Pharyngeal Airway In Patients Research Articles

Three-Dimensional Evaluation of the Effects of Different Treatment Methods on Pharyngeal Airways in Patients with Skeletal Class III Malocclusion.

Background and Objectives: The aim of this prospective study was to assess the effects of rapid maxillary expansion (RME) and/or face mask (FM) treatments on the pharyngeal airway in patients with skeletal Class III malocclusion caused by maxillary deficiency. This study utilized cone beam computed tomography (CIBT) for a three-dimensional (3D) analysis of airway changes, comparing the results with those of a control group consisting of untreated skeletal Class III patients. Materials and Methods: The study included 60 participants (34 boys, 26 girls) aged 9 to 14 years, all diagnosed with skeletal Class III malocclusion due to maxillary underdevelopment. The participants were divided into four treatment groups, each consisting of 15 individuals: Group 1-RME; Group 2-RME/FM; Group 3-FM; Group 4-Control group. The pharyngeal airway measurements were evaluated using CBCT and analyzed with Dolphin 3D software (version 11.9). Volumetric parameters and minimal axial area (MAA) were measured in the nasopharyngeal, retropalatal, retroglossal, and total airway regions. The collected data were statistically analyzed using SPSS 20.0 software. Results: The results indicated significant changes in pharyngeal airway volumes across all treatment groups compared to the control group. A statistically significant increase in nasopharyngeal, retropalatal, and total airway volume were observed in all treatment groups. Only the RME group demonstrated a significant increase in retroglossal volume. Significant increases in MAA were found in the RME/FM and FM groups in the nasopharyngeal and retropalatal regions. However, minimal changes were observed in the retroglossal region across all treatment groups. The control group showed no significant changes in any of the measured parameters, underscoring the effects of the treatments. Conclusions: The findings of this study suggest that both RME and/or FM treatments result in significant positive changes in the pharyngeal airways, particularly in the nasopharyngeal and retropalatal regions. The retroglossal region showed more limited response to the treatments. The combined RME/FM therapy was found to be particularly effective in improving airway dimensions in the anterior and mid-pharyngeal regions. These results highlight that early orthodontic interventions, such as RME and FM, can improve both airway patency and overall respiratory function, in addition to addressing skeletal Class III malocclusion.

Assessment of pharyngeal airway space with MRI In oral submucous fibrosis: A cross-sectional observational study

IntroductionOral submucous fibrosis (OSMF) alters the pharynx, which may affect airway size. MRI will be useful for diagnosing pharyngeal abnormalities. MRI is used to evaluate pharyngeal airway and soft palate changes in OSMF patients. Materials and methodsThis study is a cross-sectional observational study that included a sample size of 42 patients. Group A consisted of 21 patients with OSMF, while Group B consisted of 21 volunteers without OSMF, who served as the control group. The patients with OSMF were classified into Stages I, II, and III according to the categorization established by Pindborg JJ in 1989, Stop-Bang questionnaire was employed to assess obstructive sleep apnoea. Magnetic Resonance Imaging (MRI) was utilized to acquire evaluations of the pharyngeal airway, encompassing measurements in the midsagittal, cross-sectional width, length planes, and cross-sectional area with volume, for all participants. The Shapiro-Wilk test determines distribution normality. We utilized one-way ANOVA to compare the means between groups. ResultsThe average age of OSMF patients was 45.9 ± 8.16, while the control group was 39.19 ± 4.21. Stage I of OSMF had the highest mean Stop Bang questionnaire score (2.75), followed by stage III (2.22), and stage II (1.75). Statistically significant differences (p < 0.001) were seen in volume, linear midsagittal planes, cross-sectional width and length planes, cross-sectional area, and soft palate breadth and length between OSMF and control groups. ConclusionMRI can effectively examine early changes in the pharyngeal airway of patients with OSMF thereby serving as a constructive diagnostic and motivational tool.

Orthognathic surgery improves compromised natural head position and pharyngeal airway in patients with Skeletal Class II or III malocclusion.

