Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing – an exploratory pilot study

Abstract

BackgroundDrug induced sleep endoscopy (DISE) is hoped to identify reasons of failure of adenotonsillectomy (AT) in treating pediatric sleep disordered breathing (SDB). Maxillomandibular disproportion has been studied as another association which may explain alternative pathogenesis of SDB. We aimed to explore the relation between the size of the gonial angle and inclination of the epiglottis measured from cone beam CT (CBCT) and tongue base collapse based on DISE in children with SDB.MethodA retrospective chart review was conducted at a tertiary pediatric center. Children (6-17 years old) assessed at a multi-disciplinary Upper Airway Clinic, diagnosed with SDB and maxillo-mandibular disproportion (MMD), and who underwent DISE were eligible. Variables obtained from the electronic medical records of the clinic and prospective database included demographics, comorbidities, surgeries performed, investigations, DISE findings and CBCT findings. The gonial angle of subjects with and without tongue base collapse (TBC) on SNP were compared.ResultsIn total 29 patients (13 male, 8 female) age 6-17 (median= 9) were eligible for the study from January 2009 – July 2016. We included 11 subjects, and 10 comparators. The mean gonial angle of the TBC group was 139.3°± 7.6°, while that of the comparison group was 129.4°±3.5 (mean difference -9.937, 95% CI of -15.454 to - 4.421, P = 0.001, power of test 0.95). Additionally, the mean inclination of the epiglottis had a mild positive correlation (r=0.32, p<0.05) with the gonial angle, in the whole cohort.ConclusionsThis pilot study suggests that TBC may be mediated by a wider gonial angle in children with SDB patients. The posterior tilt of the epiglottis on CBCT may be a surrogate sign of TBC.

Severity of Mandibular Dysmorphology in Treacher Collins Syndrome for Stratification of Perioperative Airway Risk

“…Contrary to our hypothesis, however, more severely obtuse gonial angles were found to be negatively correlated with markers of perioperative airway dysfunction. Studies in non-TCS patients have found gonial angle to be positively correlated with tongue-based collapse in patients with sleep disordered breathing, 24 and risk of tracheostomy requirement in Robin sequence 25 . However, the data are less clear in TCS.…”

Digital Radiographic Study of Gonial angle in Forensic Odontology in a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…It is related to aesthetic, sleep disorders, orthodontics, risk of angle fracture, and in forensics. 8 …”

Comparison of the Gonial Angle With Age and Gender Using Cone-Beam Computed Tomography Images

“…On the other hand, it has been reported that it is controversial whether there are gender and age differences in the gonial angle values [2,17]. There are also studies in the literature investigating the relation of the gonial angle with the dental status [5,7,9,20], the postoperative stability in the treatment of mandibular prognathism [29], the dynamic tongue collapse in children with snoring [30], the course of the inferior alveolar canal [28], osteoporosis among postmenopausal women [31], location of lingula [32] and different skeletal malocclusion types [33]. In these studies, various methods such as cone-beam computed tomography (CBCT) [1], multidetector computed tomography (MDCT) [8], panoramic radiography [2,6,10,[12][13][14][15][19][20][21][22][23]26], cephalogram [5,16], both panoramic radiography and lateral cephalogram [25,27], both direct anthropometry and lateral cephalometry [24], and both CBCT and direct measurement of the dry bones [28] were used.…”