{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T11:08:09Z","timestamp":1771672089125,"version":"3.50.1"},"reference-count":29,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n        <jats:sec>\n          <jats:title>Objective:<\/jats:title>\n          <jats:p>To test the hypothesis that the capability of two-dimensional lateral cephalogram in recognizing pharyngeal obstruction is poor compared with the capability of three-dimensional magnetic resonance imaging (MRI) and clinical observation of tonsillar size.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Materials and Methods:<\/jats:title>\n          <jats:p>The study participants were 36 prepubertal children (19 male, 17 female; mean age 7.3 \u00b1 1.43\u00a0years, range 4.8\u20139.8\u00a0years) with sleep-disordered breathing diagnosed by nocturnal polygraphy. Pharyngeal airway was imaged with a low-field open-configuration MRI scanner. Tonsillar size was clinically determined and lateral skull radiographs were taken and measured. Pearson correlation coefficients were calculated between the clinical, cephalometric, and MRI variables.<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Results:<\/jats:title>\n          <jats:p>Nasopharyngeal and retropalatal cephalometric variables had a significant positive correlation with the MRI findings. Both techniques showed the narrowest measurement to be located in the retropalatal region. Clinical assessment of tonsillar size correlated inversely with MRI findings such as minimal retropalatal cross-sectional airway area (<jats:italic>P<\/jats:italic> \u200a=\u200a .000), minimal retroglossal cross-sectional airway area (<jats:italic>P<\/jats:italic> \u200a=\u200a .015), and intertonsillar airway width (<jats:italic>P<\/jats:italic> \u200a=\u200a .000). Cephalometric soft palate and tonsillar area correlated with clinical tonsillar size (<jats:italic>P<\/jats:italic> \u200a=\u200a .001).<\/jats:p>\n        <\/jats:sec>\n        <jats:sec>\n          <jats:title>Conclusions:<\/jats:title>\n          <jats:p>The hypothesis is rejected. The findings confirm that the lateral cephalogram is a valid method for measuring dimensions of the nasopharyngeal and retropalatal region. When evaluating oropharyngeal size, clinical assessment of tonsillar size is a relatively reliable method.<\/jats:p>\n        <\/jats:sec>","DOI":"10.2319\/063010-362.1","type":"journal-article","created":{"date-parts":[[2011,1,24]],"date-time":"2011-01-24T18:15:43Z","timestamp":1295892943000},"page":"433-439","source":"Crossref","is-referenced-by-count":72,"title":["Validity of upper airway assessment in children: A clinical, cephalometric, and MRI study"],"prefix":"10.2319","volume":"81","author":[{"given":"Kirsi","family":"Piril\u00e4-Parkkinen","sequence":"first","affiliation":[{"name":"Instructor, Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heikki","family":"L\u00f6pp\u00f6nen","sequence":"additional","affiliation":[{"name":"Professor, Department of Otorhinolaryngology, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Nieminen","sequence":"additional","affiliation":[{"name":"Instructor, Department of Otorhinolaryngology, Vaasa Central Hospital, Vaasa, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uolevi","family":"Tolonen","sequence":"additional","affiliation":[{"name":"Professor, Department of Clinical Neurophysiology, Oulu University Hospital, Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eija","family":"P\u00e4\u00e4kk\u00f6","sequence":"additional","affiliation":[{"name":"Department Head, Department of Radiology, Oulu University Hospital, Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pertti","family":"Pirttiniemi","sequence":"additional","affiliation":[{"name":"Professor and Department Chair, Department of Oral Development and Orthodontics, University of Oulu, Oulu, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1164","reference":[{"key":"i0003-3219-81-3-433-b01","series-title":"Acta Otolaryngol. Suppl","first-page":"1","article-title":"Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition.","volume":"265","author":"Linder-Aronson, S.","year":"1970","unstructured":"Linder-Aronson, S.\n          . Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition.Acta Otolaryngol. Suppl1970. 