World Rural Health Conference
Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 1629
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 7  |  Page : 2468-2472  

Correlation of soft palate morphology to growth pattern: A retrospective cephalometric study


1 Department of Orthodontics and Dentofacial Orthopedics, Kothiwal Dental College and Research Center, Mora Mustaqueem, Moradabad, Uttar Pradesh, India
2 Consultant Orthodontist, Phoenix Hospital, Panchkula, Haryana, India
3 Consultant Orthodontist, Ambedkar marg, Rajnagar Extension II, Palam Colony, New Delhi, India
4 Department of Orthodontics and Dentofacial Orthopedics, Maitri College of Dentistry and Research Center, Anjora, Durg, Chhattisgarh, India

Date of Submission20-Apr-2019
Date of Decision29-Apr-2019
Date of Acceptance06-May-2019
Date of Web Publication31-Jul-2019

Correspondence Address:
Dr. Poonam K Jayaprakash
Department of Orthodontics and Dentofacial Orthopedics, Kothiwal Dental College and Research Center, Mora Mustaqueem, Moradabad - 244 001, Uttar Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_322_19

Rights and Permissions
  Abstract 


Aim: The aim of the present study was to evaluate the radiographic length of velum (LV), width of velum (WV), velum angle (AV), depth of pharynx (PD), Need's ratio (NR), inclination angle (AI) in different morphological types of soft palate according to growth patterns in skeletal class I individuals. Methodology: 80 pretreatment lateral cephalograms of patients with skeletal class I malocclusion (ANB 2--4°) were divided on basis of six types of soft palate and further into three subgroups according to growth pattern and evaluation of LV, WV, angle with the palatal plane, and NR was done. Kruskal--Wallis test was used for the comparison between the groups. Results: Statistically significant difference was verified among all groups for measurement of NR. The highest NR was seen in Crook type of soft palate (mean 0.9). Similarly, the vertical growth pattern in all the six types of soft palate exhibited a higher NR than the average and horizontal growth pattern group; the highest being exhibited by vertical group in type VI (crook shaped). Velopharyngeal insufficiency is directly related to NR. Conclusion: Vertical growth pattern has the highest susceptibility to velopharyngeal insuffiency and speech and sleep apnea disorders.

Keywords: Lateral cephalogram, malocclusion, soft palate


How to cite this article:
Jayaprakash PK, Modi P, Sapawat P, Thakur RS, Choudhari T, Chandrakar J. Correlation of soft palate morphology to growth pattern: A retrospective cephalometric study. J Family Med Prim Care 2019;8:2468-72

How to cite this URL:
Jayaprakash PK, Modi P, Sapawat P, Thakur RS, Choudhari T, Chandrakar J. Correlation of soft palate morphology to growth pattern: A retrospective cephalometric study. J Family Med Prim Care [serial online] 2019 [cited 2019 Aug 25];8:2468-72. Available from: http://www.jfmpc.com/text.asp?2019/8/7/2468/263770




  Introduction Top


Nasal breathing, deglutition, and phonation are governed by a normal upper respiratory pattern. Besides respiratory or airway pattern, the velopharyngeal closure mechanism including the dimensions, shape, and dynamics of the soft palate is a reliable predetermining factor in carrying out these functions [Figure 1]. Soft palate is the posterior fibrovascular part of palate attached to posterior edge of hard palate.[1]
Figure 1: Types of soft palate on the basis of shape

Click here to view


The velopharyngeal mechanism consists of a muscular valve that extends from the posterior surface of the hard palate (roof of mouth) to the posterior pharyngeal wall and includes the velum (soft palate), lateral pharyngeal walls (sides of the throat), and the posterior pharyngeal wall (back wall of the throat). The function of the velopharyngeal mechanism is to create a tight seal between the velum and pharyngeal walls to separate the oral and nasal cavities for various purposes, including speech. Velopharyngeal closure is accomplished through the contraction of several velopharyngeal muscles including the levator veli palatini, musculus uvulae, superior pharyngeal constrictor, palatopharyngeus, palatoglossus, and salpingopharyngeus. The tensor veli palatini is thought to be responsible for  Eustachian tube More Details function.

Abnormal soft palate functionality is usually associated with craniofacial abnormalities like the cleft lip and palate patients exhibit frequent soft palate abnormalities and dysfunctions. This perpetuates in misarticulation, phonation errors, and hypernasality. Thus, the usefulness of the study. The relationship of length of velum (LV) and pharyngeal depth (PD) can be used to assess the velopharyngeal function.[2] The ratio of (PD) to (LV) is termed as Need's ratio (NR). Subtelny et al. reported that NR in normal individual ranged from 0.6 to 0.7 in normal subjects. However, a greater ratio demonstrated velopharyngeal incompetency. There have been studies demonstrating changes in upper airway resulting from orthodontic treatment, orthognathic surgery, or in individuals diagnosed with sleep apnea.[3],[4],[5],[6] Studies have also been done on airspace related to facial types and angles class I individuals.[7] However, studies taking into consideration both the growth pattern and types of soft palate has not been considered. The aim of the present study is to evaluate the radiographic LV, width of velum (WV), velum angle (AV), depth of Pharynx (PD), NR, inclination angle (AI) in different morphological types of soft palate in different growth patterns in skeletal class I individuals.


