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. Materials and 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. (Angle Orthod. 2011; 81:433-439.)