Document Type : Original Article
Authors
1 Professor and Head of Department of Orthodontics and Dentofacial Orthopaedics, Sri Hasanamba Dental College and Hospital, Hassan, India
2 Senior Resident at Department of Orthodontics and Dentofacial Orthopedics, Sri Hasanamba Dental College and Hospital, Hassan, India
3 Associate Professor, Department of Orthodontics and Dentofacial Orthopedics, Sri Hasanamba Dental College and Hospital, Hassan, India
Abstract
Aim: To evaluate and compare oxygen saturation levels in different facial patterns (average, horizontal, and vertical) existing in different anterior-posterior planes of space (Angle’s Class I, Class II, and Class III) by comparing the amount of hemoglobin bound to oxygen (SPO2) to the total amount of hemoglobin in the blood.
Methods: A prospective observational study involving a sample size of 180 adults aged 18–30 was categorized into nine different groups based on their skeletal jaw relationships in the anteroposterior plane occurring in different facial types: average, horizontal, and vertical. The study was conducted using a portable pulse oximetry device (Biosys, BPM-200) to assess the level of saturated hemoglobin in the blood (SPO2).
Results: The mean SPO2 measured was found to be in the range of 95–98%. Comparison between groups showed a statistically significant difference in the mean SPO2 (P=0.002). However, post hoc analysis showed group H had statistical significance.
Conclusion: Based on the analysis of the results obtained from the study, it was concluded that in all facial growth patterns, SPO2 levels were in the normal range. However, the class II skeletal base with a vertical skeletal pattern showed the lowest SPO2 levels. The study also supported the fact that blood oxygen saturation levels are not a concern in any type of facial pattern; hence, no orthodontic intervention as such is indicated to improve their SPO2 levels.
Keywords
Main Subjects
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2. Rubin RM. Facial deformity: a preventable disease? Angle Orthod. 1979;49(2):98-103. PMID: 286571. DOI: 10.1043/0003-3219(1979)049< 0098: FDAPD>2.0.CO;2.
3. Fernandes P, Pinto J, Ustrell-Torrent J. Relationship between Oro pharynx and nasopharynx permeability and the direction of facial growth. Eur J Paediatr Dent. 2017;18(1):37-40. PMID: 28494601. DOI: 10.23804/ejpd.2017.18.01.08.
4. Enlow, D.H. and Hans, M.G. Essentials of Facial Growth. WS Saunders Co., Philadelphia. Int J Clin Med. 1-240.
5. Shapiro PA. Effects of nasal obstruction on facial development. J Allergy Clin Immunol. 1988;81(5 Pt 2):967-71. PMID: 3286736. DOI: 10.1016/0091-6749(88)90162-5.
6. Moss ML, Salentijn L. The primary role of functional matrices in facial growth. Am J Orthod. 1969;55(6):566-77. PMID: 5253955. DOI: 10.1016/0002-9416(69)90034-7.
7. Cooper BC. Nasorespiratory function and orofacial development. OtolaryngolClin North Am. 1989;22(2):413-41. PMID: 2664660.
8. Imbaud TC, Mallozi MC, Domingos VB, Solé. Frequency of rhinitis and orofacial disorders in patients with dental malocclusion]. Rev Paul Pediatr. 2016;34(2):184-8. PMID: 26631324. DOI: 10.1016/j.rpped.2015.10.002.
9. Bresolin D, Shapiro PA, Shapiro GG, Chapko MK, Dassel S. Mouth breathing in allergic children: its relationship to dentofacial development. Am J Orthod. 1983;83(4):334. PMID: 6573147. DOI: 10.1016/0002-9416(83)90229-4.
10. Trask GM, Shapiro GG, Shapiro PA. The effects of perennial allergic rhinitis on dental and skeletal development: a comparison of sibling pairs. Am J Orthod Dentofacial Orthop. 1987;92(4):286-93. PMID: 3477946. DOI: 10.1016/0889 5406(87)90328-3.
11. Zheng W, Zhang X, Dong J, He J. Facial morphological characteristics of mouth breathers vs. nasal breathers: A systematic review and meta-analysis of lateral cephalometric data. Exp Ther Med. 2020;19(6):3738-3750. PMID: 32346438. DOI: 10.3892/etm.2020.8611.
