Mohamed A Bitar1, Anthony T Macari, Joseph G Ghafari. 1. Pediatric Otolaryngology Section, Department of Otolaryngology-Head & Neck Surgery, American University of Beirut Medical Center, PO Box 11-0236/A52, Beirut, Lebanon. mb36@aub.edu.lb
Abstract
OBJECTIVE: To evaluate the correlation between and significance of 2 methods of palatal airway assessment on lateral cephalographs. DESIGN: Diagnostic lateral cephalometric imaging study that took place from January 1, 2006, to December 31, 2007. SETTING: American University of Beirut Medical Center. PATIENTS: Children with chronic mouth breathing referred by a pediatric otolaryngologist for cephalometric evaluation by participating orthodontists. MAIN OUTCOME MEASURES: Two distances were measured on the digitized lateral cephalographs between the adenoid and soft palate: the shortest adenoid distance (SAD) and the most convex adenoid distance (CAD). The palatal airway was assessed on a grade-1 to grade-3 scale independently by the referring otolaryngologist and an orthodontist. RESULTS: A total of 200 children were included in the study (127 boys and 73 girls; mean age, 6 years; age range, 1.71-12.62 years). High correlations were observed between the airway ratings gathered by both examiners (r = 0.96) and between SAD and CAD (r = 0.92). Significant correlations were noted between the palatal airway grade and the SAD and CAD measurements (r = -0.73 and r = -0.79, respectively). Shortest adenoid distance measures of 2 mm or less corresponded mostly to grade 3 obstruction and were more prevalent in patients younger than 6 years. Age was inversely proportional to both the grade and SAD (P < .001). CONCLUSIONS: Both methods are reliable for assessment of airway obstruction by the adenoid. Because SAD and CAD are highly correlated, we recommend the use of SAD as a more readily identifiable distance on cephalometric radiographs. Removal of adenoids when SAD is less than 2 mm may be indicated because this condition reflects a severe airway obstruction associated with potential changes in dentofacial structure.
OBJECTIVE: To evaluate the correlation between and significance of 2 methods of palatal airway assessment on lateral cephalographs. DESIGN: Diagnostic lateral cephalometric imaging study that took place from January 1, 2006, to December 31, 2007. SETTING: American University of Beirut Medical Center. PATIENTS: Children with chronic mouth breathing referred by a pediatric otolaryngologist for cephalometric evaluation by participating orthodontists. MAIN OUTCOME MEASURES: Two distances were measured on the digitized lateral cephalographs between the adenoid and soft palate: the shortest adenoid distance (SAD) and the most convex adenoid distance (CAD). The palatal airway was assessed on a grade-1 to grade-3 scale independently by the referring otolaryngologist and an orthodontist. RESULTS: A total of 200 children were included in the study (127 boys and 73 girls; mean age, 6 years; age range, 1.71-12.62 years). High correlations were observed between the airway ratings gathered by both examiners (r = 0.96) and between SAD and CAD (r = 0.92). Significant correlations were noted between the palatal airway grade and the SAD and CAD measurements (r = -0.73 and r = -0.79, respectively). Shortest adenoid distance measures of 2 mm or less corresponded mostly to grade 3 obstruction and were more prevalent in patients younger than 6 years. Age was inversely proportional to both the grade and SAD (P < .001). CONCLUSIONS: Both methods are reliable for assessment of airway obstruction by the adenoid. Because SAD and CAD are highly correlated, we recommend the use of SAD as a more readily identifiable distance on cephalometric radiographs. Removal of adenoids when SAD is less than 2 mm may be indicated because this condition reflects a severe airway obstruction associated with potential changes in dentofacial structure.