YIJOM-3364; No of Pages 8

Int. J. Oral Maxillofac. Surg. 2016; xxx: xxx–xxx

http://dx.doi.org/10.1016/j.ijom.2016.02.005, available online at http://www.sciencedirect.com

Clinical Paper
Orthognathic Surgery

Correlation between hyoid bone Y.-Y. Jiang1,2

1
Department of Dentistry, Affiliated Hospital of
Weifang Medical University, Weifang City,
China; 2Department of Preventive Dentistry,

position and airway dimensions School of Stomatology, Weifang Medical

University, Weifang City, China

in Chinese adolescents by cone

beam computed tomography
analysis
Y.-Y. Jiang: Correlation between hyoid bone position and airway dimensions in
Chinese adolescents by cone beam computed tomography analysis. Int. J. Oral
Maxillofac. Surg. 2016; xxx: xxx–xxx. # 2016 International Association of Oral and
Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Abstract. This study aimed to investigate the correlation between upper airway
dimensions and hyoid bone position in Chinese adolescents based on cone beam
computed tomography (CBCT) images. CBCT images from a total of 254 study
subjects were included. The upper airway and hyoid bone parameters were
measured by Materialism’s interactive medical image control system (MIMICS)
v.16.01 (Materialise, Leuven, Belgium). The airway dimensions were evaluated in
terms of volume, cross-sectional area (CSA), mean CSA, length, anteroposterior
dimension of the cross-section (AP), lateral dimension of the cross-section (LAT),
and LAT/AP ratio. The hyoid bone position was evaluated using eight linear
parameters and two angular parameters. Facial characteristics were evaluated using
three linear parameters and three angular parameters. Most hyoid bone position
parameters (especially the distance between the hyoid bone and hard palate) were
significantly associated with most airway dimension parameters. Significant
correlations were also observed between the different facial characteristic
parameters and hyoid bone position parameters. Most airway dimension parameters
showed significant correlations with linear facial parameters, but they displayed
Key words: correlation analysis; upper airway;
significant correlations with only a few angular facial parameters. These findings hyoid bone position; Chinese adolescents;
provide an understanding of the static relationship between the hyoid bone position cone-beam computed tomography.
and airway dimensions, which may serve as a reference for surgeons before
orthodontic or orthognathic surgery. Accepted for publication 10 February 2016

