Mandibular morphology and pharyngeal airway space: A cephalometric study

Cephalometry as an aid in the diagnosis of pediatric obstructive sleep apnoea: A systematic review and meta-analysis

Background

Obstructive sleep apnoea (OSA) is part of a spectrum of sleep disorders causing snoring, gasping, and choking while sleeping. In children, OSA can also lead to behavioural issues, hyperactivity, and poor academic performance. Thus, early identification and management of OSA in children is crucial in preventing long-term health problems. The gold standard test for diagnosis is an overnight in-lab polysomnography (PSG). However, due to certain constraints associated with PSG, such as lack of accessibility, high expenses incurred, as well as the need for hospitalization, alternative diagnostic tools are needed. Cephalometry is a non-invasive, affordable diagnostic tool that may offer useful information in the evaluation of OSA. The present systematic review and meta-analysis aimed to evaluate the various cephalometric parameters associated with the diagnosis of OSA in children.

Methods

A structured literature search was performed using the search engines PubMed, Scopus, Web of Science, Cochrane, and Google scholar from inception till July 2022. The weighted mean difference (z-test) was calculated using a random effects method (REM).

Results

16 studies were included in the review and meta-analysis was executed for each cephalometric parameter. The parameters of significance (p < 0.05) in Pediatric OSA with lower heterogeneity were associated with McNamara's and Linder-Aronson's analysis, the hyoid bone position, a retrognathic mandible, and an acute cranial base angle.

Conclusions

Certain parameters in craniofacial morphology may be reliable diagnostic parameters. Further long-term studies are needed in order to shed more light in this area.

Cephalometric Evaluation of the Upper Airway in Different Skeletal Classifications of Jaws

BACKGROUND

Respiratory system is an important section in development of maxillofacial components and many studies indicated its effect on normal growth of the jaws. The aim of this study is to evaluate upper airway in different skeletal classifications of jaws in lateral cephalogram and its relation to age and gender.

MATERIALS AND METHODS

Study samples were 105 digital cephalometric radiographies, 72 females and 33 males. Lateral cephalograms were hand traced and based on Stainer analysis, there were 30 samples in Class I, 30 samples in Class II and 45 samples in Class III subgroup. Vertical linear measurements, horizontal linear measurements, and angular measurement, proportions and space measurements of the airway in the Cephalograms were analyzed by AutoCAD software.

RESULTS

Data were analyzed using SPSS software version 20. Two horizontal linear measurement (the hypo pharyngeal airway depth, the nasopharyngeal airway depth) and one space measurement (soft palate space) were significantly different in skeletal classes. Vertical and horizontal linear measurements in the 3 groups were increased significantly in men rather than women. The developmental age of groups showed some significant differences.

CONCLUSION

Upper airway dimension is different in different skeletal classes, developmental ages, and gender.

Friedman tongue position and cone beam computed tomography in patients with obstructive sleep apnea

Objective

Evaluate the correlation between Friedman Tongue Position (FTP) and airway cephalometrics in patients with obstructive sleep apnea (OSA).

Study Design

Retrospective review of adult patients with OSA undergoing Cone Beam Computed Tomography (CBCT).

Methods

Collected data included age, sex, body mass index, apnea hypopnea index, FTP, and airway cephalometric parameters. Data analyses were performed using ANOVA, dichotomous t‐testing, and linear regression.

Results

203 patients were included in the analysis. (M:F 132:71). The mean posterior airway space (PAS) was inversely correlated (p = 0.001, r =.119) with higher FTP grades with means of 12.3 mm, 7.9 mm, 6.6 mm, and 4.3 mm, I‐IV respectively. Minimal cross‐sectional area for patients with FTP I‐IV was 245.7, 179.8, 137.6, and 74.2 mm, 2 respectively (p = 0.002, r = .095). Mean hyoid‐mandibular plane (H‐MP) for FTP I‐IV was 20.6 mm, 20.4 mm, 24.7 mm, and 28.9 mm respectively. No statistically significant difference between H‐MP values when comparing patients with FTP I or II (p = 0.22). There were statistically significant differences when these two groups were individually compared to FTP III and IV (p = 0.002). Linear regression analysis confirmed an independent association between FTP and PAS (β = −2.06, p < 0.001), minimal cross‐sectional area (β = −45.07, p = 0.02), and H‐MP (β = 3.03, p = 0.01) controlling for BMI, age, AHI, and sex.

Conclusions

Use of FTP is supported by objective CBCT cephalometric results, in particular the PAS, minimal cross‐sectional area, and H‐MP. Understanding the correlation between objective measurements of retroglossal collapse should allow Otolaryngologists to more confidently select patients who may require surgery to address the retroglossal area, particularly when the ability to perform cephalometric analysis is not possible

Level of Evidence

4.