Abstract
Objective
To review recent use of three-dimensional (3D) imaging, specifically cone-beam computed tomography (CBCT), in the analysis of the upper airway for diagnosis or treatment outcomes in patients with sleep-disordered breathing (SDB).
Types of studies reviewed
Literature review of relevant medical and dental studies utilizing 3D imaging to assess the upper airway.
Results
Imaging of the upper airway provided insight into potential areas of obstruction. Accessibility of CBCT to dentists is reflected in several applications of upper airway diagnosis, treatment planning, and different treatment outcomes, as well as association with craniofacial development. However, multiple deficiencies in image acquisition, 3D reconstruction, and analysis are evident.
Practical implications
The role of CBCT in the analysis of the upper airway is growing; however, critical limitations remain. An understanding of these limitations, clarification of misconceptions, and improvements in analysis methods are required to ensure proper use and development of CBCT.
Similar content being viewed by others
References
Major MP, Flores-Mir C, Major PW. Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review. Am J Orthod Dentofac Orthop. 2006;130:700–8.
Major MP, Saltaji H, El-Hakim H, Witmans M, Major P, Flores-Mir C. The accuracy of diagnostic tests for adenoid hypertrophy: a systematic review. J Am Dent Assoc. 2014;145:247–54.
Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:930–8.
Aboudara C, Nielsen I, Huang JC, Maki K, Miller AJ, Hatcher D. Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2009;135:468–79.
Yamashina A, Tanimoto K, Sutthiprapaporn P, Hayakawa Y. The reliability of computed tomography (CT) values and dimensional measurements of the oropharyngeal region using cone beam CT: comparison with multidetector CT. Dentomaxillofac Radiol. 2008;37:245–51.
Van Holsbeke CS, Verhulst SL, Vos WG, De Backer JW, Vinchurkar SC, Verdonck PR, et al. Change in upper airway geometry between upright and supine position during tidal nasal breathing. J Aerosol Med Pulm Drug Deliv. 2014;27:51–7.
Sutthiprapaporn P, Tanimoto K, Ohtsuka M, Nagasaki T, Iida Y, Katsumata A. Positional changes of oropharyngeal structures due to gravity in the upright and supine positions. Dentomaxillofac Radiol. 2008;37:130–6.
Tiotiu A, Mairesse O, Hoffmann G, Todea D, Noseda A. Body position and breathing abnormalities during sleep: a systematic study. Pneumologia. 2011;60:216–21.
Van Holsbeke C, Vos W, Van Hoorenbeeck K, Boudewyns A, Salgado R, Verdonck PR, et al. Functional respiratory imaging as a tool to assess upper airway patency in children with obstructive sleep apnea. Sleep Med. 2013;14:433–9.
Barkdull GC, Kohl CA, Patel M, Davidson TM. Computed tomography imaging of patients with obstructive sleep apnea. Laryngoscope. 2008;118:1486–92.
Abramson Z, Susarla S, August M, Troulis M, Kaban L. Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. J Oral Maxillofac Surg. 2010;68:354–62.
Ogawa T, Enciso R, Memon A, Mah J, Clark G. Evaluation of 3D airway imaging of obstructive sleep apnea with cone-beam computed tomography. Stud Health Technol Inform. 2005;111:365–8.
Sato K, Shirakawa T, Sakata H, Asanuma S. Effectiveness of the analysis of craniofacial morphology and pharyngeal airway morphology in the treatment of children with obstructive sleep apnoea syndrome. Dentomaxillofac Radiol. 2012;41:411–6.
Arens R, McDonough JM, Costarino AT, Mahboubi S, Tayag-Kier CE, Maislin G, et al. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2001;164:698–703.
Arens R, Sin S, Nandalike K, Rieder J, Khan UI, Freeman K, et al. Upper airway structure and body fat composition in obese children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2011;183:782–7.