0901-5027/000001+08 # 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by
cone beam computed tomography analysis, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.02.005
YIJOM-3364; No of Pages 8
2 Jiang
The upper airway is a tube-shaped struc-
ture that plays an important role in respi-
ration and deglutition.1 Anatomical
anomalies of the upper airway, such as
micrognathia, retrognathia, hyperdiver-
gent growth patterns, reduced cranial base
length, and steep mandibular plane angles,
may lead to a narrow airway space, small
volume, and even obstructive sleep ap-
noea.2–4 The hyoid bone is the only bone
that is not articulated to any other bone in
the body, and is connected to the pharynx,
mandible, and cranium through muscles
and ligaments; this is necessary for talk-
ing, chewing, swallowing, and airway pa-
tency.5
Orthognathic surgery, as performed
nowadays, can alter the pharyngeal airway
dimension, and this is an interesting topic
for orthodontists.6,7 Mandibular setback
surgery can narrow the airway8,9 and
cause a significant posterior movement
of the hyoid bone.10 Mandibular advance-
ment surgery can increase the airway
space volume and thus significantly widen
the narrower sites.4,11 Certain functional
orthopaedic treatments have also been
shown to change the pharyngeal airway
dimensions and hyoid bone position in
teenagers.12 However, other functional
orthopaedic treatments such as rapid max-
illary expansion and modified bionator
treatment are believed to have no influ-
ence on the pharyngeal airway and hyoid
bone position.10,13 Furthermore, the hyoid
bone will move posteriorly and the airway
dimension will become smaller or nar-
rower in the case of the mandibular bone
being moved backwards. Therefore, the
correlations between airway dimensions
and hyoid bone position should be consid-
ered carefully during orthodontic diagno-
sis and treatment.8,14 However, an
analysis of the correlation between upper
airway dimensions and the hyoid bone
position in teenagers with normal maxil-
lofacial characteristics has not yet been
reported.
Cephalometric analysis has been used
previously to study the correlations be-
tween airway and hyoid bone positions.15
However, lateral cephalograms only dis-
play the sagittal plane, while related in-
formation on axial width, cross-sectional
area, and volume are missing when asses-
sing the morphology of the upper airway.
Cone beam computed tomography
(CBCT) provides a reliable and accurate
method to analyze the airway dimen-
sions,16,17 soft tissue, and surrounding air-
way space.18,19 As reported previously,
the CBCT scan obtained before orthodon-
tic diagnosis and treatment can help in
gaining a clear clinical judgement of the
Please cite this article in press as: Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by
cone beam computed tomography analysis, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.02.005
upper airway space and hyoid bone posi-
tion in patients.20 Therefore, CBCT is a
standard method adopted in otolaryngolo-
gy for early diagnosis and evaluation, and
assessment of the upper airway by CBCT
has become a necessary step before ortho-
dontic or orthognathic surgery.14,21 How-
ever, CBCT scans have rarely been used to
investigate the relationships between the
upper airway and hyoid bone position in
healthy teenagers.
In this study, the correlations between
upper airway dimensions and hyoid bone
position were investigated in Chinese ado-
lescents based on CBCT images, with the
goal of highlighting the need to pay great-
er attention to the adverse effects of or-
thodontic or orthognathic treatments, and
also to provide more references for appro-
priate treatment planning.
Materials and methods
Subjects
CBCT images were obtained from the
CBCT image library of the Stomatology
Hospital of Shandong University. Only
images of patients of Han Chinese ethnic-
ity, aged 6–18 years, taken between De-
cember 2010 and December 2012, were
included. Strict inclusion criteria were
applied while examining the medical his-
tory and CBCT images of the study sub-
jects.
With regard to the CBCT images, only
those for subjects meeting the following
criteria were included: (1) clinically sym-
metric; (2) class I molar relationship, nor-
mal overjet and overbite; (3) no
discrepancy in centric relation/centric oc-
clusion; (4) no history of previous ortho-
dontic treatment; (5) reasonably aligned
upper and lower incisors without severe
crowding; (6) no missing permanent teeth;
(7) acceptable oral hygiene without obvi-
ous periodontal disease.22 CBCT images
in which the airway structure was not seen
clearly or was not complete were exclud-
ed, as well as airways containing arte-
facts.23
In terms of the medical history, the
selection criteria included no history of
any craniofacial surgery or anomaly, no
congenital anomalies (such as cleft lip and
palate), no dysfunction of the masticatory
system, no respiratory pathology or pha-
ryngeal pathology (such as adenoid hyper-
trophy, tonsillitis and adenoidectomy, or
history of tonsillectomy), no history of
breathing problems, and no mouth breath-
ing habit, complaint of airway restriction,
nasal obstruction, snoring, or obstructive
sleep apnoea. This study was approved by
the necessary research ethics committee.
Finally, 254 CBCT images from 119
males and 135 females were included in
this study.
CBCT process
For CBCT scanning, each patient was
seated in an upright position and asked
to keep their jaws in maximum intercus-
pation, with the lips and tongue in a resting
position. The Frankfort horizontal plane
(FH plane) of the patients was kept paral-
lel to the floor. Patients were instructed to
breathe normally through the nose, avoid-
ing swallowing and moving their head or
tongue during the scanning process. All of
the images were acquired using a Galileos
CBCT scanner (Sirona, Bensheim,
Germany) at 85 kV, 7 mA, and 14 s per
rotation (resolution accuracy <0.15 mm).
CBCT images were then saved as DICOM
(digital imaging and communications in
medicine) files.
Segmentation and measurement
The DICOM files were imported into
Materialism’s interactive medical image
control system (MIMICS) (v.16.01; Mate-
rialise, Leuven, Belgium) to visualize the
images in the axial, coronal, and sagittal
planes by volume-rendering.
Once the DICOM files were imported,
the three-dimensional (3D) reconstruction
of the patient’s head was oriented so that
the FH plane was parallel to the axial plane
and the midsagittal plane was oriented to
the subject’s midline.11 The patient’s mid-
sagittal plane was defined as a vertical
plane passing through both the anterior
nasal spine (ANS) and the posterior mid-
point of the spine (centrum) (Fig. 1A).
Thirteen landmarks were labelled in the
midsagittal view: sella (S), nasion (N),
basion (Ba), deepest anterior point in the
concavity of the upper labial alveolar pro-
cess (A), deepest anterior point in the
concavity of the lower labial alveolar pro-
cess (B), menton (Me), anterior nasal
spine (ANS), posterior nasal spine
(PNS), the tip of uvula (UT), the base of
epiglottis (EB), the highest point of hyoid
bone (H), the most antero-inferior point on
the corpus of the third cervical vertebra
(C3), and the roof of the nasopharynx
(Roof) (Fig. 1B). The hyoid bone position
was evaluated using eight linear parame-
ters C3–Me, C3–H, H–EB, H–PNS,
H–Me, H–X, H–Y, and H–(C3–Me), as
well as two angular parameters, H–S–Ba
and H–N–S. Facial characteristics were
evaluated using three linear parameters
N–Me, N–ANS, and ANS–Me, as well
YIJOM-3364; No of Pages 8