Natural head position (NHP), pharyngeal airway and maxillofacial growth pattern are correlated. The author's previous studies proved that following surgical correction of Skeletal Class II malocclusion, the over-extended NHP returned upright, and the pharyngeal airway space (PAS) dimension expanded. The present study compares the post-operative change in NHP and PAS after orthognathic surgery in Skeletal Class II and III malocclusion patients. Patients receiving orthognathic procedures to correct Skeletal Class II or III malocclusions were reviewed in this retrospective study. Pre-operative and 6-week post-operative cone-beam computed tomography datasets were collected. Variables representing the craniofacial pattern, the NHP and the PAS were measured three-dimensionally. Post-operative variables were compared with their pre-operative counterparts using either repeat-measure 2-way analysis of variance or Wilcoxon matched-pairs signed rank test. Thirty cases of Skeletal Class II malocclusion and 13 cases of Skeletal Class III malocclusion were collected. Preoperatively, the inter-group differences were significant in craniofacial pattern (68.14 ± 3.552 degree vs. 79.63 ± 2.497 degree, p < .0001) and the NHP (68.77 ± 11.02 degree vs. 82.83 ± 7.738 degree, p = .0002) while not significant in PAS; after surgery, the intergroup differences in craniofacial pattern and the NHP between groups decreased, and the PAS increased in both groups. Orthognathic surgery may improve compromised NHP and increase PAS in Skeletal Class II and III malocclusion patients.

Assessment of pharyngeal airway space in patients with different maxillofacial skeletal abnormalities using cone beam computed tomography

Background. The patency of the pharyngeal airway has a far-reaching impact on craniofacial development. Conversely, the position of the maxillofacial skeletal components in certain disorders may lead to a compromised airway. Therefore, the evaluation of the airway is an essential step in treatment planning. Objectives. The basic aim of this study was to measure the pharyngeal air space volume in the patients with maxillofacial skeletal abnormalities (like Class II, Class III malocclusion, TMJ Ankylosis, Condylar abnormalities and Syndromic cases) and those without any skeletal abnormalities. The objectives were to assess the Linear, Cross-sectional, and Volumetric dimensions of the pharyngeal airway in patients with and without maxillofacial skeletal abnormalities. (Study and Control group) Materials and methods. The Study group included 49 patients with maxillofacial Skeletal abnormalities like Class II and Class III malocclusion, Temporomandibular Joint Ankylosis, Condylar abnormalities, Syndromic cases. 49 Control group patients did not present with any skeletal abnormalities. The Linear, Cross-sectional, and Volumetric dimensions of the pharyngeal airway in the Study group and Control group were calculated and compared within the groups. Statistical Analysis: Unpaired t -test, ANOVA test and Tukey’s Post Hoc analysis test were for the data analysis of the above study. Outcomes. The Anteroposterior dimension of the airway at the Superiormost level was found to be significantly greater in Class II (p-value-0.039), Class III (p-value-0.002), and Control groups (p-value &lt;0.001) when compared with the TMJ Ankylosis group. The Volume and Cross-sectional area of the airway at the most constricted level of the airway was found to be significantly greater in Class III (p-value &lt;0.001) and Control group (p-value 0.013, 0.003) respectively when compared with the TMJ Ankylosis group. Conclusions. The pharyngeal airway was narrowest anteroposteriorly at all three levels (Superior-most, Most constricted, and Inferior-most levels) in the TMJ Ankylosis group and widest in the Class III group. The least cross-sectional area was found in the TMJ Ankylosis group whereas the greatest was found in the Class III group. The airway volume in the TMJ Ankylosis group and Class II group is significantly lesser than that of the Control group.

Short-term Volumetric and Minimal Area Changes in the Pharyngeal Airway After Use of a Fixed Functional Appliance: A Three-dimensional CBCT Investigation

Objective Functional appliances are used in orthodontics to bring about correction of mandibular retrognathism by forward positioning and eventually remodeling the condyle- glenoid fossa to retain this new position. Research has shown that these appliances have a significant effect on pharyngeal airway of patients. The aim of this study was to evaluate changes in volume and minimum constriction area in the pharyngeal airway using CBCT imaging after correction of mandibular retrognathism with an Advansync2 Class II corrector. Methods This single-center study consisted of 20 Class II patients (mean age 14.8 years) who required correction of mandibular retrognathism. The patients were treated with the Advansync2 Class II corrector for an average of 26 weeks. CBCT records were taken at T0 (beginning of treatment) and T1 (end of functional phase). The airway was segmented into lower nasopharynx, velopharynx and oropharynx and analyzed for changes in partial volume, total volume, and minimum area using a CBCT software [NewTom 3GTM (Newtom- Cefla S.C., Verona, Italy)]. Results The partial and total volumes were significantly larger at T1 than at T0 ( p = .003, .001). In addition, minimum area also improved in each part of the airway ( p = .005, .022, .001). Conclusion The Advansync2 fixed functional appliance can be used in Class II patients requiring improvement in their airway dimensions. However, additional long-term studies are recommended to confirm these findings.

