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Craniofacial and airway growth in 9–11 years old normal dental occlusion in Iranian adolescents: A longitudinal cephalometric study
Article in Dental Hypotheses · January 2017
DOI: 10.4103/denthyp.denthyp_55_16
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Official publication of the American Biodontics Society and the Center for Research and Education in Technology www.dentalhypotheses.com Volume 8 / Issue 1 / January-March 2017 E-ISSN: 2155-8213
Dental Hypotheses • Volume 8 • Issue 1 • January - March 2017 • Pages ***-***
Craniofacial and Airway Growth in 9 – 11 Years Old Normal Dental Occlusion in Iranian Adolescents: A Longitudinal
Cephalometric Study
Homa Fathi, Elham Mohammad-Rabei1, Sattar Kabiri2, Alireza A. Baghban3, Sepideh Soheilifar4, Mahtab Nouri5
Dentist, Tehran,1School of Dentistry, Arak University of Medical Sciences, Arak,2Orthodontist, Tehran,3Proteomic Research Center, Department of Basic Sciences, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran,4Department of Orthodontics, Dental Research Center, Hamadan Medical Sciences, Hamadan, Iran,5Dentofacial Deformities Research Center, Research Institute of Dental Sciences and Orthodontic School of Dentistry, Shahid
Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Introduction:
The present study was aimed to assess the amount and direction of growth in cranial base, jaws, and soft tissue of airway structures by cephalometric analysis in 9
–11-years-old Iranian girls and boys.
Materials and Methods:Thirty-four Iranian children with normal occlusion and class I molar relationships were recruited, and 2 lateral cephalograms were obtained from 9 and 11-year-old children Cephalometric variables included variables defining cranial base length and angle, maxillomandibular length and height, dental relationship, head and cervical position, soft palate and tongue, vallecula and hyoid position, and pharyngeal dimension. Normal distribution was confirmed by Kolmogorov
–Smirnov analysis (
P>0.05). Paired
t-test was used for assessing growth changes.
Pvalue was set at 0.05.
Results:Anterior, posterior, and total cranial base length were increased significantly. The increase in total and upper anterior, total and lower posterior facial heights, ramus height, and palatal inclination were statistically significant. Maxillomandibular length increased significantly with insignificant change in their position. Dental relationship and head and cervical posture were stable. Oropharyngeal and nasopharyngeal anteroposterior dimension did not change. However, hypopharynx sagittal length increased significantly. Nasopharyngeal vertical dimension increased and hyoid moved anteriorly and inferiorly.
Conclusion:The results of the present study showed that cranial base and jaws grow anteriorly and inferiorly while maintaining dental occlusion and head posture. Most of the airway structures grow simultaneously with craniofacial components.
Key words:
Airway, Angle class I malocclusion, cephalometrics, growth, growth evaluation
I NTRODUCTION
Comprehensive understanding of the normal growth of craniofacial structures facilitates realization of significant variations in the growth and development, which is an important part of diagnosis and treatment planning. This helps to predict direction and magnitude of facial growth, which in turn facilitates treatment planning.
[1]In addition, post treatment growth in craniofacial and jaw structures would change orthodontic treatment results. Facial growth usually varies with uneven direction and amount. It is claimed that there is a relationship between facial growth and occlusion. This relationship is not necessarily constant and shows considerable interindividual and intraindividual diversity.
[2]Many studies have shown a relationship between craniofacial anomalies and “ respiration obstruction syndrome. ”
[3-8]This term has been used to describe the various conditions associated with chronic obstruction of upper airway in growing children.
[8]Soft tissue morphology of the upper airway that can be related to respiration obstruction includes large adenoids, tonsils and soft palates, and narrowed pharyngeal airway.
[9-11]Other facial features that are associated with airway obstruction
Address for correspondence:Dr. Sepideh Soheilifar, Shahid Fahmideh Street, Hamadan, Iran.
E-mail: [email protected]
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How to cite this article: Fathi H, Mohammad-Rabei E, Kabiri S, Baghban AA, Soheilifar S, Nouri M. Craniofacial and airway growth in 9–11 years old normal dental occlusion in Iranian adolescents: A longitudinal cephalometric study. Dent Hypotheses 2017;8:8-16.
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DOI:
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Original Research
8 ©2017 Dental Hypotheses | Published by Wolters Kluwer - Medknow
are excessive anterior facial height, incompetent lip posture, protruding maxillary dentition, increased mandibular angle, and posterior dental crossbite.
