Academic literature on the topic 'Tonsils hypertrophy'

The aerobic and anaerobic bacterial species and their numbers were studied in tonsillar specimens from children who had undergone elective tonsillectomy: 6 patients with recurrent tonsillitis (RT), 9 with recurrent tonsillitis with hypertrophy (RTH), and 8 with obstructive tonsillar hypertrophy (OTH). Mixed flora were present in all tonsils, yielding an average of 6.7 isolates (5.6 aerobic or facultative and 1.1 anaerobic bacteria). The highest recovery rate of organisms per tonsil was in patients with OTH (7.7 per tonsil), compared to 6.3 per tonsil in RT and 5.9 per tonsil in RTH. The predominant aerobic and facultative organisms were Haemophilus influenzae (22 isolates), Neisseria sp (16), Staphylococcus aureus (14), and Eikenella corrodens (14), and the predominant anaerobic bacteria were Fusobacterium sp (8), Bacteroides sp (7), and Prevotella melaninogenica (5). The number of bacteria per gram of tonsillar tissue varied between 104 and 108. A higher concentration of S aureus and H influenzae was found in hypertrophic tonsils (RTH and OTH) as compared to RT. These findings suggest the presence of an increased bacterial load and supports an etiologic role for H influenzae and S aureus in hypertrophic tonsils with and without inflammation (RTH and OTH). Further studies to elucidate the effect of selective antimicrobial therapy directed at these organisms may offer an alternative management of hypertrophic tonsils.

Diagnosis of hypertrophy of the tonsils is traditionally based on data from mesopharyngoscopy. However, there are conflicting views on the possibility of determining the degree of hypertrophy of the tonsils during a routine examination of the pharynx. To date, several methods have been proposed for the diagnosis of tonsil hypertrophy, which have several disadvantages: the complexity of the studies, poor reproducibility in clinical practice, the need to have non-serial equipment, the effect on the testing results of other pathological conditions (laryngopharyngeal reflux, post-nasal drip syndrome, etc.) and anatomical features of the oropharynx. The purpose of the study is to develop an effective method for the diagnosis of tonsil hypertrophy based on the results of transcervical ultrasound examination of the tonsils. Patients and methods. 132 patients with chronic tonsillitis were examined. To diagnose hypertrophy of the tonsils, ultrasound imaging of the tonsils was used, determining the transverse size of the tonsils and the degree of its vascularization. Results. In tonsils with a transverse diameter of 16–20 and 21–30 mm or more, an increase in blood flow is observed, in contrast to tonsils with a transverse smaller, up to 15 mm, diameter. At the same time, the threshold value of hypertrophy of the tonsils is increased vascularization (peri-, intratonsillar and mixed type) of tonsils with a transverse diameter of 21 mm or more.

The article presents the results of studies on using inosine pranobex in children with pharyngeal tonsils hypertrophy of the 3rd degree after surgical intervention to prevent the development of pharyngeal tonsillitis relapses and compensatory hypertrophy of palatine tonsils in the postoperative period. 355 children aged 3 to 7 years old with a diagnosis of pharyngeal tonsil hypertrophy of the 3rd degree were examined. Laboratory methods of examination included qualitative studies to detect DNA of lymphotropic herpesviruses (EBV, CMV, HHV-6) in flushes from the nasopharyngeal mucosa. As a result of the conducted research, it was revealed that the inclusion of inosine pranobex in the complex treatment of children with chronic adenoiditis with verified herpesvirus infection is clinically effective and helps to reduce the risk of recurrence of pharyngeal tonsil hypertrophy and compensatory palatine tonsil hypertrophy.

