Standardizing Pediatric Airway Analysis: The ECAA Protocol Framework

For pediatric dentistry, imprecise measurements and lack of early detection methods underscore the need for a more comprehensive approach to early childhood airway analysis. Most standards commonly known in airway evaluation are associated with adult patients, limiting accurate detection and diagnosis for pediatric airway cases. Additionally, traditional approaches to early childhood airway analysis may fall short in capturing the intricate details necessary for comprehensive diagnostics, leading to potential oversights in patient care.

In the field of oral and maxillofacial radiology, the pursuit of precision and early detection is paramount as it allows for timely intervention and treatment, helps prevent disease progression, minimizes potential complications, and ultimately enhances patient outcomes. Here at BeamReaders, we have developed a pediatric airway analysis  protocol designed to thoroughly review pediatric cone beam CT scans to extract the maximum clinical value. We are delighted to introduce our Early Childhood Airway Analysis (ECAA), which may be added to any BeamReaders’ oral radiology report.

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Overview of the ECAA Adder

The ECAA adder responds to the challenges of pediatric imaging airway analysis with a comprehensive protocol crafted in collaboration with prominent pediatric dentists and airway specialists, and oral and maxillofacial radiologists. In addition to a comprehensive BeamReaders oral radiology report, the ECAA adder includes assessment of several critical items, including:

1. Nasion-basion-C3 angle
   The nasion-basion-C3 angle, with an average of 110°, helps to standardize head positioning. Deviation of head positioning either superiorly or inferiorly at the time of the scan can significantly affect the airway dimensions.
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2. Adenoid grading system
   Enlarged adenoids can inhibit airflow, resulting in mouth breathing, obstructive sleep apnea, and reduced immune competence. This metric was developed to provide a standard metric for adenoid tissue size in relation to the nasal choanae.
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3. Objective adenoid space metrics
   This measurement relates the adenoid soft tissue to surrounding soft and hard tissues, allowing for a standardized measurement of airway space surrounding the adenoid tissue.
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4. Palatine tonsillar grading
   Like the adenoid tissue, palatine tonsils hypertrophy can significantly affect the airway dimensions. This measurement analyzes the palatine tonsil size and space occupation.
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5. Tongue positioning
   If properly positioned, the tongue rests on the roof of the mouth and occludes the palatoglossal airspace. However, the tongue can have a low posture that suggests tongue tie, mouth breathing, and/or myofunctional disorders that can affect facial development and normal breathing during sleep. This metric creates a standard tongue positioning evaluation for pediatric patients.
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6. Airway classification
   This metric evaluates the current patient airway dimensions based on minimum cross-sectional area compared with industry-accepted norms.
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7. Nasal cavity
   Septal spurring and deviation, hypertrophic soft tissue, and hypoplastic nasal fossae severely affect airflow and can contribute to persistent impeded nasal breathing. This metric comprehensively evaluates the nasal cavity as compared with pediatric standards.

Integration and Using the ECAA Adder

When requested, the ECAA adder is seamlessly integrated into any new BeamReaders report. A submitting doctor can simply select the ECAA adder during case submission to request a radiology report that includes a review within the ECAA framework. It is available to all BeamReaders users.

Summary

Tailored for thorough CBCT volume reviews, BeamReaders’ ECAA adder, developed in collaboration with experts, addresses the limitations of traditional methods for early childhood airway analysis. Assessing critical indicators such as the nasion-basion-C3 angle and the nasal cavity provides invaluable insights for enhancing diagnostic capabilities. Seamlessly integrated into existing workflows, the ECAA adder ensures efficiency for referring dentists. Take advantage of the opportunity to elevate your practice through enhanced diagnostic insights and provide a new level of care to pediatric patients.

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