Three-Dimensional Comparative Changes in the Pharyngeal Airway of Patients with Cleft after Two-Jaw Orthognathic Surgery.

The present study evaluated the three-dimensional changes of the pharyngeal airway after orthognathic surgery (OGS) in patients with unilateral and bilateral clefts, and in unilateral cleft patients with and without pharyngeal flap (PF). Forty-five patients with unilateral or bilateral clefts undergoing OGS were enrolled. Cone-beam computed tomographic images were obtained before and after OGS. We measured the pharyngeal airway volumes, minimal cross-sectional area, and the horizontal displacement of facial landmarks. The patients with bilateral cleft exhibited smaller initial velopharyngeal volume (unilateral, 8623 mm 3 ; bilateral, 7781 mm 3 ; P = 0.211), whereas the velopharyngeal volume increased significantly with a median of 744 mm 3 after OGS ( P = 0.031). The median horizontal displacement of A point was 2.9 and 2.6 mm among the patients with unilateral and bilateral clefts, respectively ( P = 0.276), and the median horizontal displacement of B point was -2.9 and -3.3 mm among patients with unilateral and bilateral clefts, respectively ( P = 0.618). The unilateral cleft patients with PF exhibited lower initial velopharyngeal volume (patients with a history of PF surgery, 7582 mm 3 ; patients without a history of PF surgery, 8756 mm 3 ; P = 0.129) and a lower increase in velopharyngeal volume (patients with a history of PF surgery, 437 mm 3 ; patients without a history of PF surgery, 627 mm 3 ; P = 0.739) after OGS. Midface hypoplasia and the decrease in the velopharyngeal volume were more prominent among the bilateral cleft patients and the unilateral cleft patients with PF. After OGS, the velopharyngeal volume increased considerably among the bilateral cleft patients, but no considerable differences were noted among the unilateral cleft patients with PF. Risk, II.

Comparison of airway changes after maxillomandibular advancement with or without genial tubercle advancement in obstructive sleep apnea using cone-beam computed tomography

This study compared the airway changes of patients with obstructive sleep apnea (OSA) after maxillomandibular advancement (MMA) with or without genial tubercle advancement (GTA) using cone-beam computed tomography. The authors retrospectively studied 26 patients with moderate to severe OSA who underwent MMA with or without GTA. Airway changes were determined from preoperative and postoperative 3-dimensional reconstructed cone-beam computed tomography images. The Wilcoxon signed rank test, Mann-Whitney U tests, and Spearman correlation coefficients were used in data analysis. Airway was changed in all dimensions significantly after MMA with or without GTA. There was no significant difference in horizontal surgical changes between MMA and MMA with the GTA group. The mean increase in total airway volume was 66.8% for MMA alone and 74.7% for MMA with GTA (P= 0.39). Patients who underwent MMA had a larger percentage change of segmented upper airway volume than patients with MMA and GTA (106.6% vs 85.3%; P= 0.65). The group with MMA and GTA had a greater percentage change of segmented lower airway volume than the MMA alone group (80.1% vs 56.3%; P= 0.42). Differences in airway changes between MMA alone and MMA with GTA were not statistically significant. Performing the GTA concomitantly with MMA may not cause greater improvement in the pharyngeal airway in patients with OSA compared with MMA alone.

