Comparison of facial soft tissue thickness, pharyngeal airway widths in different skeletal Patterns

LOUIS, Chraseeta; RAGHAVA, Siddharth; SHETTY, Praveena; MANDOLIL, George S.; E-ELANTHAJE, Ajay Rai; SILVESTER, Beniya E. S-ELANJIKKAL

doi:10.1590/2177-6709.30.3.e2524217.oar

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ORIGINAL ARTICLE • Dental Press J. Orthod. 30 (3) • 2025 • https://doi.org/10.1590/2177-6709.30.3.e2524217.oar linkcopy

Comparison of facial soft tissue thickness, pharyngeal airway widths in different skeletal Patterns

Authorship SCIMAGO INSTITUTIONS RANKINGS

Methods: The sample was divided into skeletal Patterns I, II and III, based on ANB and Wits appraisal: Pattern I, when ANB angle = 0-4° and BO was ahead AO by 1mm in males (SD = 1.17 ± 1.9mm), 0mm in females (SD = -0.10 ± 1.77mm); Pattern II, when ANB >4° and BO was located behind AO (43 subjects); and Pattern III, ANB < 0° and BO was ahead of AO (43 subjects). Each group had 43 lateral cephalograms, with a total of 129 cephalograms. The samples were divided into three groups only if they satisfied the criteria of both ANB and Wits appraisal. For this, 26 selected landmarks were identified and, using 13 linear measurements, facial soft tissue thickness and pharyngeal airway widths were measured and compared among the different skeletal patterns.

Results: There was statistically significant difference in facial soft tissue thickness in the different skeletal patterns. Labrale superius and stomion were statistically significant and higher in Pattern III and smaller in Pattern II. Labrale inferius was found to be statistically significant and higher in Pattern II and smaller in Pattern III. Though not statistically significant, the thickness at Menton, Pogonion, and Gnathion was higher in Pattern II, average in Pattern I and smaller in Pattern III. Sexual dimorphism was noted: Men had a greater soft tissue thickness than women in all sites. There was statistically significant difference in pharyngeal airway widths in different skeletal malocclusions. Both upper and lower pharyngeal airway widths were found to be statistically significant and higher in Pattern III and smaller in skeletal Pattern II.

Conclusion: When developing orthodontic treatment plans, soft tissue differences and pharyngeal airway widths need to be taken into account as crucial factors. The findings of the current study indicate that there was a substantial correlation between the thickness of the soft tissues in the face, the diameter of the pharynx, and several skeletal patterns.

Keywords:
Facial profile; Soft tissue thickness; Airway; Skeletal pattern; Cephalometrics

MEASUREMENTS	DESCRIPTION
(1) Gls-GL	Distance from the most prominent point on the frontal bone to the soft tissue prominence on the forehead.
(2) Ns-N	Distance from the point nasion to the soft tissue nasion.
(3) Rh linear	Perpendicular distance from the intersection of the nasal bone and cartilage to the soft tissue.
(4) Sn-A	Distance between subnasale and A point.
(5) Ls-Pr	Distance between the most prominent point of the upper lip and prosthion.
(6) St-U1	Distance between the most prominent point of the upper incisor and stomion.
(7) Li-Id	Distance between the most prominent point of the lower lip and infradentale.
(8) B-Lm	Distance from point B to labiomental sulcus.
(9) Pogs-pog	The distance between soft tissue pogonion and bony pogonion.
(10) Mes-Me	The distance between soft tissue menton and bony menton.
(11) Gns-Gn	The distance between soft tissue gnathion bony and gnathion.
Upper airway width	Measured from the point on the posterior outline of the soft palate to the closest point on the distal wall of pharynx. Upper airway measures around 15-20 mm, whereas reduction by 2 mm or more indicates the impairment of the upper airway.
Lower airway width	Measured from the point of intersection of the distal portion of the tongue and the lower border of the mandible to the nearest point on the distal wall of pharynx, and it is approximately 11-14 mm, irrespective of the age.

