Introduction: Altered airway and growth are interrelated; hence, a study was planned to develop a diagnostic protocol that may help in diagnosing difficult airway by utilizing routine radiographic assessment. Material and Methods: Lateral cephalograms of 60 children aged 12 to 14 years who were grouped based on the growth pattern into 3 groups with 20 cases each (Group 1—normodivergent cases; Group 2—hypodivergent cases; Group 3—hyperdivergent cases) were observed. The diagnostic protocol included 3 diagnostic methods (Handelman–Osborne area method, Maw et al method, and Holmberg et al method) routinely used by ENT surgeons for altered airway evaluation, and their diagnostic efficacy was correlated with McNamara’s airway analysis. Results: Highest specificity and diagnostic accuracy were found with Holmberg et al method followed by Maw et al method. Poor specificity was observed with Handelman–Osborne area method. Conclusion: The new diagnostic protocol which includes commonly used cephalometric methods by ENT surgeons can be helpful for orthodontists in early evaluation of altered airways, so that preventive and interceptive procedures can be carried out to normalize the altered craniofacial growth. Among the methods used in this diagnostic protocol, Holmberg et al and Maw et al methods had better sensitivity and specificity.

Introduction: Altered nasorespiratory function leads to altered craniofacial growth. Thus, airway evaluation is important for preventive, interceptive, and corrective orthodontic treatment. The aim of this study was to evaluate and compare adenoids, the upper airway, the tongue, and mandibular dimensions using “predictors of difficult airways” in class II division 1 and class II division 2 cases with class I cases. Method: Sixty subjects of age 15 to 18 years were divided into 3 groups (group 1: class I cases; group 2: class II division 1 cases; and group 3: class II division 2 cases) based on cephalometric parameters, with 20 cases in each group. Cephalometric evaluation of adenoids and the nasopharyngeal airway was done using the Handelman–Osborne area method. Upper and lower airway evaluation was done using McNamara’s linear method. “Predictors of difficult airways” were used for evaluation of the airway, which included nasal competency, the Mallampati scale, mandibular length, mandibular protrusion, and the thyromental distance. Results: The present study found a significant positive correlation between the grades of nasal competency and percentage adenoid wall area, and a significant negative correlation between the grades of nasal competency and the upper airway. There was a significant positive correlation between the grades of nasal competency and mandibular length, and a significant positive correlation between the grades of mandibular protrusion and mandibular length. There was a significant positive correlation between the grades of the thyromental distance and mandibular length. Conclusion: It was concluded that the “predictors of difficult airways” would be helpful in early diagnosis and identification of potential risk factors that may cause “breathing disorders”–related malocclusions and later on increase the risk of developing OSA.