Mohammed.doc
J Bagh College Dentistry Vol. 27(1), March 2015 Assessment of tongue
Oral Diagnosis 117
Assessment of tongue space area in a sample of Iraqi
adults with class I dental and skeletal pattern
Mohammed A. Kadhum, B.D.S., M.Sc. (1)
ABSTRACT
Background: Lateral cephalometric radiography is commonly used as a standard tool in orthodontic assessment and
treatment planning. This study aimed to determine the tongue and surrounding space area in a sample of Iraqi
adults with class I dental and skeletal pattern.
Materials and methods: The study included thirty healthy subjects (15 males and 15 females) with an age ranged
between 23-34 years and class I dental and skeletal pattern with no history of any sleep related disorders. The
assessed cephalometric measurement included length and height of the tongue and position of hyoid bone from
cervical line. Descriptive statistics were obtained for the data. Genders difference was evaluated by independent
sample t-test.
Results: There were significantly higher values in males as compared to females in most of the measurements.
Conclusions: The study provides preliminary details of tongue space area assessment in normal class I profile subjects.
Keywords: Tongue space, lateral cephalometrics. (J Bagh Coll Dentistry 2015; 27(1):117-120).
INTRODUCTION
Tongue is the most agile, versatile appendage
in the body. It is the largest organ of the oral
cavity and has no skeletal bony base. Peat (1)
emphasized the role of tongue in positioning the
dento-alveolar structure. The tongue forms a
major part of upper airway and compromise of
both extrinsic and intrinsic muscles (2). Tongue
form and size influence the shape and dimensions
of airway between palate and tongue surface (3).
Cepholometry enables the analysis of dental and
skeletal anomalies as well as soft tissue structures
and forms (4).
Many studies in the past have assessed
measurements of airway space and tongue size by
means of cephalometry in subjects with
obstructive sleep apnea in various malocclusions
(5,6). This study was aimed to collect
measurements of tongue and surrounding area
representing position of hyoid bone in relation
with tongue and cervical vertebra using lateral
cephalometric analysis in a sample of Iraqi adults
with class I dental and skeletal pattern.
MATERIALS AND METHODS
Fifty students from College of Dentistry,
Baghdad University accepted to enroll in this
study. They were subjected to clinical
examination to fulfill the inclusion criteria of this
study. The inclusion criteria included having
full permanent dentition regardless the third
molars and class I dental and skeletal relation as
indicated by Angles' classification and two finger
method of Foster with no history of any related
airway disorders like obstructive apnea.
Thirty students only fulfilled the inclusion
criteria and proceeded to standardized digital true
(1) Assistant Lecturer, Department of Oral Diagnosis, College of
Dentistry, University of Baghdad
lateral cephalometric X-ray using Planmeca
Proline cc 2002 with dimax 3 software. The
subjects were positioned within cephalostat with
Frankfort plane horizontal and teeth in maximum
intercuspation and instructed not to swallow
during exposure. The digital images were
analyzed using AutoCAD 2007 software. Firstly,
the magnification was corrected using the rule of
the nasal rod, then the cephalometric points,
planes were determined and the linear
measurements were obtained.
Cephalometric Landmarks (14)
1. Point TT: (Tip of the tongue): The most
anterior point of the tip of tongue.
2. Point S: Superior part of the tongue the most
superior point on the dorsum of the tongue.
3. Point V: (Vallecula): Junction of base of
tongue with epiglottis.
4. Point AH: The most anterior and superior
point on the body of hyoid bone.
5. Point Po: The highest point on the superior
surface of soft tissue of the external auditory
meatus.
6. Point Or: The lowest point on the average left
and right borders of the bony orbit.
7. Point A: The deepest point on the concave
outline of the upper labial alveolar process on
the frontonasal suture.
8. Point B: The deepest point on the bony
curvature between the crest of alveolus and the
pogonion point.
9. Point N: Anterior point on the frontonasal
suture.
