Radiographic adenoid evaluation: proposal of an
                    objective parameter

Feres, Murilo Fernando Neuppmann; Hermann, Juliana Sato; Sallum, Ana Carolina; Pignatari, Shirley Shizue Nagata

doi:10.1590/S0100-39842014000200008

Acessibilidade / Reportar erro

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Articles • Radiol. Bras. 47 (2) • Mar-Apr 2014 • https://doi.org/10.1590/S0100-39842014000200008 copy

Radiographic adenoid evaluation: proposal of an objective parameter^* * Study developed in the Department of Otorhinolaryngology and Head & Neck Surgery at Escola Paulista de Medicina – Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

The objective of the present study was to evaluate current radiographic parameters designed to investigate adenoid hypertrophy and nasopharyngeal obstruction, and to present an alternative radiographic assessment method.

Materials and Methods

In order to do so, children (4 to14 years old) who presented with nasal obstruction or oral breathing complaints were submitted to cavum radiographic examination. One hundred and twenty records were evaluated according to quantitative radiographic parameters, and data were correlated with a gold-standard videonasopharyngoscopic study, in relation to the percentage of choanal obstruction. Subsequently, a regression analysis was performed in order to create an original model so the percentage of the choanal obstruction could be predicted.

Results

The quantitative parameters demonstrated moderate, if not weak correlation with the real percentage of choanal obstruction. The regression model (110.119*A/N) demonstrated a satisfactory ability to “predict” the actual percentage of choanal obstruction.

Conclusion

Since current adenoid quantitative radiographic parameters present limitations, the model presented by the present study might be considered as an alternative assessment method in cases where videonasopharyngoscopic evaluation is unavailable.

Adenoids; Mouth breathing; Radiography; Diagnosis

Reference studies	Radiographic parameters
Jóhannesson(²²22 Jóhannesson S. Roentgenologic investigation of the nasopharyngeal tonsil in children of different ages. Acta Radiol Diagn (Stockh). 1968;7:299–304.)	Nasopharyngeal tonsil (NpT) (mm): greatest width of the soft tissue outlined anterior to the site of the pharyngeal tubercle, perpendicular to the bony roof of the nasopharynx (Figure 1A)
Fujioka et al.(²³23 Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-nasopharyngeal ratio. AJR Am J Roentgenol. 1979;133:401–4.)	Adenoid/ nasopharyngeal ratio (A/N): ratio between adenoid and nasoparyngeal space. Adenoid (A): greatest distance between a line drawn along the straight part of the inferior margin of the basiocciput and the point of maximal convexity of the anterior outline of adenoid.
	Nasopharyngeal space (N): distance between the posterior and superior edge of the hard palate and posteroinferior margin of the sphenobasioccipital syncondrosis (Figure 1B)
Crepeau et al.(¹1 Crepeau J, Patriquin HB, Poliquin JF, et al. Radiographic evaluation of the symptom-producing adenoid. Otolaryngol Head Neck Surg. 1982;90:548–54.)	Antroadenoid diameter (AA) (mm): shortest distance between the anterior outline of adenoid and the posterior wall of the maxillary antrum, which lies in the same plane as the posterior choanae (Figure 1C)
Maw et al.(²⁴24 Maw AR, Jeans WD, Fernando DC. Interobserver variability in the clinical and radiological assessment of adenoid size, and the correlation with adenoid volume. Clin Otolaryngol Allied Sci. 1981;6:317–22.)	Palatal airway (PA) (mm): shortest distance between the anterior outline of adenoid and the soft palate (Figure 1C)
Cohen et al.(²⁵25 Cohen D, Konak S. The evaluation of radiographs of the nasopharynx. Clin Otolaryngol Allied Sci. 1985;10:73–8.)	Air column (AC) (mm): distance between the superior outline of soft palate (at 10 mm from the posterior edge of the hard palate) and the anterior outline of adenoid (Figure 1D)
	Air column/ soft palate ratio (AC/SP): ratio between AC (see above) and SP, which represents the thickness of the soft palate (at 10 mm from the posterior edge of the hard palate) (Figure 1D)
Mlynarek et al.(¹²12 Mlynarek A, Tewfik MA, Hagr A, et al. Lateral neck radiography versus direct video rhinoscopy in assessing adenoid size. J Otolaryngol. 2004;33:360–5.)	Airway occlusion (AO) (%): ratio between NpT (see above) and nasopharynx (Np), which represents the distance between pharyngeal tubercle and the superior outline of the soft palate (Figure 1A)

	Variables	Mean ± SD^* * Standard deviation;	Min–Max^† † Minimum to maximum.
VNP examination (gold-standard)	MCO (%)	67.49 ± 18.37	9.16–100.0
Radiographic parameters	NpT (mm)	15.14 ± 3.66	8.39–24.98
	A/N	0.62 ± 0.12	0.33–0.88
	AA (mm)	7.03 ± 2.84	0.00–19.14
	PA (mm)	7.50 ± 3.37	1.15–18.62
	AC (mm)	8.77 ± 3.42	2.50–25.38
	AC/SP	1.21 ± 0.58	0.34-3.55
	AO (%)	61.24 ± 13.81	25.78–94.82

Variables	r	Pearson (p-value)
NpT (mm)	0.558	< 0.001
A/N	0.720	< 0.001
AA (mm)	−0.620	< 0.001
PA (mm)	−0.730	< 0.001
AC (mm)	−0.650	< 0.001
AC/SP	−0.476	< 0.001
AO (%)	0.674	< 0.001

Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
E-mail: radiologiabrasileira@cbr.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Mailing Address: Dr. Murilo Fernando Neuppmann Feres. Rua Afonso Celso, 982, ap. 12, Vila Mariana. São Paulo, SP, Brazil, 04119-060. E-mail: mn-feres@uol.com.br

Brasil

Brasil

Radiographic adenoid evaluation: proposal of an objective parameter* * Study developed in the Department of Otorhinolaryngology and Head & Neck Surgery at Escola Paulista de Medicina – Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.

Objective

Materials and Methods

Results

Conclusion

Radiographic adenoid evaluation: proposal of an objective parameter^* * Study developed in the Department of Otorhinolaryngology and Head & Neck Surgery at Escola Paulista de Medicina – Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.