Validity of upper airway assessment in children: a clinical, cephalometric, and MRI study.
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.


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.
Oral and Maxillofacial Department, Oulu University Hospital, Oulu, Finland. kirsi.pirila-parkkinen@oulu.fi
Kirsi
K
Pirilä-Parkkinen
Heikki
H
Löppönen
Peter
P
Nieminen
Uolevi
U
Tolonen
Eija
E
Pääkkö
Pertti
P
Pirttiniemi
D000402:Airway Obstruction / Q000175:diagnosis* / Q000473:pathology; D002508:Cephalometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009305:Nasopharynx / Q000473:pathology*; D009960:Oropharynx / Q000473:pathology*; D010160:Palate, Soft / Q000473:pathology; D014066:Palatine Tonsil / Q000033:anatomy & histology; D012015:Reference Standards; D015203:Reproducibility of Results; D012891:Sleep Apnea Syndromes / Q000473:pathology*
Eur J Orthod. 2009 Apr;31(2):160-7
19028674
Am J Respir Crit Care Med. 2001 Aug 15;164(4):698-703
11520739
Pediatrics. 2002 Apr;109(4):e55
11927728
Am J Orthod. 1979 Nov;76(5):479-90
292310
Am J Orthod. 1984 Sep;86(3):214-23
6591801
Clin Otolaryngol Allied Sci. 1981 Oct;6(5):317-22
7318226
Eur J Orthod. 1996 Dec;18(6):571-9
9009421
Sleep. 2004 Aug 1;27(5):997-1019
15453561
Am Rev Respir Dis. 1991 Oct;144(4):845-7
1928960
Br J Radiol. 1996 Nov;69(827):1000-4
8958015
Am J Orthod Dentofacial Orthop. 1994 Jul;106(1):52-9
8017350
Am J Orthod. 1973 Dec;64(6):578-606
4210182
Arch Otolaryngol Head Neck Surg. 2000 Apr;126(4):481-6
10772301
Eur J Orthod. 2010 Dec;32(6):662-71
20305055
Ear Nose Throat J. 1992 Dec;71(12):638-42
1483401
Am J Respir Crit Care Med. 2003 Sep 1;168(5):522-30
12746251
J Appl Physiol (1985). 2003 Nov;95(5):2030-8
12897029
Acta Otolaryngol Suppl. 1970;265:1-132
5272140
Clin Chest Med. 1992 Sep;13(3):399-416
1521409
Am J Orthod Dentofacial Orthop. 2006 Dec;130(6):700-8
17169731
Orthod Craniofac Res. 2003;6 Suppl 1:173-5
14606553
Proc Am Thorac Soc. 2008 Feb 15;5(2):242-52
18250218
Clin Chest Med. 2003 Jun;24(2):261-82
12800783
Clin Chest Med. 1998 Mar;19(1):33-54
9554216
Am J Respir Crit Care Med. 2003 Jan 1;167(1):65-70
12406826
Clin Radiol. 1981 May;32(3):337-40
7237915
Am J Orthod Dentofacial Orthop. 1997 Jan;111(1):12-7
9009918
Arch Pediatr Adolesc Med. 2005 Aug;159(8):775-85
16061787
Am J Respir Crit Care Med. 2002 Jun 1;165(11):1499-503
12045123