title: 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: BACKGROUND
  The 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.
  
  
  METHODS
  Twelve 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.
  
  
  RESULTS
  Eight 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).
  
  
  CONCLUSIONS
  Using 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.
authors.affiliation: School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. alsufyan@ualberta.ca.|Edmonton Clinic Health Academy- School of Dentistry, 5th floor, 11405-87 AVE NW, Edmonton, T6G 1C9, AB, Canada. alsufyan@ualberta.ca.|Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia. alsufyan@ualberta.ca.
authors.forename: Noura A
authors.initials: NA
authors.lastname: Alsufyani
authors.affiliation: Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Noga
authors.affiliation: School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Manisha
authors.initials: M
authors.lastname: Witmans
authors.affiliation: Department of Computing Science, Faculty of Science, University of Alberta, Edmonton, Canada.
authors.forename: Irene
authors.initials: I
authors.lastname: Cheng
authors.affiliation: Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
authors.affiliation: School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Major
mesh_terms: D000233:Adenoidectomy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D054893:Cone-Beam Computed Tomography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007569:Jaw Abnormalities / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D010865:Pilot Projects; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D014068:Tonsillectomy; D016896:Treatment Outcome
keywords: Adenoidectomy; Cone-beam computed tomography; Tonsillectomy; Treatment outcome