Malocclusion		Measurements
Malocclusion		GLS-GL	NS-N	RH	SN-A	LS-PR	ST-U1	LI-ID	B-LM	POGS-POG	MES-ME	GNS-GN	Upper airway	Lower airway
Pattern I n=43	Mean	5.68	6.08	2.66^a	15.38	14.85^a	7.44 a	12.86^a	12.50^a	12.13	7.49	10.08	17.91^a	13.29^a
	Std. Deviation	0.93	1.73	0.93	2.85	2.6318	2.26	2.79	1.89	1.82	1.64	2.36	0.53	0.93
	Minimum	3.2	2.4	1.1	11.2	9.4	3.7	4.7	8.9	7.7	5.1	6.4	17.1	11.1
	Maximum	7.9	9.5	6.3	23.7	20.8	15.4	19.3	17.8	17.7	12.1	18.0	18.7	15.0
Pattern II n=43	Mean	5.49	6.34	2.84^a,b	15.32	14.01^a,b	7.59^a	14.44^b	12.54^a	12.38	7.78	9.89	14.75^b	10.99^b
	Std. Deviation	0.87	1.92	0.91	2.01	2.0458	2.00	2.56	1.97	2.2402	1.69	2.75	0.39	0.40
	Minimum	3.8	2.3	1.1	11.6	10.5	3.8	10.6	8.6	8.0	4.9	5.5	14.2	9.7
	Maximum	7.7	10.0	5.3	19.7	18.6	11.5	18.9	17.7	17.7	12.3	16.0	15.7	11.7
Pattern III n=43	Mean	5.92	6.52	2.36^a	15.87	12.90^b	15.41^b	9.41 c	14.08^b	12.67	8.27	10.41	19.22^c	14.77^c
	Std. Deviation	0.96	1.83	0.63	3.02	2.80	2.10	4.34	2.70	2.26	2.66	2.52	0.67	.61
	Minimum	4.3	3.5	.9	11.2	8.4	11.2	4.6	9.0	8.7	4.4	6.9	18.1	13.2
	Maximum	8.8	10.1	3.0	21.0	18.1	18.8	17.4	17.1	17.1	13.3	16.9	20.5	15.8
F value		2.340	0.634	3.671	0.558	6.516	198.284	25.753	7.096	0.709	1.614	.461	783.621	335.318
p value		0.101	0.532	0.028*	0.574	0.002*	<0.001*	<0.001*	0.001*	0.496	0.203	0.632	< 0.001*	<0.001*

Malocclusion		Measurements
Malocclusion		GLS-GL	NS-N	RH	SN-A	LS-PR	ST-U1	LI-ID	B-LM	POGS-POG	MES-ME	GNS-GN	Upper airway	Lower airway
Pattern I (n=26)	Mean	5.44^a	5.67	2.53	14.35^a	13.84	7.15a	12.47^a	12.32^a	11.86	6.79^a	9.19^a	17.89^a	13.24^a
	Std. Deviation	0.58	1.73	1.02	2.01	2.55	1.90	2.14	2.18	1.56	1.12	1.54	0.57	0.95
	Minimum	4.3	2.4	1.1	11.2	9.4	3.7	9.6	8.9	7.7	5.1	6.8	17.1	11.7
	Maximum	6.9	8.6	6.3	19.4	20.0	10.8	16.3	17.8	15.5	9.5	12.5	18.7	15.0
Pattern II (n=29)	Mean	5.36^a	5.94	2.66	14.58^a	13.25	7.24^a	14.04^a	12.33^a	11.91	7.40^a,b	9.29^a	14.79^b	11.03^b
	Std. Deviation	0.79	1.95	0.88	1.61	1.75	1.99	2.45	1.97	2.30	1.65	2.65	0.37	0.37
	Minimum	3.8	2.3	1.1	11.6	10.5	3.8	10.8	8.8	8.0	4.9	5.5	14.2	10.5
	Maximum	7.7	9.6	4.5	16.9	18.0	11.1	18.2	17.7	17.7	11.8	15.5	15.7	11.7
Pattern III (n=32)	Mean	5.96^b	6.42	2.30	15.80^b	13.07	15.42^b	8.81^b	13.98^b	12.83	8.59^b	10.68^b	19.19^c	14.68^c
	Std. Deviation	1.03	1.77	0.69	3.10	2.67	2.18	4.05	2.78	2.23	2.89	2.63	0.68	0.61
	Minimum	4.3	3.5	0.9	11.2	8.4	11.2	4.6	9.0	8.7	4.4	6.9	18.1	13.2
	Maximum	8.8	10.0	3.0	21.0	18.1	18.8	17.4	17.1	17.1	13.3	16.9	20.4	15.7
F value		4.663	1.290	1.375	3.258	0.810	164.428	23.453	4.988	2.057	5.641	3.763	484.340	225.095
p value		0.012*	0.281	0.259	0.043*	0.449	<0.001*	<0.001*	0.009*	0.134	0.005*	0.027*	<0.001*	<0.001*