Цель. Провести анализ литературы на тему гипертрофии небных миндалин у детей, оценить ее распространенность, причины развития, клинические проявления и методы лечения. Материалы и методы. Для поиска были использованы базы данных Scopus, Web of Science, Google Scholar, PubMed, The Cochrane Library, РИНЦ. Поиск проводили по ключевым словам: «tonsillar hypertrophy», «adenotonsillar hypertrophy», «tonsilen largemen», «pediatric tonsil larhypertrophy», «tonsil hypertrophy treatment», «гипертрофия миндалин», «тонзиллэктомия». Учитывая, что большинство найденных работ освещают проблему гипертрофии лимфоглоточного кольца в целом, а публикации на тему изолированного увеличения небных миндалин достаточно редки, для анализа использованы статьи за последние 20 лет, а также фундаментальные труды авторитетных авторов. Из поиска исключены клинические случаи, статьи, в которых гипертрофия миндалин рассматривалась в совокупности с гипертрофией аденоидов, повторяющиеся статьи, исследования, не прошедшие оценку качества по шкале Jadad. Результаты. Предоставлены актуальные данные по распространенности патологии, механизмам и причинам гипертрофии тонзиллярной ткани. Поднят вопрос об отсутствии стандартных диагностических показателей гипертрофии небных миндалин. Приведены исследования о влиянии патологии на организм детей, а также статьи, оценивающие эффективность тонзиллэктомии. Заключение. Обзор литературы показал высокую распространенность патологии, ее значимое влияние на развитие детей и эффективность хирургических методов лечения по сравнению с консервативными. Purpose. To analyze the literature on the topic of hypertrophy of the palatine tonsils in children, to assess its prevalence, causes of development, clinical manifestations and treatment methods. Materials and methods. Scopus, Web of Science, Google Scholar, PubMed, The Cochrane Library, RSCI databases were used for the search using the keywords "tonsillar hypertrophy", "adenotonsillar hypertrophy", "tonsil enlargemen", "pediatric tonsillar hypertrophy", "tonsil hypertrophy treatment", "tonsillar hypertrophy", "tonsillectomy." Considering that most of the found works highlight the problem of hypertrophy of the lymphopharyngeal ring as a whole, and publications on the topic of isolated enlargement of the palatine tonsils are quite rare, articles from the last 20 years, as well as fundamental works by reputable authors, were used for analysis. Clinical cases, articles in which tonsillar hypertrophy was considered in conjunction with adenoid hypertrophy, repetitive articles, and studies that did not pass the quality assessment on the Jadad scale are excluded from the search. Results. Up-to-date data on the prevalence of pathology, mechanisms and causes of tonsillar tissue hypertrophy are provided. The issue of the absence of standard diagnostic indicators of hypertrophy of the palatine tonsils has been raised. There are studies on the effect of pathology on the body of children, as well as articles evaluating the effectiveness of tonsillectomy. Conclusion. A review of the literature showed a high prevalence of pathology, its significant impact on the development of children and the effectiveness of surgical methods of treatment over conservative ones.

<p class="abstract"><strong>Background:</strong> The major aggregate of mucosa associated lymphoid tissue located in the nasopharynx is the adenoid. The minor aggregate located in the nasopharynx is the Gerlach tonsils or tubal tonsils. The Gerlach tonsils are well described in the text books. But unlike the adenoids they are rarely visualized during routine endoscopic examination. Several studies conducted in children for recurrence of adenoids or serous otitis media after surgery; have reported tubal tonsil hypertrophy widely. This study in adults aims to see the prevalence of Gerlach or tubal tonsils visible during nasal endoscopy.</p><p class="abstract"><strong>Methods:</strong> The case records of 155 adult patients, aged between 18-50 years, who underwent pre-operative diagnostic nasal endoscopy for the management of septal deviations, chronic Sinusitis, nasal polyposis or eustachian dysfunction between Jan. 2019 to March 2020 are retrospectively reviewed and the endoscopy findings analyzed and presented. </p><p class="abstract"><strong>Results:</strong> Gerlach tonsil hypertrophy is reported to be more prevalent in children than in adults. When hypertrophied, the Gerlach tonsils can cause symptoms in adults also and can be visualized during nasal endoscopy. In this adult study, we report a 0.6% incidence of Gerlach tonsil hypertrophy. </p><p class="abstract"><strong>Conclusions:</strong> The possibility of a Gerlach tonsil hypertrophy is to be remembered during nasal endoscopy in adult patients presenting with symptoms of eustachian dysfunction and past history of allergic rhinitis and adeno tonsillectomy. Comparing the size of the contra lateral torus tubaris and the eustachian tube opening during the act of swallowing is helpful in diagnosis.</p>

