Skip to main content
NCBI home page
American Journal of Nuclear Medicine and Molecular Imaging logoLink to American Journal of Nuclear Medicine and Molecular Imaging
. 2022 Feb 15;12(1):33–40.

Comparing dimensions of upper airway in patients with nasal septal deviation and healthy people in CBCT

Nasim Jafari-Pozve 1, Hamidreza Kiani 2, Seyed-Sasan Aryanezhad 1
PMCID: PMC8918399  PMID: 35295889

Abstract

Nasal septal deviation causes the obstruction of the nasal lateral wall and sinus cavities as well as bringing some respiratory problems. Furthermore, the obstruction of the upper airway tract can cause changes in normal breathing process, which itself has an important effect on the normal development of both the mandibular and facial areas. This study aimed to assess the dimensions of airway in patients suffering from nasal septal deviation as well as comparing them with healthy individuals through CBCT images. This descriptive analytical study was performed on 127 patients (classified into two groups: with septal deviation (n=93) and without this deviation (n=34). In each patient, the presence and severity of nasal septal deviation as well as upper airway dimensions were examined from sagittal and coronal views. The obtained data were then analyzed using independent t-test and Mann-Whitney test.no significant difference was observed between the mean age of the two study groups (P=0.208). Among those subjects with and without nasal septal deviation, no significant difference was observed in the lateral view in nasopharynx (P=0.653), oropharynx (P=0.828), and hypopharynx (P=0.693) areas in terms of the anteroposterior airway dimensions. As well, no significant difference was observed in the transversal dimensions in coronal view in nasopharynx (P=0.098), oropharynx (P=0.438), and hypopharynx (P=0.676) areas. There was no significant difference in terms of anteroposterior airway dimensions in the lateral view as well as regarding transverse dimensions in coronal view in nasopharynx, oropharynx, and hypopharynx areas.

Keywords: Upper airway, nasal septal deviation, CBCT

Introduction

The nasal septum is an essential component in the development of the nose and paranasal sinuses, so nasal septal deviation is known as one of the most common diseases in humans [1], whereby the nasal septum becomes deviated either rightward or leftward [2-5]. The prevalence of nasal septal deviation can be determined by investigating genetic, environmental, and cultural factors [6]. Accordingly, its causes include trauma, nasal polyps, neoplasia, infection, and genetics [2,7,8]. Nasal septal deviation, which increases the probability of nasal obstruction, can adversely affect the verbal pronunciation, aesthetics, and respiration. It can also lead to sinusitis as well as infections of the upper airway and middle ear [9-12].

Three pharyngeal areas of nasopharynx, oropharynx, and hypopharynx constitute the upper airway, by having important functions in swallowing and respiration [13,14]. Changes in the upper airway dimensions results in the incidence of some problems, including obstructive sleep apnea (OSA). This disease develops in response to periodic obstruction of the upper airway, especially the oropharynx, and is associated with the diminished nocturnal blood oxygen [8,15-17].

Lack of the integration of the three components of adult nasal septum, including septal cartilage, the vertical ethmoid plane, and vomer bone, can consequently lead to nasal septal deviation, deformity at the cartilage to Vomer connecting, or the incidence of nasal spine at the end [18].

The description of NSD along with a comprehensive assessment of the nasal septum can be significant for pre-surgery planning [19], re-functioning, and for endoscopic surgery of the sinus plus septal plastic surgery [20].

The upper airway obstruction usually causes the alteration in normal breathing, which would have a considerable effect on the normal development of the mandibular and facial region [21-23]. Such abnormalities require early diagnosis, so that further impacts on the normal development of the jaw and face would be prevented [24]. In this regard, CBCT is one of the best diagnostic tools with some unique features. With the use of CBCT, it is possible to observe both anatomical and dimensional changes of different parts of the airway [21]. Moreover, using this technique, one can examine the relationship between airway changes across different dimensions as well as developmental changes of the jaw and face with a high accuracy [23].

