{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:05:31Z","timestamp":1791558331741,"version":"4.3.4"},"reference-count":54,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,1,14]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n To test the reliability of Lateral cephalometric radiographs (LCRs) for use in the assessment of the upper airway, hyoid bone, soft palate, and tongue.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods<\/jats:title>\n \n The records of 57 healthy Chinese children from a nonhospital population (mean age = 12.6 years, SD = 0.5, 28 males and 29 females) who received two consecutive LCRs in the natural head posture were retrospectively analyzed. Fifteen linear, angular, and area measurements were used to describe the airway, hyoid bone, soft palate, and tongue. The reliability between the two LCRs was assessed with the intraclass correlation coefficient (ICC) and\n F<\/jats:italic>\n -test. Errors were estimated with the Dahlberg and Bland-Altman method, and intra- and inter-assessor agreements were determined.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Measurements of upper airway and hyoid bone had excellent method reliability, intra-assessor reliability, and inter-assessor reliability (ICC > 0.8). However, the method reliability and the inter-assessor reliability for soft palate and tongue was less favorable (ICC from 0.60 to 0.96). Soft palate area and thickness were the most critical parameters. Intra-assessor reliability was greater than both method reliability and inter-assessor reliability (which were similar).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The measurement of upper airway morphology, defined as the intramural space, and of the hyoid bone position were highly reliable on LCRs of children. However, the limited reliability in the assessment of tongue and soft palate area may compromise the diagnostic application of LCRs to these structures.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/022119-131.1","type":"journal-article","created":{"date-parts":[[2019,8,12]],"date-time":"2019-08-12T13:38:49Z","timestamp":1565617129000},"page":"47-55","source":"Crossref","is-referenced-by-count":38,"title":["Reliability of Lateral Cephalometric Radiographs in the Assessment of the Upper Airway in Children: A Retrospective study"],"prefix":"10.2319","volume":"90","author":[{"given":"Fabio","family":"Savoldi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gou","family":"Xinyue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colman P.","family":"McGrath","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanqi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiu Cheuk","family":"Chow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James K. H.","family":"Tsoi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-90-1-47-b01","series-title":"Eur J Orthod","first-page":"662","article-title":"Cephalometric evaluation of children with nocturnal sleep-disordered breathing","volume":"32","author":"Pirila-Parkkinen","year":"2010","unstructured":"Pirila-Parkkinen\n K,\n \n \n Lopponen\n H,\n \n \n Nieminen\n P,\n \n \n \n Cephalometric evaluation of children with nocturnal sleep-disordered breathing.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t2010;\n\t\t\t\t\t32:\n\t\t\t\t\t662\u2013\n\t\t\t\t\t671."},{"key":"i0003-3219-90-1-47-b02","series-title":"Proc Am Thorac Soc","first-page":"253","article-title":"Pathophysiology of pediatric obstructive sleep apnea","volume":"5","author":"Katz","year":"2008","unstructured":"Katz\n ES,\n \n 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children","volume":"5","author":"Juliano","year":"2009","unstructured":"Juliano\n ML,\n \n \n Machado\n MA,\n \n \n de Carvalho\n LB,\n \n \n \n Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children.\n\t\t\t\t\tJ Clin Sleep Med.\n\t\t\t\t\t2009;\n\t\t\t\t\t5:\n\t\t\t\t\t554\u2013\n\t\t\t\t\t561."},{"key":"i0003-3219-90-1-47-b05","series-title":"Hong Kong Med J","first-page":"25","article-title":"Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population","volume":"9","author":"Samman","year":"2003","unstructured":"Samman\n N,\n \n \n Mohammadi\n H,\n \n \n Xia\n J.