Aim: This study aims to explore the clinical significance of measuring the oropharyngeal cavity area (S) in children with tonsillar hypertrophy using CBCT-based 3D reconstruction imaging. Methods: A retrospective analysis was conducted on 174 children aged 4-6 years with adenoid hypertrophy and tonsillar hypertrophy. The children were divided into two groups: the surgery group (87 cases, who underwent tonsillectomy) and the non-surgery group (87 cases, who did not undergo tonsillectomy). All children underwent nasopharyngeal CBCT scans for upper airway 3D reconstruction, and the oropharyngeal area was measured on the CT images for both groups. Logistic regression analysis was employed to investigate the factors significantly affecting the oropharyngeal area, and the performance of the logistic regression model in distinguishing between the surgical and non-surgical groups was evaluated using ROC curves. Results: Logistic regression analysis revealed a statistically significant difference in oropharyngeal area between the surgery and non-surgery groups (p < 0.05). ROC curve analysis showed that the logistic regression model demonstrated a high diagnostic efficacy in distinguishing between the two groups, with an area under the curve (AUC) of 0.78. A threshold value of S = 141.07 mm 2 was found to provide a good balance between sensitivity and specificity in the ROC curve. Conclusion: Oropharyngeal area can serve as an important imaging indicator for diagnosing and assessing the severity of tonsillar hypertrophy in children aged 4-6 years. This result can offer valuable clinical guidance for comprehensive surgical decision-making. Keywords: Tonsillar hypertrophy; Adenoid hypertrophy; Pediatric snoring; CBCT; Upper airway; 3D reconstruction