[7,12,13]Moreover, if left untreated, it may adversely affect the quality of life such as learning disabilities in school and inadequate sleep.
[14,15]There are some expensive or unavailable techniques for airway assessment such as computed tomography,
[16]fluoroscopy,
[17]acoustic reflection,
[18]fibrotic pharyngoscopy,
[19]and magnetic resonance imaging.
[20]Lateral cephalometric image is a less expensive and available method, which is a useful screening tool for assessing upper airway structures.
[21]Although providing two-dimensional view of a three-dimensional (3D) complex, many studies have confirmed the liability of lateral cephalometric measurements for upper airway space, and it has been shown that the measurements were highly correlated with 3D techniques such as computed tomography (CT) and magnetic resonance imaging (MRI).
[22-25]Some studies have provided reference values for upper airway for adult and children in some races.
[9,26,27]However, no cephalometric norms for upper airway of Iranian children have been established, which makes the present study a novel one. In the present study, normal occlusion children who do not have respiratory problems were selected precisely. Various soft and hard tissue variables were assessed by a computer software. The objective of this retrospective study was to obtain upper airway norms for normal Iranian children and assessing growth changes in craniofacial and airway structures in them.
M ATERIALS AND M ETHODS Participants
This retrospective cross-sectional study was conducted among 34 participants. The inclusion criteria consisted of children with normal occlusion and class I molar relationship, normal overjet and overbite, without a history of previous orthodontic treatment or mouth breathing. Research and ethics committee of Shahid Beheshti University of Medical Sciences approved this study. Two cephalograms were obtained in a period of 2 years for 9 and 11-year-old children during 1996 – 1998 in Qazvin city. Biologic age was assessed by cervical vertebral maturation (CVM) method and was evaluated to be CV2 in all included patients. One X-ray machine (PLANMECA PM 2002 CC PROLINE, Helsinki, Finland) was used to obtain all lateral cephalograms.
Lateral cephalometric radiographs were obtained using a standardized technique, with the jaw in centric relation and the teeth in occlusion, the lips relaxed, and the head in the natural head position.
The landmarks and reference lines used in the analysis are shown in the Tables 1 – 4. The variables for upper airway measurements included 43 linear, 34 angular and 1 area
measurements. Cephalometric analysis was carried out using Orthosurger X software. The accuracy of this software has been confirmed in previous studies.
[28,29]Table 1: Cephalometric landmarks and their definitions
Landmarkname
Definition
S Sella, center point of sella turcica
N Nasion, the most anterior point on frontonasal suture Or Orbitale, lowest point in the inferior border of bony orbit Po Porion, highest point in the superior border of external
auditory meatus
Ba Basion, midpoint of the anterior border of foramen magnum
Ar Articular, the intersection between posterior contour of mandible and cranial base
Ptm Pterygomaxillary, the most inferior point in pterygomaxillary fissure, where the anterior and posterior walls intersect
ANS Anterior nasal spine PNS Posterior nasal spine
SS Subspinale, the most posterior point in anterior curvature of maxilla
SM Supramental, the most posterior point in anterior curvature of mandible
Pr Prosthion, the lowest and most anterior point in the maxillary alveolar process
Id Infradentale, the highest and most anterior point in the maxillary alveolar process
Prognathion A point on the bony chin which gives the maximum length from TMJ point
Condilion The most superior point on the head of mandibular condyle
Go Gonion, the midway point on the curvature of gonial angle
T2 The most inferoposterior point on the mandible Men Menton, the lowest point on the mandibular symphysis Pog Pogonion, the most anterior point in the chin
Gn Gnathion, midway point between pogonion and menton V Vallecula, the intersection of epiglottis and base of
tongue
U Uvula, the tip of uvula
T Tip of tongue
H The most superior point on tongue
AA Anterior arch of atles, the most anterior point in the anterior arch of atlas
C2, C3, C4 The most posterior point in the inferior margin of second, third and fourth cervical vertebrae C2tg Most posterior point on superior border of tip of
odontoid process
AH The most superior and anterior point in the body of hyoid bone
RGN Retrognathion, the most inferior point on the posterior outline of mandibular symphysis
Ho Hormion, the most posterior contact point between vomer and the body of sphenoid
Sos spheno-occipital synchondrosis So midpoint of sella-basion
In inferior end of a line perpendicular from Sos on AA- PNS line
Fathi,et al.: Craniofacial growth in Iranian children
Dental Hypotheses ¦ Volume 8 ¦ Issue 1 ¦ January-March 2017 9
All lateral cephalometric radiographs were scanned by a radiographic scanner (Microtech Scan Maker 48 bit color, i800). The digitization and measurements were performed separately by two investigators. Intraclass correlation coefficient (ICC) was assessed to be 0.77. The magnification factor was taken into account for each cephalometric radiograph.
