Velopharyngeal anatomy in patients with obstructive sleep apnea versus normal subjects

Yehuda Finkelstein, Lior Wolf*, Ariela Nachmani, Uri Lipowezky, Mordechai Rub, Sa'Ar Shemer, Gilead Berger

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations


Purpose Obesity can cause disturbed breathing and is one of the most significant risk factors for obstructive sleep apnea (OSA). However, the anatomic basis of OSA and, specifically, the anatomic mechanisms leading from obesity to OSA are still unclear. We examined the anatomic features of the velopharynx in patients with OSA versus those without in correlation with the body mass index (BMI), age, history of snoring, and OSA severity and re-evaluated the contribution of adding a frontal view to the cephalometric analysis of patients with OSA. Materials and Methods Lateral and frontal cephalometric measurements were taken to assess the velopharyngeal anatomic features of 306 men with various degrees of OSA and 64 men without OSA and without a history of snoring. The demographic, polysomnographic, and cephalometric features were compared. Results The patients with OSA had an increased pharyngeal length, thicker velum, a thicker posterior pharyngeal wall, a reduced pharyngeal width, and a consequent narrowing of the pharyngeal lumen. As the BMI increased, the OSA severity increased. Also, in parallel, the velum and posterior pharyngeal wall thickness increased and the pharyngeal width decreased. Three types of velopharyngeal narrowing, with an increased occurrence in severe degrees of OSA, were identified: bottle shape, hourglass shape, and tube shape. These aerodynamically unfavorable changes might cause increased upper airway resistance, explaining the development of both OSA and hypoventilation syndrome in obese patients. Conclusions Velopharyngeal thickening and lumen narrowing were shown to be features of obese men with OSA. However, these features developed only above a threshold BMI value. The combination of frontal and lateral cephalometry is important for comprehensive evaluation of patients with OSA.

Original languageEnglish
Pages (from-to)1350-1372
Number of pages23
JournalJournal of Oral and Maxillofacial Surgery
Issue number7
StatePublished - Jul 2014


FundersFunder number
Chief Scientist Office
Ministry of Trade and Labor, Israel


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