Association Between Vomer-to-Nasopharyngeal Widths and Postadenoidectomy Outcomes in Children

Introduction: The vomer is an essential component of the nasopharynx. Although variations in vomer width (VW) can be observed, their clinical significance on post-adenoidectomy outcomes in children with sleep-disordered breathing and obstructive sleep apnea (SDB–OSA) remains uncertain.

Methods: A prospective cohort study was conducted between 2022-2023 at a tertiary center. Children who underwent adenoidectomy for SDB–OSA were included, and VW and nasopharyngeal widths (NW) were measured. Clinical improvement was collected using the OSA-18 survey. The primary outcome was to investigate the association between VW and post-adenoidectomy clinical improvement. Secondary outcomes were to investigate the variability and interplay between VW and nasopharyngeal width (NW).

Results: Of the 29 children (mean age: 3.5 years, interquartile range [IQR]: 2–4, 16 [55%] males), 26 (89.6%) showed a clinical improvement 1-month post-adenoidectomy (ΔOSA-18 score: -24.6, 95% confidence interval: -31–(-14), p=0.001). The mean VW was 3.88 millimeters (IQR: 3–4), and the mean NW was 13.76 millimeters (IQR: 13–14). In the univariable analysis, clinical improvement was associated with age <3 years (p=0.05), non-obese children (p=0.01), large adenoids (p=0.01), preoperative OSA-18 score >60 (p=0.05), and lower VW/NW (p=0.013). The odds ratio for clinical improvement was decreased by 1.08 for each 0.01 increase in VW/NW (95% CI: 1.05–1.11, p=0.01).

Conclusions: VW/NW may play a role in the postoperative outcomes in children who undergo adenoidectomy for SDB–OSA, with lower VW/NW being associated with favorable outcomes. Further randomized studies are needed to investigate whether it can serve as a therapeutic target.