Geometric morphometric analysis of the pharyngeal airway during treatment of Class III malocclusion

The pharyngeal airway is important during diagnosis and treatment planning in orthodontics. This study aimed to compare the changes in the shape of the pharyngeal airway in patients with Class III malocclusion treated with a facemask (FM) with a removable maxillary appliance and modified tandem traction bow appliance (MTTBA). This study consisted of pretreatment and posttreatment lateral cephalograms of 35 subjects with skeletal and dental Class III malocclusion. In the first group, 20 patients (12 males, 8 females; mean age, 10.2 years) were treated with MTTBA. The mean treatment time was 12 months. In the second group, 15 patients (10 males, 5 females; mean age, 10.3 years) were treated with FM. The mean treatment time was 11.7 months. Nineteen pharyngeal landmarks were considered from the image corresponding to the midsagittal plane and marked using tpsDig software (version 2.04; Stony Brook, NY). Pharyngeal airway shape difference between the groups was assessed by performing a Generalized Procrustes analysis. The shape deformation of the pharyngeal airway from the pre- to posttreatment periods was evaluated using the thin-plate spline method. There were no differences between MTTBA and FM groups according to airway shape for pretreatment and posttreatment periods. However, there were some deformities using the enlargement of the nasopharyngeal area in the FM group and oropharyngeal area in the MTTBA group according to pretreatment periods. There were no differences between the groups according to the mean pharyngeal airway shapes when the posttreatment periods of the FM and MTTBA groups were examined.

Airway Growth in Preoperative Patients with Crouzon Syndrome.

Background: Obstructive sleep apnea is common in patients with Crouzon syndrome, yet it may be caused by multiple factors. This study aims to investigate the natural history of airway development in preoperative Crouzon patients, from infants to adults. Methods: Preoperative computed tomography (CT) scans (Crouzon syndrome, n = 73; control, n = 87) were divided into five age subgroups. CT scans were measured using Materialise software. Results: Before 6 months of age, nasal airway volume in patients with Crouzon syndrome was smaller than normal by 37% (p = 0.002), and the cross-sectional area at the choana reduced by 45% (p < 0.001). The reduction of nasal airway volume and cross-sectional area reached their nadir at 2 years of age, with shortening of 44% and 63% (both p < 0.001), respectively. They gradually caught up to normal dimensions after 6 years of age. Between 2 and 6 years, the pharyngeal airway in patients with Crouzon syndrome reduced 44% (p = 0.011) compared with controls. However, the airway cross-sectional area at condylion and gonion levels was less than normal, before 6 months (35%, p = 0.024) and (44%, p = 0.006) after 2 years of age, respectively. This reduction remains into adulthood. Conclusion: Nasal airway volume is more limited in children with Crouzon syndrome who are younger than 2 years of age. Whereas after 2 years of age, the pharyngeal airway develops significant volume restriction, leading to timing and specific treatment area foci based on the site of temporal maximal constriction.

The effect of nasal and oral breathing on airway collapsibility in patients with obstructive sleep apnea: Computational fluid dynamics analyses.

The purpose of this study was to investigate the effect of breathing route on the collapsibility of the pharyngeal airway in patients with obstructive sleep apnea by using computational fluid dynamics technology. This study examined Japanese men with obstructive sleep apnea. Computed tomography scans of the nose and pharynx were taken during nasal breathing with closed mouth, nasal breathing with open mouth, and oral breathing while they were awake. Three-dimensional reconstructed stereolithography models and digital unstructured grid models were created and airflow simulations were performed using computational fluid dynamics software. Airflow velocity was significantly higher during oral breathing than during nasal breathing with open or closed mouth. No significant difference in maximum velocity was noted between nasal breathing with closed and open mouth. However, airflow during nasal breathing with open mouth was slow but rapidly sped up at the lower level of the velopharynx, and then spread and became a disturbed, unsteady stream. In contrast, airflow during nasal breathing with closed mouth gradually sped up at the oropharyngeal level without spreading or disturbance. Negative static pressure during oral breathing was significantly decreased; however, there were no significant differences between nasal breathing with closed or open mouth. Computational fluid dynamics results during nasal and oral breathing revealed that oral breathing is the primary condition leading to pharyngeal airway collapse based on the concept of the Starling Resistor model. Airflow throughout the entirety of the breathing route was smoother during nasal breathing with closed mouth than that with open mouth.

Three-Dimensional Measurements of Pharyngeal Airway in Patients with Unilateral Cleft Lip and Palate.

