Objective To explore the effects of extraction orthodontic treatment on upper airway morphology and hyoid bone position in adolescent patients with skeletal class Ⅱ high angle. Methods Sixty adolescent patients with skeletal classⅡ high angle who were treated in the Department of Orthodontics, Hospital of Stomatology, Jilin University from Jan. 2013 to Jan. 2019 were enrolled. All of them were treated with straight wire appliance. According to the different treatment strategies, they were divided into extraction group and non-extraction group, with 30 cases in each group. The upper airway, hyoid bone, and craniomaxillofacial tissue of the lateral cephalograms were fixed-point, depicted, and measured before and after orthodontic treatment. Results Compared with before treatment, the extraction group showed decreases in subspinale-nasion-supramental angle (ANB), upper incisor-SN plane (U1-SN), and lower incisor-mandibular plane (L1-MP) after treatment, while showed increases in posterior nasal spine-upper pharyngeal wall (PNS-UPW), posterior nasal spine-vallecula (PNS-V), hyoid-sella (H-S), occlusal plane-SN plane (OP-SN), and upper incisor-lower incisor (U1-L1), with statistically significant differences (all P＜0.05). Compared with before treatment, the non-extraction group showed a decrease in ANB and increases in PNS-V, H-S, and OP-SN after treatment, also with statistically significant differences (all P＜0.05). Conclusion Due to the growth and development of adolescents, the sagittal diameter and vertical height of the upper airway in adolescent patients with skeletal classⅡ high angle increase to a certain extent after treatment in both groups, and the hyoid bone position shows a trend of downward and forward displacement. Therefore, extraction orthodontic treatment has almost no adverse effect on the upper airway of adolescent patients with skeletal class Ⅱ high angle.