Codari et al. [25] in their stud5y stated that CBCT is a suitable option for airway assessment. In another study, Indriksone and Jakobsone [26] also assessed the upper airway dimensions in different facial patterns in anteroposterior dimensions. As a result, they found that in most cases, there is no significant difference among various facial patterns in anteroposterior dimension and oropharyngeal airway dimensions. In a systematic review on the papers performed on upper airway analysis using CBCT, Guijarro-Martinez and Swennen [27] concluded that by applying CBCT, it is possible to analyze the upper airway three dimensionally with high accuracy and reliability. Nevertheless, there are still important obstacles in the way of employing these techniques, including the effect of stage of respiration, the impact of the position of tongue, mandible morphology, and three-dimensional definition of the anatomical limits of the upper airway.

Considering the respiratory problems in people with nasal septal deviation along with dissimilarity of some symptoms in respiratory problems and nasal septal deviation, and since the shape, size, and craniofacial skeletal position (nasal septal deviation) may determine the airway constriction [19], and since nasal septal deviation can cause turbulent and accelerated airflow and eventually result in oral respiration (this study aimed to assess the airway dimensions in people with nasal septal deviation and to compare them with healthy individuals through CBCT images.

Materials and methods

This descriptive-analytical cross-sectional study was performed on CBCT images obtained from 127 patients (categorized into two groups: with nasal septal deviation (n=93) and without deviation (n=34)) using available sampling method. The inclusion criteria of this study were as follows: age between 18 and 80 years old; and field of view of patients, including maxilla and mandible plus desired diagnostic quality of images. On the other hand, images associated with surgery or maxillofacial trauma, any developmental or congenital disorders, and angled or irregular nasal septal deviation cases (in cases with any trauma) were excluded from the current study.

The images were prepared by Galileos (Bensheim-Germany) with 85 kvp and 10-42 mA for 14 seconds. The obtained data were analyzed using SIRONA sidexis XG software, which is mostly utilized for measuring distances.

Initially, the nasal septal deviation angle of the patients was calculated based on the connection of three points, including Crista galli, tip of the septum curve convexity, and nasal anterior spine (angle apex: Crista galli point) across the coronal section (Figure 1). As well, in order to better investigate the possible relationship between the severity of nasal septal deviation and upper airway dimensions, the group with nasal septal deviation was categorized into following three subgroups based on NSD angle: low deviation (2-10°), moderate (11-20°), and severe (over 20°).

Figure 1.

Figure 1

Open in a new tab

The three-point connection of the deviation angle in the coronal section.

To measure the airway dimensions in both anteroposterior and transversal dimensions, PNS landmarks were used as follows: the nasal posterior spine, hypothetical point X: the bottommost point of soft palate tissue, hypothetical point Y: the topmost point of epiglottis tissue (lower than Aryepiglottic folds), and hypothetical points A: the topmost point of arotinoid prominences.

Based on the above-mentioned landmarks, in each image, the airway dimensions of nasopharynx, oropharynx, and hypopharynx were measured (Figures 2, 3 and 4).

Figure 2.

Figure 2

Open in a new tab

(A) Anteroposterior dimension of nasopharynx in sagittal view, (B) transversal dimension of nasopharynx in coronal view.

Figure 3.

Figure 3

Open in a new tab

(A) Anteroposterior dimension of oropharynx in sagittal view, (B) transversal dimension of oropharynx in coronal view.

Figure 4.

Figure 4

Open in a new tab

(A) transversal dimension of hypopharynx in coronal view, (B) posterior dimension of hypopharynx in sagittal view.

Thereafter, the obtained data were analyzed through independent t-test, Mann-Whitney, Kruskal-Wallis, and Fisher-exact test through SPSS 22.

Results

In the present study, the included patients were assigned into two groups of 34 (26.8%) without deviation and 93 (73.2%) with nasal septal deviation with deviation angles of 2.10-24.90°. In terms of investigating the age frequency of the enrolled participants, it was observed that most of those with nasal septal deviation were in the age group of 60-70 years old (81.3%), while the minimum was found among the 18-30-year-old patients (62.5%), whereby no significant difference was observed between these two groups (P=0.208).

