Am. J. Respir. Crit. Care Med., Volume 165, Number 1, January 2002, 117-122

Linear Dimensions of the Upper Airway Structure during Development
Assessment by Magnetic Resonance Imaging

RAANAN ARENS, JOSEPH M. MCDONOUGH, AARON M. CORBIN, MARY ELIZABETH HERNANDEZ, GREG MAISLIN, RICHARD J. SCHWAB, and ALLAN I. PACK

Division of Pulmonary Medicine, The Children's Hospital of Philadelphia and the Center for Sleep and Respiratory Neurobiology, University of Pennsylvania Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

The upper airway undergoes progressive changes during childhood. Using magnetic resonance imaging (MRI), we studied the growth relationships of the tissues surrounding the upper airway (bone and soft tissues) in 92 normal children (47% males; range, 1 to 11 yr) who underwent brain MRI. None had symptoms of sleep-disordered breathing or conditions that impacted on their upper airway. MRI was performed under sedation. Sequential T1-weighted spin echo sagittal and axial sections were obtained and analyzed on a computer. We measured lower face skeletal growth along the midsagittal and axial oropharyngeal planes. In the midsagittal plane the mental spine-clivus distance related linearly to age (r = 0.86, p < 0.001). Along this axis, the dimensions of tongue, soft palate, nasopharyngeal airway, and adenoid increased with age and maintained constant proportion to the mental spine-clivus distance. Similarly, a linear relationship was noted for mandibular growth measured along the intermandibular line on the axial plane and age (r = 0.78, p < 0.001). In addition, the intertonsillar, tonsils, parapharyngeal fat pads, and pterygoids widths maintained constant proportion to intermandibular width with age. We conclude that the lower face skeleton grows linearly along the sagittal and axial planes from the first to the eleventh year. Our data indicate that soft tissues, including tonsils and adenoid, surrounding the upper airway grow proportionally to the skeletal structures during the same time period.

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