title: Cephalometric evaluation of adenoids: an analysis of current methods and a proposal of a new assessment tool.
abstract: BACKGROUND
  Although the scientific literature recognizes that lateral cephalometric radiographs might be clinically useful, there is no consensus in relation to the best parameter available. Therefore, this research was aimed at evaluating current radiographic assessment methods designed to investigate adenoid hypertrophy and nasopharyngeal obstruction.
  
  
  METHODS
  Children from 4 to 14 years old with nasal obstruction or oral breathing complaints, suspected to be caused by adenoid hypertrophy, received cephalometric examinations. One hundred twenty radiographic records were evaluated according to several current methods, and data were compared with respective gold-standard videonasopharyngoscopic examinations, in relation to the percentage of choanal obstruction.
  
  
  RESULTS
  Groups derived from a grading system had significantly different percentages of choanal obstruction. However, this parameter showed low sensitivity. Significant but moderate correlations were observed between most of the quantitative radiographic parameters and the percentage of choanal obstruction. Alternatively, a regression model was introduced; it demonstrated satisfactory ability to predict choanal obstruction percentage. Despite limitations, this model could also distinguish patients who might benefit from referral to otolaryngologic care.
  
  
  CONCLUSIONS
  Current adenoid assessment methods have significant limitations. A novel assessment method introduced here might be clinically useful.
authors.affiliation: Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, Federal University of São Paulo, São Paulo, Brazil. mn-feres@uol.com.br
authors.forename: Murilo Fernando Neuppmann
authors.initials: MF
authors.lastname: Feres
authors.forename: Juliana Sato
authors.initials: JS
authors.lastname: Hermann
authors.forename: Shirley Shizue Nagata
authors.initials: SS
authors.lastname: Pignatari
mesh_terms: D000234:Adenoids / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D000402:Airway Obstruction / Q000000981:diagnostic imaging*; D002508:Cephalometry / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000000981:diagnostic imaging; D016014:Linear Models; D008297:Male; D011859:Radiography; D014741:Video Recording