Avaliação radiográfica da adenoide - sugestão de parâmetros de referência

OBJECTIVE:this study aimed to evaluate the usefulness of current radiographic measurements, which were originally conceived to evaluate adenoid hypertrophy, as potential referral parameters.METHODS:children aged from 4 to 14 years, of both genders, who presented nasal obstruction complaints, were subjected to cavum radiography. Radiographic examinations (n = 120) were evaluated according to categorical and quantitative parameters, and data were compared to gold-standard videonasopharyngoscopic examination, regarding accuracy (sensitivity, negative predictive value, specificity, and positive predictive value).RESULTS:radiographic grading systems presented low sensitivity for the identification of patients with two-thirds choanal space obstruction. However, some of these parameters presented relatively high specificity rates when three-quarters adenoid obstruction was the threshold of interest. Amongst the quantitative variables, a mathematical model was found to be more suitable for identifying patients with more than two-thirds obstruction.CONCLUSION:this model was shown to be potentially useful as a screening tool to include patients with, at least, two-thirds adenoid obstruction. Moreover, one of the categorical parameters was demonstrated to be relatively more useful, as well as a potentially safer assessment tool to exclude patients with less than three-quarters obstruction, to be indicated for adenoidectomy.OBJETIVO:o objetivo deste estudo foi de investigar a utilidade de medidas radiográficas destinadas à avaliação da tonsila faríngea a serem utilizadas como potenciais parâmetros de encaminhamento.MÉTODOS:crianças de quatro a 14 anos, de ambos os gêneros, que apresentavam queixas referentes à obstrução nasal foram submetidas à radiografia do cavum. Os registros radiográficos (n = 120) foram avaliados de acordo com parâmetros categóricos e quantitativos, e dados resultantes foram comparados ao exame padrão-ouro de videonasofaringoscopia, em relação às suas taxas de acurácia (sensibilidade, valor preditivo negativo, especificidade e valor preditivo positivo).RESULTADOS:os parâmetros radiográficos categóricos apresentaram baixa sensibilidade para a identificação de pacientes portadores de 2/3 de obstrução do espaço coanal. No entanto, alguns destes parâmetros apresentaram especificidades relativamente altas quando 3/4 de obstrução coanal era o ponto de corte de interesse. Dentre as variáveis quantitativas, um modelo matemático se mostrou mais adequado para identificar pacientes com mais de 2/3 de obstrução coanal.CONCLUSÃO:este modelo demonstrou, assim, ser potencialmente útil como método de rastreamento para identificação de pacientes com pelo menos 2/3 de obstrução adenoidiana. Além disso, um dos parâmetros categóricos analisados demonstrou ser relativamente mais útil e potencialmente seguro para eliminar pacientes queixosos com menos de 3/4 de obstrução a serem indicados à adenoidectomia.Universidade São Francisco Faculdade de OdontologiaUniversidade Federal de São Paulo (UNIFESP) Department of Otorhinolaryngology, Head and Neck SurgeryUNIFESP, Department of Otorhinolaryngology, Head and Neck SurgerySciEL