In terms of the mean anteroposterior dimensions of the airway, there was no significant difference between the individuals with and without nasal septal deviation in nasopharynx (P=0.653), oropharynx (P=0.828), and hypopharynx areas (P=0.693) (Figure 5).

Figure 5.

Figure 5

Open in a new tab

The mean anteroposterior dimension of nasopharynx, oropharynx, and hypopharynx in individuals with nasal septal deviation and in those without this deviation in lateral view.

In examining the mediolateral dimensions of the airway, no significant difference was found either between those with and without nasal septal deviation in nasopharynx (P=0.98), oropharynx (P=0.438), and hypopharynx (P=0.7693) areas (Figure 6).

Figure 6.

Figure 6

Open in a new tab

The mean mediolateral dimension of nasopharynx, oropharynx, and hypopharynx in individuals with nasal septal deviation and in those without this deviation in coronal view.

Moreover, when comparing the posterior dimensions of nasopharynx, oropharynx, and hypopharynx areas in those with and without nasal septal deviation in terms of age, the mean anteroposterior dimension of nasopharynx was observed to be significantly higher in those with nasal septal deviation compared to those without it in the 40-50-year-old age group (P=0.043). However, no significant difference was observed across the other age groups in terms of the other comparisons between the individuals with and without nasal septal deviation (P>0.05) (Table 1).

Table 1.

Comparing the Anteroposterior dimensions of nasopharynx, oropharynx, and hypopharynx in those with and without nasal septal deviation in the studied age-groups

Variable Age range (year) Number No deviation With deviation P
Mean SD Mean SD
Nasopharynx 18-30 16 24.04 3.44 22.48 3.81 0.32
30-40 27 25.80 3.35 24.42 3.74 0.47
40-50 22 24.29 3.01 26.62 2.24 0.04
50-60 34 25.59 3.53 26.44 3.37 0.36
60-70 16 25.60 3.01 26.21 3.21 0.89
70-80 6 --- --- 26.40 3.91 ---
Oropharynx 18-30 16 13.97 3.83 13.39 2.95 0.82
30-40 27 12.05 3.45 13.04 3.80 0.91
40-50 22 13.90 4.06 12.67 4.25 0.41
50-60 34 13.40 4.45 13.06 4.24 0.74
60-70 16 12.44 0.83 14.78 6.61 0.34
70-80 6 --- --- 11.61 2.93 ---
Hypopharynx 18-30 16 16.87 3.65 14.09 2.98 0.19
30-40 27 16.09 3.90 16.98 3.28 0.75
40-50 22 15.36 5.40 15.63 4.75 0.96
50-60 34 15.12 3.62 14.99 4.40 0.75
60-70 16 18.15 2.16 17.03 3.17 0.43
70-80 6 --- --- 14.02 4.78 ---
Open in a new tab

By comparing the mediolateral dimension of nasopharynx, oropharynx, and hypopharynx in individuals with and without nasal septal deviation in terms of age, the mean mediolateral dimension of oropharynx was found as significantly lower in those with nasal septal deviation compared to the subjects without it in the 60-70-year-old age group (P=0.024). However, in the other comparisons, no significant difference was observed between the subjects with and without nasal septal deviation in other age groups (P>0.05) (Table 2).

Table 2.

