Nasopharyngeal Volume Research Articles

Three-dimensional volumetric magnetic resonance imaging (MRI) analysis of the soft palate and nasopharynx in brachycephalic and non-brachycephalic dog breeds.

The purpose of this study was to use magnetic resonance imaging (MRI) to compare the volumes and three-dimensional configurations of the soft palate and nasopharynx in non-brachycephalic and brachycephalic dogs with different body weights, and infer which factors influence nasopharyngeal volume. This was a retrospective observational study. The brain MRI medical records of all dogs referred to the Veterinary Medical Center, Chungbuk National University, between 2013 and 2016, for evaluation of intracranial disease were reviewed. There was a significant difference in the two-dimensional parameters including soft palate length/skull length ratio (P<0.01) and maximum soft palate thickness (P<0.01), and three-dimensional parameters which included soft palate volume (P<0.01), nasopharyngeal volume (P<0.01), soft palate/total upper airway volume ratio (P<0.01), and nasopharyngeal volume/total upper airway volume ratio (P<0.01), between brachycephalic and non-brachycephalic dog breeds. Nasopharyngeal volume correlated positively with the maximum soft palate thickness and body weight in all breeds. The three-dimensional morphologic grades of soft palate were significantly different between the two groups. In brachycephalic breeds, Grade 3 was observed in 33% of cases but was absent in non-brachycephalic breeds, where Grade 1 was present in 85% of the cases. We can conclude that three-dimensional morphology and upper airway volume are significantly different between brachycephalic and non-brachycephalic breeds, and body weight and maximum soft palate thickness are the key factors associated with a decreased nasopharyngeal volume.

Evaluation of Airway Volume in Cleft Lip and Palate Following Nasoalveolar Molding.

Patients with cleft lip and palate (CLP) have commonly reduced nasal airways and are more prone to snoring, mouth breathing and hypopnea during sleep. Therefore, the morphometric evaluation of pharyngeal airway in patients with CLP is crucial. The purpose of this study is to evaluate the pharyngeal airway volumes of patients with CLP who underwent nasoalveolar molding (NAM) and to compare them with a well-matched control group without NAM. The study consisted of 40 patients with CLP divided into 2 main groups (26 with NAM; 14 without NAM) and 4 subgroups (15 unilateral CLP [UCLP] with NAM, mean age: 10.13 ± 1.30 years; 11 bilateral CLP [BCLP] with NAM, mean age: 10.55 ± 1.51 years; 7 UCLP without NAM, mean age: 9.86 ± 1.68 years; 7 BCLP without NAM, mean age: 10.28 ± 1.89 years). Nasopharyngeal, oropharyngeal, and total airway volumes of all the patients were calculated 3-dimensionally with cone-beam computed tomography. There were statistically significant differences in nasopharyngeal volume (P < 0.05) of NAM group compared to control group; however, volumetric differences in oropharyngeal and total pharyngeal airway were not significant (P > 0.05). The amount of nasopharyngeal, oropharyngeal, and total pharyngeal airway size in the BCLP with NAM group was significantly larger compared to BCLP without NAM group (P < 0.05). However, UCLP did not show any significant difference in NAM group (P > 0.05). This study implies that NAM can effectively enlarge the nasopharyngeal airway size in patient with CLP. In addition, the pharyngeal airway volume enlargement is more apparent in BCLP than UCLP individuals.

