J Rhinol.  2020 Nov;27(2):122-126. 10.18787/jr.2020.00335.

Assessment of Friedman Classification by Measuring Actual Tonsil Size During Surgery

• Lee J
• Yoo SI
• Lee MH
• Kim DH
• Kim SW

• KMID: 2508957
• DOI: http://doi.org/10.18787/jr.2020.00335

Abstract

Background and Objectives
Adenotonsillar enlargement is a common cause of pediatric illnesses, including obstructive respiratory disease and recurrent airway infection. The current tonsil grading systems evaluate tonsil size, but the correlation with actual tonsillar size in a clinical setting has not been established. Materials and Method: Between May and July of 2018, we recruited 31 children who underwent adenotonsillectomy with no major craniofacial abnormalities. The actual size of the palatine tonsils, the long (L1) and short (S1) axes of the tonsil beyond the anterior pillar, and the real axes (L2 and S2) after tonsil extraction from the fossa were measured during surgery. Adenoid size was determined by measuring the adenoid-nasopharynx (AN) ratio through lateral view x-ray of the neck.
Results
Though S1 was related to the Friedman scale (p<0.001), measured real axes were not (L2: p=0.058, S2: p=0.056). Also, adenoid size and AN ratio did not relate statistically to the Friedman scale (p=0.565). One of the measured real tonsil size parameters (S2) was related to AN ratio (p=0.048).
Conclusion
For pediatric patients undergoing tonsillectomy and adenoidectomy, the Friedman grading scale based on physical examination may not reflect the actual size of the tonsils. Therefore, for children with obstructive sleep disorder or recurrent tonsillitis, intraoperative measurement of tonsil size can be helpful.

Keyword

Tonsillectomy; Adenoidectomy; Child; Sleep apnea; Obstructive

Figure

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  Fig. 1. The definition of palatine tonsil size. Long axis (L1) and short axis (S1) of tonsil size before traction (A) and long axis (L2) and short axis (S2) of tonsil size after traction (B).

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  Fig. 2. Lateral neck x-ray and the adenoid-nasopharyngeal ratio. The English in this document has been checked by at least two professional editors, both native speakers of English. For a certificate, please see: http://www.textcheck.com/certificate/2VZAqH. Adenoid-nasopharyngeal ratio was determined by adenoid size (A)/diameter of nasopharynx (B) on lateral view of neck X-ray.

Reference

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