Association Between Upper Airway Obstruction and Craniofacial Development and Orthodontic Outcomes in Children: A CBCT-Based Study

OBJECTIVES: This study aims to apply a CBCT-based method to assess upper airway obstruction severity and evaluate its association with craniofacial development and orthodontic treatment outcomes in children. MATERIALS AND METHODS: A cross-sectional cohort of children aged 6 to 12 years was analyzed. Lateral cephalograms and CBCT images were obtained. Tonsillar and adenoid size, as well as craniofacial variables, were measured on cephalograms, while nasopharyngeal and oropharyngeal airway dimensions were assessed on CBCT using Dolphin software. Airway obstruction severity was classified, and group differences were analyzed using t tests and ANOVA (P<0.05). RESULTS: Compared with degree I, degree II obstruction showed greater decreases in saddle angle (4.08 degrees±3.85 degrees versus -1.18 degrees±4.30 degrees, P<0.05) and gonial angle (1.44 degrees±2.38 degrees versus -2.09 degrees±2.81 degrees, P<0.05), and a greater increase in articular angle (-6.10 degrees±5.28 degrees versus 0.67 degrees±5.42 degrees, P<0.05). Children undergoing adenotonsillectomy combined with orthodontic treatment demonstrated greater increase in SNB (2.63 degrees±1.30 degrees versus 0.80 degrees±1.47 degrees, P<0.05) and a larger reduction in saddle angle (-6.98 degrees±2.29 degrees versus -0.15 degrees±3.42 degrees, P<0.05) than those receiving orthodontic treatment alone. CONCLUSIONS: Upper airway obstruction severity was associated with altered craniofacial development in children. Adenotonsillectomy combined with orthodontic treatment was associated with improved mandibular advancement. These findings highlight the importance of airway evaluation in treatment planning.