Cappabianca S, Iaselli F, Negro A, Basile A, Reginelli A, Grassi R, et al. Magnetic resonance imaging in the evaluation of anatomical risk factors for pediatric obstructive sleep apnoea-hypopnoea: a pilot study. Int J Pediatr Otorhinolaryngol. 2013;77:69–75.
Donnelly LF, Shott SR, LaRose CR, Chini BA, Amin RS. Causes of persistent obstructive sleep apnea despite previous tonsillectomy and adenoidectomy in children with down syndrome as depicted on static and dynamic cine MRI. Am J Roentgenol. 2004;183:175–81.
Fregosi RF, Quan SF, Kaemingk KL, Morgan WJ, Goodwin JL, Cabrera R, et al. Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children. J Appl Physiol. 2003;95:2030–8.
Arens R, Sin S, McDonough JM, Palmer JM, Dominguez T, Meyer H, et al. Changes in upper airway size during tidal breathing in children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2005;171:1298–304.
Donnelly LF, Surdulescu V, Chini BA, Casper KA, Poe SA, Amin RS. Upper airway motion depicted at cine MR imaging performed during sleep: comparison between young patients with and those without obstructive sleep apnea. Radiology. 2003;227:239–45.
Abbott MB, Donnelly LF, Dardzinski BJ, Poe SA, Chini BA, Amin RS. Obstructive sleep apnea: MR imaging volume segmentation analysis. Radiology. 2004;232:889–95.
Persak SC, Sin S, McDonough JM, Arens R, Wootton DM. Noninvasive estimation of pharyngeal airway resistance and compliance in children based on volume-gated dynamic MRI and computational fluid dynamics. J Appl Physiol. 2011;111:1819–27.
Ikeda K, Ogura M, Oshima T, Suzuki H, Higano S, Takahashi S, et al. Quantitative assessment of the pharyngeal airway by dynamic magnetic resonance imaging in obstructive sleep apnea syndrome. Ann Otol Rhinol Laryngol. 2001;110:183–9.
Wootton DM, Luo H, Persak SC, Sin S, McDonough JM, Isasi CR, et al. Computational fluid dynamics endpoints to characterize obstructive sleep apnea syndrome in children. J Appl Physiol. 2014;116:104–12.
Van Holsbeke C, De Backer J, Vos W, Verdonck P, Van Ransbeeck P, Claessens T, et al. Anatomical and functional changes in the upper airways of sleep apnea patients due to mandibular repositioning: a large scale study. J Biomech. 2011;44:442–9.
Vos W, De Backer J, Devolder A, Vanderveken O, Verhulst S, Salgado R, et al. Correlation between severity of sleep apnea and upper airway morphology based on advanced anatomical and functional imaging. J Biomech. 2007;40:2207–13.
Nandalike K, Shifteh K, Sin S, Strauss T, Stakofsky A, Gonik N, et al. Adenotonsillectomy in obese children with obstructive sleep apnea syndrome: magnetic resonance imaging findings and considerations. Sleep. 2013;36:841–7.
Fricke BL, Donnelly LF, Shott SR, Kalra M, Poe SA, Chini BA, et al. Comparison of lingual tonsil size as depicted on MR imaging between children with obstructive sleep apnea despite previous tonsillectomy and adenoidectomy and normal controls. Pediatr Radiol. 2006;36:518–23.
Brunetto DP, Velasco L, Koerich L, Araújo MTDS. Prediction of 3-dimensional pharyngeal airway changes after orthognathic surgery: a preliminary study. Am J Orthod Dentofacial Orthop. 2014;146:299–309.
De Souza Carvalho ACG, Magro Filho O, Garcia IR, Araujo PM, Nogueira RLM. Cephalometric and three-dimensional assessment of superior posterior airway space after maxillomandibular advancement. Int J Oral Maxillofac Surg. 2012;41:1102–11.
Raffaini M, Pisani C. Clinical and cone-beam computed tomography evaluation of the three-dimensional increase in pharyngeal airway space following maxillo-mandibular rotation-advancement for class II-correction in patients without sleep apnoea (OSA). J Craniomaxillofac Surg. 2013;41:552–7.