\n \n \n Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population.\n\t\t\t\t\tHong Kong Med J.\n\t\t\t\t\t2003;\n\t\t\t\t\t9:\n\t\t\t\t\t25\u2013\n\t\t\t\t\t30."},{"key":"i0003-3219-90-1-47-b06","series-title":"Angle Orthod","first-page":"648","article-title":"Maxillary morphology in obstructive sleep apnea: a cephalometric and model study","volume":"74","author":"Johal","year":"2004","unstructured":"Johal\n A,\n \n \n Conaghan\n C.\n \n \n Maxillary morphology in obstructive sleep apnea: a cephalometric and model study.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2004;\n\t\t\t\t\t74:\n\t\t\t\t\t648\u2013\n\t\t\t\t\t656."},{"key":"i0003-3219-90-1-47-b07","series-title":"Angle Orthod","first-page":"63","article-title":"Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects","volume":"64","author":"Pracharktam","year":"1994","unstructured":"Pracharktam\n N,\n \n \n Hans\n MG,\n \n \n Strohl\n KP,\n \n \n \n Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t1994;\n\t\t\t\t\t64:\n\t\t\t\t\t63\u2013\n\t\t\t\t\t73."},{"key":"i0003-3219-90-1-47-b08","series-title":"Am J Orthod","first-page":"882","article-title":"A cephalometric positional study of the hyoid bone","volume":"51","author":"Stepovich","year":"1965","unstructured":"Stepovich\n ML.\n \n \n A cephalometric positional study of the hyoid bone.\n\t\t\t\t\tAm J Orthod.\n\t\t\t\t\t1965;\n\t\t\t\t\t51:\n\t\t\t\t\t882\u2013\n\t\t\t\t\t900."},{"key":"i0003-3219-90-1-47-b09","series-title":"Acta Odontol Scand","first-page":"337","article-title":"Change in location of hyoid bone with mandibular positions","volume":"28","author":"Ingervall","year":"1970","unstructured":"Ingervall\n B,\n \n \n Carlsson\n GE,\n \n \n Helkimo\n M.\n \n \n Change in location of hyoid bone with mandibular positions.\n\t\t\t\t\tActa Odontol Scand.\n\t\t\t\t\t1970;\n\t\t\t\t\t28:\n\t\t\t\t\t337\u2013\n\t\t\t\t\t361."},{"key":"i0003-3219-90-1-47-b10","series-title":"Am J Orthod Dentofacial Orthop","first-page":"513","article-title":"Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms","volume":"128","author":"Malkoc","year":"2005","unstructured":"Malkoc\n S,\n \n \n Usumez\n S,\n \n \n Nur\n M,\n \n \n \n Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2005;\n\t\t\t\t\t128:\n\t\t\t\t\t513\u2013\n\t\t\t\t\t516,\n\t\t\t\t\t2005."},{"key":"i0003-3219-90-1-47-b11","series-title":"Cephalometric Analyses Based on Natural Head Posture of Chinese Children in Hong Kong [doctoral dissertation]","author":"Cooke","year":"1986","unstructured":"Cooke\n MS.\n \n \n Cephalometric Analyses Based on Natural Head Posture of Chinese Children in Hong Kong [doctoral dissertation].\n\t\t\t\t\tHong Kong:\n\t\t\t\t\tUniversity of Hong Kong;1986."},{"key":"i0003-3219-90-1-47-b12","series-title":"Acta Odontol Scand","first-page":"591","article-title":"Natural head position in standing subjects","volume":"29","author":"Solow","year":"1971","unstructured":"Solow\n B,\n \n \n Tallgren\n A.\n \n \n Natural head position in standing subjects.\n\t\t\t\t\tActa Odontol 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Bull.","first-page":"378","article-title":"Measuring nominal scale agreement among many raters","volume":"76","author":"Fleiss","year":"1971","unstructured":"Fleiss\n JL.\n \n \n Measuring nominal scale agreement among many raters.\n\t\t\t\t\tPsychol Bull.1971;\n\t\t\t\t\t76:\n\t\t\t\t\t378\u2013\n\t\t\t\t\t382."},{"key":"i0003-3219-90-1-47-b18","series-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988","unstructured":"Cohen\n J.\n \n \n Statistical Power Analysis for the Behavioral Sciences,\n\t\t\t\t\tMahwah, New Jersey, USA:\n\t\t\t\t\tLawrence Erlbaum Associates;\n\t\t\t\t\t1988."},{"key":"i0003-3219-90-1-47-b19","series-title":"Statistical Methods for Medical and Biological Students","author":"Dahlberg","year":"1940","unstructured":"Dahlberg\n G.\n \n \n Statistical Methods for Medical and Biological Students.\n\t\t\t\t\tLondon:\n\t\t\t\t\tGeorge Allen and Unwin;1940."},{"key":"i0003-3219-90-1-47-b20","series-title":"Lancet","first-page":"307","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"1","author":"Bland","year":"1986","unstructured":"Bland\n JM,\n \n \n Altman\n DG.