Hyoid bone position and airway dimensions 3

Fig. 1. (A) Midsagittal orientation (in the axial plane) defined by the anterior midpoint between the centre of the anterior nasal spine (ANS) and
the posterior midpoint of the centrum of the cervical vertebrae (centrum). (B) Thirteen landmarks were identified in the midsagittal view: S, sella;
N, nasion; Ba, basion; A, deepest anterior point in the concavity of the upper labial alveolar process; B, deepest anterior point in the concavity of
the lower labial alveolar process; Me, menton; ANS, anterior nasal spine; PNS, posterior nasal spine; UT, the tip of the uvula; EB, the base of the
epiglottis; H, the highest point of the hyoid bone; C3, the most inferior and anterior point on the corpus of the third cervical vertebra; Roof, roof of
nasopharynx. (C) Definitions of the measurement parameters in the midsagittal view. Parameters of hyoid bone position: (1) H–EB; (2) H–Me; (3)
C3–H; (4) C3–Me; (5) H–(C3–Me) (H to C3–Me line); (6) H–PNS; (7) H–X (perpendicular distance from the hyoid bone to the vertical line
passing through point S); (8) H–Y (perpendicular distance from H to the horizontal line passing through S); (9) H–N–S (angle formed by H–N line
and N–S line); (10) H–S–Ba (angle formed by H–S line and S–Ba line). Facial characteristic parameters: (I) N–ANS; (II) ANS–Me; (III) N–Me;
(IV) SNA; (V) SNB; (VI) ANB.

