Education  |   August 2018
Adenoid Facies
Author Notes
  • From the Department of Anesthesiology (A.J.S.); and the Department of Otolaryngology and Head and Neck Surgery (S.S.B.), Mahatma Gandhi Medical College and Research Institute, Pillaiyarkuppam, India.
  • Charles D. Collard, M.D., served as Handling Editor for this article.
    Charles D. Collard, M.D., served as Handling Editor for this article.×
  • Address correspondence to Dr. Bakshi:
Article Information
Education / Images in Anesthesiology / Airway Management / Gastrointestinal and Hepatic Systems / Pediatric Anesthesia / Radiological and Other Imaging / Respiratory System
Education   |   August 2018
Adenoid Facies
Anesthesiology 8 2018, Vol.129, 334. doi:
Anesthesiology 8 2018, Vol.129, 334. doi:
A 13-yr-old girl came for orthodontic correction of the facial features during general anesthesia with nasal intubation. Preanesthetic evaluation revealed a 9-month history of nasal obstruction, snoring, and typical adenoid facies. Nasopharyngeal x-ray was significant for adenoid hypertrophy (Panel A, arrow). Adenoid facies1  is defined as the open-mouthed appearance in children, associated with a narrow nose, shortened upper lip (Panel B), narrow palate, high palatal vault, and dental crowding (Panel C).
Identification of these adenoid features is prudent as hypertrophic adenoids not only cause mechanical obstruction but also increase the risk of complications of nasal intubation like bleeding, traumatic avulsion of adenoids,2  and aspiration.3  This is even more important in children undergoing dental procedures as nasal intubation is commonly employed. A thorough preoperative assessment with radiographs of the skull in lateral view along with endoscopic evaluation may be of assistance, and nasal intubation guided by flexible fiberoptic may be considered.
Competing Interests
The authors declare no competing interests.
Quick, CA, Gundlach, KK Adenoid facies. Laryngoscope 1978; 88(2 pt 1):327–33 [Article] [PubMed]
Chen, HH, Chen, LC, Hsieh, YH, Chen, MK, Chen, CH, Cheng, KI Unintended avulsion of hypertrophic adenoids in posterior nasopharynx: A case report of a rare complication caused by nasotracheal intubation. Case Rep Anesthesiol 2014; 2014:980930 [PubMed]
Ng, SY, Yew, WS Nasotracheal tube occlusion from adenoid trauma. Anaesth Intensive Care 2006; 34:829–30 [PubMed]