Abstract
PurposeNormative data on the growth and development of the upper airway across the sexes is needed for the diagnosis and treatment of congenital and acquired respiratory anomalies and to gain insight on developmental changes in speech acoustics and disorders with craniofacial anomalies.MethodsThe growth of the upper airway in children ages birth to 5 years, as compared to adults, was quantified using an imaging database with computed tomography studies from typically developing individuals. Methodological criteria for scan inclusion and airway measurements included: head position, histogram-based airway segmentation, anatomic landmark placement, and development of a semi-automatic centerline for data extraction. A comprehensive set of 2D and 3D supra- and sub-glottal measurements from the choanae to tracheal opening were obtained including: naso-oro-laryngo-pharynx subregion volume and length, each subregion’s superior and inferior cross-sectional-area, and antero-posterior and transverse/width distances.ResultsGrowth of the upper airway during the first 5 years of life was more pronounced in the vertical and transverse/lateral dimensions than in the antero-posterior dimension. By age 5 years, females have larger pharyngeal measurement than males. Prepubertal sex-differences were identified in the subglottal region.ConclusionsOur findings demonstrate the importance of studying the growth of the upper airway in 3D. As the lumen length increases, its shape changes, becoming increasingly elliptical during the first 5 years of life. This study also emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions.
Highlights
The upper airway, a virtual conduit as characterized by Marcus et al [1], has an anatomic boundary defined by other tissues while serving the functions of respiration, food ingestion, as well as vocalization/speech, the function-based terms ‘aerodigestive tract’, ‘vocal tract’, or more comprehensively the ‘aerodigestive and vocal tract’
Our findings demonstrate the importance of studying the growth of the upper airway in 3D
This study emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions
Summary
The upper airway, a virtual conduit as characterized by Marcus et al [1], has an anatomic boundary defined by other tissues (bony, cartilaginous and soft) while serving the functions of respiration, food ingestion (mastication and deglutition), as well as vocalization/speech, the function-based terms ‘aerodigestive tract’, ‘vocal tract’, or more comprehensively the ‘aerodigestive and vocal tract’. As posited by current theory on craniofacial growth, the development of the upper airway is shaped by both genetic as well as intrinsic and extrinsic epigenetic factors, such as function, mechanical forces, and trauma [5– 13]. Among the priorities was the need to study the developmental changes of the upper airway anatomy and function during childhood (neonatal to puberty) across sexes and ethnicities and to provide normative values of the upper airway. A large number of studies have examined the upper airway anatomy using different modalities, methodologies, airway regions, and age ranges. Among the 34 studies listed, only 17 studies included linear, area and volumetric measurements, and fewer than half of those studies controlled for head position during or after data acquisition.
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