as three angular parameters SNA, SNB,
and ANB (Fig. 1C).
To isolate the desired airway from the
CBCT images, the threshold value was set
to a range of 1024 to 300 Hounsfield
units (HU). The layers of the airway struc-
tures were defined and colour-coded based
on the minimum and maximum threshold
values. Finally, the upper airway in the
midsagittal plane was divided into six
planes, including plane 1: the horizontal
plane passing through Roof (superior bor-
der); plane 2: the vertical plane passing
through PNS (anterior border); EB plane
(inferior border); PNS plane: the boundary
of nasopharynx (NP) and oropharynx
(OP); UT plane: the boundary of palato-
pharynx (PP) and glossopharynx (GP); H
plane: the highest point was selected as the
marker point for the hyoid bone, which
varied with EB (Fig. 2A, B). The lateral
and posterior boundaries consisted of the
pharyngeal walls and the anterior bound-
ary, the anterior wall of the pharynx, the
base of the tongue, and the soft palate.
Meanwhile, corresponding 3D models
were also reconstructed (Fig. 2A0 , B0 ,
A00 , B00 ).
The airway dimensions were evaluated
in terms of multiple parameters, including
volume (VOL), length (L), cross-sectional
area (CSA, the ratio of VOL/L), mean
CSA, anteroposterior dimension of the
cross-section (AP), lateral dimension of
the cross-section (LAT), and LAT/AP
(Table 1, Fig. 3).
Statistical analysis
All of the parameters were measured
twice by the same investigator. Among
the 254 CBCT images from the study
subjects, 20 were selected randomly to
assess the intra-examiner concordance by
intra-class correlation test (ICC) before
the correlation analysis. The average val-
ue for each parameter from the two mea-
surement times was used for Pearson
correlation analysis to detect the correla-
tion between hyoid bone position and
airway dimensions. A P-value of <0.05
was considered to be statistically signifi-
cant. All analyses were performed using
SPSS version 13.0 software (SPSS Inc.,
Chicago, IL, USA).
Results
Assessment of intra-examiner
concordance
According to the ICC test, the concor-
dance index was greater than 0.98, indi-
cating high intra-examiner concordance.
Correlations between airway dimensions
and hyoid bone position
The length, width, area, and volume were
positively correlated with C3–Me, H–Y,
H–(C3–Me), C3–H, H–Me, and H–PNS,
while they were negatively correlated with
H–EB and H–S–Ba. Additionally, H–X
and H–EB were negatively correlated with
the volume, mean CSA, CSA, LAT, and
AP. Of note, H–PNS had a significantly
higher correlation with most of the airway
dimension parameters (Table 2).
Correlations between facial
characteristics and hyoid bone position
With regard to the linear facial parameters,
N–Me, N–ANS, and ANS–Me were
negatively correlated with H–S–Ba.

Please cite this article in press as: Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by
cone beam computed tomography analysis, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.02.005
YIJOM-3364; No of Pages 8

4 Jiang

Fig. 2. Airway segmentation and reference planes. Reference planes were viewed in the midsagittal plane (A, B) and 3D model (A0 , B0 , A000 , B00 ). Plane
1: the axial plane passing through the Roof point. Plane 2: the coronal plane passing through the PNS point. PNS plane: the axial plane passing through
the PNS point. UT plane: the axial plane passing through the UT point. EB plane: the axial plane passing through the EB point. H plane: the axial plane
passing through the H point. NP, nasopharynx; OP, oropharynx; PP, palatopharynx; GP, glossopharynx; Hyp, the top part of the hypopharynx.

Furthermore, each of these was positively
correlated with the other hyoid bone posi-
tion parameters, except H–EB, H–X, and
H–N–S. Meanwhile, for the angular facial
parameters, SNA, SNB, and ANB were
positively correlated with hyoid bone po-
sition parameters, except H–(C3–Me), H–
PNS, H–EB, and H–S–Ba (Table 3).
Correlations between facial
characteristics and airway dimensions
There was a positive correlation between
N–Me, N–ANS, ANS–Me, SNA, and
SNB, and the volume, mean CSA, CSA,
LAT, and AP, except between VOL4 and
N–Me and between VOL4 and ANS–Me.
Meanwhile, ANB was negatively correlat-
ed with length, volume, mean CSA, CSA,
LAT, and AP (Table 4).
Discussion
In this study, the correlations between
upper airway dimensions, hyoid bone po-
sition, and facial characteristics were in-
vestigated in Chinese adolescents based
on CBCT images, with the goal of learning
more about the effects of orthognathic
treatments on upper airway dimensions.
The airway is a void space surrounded
by hard and soft tissues, and effective
assessment is necessary. In this study,
the parameters volume, length, CSA (the
ratio of volume/length), mean CSA, ante-
roposterior dimension of the cross-section
(AP), lateral dimension of the cross-sec-
tion (LAT), and LAT/AP were measured
based on CBCT images to evaluate the
airway dimensions. Automatic segmenta-
tion was used to remove the hard and soft
tissues from the CBCT images in order to

Please cite this article in press as: Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by
cone beam computed tomography analysis, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.02.005
YIJOM-3364; No of Pages 8

Hyoid bone position and airway dimensions 5

Fig. 3. Axial slice images of the pharyngeal airway in four defined planes: (A) PNS plane; (B) UT plane; (C) EB plane; (D) H plane. AP,
anteroposterior width; LAT, lateral width.

