Document Type : Original Article

Authors

1 Associate Professor, Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Dentist, Private Practice, Tehran, Iran

3 Associate Professor, Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4 Resident, Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Aim: This study aimed to assess the relationship of upper pharyngeal airway volume with tongue position in different sagittal and vertical skeletal patterns using cone-beam computed tomography (CBCT).
Methods: CBCT images of 225 participants (149 females, 76 males) over 18 years of age were evaluated in three groups with sagittal Class I, II, and III skeletal patterns. Class I and II individuals were subdivided into three vertical subgroups high angle, normal, and low angle. The CBCT scans were evaluated three-dimensionally, and the volume of the lower nasopharynx (LNP), oropharynx (ORP), and velopharynx (VLP) was calculated in addition to the total upper pharyngeal airway volume (TV). The tongue position (according to Graber’s analysis and D1-D5 and D1’-D5’ lines) was determined, and the tongue height (TGH) was measured. Data were analyzed by one-way and two-way ANOVA, Tukey’s test, and Pearson’s and Spearman’s correlation tests (a=0.05).
Results: The volume of the LNP was significantly larger in Class II than in Class III patients (P<0.05). VLP volume (r>0.5, P<0.05) and TV (r>0.5, P<0.05) in Class I high angle participants had a significant correlation with D1.
Conclusion: The present results showed greater LNP volume in Class II than in Class III individuals. In some variables (VLP, ORP, TV, intraoral airway volume) no significant difference was observed between different sagittal and vertical groups. Most of the airway variables (TV, VLP, ORP) had no correlations with some tongue variables (TGH, D1, D3, D4, D4’, D5, intraoral airway volume) in different skeletal patterns.