The aim of this study was to investigate 3-dimensional (3D) airway volume in patients with unilateral cleft lip and palate (UCLP) using computed tomography (CT). The study population comprised 15 UCLP patients (UCLP group) scheduled to receive alveolar bone grafts and 15 with impacted teeth (control group). The clinical requirements for a CT scan were met in both groups. Measurements were recorded from 3D reconstructions of Digital Imaging and Communications in Medicine data obtained from the CT images. Airway volume, cross-sectional area, and linear and angular measurements were recorded. Airway volume and cross-sectional area showed no significant difference between the two groups. The narrowest section of the airway in the UCLP group was tighter than that in the control group, however (p=0.017). The results of this study suggest that this difference in the measurements of the narrowest section of the airway is involved in the particular maxillofacial morphology found in UCLP patients.

Cone-Beam Computed Tomography Evaluation of Skeletal Deformities and Pharyngeal Airway in Chinese Han Individuals With Nonsyndromic Unilateral Cleft Lip and Palate.

This study examined the relationships between skeletal deformities and the pharyngeal airway of patients with nonsyndromic unilateral cleft lip and palate (UCLP). Retrospective study. Orthodontics and Oral and Maxillofacial Surgery Departments in the Affiliated Hospital of Stomatology, Nanjing Medical University, China. The sample comprised 30 nonsyndromic UCLP patients and 30 healthy controls. Each group has 23 males and 7 females. All cone-beam computed tomography images were obtained with the participant in the standard supine position and asked to bite with intercuspal position without swallowing or moving their heads and tongues during scanning. SNA, SNB, ANB, anterior cranial base, Wits appraisal, maxillary length (PTM-ANS || FH), maxillary position (S-PTM || FH), mandibular length (Go-Pog || MP), FMA, posterior face height, anterior face height, Posterior-Anterior face height, lower face height, pharyngeal airway volumes, and areas were evaluated by Dolphin imaging software. The UCLP group showed significantly decreased SNA, SNB, ANB, PTM-ANS || FH, S-PTM || FH, P-A Face Height compared with the controls. However, the airway volumes and areas showed no significant difference between 2 groups. The total airway volume and minimum cross-sectional area in UCLP patients were related to the Go-Pog || MP and FMA. Patients with UCLP have both the maxillary and mandibular deficiencies in the sagittal dimension. Both the sagittal and vertical relationships of the jaw might affect the airway volume and area. However, no significant difference was detected in airway volume and area in UCLP patients when compared with the controls.

Pharyngeal Airway Modifications in Skeletal Class III Patients Undergoing Bimaxillary Advancement Surgery

The purposes were to study the pharyngeal airway in patients with skeletal Class III malocclusion submitted to surgical orthodontic treatment and to correlate the alterations with bone movements. The sample consisted of multislice computed tomography images from 13 patients obtained before and 6months after maxillomandibular advancement surgery. The following measurements were obtained using Dolphin Imaging software (Dolphin Imaging, Chatsworth, CA): volume and area of the oropharynx, nasopharynx, and total airway, as well as the most constricted area, anteroposterior and lateral dimensions of the narrowest axial cross-sectional area, and airway length. The paired ttest was applied at a significance level of 5%. Sagittal displacement of the maxilla and mandible was correlated with airway alterations using the Pearson correlation test. Alterations in airway measurements were observed in all patients after surgery. We noted a significant increase (P<.05) in total airway area, oropharyngeal area, and anteroposterior dimension of the most constricted area, as well as a significant reduction (P<.05) in airway length. A significant correlation (P<.05) was observed between nasopharyngeal area and maxillary movement and between airway length and mandibular movement (P<.05). The results of this study suggest significant alterations in pharyngeal airway measurements when preoperative and postoperative periods of bimaxillary advancement surgery were compared.

Evaluation of Airway Volume in Cleft Lip and Palate Following Nasoalveolar Molding.

