|Year : 2016 | Volume
| Issue : 1 | Page : 1-2
Airway assessment using cone-beam computed tomography imaging
Muralidhar Mupparapu1, David Matthew Graham2
1 Professor of Oral Medicine, Director, Division of Oral & Maxillofacial Radiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA
2 Fellow in Oral & Maxillofacial Radiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104, USA
|Date of Web Publication||6-May-2016|
Professor of Oral Medicine, Director, Division of Oral & Maxillofacial Radiology, University of Pennsylvania School of Dental Medicine, Philadelphia, PA 19104
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mupparapu M, Graham DM. Airway assessment using cone-beam computed tomography imaging. J Orofac Sci 2016;8:1-2
|How to cite this URL:|
Mupparapu M, Graham DM. Airway assessment using cone-beam computed tomography imaging. J Orofac Sci [serial online] 2016 [cited 2023 Jun 9];8:1-2. Available from: https://www.jofs.in/text.asp?2016/8/1/1/181913
As technological advances and economics of scale make powerful diagnostic techniques more available to the average practitioner, dentists must develop a greater breadth of knowledge using these technologies and become adept at interpreting the results. Nowhere is this more evident than with cone-beam computed tomography (CBCT), wherein the addition of an extra dimension drastically increases the diagnostic yield and potential to screen for any additional incidental findings. Given that incidental airway abnormalities were detected on CBCT scans in 21-52% of the patients in prior studies, ,, obstructive sleep apnea (OSA) diagnosis has been thrust into the spotlight and has become a new standard in the head and neck assessment. Once suspected of OSA, these patients can be referred appropriately for a sleep study to assess the severity of the condition and its management.
OSA is a sleep disorder characterized by disturbed or disordered breathing due to the intermittent collapse of the airway when the tongue and pharyngeal muscles relax during sleep.  According to one study,  at least 75% of OSA cases go undiagnosed, and people with the untreated condition are 4 times more likely to die than those without. According to another study, 2-4% of the middle-aged US population suffer from OSA and its prevalence is likely to increase as the age advances. 
There is a continuing need for development of a standard protocol for evaluating an airway volume. It becomes a part of one's diagnostic algorithm to evaluate the airway since it is routinely captured within a CBCT volume of the head and neck despite the reason for which it was captured. Although the protocols of CBCT capture have been standardized, the airway analysis is still not a part of routine evaluation. One of the factors in the acquisition of CBCT volumes for assessment of the airway is that volumes are acquired in upright positions rather than the typical supine position traditionally used in multidetector CT. This can contribute to a reduction in airway volumes up to 76%, and the effect of patient positioning on the diagnostic assessment of airway volume is still being investigated. ,
To acquire and assess the airway volume pre- and post-operatively, one should have reliable landmarks for the measurement. Alsufyani et al.  explored this issue and questioned the validity of existing measures. There remains a great opportunity for research in this field.
Practitioners who are more likely to use large volume CBCT as a tool in their diagnostic armamentarium should be aware of the airway analysis and the consequences of an undiagnosed OSA. This condition has been associated with a myriad of health issues namely hypertension, arrhythmias, refractory hypertension, heart failure, impaired cognition, and poorly controlled mood disorders to name a few.
| References|| |
Allareddy V, Vincent SD, Hellstein JW, Qian F, Smoker WR, Ruprecht A. Incidental findings on cone beam computed tomography images. Int J Dent 2012;2012:871532.
Caglayan F, Tozoglu U. Incidental findings in the maxillofacial region detected by cone beam CT. Diagn Interv Radiol 2012;18:159-63.
Price JB, Thaw KL, Tyndall DA, Ludlow JB, Padilla RJ. Incidental findings from cone beam computed tomography of the maxillofacial region: A descriptive retrospective study. Clin Oral Implants Res 2012;23:1261-8.
Enciso R, Nguyen M, Shigeta Y, Ogawa T, Clark GT. Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:285-93.
Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, et al.
Sleep disordered breathing and mortality: Eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 2008;31:1071-8.
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5.
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.
Camacho M, Capasso R, Schendel S. Airway changes in obstructive sleep apnoea patients associated with a supine versus an upright position examined using cone beam computed tomography. J Laryngol Otol 2014;128:824-30.
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;118:371-83.