Developing pediatric three-dimensional upper airway normative values using fixed and interactive thresholds

  • Ahmed I. MasoudEmail author
  • Farhan H. Alwadei
  • Abdurahman H. Alwadei
  • Edward Y. Lin
  • Maria Grace Costa Viana
  • Budi Kusnoto
  • Carla A. Evans
Original Article



To develop and compare pediatric upper airway three-dimensional normative values using the two most commonly used cone beam computed tomography (CBCT) software: Invivo5 (fixed threshold) and Dolphin 3D (interactive threshold).

Study design

Out of 3738 CBCT scans, scans of 81 pediatric patients were utilized after applying strict exclusion criteria. The sample was grouped into two age groups (7–11 and 12–17 years). Intra-class correlation coefficient was used to test intra-rater and inter-rater reliability and showed coefficients greater than 0.9 indicating good reliability of the methods used.


Paired t tests showed that volumetric and area measurements obtained using Dolphin 3D were significantly larger than those obtained using Invivo5 (p < 0.05). The mean minimal cross-sectional areas (MCSA) for Dolphin 3D were 151 mm2 and 177 mm2 for age groups 1 and 2, respectively. The mean MCSA values for Invivo5 for age groups 1 and 2 were 120 mm2 and 145 mm2, respectively.


Pediatric upper airway volumetric, area, and linear measurements were reported after applying strict exclusion criteria including a validated sleep questionnaire. Our goal is that clinicians utilize the proposed-here normative values for screening and assist in the timely diagnosis and management of pediatric sleep apnea.


Airway CBCT OSA Sleep apnea Adenoids 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standards

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.


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Copyright information

© Japanese Society for Oral and Maxillofacial Radiology and Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Orthodontics, Faculty of DentistryKing Abdulaziz UniversityJeddahSaudi Arabia
  2. 2.University of Illinois at ChicagoChicagoUSA
  3. 3.Department of Preventive Dental Sciences, College of DentistryPrince Sattam Bin Abdulaziz UniversityAl KharjSaudi Arabia
  4. 4.Department of Pediatric Dentistry and Orthodontics, Faculty of DentistryKing Saud UniversityRiyadhSaudi Arabia
  5. 5.Orthodontic Specialists of Green BayGreen Bay, WIUSA
  6. 6.Department of Orthodontics, College of DentistryUniversity of Illinois at ChicagoChicagoUSA
  7. 7.Department of OrthodonticsHenry M. Goldman School of Dental MedicineBostonUSA

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