Volumetric changes of the upper airway following maxillary and mandibular advancement using cone beam computed tomography

The objective of this project was to retrospectively evaluate changes in volume of different compartments of the upper airway in response to maxillary, mandibular, and bimaxillary advancement surgeries and to predict the extent of volumetric changes associated with these surgical movements. Pre- and post-surgical cone beam computed tomography scans of 36 patients were evaluated for changes in nasal cavity, nasopharyngeal, oropharyngeal, and hypopharyngeal compartments. The amount of movement for each surgery was measured from skeletal landmarks to reference planes and was correlated with volumetric changes. Maxillary advancement of 4.0±2.2mm increased the oropharyngeal volume significantly (41.40%), and mandibular advancement of 3.8±1.6mm also significantly increased the oropharyngeal volume (21.17%). Bimaxillary advancement of 5.1±1.3mm for the maxilla and 6.4±3.1mm for the mandible significantly increased nasopharyngeal (27.45%), oropharyngeal (66.39%), and hypopharyngeal (52.48%) volumes. Furthermore, for every millimeter anterior movement, oropharyngeal volume increased by 2319.2±771.8mm3. Bimaxillary advancement showed a greater increase than isolated maxillary and mandibular advancement in all pharyngeal compartments. Every millimeter of advancement in the bimaxillary group led to a significant increase in oropharyngeal volume, while every millimeter downward movement showed a significant increase in nasopharyngeal volume.

Evaluation of Three-Dimensional Changes in Pharyngeal Airway Following Isolated Lefort One Osteotomy for the Correction of Vertical Maxillary Excess: A Prospective Study.

Orthognathic surgery involves movement of jaws in all three planes, and this being a part of airway complex, displacement of jaws can influence the dimension of airway at all levels. Lefort one osteotomy surgery with superior repositioning is a common procedure done for patients with vertical maxillary excess. The purpose of this study was to evaluate the three-dimensional volumetric changes in airway after lefort one impaction surgery using three-dimensional cone beam computed tomography (3D-CBCT) in patients with vertical maxillary excess (VME). A prospective analysis of 15 patients who underwent isolated lefort one impaction surgery was done with pre-operative (T0) and 3-months (T1) post-operative 3D-CBCT scans. Airway was divided into three segments, nasopharyngeal, velopharyngeal and oropharyngeal. Volumetric analysis of all these segments was done before and after surgery. Paired 't test' was used to assess the mean difference in airway volume and area between T0 and T1. One-way ANOVA was used to check the mean percentage difference in airway volume and area among the three segments. The mean percentage of nasopharyngeal volume difference was - 0.6299 ± 0.9146%, velopharyngeal volume difference was - 0.5205 ± 1.107%, oropharyngeal volume difference was - 1.492 ± 2.745%. Though volume and area of pharyngeal airway were decreased after maxillary impaction surgery in all three segments of airway studied, they were not statistically significant. Among the three segments of airway studied, oropharyngeal airway volume has shown the highest post-surgical reduction though statistically insignificant. ESS scores were within normal limits. Hence, we are of the opinion that there is lack of evidence to conclude that the patients undergoing lefort one superior repositioning for the treatment of VME might develop significant narrowing of PAS that may predispose the patient to breathing disorders.

Changes of nasal and oronasopharyngeal airway morphologies and nasal respiratory function following orthognathic surgery

ObjectiveThe aim of this study was to determine the effects of maxillomandibular movements by orthognathic surgery on nasal and oronasopharyngeal airway morphologies and nasal respiratory function. MethodsThe subjects were 32 patients in whom jaw deformities were corrected by two jaw surgery. The amount of jaw movements was evaluated on cephalograms taken before surgery and more than six months after surgery, and morphological changes were evaluated using helical computed tomography (CT), and nasal airway resistance (NAR) for the objective evaluation of nasal respiratory function was measured by anterior rhinomanometry. The results showed that the volume of the nasal cavity and NAR was not changed significantly after surgery. However, the change of NAR was negatively correlated with changes of nasopharyngeal volume and the cross-sectional area in the palatal section (P-CSA). The change of NAR correlated with horizontal movement at B-point. Furthermore, the amount of vertical movement of the maxilla at the posterior nasal spine (PNS) was significantly correlated with reductions in the volume of the oropharynx upper region. ConclusionThere was little association of changes in maxillomandibular position or nasal and oronasopharyngeal airway morphologies with nasal respiratory function. This might be because of compensatory biomedical action to maintain nasal respiratory function.