Statistical analysis
Mean and standard deviation (SD) was calculated for each measurement. Data distribution was analyzed with the Kolmogorov – Smirnov tests. All the cephalometric variables were normally distributed ( P= 0.05). For comparison of statistical changes, paired t -test was used. The data were analyzed using SPSS 20 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY:
IBM Corp.) with a 5% level of significance ( P< 0.05).
R ESULT
A total of 34 patients were recruited, from which 2 were lost to follow up. The results of paired t -test on cephalometric variables are shown in Tables 5 and 6.
D ISCUSSION
In the present study, craniofacial and airway growth of 9 – 11-year- old patients were assessed via cephalometric analysis. It has been proposed that early orthodontic treatment can improve skeletal, muscular, and dentoalveolar abnormalities.
[30]Orthodontists usually monitor patients before the onset of adolescence.
Therefore, it would be important to determine normal growth of craniofacial structures during this critical period. Therefore, this age range was chosen.
Cranial base length shows significant changes as anterior, posterior, and total cranial base length were increased from 9-year-old to 11-year-old. This result is in agreement with previous studies. A recent systematic review has shown that anterior cranial base is not a stable structure and its length increases up to adulthood.
[31]Remodeling of sella turcica in the backward and downward direction and bone apposition in frontal bone and increase in the size of frontal sinus play a role in this phenomenon.
[32,33]Spheno-occipital synchondrosis grows up to late ages, and posterior cranial base length increases in a backward and downward direction.
[34,35]However, this increase is not reflected in the sella-articular length. Despite the fact that sella point
Table 2: Reference lines and their definitions
Reference line DefinitionFH Frankfort plane, the line from po to or
NSL The line between N and S
ML Mandibular line. The line between Gn and T2 NL Nasal line, the line between ANS and PNS CVT Cervical vertebra tangent, the line from C4 to C2tg OPT Odontoid process tangent, the line from C2 to C2tg
Table 3: Craniofacial cephalometric variables and their definitions
Variable Definition
S-N Sella to nasion length, indicating anterior cranial base length
S-Ba Sella to basion length, indicating posterior cranial base length
S-Ar Sella to articular length, indicating posterior cranial base length
S-ptm Sella to pterygomaxillary point
N-Ba Nasion to basion length, indicating total cranial base length
N-Ar Nasion to articular length, indicating total cranial base length
Ba-S-N The angle between basion, sella and nasion Ar-S-N The angle between articulare, sella and nasion N-ANS Sella to anterior nasal spine length, indicating
upper anterior facial height
Na-Gn Nasion to gnathion length, indicating total anterior facial height
ANS-Gn Anterior nasal spine to gnathion, indicating lower anterior facial height
S-Go Sella to gonion length, indicating posterior facial height
Ar-Go Articular to gonion length, indicating ramus height
NSL.NL SN plane to palatal plane angle NSL.ML SN plane to mandibular line
Refcrb.ML The angle between mandibular plane and Refcrb (reference line which passes from the fiducial point in cranial base)
NSL.RefML The angle between SN plane and RefML (reference line which passes from the fiducial point in mandibular plane)
Refcrb.RefML The angle between Refcrb and RefML
ML.RL Gonial angle
P.OL Palatal plane to occlusal plane distance ANS-PTM Anterior nasal spine to pterygomaxillary length ss-PTM Subspinale to pterygomaxillary length Palatal length Anterior nasal spine to posterior nasal spine Effective length of
maxilla
Condilion to A point Anterior cranial
base.palatal Plane angle
The angle between Palatal plane and S-N line
Prognathion- Condilion
The distance between Prognathion and Condilion Pog-Go The distance between Pogonion and Gonion S-N-ANS The angle between Sella, Nasion and Anterior
Nasal Spine
S-N-SS The angle between Sella, Nasion and Subspinale S-N-Sm The angle between Sella, Nasion and
Supramentale
S-N-Pog The angle between Sella, Nasion and Pogonion SS-N-SM The angle between subspinal, Nasion and
supramentale
SS-N-Pog The angle between subspinale, Nasion and Pogonian
ILs.NL The angle between upper incisor axis and palatal plan
(Continued) Fathi,et al.: Craniofacial growth in Iranian children
10 Dental Hypotheses ¦ Volume 8 ¦ Issue 1 ¦ January-March 2017
position is somewhat stable in the horizontal plan in this age,
[32]sella-basion length increases because of the dorsal displacement of the basion point, where as articular point which is dependent on mandibular position and morphology shows more variation than basion point.