12. Harari D, Redlich M, Miri S, Hamud T, Gross M. The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope. 2010;120(10):2089-93. PMID: 20824738. DOI: 10.1002/lary.20991.
13. Souki BQ, Lopes PB, Pereira TB, Franco LP, Becker HM, Oliveira DD. Mouth breathing children and cephalometric pattern: does the stage of dental development matter? Int J Pediatr Otorhinolaryngol. 2012;76(6):837-41. PMID: 22425033. DOI: 10.10 16/j.ijporl.2012.02.054.
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20. Clementine YF. Arterial blood gases. Proc Singapore Healthc. 2011;3(20):227-235. Doi: 10. 1177/201010581102000313.
21. World Health Organization. Pulse oximetry training manual. Geneva: WHO2011.
22. Hafen BB, Sharma S. Oxygen Saturation. Treasure Island (FL): Stat Pearls Publishing. 2023: https://www.ncbi.nlm.nih.gov/books/NBK525974/
23. Marcus CL, Omlin KJ, Basinki DJ, Bailey SL, Rachal AB, Von Pechmann WS, Keens TG, Ward SL. Normal polysomnographic values for children. Am Rev Respir Dis. 1992;146(5):1235-9. PMID: 1443877. DOI: 10.1164/ajrccm/146.5_Pt_1.1235.
24. Technical and regulatory aspects of the use of pulse oximeters in monitoring COVID-19 patients. The pan American health organization PAHO. Washington DC, US. https://iris.paho.org/bitstream/handle/10665.2/5 2589/PAHOHSSMTCOVID-19200029_eng.pdf?seq uence=1&isAllowed=y.
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26. Niaki EA, Chalipa J, Taghipoor E. Evaluation of oxygen saturation by pulse Oximetry in mouth breathing patients. Acta Med Iran. 2010;48(1):9-11. PMID: 21137662.
27. Cooper BC. Nasorespiratory function and orofacial development. Otolaryngol Clin North Am. 1989;22(2):413-41. PMID: 2664660.
28. Yamada T, Tanne K, Miyamoto K, Yamauchi K. Influences of nasal respiratory obstruction on craniofacial growth in young Macacafuscatamonkeys. Am J Orthod Dentofacial Orthop.1997;111:38-43. Doi: 10.1016/s0889-5406(97)70300-7.
29. Martin O, Muelas L, Viñas MJ. Nasopharyngeal cephalometric study of ideal occlusions. Am J Orthod Dentofacial Orthop. 2006;130(4): 436.e1-9. PMID: 17045141. Doi: 10.1016/j.ajodo.2006.03.022.
30. De Freitas MR, Alcazar NM, Janson G, de Freitas KM, Henriques JF. Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofacial Orthop. 2006;130(6):742-5. PMID: 17169736. Doi: 10.1016/j.ajodo.2005.01.033.
31. Godt A, Koos B, Hagen H, Göz G. Changes in upper airway width associated with Class II treatments (headgear vs activator) and different growth patterns. Angle Orthod. 2011;81(3):440-6. PMID: 21261483. Doi: 10.2319/090710-525.1.
32. Zhao Y, Nguyen M, Gohl E, Mah JK, Sameshima G, Enciso R. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl): S71-8. PMID: 20381764. Doi: 10.1016/j.ajodo.2008.08.026.
33. El H, Palomo JM. Airway volume for different dentofacial skeletal patterns. American journal of orthodontics and dentofacial orthopedics. 2011 Jun 1;139(6):e511-21.
34. Hong JS, Oh KM, Kim BR, Kim YJ, Park YH. Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible. Am J Orthod Dentofacial Orthop. 2011;140(4):e161-9. PMID: 21967954. Doi: 10.1016/j.ajodo.2011.04.020.
35. Ucar FI, Uysal T. Orofacial airway dimensions in subjects with Class I malocclusion and different
growth patterns. Angle Orthod. 2011;81(3):460-8. PMID: 21299381. Doi: 10.2319/091910-545.1.
36. Memon S, Fida M, Shaikh A. Comparison of different craniofacial patterns with pharyngeal widths. J Coll Physicians Surg Pak. 2012;22(5):302-6. PMID: 22538035.