Reliability of radiographic parameters in adenoid evaluation

The assessment of adenoids by x-ray imaging has been the topic of heated debate, but few studies have looked into the reliability of most existing radiographic parameters. OBJECTIVE: This study aims to verify the intra-examiner and inter-examiner reproducibility of the adenoid radiographic assessment methods. MATERIALS AND METHODS: This is a cross-sectional case series study. Forty children of both genders aged between 4 and 14 were enrolled. They were selected based on complaints of nasal obstruction or mouth breathing and suspicion of pharyngeal tonsil hypertrophy. Cavum x-rays and orthodontic teleradiographs were assessed by two examiners in quantitative and categorical terms. RESULTS: All quantitative parameters in both x-ray modes showed excellent intra and inter-examiner reproducibility. Relatively better performance was observed in categorical parameters used in cavum x-ray assessment by C-Kurien, C-Wang, C-Fujioka, and C-Elwany over C-Cohen and C-Ysunza. As for orthodontic teleradiograph grading systems, C-McNamara has been proven to be more reliable than C-Holmberg. CONCLUSION: Most instruments showed adequate reproducibility levels. However, more research is needed to properly determine the accuracy and viability of each method.Embora a avaliação radiográfica da hipertrofia de tonsila faríngea tenha sido constantemente debatida, há ainda carência de estudos que testem a confiabilidade da maioria dos parâmetros radiográficos existentes. OBJETIVO: Verificar a reprodutibilidade intra e interexaminadores de vários métodos destinados à avaliação da tonsila faríngea. Forma de estudo: Estudo de série, metodológico e transversal. MATERIAL E MÉTODO: Quarenta crianças de ambos os sexos, de 4 a 14 anos, foram selecionadas mediante apresentação de queixas de obstrução nasal ou respiração oral, com suspeita de diagnóstico de hipertrofia de tonsila faríngea. Radiografias do cavum faríngeo e telerradiografias ortodônticas foram obtidas e, posteriormente, avaliadas por dois examinadores por meio de instrumentos de avaliação quantitativos e categóricos. RESULTADOS: Todos os parâmetros quantitativos de ambas as modalidades radiográficas apresentaram excelente reprodutibilidade intra e interexaminadores. Dentre os parâmetros categóricos de avaliação da radiografia de cavum, observou-se desempenho relativamente melhor de C-Kurien, C-Wang, C-Fujioka e C-Elwany sobre C-Cohen e C-Ysunza. Em relação aos sistemas destinados à classificação da telerradiografia, C-McNamara apresentou maior reprodutibilidade que C-Holmberg. CONCLUSÃO: A maioria dos instrumentos apresentou reprodutibilidade adequada. No entanto, novas investigações ainda devem ser realizadas com o intuito de determinar a capacidade de cada parâmetro em relação sua acurácia e viabilidade.Universidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Adenoid evaluation according to cavum x-ray and cephalometric examinations: correlation to videonasopharyngoscopy

Objetivo: Esta serie de pesquisas teve como objetivo geral avaliar a utilidade de exames radiograficos cranianos laterais, sejam estes a telerradiografia lateral ortodontica, ou o raio-X simples de cavum, na avaliacao da hipertrofia de tonsila faringea. Metodos: Criancas de 4 a 14 anos, de ambos os generos, apresentando queixas de obstrucao nasal ou respiracao oral com suspeita de hipertrofia de tonsila faringea foram submetidas a ambos os exames radiograficos. Ao todo, registros radiograficos de cento e vinte sujeitos (n=120) foram avaliados de acordo com diversos metodos de afericao, sejam estes quantitativos ou categoricos. Na mesma ocasiao, os sujeitos realizaram o exame de videonasofaringoscopia, considerado como padrao-ouro, tendo em vista a porcentagem de obstrucao coanal provocada pelo tecido da tonsila faringea. As variaveis radiograficas foram inicialmente avaliadas em relacao a sua reprodutibilidade intra e interexaminadores. Para isso, um terco da amostra inicial teve suas radiografias avaliadas em momentos distintos e por observadores independentes. Posteriormente a analise referida, os instrumentos radiograficos efetivamente reprodutiveis foram entao testados quanto a sua acuracia em toda a amostra. Para isso, os sistemas classificatorios tiveram suas categorias comparadas entre si em relacao a porcentagem de obstrucao coanal verificada em videonasofaringoscopia. Alem disso, estes mesmos instrumentos foram avaliados conforme suas taxas de sensibilidade e especificidade, tendo como referencias pontos de corte de 66,67% e 75,00% de obstrucao coanal vista em videonasofaringoscopia. Os parametros quantitativos, por sua vez, tiveram sua acuracia avaliada mediante analises de correlacao com a mesma medida de referencia. Resultados: Todos os metodos quantitativos demonstraram excelente reprodutibilidade intra e interexaminadores. Dos metodos classificatorios, a menor parte apresentou reprodutibilidade inadequada (C-Holmberg, C-Cohen, C-Ysunza). Os instrumentos de categorizacao remanescentes (C-McNamara, C-Fujioka, C-Elwany, C-Wang e C-Kurien), apesar de apresentarem porcentagens de obstrucao coanal significativamente diferentes entre suas classes, demonstraram baixa sensibilidade para identificacao de portadores de obstrucao minima de 66,67% e 75,00%. Alem disso, a maioria dos parametros quantitativos apresentou, embora significativas, correlacoes moderadas em relacao ao padrao-ouro. Diante destas limitacoes, foram desenvolvidos dois modelos matematicos. Um deles (110,119 x A/N), viabilizado a partir de variaveis medidas em radiografias de cavum, demonstrou boa capacidade de predicao do real valor de obstrucao. O segundo (Ad/Nf -1,323 x Pm-ad1), gerado pelas variaveis aferidas em telerradiografias, apresentou semelhante habilidade de predicao, alem de capacidade para identificacao de pacientes portadores de obstrucao minima de 66,67%. Ainda, tendo em vista a utilizacao isolada de parametros designados a avaliacao de radiografias de cavum, foram calculados e sugeridos novos limiares capazes de identificar portadores de obstrucao coanal minima de 66,67% (PA ou A/N) e 75,00% (PA ou OVA). Conclusoes: Os resultados provenientes desta serie de pesquisas verificaram limitacoes em relacao a reprodutibilidade ou a acuracia dos metodos radiograficos atualmente disponiveis. Novos e potencialmente uteis instrumentos foram entao introduzidos. No entanto, pesquisas futuras devem ainda ser empreendidas com os propositos de confirmacao das utilidades sugeridas, e investigacao acerca do proveito destes novos parametros em relacao a escolha por condutas terapeuticas especificas e previsibilidade de prognostico consequenteBV UNIFESP: Teses e dissertaçõe

Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers

OBJECTIVE: To assess short-term tomographic changes in the upper airway dimensions and quality of life of mouth breathers after rapid maxillary expansion (RME). METHODS: A total of 25 mouth breathers with maxillary atresia and a mean age of 10.5 years old were assessed by means of cone-beam computed tomography (CBCT) and a standardized quality of life questionnaire answered by patients' parents/legal guardians before and immediately after rapid maxillary expansion. RESULTS: Rapid maxillary expansion resulted in similar and significant expansion in the width of anterior (2.8 mm, p < 0.001) and posterior nasal floor (2.8 mm, p < 0.001). Although nasopharynx and nasal cavities airway volumes significantly increased (+1646.1 mm3, p < 0.001), oropharynx volume increase was not statistically significant (+1450.6 mm3, p = 0.066). The results of the quality of life questionnaire indicated that soon after rapid maxillary expansion, patients' respiratory symptoms significantly decreased in relation to their initial respiratory conditions. CONCLUSIONS: It is suggested that RME produces significant dimensional increase in the nasal cavity and nasopharynx. Additionally, it also positively impacts the quality of life of mouth-breathing patients with maxillary atresia

Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: A systematic review

Objectives: Many studies have been developed aiming to reveal the usefulness of cavum X-rays and telerradiographies as diagnostic tools for the detection of upper airway obstruction due to adenoid hypertrophy. However, the scientific literature is diverse and controversial. Therefore, a systematic review is proposed; with the objective to determine the diagnosis value of lateral X-ray view of the skull regarding adenoid hypertrophy.Methods: Searching was conducted on Pubmed, Lilacs, Cochrane Library, Embase, and Web of Knowledge databases; and was restricted to studies published in English, Portuguese or Spanish languages, carried out on humans under 18 years of age. All the obtained publications were first submitted to a pre-selection, and then, full-texts (n = 66) were analyzed and selected by independent examiners. the resultant studies (n = 11) were systematically and critically analyzed, and qualified according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) questionnaire, an assessment tool designed to qualify diagnostic tests accuracy studies.Results: Searching and selection procedures generated 11 studies which were considered adequate to be systematically analyzed. Accordingly, large variation was observed concerning the evaluation methods of radiographic and fibronasoendoscopic exams, and the sample characteristics. Additionally, little amount of scientific evidences could be provided, since few radiographic variables were analyzed simultaneously. Moreover, assessment methods were, at most, subjective or poorly described. QUADAS application revealed other significant limitations related to the sampling, such as inadequate spectrum of the investigated disease (adenoid hypertrophy), and poor report of the subjects' enrollment and participation process. Further, QUADAS revealed inadequacies regarding methodological features, including poor description of the radiographic exams and assessment methods. in addition, it was also shown that most of the studies did not specify the moment in clinical time when both exams were performed; neither reported a strategy of blindness by the examiners.Conclusions: Despite such limitations, the majority of the resultant data indicates that lateral X-rays might be considered somewhat useful, even though it could not be clearly demonstrated. Future research should then adhere to greater methodological rigor, in order to investigate the significance of radiographies as a screening test. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Universidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-18040710 Sorocaba, SP, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol, Div Pediat Otolaryngol, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-02016001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-04101300 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-18040710 Sorocaba, SP, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol, Div Pediat Otolaryngol, BR-04025002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-02016001 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, BR-04101300 São Paulo, BrazilWeb of Scienc