Cephalometric planes:
1. Frankfort plane (FP): The line runs from
orbitale to porion ,it represent the ideal
horizontal position of head when patient stand
erect.
J Bagh College Dentistry Vol. 27(1), March 2015 Assessment of tongue
Oral Diagnosis 118
2. Cervical line (CL): The line overlying the
anterior surface of second and third cervical
vertebrae
Linear measurements
1. V-TT: Distance from tip of tongue to base of
tongue and represent tongue length.
2. TH: Tongue height from S point perpendicular
to VTT.
3. V-FP: The line from V perpendicular to FP.
4. V-CL: The line form V to CL parallel to FP
5. AH-FP: Line from tip of anterior of hyoid to and
perpendicular on Frankfort plane.
6. AH-CL: Line from tip of anterior of hyoid to
cervical line parallel to Frankfort plane.
7. Tongue area: The area formed by the line
encircling the tongue boundaries passing through
tip of the tongue, S point and V point.
Figure 1: Linear measurements and area of tongue.
Statistical Analyses
All the data of the sample were subjected to
computerized statistical analysis using SPSS
version 19 computer program. The statistical
analysis included:
1. Descriptive Statistics: Means and
standard deviations.
2. Inferential Statistics: Independent-
samples t-test for the comparison
between both genders
In the statistical evaluation, the following
levels of significance are used:
P > 0.05 NS Non-significant
0.05 ≥ P > 0.01 S Significant
P ≤ 0.01 HS Highly significant
RESULTS
As indicated in table 1, the results showed that
the vertical and horizontal measurements of
vallecula and hyoid bone and tongue area were
higher in males than in females with a highly
significant difference.
Table 1: Descriptive statistics and genders difference for the measured variables
Variables Genders
Descriptive statistics Genders difference (d.f.=28)
N Mean S.D. Min. Max. Mean Difference t-test p-value
V-TT
(mm.)
Males 15 76.08 4 69.35 82.9 7.71 7.02 0.000 (HS) Females 15 68.38 1.44 66.2 70.7
TH
(mm.)
Males 15 33.46 1.84 30.52 36.5 4.53 7.77 0.000 (HS) Females 15 28.93 1.31 26.67 31
V-FP
(mm.)
Males 15 80.52 4.05 73.8 87.9 10.97 6.74 0.000 (HS) Females 15 69.55 4.83 60.5 77.7
V-CL
(mm.)
Males 15 19.98 2.45 15.23 23.8 3.53 4.80 0.000 (HS) Females 15 16.45 1.45 14.12 18.6
AH-FP
(mm.)
Males 15 87.32 4.29 81.45 94.6 14.79 8.35 0.000 (HS) Females 15 72.53 5.35 63.3 80.7
AH-CL
(mm.)
Males 15 34.14 2.78 27.2 38.1 6.47 7.05 0.000 (HS) Females 15 27.67 2.21 24.21 30.9
T-AREA
(mm2.)
Males 15 2551.67 77.31 2398 2672 383.07 13.78 0.000 (HS) Females 15 2168.60 74.89 1990 2293
J Bagh College Dentistry Vol. 27(1), March 2015 Assessment of tongue
Oral Diagnosis 119
DISCUSSION
The lateral cephalogram is a two dimensional
image showing the sagittal aspect of head and
neck region and usually used for orthodontic
treatment. Maltais et al (8) had opined that the use
of cephalometric radiographs to assess the upper
airway anatomy is helpful because it is simpler
than other methods for measuring airway
patency.
Parkkinen et al (12) confirmed in their study
that lateral cephalogram is a valid method for
measuring dimensions of nasopharangeal and
retropalatal region. The present study included a
group of Iraqi subjects with clinically normal
dental and skeletal relations, any reported
abnormality of upper airway were excluded from
this study. Similar studies have been conducted
on normal adults in various populations (7,10).