Comparing the mediolateral dimensions of nasopharynx, oropharynx, and hypopharynx in those with and without nasal septal deviation in the studied age-groups

Variable Age range Numbers No deviation With deviation P
Mean SD Mean SD
Nasopharynx 18-30 16 23.50 3.97 24.06 3.74 0.914
30-40 27 25.26 6.39 28.84 4.37 0.193
40-50 22 25.89 3.14 25.75 3.54 0.973
50-60 34 25.67 5.32 27.87 6.09 0.416
60-70 16 28.82 4.10 26.01 3.64 0.281
70-80 6 --- --- 29.58 3.01 ---
Oropharynx 18-30 16 18.61 8.07 25.21 7.67 0.159
30-40 27 23.68 3.92 24.03 6.17 0.825
40-50 22 27.02 6.77 26.78 6.01 0.835
50-60 34 25.19 5.71 26.75 4.31 0.925
60-70 16 35.71 1.94 28.02 5.79 0.026
70-80 6 --- --- 24.64 6.05 ---
Hypopharynx 18-30 16 36.33 7.12 34.45 3.12 0.668
30-40 27 34.54 4.97 34.38 4.01 0.885
40-50 22 33.26 6.22 35.38 2.18 0.191
50-60 34 33.67 4.20 33.36 3.97 0.741
60-70 16 40.47 3.77 34.02 4.59 0.121
70-80 6 --- --- 30.12 2.54 ---
Open in a new tab

Discussion

This study evaluated the upper airway dimensions in the patients with and without nasal septal deviation using the CBCT device.

By investigating the relationship between age and nasal septum deviation, the major group with deviation was found as the age range of 60 to 70 years old (81.3%), while the minimum was found among the 18-30-yeer-old patients (62.5%). There was no significant relationship between nasal septal deviation and age, which is in line with the results of other studies [28-30]. In the study by Teul et al. [31], the largest deviation was observed in 15-20 and 4-14-year-old age groups, and there was a significant correlation between septum deviation and age. This was inconsistent with our results, which can be attributed to the selection of different age groups across the two studies.

In the present study, after investigating the mean values of the anteroposterior dimensions of nasopharynx, oropharynx, and hypopharynx areas in the lateral view in the cases with and without nasal septal deviation, it was found that no significant difference exists between these two groups. Additionally, by investigating the mean mediolateral dimension of nasopharynx, oropharynx, and hypopharynx, no significant difference was observed in the coronal view.

In the present study, the mean anteroposterior dimensions of the nasopharynx were significantly larger in those with nasal septal deviation compared to the healthy individuals in the 40-50-year-old age group. However, by comparing different age groups, no significant difference was observed between those with nasal septal deviation and the subjects without it in terms of the anteroposterior dimensions of nasopharynx, oropharynx, and hypopharynx. Finally, by investigating the mean mediolateral dimension of oropharynx, the 60-70-year-old age group showed significantly lower values among those with nasal septal deviation compared to the subjects without it.

Subsequently, considering the examination of the relationship between upper airway changes and age, Moradi et al. [32] in their research found that the volume of different airway parts (nasopharynx, oropharynx, and hypopharynx) and all the measurements of anterior posterior dimension were significantly higher in the 21-40-year-old age group compared to the 6-20-year-old counterparts. Furthermore, these measurements were lower in 41-60-year-old age group compared to the 21-40-year-old counterparts; however, this difference was not statistically significant. Nevertheless, in the study by Moradi, unlike the present study, the nasal septal deviation index had not been considered. Moreover, Schendel et al. [33] in their study observed that the total volume of the upper airway increases with aging up to 20 years old, it remains constant up to around 40 years old, and then slightly diminishes from 40 to 60 years old.

In another study, Sheng et al. [34] observed a significant increase in airway dimensions in the 10-22-year-old age group. Besides, Martin et al. [35] in their study conducted on examining the upper airway dimensions of 16-74-year-old people reported that the upper away dimensions decreased in both men and women with aging, which was in line with the results of the present study. Indriksone and Jakobsone [26] in their review study concluded that in 75% of studies, they observed no nasopharynx dimensions in craniofacial patterns. As well, the oropharynx was found to be larger in the class III pattern.

CBCT technique, while creating a three-dimensional image, has far lower radiation doses compared to CT scan [36]. Other advantages of CBCT over CT include its higher scanning rate as well as greater image resolution (0.1-0.4 mm) [33].

