Impact of adenotonsillectomy on the dentofacial development of obstructed children: a systematic review and meta-analysis

Background: Dentofacial deformities frequently require orthodontic treatment. Understanding of preventable risk factors is essential for reducing treatment need. Upper airway obstruction (for example due to hypertrophic adenoids and/or tonsils) has been hypothesized to be a risk factor.Objectives: This systematic review aimed to reflect the contemporary evidence on the risk of obstruction by hypertrophic adenoids and/or tonsils, by assessing the dentofacial changes after adeno-and/or tonsillectomy.Search methods: A systematic search of electronic databases and manual searches of grey literature and reference lists of relevant studies was performed.Selection criteria: No restrictions were placed on publication language. Experimental, cohort, and case-control studies were eligible for inclusion. Studies reporting associations between treatment of adenoid and/or tonsil hypertrophy and dentofacial deformities in children were included. Adenoidectomy and/or tonsillectomy were performed in all patients; outcomes were assessed before and after surgery.Data collection and analysis: Data were extracted by two independent reviewers in duplicate. The Cochrane Risk of Bias tool was used to assess the methodological quality of the included papers.Results: The initial search yielded 1196 papers, of which 16 articles could be included. All papers described controlled prospective cohort studies, reporting on a total of 461 patients and controls (mean age, 4.1-13.9 years). A descriptive and quantitative synthesis of dentofacial change postoperatively is presented. Consistent findings across studies were the normalisation towards labial inclination of the upper and lower incisors and towards a more horizontal mandibular growth pattern. No change in vertical or sagittal maxillary growth was reported after surgical treatment. Post-surgical increase in maxillary archwidth and decrease in lateral crossbite-frequency were consistently reported. Findings on overjet, overbite and angle from S to N to B (SNB-angle), mandibular arch width, and gonial angle were inconsistent.Conclusion: The available literature suggests that treatment of hypertrophic adenoids and/or tonsils affects dentofacial deformity. This could indicate a relationship between nasopharyngeal obstruction (i.e. upper airway obstruction) and the dentofacial growth pattern. However, the high risk of bias and considerable diversity between studies impedes a clear conclusion regarding this effect