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A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy
L Brodsky1, L Moore, J F Stanievich
1Department of Otolaryngology, State University of New York at Buffalo, NY 14222.
Insights
Children with obstructive sleep apnea often have enlarged tonsils and adenoids. Subclinical oropharyngeal variations may predispose children to this condition, impacting airway dimensions.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Craniofacial Anatomy
Background:
- Enlarged tonsils and adenoids are the primary cause of obstructive sleep apnea (OSA) in children.
- Subtle variations in oropharyngeal dimensions may predispose children to OSA, even without apparent craniofacial abnormalities.
Purpose of the Study:
- To investigate subclinical variations in oropharyngeal dimensions in children with and without obstructive sleep apnea.
- To correlate patient anthropometrics with specific oropharyngeal measurements.
Main Methods:
- Compared 18 children with small tonsils (no snoring) to 33 children with large tonsils (OSA symptoms).
- Measured oropharyngeal dimensions intraoperatively: soft palate length, nasopharyngeal depth, and pharyngeal wall distances.
- Correlated age, height, weight, and body surface area with these measurements.
Main Results:
- In children with small tonsils, increased height, weight, and surface area correlated with wider lateral pharyngeal walls and longer soft palates.
- No such correlation was found in children with obstructive adenotonsillar hypertrophy.
- Children with obstructive hypertrophy had significantly narrower lateral pharyngeal walls (P < 0.01).
- Children without obstruction had significantly longer soft palates (P < 0.01) and shallower nasopharynges (P < 0.01).
Conclusions:
- Oropharyngeal dimensions, particularly lateral pharyngeal wall distance and soft palate length, differ between children with and without obstructive sleep apnea.
- These subclinical variations may play a role in the development of pediatric obstructive sleep apnea.
Abstract:
Hypertrophy of the tonsils and adenoids is the most common cause of obstructive sleep apnea in children. There is relatively little known about the occurrence of subclinical variations in the dimensions of the oropharynx which may predispose to the development of obstructive sleep apnea in children without obvious craniofacial abnormalities. Fifty-one children (3-10 years) were divided into two groups: the first group consisted of 18 patients with small tonsils and no history of snoring who underwent tonsillectomy for chronic tonsillitis. They were compared to a second group of 33 patients with large tonsils who underwent tonsillectomy and adenoidectomy for symptoms of obstructive sleep apnea. Age, height, weight, body surface area and tonsil weight were correlated to the dimensions of the oropharynx obtained by direct measurement intraoperatively including the length of the soft palate, anterior-posterior depth of the nasopharynx and the distances between the medial tonsillar surfaces, anterior tonsillar pillars and lateral pharyngeal walls at mid-tonsil level. Increased patient height, weight and surface area correlated positively to increased distance between the lateral pharyngeal walls and to the length of the soft palate in the patients with small tonsils. No such correlation existed in the patients with obstructive adenotonsillar hypertrophy. In addition, the distance between the lateral pharyngeal walls was significantly decreased in the group with large, obstructing tonsils as compared to those with small tonsils and no history of obstruction (P less than 0.01). However, the patients with small tonsils and no obstruction had significantly longer soft plates (P less than 0.01) and less depth tot eh nasopharynx (P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)