New insights on age-related association between nasopharyngeal airway clearance and facial morphology.
OBJECTIVE
To evaluate the relation between adenoid hypertrophy and facial morphology across age in a pediatric population.


METHODS
The American University of Beirut Department of Otolaryngology. Two-hundred consecutive children (age 6.00 ± 2.62 years) referred from the Pediatric Otolaryngology unit to the Orthodontic division and requiring a lateral cephalogram for adenoid hypertrophy assessment.


METHODS
Cephalometric measurements included relations among cranial base, maxilla and mandible, and airway clearance measured from adenoid to soft palate (AD). The children were classified into two age groups, Group 1: ≤ 6 years (n = 124) and Group 2: ≥ 6.01 years (n = 76), and also stratified in four subgroups (A, B, C, D) based on maxillo-mandibular divergence (palatal to mandibular plane angle, PP-MP): A- PP-MP ≤ 27.5°, n = 34; B- 27.5° < PP-MP ≤ 32°, n = 68; C- 32°<PP/MP<36.5°, n = 67; D- PP-MP ≥ 36.5°, n = 31. Statistics included t-tests and anova for group differences.


RESULTS
Differences between groups 1 and 2 were statistically significant (p < 0.05) for AD (Group 1: 3.19 ± 2.32 mm, Group 2: 4.78 ± 2.80 mm), ANB (5.38 ± 2.24°, 4.38 ± 2.54°), LFH (56.61 ± 1.95%, 55.38 ± 1.84%), PP-H (-8.41 ± 3.28°, -6.49 ± 3.46°), and overbite (0.55 ± 2.00 mm, 1.16 ± 2.36 mm). Among subgroups, statistically significant differences (p < 0.05) occurred mainly between the most hyperdivergent group (D) and the hypodivergent (A) and normodivergent (B) groups.


CONCLUSIONS
Airway measurements were smallest in children ≤ 6 years and those presenting severe hyperdivergent pattern, which denoted the most severe airway obstruction. The findings suggest airway clearance before age 6 in the most severely affected children, but follow-up research on actual adenoidectomies in younger children is needed to determine guidelines.
Division of Orthodontics and Dentofacial Orthopedics, Department of Otolaryngology-Head and Neck Surgery, American University of Beirut, Faculty of Medicine and Medical Center, Beirut, Lebanon.
A T
AT
Macari
M A
MA
Bitar
J G
JG
Ghafari
D000234:Adenoids / Q000473:pathology*; D000367:Age Factors; D000402:Airway Obstruction / Q000209:etiology; D002508:Cephalometry / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005145:Face; D005260:Female; D006801:Humans; D006984:Hypertrophy; D007091:Image Processing, Computer-Assisted / Q000379:methods; D007223:Infant; D008297:Male; D008310:Malocclusion / Q000473:pathology; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000473:pathology; D009058:Mouth Breathing / Q000209:etiology*; D009295:Nasal Bone / Q000473:pathology; D009305:Nasopharynx / Q000473:pathology*; D057887:Overbite / Q000473:pathology; D010160:Palate, Soft / Q000473:pathology; D012123:Pulmonary Ventilation / Q000502:physiology*; D019291:Skull Base / Q000473:pathology