CC BY 4.0 · European Journal of General Dentistry
DOI: 10.1055/s-0045-1804927
Original Article

A Study on the Association between Skeletal Malocclusion, Upper Airway Cross-Sectional Area, and Upper Airway Volume Using CBCT Scans

Yazan Mohamad Mahmoud
1   Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
,
1   Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
,
Saad Al-Bayatti
1   Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
,
Snigdha Pattanaik
2   Department of Orthodontics, Pediatric and Community Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
,
Kamis Gaballah
1   Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
,
Serene Badran
2   Department of Orthodontics, Pediatric and Community Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
3   Department of Pediatric Dentistry, Orthodontics and Preventive Dentistry, The University of Jordan, Jordan
,
Nisha Manila
4   College of Dental Medicine, California Northstate University, Sacramento, California, United States
,
Vinayak Kamath
5   Department of Public Health Dentistry, Goa Dental College and Hospital, Goa, India
,
Asok Mathew
6   Department of Clinical Science, Center for Medical and Bioallied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
,
1   Department of Oral and Craniofacial Health Sciences, College of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
› Author Affiliations
Funding None.

Abstract

Objective The main aim of this study was to analyze the volume and area of the pharyngeal airway among different sagittal skeletal relationships. The secondary aim was to study the association between the upper airway volume and upper airway cross-sections among the three sagittal skeletal relationships.

Materials and Methods A retrospective study of 90 cone beam computed tomography (CBCT) scans of patients reporting for dental treatment to University Dental Hospital, Sharjah was conducted. Among the 90 CBCT scans, 30 scans were of patients with class I skeletal pattern, 30 with class II skeletal pattern, and 30 with class III skeletal pattern. The extract airway module of Romexis software 6.2.1 was used for segmentation of the upper airway. The maximum cross-sectional area (MACA), minimum cross-sectional area (MICA), cross-sectional area at the level of the hard palate cross-sectional area (PCA), and cross-sectional area at the level of the epiglottis cross-sectional area (ECA) of the airway way and volume (Vol) were obtained.

Results There was a significant difference in the cross-sectional airway variables (MACA, MICA, ECA) and volume among patients with class I, II, and III skeletal malocclusion (p < 0.001). The PCA did not show any significant difference among the three study groups (p = 0.13).

Conclusion Patients with skeletal class II malocclusion had the lowest cross-sectional airway variables and volume values among all the study groups. The MICA of the airway was a reliable predictor for airway volume.



