Size of the Tonsil on Ultrasound in Children Without Tonsil-Associated Symptoms

Incompetent lip seal and nail biting as risk factors for malocclusion in Japanese preschool children aged 3-6 years

BACKGROUND

Malocclusion is a multifactorial condition associated with genetic and environmental factors. The purpose of this study was to investigate the prevalence of occlusal traits, oral habits, and nose and throat conditions by age and to assess the association between malocclusion and its environmental factors in Japanese preschool children.

METHODS

A total of 503 Japanese children (258 boys and 245 girls aged 3-6 years) were recruited. Occlusal traits were assessed visually to record sagittal, vertical, and transverse malocclusion, and space discrepancies. Lip seal was recorded by an examiner, and oral habits (finger sucking, lip sucking or lip biting, nail biting, chin resting on a hand) and nose and throat conditions (tendency for nasal obstruction, allergic rhinitis, palatine tonsil hypertrophy) were assessed by a questionnaire completed by the parents. The prevalence of each item was calculated, and binary logistic regression was used to examine the factors related to malocclusion.

RESULTS

62.0% of preschool children in the present study exhibited malocclusion, and 27.8% exhibited incompetent lip seal. Nail biting was the most frequent oral habit with a prevalence of 18.9%. Nasal obstruction was recorded in 30.4% of children. The results of binary logistic regression showed that incompetent lip seal was significantly related to malocclusion, and that nail biting was significantly negatively related.

CONCLUSIONS

Incompetent lip seal is significantly associated with malocclusion, but nail biting may not necessarily be a deleterious habit for the occlusion in Japanese preschool children.

Evaluation of Presumptive Normal Feline Tonsils with Low-Field Magnetic Resonance Imaging: A Preliminary Retrospective Study

Palatine tonsils are lymphoid organs, whose anatomic localization gives them a role against antigens entering the body during feeding and breathing. In human medicine, MRI is used to investigate tonsillar diseases. In veterinary medicine, a recent study on healthy dogs described the MRI appearance of canine palatine tonsils, with no available reports about feline ones. Due to the similarities between animals and humans, and based on the study on canine tonsils, the authors aimed to evaluate the feasibility of low-field MRI to detect and describe presumed normal features of feline palatine tonsils, assessing the finding's reproducibility. Low-field MRI of the heads of 14 cats was reviewed, and qualitative findings (visualization, shape, margins, signal intensity, and pattern) and size of each tonsil were recorded. Each observer recorded 71% of the expected tonsils. Most of them were classified as oval, ill-defined, and hyperintense structures with both homogeneous and heterogeneous signal patterns; the overall agreement was considered good. Low-field MRI is potentially a useful imaging modality to visualize palatine tonsils in cats, and their normal appearance has been described for the first time. The authors recommend the evaluation of tonsils in the transverse plane and consider the most accurate estimation of the short axis.

Shear-wave Elastography of Palatine Tonsils: A Normative Study in Children

Background

Shear-wave elastography (SWE) was used to determine normal elasticity values of palatine tonsils (PTs) in children and adolescents who did not have any health problem, and the relationship between these values and various parameters influencing this result was examined.

Methods

The current prospective study has been approved by the local Institutional Review Board. Our study included 122 people aged 2-18 years. SWE values for both PTs, as well as gender, age, and body mass index (BMI), were recorded. The Kolmogorov-Smirnov test was used to determine whether the data had a normal distribution. Numerical variables with a normal distribution are reported as mean ± standard deviation, while variables with a nonnormal distribution are reported as medians with minimum and maximum values. Numbers and percentages are used to report categorical variables.

Results

The study group's average age was 10.77 ± 4.35 years. The mean SWE values were 9.89 ± 2.494 kPa for the right PT and 9.57 ± 2.631 kPa for the left PT. Both PT volumes were found to be 1.6 ± 0.9 mm3. There was no significant correlation between the SWE values obtained and age, height, weight, and BMI. Tonsil dimensions show a positive correlation with age, height, weight, and BMI.

Conclusion

PT dimensions have a positive correlation with age, height, weight, and BMI, but not with SWE values. SWE may be a reliable diagnostic criterion independent of anthropometric values.

Can Shear Wave Elastography Help Differentiate Acute Tonsillitis from Normal Tonsils in Pediatric Patients: A Prospective Preliminary Study

Shear wave elastography (SWE) is a non-invasive imaging technique used to quantify the elasticity/stiffness of any tissue. There are normative SWE studies on tonsils in healthy children in the literature. The purpose of this study is to analyze the palatine tonsils in children with acute tonsillitis using ultrasound and SWE. In this prospective study, pediatric patients aged 4-18 years diagnosed with acute tonsillitis and healthy children were included. Those with antibiotic use, chronic tonsillitis, adenoid hypertrophy, and having chronic disease, immunodeficiency, and autoimmune disease, or any rheumatological disease were excluded. The volume and elasticity of palatine tonsil were measured via ultrasound and SWE. The study included 81 (46 female, 35 male) acute tonsillitis patients, and 63 (38 female, 25 male) healthy children between the ages of 4 and 18. Elasticity (kPa) values of tonsils were found significantly higher in the tonsillitis group (SWE-R: 25.39 ± 4.64, SWE-L: 25.01 ± 4.17) compared to the normal group (SWE-R: 9.71 ± 2.37, SWE-L: 9.39 ± 2.19) (p < 0.001). In the tonsillitis group, a significant positive correlation was found between tonsil volume and elasticity (r: 0.774, p: 0.002). In conclusion, in pediatric patients with acute tonsillitis, higher kPa values were obtained with SWE in the palatine tonsils.

Palatine Tonsil Measurements and Echogenicity during Tonsillitis Using Ultrasonography: A Case-Control Study

This case-control study aimed to assess the size and echogenicity of inflamed tonsils using ultrasonography. It was carried out at different hospitals, nurseries, and primary schools in Khartoum state. About 131 Sudanese volunteers between 1 and 24 years old were recruited. The sample included 79 volunteers with normal tonsils and 52 with tonsillitis according to hematological investigations. The sample was divided into groups according to age-1-5 years old, 6-10 years old, and more than ten years. Measurements in centimeters of height (AP) and width (transverse) of both tonsils (right and left) were taken. Echogenicity was assessed according to normal and abnormal appearances. A data collection sheet containing all the study variables was used. The independent samples test (t-test) showed an insignificant height difference between normal controls and cases with tonsillitis. The transverse diameter increased significantly with inflammation (p-value < 0.05) for both tonsils in all groups. Echogenicity can differentiate between normal and abnormal tonsils (p-value < 0.05 using the chi-square test) for samples from 1-5 years and 6-10 years. The study concluded that measurements and appearance are reliable indicators of tonsillitis, which can be confirmed with the use of ultrasonography, helping physicians to make the correct diagnosis and decisions.

Ultrasound imaging for evaluation of impalement-related injuries to the oral cavity in pediatric patients: a case series study

BACK GROUND

An impalement-related injury to the oral cavity is common in pediatric patients at emergency department. A computed tomography evaluation is not always suitable in these cases. Herein, we aimed to present oral sonography findings from six pediatric patients presenting with impalement-related injury to the oral cavity.

CASE SERIES

All included patients were younger than 4 years and sustained injuries with a toothbrush, chopstick, water gun, and fork to the tonsils, submandibular gland area, uvula, and under the tongue.

CONCLUSION

Ultrasound imaging appeared useful in helping diagnose impalement-related injuries lateral to the midline.

Role of ultrasound in the treatment of pediatric infectious diseases: case series and narrative review

BACKGROUND

Infectious diseases are common in pediatric patients. In these patients, ultrasound is a useful imaging modality that involves no irradiation or sedation and can be performed repeatedly at the patient's bedside. The purpose of this review was to show pediatric cases with infectious disease that used ultrasound to decide the methods of treatment.

DATA SOURCES

Literature review was performed using Pubmed as the medical database source. No year-of-publication restriction was placed. The mesh terms used were: "ultrasound", "sonography", "infectious disease", "treatment", "antibiotics", "surgical intervention", "pediatric", "children", "deep neck abscess", "pyothorax", "empyema", "pneumonia", "urinary tract infection", "intra-abdominal abscess", "soft tissue infection", "septic arthritis", "osteomyelitis", and "surgical site infection".

RESULTS

We presented pediatric case series with infectious diseases, including deep neck abscess, pyothorax and empyema, pneumonia, urinary tract infection, intra-abdominal abscess, soft tissue infection, septic arthritis and osteomyelitis, and surgical-site infection. Ultrasound was useful for evaluating the extent and location of inflammation and abscess and for decision-making concerning surgical intervention.

CONCLUSION

Knowledge of these sonographic findings is important for sonographers during examinations and for physicians when determining the treatment plan and period of antibiotic therapy for infected lesions.

A New Approach for Evaluating Palatine Tonsillar Hypertrophy in Children Based on Ultrasound: A Pilot Study

OBJECTIVES

To develop a novel ultrasound (US) plane to diagnose palatine tonsillar hypertrophy objectively in children.

METHODS

Tonsillar ultrasonography of children (age 2-14 years) who had a clinical diagnosis of tonsillar hypertrophy or not were analyzed retrospectively. Clinical data (including gender, age, body mass index (BMI)), and volume (V) of tonsils measured by the US, were recorded. Furthermore, we found a new US plane to diagnose tonsillar hypertrophy and named it the submental oblique cross-section. In this plane, diameters of the left tonsil, right tonsil, and central oropharynx were designated as T1, T2, and O. Then, we calculated the ratio by the formula (T1 + T2)/O.

RESULTS

A total of 172 cases (85 hypertrophy and 87 non-hypertrophy) were included in this study. There were no significant differences in gender (P = .844), age (P = .666), and BMI (P = .089) between the groups. In the non-hypertrophy group, the V of both sides had a positive linear correlation with age or BMI. In contrast, there was no linear correlation between ratio and age or BMI. The area under the curve (AUC) of ratio and V was 0.970 (95%CI: 0.947-0.993) and 0.835 (95%CI: 0.778-0.893) by receiver operating characteristic (ROC) analysis, respectively. The optimal cutoff value of ratio for diagnosis of tonsillar hypertrophy was 2.293 (sensitivity = 88.2%, specificity = 95.4%).

CONCLUSIONS

We established a new US section to evaluate tonsillar hypertrophy. This approach could be easily acquired and provide a reference value to guide clinical practice.

Prevalence of an incompetent lip seal during growth periods throughout Japan: a large-scale, survey-based, cross-sectional study

BACKGROUND

Systemic and local factors may lead to disruption of craniofacial growth and development, causing an imbalance between the orofacial skeleton, muscle and soft tissue, dental occlusion, and the dental arch during growth periods. We aimed to reveal whether the prevalence of incompetent lip seal (ILS) varies with age and region, as well as to clarify the factors related to an ILS, in a national, large-scale epidemiological study.

METHODS

We surveyed 3399 children, from 3 to 12 years of age, visiting 66 pediatric dental clinics throughout Japan. For this survey, we employed a questionnaire consisting of 44 questions regarding daily health conditions and lifestyle habits. We evaluated the differences in ILS prevalence by age and region (using a Cochran-Armitage test for trend and a Kruskal-Wallis test), and the relationship between ILS and factors investigated in the questionnaire (using Spearman's rank correlation coefficient).

RESULTS

We observed that 30.7% of Japanese children exhibited an ILS and that the ILS rate increased with age (p < 0.001). There were no regional differences in the rate of ILS in Japanese children (p = 0.506). We revealed that 12 of 44 survey items exhibited a statistically significant correlation with ILS (p < 0.001), using Spearman's rank correlation coefficient. These items involved orofacial morphology, mouth breathing, and possibly, allergic rhinitis.

CONCLUSION

The rate of ILS seems to increase with age in children, throughout Japan. Therefore, this disorder may not self-correct during the growth periods in these children. Guidelines are required for pediatric dentists to recognize ILS among children aged 3-12 years.

Normal palatine tonsil size in healthy children: a sonographic study

OBJECTIVES

Magnetic resonance imaging (MRI) and computerized tomography (CT) have been widely used to assess palatine tonsils. However, these imaging modalities have some limitations, such as high costs, need for sedation, and exposure to ionizing radiation. Ultrasound has been increasingly used to diagnose tonsillar pathologies. We aim to define normal tonsil size and volume of healthy children according to age.

METHODS

A total of 274 healthy children were included. Both right and left tonsil sizes were measured in anteroposterior (AP), transverse (Tr.), and longitudinal (Long.) planes. Patients were divided into six subgroups according to their age, and analysis was performed for these subgroups. Age, sex, height, weight, and body mass index were recorded to find possible correlations.

RESULTS

Median age of the whole population was 7 years (0-16 years). Mean tonsil volume is 1.5 ± 0.9 cm³ for right and left sides. We cannot detect any significant correlation between PT values and sex. We detected a significant positive correlation between PT values and height, weight and BMI.

CONCLUSION

US can be used as a diagnostic tool for PT pathologies. PT size correlates with age, height, weight, and BMI; however, no correlation is present for sex and side.

Assessment of Tonsil Volume With Transcervical Ultrasonography in Both Children and Adults

OBJECTIVES

To investigate the success of ultrasonography (USG) in the objective measurement of palatin tonsil volume in both children and adults and to compare those results with clinical findings.

METHODS

Eighty-five patients, who were scheduled to undergo tonsillectomy with the indications of recurrent tonsillitis and obstructive sleep apnea syndrome, were included in the study. The tonsil grades of the patients were recorded according to the Friedman tonsil grading. The tonsil size and volume were measured with transcervical USG. After tonsillectomy, the volumes of the tonsils were calculated by the displacement method. The correlation between the obtained data was evaluated. In all analyses, P < .05 was accepted as a statistical level of significance.

RESULTS

Fifty children and 35 adults were included in the study. In children, the mean actual volume ± SD of 100 tonsils was measured as 3.5 ± 1.45 mL, and the USG volume was 3.67 ± 1.59 mL; a high correlation was found between both methods (r = 0.842; P < .05). In adults, the mean actual volume of 70 tonsils was measured as 5.15 ± 2.25 mL, and the USG volume was 5.71 ± 2.98 mL; a moderate correlation was found between the methods (r = 0.589; P < .05). In children, a moderate correlation was found between the Friedman grading and the USG (r = 0.532; P < .05), and actual (r = 0.549; P < .05) tonsil volumes. In adults, a low correlation was found between the Friedman grading and the USG (r = 0.363; P < .05) and actual (r = 0.384; P < .05) tonsil volumes.

CONCLUSIONS

Ultrasonography is a useful, accessible, and noninvasive imaging method for objective measurement of tonsil volume in adults and children.