J Oral Maxillofac Surg 56: 135-l 39, 1998 A Cephalometric Comparative Study of the Soft Tissue Airway Dimensions in Persons with Hyperdivergent and Normodivergent Facial Patterns Abu A. Joseph, DMD, *Jeffrey Elbaum, DDS, f GeorgeJ Cisneros, DMD, MMScf and Sidney B. Eisig, DDSf Purpose: This study was performed to compare the dimensions of the nasopharynx, oropharnynx, and hypopharynx of persons with hyperdivergent and normodivergent facial types, and to determine whether any variations exist. Patients and Methods: Lateral cephalometric records of a population with a normodivergent facial pattern (n = 23) and a group with a hyperdivergent facial pattern (n = 27) as evidenced by increased mandibular plane angle were used to compare the soft tissue airway dimensions. Statistical analysis consisted of Student’s t-tests, Wilcoxon rank sums, and x2. Statistical significance was set .05. Results: Overall the hyperdivergent group had a narrower anteroposterior pharyngeal dimension than the normodivergent control group. This narrowing was specifically noted in the nasopharynx at the level of the hard palate and in the oropharynx at the level of the tip of the soft palate and the mandible. In addition, the posterior pharyngeal wall had a thinning at the level of the inferior border of the third cervical vertebrae, and there was a more obtuse palatal angle. The tongue was also positioned more inferiorly and posteriorly in the hyperdivergent group, as evidenced by the increased distance between the hyoid bone and the mandibular plane and the increased distance between the soft palate tip and the epiglottis. The hyperdivergent group had more retruded maxillary and mandibular apical bases and a higher Class II skeletal discrepancy. Conclusions: The narrower anteroposterior dimension of the airway in hyperdivergent patients may be attributable to skeletal features common to such patients, that is, retrusion of the maxilla and the mandible and vertical maxillary excess. Other features, such as an obtuse soft palate and low-set hyoid, also may be contributory factors. The relatively thin posterior pharyngeal wall observed in hyperdivergent patients might be a compensatory mechanism. Respiratory function may play a significant role in the development of the face and occlusion.’ It has been hypothesized that chronic nasal obstruction causes hyperdivergent facial growth. Patients exhibiting this pattern typically have “long face syndrome” character- Received from the Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY. *Former Resident, Currently, Clinical Instructor, Orthodontics tFormer Chief Resident, Oral and Maxillofacial Surgery. Currently in private practice, Freehold, NJ. #Associate Professor, Pediatric Dentistry and Orthodontics, Direc- tor of Orthodontics. $Associate Professor, Oral and Maxillofacial Surgery. Address correspondence and reprint requests to Dr Eisig: Depart- ment of Dentistry, 111 E 210th St, Bronx, NY 10467-2490. Ed 1998 American Association of Oral and Maxillofacial Surgeons 0278.2391/98/56020004$3.00/0 ized by a vertically long lower face height, narrow alae, lip incompetency, a narrow maxillary arch, and a greater than normal mandibular plane angle.2 Hered- ity, muscle tonicity, and other environmental factors also may influence facial growth.3 There have been various methods used to evaluate the airway, including nasopharyngoscopy, cephalom- etry, nasal airway resistance, as well aspolysomnogra- phy.1ss,411 Lateral and frontal radiographs also have been used to assess the pharyngeal airway.*,12 How- ever, most of these studies have focused only on the adenoid region,‘-9 few have evaluated the full length and width of the airway. ls Rarely have facial types and the associated airway dimensions been compared. The purpose of this study was to compare the naso- pharynx, oropharynx and hypopharynx of persons with hyperdivergent and normodivergent facial pat- terns and to determine any variations between these facial types. 135