The aim of the work is to evaluate the prevalence of herpes virus infection of nasopharynx mucosa in children with hypertrophy of adenoid and palatine tonsils to improve the complex treatment methods. An open continuous prospective analytical study was carried out, which included examination and treatment of 186 patients with chronic adenoiditis. The patients were divided into three groups. The first group included 146 children with a diagnosis of adenoids grade 3 – 90 people; adenoids grade 3, hypertrophy of the tonsils grade 2-3 – 56 people. Endoscopic adeno- or adenotonsillotomy was performed in patients of the first group. Patients of the second group had adenoids grade 1–2 and received conservative treatment. Patients of the third group were children with compensatory hypertrophy of the palatine tonsils and recurrences of adenoids, who had a history of endoscopic anesthetic adenotomy. All patients were examined for the presence of Epstein-Barr and cytomegaloviruses DNA in swabs from the nasopharynx and oropharynx by PCR. The result was positive in 63.3% of patients with pharyngeal tonsil hypertrophy and in 76.8% of patients with pharyngeal and tonsil hypertrophy. The calculation of the odds ratio indicated that the probability of hypertrophy of these tonsils in children infected with herpes viruses is 3.3 times higher (OR 3.3; 95% CI 1.2-9.1) than in uninfected ones. Patients from the first group with a positive test result for herpes viruses, in addition to surgical and basic therapy, received a drug with antiviral and immunomodulatory activity. The results of endoscopic adenotomy and adenotonzillotomy in combination with the administration of etiotropic therapy indicated a high treatment efficiency.

The aim. To assess the correlation between subjective measurements and objective volume of palatine tonsils in adults, and to test the effect of oropharyngeal anatomy, body mass index, age, and OSA severity on actual tonsil volume. In addition, we evaluated the effect of tonsil size on the development of OSA in adults.
 Materials and methods. A prospective study of 130 patients with rhonchopathy and obstructive sleep apnea syndrome was conducted. Patients underwent a physical examination, nocturnal polysomnography, Epworth Sleepiness Scale, body mass index (BMI, kg/m²), and a subjective assessment of snoring on an analog scale from 1 (not important) to 10 (worst possible).
 Results: pharyngeal tissues are also found to be proportional to body size in both patients with rhonchopathy and patients with OSA, which indicates a secondary role of anatomy in the pathogenesis of OSA development. Tonsil volume (p = 0.053) tended to correlate with the degree of severity OSA There were no significant differences in the mean apnea-hypopnea index (AHI) between patients with grade I (30.5), II (29.6), or III (38.2) tonsil hypertrophy. Patients with grade IV tonsil hypertrophy had a higher AHI (mean 103.2) than patients with grade I (p = 0.01), II (p = 0.01) or III (p = 0.03) hypertrophy.
 Conclusions: In adult patients with rhonchopathy and OSA, there is a reliable correlation between the clinical degree of tonsil hypertrophy and the objective volume of the tonsils. Possible changes in pharyngeal geometry associated with OSA do not affect the clinical ability to determine tonsil volume. Although tonsil volume correlates with AHI, clinically only grade IV tonsils are predictive of severe OSA. Pharyngeal tissue volume likely reflects body mass index rather than OSA.

Radiofrequency surgery is a widely used modern technique for submucosal volume reduction of the tonsils. So far there is very limited information on morphologic changes in the human tonsils after radiofrequency surgery. We performed histopathological study of tonsillectomy specimens after previous bipolar radiofrequency induced thermotherapy (RFITT). A total of 83 patients underwent bipolar RFITT for hypertrophy of palatine tonsils. Tonsil volume reduction was measured by 3D ultrasonography. Five patients subsequently underwent tonsillectomy. Profound histopathological examination was performed to determine the effect of RFITT on tonsillar architecture. All tonsillectomy specimens showed the intact epithelium, intact germinal centers, normal vascularization, and no evidence of increased fibrosis. No microscopic morphological changes in tonsillectomy specimens after bipolar RFITT were observed. RFITT is an effective submucosal volume reduction procedure for treatment of hypertrophic palatine tonsils with no destructive effect on microscopic tonsillar architecture and hence most probably no functional adverse effect.