Pharyngeal airway changes after mono-maxillary advancement surgery

Introduction/Objective. Maxillary or mandibular retrognathism are common dentofacial deformities treated by combined orthodontic-surgical treatment. Surgical maxillary or mandibular advancement changes the position and strain of surrounding structures, which may also affect pharyngeal airway dimensions. The aim of this study was to evaluate and compare three-dimensional pharyngeal airway space changes in patients treated with maxillary advancement and those treated with mandibular advancement. Methods. The sample consisted of 25 patients ? 12 treated with maxillary advancement and 13 with mandibular advancement surgery. Nasopharyngeal (NP) volume, oropharyngeal (OP) volume, and the area of maximum constriction (AMC) in the OP were measured on cone beam computed tomography scans (2 mA / 120 kV / 12?? FOV) taken before and at least three months after surgery. Paired samples t-test was used for analyzing statistical significance of changes (p ? 0.05). Results. Postoperative OP and NP volumes, as well as the AMC, increased insignificantly in both groups. Conclusion. Results suggest that mono-maxillary surgical advancement of the maxilla or the mandible increases pharyngeal airway dimensions.

Pre- and post-operative application of acoustic rhinometry in children with otitis media with effusion and with or without adenoid hypertrophy-a retrospective analysis

BackgroundThere is no standardized scheme for preoperative evaluation of adenoid hypertrophy or a consensus on surgical indications for adenoidectomy in children with otitis media with effusion (OME), especially for young children intolerant to nasal endoscopic assessment. The aim of this study was to evaluate the efficacy and reliability of acoustic rhinometry (AR) in evaluating benefits from adenoidectomy in children with OME. MethodChildren with OME who were scheduled for surgical intervention were reviewed and AR tests performed preoperatively and postoperatively. The patients were divided into two groups based on the surgical strategy (Group I: tympanostomy tube placement alone; Group II: tympanostomy tube placement plus adenoidectomy). Correlation and regression analyses were performed to assess the relationship between findings of AR and nasal endoscopy. AR parameters including minimal nasal cross-sectional area (MCA), and nasopharyngeal volume (NPV), as well as scores of subjective symptoms were obtained to evaluate the utility of AR pre- and post-surgery. ResultsSixty-five children aged 4–10 years who met the inclusion criteria were included. No significant differences in gender or age distribution were observed between Group I and Group II. MCA, as well as NPV significantly decreased in Group II when compared with Group I (p = 0.000). A significant inverse correlation was observed between NPV and choanal obstruction ratio in both groups I (r = -0.625, p < 0.001) and II (r = −0.570, p < 0.001). A significant difference between preoperative and postoperative NPV and subjective symptom scores was observed in group II after adenoidectomy (p = 0.000). ConclusionAR parameters showed a good clinical correlation with findings of nasal endoscopy and thus may be useful for evaluating candidacy for surgical adenoidectomy among children with OME, especially in whom preoperative nasal endoscopic examination is not feasible. Additionally, AR can reveal the changes occurring within the nasopharyngeal passage before and after adenoidectomy.

Subcranial and orthognathic surgery for obstructive sleep apnea in achondroplasia