37. Wang T, Yang Z, Yang F, Zhang M, Zhao J, Chen J, Li Y. A three dimensional study of upper airway in adult skeletal Class II patients with different vertical growth patterns. PLoS One. 2014;9(4):e95544. PMID: 24755893. Doi: 10.1371/journal.pone.0095544.
38. Zheng ZH, Yamaguchi T, Kurihara A, Li HF, Maki K. Three-dimensional evaluation of upper airway in patients with different anteroposterior skeletal patterns. Orthod Craniofac Res. 2014;17(1):38-48. PMID: 24033888. Doi: 10.1111/ocr.12029.
39. Fastuca R, Perinetti G, Zecca PA, Nucera R, Caprioglio A. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod. 2015;85(6):955-61. PMID: 26516709. Doi: 10.2319/072014-504.1.
40. Salehi P, Shahidi S, Majdi B, Omidi M, Rezapoorgavareshki S, Hamedani S. Evaluation of the Relationship between Airway Volumes and Vertical Facial Growth Patterns in Adult Patients. Journal title. 2015;4(4):20-30. Doi: 10.18869/acadpub.3dj.4.4.20.
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42. Alhammadi MS, Almashraqi AA, Halboub E, Almahdi S, Jali T, Atafi A, Alomar F. Pharyngeal airway spaces in different skeletal malocclusions: a CBCT 3D assessment. Cranio. 2021;39(2):97-106. PMID: 30821659. Doi 10.1080/08869634.2019.1583301.
43. Mohammed Korayem., et al. “Upper Airway Characteristics in Different SkeletalPatterns; A Review of Literature”. Acta Scientific Dental Sciences. 2019:139-145. https://actascientific.com/ASDS/pdf/ASDS-03-05 32.pdf.
44. Jadhav M, Bhosale V, Patil A, Shinde S. Comparison of Volumetric Dimensions of Pharyngeal Airway for Different Dentofacial Skeletal Patterns Using Cone Beam Computed Tomography. Folia Med (Plovdiv). 2020;62(3):572-577. PMID: 33009755. Doi: 10.3897/folmed.62. e48930.
45. Alimohammadi M, Dadgar S, Mardanshahi Z, Moosazadeh M, Aryana M, Sobouti F. Comparing Pharyngeal Airway Dimensions in Cephalograms of Patients with Different Skeletal Patterns. J Mazandaran Univ Med Sci. 2020;30(188) :107 115.
46. Nath M, Ahmed J, Ongole R, Denny C, Shenoy N. CBCT analysis of pharyngeal airway volume and comparison of airway volume among patients with skeletal Class I, Class II, and Class III malocclusion: A retrospective study. Cranio. 2021;39(5):379-390. PMID: 31405348. Doi: 10.1080/08869634.2019. 1652993.
47. Shokri A, Mollabashi V, Zahedi F, Tapak L. Position of the hyoid bone and its correlation with airway dimensions in different classes of skeletal malocclusion using cone-beam computed tomography. Imaging Sci Dent. 2020;50(2):105-115. PMID: 32601585. Doi: 10.5624/isd.2020.50.2.105.
48. Chen X, Liu D, Liu J, Wu Z, Xie Y, Li L, Liu H, Guo T, Chen C, Zhang S. Three-Dimensional Evaluation of the Upper Airway Morphological Changes in Growing Patients with Skeletal Class III Malocclusion Treated by Protraction Headgear and Rapid Palatal Expansion: A Comparative Research. PLoS One. 2015;10(8): e0135273. PMID: 26252015. Doi: 10.1371/journal.pone.0135273.
49. Lakshmi KB, Yelchuru SH, Chandrika V, Lakshmikar OG, Sagar VL, Reddy GV. Comparison between Growth Patterns and Pharyngeal Widths in Different Skeletal Malocclusions in South Indian Population. J Int Soc Prev Community Dent.
2018;8(3):224-228. PMID: 29911059. Doi: 10.4103/jispcd.JISPCD_77_18.
50. Kochhar AS, Sidhu MS, Bhasin R, Kochhar GK, Dadlani H, Sandhu J, Virk B. Cone beam computed tomographic evaluation of pharyngeal airway in North Indian children with different skeletal patterns. World J Radiol. 2021;13(2):40-52. PMID: 33728030. Doi: 10.4329/wjr. v13.i2.40.