Butterfield KJ, Marks PLG, McLean L, Newton J. Pharyngeal airway morphology in healthy individuals and in obstructive sleep apnea patients treated with maxillomandibular advancement: a comparative study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;119:285–92.
Valladares-Neto J, Silva MAG, Bumann A, Paiva JB, Rino-Neto J. Effects of mandibular advancement surgery combined with minimal maxillary displacement on the volume and most restricted cross-sectional area of the pharyngeal airway. Int J Oral Maxillofac Surg. 2013;42:1437–45.
Park SB, Kim YI, Son WS, Hwang DS, Cho BH. Cone-beam computed tomography evaluation of short- and long-term airway change and stability after orthognathic surgery in patients with class III skeletal deformities: bimaxillary surgery and mandibular setback surgery. Int J Oral Maxillofac Surg. 2012;41:87–93.
Shin JH, Kim MA, Park IY, Park YH. A 2-year follow-up of changes after bimaxillary surgery in patients with mandibular prognathism: 3-dimensional analysis of pharyngeal airway volume and hyoid bone position. J Oral Maxillofac Surg. 2015;73:340.e1–9.
Gokce SM, Gorgulu S, Gokce HS, Bengi AO, Karacayli U, Ors F. Evaluation of pharyngeal airway space changes after bimaxillary orthognathic surgery with a 3-dimensional simulation and modeling program. Am J Orthod Dentofacial Orthop. 2014;146:477–92.
Hatab NA, Konstantinović VS, Mudrak JKH. Pharyngeal airway changes after mono- and bimaxillary surgery in skeletal class III patients: cone-beam computed tomography evaluation. J Craniomaxillofac Surg. 2014;43:491–6.
Li YM, Liu JL, Zhao JL, Dai J, Wang L, Chen JW. Morphological changes in the pharyngeal airway of female skeletal class III patients following bimaxillary surgery: a cone beam computed tomography evaluation. Int J Oral Maxillofac Surg. 2014;43:862–7.
Sears CR, Miller AJ, Chang MK, Huang JC, Lee JS. Comparison of pharyngeal airway changes on plain radiography and cone-beam computed tomography after orthognathic surgery. J Oral Maxillofac Surg. 2011;69:e385–e94.
Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. Am J Orthod Dentofac Orthop. 2013;143:235–45.
Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kanomi R, Hayasaki H, et al. Evaluation of upper airway obstruction in class II children with fluid-mechanical simulation. Am J Orthod Dentofac Orthop. 2011;139:e135–e45.
Bouserhal J, Bassil-Nassif N, Tauk A, Will L, Limme M. Three-dimensional changes of the naso-maxillary complex following rapid maxillary expansion. Angle Orthod. 2014;84:88–95.
Smith T, Ghoneima A, Stewart K, Liu S, Eckert G, Halum S, et al. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofac Orthop. 2012;141:618–26.
Zhao Y, Nguyen M, Gohl E, Mah JK, Sameshima G, Enciso R. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofac Orthop. 2010;137:S71–8.
Chang Y, Koenig LJ, Pruszynski JE, Bradley TG, Bosio JA, Liu D. Dimensional changes of upper airway after rapid maxillary expansion: a prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop. 2013;143:462–70.
Ribeiro ANC, De Paiva JB, Rino-Neto J, Illipronti-Filho E, Trivino T, Fantini SM. Upper airway expansion after rapid maxillary expansion evaluated with cone beam computed tomography. Angle Orthod. 2012;82:458–63.
El H, Palomo JM. Three-dimensional evaluation of upper airway following rapid maxillary expansion: a CBCT study. Angle Orthod. 2014;84:265–73.
Zeng J, Gao X. A prospective CBCT study of upper airway changes after rapid maxillary expansion. Int J Pediatr Otorhinolaryngol. 2013;77:1805–10.
Fastuca R, Zecca PA, Caprioglio A. Role of mandibular displacement and airway size in improving breathing after rapid maxillary expansion. Prog Orthod. 2014;15:40.