In various studies, the accuracy and reliability of CBCT have been evaluated for three dimensionally assessment of upper airway. Ghoneima and Kula [37] employed an acrylic model in their research, and reported that CBCT can regenerate the airway three dimensionally with minimum cross-section and a high accuracy. In addition, Hatcher [38] indicated that the potential of CBCT in diagnosing upper airway problems. Guijarro-Martinez and Swennen [27] in their review study concluded that CBCT has high accuracy and reliability in upper airway assessment. Nevertheless, some limitations have also been mentioned when using CBCT, including inability to control the respiration stage, the effect of tongue position, the impact of mandible morphology, and three-dimensional definition of anatomical limits of the upper airway.

Conclusion

No significant difference was found in Antero posterior airway dimensions in lateral as well as transversal in the coronal view in the nasopharynx, oropharynx, and hypopharynx areas.

Disclosure of conflict of interest

None.

References

  • 1.Yildirim I, Okur E. The prevalence of nasal septal deviation in children from Kahramanmaras, Turkey. Int J Pediatr Otorhinolaryngol. 2003;67:1203–1206. doi: 10.1016/j.ijporl.2003.07.005. [DOI] [PubMed] [Google Scholar]
  • 2.Kim YM, Rha KS, Weissman JD, Hwang PH, Most SP. Correlation of asymmetric facial growth with deviated nasal septum. Laryngoscope. 2011;121:1144–1148. doi: 10.1002/lary.21785. [DOI] [PubMed] [Google Scholar]
  • 3.Rahimi Varposhti M, Moradi Farsani D, Ghadimi K, Asadi M. Reduction of oculocardiac reflex with tetracaine eye drop in strabismus surgery. Strabismus. 2019;27:1–5. doi: 10.1080/09273972.2018.1561732. [DOI] [PubMed] [Google Scholar]
  • 4.Etemadifar M, Ghadimi M, Ghadimi K, Alsahebfosoul F. The serum amyloid β level in multiple sclerosis: a case-control study. Casp J Neurol Sci. 2017;3:214–221. [Google Scholar]
  • 5.Zadeh NM, Asl NSM, Forouharnejad K, Ghadimi K, Parsa S, Mohammadi S, Omidi A. Mechanism and adverse effects of COVID-19 drugs: a basic review. Int J Physiol Pathophysiol Pharmacol. 2021;13:102–109. [PMC free article] [PubMed] [Google Scholar]
  • 6.Zielnik-Jurkiewicz B, Olszewska-Sosińska O. The nasal septum deformities in children and adolescents from Warsaw, Poland. Int J Pediatr Otorhinolaryngol. 2006;70:731–736. doi: 10.1016/j.ijporl.2004.09.014. [DOI] [PubMed] [Google Scholar]
  • 7.Fahim M, Zadeh AR, Shoureshi P, Ghadimi K, Cheshmavar M, Sheikhinia N, Afzali M. Alcohol and multiple sclerosis: an immune system-based review. Int J Physiol Pathophysiol Pharmacol. 2020;12:58–69. [PMC free article] [PubMed] [Google Scholar]
  • 8.Haddad S, Ghadimi K, Abrishamkar R, Asl NSM. Comparing laparoscopy and laparotomy procedures in the radical hysterectomy surgery for endometrial cancer: a basic review. Am J Transl Res. 2021;13:2456–2461. [PMC free article] [PubMed] [Google Scholar]
  • 9.Yasan H, Doĝru H, Baykal B, Döner F, Tüz M. What is the relationship between chronic sinus disease and isolated nasal septal deviation? Otolaryngol Head Neck Surg. 2005;133:190–193. doi: 10.1016/j.otohns.2005.04.013. [DOI] [PubMed] [Google Scholar]
