Assessment of lateral cephalometric diagnosis of adenoid hypertrophy and posterior upper airway obstruction: A systematic review

Boston University, Boston, Massachusetts, United States
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics (Impact Factor: 1.38). 01/2007; 130(6):700-8. DOI: 10.1016/j.ajodo.2005.05.050
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Our objective was to evaluate the capability of lateral cephalograms in diagnosing hypertrophied adenoids and obstructed posterior nasopharyngeal airways.
A systematic review of the literature by using several electronic databases (Cochrane Library, Medline, Medline in progress, PubMed, Web of Science, Embase, and Lilacs) was performed with the help of a senior health-sciences librarian. The electronic search was followed up with hand searches. After applying our inclusion-exclusion criteria, the search yielded 11 articles that were then scored based on their methodological validity.
Lateral cephalograms performed reasonably well in evaluating adenoid size; both quantitative measures of adenoid area and subjective grading of adenoid size on lateral cephalograms had reasonable correlations to actual adenoid size (range of r, 0.60 to 0.88). However, evidence suggested that cephalograms were less ideal for evaluating the size of the posterior nasopharyngeal airway. The diagnostic difference is likely because the adenoid is a simpler 3-dimensional structure than the nasopharynx; therefore, it loses less information when compressed into 2 dimensions by the radiograph.
Being used as a screening tool to determine the need for more rigorous ENT follow-up appears to be the greatest utility of lateral cephalograms. Because no consensus could be reached on what are the most useful landmarks, we recommend that clinicians look for multiple deviant measures of adenoid size rather than one definitive quantification.

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Available from: Michael Major, Oct 11, 2015
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    • "Both upper airway and craniofacial structures can be observed in the same lateral cephalograms, and lateral cephalometric radiography was therefore considered to be a useful screening tool to assess upper airway structures, and identify subjects at risk of SDB [19,20]; its validity has been tested using three-dimensional computed tomography (CT) and magnetic resonance imaging (MRI) [21,22]. "
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    ABSTRACT: Objective To establish cephalometric norms for the upper airway of 12-year-old Chinese children, and to assess these norms with regard to gender, age, ethnicity and other craniofacial structures. Methods Lateral cephalograms were obtained from a random sample of 425 12-year-old Chinese children (224 boys and 201 girls) to establish the Chinese norms, and from a matched group of 108 12-year-old Caucasian children (61 boys and 47 girls) as an ethnic comparison. Published data on the upper airway norms of Chinese adults were used to make age comparisons. Nine upper airway and 14 craniofacial variables were measured. Results Chinese boys tended to have a thicker soft palate (P = 0.008), and less depth in the retropalatal (P = 0.011), retroglossal (P = 0.034) and hypopharyngeal (P < 0.001) pharynx than Chinese girls, whereas no gender dimorphism was found in Caucasian children. Ethnic differences were found in the depth of the retroglossal oropharynx in both genders and the position of the hyoid bone in boys. Compared with Chinese adults, the overall size of the upper airway in Chinese children was smaller. The mandibular body length and the craniocervical inclination were found to be statistically significantly, albeit weakly correlated with upper airway variables. Conclusions Cephalometric norms for the upper airway of Chinese 12-year-old children were established, indicating gender-specific differences, and some ethnic differences were found in comparison with those of 12-year-old Caucasian children. An association between the mandibular body length and the craniocervical inclination with upper airway variables was also noticeable.
    Head & Face Medicine 09/2014; 10(1):38. DOI:10.1186/1746-160X-10-38 · 0.85 Impact Factor
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    • "Endoscopic examination allows the nasal cavities and nasopharynx to be observed directly and permits a more accurate diagnosis to be made. Nevertheless , nasal endoscopy can present some disadvantages: as some authors state, it allows little opportunity for objective measurement, often causing low interobserver agreement (Filho et al., 2001; Major et al., 2006). Studies by Lertsburapa et al. (2010) on 99 children revealed a correlation between flexible fiber-optic nasal endoscopy and intraoperative nasopharyngoscopy performed during adenoidectomy. "
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    ABSTRACT: Adenoids are strategically located for mediating local and regional immune functions as they are exposed to antigens from both the outside air and the alimentary tract. Recurrent or chronic respiratory infections can induce histomorphological and functional changes in the adenoidal immunological barrier, sometimes making surgical treatment necessary. Our aim in this review is to summarize the crucial points about not only the immunological histopathology of adenoidal tissue, especially in patients with adenoid hypertrophy, but also the most common and useful diagnostic techniques and surgical options. Clin. Anat., 2014. © 2014 Wiley Periodicals, Inc.
    Clinical Anatomy 04/2014; 27(3). DOI:10.1002/ca.22373 · 1.33 Impact Factor
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    • "While adenoidal hypertrophy is one of the most important causes of nasal obstruction in children [10,11], methods for evaluating adenoid size remain controversial and unsatisfactory. Many different ways, including lateral radiographs [21,30-33], fiberoptic endoscopy [34,35], and acoustic rhinometry [36], have been advocated as reliable in detecting the adenoidal hypertrophy and its connection to upper airway obstruction. "
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    ABSTRACT: To investigate the contributions of adenoid and tonsil size to childhood obstructive sleep apnea (OSA) and the interactions between adenotonsillar hypertrophy, age, and obesity in children with OSA. In total, 495 symptomatic patients were recruited. The patients were assigned to four groups according to age:toddler (age 1-3, n=42), preschool (age 3-6, n=164), school (age 6-12, n=200), and adolescence (age 12-18, n=89). All subjects had tonsil size graded by otolaryngologists, adenoid size determined on lateral radiographs (Fujioka method), and a full-night polysomnography. The apnea-hypopnea index (AHI), adenoid size, and tonsil size were compared in obese and non-obese children in the four age groups. Adjusted odds ratios (ORs) and 95% confidence interval (CI) of adenotonsillar hypertrophy and OSA risk were estimated by multi-logistic regression. The AHI was positively related to tonsil grade (r=0.33, p <0.001) and adenoid size (r=0.24, p <0.01) in all patients. Tonsil grade was positively related to AHI in all four age groups. Adenoid size was positively related to AHI in the toddler, preschool, school groups, but not in the adolescent group (r=0.11, p=0.37). Tonsil grade and adenoid size were both positively related to AHI in obese and non-obese children. In the regression model, obesity (OR=2.89; 95% CI 1.47-5.68), tonsillar hypertrophy (OR=3.15; 95% CI 2.04-4.88), and adenoidal hypertrophy (OR=1.89; 95% CI 1.19-3.00) significantly increased OSA risk. Adenotonsillar hypertrophy and obesity are the major determinants of OSA in children. However, the influence of adenoid size decreases in adolescence.
    PLoS ONE 10/2013; 8(10):e78666. DOI:10.1371/journal.pone.0078666 · 3.23 Impact Factor
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