Is nasal airway size a marker for susceptibility toward clefting?

Johnston and Hunter (1989) reported that in monozygotic twins discordant for cleft lip +/- palate, the noncleft twins demonstrated what appeared to be a bimodal distribution of nasal cavity width. Two thirds showed reduced airway size and one third showed normal or slightly greater airway size. They suggested that the two-thirds group may represent reduced size of the medial nasal prominences and the other may represent underdevelopment of the maxillary prominence. We were particularly interested in the findings because the difference in distribution may represent differences in pathogenesis and therefore have etiologic significance. With this in mind we assessed nasal cross-sectional areas in 37 subjects with cleft lip or cleft lip +/- palate using the pressure-flow technique during breathing. A group of 72 noncleft individuals served as controls. As expected, the data revealed that subjects with clefts had a significantly reduced nasal airway (p = .0001). More important, the distribution of nasal airway size in the cleft group was similar to that reported by Johnston and Hunter (1989). This comparability suggests that it may be possible to assign most cleft lip +/- palate patients to a particular group. Since heredity may differ among the two groups (Chung et al., 1986), we may have a simple technique to assess the risk of occurrence for cleft lip +/- palate.