Cephalometric Screening Assessment for Superior Airway Space Narrowing : Added Value of Three-Dimensional Imaging
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Philipps-Universität Marburg
Abstract
Assessing the morphology of the superior airway space is a crucial diagnostic
step in the treatment planning of patients with obstructive sleep apnea syndrome (OSAS) or prior to
orthognathic surgery. The aim of this study is to evaluate the necessary scope of a two-dimensional
cephalometric assessment and the necessity of three-dimensional imaging in the identification of
superior airway space narrowing (SASN). Methods: The computed tomography studies of 100 nonobese,
non-OSAS patients were evaluated and analyzed retrospectively. Multiplanar reconstructions
were created and underwent cephalometric evaluation. The three-dimensional superior airway
morphology was segmented and measured for the minimal cross-sectional area (Amin) and volume
(V0). Patients were grouped according to Amin < 80 mm2 and V0 < 12 cm3. Cephalometric parameters
(CPs) were analyzed according to Amin and V0 with an unpaired t-test, Pearson correlation, and
ROC-curve analysis. Results: The CPs regarding sagittal airway space dimensions (IPAS, MPAS,
SPAS) and mandibular body length (GoGn) show the strongest correlation to the three-dimensional
minimal cross-sectional area (Amin). The ROC-curve analysis classifying for SASN led to an AUC
of 0.86 for IPAS, 0.87 for MPAS, 0.88 for SPAS, and 0.63 for GoGn. Three-dimensional imaging may
further improve the diagnostic accuracy in the identification of SASN for IPAS below 13.5 mm, MPAS
below 10.2 mm, SPAS below 12.5 mm, and GoGn below 90.2 mm. Conclusions: Two-dimensional
cephalometric sagittal airway space diameters and mandibular body length are useful initial screening
parameters in the identification of superior airway space narrowing. Nevertheless, as the correlation
of two-dimensional cephalometric parameters with three-dimensional upper airway space narrowing
is varying and highly dependent on acquisition circumstances, indications for three-dimensional
imaging, if possible, in the supine position to evaluate upper airway space morphology should
be provided generously, especially in patients with low but normal airway space parameters in
two-dimensional cephalometry.