  • 10.Aziz T, Ansari K, Lagravere MO, Major MP, Flores-Mir C. Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review. Prog Orthod. 2015;16:15. doi: 10.1186/s40510-015-0084-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Rogha M, Abtahi H, Asadpour L, Ghazavi H, Pourmohammadi R, Maleki M, Ghadimi K. Therapeutic effect of intratympanic injection of dexamethasone plus hyaluronic acid on patients with Meniere’s disease. Iran J Otorhinolaryngol. 2019;31:217. [PMC free article] [PubMed] [Google Scholar]
  • 12.Ashtari F, Madanian R, Shaygannejad V, Zarkesh SH, Ghadimi K. Serum levels of IL-6 and IL-17 in multiple sclerosis, neuromyelitis optica patients and healthy subjects. Int J Physiol Pathophysiol Pharmacol. 2019;11:267. [PMC free article] [PubMed] [Google Scholar]
  • 13.Dehesh MM, Sadeghi H, Shahrbabaki ME, Hosseini R. Personality disorders in patients with acute coronary syndrome. Intern Med Med Investig J. 2021:5. [Google Scholar]
  • 14.Ceylan I, Oktay H. A study on the pharyngeal size in different skeletal patterns. Am J Orthod Dentofacial Orthop. 1995;108:69–75. doi: 10.1016/s0889-5406(95)70068-4. [DOI] [PubMed] [Google Scholar]
  • 15.Bolger WE, Parsons DS, Butzin CA. Paranasal sinus bony anatomic variations and mucosal abnormalities: CT analysis for endoscopic sinus surgery. Laryngoscope. 1991;101:56–64. doi: 10.1288/00005537-199101000-00010. [DOI] [PubMed] [Google Scholar]
  • 16.Alavi A, Izadpanahi MH, Haghshenas L, Faridizad R, Eslami MJ, Ghadimi K. Comparing urine levels of BLCA-4 nuclear matrix protein in patients with bladder cancer and non-bladder cancer. Int J Physiol Pathophysiol Pharmacol. 2019;11:289–292. [PMC free article] [PubMed] [Google Scholar]
  • 17.Ali Kiaei B, Moradi Farsani D, Ghadimi K, Shahali M. Evaluation of the relationship between serum sodium concentration and mortality rate in ICU patients with traumatic brain injury. Archives of Neuroscience. 2018;5 [Google Scholar]
  • 18.Sadeghniiat-Haghighi K, Yazdi Z, Firoozeh M. Relationship between obstructive sleep apnea and morning headache. Journal of Inflammatory Disease. 2011;15:26–32. [Google Scholar]
  • 19.Lin JK, Wheatley FC, Handwerker J, Harris NJ, Wong BJ. Analyzing nasal septal deviations to develop a new classification system. JAMA Facial Plast Surg. 2014;16:183–7. doi: 10.1001/jamafacial.2013.2480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Buyukertan M, Keklikoglu N, Kokten G. A morphometric consideration of nasal septal deviations by people with paranasal complaints; a computed tomography study. Rhinology. 2003;41:21–24. [PubMed] [Google Scholar]
  • 21.Alsufyani NA, Flores-Mir C, Major PW. Three-dimensional segmentation of the upper airway using cone beam CT: a systematic review. Dentomaxillofac Radiol. 2012;41:276–284. doi: 10.1259/dmfr/79433138. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Defabjanis P. Impact of nasal airway obstruction on dentofacial development and sleep disturbances in children: preliminary notes. J Clin Pediatr Dent. 2004;27:95–100. doi: 10.17796/jcpd.27.2.27934221l1846711. [DOI] [PubMed] [Google Scholar]
  • 23.Nieminen P, Löppönen T, Tolonen U, Lanning P, Knip M, Löppönen H. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics. 2002;109:e55. doi: 10.1542/peds.109.4.e55. [DOI] [PubMed] [Google Scholar]
  • 24.Yu X, Fujimoto K, Urushibata K, Matsuzawa Y, Kubo K. Cephalometric analysis in obese and nonobese patients with obstructive sleep apnea syndrome. Chest. 2003;124:212–218. doi: 10.1378/chest.124.1.212. [DOI] [PubMed] [Google Scholar]