Hypertrophy of the lingual tonsil is a condition in which the lingual tonsil, located at the base of the tongue, enlarges. This tonsil consists of clusters of follicles separated by a central groove. In children under 5 years old, the number of follicles usually ranges from 10 to 12, while in adults up to 40 years old, it can reach 35 to 40. This structure plays an important role in the immune system, helping the body fight infections and microbes. Like other tonsils in the throat, the lingual tonsil can sometimes cause problems, such as hypertrophy (enlargement) or chronic infections. The causes of lingual tonsil hypertrophy can be diverse. In some cases, it develops as a compensatory process after the removal of the palatine tonsils. The primary cause in adults may be chronic inflammation of the pharynx. Severe degrees of lingual tonsil hypertrophy are very rare but can lead to various symptoms, such as coughing, difficulty swallowing and breathing, a feeling of pressure in the area beneath the tongue, and other nonspecific complaints. These symptoms are not pathognomonic for lingual tonsil hypertrophy. The challenges in diagnosis and the lack of a standardized approach to surgical treatment require detailed consideration and description in each individual case. Sometimes, patients with lingual tonsil hypertrophy complain of coughing paroxysms. In such cases, mechanical irritation of the lingual tonsil with a probe can provide some assistance in diagnosis. In the context of this study, lingual tonsillectomy surgery was performed on a patient using a diode laser. The results obtained confirmed the high level of technological feasibility and appropriateness of using laser ablation for the treatment of lingual tonsil hypertrophy. Laser ablation is one of the possible surgical procedures for treating lingual tonsil hypertrophy. It can be an effective and technologically advanced method, although it requires experience and qualification of specialists.

Hypertrophy of the lingual tonsil is a condition in which the lingual tonsil, located at the base of the tongue, enlarges. This tonsil consists of clusters of follicles separated by a central groove. In children under 5 years old, the number of follicles usually ranges from 10 to 12, while in adults up to 40 years old, it can reach 35 to 40. This structure plays an important role in the immune system, helping the body fight infections and microbes. Like other tonsils in the throat, the lingual tonsil can sometimes cause problems, such as hypertrophy (enlargement) or chronic infections. The causes of lingual tonsil hypertrophy can be diverse. In some cases, it develops as a compensatory process after the removal of the palatine tonsils. The primary cause in adults may be chronic inflammation of the pharynx. Severe degrees of lingual tonsil hypertrophy are very rare but can lead to various symptoms, such as coughing, difficulty swallowing and breathing, a feeling of pressure in the area beneath the tongue, and other nonspecific complaints. These symptoms are not pathognomonic for lingual tonsil hypertrophy. The challenges in diagnosis and the lack of a standardized approach to surgical treatment require detailed consideration and description in each individual case. Sometimes, patients with lingual tonsil hypertrophy complain of coughing paroxysms. In such cases, mechanical irritation of the lingual tonsil with a probe can provide some assistance in diagnosis. In the context of this study, lingual tonsillectomy surgery was performed on a patient using a diode laser. The results obtained confirmed the high level of technological feasibility and appropriateness of using laser ablation for the treatment of lingual tonsil hypertrophy. Laser ablation is one of the possible surgical procedures for treating lingual tonsil hypertrophy. It can be an effective and technologically advanced method, although it requires experience and qualification of specialists.

