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930
ANTHROPOMETRIC PARAMETERS OF PHYSICAL DEVELOPMENT OF
CHILDREN WITH ADENOID HYPERTROPHY BEFORE AND AFTER
ADENOIDECTOMY
Alimova Nigina Pulatovna
Bukhara State Medical Institute
Uzbekistan
E-mail:
ORCID ID: 0000-0002-9665-226X
Annotation:
The proportion of children with chronic adenotonsillitis varies 20-50%, and among
frequently ill children these diseases are 37-70%. This indicates an increase in hypertrophy of the
pharyngeal tonsil, an increase in the frequency of adenoid pathology in children, which adversely
affects the structural formation of the jaw complex. It has been revealed that the influence of a
long-term course of diseases in children leads to a violation of the formation of the facial
skeleton, which is reflected in the form of a sagging lower jaw. the formation of its narrow and
distant, improper development of the hard palate and occlusion. In the development of
dentoalveolar anomalies at the age of 8-10 years, a significant role is played by diseases of the
ENT organs, in particular, the proliferation of adenoids.
Keywords:
anthropometry, adenoidectomy, adenoid hypertrophy, children
Objective:
to analyze the parameters of physical development of children 3-11 years old and
children with adenoid hypertrophy
Materials and methods:
The study was carried out on the basis of the ENT department of the
Bukhara Regional Children's Hospital. The number of children before and after adenotomy
surgery was 348 (181 boys and 167 girls). Accordingly, in children with adenoid hypertrophy
and 6 months after surgery, div length was measured with a height meter, div weight with
special medical scales, chest circumference with a measuring tape the state of children (Table 1).
The subject of the study was the anthropometric parameters of the head and face. In conducting
scientific research, a set of methods was used, depending on the tasks: anthropometric,
morphometric, statistical methods.
Introduction.
Although there are advances in the diagnosis and treatment of adenoids in
children, they are diagnosed quite late. As a result, this harms the quality of treatment of patients
(Skordis N et al., 2012).
The growth and development of the human div from the embryonic stage to its adult state is a
very complex phenomenon consisting of many changes under the neurohumoral regulatory
mechanisms that control the differentiation, development and maturation of organs and systems.
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Various reasons such as familial and pathological can affect the growth parameters of various
parts of the human div
Knowledge of the patterns of growth and development of facial bones will help prevent an
increase in the number of disorders in the maxillofacial area (D.A. Domenyuk, 2016).
The number of works devoted to the study of the morphogenesis of the craniofacial complex in
childhood in one or another pathology, especially in hypertrophy of the pharyngeal tonsil, is
extremely limited. It is known from the literature that the maxillofacial area undergoes radical
transformations in the process of development. (V.T. Yagupova, 2019).
In the literature, it is shown that mental stress (Lukina S.F. et al., 2012) affects the physical and
functional development of children (Mazen Mohammed Youssef Hassan Hussein., 2014).
The mechanisms that regulate the growth of the human head and face are complex processes
where there is an interaction between hormones and epigenetic factors. The above factors
determine the formation of craniofacial bones, the violation of which can lead to irreversible
changes in this area (Juloski J. et al., 2016).
With a violation of the interaction of regulatory factors for the growth of the bones of the facial
skeleton, there is an unequal slowdown in bone growth, which leads to anomalies in the
formation of the face. In various genetic abnormalities or syndromic pathologies, there is a lag in
the development of the dentition (Haynes A, Bulsara MK., 2012).
Knowledge of facial dysmorphic features is important in the diagnosis of many congenital
diseases, such as Down syndrome or fetal alcoholic disease (Koca C.F. et al, 2016, Suttie M. et
al, 2018). Some chronic diseases that occur during the development period can lead to
abnormalities in facial parameters. A group particularly susceptible to the development of
craniofacial anomalies are children with chronic nasopharyngeal obstruction, who often have
mouth breathing. In the long term, mouth breathing can lead to an increase in the anterior height
of the face, a retrognatic mandible, a steep angle of the mandible, lip incompetence and narrow
maxillary and mandibular dental arches. The combination of these changes is usually called an
"adenoid face" because it is characteristic of children with hypertrophy of the adenoids and
tonsils (Nagaeva T.A. et al., 2016, Tastanova G. et al., 2021, Koval Yu.N. et al., 2021).
The mechanistic nature of abnormal facial growth in children is a consequence of adenotonsillar
hypertrophy. The classical model suggests that an unclear inflammatory process or infection
leads to hypertrophy of the adenoids or tonsils. Enlarged adenoids and tonsils block the upper
airways and force the child to breathe through the mouth. (Arsenina O. I. et al. 2014) due to
weak stimulation of local bones (Pawłowska-Seredyńska K. et al. 2020, Chuang H. H. et al.
2020).
An open mouth often results in a downward position of the tongue, which can lead to a low
position of the lower jaw and head. However, there is evidence that children with adenoids and
tonsil hypertrophy have abnormal nocturnal hormone secretion. It has been proven that a
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decrease in growth hormone secretion may be associated with the posterior size of the face due
to the short branch of the lower jaw (Tastanova G.E., Khodzhanov Sh., 2021).
