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Cephalometric pattern and nasal patency in children with primary snoring: the evidence of a direct correlation.

Zicari AM, Duse M, Occasi F, Luzzi V, Ortolani E, Bardanzellu F, Bertin S, Polimeni A - PLoS ONE (2014)

Bottom Line: Sleep disordered breathing (SDB) might affect craniofacial growth and children with obstructive sleep apnea syndrome present an increase in total and lower anterior heights of the face and a more anterior and inferior position of the hyoid bone when compared to nasal breathers.We found a more vertical position of the hyoid bone to the mandibular plane (H⊥VT) in patients with a higher frequency (7.3±2.7 vs 7.6±3.7 vs 10.9±2.5 in children snoring 3 nights/week, 4-6 nights/week and every night/week respectively; p = 0.032).Concerning nasal patency significant correlations were found with ANB (maxillary and jaw position with respect to the cranial base), NS∧Ar (growth predictor), sumangle, FMA (total divergence), SnaSnp∧GoMe (inferior divergence), BaN∧PtGn (facial growth pattern), Phw1_PsP (posterosuperior airway space), AHC3H (the horizontal distance between the most anterosuperior point of the hyoid bone and the third cervical vertebra).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.

ABSTRACT

Introduction: Sleep disordered breathing (SDB) might affect craniofacial growth and children with obstructive sleep apnea syndrome present an increase in total and lower anterior heights of the face and a more anterior and inferior position of the hyoid bone when compared to nasal breathers.

Objective: To investigate the correlation between rhinomanometric and cephalometric parameters in children with primary snoring (PS), without apnea or gas exchange abnormalities.

Materials and methods: Thirty children with habitual snoring (16 females and 14 males) aged 4-8 years (mean age 6.85±1.51 years) were selected by a SDB validate questionnaire. All subjects underwent lateral cephalometric, panoramic radiographies.

Results: In our sample 10 children (33%) had snoring 3 nights/week, 11 (37%) 4-6 nights/week and 9 (30%) every night/week. Overall 7 patients (23.3%) were affected by adenoid hypertrophy (AH), 4 (13.3%) by tonsillar hypertrophy (TH) and 13 (43.3%) by AH and TH. We found a more vertical position of the hyoid bone to the mandibular plane (H⊥VT) in patients with a higher frequency (7.3±2.7 vs 7.6±3.7 vs 10.9±2.5 in children snoring 3 nights/week, 4-6 nights/week and every night/week respectively; p = 0.032). Concerning nasal patency significant correlations were found with ANB (maxillary and jaw position with respect to the cranial base), NS∧Ar (growth predictor), sumangle, FMA (total divergence), SnaSnp∧GoMe (inferior divergence), BaN∧PtGn (facial growth pattern), Phw1_PsP (posterosuperior airway space), AHC3H (the horizontal distance between the most anterosuperior point of the hyoid bone and the third cervical vertebra).

Conclusion: The present study supports the relationship between nasal obstruction and specific craniofacial characteristics in children with primary snoring and lead us to hypothesize that nasal obstruction might explain the indirect link between snoring and cephalometric alterations.

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Related in: MedlinePlus

SNA (degrees), SNB (degrees), and ANB (degrees) were used to define the maxillary and jaw position with respect to the cranial base (SN) and the respective skeletal Class; NS∧Ar (degrees), SAr∧Go (degrees), ArGo∧Me (degrees) study growth direction; BaN ∧ PtGn is the upper angle, measured between total cranic base (BaN) and facial axis (Pt Gn) and defines the facial growth; Po-Or ∧GoMe or FMA (degrees) is measured between the Frankfort horizontal plane and the mandibular plane and represents the total divergence while PFH∧SnaSnp the superior divergence and SnaSnp∧GoMe, the inferior divergence.AH-C3H (mm), the horizontal distance from AH to C3; AH-AH' (mm), the vertical position of the hyoid to the mandibular plane; H VT, representing the vertical position of the tongue; Phw1-Psp (mm), posterior superior airway space; PhwN-STBn, the middle pharyngeal width; PhwI-STBi, inferior airway space.
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pone-0111675-g001: SNA (degrees), SNB (degrees), and ANB (degrees) were used to define the maxillary and jaw position with respect to the cranial base (SN) and the respective skeletal Class; NS∧Ar (degrees), SAr∧Go (degrees), ArGo∧Me (degrees) study growth direction; BaN ∧ PtGn is the upper angle, measured between total cranic base (BaN) and facial axis (Pt Gn) and defines the facial growth; Po-Or ∧GoMe or FMA (degrees) is measured between the Frankfort horizontal plane and the mandibular plane and represents the total divergence while PFH∧SnaSnp the superior divergence and SnaSnp∧GoMe, the inferior divergence.AH-C3H (mm), the horizontal distance from AH to C3; AH-AH' (mm), the vertical position of the hyoid to the mandibular plane; H VT, representing the vertical position of the tongue; Phw1-Psp (mm), posterior superior airway space; PhwN-STBn, the middle pharyngeal width; PhwI-STBi, inferior airway space.

