Adenoid Facies and Its Impact on Craniofacial Development in Children: A Systematic Review

Abstract

Background: Adenoid hypertrophy is among the most prevalent conditions in paediatric otolaryngology and dentistry, with a well-established causal relationship to altered craniofacial growth patterns collectively described as adenoid facies. Despite its clinical importance, the full spectrum of skeletal, dental, and soft-tissue consequences remains incompletely characterised in the systematic literature.

Objectives: This systematic review aims to synthesise evidence on the anatomical, pathophysiological, clinical, diagnostic, and therapeutic aspects of adenoid facies and its impact on craniofacial development in children aged 3–18 years.

Methods: A comprehensive literature search was conducted in PubMed, MEDLINE, Cochrane Library, Scopus, and EMBASE for articles published between January 2000 and December 2025. Original research articles (observational studies and RCTs) and systematic reviews were separately identified and assessed; systematic reviews were used for contextual and comparative purposes only to avoid double-counting of participants. Quality assessment used the Newcastle- Ottawa Scale (NOS), Cochrane Risk of Bias 2.0 (RoB 2.0), and AMSTAR-2. Quantitative pooling (meta-analysis) was not performed owing to substantial heterogeneity in study design, outcome measures, adenoid grading systems, and reported metrics across included studies.

Results: Seventy-four studies met inclusion criteria. Evidence consistently demonstrates that adenoid hypertrophy-induced nasal obstruction triggers chronic mouth breathing, leading to characteristic craniofacial deformities including increased lower facial height, backward mandibular rotation, high-arched palate, dental malocclusion, and altered soft-tissue posture. Across included studies, reported values for lower anterior facial height/total anterior facial height (LAFH/TAFH) ratios generally exceeded 0.60 (normal: 0.55 ± 0.02), ANB angles ranged 5–8° (normal: 2 ± 2°), and posterior crossbite prevalence ranged from 23% to 56%. Early surgical and orthodontic interventions were associated with measurable improvements in craniofacial morphology when applied before skeletal maturity; however, complete reversal of established skeletal abnormalities was not consistently demonstrated and should not be assumed.

Conclusions: Adenoid facies represent a multidimensional consequence of untreated adenoid hypertrophy with long-lasting implications for dentofacial function and psychosocial wellbeing. Interdisciplinary management is essential for optimal outcomes. Future research should prioritise prospective registration, standardized outcome reporting, and longer-term follow-up.