Adenotonsillar hypertrophy (ATH) seems to be more frequent and persistent in children with sickle cell disease (SCD), which causes a negative impact since it increases the recurrence of pharyngitis and leads to sleep-disordered breathing (SDB), thus increasing the risk of polymerization of hemoglobin S and thereby vaso-occlusive crisis and other complications. The objectives of the study were to determine the frequency of ATH in preschool children with SCD; observe whether there is an association between ATH and age within the age group studied, assess whether the subscale of SDB is associated with the diagnosis of ATH in preschool children with or without SCD and correlate the presence of ATH with features and clinical complications in preschool children with SCD. It is an analytical observational study, consisting of a study group composed of 48 children with SCD and a control group of 35 children without such disease. All children underwent oropharyngoscopy with front light and nasal video endoscopy, while parents and / or guardians answered the questions of SDB subscale of the Sleep Disturbance Scale for Children (SDSC). The presence of ATH was considered when palatine tonsils were grades three or four of Brodsky scale (1989) and / or when pharyngeal tonsil occluded choanaes in at least 70% (1st criterion) or 50% (2nd criterion). In children with SCD were also surveyed on records the following characteristics and clinical complications of SCD: level of hemoglobin F (HbF), child's age when they began presenting specific symptoms of SDC, history of transfusions and hospitalizations due to painful crises, cerebrovascular accident (CVA) and acute chest syndrome (ACS). Twelve children from the study group (25%) and eight children in the control group (20%) had ATH when we used the 1st criterion of obstruction by the pharyngeal tonsil. When used the 2nd criterion, 18 (37.5%) children in the study group and 13 (37.1%) children in the control group received this diagnosis, with no significant difference between the frequencies in both groups regardless of the obstruction criteria used (p = 0.246 and p = 0.061, respectively). There was only association between ATH and age in the control group and only when the 1st criterion of obstruction by the pharyngeal tonsil was used (p = 0.043). The SDB subscale of EDSC joined the diagnosis of ATH regardless of pharyngeal obstruction criteria used both in the study group (p = 0.0025 for 1st criterion and p = 0.008 for the 2nd), as in the control group (p = 0.0026 for 1st criterion and p = 0.0018 for 2nd). Among the features and clinical complications of SDC, the ATH showed a correlation only with a higher percentage of HbF. It was concluded that ATH was not associated with SDC in preschool children in the study sample; the age of five years was the most affected by ATH in children without the diagnosis of SDC, when used 1st criterion of pharyngeal obstruction; the SDB subscale of SDSC presented itself as a useful tool for the suspected diagnosis of ATH in preschool children with or without SDC; ATH was associated with a higher percentage of HbF in children with SCD.<br>A hipertrofia adenotonsilar (HAT) parece ser mais frequente e com tendência a prolongar-se em crianças com doença falciforme (DF), o que traz um impacto negativo na medida em que aumenta a recorrência de faringites e leva a distúrbios respiratórios do sono (DRS), elevando assim o risco de polimerização da hemoglobina S e, consequentemente, fenômenos vasoclusivos e outras complicações. Os objetivos do trabalho foram: verificar a frequência de HAT em pré-escolares portadores de DF; observar se há associação entre HAT e idade dentro da faixa etária estudada, avaliar se a subescala de DRS associa-se ao diagnóstico de HAT em pré-escolares com ou sem DF e correlacionar a presença de HAT com características e complicações clínicas nos pré-escolares portadores de DF. Trata-se de um estudo observacional analítico, constituído por um grupo-estudo composto por 48 crianças com DF e de um grupo-controle formado por 35 crianças sem a referida doença. Todas as crianças foram submetidas a orofaringoscopia com luz frontal e vídeo-endoscopia nasal, enquanto os pais e/ou responsáveis responderam às três questões da subescala de DRS da Escala de Distúrbio do Sono em Crianças (EDSC). A presença de HAT era considerada quando as tonsilas palatinas situavam-se nos graus três ou quatro da escala de Brodsky (1989) e/ou quando a tonsila faríngea ocluía as coanas em no mínimo 70% (1º critério) ou 50% (2º critério). Em relação às crianças com DF foram ainda pesquisadas em prontuário as seguintes características e complicações clínicas da doença: porcentagem de hemoglobina F (HbF), idade da criança quando se iniciaram os sintomas específicos da DF, histórico de transfusões e internamentos decorrentes de crises álgicas, acidente vascular encefálico (AVE) e síndrome torácica aguda (STA). Doze crianças do grupo-estudo (25%) e oito crianças do grupo-controle (20%) apresentaram HAT quando foi utilizado o 1º critério de obstrução pela tonsila faríngea. Quando utilizado o 2º critério, 18 (37,5%) crianças do grupo-estudo e 13 (37,1%) crianças do grupo-controle receberam este diagnóstico, não havendo diferença significativa entre as frequências nos dois grupos independentemente do critério de obstrução utilizado (p=0,246 e p=0,061, respectivamente). Só houve associação entre HAT e idade no grupo-controle e somente quando utilizado o 1º critério de obstrução pela tonsila faríngea (p=0,043). A subescala de DRS da EDSC associou-se ao diagnóstico de HAT independentemente do critério de obstrução faríngea utilizado, tanto no grupo-estudo (p=0,0025 pelo 1º critério e p=0,008 pelo 2º), quanto no grupo-controle (p=0,0026 pelo 1º critério e p=0,0018 pelo 2º). Dentre as características e complicações clínicas da DF, a HAT demonstrou associação somente com uma porcentagem mais alta de HbF. Concluiu-se que a HAT não esteve associada à DF em pré-escolares na amostra estudada; a idade de cinco anos foi a mais acometida por HAT em crianças sem o diagnóstico de DF, quando utilizado o 1º critério de obstrução faríngea; a subescala de DRS da EDSC apresentou-se como um instrumento útil para a suspeita diagnóstica de HAT em pré-escolares com ou sem DF; a HAT esteve associada a uma maior porcentagem de HbF nas crianças com DF.

Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy+adenoidectomy or tonsillotomy +adenoidectomy) on vocal function perceptually and acoustically. Study Design: Sixty-seven children, aged 50-65 months, on waiting list for tonsil surgery were randomized to tonsillectomy (n=33) or tonsillotomy (n=34). Fifty-seven age and gender matched healthy pre-school children were controls. Twenty-eight of them, aged 48-59 months, served as control group before surgery, and 29, aged 60-71 months, after surgery Methods: Before surgery and six months postoperatively, the children were recorded producing three sustained vowels (/A, u, i/) and 14 words. The control groups were recorded only once. Three trained speech and language pathologists performed the perceptual analysis using Visual Analogue Scales (VAS) for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio and the centre frequencies of formants 1-3 Results: Before surgery the children were rated to have more hyponasality and compressed/throaty voice (p&lt;0,05) and  lower mean pitch (p&lt;0,01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formant. After surgery there were no differences perceptually. Perturbation measures decreased but were still higher compared to the control group’s, p&lt;0, 05. Differences in formant frequencies for /i/ and /u/ remained. No differences were found between the two surgical methods. Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

Alterações morfológicas e dentofaciais têm sido repetidamente atribuídas ao impedimento da função naso-respiratória devido à hipertrofia de tonsilas faríngea e palatinas. O objetivo da presente investigação foi avaliar o padrão esquelético e características oclusais de crianças respiradoras bucais antes (T1) e em média 28 meses após (T2) serem submetidas à cirurgia para remoção de tonsilas hipertrofiadas, comparando com crianças respiradoras nasais. O grupo experimental foi composto de 33 crianças respiradoras bucais (RB) e o grupo controle, de 32 crianças respiradoras nasais (RN). Os exames ortodônticos (radiografia cefalométrica e modelos de estudo) foram realizados em ambos os grupos nos tempos T1 e T2. Na comparação entre os grupos, os resultados permitiram concluir que os respiradores bucais apresentaram maior inclinação do plano mandibular em relação à base craniana e ao plano palatal (SN.GoGn; PP.PM); ângulo goníaco mais obtuso (ArGo.GoMe); tendência ao tipo morfológico dolicofacial (BaN.PtGn); altura do ramo da mandíbula (Ar-Go) e altura posterior da face (S-Go) diminuídas; maior número de mordidas cruzadas e menor distância intermolares. Em T2, o padrão morfológico predominante da face foi mesofacial no grupo RN e dolicofacial no grupo RB; o overbite foi normal nos RB e profundo nos RN e o overjet apresentou-se maior nos RB. Em relação à mordida aberta, mordida cruzada, relação de caninos, plano terminal dos segundos molares decíduos e distância intercaninos e intermolares houve semelhança entre os grupos RB e RN. Ao analisar cada grupo separadamente, verificou-se que, vinte e oito meses após a cirurgia, nos RB, houve alteração na direção do crescimento da face e inclinação do plano mandibular no sentido anti-horário, com diminuição dos valores de SN.GoGn, PP.PM, SNGn, ArGo.GoMe e aumento de BaN.PtGn. Em ambos os grupos houve crescimento vertical anterior e posterior da face, evidenciado pelo aumento das medidas verticais lineares (N-Me, N-ENA, ENA-Me, S-Go, S-Ar, Ar- Go). O plano terminal dos segundos molares decíduos modificou-se de reto para degrau mesial nos dois grupos; o overbite alterou de negativo para normal no grupo RB e tornou-se profundo, no grupo RN. No presente estudo, a desobstrução das vias aéreas através da remoção cirúrgica das tonsilas faríngea e/ou palatinas em crianças entre 3 e 6 anos de idade, resgatou o padrão de crescimento normal para esses pacientes respiradores bucais, mostrando resultados excelentes sobre as características oclusais e esqueléticas.<br>Morphological and dentofacial abnormalities have been attributed to respiratory obstruction caused by adenoid and tonsils hypertrophy. The objective of the present study was to evaluate the skeletal patterns and occlusal characteristics in mouthbreathing children before (T1) and a mean of 28 months after (T2) they have been were submitted to surgery for tonsils hypertrophy, compared with those of nosebreathing children. The experimental group was composed of 33 mouth-breathing children (MB) and the control group, 32 nose-breathing children (NB). Orthodontic examinations (cephalometric radiography and study models) were performed on both groups at the times T1 and T2. After comparisons between the groups, it could be concluded that the MB presented greater inclination of the mandibular plane in relation to the cranial base and palatal plane (SN.GoGn, PP.PM); more obtuse gonial angle (ArGo.GoMe); tendency towards the dolicofacial pattern (BaN.PtGn); reduced height of the mandibular ramus (Ar-Go) and lower posterior height of the face (S-Go); higher frequency of crossbite and smaller intermolar distance. After surgery (T2), the predominant morphological pattern of the face was mesofacial in NB and dolicofacial in MB; the overbite was normal in MB and deep in NB; the overjet was greater in MB; the two groups were similar in relation to open bite, crossbite, the antero-posterior canines relationship and the second deciduous molars terminal plane, and the intercanine and intermolar distances. Separate analysis on each group showed that, 28 months after surgery, the MB presented an counterclockwise rotation of the mandible, smaller SN.GoGn, PP.PM, SNGn and ArGo.GoMe values and larger BaN.PtGn value. In both groups, there was anterior and posterior vertical growth of the face, with increase in the linear vertical measurements (N-Me, N-ENA, ENA-Me, S-Go, S-Ar and Ar-Go). The second deciduous molars terminal plane changed from straight to mesial, in both groups; the overbite changed from negative to normal in MB and it became deep in NB. In the present study, the surgery for tonsils hypertrophy in children aged 3 to 6 years restored the normal growth pattern for these mouth-breathing patients, with excellent results regarding occlusal and skeletal characteristics.