[36]Lewis et al . found that cranial base length undergoes growth spurt in both genders.
[37,38]It has been shown that their growth is almost complete approximately in 11 – 13 years old in females and 15 years old in males.
[39]In contrast, some studies have shown that cranial base would not grow after 7 years old.
[40]Differences in study design (longitudinal versus cross sectional), landmarks, and sample population may justify these differences. Anterior and posterior cranial base increased in similar increments. Cranial base angle (Ba-S-N and Ar-S-N) was not changed during the study period. Wilhelm et al . reported that cranial base angle decreases significantly from 1 month to 2 years old, however, remained unchanged afterwards.
[41]Sella-ptm length showed insignificant increase during the 2- year follow-up. This is in agreement with the results of previous studies where ptm showed insignificant drift during the treatment.
[32]Vertical analysis showed that total anterior facial height (Na-Gn) and upper anterior facial height (N-ANS) underwent significant increase where as lower anterior facial height increase was insignificant. Moss et al . demonstrated that from 6 to 14 years, the upper anterior facial height increments were larger than lower anterior facial height.
[42]In addition, in Snodell et al . study, from 6 to 8 years old, lower anterior facial height was more mature than upper anterior facial height, gaining 75 – 84%
of its length versus 71 – 82% up to 6 years old.
[43]In addition, ramus height (Ar-Go) and posterior facial height (S-Go) increased significantly. Lux et al . stated that ramus height increase is more than mandibular length and mandibular width between 7 and 15 years old.
[44]Yavus et al . found that from 10 to 14 years old ramus height increases significantly.
[45]Posterior facial height increased significantly in Yoon et al . study.
[1]In the present study, anterior facial height increased more than posterior facial height whereas ramus height growth was more than lower anterior facial height.
Palatal plane angle (NSL-NL) increased significantly. This can be attributed to significant increase in upper anterior facial height. This finding is in contrast to the results of previous studies.
[46-48]However, in the study by Nanda et al ., the palatal plane inclination increased from 6 to 11 years and then decreased from 17 to 23 years old with overall insignificant changes.
[48]It appears that palatal plane inclination shows fluctuation during growth, increasing in a period while decreasing in another, causing diversity in results of different studies. Mandibular plane angle decreased insignificantly. This finding reflects the significant increase in ramus height and insignificant increase in anterior facial height. Previous studies have shown that mandibular plane angle decreases significantly.
[2,49]In the study by Sinclair et al., the decrease in the angle was small in both sexes from 9 to 13 years old and was only significant in males.
[2]The difference can be attributed to differences in age ranges (9 – 11 versus 9 – 13) and the mixed nature of our participants.
Maxillary length (ANS-ptm and ss-ptm), mandibular total length (con-prognathion), mandibular body length (pog-go) increased significantly. This is in agreement with the results of previous studies.
[1,44]As expected, total mandibular length increased more than body length and maxillary length, reflecting the 3-dimensional mandibular growth.
Maxillomandibular position relative to cranial base did not change from 9 to 11 years. This can be attributed to forward drift of the nasion point, which is accompanied by forward growth of jaws.
[50]In addition anterior portion of the mandible and maxilla are resorptive and anterior nasal spine and A point drift inferiorly and posteriorly, which causes insignificant changes in landmarks associated with mandibular and maxillary position.
[47,51,52]Similarly, Bhatia et al . had stated that S-N-Pog remains in almost the same level from 4 to 17 years old.
