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J Neurosurg. 2017 Feb;126(2):626-633. doi: 10.3171/2016.1.JNS151590. Epub 2016 May 6.

Cephalometric oropharynx and oral cavity analysis in Chiari malformation Type I: a retrospective case-control study.

Author information

  • 1Pediatric Neurology Research Group, Vall d'Hebron Research Institute.
  • 2Conquer Chiari Research Center, Department of Mechanical Engineering, The University of Akron, Ohio.
  • 3Sleep Unit, Department of Clinical Neurophysiology.
  • 4Department of Neurosurgery and Neurotraumatology and Neurosurgery Research Unit, and.
  • 5Magnetic Resonance Unit (IDI), Department of Radiology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Spain; and.


OBJECTIVE Traditionally, Chiari malformation Type I has been related to downward herniation of the cerebellar tonsils as a consequence of an underdeveloped posterior cranial fossa. Although the common symptoms of Chiari malformation Type I are occipital headaches, cervical pain, dizziness, paresthesia, and sensory loss, patients often report symptoms related to pharyngeal dysfunction such as choking, regurgitation, dysphagia, aspiration, chronic cough, and sleep disorders. In addition, tracheal intubation is often difficult in these patients. The purpose of this study was to analyze the morphological features of the oropharynx and oral cavity in patients with Chiari malformation Type I to help identify underlying anatomical anomalies leading to these debilitating symptoms. METHODS Seventy-six adult patients with symptomatic Chiari malformation Type I with cerebellar tonsillar descent greater than 5 mm below the foramen magnum and a small posterior cranial fossa and 49 sex-matched controls were selected to perform a retrospective case-control MRI-based morphometric study in a tertiary hospital. Eleven linear and areal parameters of the oropharyngeal cavity on midsagittal T1-weighted MRI were measured and the average values between patients and control cohorts were compared. Correlations between variables showing or approaching statistical significance in these structures and posterior cranial fossa measurements related with the occipital bone were sought. RESULTS Significant differences were detected for several oropharynx and oral cavity measures in the patient cohort, primarily involving the length and thickness of the soft palate (p = 9.5E-05 and p = 3.0E-03, respectively). A statistically significant (p < 0.01) moderate correlation between some of these variables and posterior cranial fossa parameters was observed. CONCLUSIONS The existence of structural oropharyngeal and oral cavity anomalies in patients with Chiari malformation Type I was confirmed, which may contribute to the frequent occurrence of respiratory and deglutitory complications and sleep disorders in this syndrome.


CMI = Chiari malformation Type I; Chiari malformation Type I; FM = foramen magnum; MRI; PCF = posterior cranial fossa; magnetic resonance imaging; oropharynx and oral cavity; soft palate

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