265:1\u2013132."},{"key":"i0003-3219-81-3-433-b02","series-title":"Am J Orthod","first-page":"578","article-title":"Neuromuscular and skeletal adaptations to altered functions in the orofacial region.","volume":"64","author":"McNamara\n              Jr, J. A.","year":"1973","unstructured":"McNamara\n              Jr, J. A.\n          . Neuromuscular and skeletal adaptations to altered functions in the orofacial region.Am J Orthod1973. 64:578\u2013606."},{"key":"i0003-3219-81-3-433-b03","series-title":"Am J Orthod","first-page":"214","article-title":"Airway adequacy, head posture, and craniofacial morphology.","volume":"86","author":"Solow, B.","year":"1984","unstructured":"Solow, B., S.Siersbaek-Nielsen, and E.Greve. Airway adequacy, head posture, and craniofacial morphology.Am J Orthod1984. 86:214\u2013223."},{"key":"i0003-3219-81-3-433-b04","series-title":"Arch Pediatr Adolesc Med","first-page":"775","article-title":"Pediatric obstructive sleep apnea syndrome.","volume":"159","author":"Guilleminault, C.","year":"2005","unstructured":"Guilleminault, C., J. H.Lee, and A.Chan. Pediatric obstructive sleep apnea syndrome.Arch Pediatr Adolesc Med2005. 159:775\u2013785."},{"key":"i0003-3219-81-3-433-b05","series-title":"Clin Chest Med","first-page":"261","article-title":"Obstructive sleep-disordered breathing in children: new controversies, new directions.","volume":"24","author":"Carroll, J. L.","year":"2003","unstructured":"Carroll, J. L.\n          . Obstructive sleep-disordered breathing in children: new controversies, new directions.Clin Chest Med2003. 24:261\u2013282."},{"key":"i0003-3219-81-3-433-b06","series-title":"Clin Chest Med","first-page":"33","article-title":"Upper airway imaging.","volume":"19","author":"Schwab, R. J.","year":"1998","unstructured":"Schwab, R. J.\n          . Upper airway imaging.Clin Chest Med1998. 19:33\u201354."},{"key":"i0003-3219-81-3-433-b07","series-title":"Orthod Craniofac Res","first-page":"173","article-title":"A three-dimensional evaluation of the upper airway in adolescents.","volume":"6","author":"Aboudara, C. A.","year":"2003","unstructured":"Aboudara, C. A., D.Hatcher, I. L.Nielsen, and A.Miller. A three-dimensional evaluation of the upper airway in adolescents.Orthod Craniofac Res2003. 6:173\u2013175."},{"key":"i0003-3219-81-3-433-b08","series-title":"Am J Respir Crit Care Med","first-page":"522","article-title":"Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging.","volume":"168","author":"Schwab, R. J.","year":"2003","unstructured":"Schwab, R. J., M.Pasirstein, R.Pierson, A.Mackley, R.Hachadoorian, R.Arens, G.Maislin, and A. I.Pack. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging.Am J Respir Crit Care Med2003. 168:522\u2013530."},{"key":"i0003-3219-81-3-433-b09","series-title":"Pediatrics","first-page":"e55","article-title":"Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea.","volume":"109","author":"Nieminen, P.","year":"2002","unstructured":"Nieminen, P., T.L\u00f6pp\u00f6nen, U.Tolonen, P.Lanning, M.Knip, and H.L\u00f6pp\u00f6nen. Growth and biochemical markers of growth in children with snoring and obstructive sleep apnea.Pediatrics2002. 109:e55."},{"key":"i0003-3219-81-3-433-b10","series-title":"Eur J Orthod","first-page":"571","article-title":"Airway dimensions and head posture in obstructive sleep apnoea.","volume":"18","author":"Solow, B.","year":"1996","unstructured":"Solow, B., S.Skov, J.Ovesen, P. W.Norup, and G.Wildschi\u00f8dtz. Airway dimensions and head posture in obstructive sleep apnoea.Eur J Orthod1996. 18:571\u2013579."},{"key":"i0003-3219-81-3-433-b11","series-title":"Arch Otolaryngol Head Neck Surg","first-page":"481","article-title":"Snoring and obstructive sleep apnea in children. A 6-month follow-up-study.","volume":"126","author":"Nieminen, P.","year":"2000","unstructured":"Nieminen, P., U.Tolonen, and H.L\u00f6pp\u00f6nen. Snoring and obstructive sleep apnea in children. A 6-month follow-up-study.Arch Otolaryngol Head Neck Surg2000. 126:481\u2013486."},{"key":"i0003-3219-81-3-433-b12","series-title":"Sleep","first-page":"997","article-title":"Pathophysiology of upper airway obstruction: a developmental perspective.","volume":"27","author":"Arens, R.","year":"2004","unstructured":"Arens, R. and C. L.Marcus. Pathophysiology of upper airway obstruction: a developmental perspective.Sleep2004. 