnosing airway alterations related to craniofacial anomalies and in guiding treatment planning for functional and aesthetic rehabilitation.