Adenotonsillectomy remains one of the most commonly performed surgical procedures in the pediatric age group, with the 2 most frequent indications for surgery being obstructive sleep apnea and chronic adenotonsillitis. As nicely exemplified by Clark, there is an on-going argument in the literature about whether prevention of craniofacial dysmorphologic traits constitutes an additional indication for adenotonsillectomy.
Can severe nasal airway obstruction (NAO) and mouth breathing lead to abnormal craniofacial growth? This argument arises from the description of the so-called adenoid facies. Adenoid facies has been vaguely defined as a long, thin face with malar hypoplasia, high-arched palate, narrow maxillary arch, and angle class II malocclusion. At the root of the dispute is cause and effect: Can children with adenoid facies have NAO, or can NAO lead to adenoid facies? The answer to the first question is unquestionably yes. However, the answer to the second question is unknown.
Elluru RG. Adenoid Facies and Nasal Airway ObstructionCause and Effect?. Arch Otolaryngol Head Neck Surg. 2005;131(10):919-920. doi:10.1001/archotol.131.10.919