Table 1. Definitions of airway dimension parameters.

Description Parameter Symbol Unit Definition
Volume VOL VOL1 cm 3 Volume of NP
VOL2 Volume of PP
VOL3 Volume of GP
VOL4 Volume of Hyp
VOL5 Volume of OP
VOL6 Volume of total airway
Mean cross-sectional area Mean CSA Mean CSA1 mm 2 Mean CSA of NP
Mean CSA2 Mean CSA of PP
Mean CSA3 Mean CSA of GP
Mean CSA4 Mean CSA of Hyp
Mean CSA5 Mean CSA of OP
Mean CSA6 Mean CSA of total airway
Length L L1 mm Length of NP
L2 Length of PP
L3 Length of GP
L4 Length of Hyp
L5 Length of OP
L6 Length of total airway
Cross-sectional area CSA CSA I mm 2 CSA of the airway in PNS plane
CSA II CSA of the airway in UT plane
CSA III CSA of the airway in EB plane
CSA IV CSA of the airway in H plane
Anteroposterior dimension of the cross-sections AP AP I mm AP of the airway in PNS plane
AP II AP of the airway in UT plane
AP III AP of the airway in EB plane
AP IV AP of the airway in H plane
Lateral dimension of the cross-sections LAT LAT I mm LAT of the airway in PNS plane
LAT II LAT of the airway in UT plane
LAT III LAT of the airway in EB plane
LAT IV LAT of the airway in H plane
Shape of the cross-sectional area LAT/AP LAT I/AP I – LAT/AP in PNS plane
LAT II/AP II LAT/AP in UT plane
LAT III/AP III LAT/AP in EB plane
LAT IV/AP IV LAT/AP in H plane
NP, nasopharynx; PP, palatopharynx; GP, glossopharynx; Hyp, hypopharynx; OP, oropharynx; CSA, cross-sectional area; PNS, posterior nasal
spine; UT, the tip of uvula; EB, the base of epiglottis; H, the highest point of hyoid bone; AP, anteroposterior.

isolate the airway sections of interest. It
has been proven that automatic segmenta-
tion is more accurate than the convention-
al manual tracing method.24 Furthermore,
the actual volumes may sometimes be
overestimated or underestimated due to
the restriction on image threshold, and
linear parameters alone cannot represent
the upper airway accurately.25,26 Thus, the
cross-sectional area was also measured in
this study, which may be a better indicator
when evaluating the changes in the upper
airway size and volume.14 Furthermore,
the combination of linear parameters,
area, and volume parameters was also
investigated for the assessment of airway
dimensions.
It has been reported previously that
linear and angular parameters based on
CBCT images in the midsagittal view
are more reliable and accurate than those

Please cite this article in press as: Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by
cone beam computed tomography analysis, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.02.005
YIJOM-3364; No of Pages 8

