Cephalometric Features of Subjects with Adenoid Hypertrophy, Tonsillar Enlargement, and Combined Adenotonsillar Hypertrophy: An Early Predictor of Pediatric Sleep Apnea

Context: Enlargement of lymphoid tissue, in particular the palatine tonsils and adenoids, has been associated with developmental aberrations in the craniofacial structures as well as a leading cause of pediatric obstructive sleep apnea (OSA).This correlation has been well documented in orthodontic literature, but as yet, remains subjective and variable.Aims: In view of the above, a study is proposed to objectively correlate the anteroposterior and vertical cephalometric features of subjects with adenoid hypertrophy, tonsillar enlargement, and combined adenotonsillar hypertrophy. Settings and design:A cross-sectional study design was utilized, with the sample including 122 children reporting to the Department of Orthodontics and Dentofacial Orthopedics of Military Dental Facility and screened at Department of Otorhinolaryngology of Military Hospital.Materials and methods: The subjects were divided into 4 groups-adenoid enlargement (AG), tonsillar enlargement (TG), adenotonsillar enlargement (ATG), and control group (CG).Lateral cephalogram was used to evaluate skeletal discrepancy in sagittal and vertical planes.Statistical analysis used: Differences between the four participant groups were examined using a Kruskal-Wallis one-way analysis of variance.Furthermore, for each significant comparison, post-hoc pair-wise comparisons were conducted to determine differences between each group.The significance threshold was set at p < 0.05.Results: No significant differences were found in subjects with AG and ATG.Subjects in AG and ATG exhibited smaller SNB and larger ANB compared with CG.Conversely, TG showed larger SNB and smaller ANB in comparison with both AG and ATG.The AG and ATG subjects also had a vertical growth pattern with higher SN-GoGn, FMPA, and Y-axis in comparison with TG.There were a higher proportion of class II skeletal relationships and hyperdivergent pattern in AG and ATG in comparison with CG.In contrast, there were higher proportion of class III skeletal relationship in TG in comparison with CG. Conclusion:The study highlights the paramount importance of evaluation and screening of enlarged lymphoid tissue.Timely intervention can enhance nasal breathing and prevent potential, or reverse existing, abnormal facial growth and/or deleterious effects of pediatric OSA.