PurposeObstructive sleep apnea (OSA) is a common problem in patients with achondroplasia. The purpose of this study was to assess changes in airway volumes following various degrees of facial skeletal advancement. MethodsThis was a retrospective evaluation of patients with achondroplasia who underwent facial skeletal advancement for obstructive sleep apnea. Patients were treated with either an isolated Le Fort III distraction (LF3) or Le Fort II distraction with or without subsequent Le Fort I and bilateral sagittal split osteotomies (LF2 ± LF1/BSSO). Demographic, cephalometric, volumetric, and polysomnographic variables were recorded pre- and postoperatively. ResultsSix patients with achondroplasia underwent midface advancement for treatment of OSA (2 LF2 + LF1/BSSO, 2 LF2, 2 LF3). Patients undergoing LF2 + LF1/BSSO had consistent volumetric improvements at the nasopharyngeal and oropharyngeal levels (Δ ≥ +347% and ≥+253%, respectively). Patients undergoing LF2 alone had consistent improvement in the nasopharyngeal airway alone (Δ ≥ +214%). Patients undergoing LF3 alone had consistent, but less dramatic, changes in nasopharyngeal volume (Δ ≥ +97.1%). All patients undergoing LF2 distraction (with or without LF1/BSSO) had a ≥50% reduction in the apnea–hypopnea index (AHI) postoperatively; there was no improvement in AHI with LF3 alone. ConclusionIn patients with achondroplasia-associated OSA there are variable improvements in airway volume. This preliminary report suggests that LF2 distraction, with or without subsequent LF1/BSSO, may provide consistent reductions in AHI relative to LF3 distraction.

Acoustic Rhinometry for Evaluation of Velopharyngeal Function in Preschool Children Post Palatoplasty

To assess the feasibility of acoustic rhinometry for the evaluation of velopharyngeal function in preschool children by detecting changes in nasal cavity volume (NV) and minimal cross-sectional area (MCSA) after palatoplasty. Sixty-one preschool children with incomplete cleft palate who underwent Sommerlad palatoplasty were examined by acoustic rhinometry. MCSA, distance of the MCSA from the nostril (DMCA), NV, and nasopharyngeal volume (NPV) were measured. Patients were grouped according to velopharyngeal state and lateral cephalographic findings. MCSA, NV, and NPV showed a meaningful difference between the experimental and control groups. DMCA in the experimental group (7.09±1.33mm) was not markedly different between the 2sides. NV, NPV, and MCSA in the velopharyngeal insufficiency (VPI) subgroup were obviously larger than those in the velopharyngeal competence (VPC) and marginal VPI subgroups. NV in the VPC group showed no relevant difference from that in the control group. No relevant difference in MCSA, DMCA, and NPV was observed among the 3 subgroups at radiographic evaluation. NV in the noncontact group was markedly larger than in the control group. The curve showed marked constriction in the anterior part but an elevation in the posterior part, especially at a distance of 7.09cm. Acoustic rhinometry is a rapid, noninvasive, and reproducible method that can be used in lieu of lateral cephalography for quantitative evaluation of the NV and MCSA. It can be used to assess postoperative velopharyngeal function in children and has good adaptability.

Relationship Between Age and Diagnosis on Volumetric and Linear Velopharyngeal Measures in the Cleft and Noncleft Populations.

The purpose of this study was to create a 3D volumetric segmentation from magnetic resonance imaging (MRI) of the nasopharyngeal space and adenoid tissue and to examine the relationship between nasopharyngeal volume (NPV), adenoid volume, and linear measures of the velopharyngeal structures, pharynx, and vocal tract in children with and without cleft palate. A total of 24 participants including 18 typically developing children (4-8 years of age) and 6 children (4-8 years of age) with varying degrees of cleft palate were imaged using MRI. Linear and volumetric variables varied significantly based on age. Overall, NPV demonstrates a modest increase with age. Nasopharyngeal volume was positively correlated with age (P = 0.000), oronasopharyngeal volume (P = 0.000), velar length (P = 0.018), and velar thickness (P = 0.046). These variables tend to increase together. Differences in NPV between groups (bilateral cleft lip and palate, submucous cleft lip and palate, unilateral cleft lip and palate [UCLP], and noncleft) were statistically significant (P = 0.007). Participants with bilateral cleft lip and palate demonstrated greater NPVs than those with UCLP and submucous cleft palate.