6 Jiang

Table 2. Correlations between airway dimensions and hyoid bone position (N = 254).
Measurements C3–Me H–X H–Y H–(C3–Me) C3–H H–EB H–PNS H–Me H–S–Ba H–N–S
L1 0.182** 0.069 0.414** 0.187** 0.169** 0.112 0.317** 0.118 0.132 0.213**
L2 0.296** 0.298** 0.519** 0.333** 0.187** 0.054 0.635** 0.217** 0.177** 0.047
L3 0.295** 0.015 0.759** 0.502** 0.232** 0.208** 0.808** 0.239** 0.286** 0.261**
L4 0.142* 0.048 0.112 0.092 0.008 0.332** 0.125* 0.210** 0.135* 0.078
L5 0.355** 0.159* 0.807** 0.525** 0.260** 0.179** 0.899** 0.275** 0.294** 0.218**
L6 0.359** 0.109 0.812** 0.501** 0.274** 0.188** 0.858** 0.271** 0.291** 0.252**
VOL1 0.256** 0.169** 0.434** 0.132* 0.206** 0.171** 0.344** 0.254** 0.006 0.124*
VOL2 0.560** 0.082 0.528** 0.261** 0.366** 0.258** 0.591** 0.508** 0.101 0.005
VOL3 0.568** 0.197** 0.530** 0.301** 0.371** 0.389** 0.594** 0.525** 0.312** 0.014
VOL4 0.149* 0.055 0.129* 0.058 0.033 0.236** 0.129* 0.193** 0.123* 0.055
VOL5 0.588** 0.152* 0.545** 0.282** 0.378** 0.352** 0.613** 0.544** 0.227** 0.004
VOL6 0.542** 0.172** 0.560** 0.259** 0.357** 0.331** 0.587** 0.507** 0.179** 0.038
Mean CSA1 0.230** 0.172** 0.324** 0.042 0.184** 0.185** 0.274** 0.278** 0.062 0.028
Mean CSA2 0.539** 0.209** 0.433** 0.178** 0.348** 0.286** 0.454** 0.516** 0.055 0.018
Mean CSA3 0.587** 0.257** 0.366** 0.161* 0.356** 0.404** 0.412** 0.566** 0.273** 0.087
Mean CSA4 0.376** 0.236** 0.309** 0.095 0.233** 0.290** 0.343** 0.377** 0.285** 0.085
Mean CSA5 0.589** 0.240** 0.389** 0.152* 0.357** 0.366** 0.427** 0.570** 0.177** 0.070
Mean CSA6 0.536** 0.255** 0.393** 0.118 0.336** 0.342** 0.399** 0.535** 0.122 0.047
CSA I 0.368** 0.096 0.401** 0.091 0.277** 0.190** 0.380** 0.356** 0.007 0.017
CSA II 0.569** 0.332** 0.307** 0.082 0.340** 0.276** 0.319** 0.562** 0.137* 0.072
CSA III 0.534** 0.324** 0.486** 0.207** 0.376** 0.367** 0.522** 0.466** 0.319** 0.034
CSA IV 0.527** 0.312** 0.434** 0.190** 0.364** 0.369** 0.471** 0.472** 0.331** 0.046
LAT I 0.390** 0.092 0.445** 0.128* 0.263** 0.241** 0.463** 0.352** 0.162* 0.010
AP I 0.428** 0.009 0.358** 0.062 0.318** 0.169** 0.402** 0.384** 0.036 0.065
LAT II 0.570** 0.206** 0.492** 0.217** 0.312** 0.324** 0.531** 0.535** 0.205** 0.024
AP II 0.654** 0.306** 0.203** 0.025 0.424** 0.273** 0.240** 0.647** 0.162* 0.150*
LAT III 0.356** 0.171** 0.585** 0.319** 0.211** 0.278** 0.623** 0.329** 0.260** 0.085
AP III 0.637** 0.266** 0.318** 0.055 0.414** 0.288** 0.362** 0.551** 0.253** 0.125*
LAT IV 0.345** 0.212** 0.538** 0.292** 0.211** 0.221** 0.553** 0.319** 0.262** 0.035
AP IV 0.516** 0.209** 0.230** 0.039 0.307** 0.316** 0.288** 0.479** 0.184** 0.112
LAT I/AP I 0.120 0.056 0.031 0.064 0.124* 0.078 0.008 0.105 0.179** 0.114
LAT II/AP II 0.035 0.076 0.377** 0.245** 0.064 0.088 0.381** 0.074 0.069 0.149*
LAT III/AP III 0.447** 0.186** 0.028 0.141* 0.307** 0.139* 0.004 0.382** 0.115 0.188**
LAT IV/AP IV 0.313** 0.103 0.110 0.129* 0.188** 0.162* 0.047 0.274** 0.020 0.162*
*
Represents a significant difference, P < 0.05.
**
Represents an extremely significant difference, P < 0.01.