Kabalan O, Gordon J, Heo G, Lagravère MO. Nasal airway changes in bone-borne and tooth-borne rapid maxillary expansion treatments. Int Orthod. 2015;13:1–15.
Li L, Liu H, Cheng H, Han Y, Wang C, Chen Y, et al. CBCT evaluation of the upper airway morphological changes in growing patients of class ii division 1 malocclusion with mandibular retrusion using twin block appliance: a comparative research. PLoS One. 2014;9:e94378.
Erbas B, Kocadereli I. Upper airway changes after Xbow appliance therapy evaluated with cone beam computed tomography. Angle Orthod. 2014;84:693–700.
Iwasaki T, Takemoto Y, Inada E, Sato H, Saitoh I, Kakuno E, et al. Three-dimensional cone-beam computed tomography analysis of enlargement of the pharyngeal airway by the Herbst appliance. Am J Orthod Dentofac Orthop. 2014;146:776–85.
Yu CC, Hsiao HD, Lee LC, Yao CM, Chen NH, Wang CJ, et al. Computational fluid dynamic study on obstructive sleep apnea syndrome treated with maxillomandibular advancement. J Craniofac Surg. 2009;20:426–30.
Huynh J, Kim D, McQuilling M. Pharyngeal airflow analysis in obstructive sleep apnea patients pre- and post-maxillomandibular advancement surgery. J Fluids Eng. 2009;131:091101–11.
Luo H, Sin S, McDonough JM, Isasi CR, Arens R, Wootton DM. Computational fluid dynamics endpoints for assessment of adenotonsillectomy outcome in obese children with obstructive sleep apnea syndrome. J Biomech. 2014;47:2498–503.
Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kanomi R, Hayasaki H, et al. Improvement of nasal airway ventilation after rapid maxillary expansion evaluated with computational fluid dynamics. Am J Orthod Dentofac Orthop. 2012;141:269–78.
Iwasaki T, Takemoto Y, Inada E, Sato H, Suga H, Saitoh I, et al. The effect of rapid maxillary expansion on pharyngeal airway pressure during inspiration evaluated using computational fluid dynamics. Int J Pediatr Otorhinolaryngol. 2014;78:1258–64.
Abdelkarim A. A cone beam CT evaluation of oropharyngeal airway space and its relationship to mandibular position and dentocraniofacial morphology. J World Fed Orthod. 2012;1:e55–e9.
El H, Palomo JM. Airway volume for different dentofacial skeletal patterns. Am J Orthod Dentofac Orthop. 2011;139:e511–e21.
Alves M Jr, Franzotti ES, Baratieri C, Nunes LKF, Nojima LI, Ruellas ACO. Evaluation of pharyngeal airway space amongst different skeletal patterns. Int J Oral Maxillofac Surg. 2012;41:814–9.
Zheng ZH, Yamaguchi T, Kurihara A, Li HF, Maki K. Three-dimensional evaluation of upper airway in patients with different anteroposterior skeletal patterns. Orthod Craniofac Res. 2014;17:38–48.
Celikoglu M, Bayram M, Sekerci AE, Buyuk SK, Toy E. Comparison of pharyngeal airway volume among different vertical skeletal patterns: a cone-beam computed tomography study. Angle Orthod. 2014;84:782–7.
Claudino LV, Mattos CT, Ruellas ACDO, Sant Anna EF. Pharyngeal airway characterization in adolescents related to facial skeletal pattern: a preliminary study. Am J Orthod Dentofac Orthop. 2013;143:799–809.
Grauer D, Cevidanes LSH, Styner MA, Ackerman JL, Proffit WR. Pharyngeal airway volume and shape from cone-beam computed tomography: relationship to facial morphology. Am J Orthod Dentofac Orthop. 2009;136:805–14.