Cephalometric evaluation of adenoids: An analysis of current methods and a proposal of a new assessment tool

Introduction: Although the scientific literature recognizes that lateral cephalometric radiographs might be clinically useful, there is no consensus in relation to the best parameter available. Therefore, this research was aimed at evaluating current radiographic assessment methods designed to investigate adenoid hypertrophy and nasopharyngeal obstruction. Methods: Children from 4 to 14 years old with nasal obstruction or oral breathing complaints, suspected to be caused by adenoid hypertrophy, received cephalometric examinations. One hundred twenty radiographic records were evaluated according to several current methods, and data were compared with respective gold-standard videonasopharyngoscopic examinations, in relation to the percentage of choanal obstruction. Results: Groups derived from a grading system had significantly different percentages of choanal obstruction. However, this parameter showed low sensitivity. Significant but moderate correlations were observed between most of the quantitative radiographic parameters and the percentage of choanal obstruction. Alternatively, a regression model was introduced; it demonstrated satisfactory ability to predict choanal obstruction percentage. Despite limitations, this model could also distinguish patients who might benefit from referral to otolaryngologic care. Conclusions: Current adenoid assessment methods have significant limitations. A novel assessment method introduced here might be clinically useful. (Am J Orthod Dentofacial Orthop 2012; 142: 671-8)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Otolaryngol Head & Neck Surg, Div Pediat Otolaryngol, São Paulo, BrazilFAPESP: 08/53538-0Web of Scienc

Comparative tomographic study of the maxillary central incisor collum angle between Class I, Class II, division 1 and 2 patients

INTRODUCTION: It has been reported that Class II, division 2 maxillary central incisors frequently demonstrate increased collum angles, which indicates an excessive palatal “bend” of the crown. However, evidence supporting such observation is mostly derived from radiographic studies. OBJECTIVE: The objective of this study was to evaluate and compare the collum angle of maxillary central incisors in Class I, Class II, division 1, and Class II, division 2 cases using cone-beam computed tomography. MATERIALS AND METHODS: Forty-eight consecutive orthodontic cases (16 Class I, 16 Class II, division 1, and 16 Class II, division 2 malocclusion) with cone-beam computed tomography as part of their initial diagnostic records were evaluated. Cross-sections including maxillary right and left central incisors were used to calculate the angulation between the crown and root long axes (collum angle). Comparisons between groups were performed using analysis of variance for multiple and post-hoc Tukey for paired analyses. RESULTS: Mean collum angle observed in Class II, division 2 cases was significantly larger (5.2 ± 1.3°) than the ones obtained for Class I (1.1 ± 4.2°) (P = 0.034) or Class II, division 1 cases (0.1 ± 0.7°) (P = 0.014). CONCLUSIONS: Our findings suggest that Class II, division 2 individuals demonstrate accentuated lingual inclination of the maxillary central incisor crown compared to the other types of malocclusion studied here. Such morphological feature indicates the need for better tooth movement planning, especially in regard to root palatal torqueing of the maxillary central incisors