[53]Some studies have shown that Table 3
(Continued)Variable Definition
ILI.ML The angle between lower incisor axis and mandibular (T2-Gn) line
PrNSS The angle between Prosthion, Nasion and subspinale points. Indicating amount of incisors prominence related to skeletal of maxilla CL.ML The angle between Id-Pog and T2-Gn, Indicating
eminence of chin hard tissue
Overjet Horizontal Distance between upper and lower incisor edges
Overbite Vertical Distance between upper and lower incisor edges.
Cvt.FH The angle between cervical vertebra axis and Frankfort
Cvt.Hor The angle between cervical vertebra axis and true horizontal plane
Cvt.NL The angle between cervical vertebra axis and nasal line
Cvt.NSL The angle between cervical vertebra axis and S- N line
Opt.FH The angle between posterior tangent line of C2 and Frankfort
Opt.Hor The angle between posterior tangent line of C2 and true horizontal plane
Opt.NL The angle between posterior tangent line of C2 and nasal line
Opt.NLS The angle between posterior tangent line of C2 and S-N line
NSL.ver The angle between S-N line and true vertical line
FH.ver The angle between Frankfort and true vertical line
NL.ver The angle between nasal line and true vertical line
Fathi,et al.: Craniofacial growth in Iranian children
Dental Hypotheses ¦ Volume 8 ¦ Issue 1 ¦ January-March 2017 11
maxillomandibular position (indicated by SNA and SNB) to cranial base increases with time.
[2,49]In the study by Chung et al ., the participants were followed from 9 to 18 years old.
However, in the present study, the follow-up period was assigned to be from 9 to 11 years old. The difference in findings may be attributed to the longer follow-up period.
[49]In addition, in the study by Sinclair et al ., SNA and SNB angles showed small but statistically significant increase from 9 to 13 years old, whereas these variables changed insignificantly in females. ANB angle was not changed significantly. In our study, both males and females were included and it was not possible to analyze the results separately. This fact may create the difference between findings.
[2]Incisor angulation and anteroposterior position did not change significantly, and consequently, overjet and overbite
remained unchanged. Sinclair et al . had shown that from 9 – 13 years, incisor position remained reasonably stable, except the proclination of lower incisors relative to mandibular plane in males. Others had stated that changes in tooth position is correlated to the amount and direction of craniofacial growth. However, incisor angular positioned remained unchanged, perhaps due to functional stabilization, reflecting the stable position of jaws in present study.
[47]The craniocervical inclination (reflected in CVT-FH, CVT-NL, CVT-NSL, OPT-FH, OPT-NL, OPT-NSL) and cervical inclination to horizontal plan (reflected in CVT-Ho, OPT-Ho) did not change significantly.
The results of other studies are the same as ours.
[54]Table 4: Airway and retrolinual cephalometric measurements and their definition
Pharyngeal anteroposterior length
V.LPW The distance between vallecula and lower pharyngeal wall (the intersection of perpendicular line from valleculla and posterior pharyngeal wall)
Ptm.UPW The distance between Pm (intersection of pterygomaxilla and PNS) and upper pharyngeal wall (the intersection of perpendicular line from PNS and posterior pharyngeal wall)
U.MPW The distance between uvula and middle pharyngeal wall (the intersection of perpendicular line from uvulla and posterior pharyngeal wall)
Ptm.aa The distance between pm and anterior arch of Atlas Ptm.ba The distance between pm and basion
Soft palate and tongue
NL.PmU The angle between palatal plane and inclination of soft palate V.T The distance between vallecula and tongue tip
H.vt Tongue height, the perpendicular distance between H (The most superior point of tongue) and VT line Vallecula position
Ptm.V The distance between vallecular and ptm
V.FH Perpendicular distance between vallecula and FH plane
V.C3 The distance between vallecula and third cervical vertebrae in a line parallel to FH plane Hyoid position
AH.C3Hor The horizontal distance between hyoid bone and third cervical vertebrae in a line parallel to FH plane AH.C3Ver The vertical distance between hyoid bone and third cervical vertebrae in a line perpendicular to FH plane AH.FH The vertical distance between hyoid bone and FH plane
AH.ML The vertical distance between hyoid bone and mandibular line AH.Sver The vertical distance between hyoid bone and S
AA-AH The distance between anterior arch of atlas and hyoid AH-Rgn The distance between hyoid and retrognathion point Nasopharyngeal vertical dimensions
Posterior height of nasal cavity
The distance between S and PNS Length of pharyngeal
cavity
The distance between ba and ho Vertical diachoanal
opening
The distance between ho and PNS
So-In The distance between So and In
Nasopharyngeal depth The distance between ba and PNS Nasopharyngeal floor
length
The distance between AA and PNS Vertical angle of
nasopharynx
The angle between PNS, ba and S Roof angle of
nasopharynx
The angle between ba, ho and PNS
Total Nasopharynx area The area between the line tangent to inferior border of sphenoid, vertical points from ba and PNS, and ba-PNS Fathi,et al.: Craniofacial growth in Iranian children
12 Dental Hypotheses ¦ Volume 8 ¦ Issue 1 ¦ January-March 2017
Craniovertical angulation (indicated by NSL-VER, FH-VER, NL, VER) was stable from 9 to 11 years old and this result has been shown in other studies as well.
