Airway assessment on cephalometric radiography
Head posture when taking a ceph can influence the apparent size of the oropharynx.
Slide 1 shows 2 cephs. Left, initial ceph; right, ceph taken 14 months later. Similar head posture is assessed by the angulation of the occlusal plane.
Slide 2 shows the same case, but the radiograph on the right demonstrates a raised head posture, as the occlusal plane is more horizontal.
Slide 3 shows the same case, but with the 2 cephs taken a few minutes apart. The change in head posture and occlusal plane is apparent. The airway is clearer when the head is more upright.
In conclusion, care must be taken when assessing the airway on a cephalometric radiograph. It is essential that the postures are similar to conclude that there has been a change.
Note that bimaxillary advancement surgery is planned to treat his obstructive sleep apnea condition.
Slide 4 shows a patient who underwent maxillo-mandibular advancement for the treatment of his obstructive sleep apnea. Head posture is similar. The arrows indicate the change in width in the upper oropharynx. This patient no longer suffers from obstructive sleep apnea and no longer requires CPAP or a mandibular advancement orthosis.
Slide 5 shows the undesirable side effects of prolonged use of a mandibular advancement orthosis (TAP and ORM). Observe linguoversion of the upper incisors and labioversion of the lower incisors. He had only 2 teeth in occlusion. These compensatory movements had to be reversed prior to orthognathic surgery (right ceph). The post-surgical result is shown in slide 4.