Adenoid-Nasopharyngeal Ratio and craniofacial growth in Children: A two-center longitudinal study with…

Cohort studyEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery· Jun 2026

Adenoid-Nasopharyngeal Ratio and craniofacial growth in Children: A two-center longitudinal study with threshold and causal analyses.

Bo Duan, Hengci Zhang, Jia Liang, Wenxia Chen

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Pediatric ENTCohort studyQ1IF 2.5

Adenoid hypertrophy was associated with about 3° lower sella-nasion-A angle and SNB angles.

Adenoid-Nasopharyngeal Ratio and craniofacial growth in Children: A two-center longitudinal study with threshold and causal analyses.

Bo Duan … Wenxia Chen

European archives of oto-rhino-laryngology · Jun 2026 · Q1 in Otorhinolaryngology

Purpose

Adenoid hypertrophy is a common cause of pediatric upper-airway obstruction and is suspected to contribute to "adenoid facies", but longitudinal thresholds and causal dose-response relations between the adenoid-nasopharyngeal (A/N) ratio and craniofacial growth indices remain unclear.

Methods

We performed a two-center longitudinal cohort study of children aged 3-10 years who underwent clinically indicated lateral nasopharyngeal or cephalometric radiography between July 2021 and July 2024 at tertiary pediatric hospitals in Shanghai and Chongqing, China.

n = 4,271 children

Results

3°

adenoid hypertrophy meant a flatter maxilla and mandible relative to the skull base

n = 4,271 children

More results

The median baseline A/N ratio was 0.601 (interquartile range, 0.549-0.652).

Across 189 angles, segmented regression identified a reproducible breakpoint band around A/N ≈ 0.62-0.69.

More results

Generalized propensity score analyses showed positive, approximately linear dose-response functions for multiple cranial-base and posterior maxillary/nasopharyngeal angles, with global slopes typically 10-25°/year per 1.0 increase in A/N and 80th-20th percentile contrasts of about 1-4°/year.

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Conclusion · 1 of 2

Higher radiographic A/N ratios were associated with threshold-sensitive, age- and sex-dependent craniofacial remodeling. As a 2D radiographic surrogate, A/N does not replace endoscopic or functional assessment.

Conclusion · 2 of 2

Combining A/N with selected cephalometric angles may help identify children who warrant closer follow-up and endoscopic evaluation during sensitive growth windows.

Adenoid-Nasopharyngeal Ratio and craniofacial growth in Children: A two-center longitudinal study with threshold and causal analyses.

Adenoid-Nasopharyngeal Ratio and craniofacial growth in Children: A two-center longitudinal study with threshold and causal analyses.

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