[54]Palatal plane to soft palate angle decreased insignificantly, and this result is similar to those of Akcam et al . in normal population.
[55]Thickness of pharyngeal space at the palatal level (pm-UPW) and uvula level (u-MPW) increased insignificantly during the observational period. However, Akcam et al . had stated that the former increases significantly, whereas the later undergoes insignificant changes. Taylor et al . had demonstrated that measurements that include posterior pharyngeal wall show little change from 9 – 12 years. This is similar to our results and can be attributed to the involution of adenoids in this period.
[56]The hypopharynx underwent a significant increase. This can be attributed to the fact that this area lacks adenoids which show involution.
Hyoid bone moved inferiorly and slightly anteriorly. These movements can be attributed to forward displacement of the mandible and vertical growth of cervical vertebrae, respectively.
[56]The results of a study has shown that hyoid position is dependent on age and facial type and is independent of obesity.
[57]In addition, vallecula moved inferiorly. Kollias et al . found a similar phenomenon in adults aged 22 to 42 years old.
[58]This can be attributed to caudally extended tongue mass which in turn can increase tongue length from vallecula to tongue tip, as observed in the present study. Tongue height was increased significantly, which was similar to results of Chavanavesh et al .
[59]Vertical growth along with elongation and consequent changes in orientation of vallecula-tongue tip length can explain this change.
The distance between posterior portion of maxilla to the anterior arch of Atlas (lower bony nasopharynx) and Basion (upper bony nasopharynx) showed insignificant decrease which can be attributed to continued elongation of maxillary and palatal length along with forward growth of anterior arch of atlas which compensates spheno- occipital synchondrosis growth. This is in agreement with significant increase in the palatal length observed in present study. Taylor et al . found similar results from 12 to 18 years old.
[56]King et al . had proposed that sagittal length Table 5: Results of paired- t test in craniofacial variables
from 9 – 11 years old
Variable Mean
(9 years old)
Mean (11 years old)
P value Cranial base
S-N 72.0034 73.4906 .008*
S-Ba 46.3600 47.6481 .048*
S-Ar 34.6769 35.1694 .307
S-PTM 40.7434 41.0156 .572
N-Ba 107.3775 109.9903 .002*
N-Ar 94.8109 96.8097 .021*
Ba-S-N 129.5534 129.7275 .758
Ar-SN 120.7625 121.5237 .299
Vertical
N-ANS 52.1394 54.0216 .001*
Na-Gn 114.3328 117.4106 .001*
ANS-Gn 63.1797 64.4153 .068
S-Go 74.9497 77.2456 .003*
Ar-Go 43.3959 45.5712 .0001*
NSL.NL 16.1556 17.4216 .031*
NSL.ML 31.5388 31.1841 .607
Referb.ML 31.5388 31.1841 .607
NSL.RefML 31.5388 31.1841 .607
Refcrb.
RefML
31.5388 31.1841 .607
NL.ML 15.3838 13.7619 .039*
ML.RL 123.1519 122.9000 .682
P.OL 18.3838 18.9659 .188
Sagittal
ANS-ptm 52.8750 54.9000 .001*
ss-ptm 51.8262 53.8041 .0001*
Palatal length 50.5431 52.0531 .010*
Effective length of maxilla
90.9316 93.8900 .002*
Anterior cranial base.