Publication History

Article published online:
19 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Eslamian L, Badiee MR, Yousefinia S, Kharazifard MJ. Radiographic assessment of upper airway size in skeletal sagittal and vertical jaw discrepancies. J Islam Dent Assoc Iran 2014; 26 (01) 15-20
  • 2 Swathi K, Margathavalli G. Cephalometric assessment of the width of pharyngeal airway space and correlation with skeletal malocclusion: a retrospective study. J Pharmacological Sci Res 2019; 11 (06) 2263-2266
  • 3 Vilaza I, Araya-Díaz P, Palomino H. Two-dimensional and three-dimensional assessment of the upper airway. Int J Morphol 2017; 35: 357-362
  • 4 Flores-Blancas AP, Carruitero MJ, Flores-Mir C. Comparison of airway dimensions in skeletal class I malocclusion subjects with different vertical facial patterns. Dental Press J Orthod 2017; 22 (06) 35-42
  • 5 Lopatienė K, Šidlauskas A, Vasiliauskas A, Čečytė L, Švalkauskienė V, Šidlauskas M. Relationship between malocclusion, soft tissue profile, and pharyngeal airways: a cephalometric study. Medicina (Kaunas) 2016; 52 (05) 307-314
  • 6 Bronoosh P, Khojastepour L. Analysis of pharyngeal airway using lateral cephalogram vs CBCT images: a cross-sectional retrospective study. Open Dent J 2015; 9: 263-266
  • 7 El Rawdy A, Elgemeeay W. Volumetric analysis of total pharyngeal airway space using cone beam computed tomography among adult Egyptians. Egypt Dent J 2018; 64 (03) 2183-2189
  • 8 Hong J-S, Oh K-M, Kim B-R, Kim Y-J, Park Y-H. Three-dimensional analysis of pharyngeal airway volume in adults with anterior position of the mandible. Am J Orthod Dentofacial Orthop 2011; 140 (04) e161-e169
  • 9 Buyukcavus MH, Kocakara G. Cephalometric Evaluation of Nasopharyngeal Airway and Hyoid Bone Position in Subgroups of Class II Malocclusions. Odovtos International Journal of Dental Sciences 2021; 23 (01) 155-167
  • 10 Steiner CC. Cephalometrics for you and me. Am J Orthod 1953; 39: 729-755
  • 11 Daraze A, Delatte M, Liistro G, Majzoub Z. Cephalometrics of pharyngeal airway space in Lebanese adults. Int J Dent 2017; 2017: 3959456
  • 12 Zheng DH, Wang XX, Ma D, Zhou Y, Zhang J. Upper airway asymmetry in skeletal class III malocclusions with mandibular deviation. Sci Rep 2017; 7 (01) 12185
  • 13 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 (01) 1-11
  • 14 Shokri A, Miresmaeili A, Ahmadi A, Amini P, Falah-Kooshki S. Comparison of pharyngeal airway volume in different skeletal facial patterns using cone beam computed tomography. J Clin Exp Dent 2018; 10 (10) e1017-e1028
  • 15 Vidya B, Dinesh G, Balakrishna R, Khan A. Comparison of 3 dimensional airway volume in class I patients, class II and class III skeletal deformities. Eur J Mol Clin Med 2020; 7 (09) 1219-1241
  • 16 Yıldırım E, Karaçay Ş. Volumetric evaluation of pharyngeal airway after functional therapy. Scanning 2021; 2021: 6694992
  • 17 Bokhari F, Yosafy U, Qayyum F, Jamil A, Jameel M. CBCT based comparison of pharyngeal airway area and volume in patients with angle's class I and class II malocclusion: a retrospective study. Pak J Med Health Sci 2022; 16 (07) 21-23
  • 18 Alves Jr M, Franzotti ES, Baratieri C, Nunes LKF, Nojima LI, Ruellas ACO. Evaluation of pharyngeal airway space amongst different skeletal patterns. Int J Oral Maxillofac Implants 2012; 41 (07) 814-819
  • 19 Ravelo V, Olate G, Muñoz G, de Moraes M, Olate S. The airway volume related to the maxillo-mandibular position using 3D analysis. BioMed Res Int 2021; 2021: 6670191
  • 20 Iwasaki T, Hayasaki H, Takemoto Y, Kanomi R, Yamasaki Y. Oropharyngeal airway in children with class III malocclusion evaluated by cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2009; 136 (03) 318.e1-318.e9 , discussion 318–319
  • 21 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 (05) 379-390
  • 22 Dogan E, Isik A, Dogan S. Comparison of pharyngeal airway dimensions between orthodontic malocclusions: a retrospective study. J Int Oral Health 2020; 12: 385-393
  • 23 Alhammadi MS, Almashraqi AA, Halboub E. et al. Pharyngeal airway spaces in different skeletal malocclusions: a CBCT 3D assessment. Cranio 2021; 39 (02) 97-106
  • 24 Chousangsuntorn K, Bhongmakapat T, Apirakkittikul N, Sungkarat W, Supakul N, Laothamatas J. Upper airway areas, volumes, and linear measurements determined on computed tomography during different phases of respiration predict the presence of severe obstructive sleep apnea. J Oral Maxillofac Surg 2018; 76 (07) 1524-1531
  • 25 Zhang Z, Wang S, Li J, Yang Z, Zhang X, Bai X. Quantification of pharyngeal airway space changes after two-jaw orthognathic surgery in skeletal class III patients. BMC Oral Health 2023; 23 (01) 345
  • 26 Ünüvar YA, Zortuk FB, Özer T, Beycan K. Comparison of the pharyngeal airways of patients with class II malocclusion with different sagittal jaw positions by cone-beam computed tomography. Makara J Health Res 2021; 25 (02) 113-121
  • 27 Al-Somairi MAA, Liu Y, Almashraq AA. et al. Correlation between the three-dimensional maxillomandibular complex parameters and pharyngeal airway dimensions in different sagittal and vertical malocclusions. Dentomaxillofac Radiol 2023; 52 (03) 20220346
  • 28 Sprenger R, Martins LAC, Dos Santos JCB, de Menezes CC, Venezian GC, Degan VV. A retrospective cephalometric study on upper airway spaces in different facial types. Prog Orthod 2017; 18 (01) 25
  • 29 Shetty SS, Sorake A, Shetty N. Comparison of volumetric dimensions of orofacial airway in subjects with class I and class II malocclusion: a CBCT study. J Contemp Orthod 2021; 5 (02) 31-34
  • 30 Dastan F, Ghaffari H, Shishvan HH, Zareiyan M, Akhlaghian M, Shahab S. Correlation between the upper airway volume and the hyoid bone position, palatal depth, nasal septum deviation, and concha bullosa in different types of malocclusion: A retrospective cone-beam computed tomography study. Dent Med Probl 2021; 58 (04) 509-514
  • 31 Zhang W, Phillips A, Wang BY. Correlation analysis between airway volume and risk of sleep apnea/periodontitis. J Oral Maxillofac Res 2022; 13 (02) e5
  • 32 Rodrigues J, Evangelopoulos E, Anagnostopoulos I. et al. Impact of class II and class III skeletal malocclusion on pharyngeal airway dimensions: a systematic literature review and meta-analysis. Heliyon 2024; 10 (06) e27284