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Title Lateral Cephalometric Radiograph Analysis in Children Over the Age of Six is an Effective Diagnostic Method for Adenoid Hypertrophy
Clinical Question In mouth-breathing children, how effective is a lateral cephalometric radiograph in diagnosing adenoid obstruction of the nasopharynx compared to a flexible fiber optic endoscopy diagnosis?
Clinical Bottom Line Although flexible fiber optic endoscopy (FFE) remains the gold standard in the diagnosis of adenoid hypertrophy, lateral cephalometric radiograph (LCR) analysis is a valid method of diagnosing the condition in mouth-breathing children between the ages of six and twelve. This makes it a useful screening tool to guide referrals to ENT specialists for assessment of Obstructive Sleep Apnea (OSA). These findings are based on a blind comparative study of 86 patients.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 22428943Souki/201286 mouth-breathing children (grouped by age 3-5yrs, 6-8yrs, 9-12yrs)Blind Comparative Study to the Gold Standard
Key resultsBoth linear (McNamara) and ratio (Kemaloglu et al.) measurements were evaluated, and validity varied between age groups. The sensitivity ranged from 71% (ratio) to 84% (linear). The specificity ranged from 83% (linear) to 97% (ratio). The PPV ranged from 88% (linear) to 97% (ratio). The NPV ranged from 70% (ratio) to 78% (linear).
Evidence Search lateral cephalometric radiograph AND adenoid hypertrophy
Comments on
The Evidence
The validity of the study varies between age groups and between measurement techniques; however, in general the high specificity and PPV suggest that the false positives will be minimal. Patients with LCRs that indicate enlarged adenoids will most likely be at risk for OSA. Sensitivity and NPV values are not as high, so false negatives are more likely. Therefore, patients who show clinical signs of nasopharyngeal obstruction should be evaluated further regardless of a LCR that does not indicate it.
Applicability LCRs are widely used by orthodontists in orthodontic diagnoses and treatment planning; evaluation of the nasopharynx on these LCRs would not require any additional investment by the provider or cost to the patient and could be done during cephalometric analysis. In patients six years and older this test is shown to be valuable in this setting as it can identify individuals with compromised nasal airways and facilitate their referral to an ENT specialist for assessment of OSA, a potentially life-altering disorder. Souki et al. note that early detection of OSA in children younger than six years of age would be beneficial for early management of the condition. However, this study did not find a strong correlation between LCR and FFE measurements in patients in this age range, warranting further investigation.
Specialty/Discipline (Oral Medicine/Pathology/Radiology) (Orthodontics) (Pediatric Dentistry)
Keywords lateral cephalometry, adenoid hypertrophy, nasopharynx, endoscopy
ID# 2521
Date of submission: 08/06/2013spacer
E-mail patelj2@uthscsa.edu
Author Jaanki Patel
Co-author(s) Inna Piskorska
Co-author(s) e-mail Piskorska@livemail.uthscsa.edu
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