Mentions: All subjects underwent lateral cephalometric, panoramic radiographies and dental impression in the Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome. Cephalograms were obtained with the teeth in centric occlusion and with the lips in light contact. Centric occlusion was used to minimize variability in mandibular and soft tissue measurements, often associated with rest position. The lateral cephalogram was taken using natural head posture, found by having the patient look in front of him or herselves. All cephalometric landmarks were located and digitized by the same investigator using the Oris ceph software and was evaluated according to Kulnis et al. [18] as showed in Figure 1 and Figure 2. For the sagittal analysis, angles SNA (degrees), SNB (degrees), and ANB (degrees) were used to define the maxillary and jaw position with respect to the cranial base (SN) and the respective skeletal Class. For the vertical analysis we used the angle FMA (degrees), measured between the Frankfort horizontal plane and the mandibular plane, representing the total divergence, the angles PFH∧SnaSnp for the superior divergence and SnaSnp∧GoMe for the inferior divergence. Concerning growth predictors: NS∧Ar (degrees), SAr∧Go (degrees), ArGo∧Me (degrees) and respective sumangle based on Jarabak analysis (the increase sumangle correspond to a posterior rotation of the jaw and to a greater vertical growth); BaN∧PtGn, based on Ricketts analysis, is the upper angle, measured between total cranic base (BaN) and facial axis (Pt Gn) and it defines the facial growth, with an increased angle value corresponding to a prevalent horizontal growth and the reverse if reduced. The hyoid bone position was evaluated with AH-C3 H (mm), the horizontal distance from AH to C3; AH is the most anterior and superior point on the body of the hyoid bone and represents the inferior part of the tongue; C3 is the third cervical vertebra; AH-AH' (mm) is the vertical position of the hyoid to the mandibular plane. H⊥VT represents the vertical position of the tongue; VT is the distance from the intersection of the epiglottis and the base of the tongue to the tip of the tongue. Soft tissue and oropharyngeal dimension were measured according to Pracharktam et al. [19]: Phw1-Psp (mm), posterosuperior airway space measured along a line parallel to B-Go; PhwN-STBn, the middle pharyngeal width measured between posterior pharyngeal wall at narrowest point and the most anterior point in the airway on the soft palate; PhwI-STBi, inferior airway space between posteroinferior pharyngeal wall and the most anterior point in the airway on the tongue.


Cephalometric pattern and nasal patency in children with primary snoring: the evidence of a direct correlation.

Zicari AM, Duse M, Occasi F, Luzzi V, Ortolani E, Bardanzellu F, Bertin S, Polimeni A - PLoS ONE (2014)

SNA (degrees), SNB (degrees), and ANB (degrees) were used to define the maxillary and jaw position with respect to the cranial base (SN) and the respective skeletal Class; NS∧Ar (degrees), SAr∧Go (degrees), ArGo∧Me (degrees) study growth direction; BaN ∧ PtGn is the upper angle, measured between total cranic base (BaN) and facial axis (Pt Gn) and defines the facial growth; Po-Or ∧GoMe or FMA (degrees) is measured between the Frankfort horizontal plane and the mandibular plane and represents the total divergence while PFH∧SnaSnp the superior divergence and SnaSnp∧GoMe, the inferior divergence.AH-C3H (mm), the horizontal distance from AH to C3; AH-AH' (mm), the vertical position of the hyoid to the mandibular plane; H VT, representing the vertical position of the tongue; Phw1-Psp (mm), posterior superior airway space; PhwN-STBn, the middle pharyngeal width; PhwI-STBi, inferior airway space.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216138&req=5