Table 3. Correlations between facial characteristics and hyoid bone position (N = 254).
Measurements C3–Me H–X H–Y H–(C3–Me) C3–H H–EB H–PNS H–Me H–S–Ba H–N–S
N–Me 0.371** 0.076 0.556** 0.175** 0.279** 0.100 0.610** 0.302** 0.203** 0.075
N–ANS 0.232** 0.078 0.393** 0.145* 0.166** 0.093 0.358** 0.170** 0.240** 0.042
ANS–Me 0.268** 0.064 0.575** 0.169** 0.271** 0.008 0.602** 0.171** 0.259** 0.040
SNA 0.153* 0.080 0.276** 0.085 0.132* 0.012 0.091 0.148* 0.023 0.562**
SNB 0.277** 0.135* 0.243** 0.110 0.193** 0.044 0.067 0.296** 0.010 0.605**
ANB 0.269** 0.111 0.023 0.040 0.149* 0.028 0.017 0.295** 0.062 0.132*
*
Represents a significant difference, P < 0.05.
**
Represents an extremely significant difference, P < 0.01.

in lateral cephalograms when used for the
measurement of airway volume.16 Since
landmarks on the midsagittal plane can be
checked on the axial and frontal planes,
the midsagittal view of CBCT images is
frequently used to identify all of the land-
marks and linear parameters. In this study,
eight linear parameters (C3–Me, C3–H,
H–EB, H–PNS, H–Me, H–(C3–Me), H–
X, and H–Y) and two angular parameters
(H–S–Ba and H–N–S) were measured on
the midsagittal view to evaluate the posi-
tion of the hyoid bone. Significant correla-
tions were detected between multiple
parameters describing airway dimensions
and hyoid bone position (especially H–Me
and H–Y). This may explain why changes
in the position of the hyoid bone by move-
ment of the mandible can affect the upper
airway dimensions.15,27 As the hyoid bone
position was significantly correlated with
the upper airway dimensions, it is pre-
sumed that the hyoid bone is useful in
maintaining and stabilizing the airway.
In addition, analysis of the correlation
between facial characteristics and hyoid
bone position also showed significant cor-
relations between linear and angular facial
parameters and hyoid bone position pa-
rameters, indicating that facial character-
istics affect hyoid bone position.
Meanwhile, analysis of the correlation
between facial characteristics and airway
dimensions also revealed significant cor-
relations between the linear facial param-
eters and the volume of the nasopharynx.
The significant correlations between facial
height and airway dimensions or hyoid
bone position suggest that a change in
facial height will not only affect the hyoid
bone position, but could also influence the
airway dimensions.
There are some limitations to this study.
First, this study was a cross-sectional sur-
vey, which can only reflect the overall

Please cite this article in press as: Jiang YY. Correlation between hyoid bone position and airway dimensions in Chinese adolescents by
cone beam computed tomography analysis, Int J Oral Maxillofac Surg (2016), http://dx.doi.org/10.1016/j.ijom.2016.02.005
YIJOM-3364; No of Pages 8

Hyoid bone position and airway dimensions 7

Table 4. Correlations between facial characteristics and airway dimensions (N = 254).

