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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 74-77

A study to compare nasopharyngeal airway space in skeletal Class I, Class II, and Class III malocclusion


1 Senior Lecturer, Department of Orthodontics and Dentofacial Orthopedics, Rural Dental College, PIMS, Ahmednagar, Maharashtra, India
2 HOD and Professor, Department of Orthodontics and Dentofacial Orthopedics, CKS Teja Institute of Dental Sciences and Research, Tirupati, India
3 Reader, Department of Orthodontics and Dentofacial Orthopedics, CKS Teja Institute of Dental Sciences and Research, Tirupati, India
4 Associate Professor, Department of Orthodontics and Dentofacial Orthopedics, CKS Teja Institute of Dental Sciences and Research, Tirupati, India
5 Private Practice, Satish Dental Clinic, Madanpalli, Andhra Pradesh, India

Date of Submission02-Jul-2021
Date of Acceptance20-Jul-2021
Date of Web Publication09-Sep-2021

Correspondence Address:
Dr. Vijaysinh Ramchandra Tanpure
Senior Lecturer, Department of Orthodontics and Dentofacial Orthopedics, Rural Dental College, PIMS, Ahmednagar, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpcdr.ijpcdr_26_21

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  Abstract 


Background: Studies in the past have assessed relation between airway and type of malocclusion and found no association between rhinomanometric measures of airway adequacy and type of malocclusion or craniofacial morphology. Hence, the present study was undertaken to test whether there is any association between pharyngeal airway and type of malocclusion.
Methodology: The subjects were divided into 3 groups based on skeletal pattern with 20 subjects in each group: Group 1 with Class I skeletal pattern, Group 2 with Class II skeletal pattern, and Group 3 with Class III skeletal pattern. All the cephalograms were taken in natural head position.
Results: There is no significant difference found in total nasopharyngeal area between 3 groups. However, aerial area was significantly reduced in Group 3 (398.4 mm2) than that of Group 2 (485.737 mm2) (P = 0.012). Whereas, significant reduction in adenoidal area was observed in Group 2 (184.021 mm2) when compared with that of Group 3 (286.183 mm2).
Conclusion: There was no statistically significant relationship between different skeletal groups and nasopharyngeal soft-tissue characteristics, except for two measurements i.e. aerial and adenoidal area of Group 2 and Group 3.

Keywords: Malocclusion, nasopharyngeal airway space, orthodontics


How to cite this article:
Tanpure VR, Kalavani S V, Palagiri FB, Bhagyalakshmi K, Devaki SB. A study to compare nasopharyngeal airway space in skeletal Class I, Class II, and Class III malocclusion. Int J Prev Clin Dent Res 2021;8:74-7

How to cite this URL:
Tanpure VR, Kalavani S V, Palagiri FB, Bhagyalakshmi K, Devaki SB. A study to compare nasopharyngeal airway space in skeletal Class I, Class II, and Class III malocclusion. Int J Prev Clin Dent Res [serial online] 2021 [cited 2021 Nov 29];8:74-7. Available from: https://www.ijpcdr.org/text.asp?2021/8/3/74/325839




  Introduction Top


Evaluation of the soft tissue, such as tonsils, adenoids, nasal polyps, neuromuscular functional jaw patterns, and facial contours, should be an integral part of treatment planning to aid in stability and esthetics of the orthodontic or orthopedic results. The influence of airway obstruction on the developmental pattern of face has always been controversial.[1],[2],[3],[4],[5] Studies in the past have assessed relation between airway and type of malocclusion and found no association between rhinomanometric measures of airway adequacy and type of malocclusion or craniofacial morphology.[6],[7],[8],[9],[10],[11] Hence, the present study was undertaken to test whether there is any association between pharyngeal airway and type of malocclusion.


  Methodology Top


The sample comprised of 60 subjects with an age range of 18–25 years. The subjects were screened from the orthodontic department of CKS Theja Institute of Dental Sciences and Research, Tirupati, Andhra Pradesh, India. The subjects were divided into 3 groups based on skeletal pattern with 20 subjects in each group: Group 1 with Class I skeletal pattern, Group 2 with Class II skeletal pattern, and Group 3 with Class III skeletal pattern. Each group consisted of equal number of males and females. All procedures performed in the study were conducted in accordance with the ethics standards given in 1964 Declaration of Helsinki, as revised in 2013. The study proposal was submitted for approval and clearance was obtained from the ethical committee of our institution. A written informed consent was obtained from each participant. All the cephalograms were taken in natural head position (NHP). A modified mirror method was used to obtain NHP. A mirror was placed about 3 feet front from floor level. To obtain a true vertical, a plumb line was created by suspending a weight of 4 kg on a 0.016-inch wire hung from the ceiling, 9 feet in front of the mirror. The subject stands to the left of the plumb line looking into the mirror. A Kavo light source (12V) was fixed 7 foot 6 inches to right wall, at a height of 5 foot 3 inches. The rod can move only in a vertical direction to adjust the level of the light source depending on subject's head height. The light casts a shadow of the wire on the right side of subject's face; just distal to the lateral canthus of the eye [Figure 1]. The light does not have any horizontal movement thus preventing a shift of the wire shadow in a horizontal direction since this could alter the true vertical reference. The subject was asked to maintain the self-balanced position of the head by tilting the head backward and forward with decreasing amplitude to find the most natural position in between [Figure 2], [Figure 3], [Figure 4]. After determining the self-balanced neural position, the subject was asked to look into his/her own eyes in the mirror. At this junction, two points were marked using a pen along the wire shadow on the right side of the subject's face, one near the lateral canthus of the eye and the other at the lower border of the mandible. These areas were selected for placing the markers since no important cephalometric landmarks are located here [Figure 5]. The marker gave radiopaque shadows on the lateral cephalogram. Thus, the natural vertical axis is fixed on the face. After completing the above procedure, the subject was positioned in the cephalostat with teeth holding in centric occlusion. A lateral cephalogram was taken in the standard manner. A line drawn to join the two markers shadows denotes the natural true vertical line on the cephalometric tracing. While tracing, the cephalogram was rotated so as to align the true vertical, parallel to the side of the rectangular tracing sheet. This helps to orientate the head in the NHP on the tracing sheet.
Figure 1: Shadow of the wire on the face