Malocclusion		Measurements
Malocclusion		GLS-GL	NS-N	RH	SN-A	LS-PR	ST-U1	LI-ID	B-LM	POGS-POG	MES-ME	GNS-GN	Upper airway	Lower airway
Pattern I (n=17)	Mean	6.05	6.71	2.87	16.97	16.40^a	7.89^a	13.45^a	12.77	12.55	8.55	11.44	17.94^a	13.37^a
	Std. Deviation	1.23	1.58	0.76	3.25	1.95	2.72	3.56	1.36	2.14	1.77	2.77	0.46	0.92
	Minimum	3.2	3.4	2.0	12.7	13.4	4.0	4.7	10.7	8.3	5.4	6.4	17.2	11.1
	Maximum	7.9	9.5	4.6	23.7	20.8	15.4	19.3	15.5	17.7	12.1	18.0	18.7	14.9
Pattern II (n=14)	Mean	5.75	7.16	3.21	16.84	15.58^a	8.30a	15.27^b	12.96	13.34	8.56	11.14	14.67^b	10.92^b
	Std. Deviation	0.99	1.60	0.91	1.93	1.71	1.88	2.70	1.97	1.84	1.54	2.62	0.42	0.46
	Minimum	4.2	4.4	2.1	12.9	11.9	5.5	10.6	8.6	10.3	6.3	7.0	14.2	9.7
	Maximum	7.7	10.0	5.3	19.7	18.6	11.5	18.9	17.0	17.6	12.3	16.0	15.7	11.7
Pattern III (n=11)	Mean	5.78	6.82	2.51	16.07	12.41^b	15.39^b	11.14^a,b	14.36	12.24	7.36	9.63	19.29^c	15.04^c
	Std. Deviation	0.72	2.07	0.40	2.89	3.25	1.95	4.90	2.56	2.41	1.63	2.08	0.63	0.53
	Minimum	4.3	3.5	1.8	12.3	8.4	13.4	4.6	10.4	8.7	4.4	6.9	18.3	14.2
	Maximum	7.2	10.1	2.9	20.3	18.1	18.7	16.2	17.1	17.1	9.8	12.2	20.5	15.8
F value		0.378	0.268	2.675	0.378	10.665	41.948	3.830	2.483	0.945	2.127	1.801	296.654	111.045
p value		0.688	0.766	0.082	0.688	<0.001*	<0.001*	0.030*	0.097	0.397	0.133	0.179	<0.001*	<0.001*

Sex		Measurements
Sex		GLS-GL	NS-N	RH	SN-A	LS-PR	ST-U1	LI-ID	B-LM	POGS-POG	MES-ME	GNS-GN	Upper airway	Lower airway
Female (n=26)	Mean	5.44	5.67	2.53	14.35	13.84	7.15	12.47	12.32	11.86	6.79	9.19	17.89	13.24
	Std. Deviation	0.58	1.73	1.02	2.02	2.554	1.90	2.14	2.18	1.56	1.12	1.54	0.57	0.95
	Minimum	4.3	2.4	1.1	11.2	9.4	3.7	9.6	8.9	7.7	5.1	6.8	17.1	11.7
	Maximum	6.9	8.6	6.3	19.4	20.0	10.8	16.3	17.8	15.5	9.5	12.5	18.7	15.0
Male (n=17)	Mean	6.05	6.71	2.87	16.97	16.40	7.89	13.45	12.77	12.55	8.55	11.44	17.94	13.37
	Std. Deviation	1.23	1.58	0.76	3.25	1.95	2.72	3.56	1.36	2.14	1.77	2.77	0.46	0.92
	Minimum	3.2	3.4	2.0	12.7	13.4	4.0	4.7	10.7	8.3	5.4	6.4	17.2	11.1
	Maximum	7.9	9.5	4.6	23.7	20.8	15.4	19.3	15.5	17.7	12.1	18.0	18.7	14.9
t value		-2.191	-2.008	-1.188	-3.277	-3.518	-1.063	-1.140	-0.754	-1.215	-4.003	-3.434	-0.295	-0.444
p value		0.0034*	0.051	0.242	0.002*	0.001*	0.294	0.261	0.455	0.231	<0.001*	0.001*	0.769	0.660

