Association of Soft Palate Morphology with Need’s Ratio: A Lateral Digital Cephalometric Study

Aim: Obstructive sleep apnea in children can result in significant developmental, behavioral, and cardiopulmonary complications if untreated. This study aimed to determine whether variations in soft palate morphology observed on lateral cephalograms correlate with the Need’s ratio (pharyngeal depth to soft palate length), potentially aiding in obstructive sleep apnea risk stratification. Methods: This cross-sectional study evaluated 276 patients with mean age of 16.59±5.29 years. Lateral cephalometric radiographs, were analyzed for soft palate length and thickness, pharyngeal depth, and the Need’s ratio. Soft palate morphology was classified into six types (leaf-shaped, rat-tail, butt-like, straight, distorted, crook-shaped). Body mass index (BMI) and habitual snoring frequency (≥3 nights/week) were recorded. Intra- and inter-operator reliability was assessed using the intraclass correlation coefficient (ICC), and statistical analyses included Chi-squared test, independent t-test, Spearman’s correlation, and Mann-Whitney test. P<0.05 was considered as significant. Results: Leaf-shaped was the most common palate morphology (29.3%), while butt-shaped was the least common (7.6%). Butt-shaped palates had a slightly higher Need’s ratio (0.77) compared to others (0.73–0.76), but overall, Need’s ratio remained relatively stable across morphologies. Females had a higher Need’s ratio than males (P<0.001). Crook-shaped palates were most associated with snoring (38.5%), while straight morphologies were the least (6.9%). BMI was significantly higher in snorers of patients older than 18 years. Conclusions: While Need’s ratio varied slightly, it did not strongly correlate with morphology or snoring. Soft palate morphology and BMI showed stronger associations, suggesting their importance in obstructive sleep apnea risk evaluation.