Computerized measurement of the location and value of the minimum sagittal linear dimension of the upper airway on reconstructed lateral cephalograms compared with 3-dimensional values.

INTRODUCTION: Identifying the location and value of the smallest airway dimension can be useful in screening and planning treatment for patients with obstructive sleep apnea. Our objectives in this study were to (1) objectively identify the vertical location and value of the minimum sagittal linear dimension (MSLD) on 2-dimensional reconstructed lateral cephalograms (RLCs), (2) compare the location and value of the MSLD on RLCs with the vertical location and sagittal dimension of the minimum cross-sectional area (MCSA), and (3) investigate the association between the MSLD on RLCs and both the MCSA and the airway volume.

METHODS: Cone-beam computed tomography (CBCT) scans of 91 patients, in 3 age groups (<20, 20-40, and >40 years), were used to perform 3-dimensional assessments of the upper airway and reconstruct lateral cephalograms. Airway volume, MCSA, vertical level, and sagittal dimension of MCSA on the CBCT scans were obtained using Dolphin 3D software (version 11.7; Dolphin Imaging, Chatsworth, Calif). Customized software was used to objectively obtain the location and value of the MSLD of the airway on RLCs.

RESULTS: In all age groups, correlation tests showed significant correlations between the MSLD on RLCs and both the MCSA (rs ≥0.59; P <0.001) and the airway volume (rs ≥0.37; P <0.05). Additionally, there were significant correlations between the vertical location of the MSLD and the vertical location of the MCSA (rs ≥0.41; P <0.05) and between the MSLD and the sagittal dimension of the MCSA (r ≥0.61; P <0.001). Bland-Altman plots for the MSLD and the sagittal dimension of the MCSA showed much narrower 95% limits of agreement compared with the Bland-Altman plots for the vertical locations of the MSLD and the MCSA.

CONCLUSIONS: Two-dimensional images may be used as a screening tool and to identify the sagittal dimension of the smallest airway dimension. However, comprehensive assessment of airway characteristics is better achieved with CBCT-based 3-dimensional evaluation.