\n \n \n Statistical methods for assessing agreement between two methods of clinical measurement.\n\t\t\t\t\tLancet.\n\t\t\t\t\t1986;\n\t\t\t\t\t1:\n\t\t\t\t\t307\u2013\n\t\t\t\t\t310."},{"key":"i0003-3219-90-1-47-b21","series-title":"Psychol Bull","first-page":"420","article-title":"Intraclass correlations: uses in assessing rater reliability","volume":"86","author":"Shrout","year":"1979","unstructured":"Shrout\n PE,\n \n \n Fleiss\n JL.\n \n \n Intraclass correlations: uses in assessing rater reliability.\n\t\t\t\t\tPsychol Bull.\n\t\t\t\t\t1979;\n\t\t\t\t\t86:\n\t\t\t\t\t420\u2013\n\t\t\t\t\t428."},{"key":"i0003-3219-90-1-47-b22","series-title":"Comprehensive Textbook of Psychiatry. 8th ed","first-page":"929","article-title":"Psychiatric rating scales","author":"Blacker","year":"2005","unstructured":"Blacker\n D.\n \n \n Psychiatric rating scales.\n\t\t\t\t\tInSadockBJ,SadockV,eds:Comprehensive Textbook of Psychiatry. 8th ed,\n\t\t\t\t\tPhiladelphia, PA:\n\t\t\t\t\tLippincott Williams & Wilkins;\n\t\t\t\t\t2005:\n\t\t\t\t\t929\u2013\n\t\t\t\t\t955."},{"key":"i0003-3219-90-1-47-b23","series-title":"Int J Oral Maxillofac Surg","first-page":"579","article-title":"The effect of head posture on the pharyngeal airway space (PAS)","volume":"31","author":"Muto","year":"2002","unstructured":"Muto\n T,\n \n \n Takeda\n S,\n \n \n Kanazawa\n M,\n \n \n \n The effect of head posture on the pharyngeal airway space (PAS).\n\t\t\t\t\tInt J Oral Maxillofac Surg.\n\t\t\t\t\t2002;\n\t\t\t\t\t31:\n\t\t\t\t\t579\u2013\n\t\t\t\t\t583."},{"key":"i0003-3219-90-1-47-b24","series-title":"Int J Oral Maxillofac Surg","first-page":"805","article-title":"Lateral cephalometric analysis of the pharyngeal airway space affected by head posture","volume":"37","author":"Anegawa","year":"2008","unstructured":"Anegawa\n E,\n \n \n Tsuyama\n H,\n \n \n Kusukawa\n J.\n \n \n Lateral cephalometric analysis of the pharyngeal airway space affected by head posture.\n\t\t\t\t\tInt J Oral Maxillofac Surg.\n\t\t\t\t\t2008;\n\t\t\t\t\t37:\n\t\t\t\t\t805\u2013\n\t\t\t\t\t809."},{"key":"i0003-3219-90-1-47-b25","series-title":"Am J Orthod Dentofacial Orthop","first-page":"489","article-title":"Five-year reproducibility of natural head posture: a longitudinal study","volume":"97","author":"Cooke","year":"1990","unstructured":"Cooke\n MS.\n \n \n Five-year reproducibility of natural head posture: a longitudinal study.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t1990;\n\t\t\t\t\t97:\n\t\t\t\t\t489\u2013\n\t\t\t\t\t494."},{"key":"i0003-3219-90-1-47-b26","series-title":"Dysphagia","first-page":"24","article-title":"Bolus consistency and swallowing in children and adults","volume":"17","author":"Ruark","year":"2002","unstructured":"Ruark\n JL,\n \n \n McCullough\n GH,\n \n \n Peters\n RL,\n \n \n \n Bolus consistency and swallowing in children and adults.\n\t\t\t\t\tDysphagia.\n\t\t\t\t\t2002;\n\t\t\t\t\t17:\n\t\t\t\t\t24\u2013\n\t\t\t\t\t33."},{"key":"i0003-3219-90-1-47-b27","series-title":"Am J Respir Crit Care Med","first-page":"1295","article-title":"Understanding the anatomic basis for obstructive sleep apnea syndrome in adolescents","volume":"191","author":"Schwab","year":"2015","unstructured":"Schwab\n RJ,\n \n \n Kim\n C,\n \n \n Bagchi\n S,\n \n \n Keenan\n BT,\n \n \n \n Understanding the anatomic basis for obstructive sleep apnea syndrome in adolescents.\n\t\t\t\t\tAm J Respir Crit Care Med.\n\t\t\t\t\t2015;\n\t\t\t\t\t191:\n\t\t\t\t\t1295\u2013\n\t\t\t\t\t309."},{"key":"i0003-3219-90-1-47-b01","series-title":"Eur J Orthod","first-page":"662","article-title":"Cephalometric evaluation of children with nocturnal sleep-disordered breathing","volume":"32","author":"Pirila-Parkkinen","year":"2010","unstructured":"Pirila-Parkkinen\n K,\n \n \n Lopponen\n H,\n \n \n Nieminen\n P,\n \n \n \n Cephalometric evaluation of children with nocturnal sleep-disordered breathing.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t2010;\n\t\t\t\t\t32:\n\t\t\t\t\t662\u2013\n\t\t\t\t\t671."},{"key":"i0003-3219-90-1-47-b02","series-title":"Proc Am Thorac Soc","first-page":"253","article-title":"Pathophysiology of pediatric obstructive sleep apnea","volume":"5","author":"Katz","year":"2008","unstructured":"Katz\n ES,\n \n \n D'Ambrosio\n CM.