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2. Rubin RM. Facial deformity: a preventable disease? Angle Orthod. 1979;49(2):98-103. PMID: 286571. DOI: 10.1043/0003-3219(1979)049< 0098: FDAPD>2.0.CO;2.
3. Fernandes P, Pinto J, Ustrell-Torrent J. Relationship between Oro pharynx and nasopharynx permeability and the direction of facial growth. Eur J Paediatr Dent. 2017;18(1):37-40. PMID: 28494601. DOI: 10.23804/ejpd.2017.18.01.08.
4. Enlow, D.H. and Hans, M.G. Essentials of Facial Growth. WS Saunders Co., Philadelphia. Int J Clin Med. 1-240.
5. Shapiro PA. Effects of nasal obstruction on facial development. J Allergy Clin Immunol. 1988;81(5 Pt 2):967-71. PMID: 3286736. DOI: 10.1016/0091-6749(88)90162-5.
6. Moss ML, Salentijn L. The primary role of functional matrices in facial growth. Am J Orthod. 1969;55(6):566-77. PMID: 5253955. DOI: 10.1016/0002-9416(69)90034-7.
7. Cooper BC. Nasorespiratory function and orofacial development. OtolaryngolClin North Am. 1989;22(2):413-41. PMID: 2664660.
8. Imbaud TC, Mallozi MC, Domingos VB, Solé. Frequency of rhinitis and orofacial disorders in patients with dental malocclusion]. Rev Paul Pediatr. 2016;34(2):184-8. PMID: 26631324. DOI: 10.1016/j.rpped.2015.10.002.
9. Bresolin D, Shapiro PA, Shapiro GG, Chapko MK, Dassel S. Mouth breathing in allergic children: its relationship to dentofacial development. Am J Orthod. 1983;83(4):334. PMID: 6573147. DOI: 10.1016/0002-9416(83)90229-4.
10. Trask GM, Shapiro GG, Shapiro PA. The effects of perennial allergic rhinitis on dental and skeletal development: a comparison of sibling pairs. Am J Orthod Dentofacial Orthop. 1987;92(4):286-93. PMID: 3477946. DOI: 10.1016/0889 5406(87)90328-3.
11. Zheng W, Zhang X, Dong J, He J. Facial morphological characteristics of mouth breathers vs. nasal breathers: A systematic review and meta-analysis of lateral cephalometric data. Exp Ther Med. 2020;19(6):3738-3750. PMID: 32346438. DOI: 10.3892/etm.2020.8611.
12. Harari D, Redlich M, Miri S, Hamud T, Gross M. The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope. 2010;120(10):2089-93. PMID: 20824738. DOI: 10.1002/lary.20991.
13. Souki BQ, Lopes PB, Pereira TB, Franco LP, Becker HM, Oliveira DD. Mouth breathing children and cephalometric pattern: does the stage of dental development matter? Int J Pediatr Otorhinolaryngol. 2012;76(6):837-41. PMID: 22425033. DOI: 10.10 16/j.ijporl.2012.02.054.
14. Zhao Z, Zheng L, Huang X, Li C, Liu J, Hu Y. Effects of mouth breathing on facial skeletal development in children: a systematic review and meta-analysis. BMC Oral Health. 2021;21(1):108. PMID: 33691678. DOI: 10.1186/s12903-021-01458-7.
15. Jiménez EL, Barrios R, Calvo JC, de la Rosa MT, Campillo JS, Bayona JC, Bravo M. Association of oral breathing with dental malocclusions and general health in children. Minerva Pediatr. 2017;69(3):188-193. PMID: 26154526. DOI: 10.23736/S0026-4946.16.04288-2.
16. Lin L, Zhao T, Qin D, Hua F, He H. The impact of mouth breathing on dentofacial development: A concise review. Front Public Health. 2022;10: 929165. PMID: 36159237. DOI: 10.3389/fpubh.2022.929165
17. Rodríguez-Olivos LHG, Chacón-Uscamaita PR, Quinto-Argote AG, Pumahualcca G, Pérez-Vargas LF. Deleterious oral habits related to vertical, transverse and sagittal dental malocclusion in pediatric patients. BMC Oral Health. 2022;22(1):88. PMID: 35321719. DOI: 10.1186/s12903-022-02122-4.
