Adenoid and Tonsil Hypertrophy in Children and Facial Malformations

The controversy over the influence of nasal breathing on facial bone development has continued for decades and otolaryngologists are often questioned on this subject. The pharynx is a segment of the airway whose walls are soft and shaped primarily by the constrictor muscles and tongue, which attributes a very dynamic character. This tract is also delimited by the adenoids, tonsils and the lingual tonsil forming part of the lymphatic Waldeyer’s ring, which is normal and common to all human beings. The development of the adenoids starts at 3 years old and continues until 5 years of age whereafter a progressive shrinkage may be expected. They have an immunocompetent role as a first line of defence for the human body, consequently, growth is influenced by the environment, infections and allergic factors. An enlarged adenoid contributes to obstruction of nasal breathing, which can manifest itself as nocturnal snoring, mouth breathing, nasal discharge and serous otitis, often of chronic nature. Also, tonsil hypertrophy may lead to the obstruction of the airway mainly at night, during sleep and could also potentially influence the muscular development of the face, as some researchers have claimed, generating myofunctional variations as hypotonia of the orofacial musculature and the tongue adopting a low position in the mouth, which may apparently contribute to malformation of the jaw and its rotation backward or forward, as well as hard palate malformation and therefore an abnormal facial development, which may constitute what is known as adenoid facies, characterized by an elongated face with mouth ajar and anteverted upper lip. Hypertrophy of a particular tissue, either adenoid or tonsil, could potentially generate a specific cephalometric pattern as suggested recently [1,2].