Long-term efficacy of intensity-modulated radiotherapy with or without chemotherapy in treatment of nasopharyngeal carcinoma and its influencing factors: an analysis of 454 patients

Objective To analyze the long-term efficacy of intensity-modulated radiotherapy (IMRT) with or without chemotherapy in treatment of 454 patients with nasopharyngeal carcinoma (NPC) and its influencing factors. Methods A retrospective analysis was performed on the clinical data of 454 patients with non-metastatic NPC who received IMRT with or without chemotherapy in our center from 2007 to 2012. Prescribed doses of 69.96-73.92 Gy in 33 fractions, 69.96 Gy in 33 fractions, 60.06 Gy in 33 fractions, and 50.96 Gy in 28 fractions were applied to nasopharyngeal gross tumor volume, cervical metastatic lymph nodes, high-risk drainage area, and low-risk drainage area, respectively. In all patients, 438 received induction chemotherapy, 420 concurrent chemotherapy, and 216 adjuvant chemotherapy, most of which were based on cisplatin and taxol. The Kaplan-Meier method was used for calculating survival rates and the log-rank test was used for survival difference analysis and univariate prognostic analysis. The Cox model was used for the multivariate prognostic analysis. Results The 3-year sample size was 210. The 3-year overall survival (OS), local recurrence-free survival, nodal relapse-free survival, progression-free survival, and distant metastasis-free survival (DMFS) rates were 88.1%, 91.0%, 90.7%, 80.5%, and 85.1%, respectively. Age, T stage, and N stage were influencing factors for the OS rate (P=0.011; P=0.005; P=0.033); T stage and N stage were influencing factors for the disease progression-free survival (P=0.017; P=0.005) and DMFS (P=0.012; P=0.019). The grade ≥3 acute and late adverse reactions included hematological toxicity, oral mucositis, xerostomia, dysphagia, and brain injury. Conclusions IMRT promotes the long-term survival rates in patients with NPC. The distant metastasis is the major reason for treatment failure. The adverse reactions induced by IMRT combined with chemotherapy are tolerable. Key words: Nasopharyngeal neoplasms/radiotherapy; Radiotherapy, intensity-modulated; Prognosis

Nasopharyngeal Airway Volume for Different GOSLON Scores in Patients With Unilateral Cleft Lip and Palate.

The aim of this study is to evaluate the nasopharyngeal airway volumes of patients with unilateral cleft lip and palate (UCLP) with different GOSLON scores. The study sample consisted of 34 patients with UCLP and 20 controls with no cleft history. In the UCLP group, three experienced examiners used the GOSLON Yardstick to rate dental arch relationships, and the sample was divided into three groups as GOSLON 2 (G2) (n = 13), GOSLON 3 (G3) (n = 10), and GOSLON 4 (G4) (n = 11). Airway volumes were constructed using three-dimensional computed tomography data and divided into four compartments named the nasal airway, and superior, middle, and inferior pharyngeal airways. No statistically significant difference was detected among G2, G3, and G4 between the constitutive airway departments of the nasopharyngeal region. However, nasal airway volumes were significantly higher in the control group when compared with the UCLP group. Although there was no correlation among the investigated parameters, it is also a fact that airway capacities display a great variability among patients when investigated three dimensionally. Although the severity of GOSLON scores might predetermine the extent of which the airways are affected from the cleft, a larger sample size is needed in future studies.

Validity of acoustic rhinometry in the evaluation of patients with adenoid hypertrophy.

Reliability of acoustic rhinometry (AR) for preoperative diagnosis and decision of surgery in children with adenoid hypertrophy were investigated in this study. Fifty-five children who cannot tolerate nasal endoscopic examination were included. The AR was performed preoperatively and postoperatively 1 month later. The volume of distance between the 6th and 10th centimeters in rhinogram curve was calculated for evaluating the adenoid notch (AN) region. The volume of AN region was compared with each patient's volume of the adenoid tissue removed with adenoidectomy. Whereas the median adenoid specimen volume was 2.0 (1.0-2.0) cm3 in 23 patients with complaint of nasal obstruction, median AN volumes in the rhinogram curve was 2.3 (0.8-5.2) cm3. All children whose preoperative nasopharyngeal volume was 4.2 cm3 or less had increased volume in the area representing the nasopharynx on rhinogram. We found a statistically significant relationship between the AN and the adenoid specimen volume (P = 0.000, r = 0.797). The sensitivity and specificity were found as 61.2% and 95.8%, respectively. We concluded that the children whose preoperative nasopharyngeal volumes were measured as 4.2 cm3 or less by AR could benefit more from adenoidectomy.

Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate

Patients affected by cleft lip and palate often have complaints of snoring and respiratory difficulties during sleep. The purposes of this study were to evaluate nasopharyngeal, oropharyngeal, and total airway volumes of patients affected by unilateral cleft lip and palate and to compare them with a well-matched control group without unilateral cleft lip and palate using cone-beam computed tomography. The study sample consisted of 60 patients (26 girls, 34 boys) divided into 2 groups: unilateral cleft lip and palate (20 boys, 10 girls; 8 right sided, 22 left sided; mean age, 14.6±3.2years) and no cleft (control group; 14 boys, 16 girls; mean age, 14.8±2.8years). Nasopharyngeal, oropharyngeal, and total airway volumes of the subjects in both groups were calculated 3 dimensionally with cone-beam computed tomography. Group differences in relation to cleft side, sex, and cleft presence were statistically tested at P<0.05. Patients affected by unilateral cleft lip and palate had similar airway volumes regardless of the side of the cleft. In addition, no statistically significant differences were found between the sexes in the 2 groups. Patients affected by unilateral cleft lip and palate had smaller nasopharyngeal, oropharyngeal, and total airway volumes when compared with the control group. The difference for oropharyngeal airway volume (-4036.7mm(3)) was statistically significant (P<0.05), whereas nasopharyngeal volume (-21.6mm(3)) and total airway volume (-4057.3mm(3)) differences were not significant (P>0.05). Patients affected by unilateral cleft lip and palate had decreased volumes of oropharyngeal (P<0.05) and total (P>0.05) airways compared with the well-matched control group without unilateral cleft lip and palate.

Correlation between nasopharyngeal carcinoma tumor volume and the 2002 International Union Against Cancer tumor classification system

BackgroundThe correlation between primary tumor volume and nasopharyngeal carcinoma (NPC) UICC 2002 T classification, N classification and distant metastasis after radiation therapy was discussed to provide further evidence for the inclusion of tumor volume into the TNM classification staging system.MethodsBetween February 2001 and December 2008, 666 patients with NPC treated with intensity-modulated radiation therapy (IMRT) were analyzed retrospectively. Primary gross tumor volume was calculated from treatment planning computed tomography scans. The Kruskal-Wallis and Mann–Whitney tests were used for comparison of continuous variables and the chi-square test was used for categorical variables. A logistic regression model was used for multivariate analysis.ResultsMedian primary tumor volume of the 666 patients was 20.35 ml (range, 0.44 − 192.63 ml), and it gradually increased with T classification. Statistically significant differences in tumor volume were observed between patients with different T classifications (p < 0.001). The cervical lymph node metastasis rate was 64.7% (430/666); the differences in primary tumor volume between patients with or without lymph node metastasis were statistically significant (p < 0.001). Posttreatment distant metastasis occurred in 100 NPC patients, and the five-year distant metastasis-free survival was 84.2%. Univariate and multivariate analyses showed that N classification (p < 0.001) and tumor volume (p = 0.007) were the main factors influencing distant metastasis.ConclusionTumor volume was correlated with T classification, cervical lymph node mestastasis and distant metastasis after radiation therapy in nasopharyngeal carcinoma, suggesting that tumor volume should be included into the TNM staging system.