pone-0111675-g001: SNA (degrees), SNB (degrees), and ANB (degrees) were used to define the maxillary and jaw position with respect to the cranial base (SN) and the respective skeletal Class; NS∧Ar (degrees), SAr∧Go (degrees), ArGo∧Me (degrees) study growth direction; BaN ∧ PtGn is the upper angle, measured between total cranic base (BaN) and facial axis (Pt Gn) and defines the facial growth; Po-Or ∧GoMe or FMA (degrees) is measured between the Frankfort horizontal plane and the mandibular plane and represents the total divergence while PFH∧SnaSnp the superior divergence and SnaSnp∧GoMe, the inferior divergence.AH-C3H (mm), the horizontal distance from AH to C3; AH-AH' (mm), the vertical position of the hyoid to the mandibular plane; H VT, representing the vertical position of the tongue; Phw1-Psp (mm), posterior superior airway space; PhwN-STBn, the middle pharyngeal width; PhwI-STBi, inferior airway space.
Mentions: All subjects underwent lateral cephalometric, panoramic radiographies and dental impression in the Department of Oral and Maxillo-Facial Sciences, “Sapienza” University of Rome. Cephalograms were obtained with the teeth in centric occlusion and with the lips in light contact. Centric occlusion was used to minimize variability in mandibular and soft tissue measurements, often associated with rest position. The lateral cephalogram was taken using natural head posture, found by having the patient look in front of him or herselves. All cephalometric landmarks were located and digitized by the same investigator using the Oris ceph software and was evaluated according to Kulnis et al. [18] as showed in Figure 1 and Figure 2. For the sagittal analysis, angles SNA (degrees), SNB (degrees), and ANB (degrees) were used to define the maxillary and jaw position with respect to the cranial base (SN) and the respective skeletal Class. For the vertical analysis we used the angle FMA (degrees), measured between the Frankfort horizontal plane and the mandibular plane, representing the total divergence, the angles PFH∧SnaSnp for the superior divergence and SnaSnp∧GoMe for the inferior divergence. Concerning growth predictors: NS∧Ar (degrees), SAr∧Go (degrees), ArGo∧Me (degrees) and respective sumangle based on Jarabak analysis (the increase sumangle correspond to a posterior rotation of the jaw and to a greater vertical growth); BaN∧PtGn, based on Ricketts analysis, is the upper angle, measured between total cranic base (BaN) and facial axis (Pt Gn) and it defines the facial growth, with an increased angle value corresponding to a prevalent horizontal growth and the reverse if reduced. The hyoid bone position was evaluated with AH-C3 H (mm), the horizontal distance from AH to C3; AH is the most anterior and superior point on the body of the hyoid bone and represents the inferior part of the tongue; C3 is the third cervical vertebra; AH-AH' (mm) is the vertical position of the hyoid to the mandibular plane. H⊥VT represents the vertical position of the tongue; VT is the distance from the intersection of the epiglottis and the base of the tongue to the tip of the tongue. Soft tissue and oropharyngeal dimension were measured according to Pracharktam et al. [19]: Phw1-Psp (mm), posterosuperior airway space measured along a line parallel to B-Go; PhwN-STBn, the middle pharyngeal width measured between posterior pharyngeal wall at narrowest point and the most anterior point in the airway on the soft palate; PhwI-STBi, inferior airway space between posteroinferior pharyngeal wall and the most anterior point in the airway on the tongue.

Bottom Line: Sleep disordered breathing (SDB) might affect craniofacial growth and children with obstructive sleep apnea syndrome present an increase in total and lower anterior heights of the face and a more anterior and inferior position of the hyoid bone when compared to nasal breathers.We found a more vertical position of the hyoid bone to the mandibular plane (H⊥VT) in patients with a higher frequency (7.3±2.7 vs 7.6±3.7 vs 10.9±2.5 in children snoring 3 nights/week, 4-6 nights/week and every night/week respectively; p = 0.032).Concerning nasal patency significant correlations were found with ANB (maxillary and jaw position with respect to the cranial base), NS∧Ar (growth predictor), sumangle, FMA (total divergence), SnaSnp∧GoMe (inferior divergence), BaN∧PtGn (facial growth pattern), Phw1_PsP (posterosuperior airway space), AHC3H (the horizontal distance between the most anterosuperior point of the hyoid bone and the third cervical vertebra).

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, "Sapienza" University of Rome, Rome, Italy.

ABSTRACT

Introduction: Sleep disordered breathing (SDB) might affect craniofacial growth and children with obstructive sleep apnea syndrome present an increase in total and lower anterior heights of the face and a more anterior and inferior position of the hyoid bone when compared to nasal breathers.

Objective: To investigate the correlation between rhinomanometric and cephalometric parameters in children with primary snoring (PS), without apnea or gas exchange abnormalities.

Materials and methods: Thirty children with habitual snoring (16 females and 14 males) aged 4-8 years (mean age 6.85±1.51 years) were selected by a SDB validate questionnaire. All subjects underwent lateral cephalometric, panoramic radiographies.

Results: In our sample 10 children (33%) had snoring 3 nights/week, 11 (37%) 4-6 nights/week and 9 (30%) every night/week. Overall 7 patients (23.3%) were affected by adenoid hypertrophy (AH), 4 (13.3%) by tonsillar hypertrophy (TH) and 13 (43.3%) by AH and TH. We found a more vertical position of the hyoid bone to the mandibular plane (H⊥VT) in patients with a higher frequency (7.3±2.7 vs 7.6±3.7 vs 10.9±2.5 in children snoring 3 nights/week, 4-6 nights/week and every night/week respectively; p = 0.032). Concerning nasal patency significant correlations were found with ANB (maxillary and jaw position with respect to the cranial base), NS∧Ar (growth predictor), sumangle, FMA (total divergence), SnaSnp∧GoMe (inferior divergence), BaN∧PtGn (facial growth pattern), Phw1_PsP (posterosuperior airway space), AHC3H (the horizontal distance between the most anterosuperior point of the hyoid bone and the third cervical vertebra).

Conclusion: The present study supports the relationship between nasal obstruction and specific craniofacial characteristics in children with primary snoring and lead us to hypothesize that nasal obstruction might explain the indirect link between snoring and cephalometric alterations.

Show MeSH
Related in: MedlinePlus