Alves PVM, Zhao L, O’Gara M, Patel PK, Bolognese AM. Three-dimensional cephalometric study of upper airway space in skeletal class II and III healthy patients. J Craniofac Surg. 2008;19:1497–507.
Di Carlo G, Polimeni A, Melsen B, Cattaneo PM. The relationship between upper airways and craniofacial morphology studied in 3D: a CBCT study. Orthod Craniofac Res. 2015;18:1–11.
Alsufyani NA, Flores-Mir C, Major PW. Three-dimensional segmentation of the upper airway using cone beam CT: a systematic review. Dentomaxillofac Radiol. 2012;41:276–84.
Shi H, Scarfe W, Farman A. Upper airway segmentation and dimensions estimation from cone-beam CT image datasets. Int J CARS. 2006;1:177–86.
Cheng I, Nilufar S, Flores-Mir C, Basu A. Airway segmentation and measurement in CT images. Conf Proc IEEE Eng Med Biol Soc. 2007;2007:795–9.
Parikh SR, Coronel M, Lee JJ, Brown SM. Validation of a new grading system for endoscopic examination of adenoid hypertrophy. Otolaryngol Head Neck Surg. 2006;135:684–7.
Weissheimer A, Menezes LMD, Sameshima GT, Enciso R, Pham J, Grauer D. Imaging software accuracy for 3-dimensional analysis of the upper airway. Am J Orthod Dentofac Orthop. 2012;142:801–13.
Ghoneima A, Kula K. Accuracy and reliability of cone-beam computed tomography for airway volume analysis. Eur J Orthod. 2013;35:256–61.
de Water VR, Saridin JK, Bouw F, Murawska MM, Koudstaal MJ. Measuring upper airway volume: accuracy and reliability of Dolphin 3D Software compared to manual segmentation in craniosynostosis patients. J Oral Maxillofac Surg. 2014;72:139–44.
Schulze R, Heil U, Gross D, Bruellmann DD, Dranischnikow E, Schwanecke U, et al. Artefacts in CBCT: a review. Dentomaxillofac Radiol. 2011;40:265–73.
Seo A, Chung SK, Lee J, Kim JI, Kim H. Semiautomatic segmentation of nasal airway based on collaborative environment. Proceedings of the International Symposium on Ubiquitous Virtual Reality ISUVR; 2010 July 7–10; Washington, DC, USA. doi:10.1109/ISUVR.2010.24.
Perchet D, Fetita C, Prêteux F. Three-dimensional reconstruction of upper airways from MDCT. Proceedings of SPIE5672, Image Processing: Algorithms and systems IV; 2005 March 8; San Jose, CA, USA. doi:10.1117/12.587741.
Tingelhoff K, Moral AI, Kunkel ME, Rilk M, Wagner I, Eichhorn KWG, et al. Comparison between manual and semi-automatic segmentation of nasal cavity and paranasal sinuses from CT images. Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology; 2007 August 23–26; Lyon, France. doi:10.1109/IEMBS.2007.4353592.
Alsufyani NA, Al-Saleh MA, Major PW. CBCT assessment of upper airway changes and treatment outcomes of obstructive sleep apnoea: a systematic review. Sleep Breath. 2013;17:911–23.
Muto T, Takeda S, Kanazawa M, Yamazaki A, Fujiwara Y, Mizoguchi I. The effect of head posture on the pharyngeal airway space (PAS). Int J Oral Maxillofac Surg. 2002;31:579–583.
Alsufyani NA, Dietrich NH, Lagravère MO, Carey JP, Major PW. Cone beam computed tomography registration for 3-D airway analysis based on anatomic landmarks. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118:371–383.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors have no conflict of interest.
This article does not contain any studies with human or animal subjects performed by any of the authors.
Rights and permissions
About this article
Cite this article
Alsufyani, N.A., Noga, M.L., Witmans, M. et al. Upper airway imaging in sleep-disordered breathing: role of cone-beam computed tomography. Oral Radiol 33, 161–169 (2017). https://doi.org/10.1007/s11282-017-0280-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11282-017-0280-1