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Introduction: The objective of this study was to characterize the volume and the morphology of the pharyngeal
airway in adolescent subjects, relating them to their facial skeletal pattern. Methods: Fifty-four subjects who had
cone-beam computed tomography were divided into 3 groupsskeletal Class I, Class II, and Class III
according to their ANB angles. The volumes of the upper pharyngeal portion and nasopharynx, and the
volume and morphology of the lower pharyngeal portion and its subdivisions (velopharynx, oropharynx, and
hypopharynx) were assessed with software (version 11.5; Dolphin Imaging & Management Solutions,
Chatsworth, Calif). The results were compared with the Kruskal-Wallis and the Dunn multiple comparison
tests to identify intergroup differences. Correlations between variables assessed were tested by the
Spearman correlation coefcient. Correlations between the logarithms of airway volumes and the ANB angle
values were tested as continuous variables with linear regression, considering the sexes as subgroups.
Results: The minimum areas in the Class II group (112.9 6 42.9, 126.9 6 45.9, and 142.1 6 83.5 mm2)
were signicantly smaller than in Class III group (186.62 6 83.2, 234.5 6 104.9, and 231.1 6 111.4 mm2) for
the lower pharyngeal portion, the velopharynx, and the oropharynx, respectively, and signicantly smaller
than the Class I group for the velopharynx (201.8 6 94.7 mm2). The Class II group had a statistically signicant
different morphology than did the Class I and Class III groups in the velopharynx. There was a tendency to decreased airway volume with increased ANB angle in the lower pharyngeal portion, velopharynx, and oropharynx.
In the upper pharyngeal portion, nasopharynx, and hypopharynx, there seemed to be no association between
the airway volume and the skeletal pattern. Conclusions: The Class II subjects had smaller minimum
and mean areas (lower pharyngeal portion, velopharynx, and oropharynx) than did the Class III group and
signicantly less uniform velopharynx morphology than did the Class I and Class III groups. A negative correlation was observed between the ANB value and airway volume in the lower pharyngeal portion and the
velopharynx (both sexes) and in the oropharynx (just in male subjects). (Am J Orthod Dentofacial Orthop
2013;143:799-809)
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Fig 1. Limits of the upper pharyngeal portion: A, determination of the last axial slice before the nasal
septum fuses with the pharyngeal posterior wall; B, the reection of that slice in the sagittal plane denes the upper limit, and the palatal plane determines the lower limit.
normality of the data. No signicant sex-related differences were found; therefore, the data were combined.
The Kruskal-Wallis test was used to verify whether there
were statistically signicant differences (P \0.05)
among the groups. The Dunn multiple comparison test
was then used to identify where these differences were.
Correlations among the variables were tested by the
Spearman correlation coefcient. The P values were adjusted for multiple comparisons. Correlations between
the logarithms of airway volumes and the ANB angle
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Fig 3. Lower pharyngeal portion limits and measurements: A, Upper limit, palatal plane (ANS-PNS line)
extended to the pharyngeal posterior wall, and lower limit, plane parallel to the palatal plane (pp) intersecting the lower and most anterior point in the fourth cervical vertebra (C4); the horizontal white line
represents the most constricted axial area (minimum axial area) within these limits; Ul, Upper length;
Tl, total length. B, Axial view of the minimum axial area determined by the software within these limits.
Fig 4. Limits used in the lower pharyngeal portion segments: A, velopharynx upper limit, palatal plane
(pp), and lower limit, plane parallel to the palatal plane intersecting the uvula (U); B, oropharynx upper
limit, plane parallel to the palatal plane intersecting the uvula (U), and lower limit, plane parallel to the
palatal plane intersecting the upper point in the epiglottis (EP); C, hypopharynx upper limit, plane parallel to the palatal plane intersecting the upper point in the epiglottis (EP), and lower limit, plane parallel
to the palatal plane intersecting the lower and most anterior point in the fourth cervical vertebra (C4).
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Class I (n 5 17)
Mean (SD)
66.7 (7.0)a
50.8 (14.5)a
132.45 (48.5)a,b
205.38 (68.7)a,b
0.7 (0.2)a
0.5 (0.1)a
Class II (n 5 20)
Mean (SD)
67.0 (7.8)a
31.30 (15.2)b
112.9 (42.9)a
211.8 (52.9)a
0.5 (0.2)b
0.5 (0.1)a
VP length (mm)
VP minimum area (mm2)
VP mean area (mm2)
VP morphology (Amin/Amean)
Class I (n 5 17)
Mean (SD)
29.5 (4.9)a
201.8 (94.7)a
291.0 (93.6)a
0.7 (0.1)a
Class II (n 5 20)
Mean (SD)
28.7 (4.1)a
126.9 (45.9)b
218.8 (87.8)b
0.6 (0.1)b
OP length (mm)
OP minimum area (mm2)
OP mean area (mm2)
OP morphology (Amin/Amean)
Class I (n 5 17)
Mean (SD)
18.56 (3.9)a
160.2 (62.6)a,b
210.9 (86.9)a,b
0.76 (0.1)a
Class II (n 5 20)
Mean (SD)
14.73 (5.4)a
142.1 (83.5)a
195.1 (85.3)a
0.7 (0.1)a
The main objective of this study was to assess the volumes of the upper pharyngeal portion and nasopharynx
and the volumes, the minimum axial areas, and the morphology of the lower pharyngeal portion and its segments (velopharynx, oropharynx, and hypopharynx)
using CBCT scans of 13- to 20-year-old subjects divided
into Class I, Class II, and Class III groups according to
their ANB angles.
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HP length (mm)
HP minimum area (mm2)
HP mean area (mm2)
HP morphology (Amin/Amean)
Class II (n 5 20)
Mean (SD)
21.8 (5.1)a
149.6 (53.0)a
235.4 (69.9)a
0.6 (0.1)a
ANB
0.045
-
FMA
0.151
0.050
0.107
0.011
0.183
0.023
Age
0.197
0.229
0.356
0.185
0.052
0.162
Sex*
0.077
0.299
0.094
0.260
0.404
0.178
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Fig 5. Plots showing the linear regression analyses between the logarithms of airway volume and the
ANB angle values tested as continuous variables, with the sexes as subgroups. The blue circles represent males, and the green circles represent females. The black line represents the mean correlation of
the entire sample. The blue and green lines represent the mean correlations for male and female subjects, respectively. Segments analyzed: A, upper pharyngeal portion; B, nasopharynx; C, lower pharyngeal portion; D, velopharynx; E, oropharynx; F, hypopharynx. *P \0.05; **P \0.01; ***P \0.001.
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CONCLUSIONS
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