Results of the study.
Long-term chronic inflammatory pathology of the tonsils of the
lymphoepithelial ring of the pharynx leads to secondary immune deficiency in the pediatric
population, which reduces the quality of life of the child and the family. Growth retardation has
been frequently reported (27–56%) in children with adenoid hypertrophy. Adenoid hypertrophy
is the main cause in children who are not up to development or retardation of physical and
mental development, and, as a rule, ended in adenoidectomy.
Table 1.
Distribution by sex and age composition of the total number of examined children with
adenoids before and after surgery
A
ge
Before surgery
After the surgery
Floor
Boys
Girls
Boys
Girls
ab
s
M
(%)
m
ab
s
M (%) m
ab
s
M (%) m
ab
s
M (%) m
3
years
10
4,29 1,33 9
4,3
1,40 9 4,9
1,62 6
3,59
1,44
4
years
12
5,15 1,45 8
3,8
1,32 8 4,4
1,53 7
4,19
1,55
5
years
19
8,15 1,79 22
10,5
2,11 16 8,8
2,11 16
9,58
2,28
6
years
22
9,44 1,92 19
9,1
1,98 18 9,9
2,22 12
7,19
2,00
7
years
29
12,5 2,16 21
10,0
2,07 22 12,2 2,43 19
11,4
2,46
8
years
32
13,7 2,25 31
14,8
2,45 26 14,4 2,61 23
13,8
2,67
9
years
30
12,9 2,19 28
13,3
2,35 23 12,7 2,48 21
12,6
2,57
10
years
28
12,0 2,13 25
11,9
2,23 15 8,3
2,05 18
10,8
2,40
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933
11
years
26
11,2 2,06 26
12,38 2,27 20
11,1
2,33 24
14,4
2,71
Altog
ether
23
3
100,
0
0,00 21
0
100,0 0,00 18
1
100,0 0,00 167
100,0 0,00
R
Pearson chi-square = 1.985; p = 0.992
Pearson chi-square = 2.638; p = 0.977
Pathology of the pharyngeal tonsils more often (p<0.05) has a negative impact on the growth and
div weight of the growing div of children, therefore, children with chronic pathologies of the
ENT organs show a discrepancy in weight, that is, excess or deficit of div weight. But in
children with pathology of the ENT organs, in part with "adenoids", excess div weight is more
detected. After adenoidectomy and facilitation of nasal breathing, accelerated growth of the
lower jaw and closure of the angle of the mandibular plane was noted. All proven factors can be
improved after adenoidectomy due to the fact that children with normal and overweight after
adenoidectomy or without it can quickly gain weight.
Insufficient research has been done on the effects of adenoidectomy, taking into account the
effect of time and the state of preoperative growth.
Parents were asked to respond to a questionnaire about children. Questions regarding the degree
of adenoid hypertrophy and/or the presence of tonsil hypertrophy were included in the
questionnaire. In addition, the specific symptoms associated with these diseases have been
studied.
In addition, the patient's overall score was assessed on a scale of 0 (remission) to 10 (maximum
symptomatology). Each object was examined before and after surgery. A detailed form was
completed for each child. Differences in scores attributed to the patient's overall score before and
after social distancing were assessed using
the Student's
t-test.
There were insignificant sex differences in all anthropometric measurements of the subjects.
However, the girls had a higher div weight, while they lagged behind in height, but had higher
values of BMI, chest circumference (Table 2)
Table 2
Anthropometric characteristics of the comparison between boys and girls with adenoids
before and after adenoidectomy
Floor
Boys
Girls
Period
Before
After
Before
after
Weight (kg)
16,39±4,15
17,42±3,25
20,25±6,02
21,5±5,02
Height (cm)
105±9,07
109±8,03
102,6±5,09
108,6±4,09
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Chest circumference (cm)
53,6±3,05
54,5±3,04
55,8±4,06
56,1±3,09
BMI (kg/m2)
15,8±5,12
15,9±4,09
20,6±1,75
22,3±3,09
In all anthropometric measurements studied, minor sex differences were observed, as well as the
frequency of growth disorders. A slight statistical difference was found between children in the
1st and 2nd periods of childhood and children with grade 3 and 4 adenoid hypertrophy in relation
to all anthropometric measurements.
Figure 1. BMI in children before and after surgery (%)
The present study was designed to evaluate the relationship between the severity of chronic
adenotonsillar hypertrophy and its impact on physical development. The predominance of the
female sex in all aspects was revealed. These parameters differ from previous researchers,
However, they also reported that their height in both sexes was within the normal range. Kartal
et al. observed that the percentages of weight and height were normal in most patients.
Vontetsianos et al. In their study, they observed minor sex differences in weight and height in
children with adenotonsillar hypertrophy.
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Figure 2. Assessments of the condition of children before and after surgery
Thus, adenoid hypertrophy (HA) had a significant impact on the anthropometric measurements
of children. In all anthropometric studies, sex differences and growth disorders were revealed.
This mainly has a negative effect on growth in boys. After adenotomy, all anthropometric
parameters (div weight, height and chest circumference) change 1.5 times and the results are
more pronounced in girls.
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