palatal length
7.2441 6.9019 .502
Prognathion- Condilion
110.0953 113.8316 .0001*
Pog-tGo 74.2628 76.4678 .0001*
SNAN 84.5409 85.0316 .331
SNSS 81.7950 82.2272 .370
SNSm 77.7084 77.9516 .473
SN-Pog 77.7459 78.3428 .074
SSNSM 4.0863 4.2763 .465
SSNPog 4.0491 4.0019 .860
Dental
ILs.NL 120.8778 121.1325 .763
ILI.ML 80.0853 80.1713 .931
PrNSS 1.4997 1.6897 .420
CL.ML 78.2419 77.9706 .658
Overjet 3.5666 3.4009 .481
Overbite 2.0337 2.3416 .105
Head and cranial posture
Cvt.FH 92.5063 92.2797 .900
Cvt.Hor 91.2763 93.1603 .200
Cvt.NL 82.2931 81.6131 .632
(Continued)
Table 5
(Continued)Variable Mean
(9 years old)
Mean (11 years old)
P value
Cvt.NS 98.4481 99.0353 .652
Opt.FH 89.3522 89.2928 .975
Opt.Hor 88.1219 90.1753 .207
Opt.NL 79.1384 78.6275 .727
Opt.NLS 95.2938 96.0503 .591
NSL.ver 82.8272 84.1247 .299
FH.ver 88.7697 90.8813 .180
NL.ver 98.9838 101.5469 .052
*Statistically significant.
Fathi,et al.: Craniofacial growth in Iranian children
Dental Hypotheses ¦ Volume 8 ¦ Issue 1 ¦ January-March 2017 13
of nasopharynx is established in early infancy.
[60,61]Nasopharyngeal height increased significantly, whereas nasopharyngeal depth showed insignificant change.
Finally, it should be mentioned that assessing growth changes in lateral cephalometry poses some shortcoming including 2- dimensional view and difficulty in defining landmarks.
[50]In addition, airway evaluation is even more difficult because it is not possible to precisely monitor the respiratory cycle, which may directly affect the airway morphology and size.
[62]However, lateral cephalometry is an inexpensive method which provides good assessment of airway elements.
[58]Prospective and functional analysis of airway tract is proposed for future studies.
C ONCLUSION
The present study concludes that among 9 – 11 years old:
(1) Cranial base length, maxillomandibular length, and anterior and posterior facial height increased.
(2) Airway analysis revealed an increase in nasopharyngeal height, hypopharyngeal depth, tongue length, and height. Hyoid bone drifted anteriorly and inferiorly.
(3) No changes in head posture was observed.
(4) Dental relationship was stable.
Financial support and sponsorship Nil.
Conflicts of Interest
There are no conflicts of interest.
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4. Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW.
Craniofacial morphological characteristics in children with obstructive
Table 6: Results of paired t test in airway and retrolingual variables from 9 – 11 years old
Variable Mean (9 years old) Mean (11 years old) Pvalue
Pharyngeal anteroposterior length
V.LPW 14.8719 16.1150 .014*
Ptm.UPW 15.1931 15.8987 .291
U.MPW 9.8803 9.4859 .449
Ptm.aa 35.8834 35.7259 .775
Ptm.ba 47.1703 46.8941 .661
Soft palate and tongue
NL.PmU 114.1678 112.9250 .282
V.T 65.5866 69.0200 .001*
H.vt 29.6778 31.7159 .001*
Vallecula position
Ptm.V 38.3859 40.8016 .009*
V.FH 73.6875 77.6009 .007*
V.C3 33.4475 34.6291 .097
Hyoid position
AH.C3Hor 44.7500 45.7500 .163
AH.C3Ver 90.7863 86.1172 .041*
AH.FH 75.9212 79.2038 .021*
AH.ML 9.4184 10.4725 .172
AH.Sver 96.9500 100.5297 .006*
AA-AH 51.2159 53.9916 .005*
AH-Rgn 40.2975 41.7144 .106
Nasopharyngeal vertical dimensions
Posterior height of nasal cavity 48.7597 50.4744 .004*
Length of pharyngeal cavity 38.5428 38.5913 .948
Vertical diachoanal opening 25.3163 27.1266 .003*
So-In 28.8897 29.9034 .063
Nasopharyngeal depth 60.4362 59.7528 .334
Nasopharyngeal floor length 35.3638 35.7753 .453
Vertical angle of nasopharynx 62.2641 63.0159 .347
Roof angle of nasopharynx 94.9722 95.1828 .876
Total nasopharygeal area 47.8562 49.0797 .112
*Statistically significant.
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14 Dental Hypotheses ¦ Volume 8 ¦ Issue 1 ¦ January-March 2017
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