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: 1.44). 01/2007; 130(6):700-8. DOI: 10.1016/j.ajodo.2005.05.050
Source: PubMed

ABSTRACT 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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    International Orthodontics 02/2015; DOI:10.1016/j.ortho.2014.12.009
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    ABSTRACT: Chronic nasal obstruction due to adenoid hypertrophy is a very common disorder. Although the clinical assessment of adenoid hypertrophy is essential, its real value in young children is difficult to evaluate. The purpose of this prospective study was to validate a simple clinical score to predict the severity of adenoid obstruction and to evaluate the relationship between this method of clinical scoring with radiography and nasopharyngeal endoscopy. Ninety symptomatic children were enrolled into this study. The clinical score included difficulty of breathing during sleep, apnea, and snoring. We investigated the relationship between clinical scoring, nasal endoscopy, and radiographic findings. The clinical score correlated very well with endoscopic findings (P<0.000), but the correlation between the clinical score and radiologic findings (P>0.05) and endoscopic findings and imaging (P>0.05) was weak. Clinical findings could be used to select children for adenoidectomy, especially when endoscopic examination is not available or cannot be performed.
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May 16, 2014