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Figure 2: Pen marking on the face for placing markers

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Figure 3: Determinationofself-balancedpositionoftheheadbylettingthepatientstilttheheadbackwardandforwardwithdecreasingamplitudetofinethemostneuralpositioninbetween

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Figure 4: Determinationofself-balancedpositionoftheheadbylettingthepatientstilttheheadbackwardandforwardwithdecreasingamplitudetofinethemostneuralpositioninbetween

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Figure 5: Determinationofself-balancedpositionoftheheadbylettingthepatientstilttheheadbackwardandforwardwithdecreasingamplitudetofinethemostneuralpositioninbetween

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Formula to calculate total nasopharyngeal area,



All cephalometric tracings were done by single calibrated examiner. Intergroup comparisons were performed using analysis of variance test. If P value (level of significance) was significant, then a post hoc Turkey's test was done to check which two groups were statistically different from each other. A P < 0.05 is set to be statistically significant.


  Results Top


We compared the nasopharyngeal airway space in skeletal Class I, Class II, and Class III malocclusion. Various cephalometric parameters such as posterior nasal spine (PNS)-AD1, AD1-Ba, PNS-Ba, PNS-AD2, AD2-H, PNS-H, N-H, S-N Mc Namara's UPD, Mc Namara's line printer daemon did not show statistically difference between 3 groups. There is no significant difference found in total nasopharyngeal area between 3 groups. However, aerial area was significantly reduced in Group 3 (398.4 mm2) than that of Group 2 (485.737 mm2) (P = 0.012). Whereas significant reduction in adenoidal area was observed in Group 2 (184.021 mm2) when compared with that of Group 3 (286.183 mm2) (P = 0.018) [Graph 1], [Graph 2], [Graph 3].




  Discussion Top


In our study, we found that there was no statistically significant relationship between different skeletal groups and nasopharyngeal soft-tissue characteristics, except for two measurements, i.e. aerial and adenoidal area of Group 2 and Group 3. Our findings are similar to those of Sosa et al.,[7] in which statistically significant relationships were not found between the pharyngeal structures and the ANB angles of the subjects with Class I and Class II, Division 1 malocclusions. Similarly, Solow et al.[8] and Wenzel et al.[11] could find no relationship between the pharyngeal size and the measurements regarding the anteroposterior jaw relationship. Furthermore, Ceylan and Oktay[1] in their study concluded that a number of postural changes can occur and these can involve the structures of head-and-neck regions in response to the changes in sagittal jaw relationship. The size of the pharyngeal airway does not change appreciably.


  Conclusion Top


There was no statistically significant relationship between different skeletal groups and nasopharyngeal soft-tissue characteristics, except for two measurements, i.e., aerial and adenoidal area of Group 2 and Group 3.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ceylan I, Oktay H. A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofacial Orthop 1995;108:69-75.  Back to cited text no. 1
    
2.
Meredith GM. The airway and dentofacial development. Ear Nose Throat J 1987;66:190-5.  Back to cited text no. 2
    
3.
Rubin RM. Mode of respiration and facial growth. Am J Orthod 1980;78:504-10.  Back to cited text no. 3
    
4.
Subtenly J. The significance of adenoid tissue in orthodontia. Angle Orthod 1954;24:235-50.  Back to cited text no. 4
    
5.
Ricketts RM. Respiratory obstruction syndrome. Am J Orthod 1968;54:495-507.  Back to cited text no. 5
    
6.
Kim YJ, Hong JS, Hwang YI, Park YH. Three-dimensional analysis of pharyngeal airway in preadolescent children with different anteroposterior skeletal patterns. Am J Orthod Dentofacial Orthop 2010;137: 11.e1-11.  Back to cited text no. 6
    
7.
Sosa FA, Graber TM, Muller TP. Postpharyngeal lymphoid tissue in Angle Class I and Class II malocclusions. Am J Orthod 1982;81:299-309.  Back to cited text no. 7
    
8.
Solow B, Siersbaek-Nielsen S, Greve E. Airway adequacy, head posture, and craniofacial morphology. Am J Orthod 1984;86:214-23.  Back to cited text no. 8
    
9.
Warren DW, Lehman MD, Hinton VA. Analysis of simulated upper airway breathing. Am J Orthod 1984;86:197-206.  Back to cited text no. 9
    
10.
Cooke MS, Wei SH. The reproducibility of natural head posture: A methodological study. Am J Orthod Dentofacial Orthop 1988;93:280-8.  Back to cited text no. 10
    
11.
Wenzel A, Williams S, Ritzau M. Relationships of changes in craniofacial morphology, head posture, and nasopharyngeal airway size following mandibular osteotomy. Am J Orthod Dentofacial Orthop 1989;96:138-43.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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