Radiographic Evaluation of Children with Nasopharyngeal Obstruction Due to the Adenoid

Abstract

The adenoidal-nasopharyngeal ratio (ANR) was proposed as a convenient and practical method to evaluate adenoidal enlargement. We analyzed cephalometric radiographs of 150 children divided into 6 subgroups according to clinical assessment (possible adenoidectomy candidates [PACs] and controls) and age. Our purpose was to investigate the predictive reliability of different ANRs calculated on the same reference line. Each of the ANRs described in this study presented statistically significant differences between PACs and control groups, and highly significant correlations with clinical symptoms of nasal obstruction. Further, the mean adenoidal depth was significantly larger in PACs than in normals, and it was found that the adenoidal depth in PACs did not show a significant decrement with age. in contrast to normals. On the other hand, although nasopharyngeal depth was not different between PACs and normals, an age-dependent increment was observed in PACs, in contrast to normals. Thus, it could be said that the ANR is a more reliable method for determining whether adenoidal hyperplasia is clinically significant or not, rather than the size of the adenoid or nasopharynx.

Reliability of subjective, linear, ratio and area cephalometric measurements in assessing adenoid hypertrophy among different age groups

“…10 Though the use of cavum and lateral cephalometric radiography has been described in the medical and dental literature for years, [14][15][16][17][18] it has also been the target of criticism in some studies. 20,22 These skeptical conclusions, though, were questioned in a systematic review on this topic.…”

“…The larger sample size, inclusion of a control group (mouth breathing without adenoid hypertrophy), prospective design (instead of retrospective), and use of strict LCR methods were in accordance with the recommended guidelines. Four well-established measurements from the orthodontic literature were chosen: the Holmberg and Linder-Aronson subjective method, 15 McNamara's linear method, 16 the Kemaloglu et al 17 ratio, and the Handelman and Osborne 18 area method. Recently, three-dimensional imaging has progressively become a more accessible tool, and some investigations have used it in the assessment of the pediatric upper airway.…”

“…16 The ratio measure had six cut-off points based on the age groups and genders of the children. 17 Tracings were scanned (300 dots per inch on gray scale), imported into a commercially available software system (AutoCAD 2006, San Rafael, Calif.) and processed for area measurement (mm 2 ). Cut-off points defining nasopharyngeal obstruction were based on a previous description.…”

“…[15][16][17][18] Despite the inability of LCR to provide volumetric data, 19 and several claims against its use in the diagnosis of airway problems, 20,21 there is evidence that LCR is a useful screening tool for evaluating nasopharyngeal obstruction. 19,22 As is the case with all diagnostic tests, LCR has imperfections, and thus, its clinical reliability should be critically evaluated by four indices: sensitivity, specificity, positive predictive value, and negative predictive value.…”

Vicissitude of Curetted Adenoid Vegetations

“…In previous studies, simple X-ray photographs were routinely employed to diagnose adenoid hypertrophy [26][27][28] (Figure 6). In X-ray images, one can observe sections and sagittal expansion of the adenoids.…”