Adenoid facies

Adenoid facies refers to the long, open-mouthed face of children with adenoid hypertrophy. Hypertrophy of the nasopharyngeal pad of lymphoid tissues (the adenoids) is the most common cause of nasal obstruction in children. The mouth is always open because upper airway congestion has made patients obligatory mouth breathers. Persistent mouth breathing due to nasal obstruction in childhood may be associated with the development of craniofacial anomalies such asthe adenoid facies ( also called the “long face syndrome”. The most common presenting symptoms are chronic mouth breathing and snoring”  The most dangerous symptom is sleep apnea.

The characteristic facial appearance consists of:

• underdeveloped thin nostrils
• short upper lip
• prominent upper teeth
• crowded teeth
• narrow upper alveolus 
• high-arched palate
• hypoplastic maxilla

 Adenoid facies is also typical of recurrent upper respiratory tract allergies. It is diagnostic features are:

• Dennie`s lines, which are horizontal creases under both lower eyelids (first described by the American physician Charlies Dennie)
• a nasal pleat, which is the horizontal crease just above the tip of the nose produced by the recurrent upward wiping of nasal secretions
•  allergic shiners, which are bilateral shadows under the eyes produced by chronic venous congestion. Incidentally, upward wiping of nasal secretions with either the palm or the dorsum of the hands is so common that often it is called the “allergic salute”. Finally, adenoid facies can be part of Cowden syndrome

Diagnosis

Enlarged adenoids are not easily identified on physical examination. A lateral radiograph of the nasopharynx provides a simple and cost-effective method for assessing the size of adenoids and the amount of post-nasal airway space remaining.