  Material and Methods Top


This was a retrospective study carried out in the Department of Orthodontics and Dentofacial Orthopaedics. A total of 80 pretreatment digital lateral cephalograms were randomly selected from the records of department of orthodontics were included.

Inclusion criteria

  1. 80 pretreatment digital lateral cephalograms of orthodontic patients
  2. Age group 18--30 years irrespective of gender
  3. Permanent dentition
  4. Skeletal class I determined by Steiner's variable ANB 2--4°.[8]


Exclusion criteria

  1. Lateral cephalograms that was unclear
  2. Previous history of palatine tonsils or pharyngeal tonsillar surgeries
  3. History of extraction or previous orthodontic treatment
  4. Previous history of orthodontic treatment
  5. Craniofacial abnormalities like cleft lip and palate.


Methodology

The radiographs were traced manually on an acetate sheet (0.003 inch thickness) with 0.35 mm HB lead in a dark room by a single observer on a laminator [Figure 2]. The Tweed FMA [9] and Y Axis measurements were used to select growth pattern. The FMA measurement reference value was 25°. Values above 30° were considered as vertical growth pattern while below 20° were considered as horizontal growth pattern. Y axis mean value was considered 59°. All 80 subjects were morphologically classified according to You et al. classification [Table 1] and [Figure 2].
Figure 2: (1) PNS- S –velum length; (2) velum width (VW); (3) Pharyngeal depth (PD); (4) Velum angle (AV)

Click here to view
Table 1: Types of soft palate according to shape

Click here to view


Following parameters were noted on digital lateral cephalogram [Table 2].
Table 2: Parameters considered for the lateral cephalograms

Click here to view


Statistical analysis

A comparison was made between mean LV, WV, ration, and AV according to different growth patterns by Kruskal--Wallis test.


  Result Top


A total of 80 lateral cephalograms were evaluated with mean age of subjects as 22.5 years. All samples were classified into six types of soft palate as per the You et al. classification. However, only one subject presented with s type of soft palate while straight type of soft palate was seen in two subjects. Type I soft palate was seen in around 60% of subjects while S-shaped palate was lowest in incidence [Figure 3]. In type I cases, values were significant for all the parameters except the AV, while group II showed significant different in only the NR. The highest NR was seen in Crook type of soft palate (mean 0.92) [Table 3]. Similarly, the vertical growth pattern in all the six types of soft palate exhibited a higher NR than the average and horizontal growth pattern group; the highest being exhibited by vertical group in type VI (crook shaped) [Table 4].
Figure 3: Shows the distribution of different types of soft palate in the sample

Click here to view
Table 3: Comparison of length, width, velum angle and Need's ratio in various types of soft palate

Click here to view
Table 4: Comparison of Need's ratio in different types of soft palate according to Growth pattern

Click here to view


[Table 3] shows comparison of length, width, AV, and NR in various types of soft palate. It was observed that crook-shaped palate (type VI) showed highest NR. Butt-shaped soft palate (type III) had all the parameters significant while in leaf shaped soft palate (type I), all parameters except AV were significant.

[Table 4] shows comparison of NR in different types of soft palate according to growth pattern. The NR was highest in all types of soft palates followed by average and vertical growth pattern. NR is highest in crook-shaped (type VI) soft palate in vertical growth pattern.

Of all the types of soft palates in the sample, leaf shaped soft palate [Table 5] constituted around 63.1% followed by rat tail shaped (18.4%). Only 1% had S-shaped soft palate while butt-shaped, straight and crook shaped were around 8.5%, 3.5%, and 5.5%, respectively.
Table 5: Shows % distribution of various types of soft palate

