Brodsky L, Adler E, Stanievich J F
Department of Otolaryngology, State University of New York, Buffalo.
Int J Pediatr Otorhinolaryngol. 1989 Feb;17(1):1-11. doi: 10.1016/0165-5876(89)90288-7.
Sixty children (3-11 years) were evaluated to determine variations in naso- and oropharyngeal dimensions associated with tonsil and adenoid hypertrophy. The subjects were grouped according to tonsil size and a clinical history of chronic upper airway obstruction. Intraoperative measurements included oropharyngeal diameter, length of the hard and soft palates, width and arch of the hard palate, nasopharyngeal volume, as well as tonsil and adenoid weights and volumes. A significantly larger oropharyngeal diameter was found in children with small, non-obstructing tonsils (P less than 0.01). Children with large, non-obstructing tonsils had a similar oropharyngeal diameter to those children with large, obstructing tonsils. However, tonsil volume, not weight, was increased in the children with large obstructing tonsils as compared to those with large non-obstructing tonsils and small non-obstructing tonsils (P less than 0.04). A shorter soft palate was associated with larger, obstructing tonsils (P less than 0.004). The length of the hard palate was similar in all patients, however, a trend towards a higher arched palate was seen in patients with larger, obstructing tonsils. The distance from the soft palate to the posterior pharyngeal wall was greater in obstructed patients with adenotonsillar hypertrophy (P less than 0.003). In patients requiring adenoidectomy, the nasopharyngeal volume prior to adenoidectomy was significantly smaller in patients with obstructive symptoms (P less than 0.001). Postadenoidectomy, no significant difference was found in the nasopharynx volume amongst all subjects. These data indicate that subtle differences in oropharyngeal dimensions exist which along with increased lymphoid tissue volume, lead to the development of obstructive symptoms. Etiologic considerations are discussed.
对60名3至11岁儿童进行评估，以确定与扁桃体和腺样体肥大相关的鼻和口咽尺寸变化。根据扁桃体大小和慢性上呼吸道阻塞的临床病史对受试者进行分组。术中测量包括口咽直径、硬腭和软腭长度、硬腭宽度和弓度、鼻咽容积，以及扁桃体和腺样体的重量和体积。发现扁桃体小且无阻塞的儿童口咽直径明显更大（P小于0.01）。扁桃体大但无阻塞的儿童与扁桃体大且有阻塞的儿童口咽直径相似。然而，与扁桃体大但无阻塞和扁桃体小且无阻塞的儿童相比，扁桃体大且有阻塞的儿童扁桃体体积增加，而非重量增加（P小于0.04）。软腭较短与扁桃体大且有阻塞有关（P小于0.004）。所有患者硬腭长度相似，然而，扁桃体大且有阻塞的患者硬腭弓度有增高趋势。腺样体扁桃体肥大且有阻塞的患者软腭至咽后壁的距离更大（P小于0.003）。在需要腺样体切除术的患者中，有阻塞症状的患者术前鼻咽容积明显较小（P小于0.001）。腺样体切除术后，所有受试者的鼻咽容积无显著差异。这些数据表明，口咽尺寸存在细微差异，这些差异与淋巴组织体积增加一起导致阻塞症状的出现。本文讨论了病因学方面的考虑因素。
