THE INFLUENCE OF MAXILLOFACIAL SKELETAL MORPHOLOGY ON AIRWAY DIMENSIONS AND ASSOCIATED ENT DISORDERS IN PEDIATRIC PATIENTS.
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Keywords
Maxillofacial Morphology, Pediatric Airway, Obstructive Sleep Apnea (OSA), Mandibular Retrognathia, CBCT, Interdisciplinary Care.
Abstract
Optimal upper airway function is essential for normal pediatric craniofacial development and overall health. While common ENT disorders like Obstructive Sleep Apnea (OSA) and adenotonsillar hypertrophy are known causes of airway obstruction, the reciprocal influence of underlying maxillofacial skeletal morphology—specifically, deviations in the maxilla and mandible—on airway dimensions remains a critical area requiring precise quantification.
Objective: This study aimed to quantitatively analyze the correlation between specific three-dimensional (3D) maxillofacial skeletal variables and volumetric airway dimensions in a pediatric cohort, and to compare these airway measurements across distinct clinical ENT diagnostic groups.
Methods: A retrospective cross-sectional analysis was performed on Cone-Beam Computed Tomography (CBCT) scans and medical records of pediatric patients 46. Standardized 3D landmark analysis was used to measure key skeletal parameters. The upper airway was segmented and quantified for Nasopharyngeal Volume (NPV), Oropharyngeal Volume (OPV), and the Minimum Cross-Sectional Area (MCA). Patients were categorized into three groups: No ENT Issues, Adenoid/Tonsil Hypertrophy, and Diagnosed OSA. Statistical analyses included Pearson’s correlation, ANOVA, and Multiple Linear Regression.
Results: Significant negative correlations were found between specific skeletal patterns and airway dimensions. Specifically, mandibular retrognathia (increased ANB angle) showed the strongest negative correlation with both OPV (r = -0.65, p < 0.001) and MCA (r = -0.71, p < 0.001). Furthermore, the OSA group exhibited significantly reduced mean OPV and MCA compared to both the No ENT Issues group and the Hypertrophy group (p < 0.01). Regression analysis confirmed that the ANB angle was the most significant independent predictor of reduced oropharyngeal airway volume, even when controlling for soft tissue factors.
Conclusion: Specific maxillofacial skeletal patterns, particularly those indicative of mandibular retrognathia and increased vertical growth, constitute a significant anatomical predisposition to reduced upper airway dimensions in children. This skeletal compromise is strongly associated with common pediatric ENT disorders, especially OSA. These findings advocate for the inclusion of early, detailed 3D skeletal and airway assessment in the collaborative management protocols between Dental/Orthodontic and ENT specialists to facilitate proactive intervention and improve long-term respiratory health.
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Dr. Ankur Mukherjee
Assistant Professor, Department of ENT, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur.
Dr. Sankarsan Choudhury
Assistant Professor, Department of Dentistry, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur.