Digital Radiographic Evaluation of Skull Dimensional Patterns in Paediatric Patients with Adenoids: Emphasis on Anterior-Posterior versus Transverse Diameter

Abstract

Background: Adenoid hypertrophy is a clinical condition of significant concern in children, with implications for craniofacial growth and respiratory health. The relationship between skull dimension patterns and adenoid pathology has not been clearly defined, particularly as it relates to the relative significance of anterior-posterior vs. transverse diameters in predicting disease outcomes. Methods: This is a cross-sectional study enrolling 80 children aged 3-12 years who had symptoms indicative of adenoid hypertrophy. Lateral cephalometric X-rays were taken using standard digital radiography protocols. Digital measurements were taken of the anterior-posterior and transverse diameters of the skull using calibrated software instruments. Adenoid severity was graded as mild, moderate, or severe based on radiographic evaluation. Statistical analysis was done using SPSS v.26including multinomial logistic regression and Cox proportional hazards modeling to examine associations between skull measurements and adenoid severity. Results: Anterior-posterior diameter was 118.4 ± 8.5 mm, while the transverse diameter was 126.2 ± 9.1 mm (p=0.032). Transverse dominance was observed in 71.3% of patients, and prevalence was significantly increased in advanced age groups (80% in 9-12 years vs 68% in 3-5 years, p=0.045). Multinomial logistic regression revealed anterior-posterior diameter to significantly predict moderate (RRR=1.15, p=0.005) and severe adenoid hypertrophy (RRR=1.22, p=0.001). The Cox proportional hazards model indicated that with each 1 mm increase in anterior-posterior diameter, the risk of advancing to severe adenoid obstruction was 12% increased (HR=1.12, p=0.006). Conclusion: This study indicates the anterior-posterior diameter of the skull as a predictor of the severity and course of adenoid hypertrophy in children, despite transverse patterns of growth being dominant.