18. Levrini L, Mangano A, Ambrosoli A, Merlo P, Mangano C, Caprioglio A. Craniofacial growth and respiration: a study on an animal model. Ann Stomatol (Roma). 2015;6(2):53-7. PMID: 26330905.
19. Ung N, Koenig J, Shapiro PA, Shapiro G, Trask G. A quantitative assessment of respiratory patterns and their effects on dentofacial development. Am J Orthod Dentofacial Orthop. 1990;98(6):523-32. Doi: 10.1016/0889-5406(90)70019-9.
20. Clementine YF. Arterial blood gases. Proc Singapore Healthc. 2011;3(20):227-235. Doi: 10. 1177/201010581102000313.
21. World Health Organization. Pulse oximetry training manual. Geneva: WHO2011.
22. Hafen BB, Sharma S. Oxygen Saturation. Treasure Island (FL): Stat Pearls Publishing. 2023: https://www.ncbi.nlm.nih.gov/books/NBK525974/
23. Marcus CL, Omlin KJ, Basinki DJ, Bailey SL, Rachal AB, Von Pechmann WS, Keens TG, Ward SL. Normal polysomnographic values for children. Am Rev Respir Dis. 1992;146(5):1235-9. PMID: 1443877. DOI: 10.1164/ajrccm/146.5_Pt_1.1235.
24. Technical and regulatory aspects of the use of pulse oximeters in monitoring COVID-19 patients. The pan American health organization PAHO. Washington DC, US. https://iris.paho.org/bitstream/handle/10665.2/5 2589/PAHOHSSMTCOVID-19200029_eng.pdf?seq uence=1&isAllowed=y.
25. Major MP, Flores-Mir C, Major PW. Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofacial Orthop. 2006;130(6):700-8. PMID: 17169731. Doi: 10.1016/j.ajodo.2005.05.050.
26. Niaki EA, Chalipa J, Taghipoor E. Evaluation of oxygen saturation by pulse Oximetry in mouth breathing patients. Acta Med Iran. 2010;48(1):9-11. PMID: 21137662.
27. Cooper BC. Nasorespiratory function and orofacial development. Otolaryngol Clin North Am. 1989;22(2):413-41. PMID: 2664660.
28. Yamada T, Tanne K, Miyamoto K, Yamauchi K. Influences of nasal respiratory obstruction on craniofacial growth in young Macacafuscatamonkeys. Am J Orthod Dentofacial Orthop.1997;111:38-43. Doi: 10.1016/s0889-5406(97)70300-7.
29. Martin O, Muelas L, Viñas MJ. Nasopharyngeal cephalometric study of ideal occlusions. Am J Orthod Dentofacial Orthop. 2006;130(4): 436.e1-9. PMID: 17045141. Doi: 10.1016/j.ajodo.2006.03.022.
30. De Freitas MR, Alcazar NM, Janson G, de Freitas KM, Henriques JF. Upper and lower pharyngeal airways in subjects with Class I and Class II malocclusions and different growth patterns. Am J Orthod Dentofacial Orthop. 2006;130(6):742-5. PMID: 17169736. Doi: 10.1016/j.ajodo.2005.01.033.
31. Godt A, Koos B, Hagen H, Göz G. Changes in upper airway width associated with Class II treatments (headgear vs activator) and different growth patterns. Angle Orthod. 2011;81(3):440-6. PMID: 21261483. Doi: 10.2319/090710-525.1.
32. Zhao Y, Nguyen M, Gohl E, Mah JK, Sameshima G, Enciso R. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2010;137(4 Suppl): S71-8. PMID: 20381764. Doi: 10.1016/j.ajodo.2008.08.026.
33. El H, Palomo JM. Airway volume for different dentofacial skeletal patterns. American journal of orthodontics and dentofacial orthopedics. 2011 Jun 1;139(6):e511-21.
34. Hong JS, Oh KM, Kim BR, Kim YJ, Park YH. Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible. Am J Orthod Dentofacial Orthop. 2011;140(4):e161-9. PMID: 21967954. Doi: 10.1016/j.ajodo.2011.04.020.
35. Ucar FI, Uysal T. Orofacial airway dimensions in subjects with Class I malocclusion and different
growth patterns. Angle Orthod. 2011;81(3):460-8. PMID: 21299381. Doi: 10.2319/091910-545.1.
