Introduction

Adenoid and tonsillar hypertrophy in children often leads to adverse respiratory symptoms and obstructive sleep apnea (OSA). Current clinical guidelines from the American Academy of Pediatrics and American Academy of Otolaryngology-Head and Neck Surgery recommend tonsillectomy as the first line of pediatric OSA treatment for children with tonsillar hypertrophy. Rapid palatal expansion (RPE) performed by orthodontists improves obstructive sleep apnea in children by reducing nasal airway resistance, increasing nasal volume, raising tongue posture, and enlarging pharyngeal airway. However, the role of RPE in alleviating adenoid and tonsillar hypertrophy remains elusive. In this study, we aim to evaluate the changes in adenoid and palatine tonsil sizes following RPE using 3D volumetric analysis of cone beam computational tomography (CBCT) imaging.

Materials and methods

In this retrospective cohort study, a total of 60 pediatric patients (mean age: 8.00, range: 5-15, 32 females and 28 males) who had tonsillar hypertrophy (size 3 and 4) were included and divided into the control group (n = 20) and expansion group (n = 40). The control group did not undergo any treatment. The expansion group underwent RPE using a conventional Hyrax expander, activated 0.25 mm per day for 4-6 weeks. Final CBCT scans (T2) were performed 13.8 ± 6.5 months after the initial scan (T1). Pediatric sleep questionnaire (PSQ) and BMI were obtained at each timepoint. Volumetric analysis of adenoid and palatine tonsils was performed using a combination of bony and soft tissue landmarks in CBCT scans through Anatomage Invivo 6 imaging software. Paired t-tests were used to evaluate the difference between the initial and final adenoid and tonsil volumes. p values less than 0.05 were considered statistically significant.

Results

Compared to the control group, the expansion group experienced a statistically significant decrease in both adenoid and tonsil volume. There was non-statistically significant increase in volume from T1 to T2 for the control group. For the expansion group, 90.0% and 97.5% of patients experienced significant reduction in adenoid and tonsil volume, respectively. The average volume decrease of adenoids was 16.8% while that of tonsils was 38.5%. The patients had up to 51.6% and 75.4% reduction in adenoid and tonsil size, respectively, following RPE orthodontic treatment. Pearson correlation ranged from 0.88 to 0.99 for each measurement, representing excellent internal consistency. There was a significant reduction in the PSQ scores from 5.81 ± 3.31 to 3.75 ± 2.38 in expansion group (p < 0.001).

Conclusions

Our results demonstrated that RPE significantly reduced the size of both adenoid and palatine tonsils and revealed another long-term benefit of RPE treatment. To our knowledge, this is the first study to quantify the changes of adenoids and tonsils following RPE. RPE treatment can be considered as a valid and effective treatment option for pediatric OSA population with narrow high arch palate and adenotonsillar hypertrophy.

Overview (Air Mover): Carbon dioxide plays an important role in the earth's ecosystem; the lives of many organisms are based on the balancing of this gas. Plants and animals need it for survival however, an excess of carbon dioxide can also end the organism’s life. The production of the gas mostly comes from the combustion of fossil fuel, power plants, big industries, vehicles, and processes involving natural gasses. One of the most known issues of carbon dioxide pollution is global warming. The greenhouse gas essentially traps heat in the atmosphere, increasing the global temperature. The methodology provided is an innovative solution towards the creation of an environmentally friendly carbon dioxide filter. Current air filtration systems are restricted to industrial environments limiting the ability to filter the air. Due to the large noise and low range of operation of axial fans the filtration systems need controlled environments for longevity. The paper presents a versatile air mover that can be mounted onto multiple surfaces due to its low profile and bracket mounts. Furthermore, the usage of a diagonal fan inside of a PVC pipe allows for a durable system that can operate at high efficiency and low noise. The main challenge in designing the air mover was figuring out how to quantify the scalability of the device and what parameters could be changed in order to make the device more viable. The designs most prominent feature are the inclusion of a modular enclosure that can be adapted to multiple areas and environments while withstanding harsh conditions due to the PVC piping that can be coated with a diagonal fan for high volumetric flow rates and pressure differential for versatility in environments the device is placed in as well as efficiency. Overview (Carbon Storer): The Civil and Environmental Engineering team is responsible for finding a cost effective and sustainable way to transport, store and recycle the carbon caught in the air from the Carbon Catcher designed by the other engineering teams. In the team’s design, the Carbon Catcher will reduce the harmful emissions in the air by capturing CO2, store it and then utilize it in another industry which will reduce the need to mine for more raw materials which would thus further reduce the pollution emitted into the environment. Our plan is to recycle the carbon emitted from a factory and utilize it in CO2 dry ice. It's the Civil and Environmental Engineers’ job to find a way to connect a sustainable solution with a solution that improves the public’s quality of life. There are many industries that pollute immense amounts from the mining of raw material or the emission of pollutants. The team wants to show industries that the economic solution can also be the sustainable solution. Overview (Membrane) The team’s solution focuses on the use of cryogenic carbon capture, a method in which the selective freezing points of the gaseous components of air are used to separate out carbon dioxide. For this process, the team will be utilizing a 4 step filtration process. First, the flue gas will be run through a particulate filter to catch all macroscopic particles that may be present within the air. Afterwards, the gas is then passed through a dehumidifier where a majority of water content will be extracted. Following this, The gas was then run through a long pipe and progressively cool it down to the freezing point of carbon dioxide. Finally, the filtered gas is extracted, and a bubbler is used to separate the solid carbon dioxide. The carbon dioxide is then compressed and recycled around the feed pipe to help in the cooling process. Along the process of this design, the team encountered problems finding the optimum materials for temperatures this low. As well, coming up with a way to eliminate heat transfer from the outside posed a huge problem. Through the experience, the team was able to gain a greater view of what benefits and drawbacks must be balanced, along with the economic interest that comes with designing an efficient process. Unlike how most designs are focused, It was understood that using a membrane only provided so much creativity when it came to filtration. As a result, the team researched other successful methods and arrived at utilizing cryogenics to filter. Goal Research to provide a single solution to remove levels of carbon dioxide in the immediate atmosphere, transport it to a storage mechanism, and find a way to recycle it. Powerful research is required to ensure effective methodologies, material usage, and flexible scalability of the overall device. This particular team seeks to find an alternative separation process to membrane filtration, the efficacy of which has not been demonstrated beyond the scale of a laboratory.