Click here to view



  Discussion Top


Nasopharyngeal fiberscope and magnetic resonance imaging method are used for recording the pattern of growth and development of soft palate.[10],[11] Lateral cephalogram being an affordable, readily available, and feasible diagnostic aid that can give quantitative assessment of the PD and palatal inclination in the form of AV, PD, and NR. Thus, it can act as a prediagnostic aid for velopharyngeal insufficiency problems like misarticulation and sleep apnea. In the present study, the highest NR was seen in vertical growth pattern subjects having a crook-shaped morphology which coincides with the study by Elkunchwar et al.[12] The shape of soft palate may differ. Six major types of soft palate have been recognized. In the present study, leaf-shaped soft palate was found in majority of the subjects. It has been shown that the pharyngeal morphology changes throughout adulthood. Therefore, the subjects of mean age 22.5 years were taken. The clinician could follow the stability of this NR for early diagnosis of sleep apnea and misarticulations. Stellzig–Eisenheuer pointed out the ratio between soft palate and sagittal depth of nasopharyngeal airway was of prime importance in resonance. Pepin et al. found that S-shaped morphology of velum indicated the highest risk for obstructive sleep apnea. He hypothesized that hook-shaped soft palate contributes an abrupt and major reduction in the oropharyngeal dimension. This causes increase in the upper airway resistance culminating into pharyngeal collapse. In the present study, only one subject were seen to possess S-shaped morphology and showed a high NR (0.9), highest being crook-shaped soft palate (0.92) Studies have been conducted on various facial types. Sprenger et al. in a cephalometric study concluded that there is a significant difference in linear space measurement posterior to palate in the region of oropharynx. This was found to be predominant in individuals who had dolicofacial growth pattern.[7] The present study combines both the growth patterns as well as different types of soft palates. Taking into consideration the types of soft palate, the type most predisposed to velopharyngeal insufficiency and sleep apnea can be recognized. In present study, vertical growth pattern was seen to be most predisposed to obstructive sleep apnea especially with crook-shaped soft palate. This study was performed using two-dimensional digital lateral cephalogram that is a limitation. Therefore, it is important to recognize that three-dimensional evaluation of the airways by means of cone-beam computed tomography, respecting legal and ethical aspects, due a higher dose of radiation, could be useful for improved assessment in further studies to minimize this limitation. The limitation of the study was unequal distribution of samples. Equitable distribution of samples would prove to be more validating.


  Conclusion Top


Type I Leaf-shaped soft palate is the most common shape of soft palate. Crook-shaped type of soft pate showed overall larger values in all parameters. Vertical growth pattern showed an increased NR in all groups, the highest being crook-shaped group. Crook shape soft palate in vertical growth pattern is more likely predisposed to velopharyngeal insufficiency resulting into misarticulation and sleep apnea.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
You M, Li X, Wang H, Zhang J, Wu H, Liu Y, et al. Morphological variety of soft palate in normal individuals: A digital cephalometric study. Dentomaxillofac Radiol 2008;37:344-9.  Back to cited text no. 1
    
2.
Subtelny JD. A cephalometric study of growth of soft palate. Plast Reconstr Surg 1957;19:49-62.  Back to cited text no. 2
    
3.
Borges PTM, Silva BM, Neto JMM, Borges NE, Li ML. Cephalometeric and anthropometric data of obstructive sleep apnoea in different age groups. Braz J Otorhinolayngol 2015;81:79-84.  Back to cited text no. 3
    
4.
Gornic C, Nascimento PP, Melgaço CA, Ruellas AC, Medeiros PJ, Sant'Anna EF. Cephalometric analysis of upper airways of Class III patients subjected to orthosurgical treatment. Dent Press J Orthod 2011;16:82-8.  Back to cited text no. 4
    
5.
Fernández-Ferrer L, Montiel-Company JM, Pinho T, Almerich-Silla JM, Bellot-Arcís C. Effects of mandibular set back surgery on upper airway dimensions and their influence on obstructive sleep apnoea- A systematic review. J Craniomaxillofac Surg 2015;43:248-53.  Back to cited text no. 5
    
6.
Koay WL, Yang Y, Tse CS, Gu M. Effects of two-phase treatment with Herbst and preadjusted edgewise appliances on upper airway dimensions. Sci World J 2016;2016. doi: 10.1155/2016/4697467.  Back to cited text no. 6
    
7.
Sprenger R, Martins LAC, Dos Santos JCB, de Menezes CC, Venezian GC, Degan VV. A retrospective cephalometric study on upper airway spaces in different facial types. Prog Orthod 2017;18:1-7.  Back to cited text no. 7
    
8.
Maschtakow PSL. Cephalometeric analysis for diagnosis of sleep apnoea: A comparative study between reference values and measurements obtained for Brazilian subjects. Dent Press J Orthod 2013;18:143-9.  Back to cited text no. 8
    
9.
Tweed CH. Was the development of diagnostic facial triangle as an accurate analysis based on fact or fancy? Am J Orthod 1962;48:823-40.  Back to cited text no. 9
    
10.
Akguner M. Velopharyngeal anthropometric analysis with MRI in normal subjects. Ann Plast Surg 1999;43:142-47.  Back to cited text no. 10
    
11.
Igawa H, Nishizawa N, Sugihara T, Inuyama Y. A fiberscopic analysis of velopharyngeal movement before and after primary palatoplasty in cleft palate infants. Plast Reconstr Surg 1998;102:668-74.  Back to cited text no. 11
    
12.
Elkunchwar G, Gulve N, Nehete A, Shah K, Aher S. Evaluation of airway in different types of soft palate according to growth pattern. Int Organistion Scientific Research J Dent Med Sci 2018;17;53-8.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
   
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Material and Methods
  Result
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed36    
    Printed0    
    Emailed0    
    PDF Downloaded11    
    Comments [Add]    

Recommend this journal