36. Memon S, Fida M, Shaikh A. Comparison of different craniofacial patterns with pharyngeal widths. J Coll Physicians Surg Pak. 2012;22(5):302-6. PMID: 22538035.
37. Wang T, Yang Z, Yang F, Zhang M, Zhao J, Chen J, Li Y. A three dimensional study of upper airway in adult skeletal Class II patients with different vertical growth patterns. PLoS One. 2014;9(4):e95544. PMID: 24755893. Doi: 10.1371/journal.pone.0095544.
38. Zheng ZH, Yamaguchi T, Kurihara A, Li HF, Maki K. Three-dimensional evaluation of upper airway in patients with different anteroposterior skeletal patterns. Orthod Craniofac Res. 2014;17(1):38-48. PMID: 24033888. Doi: 10.1111/ocr.12029.
39. Fastuca R, Perinetti G, Zecca PA, Nucera R, Caprioglio A. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod. 2015;85(6):955-61. PMID: 26516709. Doi: 10.2319/072014-504.1.
40. Salehi P, Shahidi S, Majdi B, Omidi M, Rezapoorgavareshki S, Hamedani S. Evaluation of the Relationship between Airway Volumes and Vertical Facial Growth Patterns in Adult Patients. Journal title. 2015;4(4):20-30. Doi: 10.18869/acadpub.3dj.4.4.20.
41. Silva NN, Lacerda RH, Silva AW, Ramos TB. Assessment of upper airway measurements in patients with mandibular skeletal Class II malocclusion. Dental Press J Orthod. 2015; 20:86-93. PMID: 26560826. Doi: 10.1590/2177-6709.20.5.086-093.oar.
42. Alhammadi MS, Almashraqi AA, Halboub E, Almahdi S, Jali T, Atafi A, Alomar F. Pharyngeal airway spaces in different skeletal malocclusions: a CBCT 3D assessment. Cranio. 2021;39(2):97-106. PMID: 30821659. Doi 10.1080/08869634.2019.1583301.
43. Mohammed Korayem., et al. “Upper Airway Characteristics in Different SkeletalPatterns; A Review of Literature”. Acta Scientific Dental Sciences. 2019:139-145. https://actascientific.com/ASDS/pdf/ASDS-03-05 32.pdf.
44. Jadhav M, Bhosale V, Patil A, Shinde S. Comparison of Volumetric Dimensions of Pharyngeal Airway for Different Dentofacial Skeletal Patterns Using Cone Beam Computed Tomography. Folia Med (Plovdiv). 2020;62(3):572-577. PMID: 33009755. Doi: 10.3897/folmed.62. e48930.
45. Alimohammadi M, Dadgar S, Mardanshahi Z, Moosazadeh M, Aryana M, Sobouti F. Comparing Pharyngeal Airway Dimensions in Cephalograms of Patients with Different Skeletal Patterns. J Mazandaran Univ Med Sci. 2020;30(188) :107 115.
46. Nath M, Ahmed J, Ongole R, Denny C, Shenoy N. CBCT analysis of pharyngeal airway volume and comparison of airway volume among patients with skeletal Class I, Class II, and Class III malocclusion: A retrospective study. Cranio. 2021;39(5):379-390. PMID: 31405348. Doi: 10.1080/08869634.2019. 1652993.
47. Shokri A, Mollabashi V, Zahedi F, Tapak L. Position of the hyoid bone and its correlation with airway dimensions in different classes of skeletal malocclusion using cone-beam computed tomography. Imaging Sci Dent. 2020;50(2):105-115. PMID: 32601585. Doi: 10.5624/isd.2020.50.2.105.
48. Chen X, Liu D, Liu J, Wu Z, Xie Y, Li L, Liu H, Guo T, Chen C, Zhang S. Three-Dimensional Evaluation of the Upper Airway Morphological Changes in Growing Patients with Skeletal Class III Malocclusion Treated by Protraction Headgear and Rapid Palatal Expansion: A Comparative Research. PLoS One. 2015;10(8): e0135273. PMID: 26252015. Doi: 10.1371/journal.pone.0135273.
49. Lakshmi KB, Yelchuru SH, Chandrika V, Lakshmikar OG, Sagar VL, Reddy GV. Comparison between Growth Patterns and Pharyngeal Widths in Different Skeletal Malocclusions in South Indian Population. J Int Soc Prev Community Dent.
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