\n \n \n Pathophysiology of pediatric obstructive sleep apnea.\n\t\t\t\t\tProc Am Thorac Soc.\n\t\t\t\t\t2008;\n\t\t\t\t\t5:\n\t\t\t\t\t253\u2013\n\t\t\t\t\t262."},{"key":"i0003-3219-90-1-47-b03","series-title":"Am J Orthod Dentofacial Orthop","first-page":"20","article-title":"Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis","volume":"143","author":"Katyal","year":"2013","unstructured":"Katyal\n V,\n \n \n Pamula\n Y,\n \n \n Martin\n AJ,\n \n \n \n Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2013;\n\t\t\t\t\t143:\n\t\t\t\t\t20\u2013\n\t\t\t\t\t30.e23."},{"key":"i0003-3219-90-1-47-b04","series-title":"J Clin Sleep Med","first-page":"554","article-title":"Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children","volume":"5","author":"Juliano","year":"2009","unstructured":"Juliano\n ML,\n \n \n Machado\n MA,\n \n \n de Carvalho\n LB,\n \n \n \n Polysomnographic findings are associated with cephalometric measurements in mouth-breathing children.\n\t\t\t\t\tJ Clin Sleep Med.\n\t\t\t\t\t2009;\n\t\t\t\t\t5:\n\t\t\t\t\t554\u2013\n\t\t\t\t\t561."},{"key":"i0003-3219-90-1-47-b05","series-title":"Hong Kong Med J","first-page":"25","article-title":"Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population","volume":"9","author":"Samman","year":"2003","unstructured":"Samman\n N,\n \n \n Mohammadi\n H,\n \n \n Xia\n J.\n \n \n Cephalometric norms for the upper airway in a healthy Hong Kong Chinese population.\n\t\t\t\t\tHong Kong Med J.\n\t\t\t\t\t2003;\n\t\t\t\t\t9:\n\t\t\t\t\t25\u2013\n\t\t\t\t\t30."},{"key":"i0003-3219-90-1-47-b06","series-title":"Angle Orthod","first-page":"648","article-title":"Maxillary morphology in obstructive sleep apnea: a cephalometric and model study","volume":"74","author":"Johal","year":"2004","unstructured":"Johal\n A,\n \n \n Conaghan\n C.\n \n \n Maxillary morphology in obstructive sleep apnea: a cephalometric and model study.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2004;\n\t\t\t\t\t74:\n\t\t\t\t\t648\u2013\n\t\t\t\t\t656."},{"key":"i0003-3219-90-1-47-b07","series-title":"Angle Orthod","first-page":"63","article-title":"Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects","volume":"64","author":"Pracharktam","year":"1994","unstructured":"Pracharktam\n N,\n \n \n Hans\n MG,\n \n \n Strohl\n KP,\n \n \n \n Upright and supine cephalometric evaluation of obstructive sleep apnea syndrome and snoring subjects.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t1994;\n\t\t\t\t\t64:\n\t\t\t\t\t63\u2013\n\t\t\t\t\t73."},{"key":"i0003-3219-90-1-47-b08","series-title":"Am J Orthod","first-page":"882","article-title":"A cephalometric positional study of the hyoid bone","volume":"51","author":"Stepovich","year":"1965","unstructured":"Stepovich\n ML.\n \n \n A cephalometric positional study of the hyoid bone.\n\t\t\t\t\tAm J Orthod.\n\t\t\t\t\t1965;\n\t\t\t\t\t51:\n\t\t\t\t\t882\u2013\n\t\t\t\t\t900."},{"key":"i0003-3219-90-1-47-b09","series-title":"Acta Odontol Scand","first-page":"337","article-title":"Change in location of hyoid bone with mandibular positions","volume":"28","author":"Ingervall","year":"1970","unstructured":"Ingervall\n B,\n \n \n Carlsson\n GE,\n \n \n Helkimo\n M.\n \n \n Change in location of hyoid bone with mandibular positions.\n\t\t\t\t\tActa Odontol Scand.\n\t\t\t\t\t1970;\n\t\t\t\t\t28:\n\t\t\t\t\t337\u2013\n\t\t\t\t\t361."},{"key":"i0003-3219-90-1-47-b10","series-title":"Am J Orthod Dentofacial Orthop","first-page":"513","article-title":"Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms","volume":"128","author":"Malkoc","year":"2005","unstructured":"Malkoc\n S,\n \n \n Usumez\n S,\n \n \n Nur\n M,\n \n \n \n Reproducibility of airway dimensions and tongue and hyoid positions on lateral cephalograms.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2005;\n\t\t\t\t\t128:\n\t\t\t\t\t513\u2013\n\t\t\t\t\t516,\n\t\t\t\t\t2005."},{"key":"i0003-3219-90-1-47-b11","series-title":"Cephalometric Analyses Based on Natural Head Posture of Chinese Children in Hong Kong 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