Correlation between gonial angle and dynamic tongue collapse in children with snoring/sleep disordered breathing - an exploratory pilot study.
BACKGROUND
Drug induced sleep endoscopy (DISE) is hoped to identify reasons of failure of adenotonsillectomy (AT) in treating pediatric sleep disordered breathing (SDB). Maxillomandibular disproportion has been studied as another association which may explain alternative pathogenesis of SDB. We aimed to explore the relation between the size of the gonial angle and inclination of the epiglottis measured from cone beam CT (CBCT) and tongue base collapse based on DISE in children with SDB.


METHOD
A retrospective chart review was conducted at a tertiary pediatric center. Children (6-17 years old) assessed at a multi-disciplinary Upper Airway Clinic, diagnosed with SDB and maxillo-mandibular disproportion (MMD), and who underwent DISE were eligible. Variables obtained from the electronic medical records of the clinic and prospective database included demographics, comorbidities, surgeries performed, investigations, DISE findings and CBCT findings. The gonial angle of subjects with and without tongue base collapse (TBC) on SNP were compared.


RESULTS
In total 29 patients (13 male, 8 female) age 6-17 (median= 9) were eligible for the study from January 2009 - July 2016. We included 11 subjects, and 10 comparators. The mean gonial angle of the TBC group was 139.3°± 7.6°, while that of the comparison group was 129.4°±3.5 (mean difference -9.937, 95% CI of -15.454 to - 4.421, P = 0.001, power of test 0.95). Additionally, the mean inclination of the epiglottis had a mild positive correlation (r=0.32, p<0.05) with the gonial angle, in the whole cohort.


CONCLUSIONS
This pilot study suggests that TBC may be mediated by a wider gonial angle in children with SDB patients. The posterior tilt of the epiglottis on CBCT may be a surrogate sign of TBC.
['Anderson|S|S|', 'Alsufyani|N|N|', 'Isaac|A|A|', 'Gazzaz|M|M|', 'El-Hakim|H|H|http://orcid.org/0000-0001-9349-8239']
D000233:Adenoidectomy D000293:Adolescent D001837:Body Weights and Measures D002648:Child D002675:Child, Preschool D054893:Cone-Beam Computed Tomography D005260:Female D006801:Humans D008297:Male D008334:Mandible D010865:Pilot Projects D012189:Retrospective Studies D012891:Sleep Apnea Syndromes D012913:Snoring D014059:Tongue D014068:Tonsillectomy D017211:Treatment Failure
Gonial angle Drug induced sleep endoscopy Pediatric sleep disordered breathing Maxillo-mandibular disproportion Adeno-tonsillectomy Pharyngeal collapse