Age-stratified study on symptoms of upper airway obstruction and craniofacial development in children.

To investigate the association between symptoms of upper airway obstruction (UAO) and craniofacial development indicators in children aged 3-14 years, and to analyze specific differences among age groups. A total of 177 children presenting with UAO symptoms (e.g., nasal congestion, snoring, mouth breathing) were enrolled between April 2024 and April 2025. Participants were divided into three age groups: 3-6 years, 7-10 years, and 11-14 years. The OSA-18 questionnaire was completed by guardians to assess symptom severity. Cone-beam computed tomography (CBCT) was performed, and two-dimensional cephalometric analysis was conducted to measure 16 craniofacial parameters, including sagittal (∠SNA, ∠SNB, ∠ANB, ∠SNPog, ∠NP-FH), vertical (∠MP-SN, ∠FH-MP, Y-axis, anterior facial height, posterior facial height), dental (∠U1-SN, ∠U1-NA, ∠U1-L1, ∠L1-NB, ∠L1-MP), and mandibular body length parameters. Correlation analyses were conducted using Pearson's or Spearman's methods in SPSS 22.0. 3-6-year group: Mouth breathing scores correlated positively with ∠MP-SN, ∠FH-MP, Y-axis angle, anterior facial height, and posterior facial height (r = 0.296, 0.366, 0.233, 0.351, 0.278; P = 0.011, 0.001, 0.046, 0.002, 0.016). All UAO symptoms correlated positively with anterior facial height. 7-10-year group: Symptom duration correlated positively with ∠SNA and ∠U1-L1 (r = 0.256, 0.228; P = 0.021, 0.041) but negatively with ∠U1-SN (r = -0.278, P = 0.012). Apnea scores correlated negatively with ∠NP-FH (r = -0.257, P = 0.020). Choking/gasping scores correlated negatively with ∠SNB (r = -0.238, P = 0.033), while total OSA-18 scores correlated positively with ∠ANB (r = 0.246, P = 0.027). 11-14-year group: Apnea scores correlated positively with ∠L1-NB (r = 0.464, P = 0.030). UAO symptoms are correlated with altered craniofacial developmental parameters in children, with notable age-related differences. The period from 3 to 10 years may constitute a critical window of susceptibility to these UAO-associated craniofacial changes. Consistent with existing literature, tonsillar hypertrophy is the most likely primary etiology of UAO in children aged 3-6 years, while adenoid hypertrophy may predominate in those aged 7-10 years. The patterns of craniofacial parameters correlated with UAO symptoms vary distinctly across these age groups. Individualized assessment and intervention strategies tailored to age-specific symptom profiles are essential to enable early identification and targeted management of high-risk children.