Three‐dimensional pharyngeal airway changes in orthodontic patients treated with and without extractions

To evaluate and compare three-dimensional pharyngeal airway changes in orthodontic patients treated with and without extractions. Pharyngeal airway was analyzed for 31 subjects (15 males, 16 females) treated with extractions of four first premolars and 31 age- and gender-matched controls (15 males, 16 females) treated without extractions. The mean age of subjects was 12.97 ± 1.15 years at the beginning and 15.69 ± 1.28 years at the end of treatment. The mean age of controls was 12.86 ± 0.74 years at the beginning and 15.18 ± 0.86 years at the end of treatment. Nasopharyngeal (NP) and oropharyngeal (OP) volumes, area of maximum pharyngeal constriction (AMPC), and upper arch perimeter were measured on T0 and T1 cone beam computed tomography (CBCT) scans. Paired samples t-test was used for analyzing statistical significance of changes (p ≤ 0.05). There were no statistically significant differences in the pharyngeal airway values between the extraction and non-extraction groups at neither T0 nor T1. The extraction group showed a statistically significant increase for NP and OP volumes and AMPC values. Such increase was also noted in the non-extraction group, without statistical significance for AMPC values. The findings suggest that an extraction or non-extraction choice for orthodontic treatment would not affect the pharyngeal airway.

Evaluation of airway volume changes in patients treated with distraction osteogenesis: a pilot study

The use of distraction osteogenesis to improve the airway volume of individuals affected by craniofacial anomalies is common practice today. The methods of assessing the outcomes of such surgical procedures have changed over the last several years. Objective : The objective of the present pilot study was to determine if the CBCT imaging modality may serve as a simple and reliable method for craniofacial practitioners to evaluate airway volume changes following distraction osteogenesis. Materials and Methods : Twelve patients who had previously undergone distraction osteogenesis for the primary purpose of improving their airways were enrolled in the current study. Pre (T0) and post-surgical (T1) CBCT’s volumes were analyzed to measure the nasopharyngeal (NP) and oropharyngeal (OP) volume changes. InVivoDental 4.0 (Anatomage Inc., San Jose, CA) (IVD) program was used to visualize and render the oropharyngeal (OP) and nasal passage (NP) volumes, separately. Means and standard deviations were calculated. Results : Of the 7 males and 5 females in the study, 4 patients underwent mandibular distraction (MandDO) and 8 underwent maxillary distraction (MaxDO). Four in the MaxDO group were treated with internal distractors and 4 were treated with external distractors. Individuals who underwent internal MaxDO greatly improved their NP volumes (1605 ± 1736 to 3273 ± 3130 mm 3 ) as did patients who underwent external MaxDO (5763 ± 5077 to 9243 ± 9442 mm 3 ). In comparison, the MandDO group’s NP volume showed modest gains (3519 ± 1944 to 3894 ± 2516 mm 3 ). With regard to the OP volumes, the MandDO group gained substantially (4906 ± 2347 to 11385.8 ± 6393.5 mm 3 ) while the MaxDO groups showed humble increases; internal MaxDO group (1779 ± 273.8 to 2639.5 ± 898.4 mm 3 ) and the external MaxDO group (8959 ± 5311 to 9734.13 ± 7124.7 mm 3 ). Conclusions : In the present preliminary study of assessing airway volume changes using CBCT on patients who have undergone different DO techniques, MandDO greatly increases OP volumes and MaxDO tends to increase NP volumes. The CBCT imaging modality holds great promise for craniofacial practitioners in its application to assess airways of individuals affected by craniofacial anomalies.

Zastosowanie rynometrii akustycznej w ocenie przerostu migdałka gardłowego oraz skuteczności zabiegu adenoidectomii

