Three dimensional analysis of the upper airway and facial morphology in children with Class II malocclusion using cone-beam computed tomography

Ji-Suk Hong; Dae-Sung Kim; Kyung-Min Oh; Yoon-Ji Kim; Kyu-Hong Lee; Yang-Ho Park

doi:10.4041/kjod.2010.40.3.134

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Hong, Kim, Oh, Kim, Lee, and Park: Three dimensional analysis of the upper airway and facial morphology in children with Class II malocclusion using cone-beam computed tomography

Original Article

Korean Journal of Orthodontics

Korean Journal of Orthodontics 2010; 40(3): 134-144.

Published online: 30 June 2010

DOI: https://doi.org/10.4041/kjod.2010.40.3.134

Three dimensional analysis of the upper airway and facial morphology in children with Class II malocclusion using cone-beam computed tomography

Ji-Suk Hong, DDS^a, Dae-Sung Kim, DDS, MSD^b, Kyung-Min Oh, DDS^a, Yoon-Ji Kim, DDS, MSD^a, Kyu-Hong Lee, DDS, MSD^c, Yang-Ho Park, DDS, MSD, PhD^d

^aResident, Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Korea.

^bGraduate Student, Graduate School of Hallym University, Korea.

^cPublic Health Doctor, Public Health Center of Namyangju-si, Korea.

^dProfessor, Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center, Korea.

Corresponding author: Yang-Ho Park. Department of Orthodontics, Kangdong Sacred Heart Hospital, Hallym University Medical Center, 445, Gil 1-dong, Gangdong-gu, Seoul 134-701, Korea. +82 2 2225 2969; dentpark64@hanmail.net

Received 29 December 2009 Revised 28 March 2010 Accepted 31 March 2010

Abstract

Objective

The aim of this study was to evaluate the volumes and areas of the upper airways in children with Class II malocclusion, using three dimensional cone-beam computed tomography (CBCT) and to compare the volumetric and cross-sectional measurements and cephalometric variables to investigate possible relationships between the upper airway and facial morphology.

Methods

CBCT scans were obtained from 37 subjects (17 boys and 20 girls; average age, 11.02 years). The upper airway volumes and areas were measured, and compared with cephalometric variables.

Results

The area of the PNS-posterior plane (S_PP) was significantly smaller in the Class II malocclusion group (p < 0.05). Also, the volumetric and cross-sectional measurements were lower in Class II than in Class I malocclusion groups, although the differences were not significant between the two groups (p > 0.05). The Class II malocclusion group showed significantly smaller values of PFH, mandibular body length, pog to N perp and showed larger values of FMA, ANB, and facial convexity than the Class I malocclusion group. The volume of the upper airway in front of PNS point (WN) showed negative correlation with ANB (p < 0.05).

Conclusions

The Class II malocclusion group had a narrower upper airway associated with a decreased posterior facial height and a divergent growth pattern than the Class I malocclusion group.

Keywords: Upper airway, CBCT, Class II malocclusion, Facial morphology

Figures and Tables

Fig. 1

The three-dimensional image was reoriented, using the FH plane as its horizontal reference plane. The FH plane was constructed from the right and left porions (Po(R), Po(L)) and the right orbitale (Or(R)).

Fig. 2

Reference planes and the cross-sectional area measurements of the upper airway. Reference planes: A, ANS plane, the coronal plane passing through the anterior nasal spine (ANS); B, PNS plane, the coronal plane passing through the posterior nasal spine (PNS); C, PNS-posterior plane, the coronal plane passing through the point on the anterior pharyngeal wall extending from PNS (PNS-posterior); D, PNS-axial plane, the axial plane perpendicular to the coronal plane from PNS. The cross-sectional area measurements of these planes: the ANS plane area (S_A), the PNS plane area (S_P), the PNS-posterior plane area (S_PP), the PNS-axial plane area (S_PA).

Fig. 3

Upper airway volumetric measuremets. To isolate the space of the airway, the threshold value was set at a range of -1,024 to -300 Hounsfield units. The airway was sculpted to be isolated and divided into two parts by the PNS plane; the volume of the upper airway in front of PNS point (W_N), the volume of the upper airway just behind of PNS point (W_P). Volumetric measurements were carried out using InVivoDental software (Anatomage Inc., San Jose, CA, USA).

Fig. 4

Two-dimensional cephalometric images were derived from the three dimensional CT scans by creating an orthogonal projection with parallel rays.

Fig. 5

Cephalometric measurements used in this study. 1, A to N perp; 2, Pog to N perp; 3, facial convexity; 4, mandibular body length; 5, ANB; 6, gonial angle; 7, anterior facial height; 8, posterior facial height; 9, FMA; 10, Ba-SE-FMN.

Table 1

Distribution of subjects

SD, Standard deviation.

Table 2

Cephalometric measurements

Table 3

Comparison of measurements between male and female

AFH, Anterior facial height; FMN, frontomaxillary nasal suture; PFH, posterior facial height; WT, total volume of the upper airway; FMA, frankfort mandibular plane angle; SD, standard deviation. ^*p< 0.05.

Table 4

Comparison of measurements between Class I and Class II

Table 5

Correlation coefficients between measurements among 19 subjects with Class II malocclusion

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