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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA ANNEXURE – II PROFORMA FOR THE REGISTRATION OF SUBJECTS FOR DISSERTATION 1. Name of the candidate and address (in block letters) DR.SRIJAN SHILPI C-26/77 , URJANAGAR, MAHAGAMA, GODDA JHARKHAND. 2. Name of the Institution M. S. RAMAIAH DENTAL COLLEGE & HOSPITAL, BANGALORE. 3. Course of Study and Subject MASTER OF DENTAL SURGERY IN DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS. 4. Date of Admission to Course 26/07/2013 5. Title of the topic RELATIONSHIP OF THE FUNCTIONAL OROPHARYNX TO CRANIOFACIAL MORPHOLOGY IN SKELETAL CLASS II PATIENTS- A CEPHALOMETRIC STUDY. 6. Brief resume of the intended work: 6.1 Need for the study. Normal airway is one of the important factor for the normal growth of craniofacial structure.The pharynx is a tube shaped structure which is divided into 3 parts – nasopharynx, oropharynx and laryngopharynx.6 The oropharyngeal airway is bound by the glotic aperture below and leads into the nasopharyngeal airway above. This portion of the upper airway has attracted less attention than its nasal counterpart. There are significant relationships between the pharyngeal dimension and craniofacial abnormalities such as ,mandibular deficiency, bimaxillary retrusion , steep occlusal plane , increased mandibular plane angle, and the more caudally positioned hyoid bone results in narrowing of the pharyngeal airway passage.6 The purpose of this study was to make a fair representation of oropharyngeal airway by measuring the linear distance between back of tongue and posterior pharyngeal wall in skeletal class II cases and then correlating with certain conventional angles in order to assess its relationship to the craniofacial morphology. 6.2 Review of literature: A study1conducted in 1998 to find the existence of relationship between functional – orthopedic treatment and increase in oropharyngeal airway dimensions in skeletal class II patients and concluded that the existence of relationship between functional- orthopedic treatment and increase in oropharyngeal airway dimension in certain skeletal class II growing subjects. A study2 conducted in 1999 to find a relationship between functional oropharyngeal airway and craniofacial morphology and concluded that there was a positive co-relation between length of mandible, the distance between third cervical vertebrae and the hyoid bone, and the cranial base. A study3 was conducted in 2002 to determine the changes that occurred in airway and surrounding structures when subjects with sleep disorder breathing moved from upright to supine position and concluded that there was no difference between the non apnoeic snorers and the obstructive sleep apnoeic subjects in any of the postural changes recorded. A study4 conducted in 2012 to test the hypothesis that the sagittal position of the anterior teeth has no effect on pharyngeal airway dimension or hyoid bone position and to investigate the influence of orthodontic retraction of the anterior teeth on each section of pharynx and hyoid position and concluded that the pharyngeal airway size became narrower after the treatment. Extraction of all four 1st premolars with retraction of incisors did affect velvopharyngeal, glossopharyngeal, hypopharyngeal and hyoid position in bimaxillary adult protrusive position. In another study5 conducted in 2012 to compare the oropharyngeal space in sideview radiographs of children with atypical deglutition and normal deglutition. The results of the study concluded that the oropharyngeal space is reduced in the group with atypical deglutition. In another study6 conducted in 2012 to test the hypothesis that there is no association between saggital maxillomandibular relationship and pharyngeal airway. The results of the study concluded that there is significant reduction in the upper airway at the level of nasopharynx and oropharynx and airway showed a tendency to decrease from class III to class I and class I to class II. 6.3 Aims and Objectives of the study : 1. To correlate functional oropharynx with craniofacial morphology in skeletal class II patients. 2. To interpret if there is any variation between different sex. 3. To determine whether there is any correlation of angular and linear measurements with functional oropharynx. 4. To assess the average width of functional oropharynx in skeletal class II patients belonging to the age group of 10-13 years. 7. Materials and methods: 7.1 Source of data:A total of 100 lateral cephalograms of patients having skeletal class II malocclusion, belonging to the age group of 10-13 years of age, present in the records of department of orthodontics and dentofacial orthopedics, M. S. Ramaiah dental college, Bangalore will be examined in this study. 7.2 Method of collection of data: Methodology The Lateral cephalograms used in the present study will be obtained from the records present in Department of Orthodontics and Dentofacial Orthopedics, M. S. Ramaiah Dental College Bangalore.( Using the same Cephalostat – PLANMECA 2002 cc Proline Panoramic Unit). Tracings will be made by the same person using a 0.3 microtip pencil on acetate paper over an illuminated opal light box.Certain conventional anatomic landmarks will be marked and these point will be joined to make angular and linear variables.For every subject the angular and the linear measurements will be obtained. Later by considering these measurements we will try to find out whether there is any relationship between functional oropharynx and craniofacial morphology in skeletal class II patients. I) Inclusion criteria : 1) Patients presenting with skeletal class II malocclusion in the age group of 1013 years of both the sexes. 2) Lateral cephalogram should be taken in reference to natural head position. 3) Frankfurt horizontal plane should not be in true horizontal plane and teeth in centric occlusion. 4) C3 cervical vertebrae, hyoid bone position and oropharyngeal airway space should be clearly identifiable. 5) ANB angle should be more than 40, along with Mcnamara readings, witts aprasial and beta angle showing skeletal class II. II).Exclusion Criteria: 1) Patients with craniofacial anomalies and syndromes will be excluded from the study. 2) Patients with Frankfurt horizontal plane of more than 10 degrees above true horizontal should not be taken. 3) Lateral cephalogram with poor resolution of reference points should not be taken. Statistical test: 1) The oropharyngeal airway will be correlated with the age and the cephalometric variables using pearsons correlation coefficient test (r). 2) Student’s t- test is used to check if there is any variation between different sex. 3) The method error (ME) was determined by random selection of 1 in 10 radiographs for retracting and remeasuring them. 4) Sample size estimation – A sample size of 91 achieves 80% power to detect a difference of -0.29000 between the null hypothesis correlation of 0.00000 and the alternative hypothesis correlation of 0.29000 using a two-sided hypothesis test with a significance level of 0.05000 7.3 Does the study require any investigation or intervention to be conducted on Patients or other human or animal? If so, please describe briefly. No. Lateral cephalograms of cases from the archieves of the departmental records will be used for the study. 7.4 Has ethical clearance been obtained in case of above? Not required 8. List of referances: 1.M. Murat Ozbek, UfukToygarMemikoglu, HakanGogen. Oropharyngeal airway dimensions and functional orthopedic treatment in skeletal class II cases. Angle Orthod 1998;68(4):327-336. 2.Michael J. Trenouth, Donald J. Timms. Relationship of the functional oropharynx to craniofacial morphology. Angle Orthod 1999;69(5):419-423. 3. Joanna M. Battagel, Amajohal, Anne-Marie smith. Postural variation in oropharyngeal dimensions in subjects with sleep disordered breathing :Aceph study. European journal of orthodontics 2002:24;263-276 . 4.Qingzhu Wang, PeizengJia, Nina K. Anderson. Changes of pharyngeal airway size and hyoid bone position following orthodontic treatment of class I bimaxillary protrusion. Angle orthod 2012;82(1):115-121. 5.Almiro Jose Machado Junior, Agricio N. Crespo. Cephalometric evaluation of the oropharyngeal space in children with atypical deglutition. Brazilian journal of otorhinolaryngology. 2012;78(1):120-5 6.Madhurima Nanda, Anil Singla, AnuragNegi. The association between maxillomandibular sagittal relationship and pharyngeal airway passage dimensions. Journal of Indian orthodontic society. 2012;46(1);48-52