The length of the tongue sagittally, height of
the tongue measured from the highest point on
the dorsam of the tongue and perpendicularly on
VTT line ,vertical and horizontal distance of
vallecula and hyoid bone from cervical line
horizontally and Frankfort line vertically were
larger in male than in females. The results of the
study by Samman et al (7) to evaluate normative
data in Hong Kong Chinese subjects were
correlated with this study.
The present study showed that the length of
tongue and tongue area in normal males subjects
were comparatively of larger dimensions with
respect to normal Indian males Guttal et al (10)
and smaller dimensions with respect to normal
Hong Kong Chinese males Samman et al (7). In
the study of Battagel et al (9) the tongue area in
normal Caucasian males subjects was 4120mm2.
However in the present study the tongue area
among normal Iraqi male subjects was 2551mm2,
implying that the tongue area in normal Iraqi
males was comparatively of smaller dimension
with respect to normal Caucasian males and
normal Hong Kong Chinese males. In the study
by Tsai et al (11) on normal Taiwanese subjects,
the position of hyoid bone in horizontal plane
correlate with the results of the present study.
The cephalometric norms of different ethnic and
racial groups established in various studies. Most
investigators have concluded that there are
significant differences between ethnic and racial
groups, and cephalometric standards have been
developed for specific ethnic and racial groups
(13).
In this study, the vertical and horizontal
distances of vallecula and hyoid bone were larger
in male than in females so that they are more
inferiorly and anteriorly positioned in men. The
present study also signifies the importance of the
use of cephalometry for the assessment of oral
and surrounding structures. The cephalometric
measurements in this study group can be used as
normative data for future studies. Further
correlation can be drawn with studies comparing
tongue and surrounding space dimensions in
normal individuals and in subjects with sleep
related disorders.
Table 2: Normative data of different studies
Variables Genders Present study Guttal et al Samman et al Battagel et al
V-TT
(mm.)
Males 76.08 71.15 72.0 -
Females 68.38 66.86 64.8 -
S-TT
(mm.)
Males 33.46 32.4 36.9 -
Females 28.93 27.8 32.9 -
V-FP
(mm.)
Males 80.52 77.6 91.2 -
Females 69.55 68.4 78.9 -
V-CL
(mm.)
Males 19.98 15.8 23.0 -
Females 16.45 11.8 20.4 -
AH-FP
(mm.)
Males 87.32 79.3 92.4 -
Females 72.53 70.5 78.5 -
AH-CL
(mm.)
Males 34.14 30.0 36.4 -
Females 27.67 24.4 31.2 -
T-AREA
(mm2.)
Males 2551.67 2479 2746 4120
Females 2168.60 2191 2259 -
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الخالصة
علم تقویم التصویر الشعاعي بواسطة صورة االشعة الراسیة الجانبیة یعتبر من االدوات االساسیة المعروفة التي تستخدم في التحلیالت المستخدمة في :الخلفیة
عن اللسان والمنطقة المحیطة باللسان في ) نقطة الرأس م( ان ھذة الدراسة تھدف الى الحصول على معلومات راسیة . االسنان و وضع الخطط العالجیة فیھ
.االشخاص البالغین الطبیعیین
سنة 34 – 23بالغین ومتوسط عمري یتراوح من صحاءالشخاص ا) اناث 15ذكور و 15( الدراسة تتضمن ثالثین صورة اشعة راسیة رقمیة :المواد والطریقة
.النوم مشاكل تنفسیة اثناءعدم وجود اي تاریخ الي ویمتلكون التصنیف االول للمظھر الجانبي مع
.وجود دالئل احصائیة بین الذكور واالناث بالنسبة لجمیع القیاسات :النتائج
.ي ان ھذة الدراسة قدمت لنا معلومات جیدة عن وضعیة اللسان واالجزاء المحیطة بھ في االشخاص البالغین ذو التصنیف االول للمظھر الجانب :االستنتاج