27:997\u20131019."},{"key":"i0003-3219-81-3-433-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"700","article-title":"Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review.","volume":"130","author":"Major, M. P.","year":"2006","unstructured":"Major, M. P., C.Flores-Mir, and P. W.Major. Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: a systematic review.Am J Orthod Dentofacial Orthop2006. 130:700\u2013708."},{"key":"i0003-3219-81-3-433-b14","series-title":"Am J Orthod","first-page":"479","article-title":"Cephalometric radiographs as a means of evaluating the capacity of the nasal and nasopharyngeal airway.","volume":"76","author":"Holmberg, H.","year":"1979","unstructured":"Holmberg, H. and S.Linder-Aronson. Cephalometric radiographs as a means of evaluating the capacity of the nasal and nasopharyngeal airway.Am J Orthod1979. 76:479\u2013490."},{"key":"i0003-3219-81-3-433-b15","series-title":"Clin Radiol","first-page":"337","article-title":"How should adenoidal enlargement be measured? A radiological study based on interobserver agreement.","volume":"32","author":"Jeans, W. D.","year":"1981","unstructured":"Jeans, W. D., D. C. J.Fernando, and A. R.Maw. How should adenoidal enlargement be measured? A radiological study based on interobserver agreement.Clin Radiol1981. 32:337\u2013340."},{"key":"i0003-3219-81-3-433-b16","series-title":"Clin Otolaryngol Allied Sci","first-page":"317","article-title":"Inter-observer variability in the clinical and radiological assessment of adenoid size, and the correlation with adenoid volume.","volume":"6","author":"Maw, A. R.","year":"1981","unstructured":"Maw, A. R., W. D.Jeans, and D. C.Fernando. Inter-observer variability in the clinical and radiological assessment of adenoid size, and the correlation with adenoid volume.Clin Otolaryngol Allied Sci1981. 6:317\u2013322."},{"key":"i0003-3219-81-3-433-b17","series-title":"Ear Nose Throat J","first-page":"638","article-title":"Lateral cervical radiographs and adenoid size: do they correlate?","volume":"71","author":"Cohen, L. M.","year":"1992","unstructured":"Cohen, L. M., P. J.Koltai, and J. R.Scott. Lateral cervical radiographs and adenoid size: do they correlate?Ear Nose Throat J1992. 71:638\u2013642."},{"key":"i0003-3219-81-3-433-b18","series-title":"Am J Respir Crit Care Med","first-page":"65","article-title":"Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome.","volume":"167","author":"Arens, R.","year":"2003","unstructured":"Arens, R., J. M.McDonough, A. M.Corbin, N. K.Rubin, M. E.Carroll, A. I.Pack, J.Liu, and J. K.Udupa. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome.Am J Respir Crit Care Med2003. 167:65\u201370."},{"key":"i0003-3219-81-3-433-b19","series-title":"Am Rev Respir Dis","first-page":"845","article-title":"The effect of posture on upper airway dimensions in normal subjects and patients with the sleep apnoea\/hypopnea syndrome.","volume":"144","author":"Yildirim, N.","year":"1991","unstructured":"Yildirim, N., M.Fitzpatrick, K. F.Whyte, R.Jalleh, A. J. A.Wightman, and N. J.Douglas. The effect of posture on upper airway dimensions in normal subjects and patients with the sleep apnoea\/hypopnea syndrome.Am Rev Respir Dis1991. 144:845\u2013847."},{"key":"i0003-3219-81-3-433-b20","series-title":"Am J Orthod Dentofacial Orthop","first-page":"52","article-title":"A cephalometric and electromyographic study of upper airway structures in the upright and supine positions.","volume":"106","author":"Pae, E. K.","year":"1994","unstructured":"Pae, E. K., A. A.Lowe, K.Sasaki, C.Price, M.Tsuchiya, and J.Fleetham. A cephalometric and electromyographic study of upper airway structures in the upright and supine positions.Am J Orthod Dentofacial Orthop1994. 106:52\u201359."},{"key":"i0003-3219-81-3-433-b21","series-title":"Clin Chest Med","first-page":"399","article-title":"Upper airway imaging in relation to obstructive sleep apnea.","volume":"13","author":"Fleetham, J. A.","year":"1992","unstructured":"Fleetham, J. A.\n          . Upper airway imaging in relation to obstructive sleep apnea.Clin Chest Med1992. 13:399\u2013416."