Efficacy of Lateral Neck Plain Radiographs in Suspecting an Obstruction at the Base of the Tongue in Children With Sleep Disordered Breathing

Background Obstructed breathing in children often requires adenotonsillar surgery as the primary treatment. Persistent symptoms may necessitate further diagnostic investigations and surgeries. Base of tongue (BOT) enlargement or lingual tonsillar hypertrophy (LTH), a common source of obstruction in these cases, is detected during flexible endoscopy, usually under sedation in the operating theatre. The role of lateral neck plain radiographs (LNPR) in this context is unknown. Objectives This study aims to assess the effectiveness of LNPR in diagnosing or suspecting obstruction at the level of BOT in the pediatric age group. Methods A retrospective cohort was conducted on children with upper airway obstruction between January 2020 and December 2023, following either failed adenotonsillar surgery or with unremarkable physical examination findings. Data included demographics, symptoms, comorbidities, sleep endoscopy findings, surgeries, and outcomes. The LNPRs were analyzed blindly by a radiologist using study-specific measurements. Radiological findings were compared with intraoperative findings, including those of sleep endoscopy, to assess diagnostic accuracy, specifically the ability to distinguish LTH from BOT enlargement and correlate with surgical outcomes. Results A total of 22 patients were included. Among them, 68.2% (15/22) were male, while 31.8% (7/22) were female. The mean age of the patients was 7.3 years, with a median of 6.2 years. Of these, 45.5% (10/22) had prior surgeries. Sleep endoscopy was done in 81.8% (18/22), and polysomnography in 40.9% (9/22). LNPRs accurately predicted obstruction at the BOT in 87.5% (14/16) of cases, with 72.2% (13/18) agreement between radiological and intraoperative findings regarding BOT surface description. Conclusion The LNPR is a valuable adjunct in evaluating BOT obstruction and may guide surgical planning. Standardization of radiological measures is recommended.