Patients with cleft lip and palate (CLP) have commonly reduced nasal airways and are more prone to snoring, mouth breathing and hypopnea during sleep. Therefore, the morphometric evaluation of pharyngeal airway in patients with CLP is crucial. The purpose of this study is to evaluate the pharyngeal airway volumes of patients with CLP who underwent nasoalveolar molding (NAM) and to compare them with a well-matched control group without NAM. The study consisted of 40 patients with CLP divided into 2 main groups (26 with NAM; 14 without NAM) and 4 subgroups (15 unilateral CLP [UCLP] with NAM, mean age: 10.13 ± 1.30 years; 11 bilateral CLP [BCLP] with NAM, mean age: 10.55 ± 1.51 years; 7 UCLP without NAM, mean age: 9.86 ± 1.68 years; 7 BCLP without NAM, mean age: 10.28 ± 1.89 years). Nasopharyngeal, oropharyngeal, and total airway volumes of all the patients were calculated 3-dimensionally with cone-beam computed tomography. There were statistically significant differences in nasopharyngeal volume (P < 0.05) of NAM group compared to control group; however, volumetric differences in oropharyngeal and total pharyngeal airway were not significant (P > 0.05). The amount of nasopharyngeal, oropharyngeal, and total pharyngeal airway size in the BCLP with NAM group was significantly larger compared to BCLP without NAM group (P < 0.05). However, UCLP did not show any significant difference in NAM group (P > 0.05). This study implies that NAM can effectively enlarge the nasopharyngeal airway size in patient with CLP. In addition, the pharyngeal airway volume enlargement is more apparent in BCLP than UCLP individuals.

Effects of maxillary protraction therapy on the pharyngeal airway in patients with repaired unilateral cleft lip and palate: A 3-dimensional computed tomographic study.

The purposes of this study were to assess the effects of maxillary protraction therapy on the pharyngeal airways in patients with repaired unilateral cleft lip and palate (UCLP) 3 dimensionally. Eighteen patients with repaired UCLP and anterior crossbite (ages, 10.4±1.3years) were enrolled in the study group. Hyrax appliances and reverse headgears were used. Cone-beam computed tomography volume scans were taken before and immediately after treatment. Fourteen patients (ages, 9.6±1.7years) with UCLP who did not receive orthopedic treatment served as the control group. The volumes of the pharyngeal airways, cross-sectional areas, sagittal diameters, and transversal diameters of 3 levels of airway cross-section were measured. After protraction, the volumes of the pharyngeal airway increased significantly. Cross-sectional area, sagittal diameter, and transversal diameter of the upper and lower pharyngeal airways also had significant increases. These changes were significant when compared with the untreated subjects except for the transversal diameter of the lower pharyngeal airway. Dimensions of the middle pharyngeal airway remained unchanged. Maxillary protraction therapy significantly affects airway dimensions in patients with repaired UCLP 3 dimensionally.

The effect of early versus late palate repair on pharyngeal airway volume in patients with unilateral cleft lip and palate

Context: Timing of surgical repair of cleft and its effect on volume of pharyngeal airway have not been investigated thoroughly. Aim: The aim of the study was to assess the effect of timing of palate repair on pharyngeal airway in patients born with unilateral cleft lip and palate (UCLP) using cone beam computed tomography (CBCT). Settings and Design: The design was a retrospective study. Subjects and Methods: The study was carried out on 20 surgically treated UCLP patients and 40 normal noncleft subjects with Class I skeletal relation within the age group of 7–14 years. Twenty UCLP subjects were further divided into two groups (early palatal repair n = 11 and late palatal repair n = 9) according to their age at which initial hard palate repair was performed. Forty normal noncleft subjects were included in the control group. Results: No significant difference was found in volume of nasopharynx, oropharynx, hypopharynx, total pharyngeal volume ( P = 0.83), and minimum axial area ( P = 0.90) of the pharynx between the groups. Conclusions: Using CBCT, this study found that there was no significant difference in the pharyngeal airway between early and late hard palatal surgery.

Assessment of the Airway Characteristics in Children with Cleft Lip and Palate using Cone Beam Computed Tomography.

ABSTRACTObjective: The aim of our study is to use cone beam computed tomography (CBCT) to assess the dimensional changes in the nasopharyngeal soft-tissue characteristics in children of Indian origin with repaired cleft lip and palate (CLP) and to compare the results with patients with ideal occlusion.Materials and methods: A sample of 20 children (10 girls, 10 boys) with repaired CLP was selected. Cone beam computed tomography scans were taken to measure the nasopharyngeal airway changes in terms of linear measurements and sagittal cross-sectional areas. Error analysis was performed to prevent systematic or random errors. Independent means t-tests and Pearson correlation analysis were used to evaluate sex differences and the correlations among the variables.Results: Nasopharyngeal soft-tissue characteristics were different in the control and the study groups. Subjects with repaired CLP had lesser lower aerial width, lower adenoidal width and lower airway width. The upper airway width was also significantly lesser. The retropalatal and the total airway area were significantly greater in the control group.Conclusion: The narrow pharyngeal airway in patients with CLP might result in functional impairment of breathing in patients. Further investigations are necessary to clarify the relationship between pharyngeal structure and airway function in patients with CLP.How to cite this article: Agarwal A, Marwah N. Assessment of the Airway Characteristics in Children with Cleft Lip and Palate using Cone Beam Computed Tomography. Int J Clin Pediatr Dent 2016;9(1):5-9.

