Validity of upper airway assessment in children: a clinical, cephalometric, and MRI study
Kirsi Pirilä-Parkkinen1, Heikki Löppönen, Peter Nieminen
1Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland. kirsi.pirila-parkkinen@oulu.fi
Insights
Lateral cephalograms effectively measure nasopharyngeal and retropalatal dimensions in children with sleep-disordered breathing. Clinical tonsillar size assessment is also reliable for evaluating oropharyngeal size.
Area of Science:
- Pediatric Sleep Medicine
- Radiology
- Otolaryngology
Background:
- Sleep-disordered breathing (SDB) in children often involves airway obstruction.
- Accurate assessment of pharyngeal dimensions is crucial for diagnosing SDB.
- Comparing imaging modalities and clinical assessments is important for diagnostic efficiency.
Purpose of the Study:
- To evaluate the diagnostic capability of two-dimensional lateral cephalograms for pharyngeal obstruction.
- To compare cephalograms with three-dimensional magnetic resonance imaging (MRI) and clinical tonsillar size assessment.
- To determine the reliability of lateral cephalograms in assessing airway dimensions.
Main Methods:
- 36 prepubertal children with diagnosed SDB were studied.
- Pharyngeal airway imaging was performed using MRI.
- Lateral skull radiographs were taken, and tonsillar size was clinically assessed.
Main Results:
- Lateral cephalometry showed significant positive correlations with MRI findings for nasopharyngeal and retropalatal regions.
- Both methods identified the narrowest airway in the retropalatal area.
- Clinical tonsillar size correlated inversely with MRI-measured airway dimensions, indicating its reliability.
Conclusions:
- The initial hypothesis that lateral cephalograms are poor at recognizing pharyngeal obstruction is rejected.
- Lateral cephalograms are validated as a reliable method for measuring nasopharyngeal and retropalatal dimensions.
- Clinical assessment of tonsillar size is a relatively reliable method for evaluating oropharyngeal size in children with SDB.
Objective:
To test the hypothesis that the capability of two-dimensional lateral cephalogram in recognizing pharyngeal obstruction is poor compared with the capability of three-dimensional magnetic resonance imaging (MRI) and clinical observation of tonsillar size.
Materials And Methods:
The study participants were 36 prepubertal children (19 male, 17 female; mean age 7.3 ± 1.43 years, range 4.8-9.8 years) with sleep-disordered breathing diagnosed by nocturnal polygraphy. Pharyngeal airway was imaged with a low-field open-configuration MRI scanner. Tonsillar size was clinically determined and lateral skull radiographs were taken and measured. Pearson correlation coefficients were calculated between the clinical, cephalometric, and MRI variables.
Results:
Nasopharyngeal and retropalatal cephalometric variables had a significant positive correlation with the MRI findings. Both techniques showed the narrowest measurement to be located in the retropalatal region. Clinical assessment of tonsillar size correlated inversely with MRI findings such as minimal retropalatal cross-sectional airway area (P = .000), minimal retroglossal cross-sectional airway area (P = .015), and intertonsillar airway width (P = .000). Cephalometric soft palate and tonsillar area correlated with clinical tonsillar size (P = .001).
Conclusions:
The hypothesis is rejected. The findings confirm that the lateral cephalogram is a valid method for measuring dimensions of the nasopharyngeal and retropalatal region. When evaluating oropharyngeal size, clinical assessment of tonsillar size is a relatively reliable method.