Measurements N–Me N–ANS ANS–Me SNA SNB ANB
L1 0.224** 0.347** 0.303** 0.137* 0.142* 0.016
L2 0.544** 0.270** 0.449** 0.030 0.050 0.027
L3 0.485** 0.322** 0.492** 0.144* 0.113 0.027
L4 0.240** 0.111 0.150* 0.047 0.018 0.043
L5 0.619** 0.368** 0.576** 0.094 0.060 0.035
L6 0.593** 0.421** 0.582** 0.123 0.097 0.023
VOL1 0.290** 0.239** 0.282** 0.142* 0.192** 0.092
VOL2 0.503** 0.263** 0.418** 0.068 0.143* 0.143*
VOL3 0.432** 0.270** 0.379** 0.078 0.137* 0.118
VOL4 0.229** 0.089 0.149* 0.015 0.021 0.005
VOL5 0.488** 0.281** 0.412** 0.073 0.145* 0.141*
VOL6 0.474** 0.296** 0.410** 0.098 0.171** 0.140*
Mean CSA1 0.257** 0.144* 0.208** 0.106 0.136* 0.062
Mean CSA2 0.395** 0.200** 0.320** 0.084 0.179** 0.173**
Mean CSA3 0.343** 0.223** 0.263** 0.051 0.137* 0.159*
Mean CSA4 0.279** 0.200** 0.253** 0.065 0.059 0.013
Mean CSA5 0.378** 0.220** 0.290** 0.060 0.160* 0.182**
Mean CSA6 0.366** 0.223** 0.285** 0.082 0.176** 0.172**
CSA I 0.371** 0.184** 0.294** 0.098 0.114 0.041
CSA II 0.297** 0.138* 0.230** 0.069 0.199** 0.234**
CSA III 0.372** 0.225** 0.321** 0.072 0.105 0.060
CSA IV 0.367** 0.254** 0.313** 0.060 0.087 0.052
LAT I 0.396** 0.243** 0.324** 0.034 0.083 0.077
AP I 0.430** 0.165** 0.361** 0.045 0.032 0.010
LAT II 0.418** 0.238** 0.303** 0.063 0.141* 0.138*
AP II 0.260** 0.096 0.194** 0.072 0.216** 0.268**
LAT III 0.383** 0.318** 0.355** 0.099 0.105 0.018
AP III 0.323** 0.233** 0.247** 0.052 0.103 0.105
LAT IV 0.374** 0.329** 0.350** 0.066 0.076 0.021
AP IV 0.299** 0.195** 0.197** 0.064 0.094 0.076
LAT I/AP I 0.142* 0.109 0.099 0.008 0.078 0.123
LAT II/AP II 0.233** 0.201** 0.149* 0.005 0.059 0.133*
LAT III/AP III 0.098 0.047 0.050 0.011 0.045 0.075
LAT IV/AP IV 0.051 0.042 0.019 0.023 0.026 0.024
*
Represents a significant difference, P < 0.05.
**
Represents an extremely significant difference, P < 0.01.

change trends in the upper airway and
hyoid bone position in adolescents, but
cannot predict the precise changes in a
given individual. Second, as a retrospec-
tive study, patient information was incom-
plete and could have been inaccurate. For
example, body mass index was not con-
sidered in this study, and this may affect
the size and morphology of the airway.28
Additionally, some of the study subjects
might have had mild pharyngeal diseases
that could not be detected.3 Third, the
number of subjects available for this in-
vestigation was small, due to the fact that
CBCT scanning is still a relatively new
technology in China and healthy patients
seldom undergo CT scanning. Finally, this
study highlights the relationship between
airway dimensions and the hyoid bone,
while no other soft tissues (e.g., tongue
and soft palate) were taken into consider-
ation.
In summary, significant correlations
were found between the upper airway
dimensions, hyoid bone position, and fa-
cial characteristics in Chinese adolescents
based on CBCT images, suggesting that
alterations in the hyoid bone position will
change the upper airway dimensions.
These findings provide an understanding
of the static relationship between the hy-
oid bone position and airway dimensions,
which may serve as a reference for sur-
geons before orthodontic or orthognathic
surgery, thus helping to reduce postopera-
tive adverse effects on airway dimensions.
Funding
This study was supported by a grant from
the Youth Foundation of the Affiliated
Hospital of Weifang Medical University
(grant number K12QC1008).
Competing interests
The author declares that there are no con-
flicts of interest to disclose.
Ethical approval
This study was reviewed and approved by
the Research Ethics Committee of Shan-
dong University Dental School.
Acknowledgements. The author wishes to
thank Dong-Xu Liu (Department of Or-
thodontics, School of Dentistry, Shan-
dong University, China) and Fu-Yan
Shi (School of Public Health, Weifang
Medical University, China) for their as-
sistance.
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Address:
Ying-Ying Jiang
Department of Dentistry
Affiliated Hospital of Weifang Medical
University
No. 2428 Yuhe Rd
Weifang City 261031
China
Tel: +86 536 8462448;
Fax: +86 536 8462448
E-mail: yingying820814@163.com