  • 25.Codari M, Zago M, Guidugli GA, Pucciarelli V, Tartaglia GM, Ottaviani F, Righini S, Sforza C. The nasal septum deviation index (NSDI) based on CBCT data. Dentomaxillofac Radiol. 2016;45:20150327. doi: 10.1259/dmfr.20150327. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26.Indriksone I, Jakobsone G. The upper airway dimensions in different sagittal craniofacial patterns: a systematic review. Stomatologija. 2014;16:109–117. [PubMed] [Google Scholar]
  • 27.Guijarro-Martínez R, Swennen G. Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature. Int J Oral Maxillofac Surg. 2011;40:1227–1237. doi: 10.1016/j.ijom.2011.06.017. [DOI] [PubMed] [Google Scholar]
  • 28.Akbay E, Cokkeser Y, Yilmaz O, Cevik C. The relationship between posterior septum deviation and depth of maxillopalatal arch. Auris Nasus Larynx. 2013;40:286–290. doi: 10.1016/j.anl.2012.07.016. [DOI] [PubMed] [Google Scholar]
  • 29.Kajan ZD, Khademi J, Nemati S, Niksolat E. The effects of septal deviation, concha bullosa, and their combination on the depth of posterior palatal arch in cone-beam computed tomography. J Dent (Shiraz) 2016;17:26–31. [PMC free article] [PubMed] [Google Scholar]
  • 30.Bahemmat N, Hadian H. The frequency of nasal septal deviation and concha bullosa and their relationship with maxillary sinusitis based on CBCT finding. International Journal of Medical Research & Health Sciences. 2016;5:152–156. [Google Scholar]
  • 31.Teul I, Zbislawski W, Baran S, Czerwinski F. Deformation of the nasal septum in children, adolescents, and adults in Western Pomerania province of Poland. Eur J Med Res. 2009;14(Suppl 4):244–7. doi: 10.1186/2047-783X-14-S4-244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Moradi E, Sheikh M, Vaezi T. Cone beam computed tomography (CBCT) evaluation of age-related upper airway changes. Bangladesh Journal of Medical Science. 2016;15:78–83. [Google Scholar]
  • 33.Schendel SA, Jacobson R, Khalessi S. Airway growth and development: a computerized 3-dimensional analysis. J Oral Maxillofac Surg. 2012;70:2174–2183. doi: 10.1016/j.joms.2011.10.013. [DOI] [PubMed] [Google Scholar]
  • 34.Sheng CM, Lin LH, Su Y, Tsai HH. Developmental changes in pharyngeal airway depth and hyoid bone position from childhood to young adulthood. Angle Orthod. 2009;79:484–490. doi: 10.2319/062308-328.1. [DOI] [PubMed] [Google Scholar]
  • 35.Martin S, Mathur R, Marshall I, Douglas N. The effect of age, sex, obesity and posture on upper airway size. Eur Respir J. 1997;10:2087–2090. doi: 10.1183/09031936.97.10092087. [DOI] [PubMed] [Google Scholar]
  • 36.Loubele M, Bogaerts R, Van Dijck E, Pauwels R, Vanheusden S, Suetens P, Marchal G, Sanderink G, Jacobs R. Comparison between effective radiation dose of CBCT and MSCT scanners for dentomaxillofacial applications. Eur J Radiol. 2009;71:461–468. doi: 10.1016/j.ejrad.2008.06.002. [DOI] [PubMed] [Google Scholar]
  • 37.Ghoneima A, Kula K. Accuracy and reliability of cone-beam computed tomography for airway volume analysis. Eur J Orthod. 2013;35:256–261. doi: 10.1093/ejo/cjr099. [DOI] [PubMed] [Google Scholar]
  • 38.Hatcher DC. Cone beam computed tomography: craniofacial and airway analysis. Dent Clin North Am. 2012;56:343–57. doi: 10.1016/j.cden.2012.02.002. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Nuclear Medicine and Molecular Imaging are provided here courtesy of e-Century Publishing Corporation

RESOURCES