Adenoid hypertrophy is a problem of more than 1/3 of children and is the predominant reason of otolaryngology consultations in this population. Diagnosis and surgical qualification are based on physical examination and other methods introduced more than 100 years ago. Development of endoscopic techniques has been found this method to be a gold standard in adenoid assessment up to date. However, the method is difficult to performed in some young patient because of their invasiveness. Acoustic assessment of nosopharyngs seems to be a new promising method. Were an assessment of nasal obstruction due to adenoid hypertrophy in group of patients referring to adenoidectomy and an objective evaluation of changes in the volume of the nasopharynx after adenoidectomy. The examination was carried on the group of 30 patients aged 5-10 y.o. with adenoid hypertrophy admitted for adenoidectomy. The control group consisted of 10 children free of otolaryngological problems. All studied individuals had acoustic rhinometry performed and additionally, endoscopic method such as rhynofiberoscopy and endoscopy of nasopharyngs were introduced in the patient's group. The study showed that children with adenoid hypertrophy have statistically significant reduction of nasopharyngeal volume (NPV) vs control group. Adenoidectomy increases the NPV parameter and makes it equal to control group. The acoustic rhynometry seems to be a promising method in assessment of nasopharyngeal volume. This and further studies may help to reduce the number of "unnecessary" adenoidectomies, by making standards for NPV in different group of age.

The influence of birch pollination on the adenoid size in children with intermittent allergic rhinitis

Allergic sensitization of the airways occurs not only in the mucosa of the shock organ, but also in the lymphatic stations draining these structures. The lymphatic structure closest to the nasal mucosa in humans is the adenoid. Many researches show that in part of children allergic rhinitis can be a risk factor for adenoid hypertrophy. We used acoustic rhinometry and endoscopy to evaluate the influence of the birch pollination on the adenoid size in 67 children between 5 and 12 years old. Four separate groups of children were examined. The study group consisted of 28 children hypersensitive to tree pollen with seasonal allergic rhinitis (interview, positive skin prick test results, presence of sIgE in the serum and positive nasal provocation test with birch pollen allergens). The first control group consisted of 14 atopic children hypersensitive to motherwort pollen. The second control group consisted of 15 non-atopic children. The third control group consisted of 10 children hypersensitive to tree pollen, they have got anti-allergic treatment (topical nasal steroid and antihistaminic) a week before birch pollination. In all of the groups the adenoid size was examined before, during and after birch pollination. In the study group, we examined the influence of specific nasal provocation test on the adenoid size too. In most children from the study group (71.4%) we observed the significant increase of adenoid size in endoscopic examination and decrease of nasopharyngeal cavity volume in acoustics rhinometry (92.9%) during the birch pollination. The changes returned after pollination period in most children (90%). In the first and the second control group there were almost no changes observed (p>0.05). The medical treatment used in the third control group avoided the increase of adenoid size during birch pollination season. In the study group there was no statistically significant correlation between the changes in nasopharyngeal volume during the pollination period and the results of nasal provocation test (r=0.18). The result of our study suggests that in children with seasonal allergic rhinitis the exposure on the allergenic factor can influence the adenoid size. Properly administered nasal glucocorticoid together with antihistaminic in standard doses can probably avoid this effect.

Accuracy of inhomogeneity correction algorithm in intensity-modulated radiotherapy of head-and-neck tumors

We examined the degree of calculated-to-measured dose difference for nasopharyngeal target volume in intensity-modulated radiotherapy (IMRT) based on the observed/expected ratio using patient anatomy with humanoid head-and-neck phantom. The plans were designed with a clinical treatment planning system that uses a measurement-based pencil beam dose-calculation algorithm. Two kinds of IMRT plans, which give a direct indication of the error introduced in routine treatment planning, were categorized and evaluated. The experimental results show that when the beams pass through the oral cavity in anthropomorphic head-and-neck phantom, the average dose difference becomes significant, revealing about 10% dose difference to prescribed dose at isocenter. To investigate both the physical reasons of the dose discrepancy and the inhomogeneity effect, we performed the 10 cases of IMRT quality assurance (QA) with plastic and humanoid phantoms. Our result suggests that the transient electronic disequilibrium with the increased lateral electron range may cause the inaccuracy of dose calculation algorithm, and the effectiveness of the inhomogeneity corrections used in IMRT plans should be evaluated to ensure meaningful quality assurance and delivery.