A 4-year-old child presents with long-standing mouth breathing, nasal voice, and failure to thrive. Examination reveals a narrow facies with an open mouth, pinched nostrils, and a high-arched palate. These features are classic for adenoid facies. Which is the most appropriate management to prevent permanent facial deformity if adenoid hypertrophy is confirmed?

• A Tonsillectomy alone
• B Nasal corticosteroid spray for 6 months
• C Continuous positive airway pressure (CPAP)
• D Adenoidectomy with or without tonsillectomy ✓

Explanation

Adenoid facies results from chronic adenoid hypertrophy causing mouth breathing during the critical growth period of the midface. Adenoidectomy (with tonsillectomy if tonsillar hypertrophy coexists) removes the obstruction and allows normal facial development. CPAP is for OSA management, not corrective. Steroids do not resolve established structural obstruction. Tonsillectomy alone would not address the nasopharyngeal obstruction from adenoids.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.