},{"key":"i0003-3219-81-3-433-b22","series-title":"Br J Radiol","first-page":"1000","article-title":"MRI of the pharynx in young patients with sleep disordered breathing.","volume":"69","author":"Suto, Y.","year":"1996","unstructured":"Suto, Y., E.Matsuda, and Y.Inoue. MRI of the pharynx in young patients with sleep disordered breathing.Br J Radiol1996. 69:1000\u20131004."},{"key":"i0003-3219-81-3-433-b23","series-title":"Am J Orthod Dentofacial Orthop","first-page":"12","article-title":"A role of pharyngeal length in obstructive sleep apnea patients.","volume":"111","author":"Pae, E. K.","year":"1997","unstructured":"Pae, E. K., A. A.Lowe, and J. A.Fleetham. A role of pharyngeal length in obstructive sleep apnea patients.Am J Orthod Dentofacial Orthop1997. 111:12\u201317."},{"key":"i0003-3219-81-3-433-b24","series-title":"Am J Respir Crit Care Med","first-page":"698","article-title":"Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome.","volume":"164","author":"Arens, R.","year":"2001","unstructured":"Arens, R., J. M.McDonough, A. T.Costarino, S.Mahboubi, C. E.Tayag-Kier, G.Maislin, R. J.Schwab, and A. I.Pack. Magnetic resonance imaging of the upper airway structure of children with obstructive sleep apnea syndrome.Am J Respir Crit Care Med2001. 164:698\u2013703."},{"key":"i0003-3219-81-3-433-b25","series-title":"Am J Respir Crit Care Med","first-page":"1499","article-title":"Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing.","volume":"165","author":"Monahan, K. J.","year":"2002","unstructured":"Monahan, K. J., E. K.Larkin, C. L.Rosen, G.Graham, and S.Redline. Utility of noninvasive pharyngometry in epidemiologic studies of childhood sleep-disordered breathing.Am J Respir Crit Care Med2002. 165:1499\u20131503."},{"key":"i0003-3219-81-3-433-b26","series-title":"J Appl Physiol","first-page":"2030","article-title":"Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children.","volume":"95","author":"Fregosi, R. F.","year":"2003","unstructured":"Fregosi, R. F., S. F.Quan, K. L.Kaemingk, W. J.Morgan, J. L.Goodwin, R.Cabrera, and A.Gmitro. Sleep-disordered breathing, pharyngeal size and soft tissue anatomy in children.J Appl Physiol2003. 95:2030\u20132038."},{"key":"i0003-3219-81-3-433-b27","series-title":"Proc Am Thorac Soc","first-page":"242","article-title":"Epidemiology of pediatric obstructive sleep apnea.","volume":"5","author":"Lumeng, J. C.","year":"2008","unstructured":"Lumeng, J. C. and R. D.Chervin. Epidemiology of pediatric obstructive sleep apnea.Proc Am Thorac Soc2008. 5:242\u2013252."},{"key":"i0003-3219-81-3-433-b28","series-title":"Eur J Orthod","first-page":"160","article-title":"Dental arch morphology in children with sleep-disordered breathing.","volume":"31","author":"Piril\u00e4-Parkkinen, K.","year":"2009","unstructured":"Piril\u00e4-Parkkinen, K., P.Pirttiniemi, P.Nieminen, U.Tolonen, U.Pelttari, and H.L\u00f6pp\u00f6nen. Dental arch morphology in children with sleep-disordered breathing.Eur J Orthod2009. 31:160\u2013167."},{"key":"i0003-3219-81-3-433-b29","series-title":"Eur J Orthod","article-title":"Cephalometric evaluation of children with nocturnal sleep-disordered breathing.","author":"Piril\u00e4-Parkkinen, K.","year":"2010","unstructured":"Piril\u00e4-Parkkinen, K., H.L\u00f6pp\u00f6nen, P.Nieminen, U.Tolonen, and P.Pirttiniemi. Cephalometric evaluation of children with nocturnal sleep-disordered breathing.Eur J Orthod2010. doi: 10.1093\/ejo\/cjp162."}],"container-title":["The Angle Orthodontist"],"original-title":[],"link":[{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/81\/3\/article-p433.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/81\/3\/article-p433.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/downloadpdf\/journals\/angl\/81\/3\/article-p433.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,16]],"date-time":"2025-05-16T00:53:09Z","timestamp":1747356789000},"score":1,"resource":{"primary":{"URL":"https:\/\/angle-orthodontist.kglmeridian.com\/view\/journals\/angl\/81\/3\/article-p433.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2011,5]]},"references-count":29,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.2319\/063010-362.1","relation":{},"ISSN":["0003-3219","1945-7103"],"issn-type":[{"value":"0003-3219","type":"print"},{"value":"1945-7103","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,5]]}}}