Three-dimensional airway changes after adenotonsillectomy in children with obstructive apnea: Do expectations meet reality?

Abstract

Introduction: The assessment of the volumetric changes of the airways after adenotonsillectomy has gained popularity among orthodontists, but the validity of such evaluation is not clear. Methods: Thirty patients with obstructive sleep apnea diagnosed with the use of polysomnography (PSG) were evaluated according to the Apnea and Hypopnea Index (AHI), the obstructive apnea index (OAI), the oxygen desaturation index (ODI), the lowest oxygen saturation (LSpO(2)), and the average oxygen saturation (ASpO(2)). The volume and the minimal cross-section of lower (oropharynx and velopharynx) and upper (nasopharynx) spaces of the airways were calculated. Patients were adenotonsillectomized; posttreatment data were collected after 12 months. Thirty comparison patients also had the volume of airways evaluated. Results: A statistically significant improvement (P < 0.05) of most PSG parameters was observed after adenotonsillectomy: AHI from 14.5 to 5.2, OAI from 9.4 to 5.5, ODI from 14.6 to 6.5, and LSpO(2) from 77% to 94%). A significant increase in airway volume of the lower space (from 2571.5 mm(3) to 5276.3 mm(3)) and the upper space (from 726 mm(3) to 1056.9 mm(3)), as well as in the minimal cross-section of the airways (from 98.5 mm(2) to 335.8 mm(2)) was found in adenotonsillectomy patients. No significant volumetric changes of the airways were observed in the comparison patients. No significant correlation was found between PSG parameters and the dimensions of the airways before adenotonsillectomy. No significant correlation was found between changes of the PSG parameters and changes of the dimensions of the airways 12 months after the adenotonsillectomy. Conclusions: Adenotonsillectomy contributed to the increase of the airway volume and minimal cross-section, and to the improvement of the PSG parameters, but there was no correlation between the magnitude of the anatomic changes and the improvement of the breathing mode.