Effects of reverse headgear on pharyngeal airway in patients with different vertical craniofacial features.

The aim of this study was to investigate the effects of reverse headgear (RH) on pharyngeal airway morphology in two groups of Class III patients with different vertical craniofacial features in comparison with an untreated Class III group. Seventeen subjects (9 males, 8 females; mean age 11.3 ± 0.98 years) with optimum vertical growth and 17 subjects (10 males, 7 females, mean age 11.5 ± 1.1 years) with a vertical growth pattern treated with a removable intra-oral appliance and a Delaire type facemask were included. An untreated Class III control group of 11 subjects (8 males, 3 females, mean age 9.1 ± 1.1 years) was included to compare the treated groups. The paired t-test for intragroup and one-way ANOVA for intergroup comparisons were performed. The relationships between changes in the craniofacial morphology and airway were assessed by Spearman correlation analysis. The airway dimensions at the adenoid side and soft palate were increased in the treatment groups compared to the control group (p < 0.05). The nasopharyngeal area demonstrated a significant difference in normodivergent and control subjects (p < 0.05). No significant difference was found in the airway morphology due to different vertical features. The effect of RH treatment on the sagittal airway dimensions revealed no significant difference between different vertical craniofacial features in the short term.

Three-dimensional analysis of pharyngeal airway in skeletal Class III patients after sagittal split ramus osteotomy

To analyze the three-dimensional changes of pharyngeal airway in patients with skeletal Class III malocclusion after the combined orthodontic and orthognathic treatment. Twenty patients (9 males, 11 females) and 40 subjects with normal occlusion were involved in the study. Cone-beam computed tomography (CBCT) were performed on patients one week and six months after treatment. Raw data were reconstructed into three-dimensional model and sagittal and transversal measurements, cross sectional areas, partial and total volumes were computed. After treatment, the sagittal diameters of each section were significantly reduced by (2.7 ± 3.5), (3.0 ± 3.8), (2.7 ± 3.3) mm, respectively (P < 0.05). The transversal diameter of laryngopharyngeal airway constricted significantly by (4.8 ± 4.1) mm (P < 0.05). Cross sectional areas and volumes of each part in patients after surgery were significantly narrower compared with those of the controls. After combined therapy the pharyngeal airway space decreased.

Clinical significance of upper airway obstruction pattern during apneic episodes on ultrafast dynamic magnetic resonance imaging

Objectives In order to assess the relationship between upper airway obstruction pattern and the clinical characteristics of obstructive sleep apnea syndrome (OSAS), we evaluated dynamic changes in the pharyngeal airway of patients with the disorder by using ultrafast dynamic magnetic resonance imaging (MRI). Methods MRI while asleep was performed on 31 patients with OSAS (29 men, 2 women; mean age, 46.6 ± 8.2 years; mean body mass index, 26.7 ± 4.9 kg/m 2; mean AHI, 40.6 ± 21.7 episodes/h). Relationships between obstruction pattern focusing on differences between single-site obstruction (SO) and multiple-site obstructions (MO) and titrated value of nasal CPAP in addition to respiratory variables were investigated. Results The velopharynx (VP) was the main obstructive site among most of the cases with SO (17 of 18 cases), and all of the cases with MO ( n = 13) showed obstruction at and below the VP. AHI was significantly higher in cases with MO than in those with SO ( P < 0.01). As for SaO 2 variables, minimum value during sleep was significantly lower and total time with SaO 2 £90% was longer in cases with MO than in those with SO ( P < 0.05 each). Titrated value of n-CPAP was also significantly higher in cases with MO than in cases with SO ( P < 0.05). Conclusions Our results strongly suggest that formation of MO manifested on ultrafast dynamic MRI could be related to increased severity of the disorder. Considering the higher titrable value of CPAP, MO could be brought about by high pharyngeal pressure.