Citation Information :
Singh GP, Jayan B, Kadu A, Kadu N, Kamat UR. Correlation of Tonsillar Grading, Adenoid Grading, and Combined Adenotonsillar Hypertrophy with Various Inter- and Intra-arch Dental Parameters: An Early Predictor for Pediatric Sleep Apnea. Indian Sleep Med 2022; 17 (3):83-91.
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 tonsillar grading, adenoid grade, and combined adenotonsillar hypertrophy with various intra- and inter-arch dental parameters.
Settings and design: A cross-sectional study design was utilized with the sample including 150 children reporting to the Department of Orthodontics and Dentofacial Orthopedics of Military Dental Facility and screened at the Department of Otorhinolaryngology of Military Hospital.
Methods and materials: The study subjects were subdivided into five groups based on an objective evaluation of tonsillar and adenoid grading. The dental arch measurements were recorded from study models.
Statistical analysis used: A Chi-square test was used for comparison between categorical variables (demographic). The strength of the association between the tonsillar grade, adenoid grade, combined adenotonsillar hypertrophy, and the quantitative dental measures were assessed by using Spearman's correlation coefficient (ρ). A Chi-square test was used to measure the strength of association of qualitative dental arch variables with the tonsillar grade, adenoid grade, and combined adenotonsillar hypertrophy. The significance threshold was set at p <0.05.
Results: Enlarged adenoids are significantly and negatively correlated with intercanine, inter-premolar, and intermolar widths. The total depth of the palatal vault and the ratio of total depth of the palatal vault to maxillary interfirst molar width were significantly and positively correlated. Grade III/IV tonsils are strongly associated with an increased prevalence of Class III canine and molar relationship. Combined adenotonsillar hypertrophy is associated with the most significant changes in dental arch parameters.
Conclusions: The study highlights the paramount importance of the 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.
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