Keywords

Main Subjects

  1. Fatima F, Fida M. The assessment of resting tongue posture in different sagittal skeletal patterns. Dental Press J Orthod. 2019;24(3):55-63. doi: 10.1590/2177-6709.24.3.055-063.oar PMID:31390450
  2. Sainath MC, Vimala G, Kalam RAA. Baseline Tongue Parameters in Normodivergent Skeletal Class I South Indian Subjects. Journal of Indian Orthodontic Society. 2013;47(6):343-7. doi:10.5005/jp-journals-10021-1184
  3. Meyer W. On Adenoid Vegetations in the Naso-pharyngeal Cavity: their Pathology, Diagnosis, and Treatment. Med Chir Trans. 1870;53:191-216.1. doi: 10.1177/095952877005300110.
  4. 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):334-40. doi: 10.1016/0002-9416(83)90229-4  PMID: 6573147
  5. Kerr WJ. The nasopharynx, face height, and overbite. Angle Orthod. 1985;55(1):31-6. doi: 10.1043/0003-3219(1985)055<0031:TNFHAO>2.0.CO;2  PMID: 3856405.
  6. Lee YS, Kim JC. A cephalometric study on the airway size according to the types of the malocclusion. The korean journal of orthodontics. 1995;25(1):19-29.
  7. McNamara JA. Influence of respiratory pattern on craniofacial growth. Angle Orthod. 1981;51(4):269-300. doi: 10.1043/0003-3219(1981)051<0269:IORPOC>2.0.CO;2 PMID: 6947703
  8. Joseph AA, Elbaum J, Cisneros GJ, Eisig SB. A cephalometric comparative study of the soft tissue airway dimensions in persons with hyperdivergent and normodivergent facial patterns. J Oral Maxillofac Surg. 1998;56(2):135-9; discussion 139-40. doi: 10.1016/s0278-2391(98)90850-3 PMID: 9461134
  9. Tourne LP. The long face syndrome and impairment of the nasopharyngeal airway. Angle Orthod. 1990;60(3):167-76. doi: 10.1043/0003-3219(1990)060<0167:TLFSAI>2.0.CO;2  PMID: 2202236.
  10. Battagel JM, Johal A, Kotecha B. A cephalometric comparison of subjects with snoring and obstructive sleep apnoea. Eur J Orthod. 2000;22(4):353-65. doi: 10.1093/ejo/22.4.353 PMID: 11029825
  11. Lowe AA, Fleetham JA, Adachi S, Ryan CF. Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop. 1995;107(6):589-95. doi: 10.1016/s0889-5406(95)70101-x  PMID: 7771363
  12. Miles PG, Vig PS, Weyant RJ, Forrest TD, Rockette HE Jr. Craniofacial structure and obstructive sleep apnea syndrome--a qualitative analysis and meta-analysis of the literature. Am J Orthod Dentofacial Orthop. 1996;109(2):163-72. doi: 10.1016/s0889-5406(96)70177-4 PMID: 8638562
  13. Chauhan A, Autar R, Pradhan KL, Yadav V. Comparison of pharyngeal airway dimension, tongue and hyoid bone position based on ANB angle. Natl J Maxillofac Surg. 2015;6(1):42-51. doi: 10.4103/0975-5950.168237 PMID: 26668452
  14. Primozic J, Farcnik F, Perinetti G, Richmond S, Ovsenik M. The association of tongue posture with the dentoalveolar maxillary and mandibular morphology in Class III malocclusion: a controlled study. Eur J Orthod. 2013;35(3):388-93. doi: 10.1093/ejo/cjs015 PMID: 22467568
  15. Subrahmanya RM, Gupta S. Assessment and comparison of tongue posture in individuals with different vertical facial patterns. Journal of Orofacial Research. 2014:67-71.
  16. Tarkar JS, Parashar S, Gupta G, Bhardwaj P, Maurya RK, Singh A, Singh P. An Evaluation of Upper and Lower Pharyngeal Airway Width, Tongue Posture and Hyoid Bone Position in Subjects with Different Growth Patterns. J Clin Diagn Res. 2016;10(1): ZC79-83. doi: 10.7860/JCDR/2016/16746.7158 PMID: 26894183
  17. Ucar FI, Uysal T. Orofacial airway dimensions in subjects with Class I malocclusion and different growth patterns. Angle Orthod. 2011;81(3):460-8. doi:10.2319/091910-545.1 PMID: 21299381
  18. Iwasaki T, Suga H, Yanagisawa-Minami A, Sato H, Sato-Hashiguchi M, Shirazawa Y, Tsujii T, Yamamoto Y, Kanomi R, Yamasaki Y. Relationships among tongue volume, hyoid position, airway volume and maxillofacial form in paediatric patients with Class-I, Class-II and Class-III malocclusions. Orthod Craniofac Res. 2019;22(1):9-15. doi: 10.1111/ocr.12251 PMID: 30421852.
  19. Chen W, Mou H, Qian Y, Qian L. Evaluation of the position and morphology of tongue and hyoid bone in skeletal Class II malocclusion based on cone beam computed tomography. BMC Oral Health. 2021;21(1):475. doi: 10.1186/s12903-021-01839-y PMID: 34579690
  20. Iwasaki T, Sato H, Suga H, Takemoto Y, Inada E, Saitoh I, Kakuno E, Kanomi R, Yamasaki Y. Relationships among nasal resistance, adenoids, tonsils, and tongue posture and maxillofacial form in Class II and Class III children. Am J Orthod Dentofacial Orthop. 2017;151(5):929-940. doi: 10.1016/j.ajodo.2016.10.027 PMID: 28457271
  21. Brito FC, Brunetto DP, Nojima MCG. Three-dimensional study of the upper airway in different skeletal Class II malocclusion patterns. Angle Orthod. 2019;89(1):93-101. doi: 10.2319/112117-806.1 PMID: 30230378
  22. Di Carlo G, Polimeni A, Melsen B, Cattaneo PM. The relationship between upper airways and craniofacial morphology studied in 3D. A CBCT study. Orthod Craniofac Res. 2015;18(1):1-11. doi: 10.1111/ocr.12053 PMID: 25237711.
  23. Indriksone I, Jakobsone G. The upper airway dimensions in different sagittal craniofacial patterns: a systematic review. Stomatologija. 2014;16(3):109-17 PMID: 25471995
  24. 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. doi: 10.1111/ocr.12029 PMID: 24033888.
  25. Alves PV, Zhao L, O'Gara M, Patel PK, Bolognese AM. Three-dimensional cephalometric study of upper airway space in skeletal Class II and III healthy patients. J Craniofac Surg. 2008;19(6):1497-507. doi: 10.1097/SCS.0b013e31818972ef PMID: 19098539
  26. El H, Palomo JM. An airway study of different maxillary and mandibular sagittal positions. Eur J Orthod. 2013;35(2):262-70. doi: 10.1093/ejo/cjr114 PMID: 22045695
  27. Claudino LV, Mattos CT, Ruellas AC, Sant' Anna EF. Pharyngeal airway characterization in adolescents related to facial skeletal pattern: a preliminary study. Am J Orthod Dentofacial Orthop. 2013;143(6):799-809. doi: 10.1016/j.ajodo.2013.01.015 PMID: 23726330
  28. 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.
  29. El H, Palomo JM. Airway volume for different dentofacial skeletal patterns. Am J Orthod Dentofacial Orthop. 2011;139(6):e511-21. doi: 10.1016/j.ajodo.2011.02.015 PMID: 21640863
  30. Alves M Jr, Franzotti ES, Baratieri C, Nunes LK, Nojima LI, Ruellas AC. Evaluation of pharyngeal airway space amongst different skeletal patterns. Int J Oral Maxillofac Surg. 2012;41(7):814-9. doi: 10.1016/j.ijom.2012.01.015 PMID: 22365893
  31. Grauer D, Cevidanes LS, Styner MA, Ackerman JL, Proffit WR. Pharyngeal airway volume and shape from cone-beam computed tomography: relationship to facial morphology. Am J Orthod Dentofacial Orthop. 2009;136(6):805-14. doi: 10.1016/j.ajodo.2008.01.020 PMID: 19962603
  32. 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. doi: 10.1016/j.ajodo.2005.01.033 PMID: 17169736
  33. Diwakar R, Kochhar AS, Gupta H, Kaur H, Sidhu MS, Skountrianos H, Singh G, Tepedino M. Effect of Craniofacial Morphology on Pharyngeal Airway Volume Measured Using Cone-Beam Computed Tomography (CBCT)-A Retrospective Pilot Study. Int J Environ Res Public Health. 2021;18(9):5040. doi:10.3390/ijerph18095040 PMID:34068732.
  34. Trenouth MJ, Timms DJ. Relationship of the functional oropharynx to craniofacial morphology. Angle Orthod. 1999;69(5):419-23. doi: 10.1043/0003-3219(1999)069<0419:ROTFOT>2.3.CO;2 PMID: 10515139.