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Correspondence between subjective and linear measurements of the palatal airway on lateral cephalometric radiographs
Mohamed A Bitar1, Anthony T Macari, Joseph G Ghafari
1Pediatric 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
Insights
Lateral cephalographs reliably assess palatal airway obstruction in children. Shortest adenoid distance (SAD) below 2 mm indicates severe obstruction, potentially requiring adenoid removal.
Area of Science:
- Dentistry
- Orthodontics
- Pediatric Otolaryngology
Background:
- Chronic mouth breathing in children can indicate palatal airway obstruction.
- Cephalometric radiography is a common diagnostic tool in orthodontics and pediatric care.
Purpose of the Study:
- To evaluate the correlation and significance of two palatal airway assessment methods on lateral cephalographs.
- To determine the reliability of shortest adenoid distance (SAD) and most convex adenoid distance (CAD) measurements.
Main Methods:
- Diagnostic lateral cephalometric imaging study involving 200 children with chronic mouth breathing.
- Measured SAD and CAD on digitized cephalographs.
- Assessed palatal airway obstruction using a 1-3 grade scale by an otolaryngologist and an orthodontist.
Main Results:
- High correlations were found between examiner ratings (r=0.96) and between SAD and CAD (r=0.92).
- Significant negative correlations existed between palatal airway grade and SAD (r=-0.73) and CAD (r=-0.79).
- SAD <= 2 mm correlated with grade 3 obstruction, particularly in children under 6; age was inversely proportional to grade and SAD (P<.001).
Conclusions:
- Both SAD and CAD are reliable methods for assessing adenoid-related airway obstruction.
- SAD is recommended due to its ease of identification on cephalometric radiographs.
- Adenoid removal may be indicated for SAD < 2 mm, signifying severe obstruction with potential dentofacial implications.
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.
