Using cone beam CT to assess the upper airway after surgery in children with sleep disordered breathing symptoms and maxillary-mandibular disproportions: A clinical pilot

Abstract

BackgroundThe surgical excision of anatomic obstructions such as adenoids, palatine or lingual tonsils are commonly performed in children with sleep disordered breathing (SDB). Imaging studies measuring airway changes post-surgery in the SDB pediatric population are scarce, rarely addresses the nasal cavity, and are based on global measures (e.g. volume) that do not represent the complexity of the upper airway anatomy. The purpose of this pilot is to test the feasibility in using cone beam CT (CBCT) to analyze the nasal and pharyngeal airway space post-surgery using meaningful methods of analyses, and correlating imaging findings with clinical outcomes in children with SDB symptoms and maxillary-mandibular disproportion.MethodsTwelve non-syndromic children with SDB symptoms and jaw disproportions were evaluated by interdisciplinary airway team before and after upper airway surgery. CBCT and OSA-18 quality of life questionnaire pre and post-operatively were completed. Conventional and new airway variables were measured based on 3D models of the upper airways and correlated with OSA-18. Conventional measures include volume, surface area, and cross-sectional area. New airway measures include constriction and patency; point-based analyses.ResultsEight females and four males were 8.8 ± 2 years with mean BMI of 18.7 ± 3. OSA-18 improved, median (lower quartile-upper quartile) from 64.2 (54.7–79.5) to 37.6 (28.7–43) postoperatively, p < 0.001. The median of all airway measures improved however with very wide range. Subjects with the smallest amounts of constriction relief and/or gain in airway patency presented with least improvement in OSA-18. New airway measures show strong correlation with changes in OSA-18 (ρ = 0.44 to 0.71) whereas conventional measures showed very weak correlation (ρ = −0.04 to 0.37).ConclusionsUsing point-based analyses, new airway measures better explained changes in clinical symptoms compared to conventional measures. Airway patency gained by at least 150% and constriction relief by at least 15% showed marked improvement in OSA-18 by 40–55%, after surgery in the tested cohort.Electronic supplementary materialThe online version of this article (doi:10.1186/s40463-017-0204-4) contains supplementary material, which is available to authorized users.

The role of upper airway morphology in apnea versus hypopnea predominant obstructive sleep apnea patients: an exploratory study

“…Özer et al reliable studies have been carried out in the areas of diagnosis and treatment of upper airways and dental diseases, both in children and adults. 6,7 Although CT is a non-invasive technique, but contains ionizing radiation effects. It is important to use low-dose protocols in studies performed especially in children due to radiation exposure.…”

Evaluation of Upper Airway in Children with Obstructive Sleep Apnea Using Cone‐Beam Computed Tomography

“…This study is one of clinical pilot pertaining to the use of CBCT measurements in childhood sleep apnea 29 . A previous study by Alsufyani et al compared CBCT before and after surgery in children with sleep‐disordered breathing symptoms, and showed that the new airway measure generated by CBCT was related to changes in clinical symptoms 29 . However, overnight PSG was not applied for the evaluation of OSA in their children.…”

“…Tikku et al showed the oropharyngeal airway volume, minimal cross‐section area, and the A‐P and lateral width of the airway in OSA was significantly less than that of normal subjects 62 . However, there is a lack of such publications in the pediatric population 29 . Moreover, the CBCT studies in adults with OSA were mainly focused on oropharyngeal measurements 62 .…”

“…Several studies applied CBCT to assess upper airway structures and dimensional changes after treatment in adults with OSA 27,28 . However, there is still a lack of such studies in the pediatric population 29 …”

The effect of altered head and tongue posture on upper airway volume based on a validated upper airway analysis—An MRI pilot study

“…Based on a validated and objective 3D UA evaluation protocol, the effect of altered head or tongue posture on the UA volume has not been thoroughly investigated although previous studies have highlighted this association 21,25,33,34 In order to perform comparable UA studies with reliable outcomes, head posture or the cranio-cervical inclination should be in a standardized posture during image acquisition, which has been highlighted as a confounding factor in the literature 1,18,20,31,35 thus calling for this study.…”