Sex		Measurements
Sex		GLS-GL	NS-N	RH	SN-A	LS-PR	ST-U1	LI-ID	B-LM	POGS-POG	MES-ME	GNS-GN	Upper airway	Lower airway
Female (n=29)	Mean	5.36	5.94	2.66	14.58	13.25	7.24	14.04	12.33	11.91	7.40	9.29	14.79	11.028
	Std. Deviation	0.79	1.95	0.88	1.61	1.76	1.99	2.45	1.97	2.30	1.65	2.65	0.37	.3673
	Minimum	3.8	2.3	1.1	11.6	10.5	3.8	10.8	8.8	8.0	4.9	5.5	14.2	10.5
	Maximum	7.7	9.6	4.5	16.9	18.0	11.1	18.2	17.7	17.7	11.8	15.5	15.7	11.7
Male (n=14)	Mean	5.75	7.16	3.207	16.84	15.58	8.30	15.27	12.96	13.34	8.56	11.14	14.67	10.921
	Std. Deviation	0.99	1.60	0.91	1.93	1.70	1.88	2.70	1.97	1.84	1.54	2.62	0.42	.4577
	Minimum	4.2	4.4	2.1	12.9	11.9	5.5	10.6	8.6	10.3	6.3	7.0	14.2	9.7
	Maximum	7.7	10.0	5.3	19.7	18.6	11.5	18.9	17.0	17.6	12.3	16.0	15.7	11.7
t value		-1.385	-2.027	-1.890	-4.026	-4.118	-1.661	-1.496	-0.995	-2.032	-2.200	-2.154	0.966	0.819
p value		0.173	0.049*	0.066	<0.001*	<0.001*	0.104	0.142	0.326	0.049*	0.033*	0.037*	0.340	0.341

Sex		Measurements
Sex		GLS-GL	NS-N	RH	SN-A	LS-PR	ST-U1	LI-ID	B-LM	POGS-POG	MES-ME	GNS-GN	Upper airway	Lower airway
Female (n=32)	Mean	5.96	6.42	2.30	15.80	13.07	15.42	8.81	13.98	12.83	8.59	10.68	19.19	14.68
	Std. Deviation	1.03	1.77	0.69	3.10	2.67	2.19	4.05	2.78	2.23	2.89	2.63	0.68	0.61
	Minimum	4.3	3.5	.9	11.2	8.4	11.2	4.6	9.0	8.7	4.4	6.9	18.1	13.2
	Maximum	8.8	10.0	3.0	21.0	18.1	18.8	17.4	17.1	17.1	13.3	16.9	20.4	15.7
Male (n=11)	Mean	5.78	6.82	2.52	16.07	12.41	15.39	11.14	14.36	12.24	7.36	9.63	19.29	15.04
	Std. Deviation	0.72	2.07	0.40	2.89	3.25	1.95	4.90	2.56	2.41	1.63	2.08	0.63	0.53
	Minimum	4.3	3.5	1.8	12.3	8.4	13.4	4.6	10.4	8.7	4.4	6.9	18.3	14.2
	Maximum	7.2	10.1	2.9	20.3	18.1	18.7	16.2	17.1	17.1	9.8	12.2	20.5	15.8
t value		0.537	-0.619	-0.984	-0.253	0.670	0.033	-1.557	-0.392	0.740	1.341	1.201	-0.414	-1.749
p value		0.594	0.539	0.331	0.802	0.507	0.974	0.127	0.697	0.464	0.187	0.237	0.681	0.088

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[TFN1] ^a,b,c Different superscript letters along the columns indicate statistically significant differences determined using Tukey’s post-hoc test. F value from ANOVA. *p<.05 indicate statistical significance from ANOVA test.