Nasal airway dimensions in patients with vertical and horizontal growth patterns: a cone-beam computed tomography evaluation
Date
2014
DOI
Authors
Doyle, Julianne C.
Version
OA Version
Citation
Abstract
Background: Obstructive sleep apnea (OSA) is one of the most commonly studied disorders involving the airway and can have serious consequences on overall health and quality of life. The role of the pharyngeal airway in OSA has been extensively studied. However, the role the nasal airway plays is less understood. The importance of the airway on facial development and malocclusion has been well established. Although greater visualization of anatomy is now possible, classifying the extent of airway disorders cannot be done without a reference. It is therefore important to establish normative values of the airway dimensions from which comparisons can be made. Recent studies have begun to establish normative values of the pharyngeal airway, but normative values of the nasal airway have yet to be established. Knowing these values in patients with different skeletal growth patterns will allow for comparison between these groups and aid in determining if patients presenting with certain skeletal growth patterns have a higher risk of developing sleep apnea or other breathing-related disorders.
Materials and Methods: 107 pre-treatment Cone Beam Computed Tomography (CBCT) films were examined retrospectively and selected from the database of a private orthodontic practice. The sample included subjects ages 9-50 who had previous CBCT scans taken as part of routine orthodontic treatment. Scans were analyzed using Anatomage Invivo5 software to identify both 2-dimensional and 3-dimensional landmarks. A custom cephalometric analysis was generated to evaluate the patients anterior-posterior (AP) growth pattern as well as the vertical growth patterns. Patients were classified by their AP growth patterns as Class I, Class II, and Class III based on the Steiner analysis. Patients were further classified by their vertical growth patterns as normodivergent, hyperdivergent or hypodivergent based on both the mandibular plane angle and the Jarabak analysis. Once the subjects were grouped by growth patterns, the maximum height (mm) and maximum width (mm) of the nasal cavity were measured through 3-dimensional visual inspection.
Statistical Analysis: Descriptive statistics were calculated for the overall sample and within each group. ANOVA as performed to determine differences among the groups for both A-P skeletal growth pattern, and for vertical growth pattern. Intra-examiner reliability was assessed using Kappa statistics
Results: The age range was 9-50 years old with a mean age of 14.66 years and a standard deviation of 7.52. The average maximum height was 44.43mm for females and 43.19mm for males with a P-value of 0.05. The average maximum width was 28.91mm for females and 28.68mm for males. The results show that, on average, the maximum height of the nasal cavity for females is statistically significantly higher than males. The average maximum height of the nasal cavity in skeletal class I, class II, and class III subjects was 43.16mm, 44.25mm, and 45.19mm respectively. The average maximum widths for class I, class II, and class III subjects was 28.70mm, 28.84mm, and 29.13mm respectively. No statistically significant difference in height or width was found in these subjects. The average maximum height in normodivergent, hyperdivergent, and hypodivergent subjects was 43.63mm, 44.22mm, and 43.48mm respectively. The average maximum width in normodivergent, hyperdivergent, and hypodivergent subjects was 29.27mm, 28.42mm, and 28.65mm respectively. No statistically significant difference in height or width was found among these subjects.
Conclusions: The dimensions of the nasal cavity increase with age- both during the pubertal growth spurt and throughout life up to the age of 50. The dimensions in height are also different between males and females with women on average having taller nasal cavities than men. No statistically significant differences were found among subjects with different A-P or vertical growth patterns. Although there was no difference detected in this study, it is likely that with improved technology, we will soon be able to measure the volume of the nasal cavity and compare these measurements among different skeletal groups. The information will aid in diagnosis and treatment planning especially in patients who may be at risk for obstructive sleep apnea.
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Thesis (MSD) --Boston University, Henry M. Goldman School of Dental Medicine, 2014 (Department of Orthodontics and Dentofacial Orthopedics).
Includes bibliographic references: leaves 34-42.
Thesis (MSD) --Boston University, Henry M. Goldman School of Dental Medicine, 2014 (Department of Orthodontics and Dentofacial Orthopedics).
Includes bibliographic references: leaves 34-42.
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This work is protected by copyright. Downloading is restricted to the BU community. If you are the author of this work and would like to make it publicly available, please contact open-help@bu.edu.