A cárie dentária é considerada uma das doenças crónicas mais comuns em crianças, sendo de origem multifatorial, resultante da interação entre um hospedeiro suscetível, os microrganismos cariogénicos e as dietas cariogénicas. Podem-se considerar como fatores de risco da cárie dentária, o fluxo salivar inadequado, baixa capacidade tampão salivar, altos níveis de bactérias cariogénicas, reduzida exposição ao flúor e consumo frequente de açúcares. Os problemas otorrinolaringológicos referem-se às patologias do ouvido, nariz e garganta, sendo estes a otite média, sinusite, rinite alérgica, amigdalites e adenoidites. O objetivo desta revisão bibliográfica é verificar se existe uma relação entre os problemas otorrinolaringológicos e a cárie dentária.<br>Dental caries is considered one of the most common chronic diseases in children, being of multifactorial origin, resulting from the interaction between a susceptible host, cariogenic microorganisms and cariogenic diets. As risk factors for dental caries, inadequate salivary flow, low salivary buffer capacity, high levels of bacteria cariogenic, reduced exposure to fluoride and frequent sugar consumption can be considered. Otorhinolaryngological problems refer to pathologies of the ear, nose and throat, which are otitis media, sinusitis, allergic rhinitis, tonsillitis and adenoiditis. The purpose of this literature review is to verify whether there is a relationship between otorhinolaryngological problems and dental caries.

Adenoids, play a significant role in inflammatory response, especially in children. Together with other tissues of the lymphatic system, it fights off infections. In most cases of nasopharyngeal cancer, though rare, other histopathological variants of adenoids are seen. Adenoid hypertrophy is mostly observed, which causes obstruction of the nasopharynx and dysfunction of the Eustachian tube because of the formation of an abnormal tissue mass. Different viral and bacterial pathogens are associated with adenoid hypertrophy, including Epstein-Barr virus (EBV), coronavirus, parainfluenza virus, Mycoplasma pneumoniae, Staphylococcus aureus, and Neisseria gonorrhoeae. Among these, EBV is associated with both adenoid hypertrophy and nasopharyngeal cancer, indicating the effect of EBV on both nasopharyngeal cancer and adenoids. We critically appraise the current evidence and discuss potential link between adenoids and nasopharyngeal carcinoma.

Adenoid tissue diseases (acute adenoiditis, adenoid hypertrophy and chronic adenoiditis) typically occur in the childhood. Adenoid hypertrophy seems to be related to many factors, such as infections, passive smoking, low vitamin D levels, while the role of allergy still remains controversial. Chronic adenoiditis incidence has increased in recent years, as a result of higher rates of upper airway infections and biofilm formation, with multiple potential clinical complications. Diagnosis is typically clinical, with physical examination and nasal endoscopy. The treatment can be medical or surgical. Non-surgical treatment of chronic adenoiditis with intranasal steroids and leukotriene inhibitors have proven to be effective, reducing the size of the adenoid tissue and symptoms. On the other hand adenoidectomy is one of the commonest ENT surgical procedures with excellent outcomes and rare adverse events. Curettage adenoidectomy is widely used by many ENT surgeon, but presents risk of residual adenoidal tissue, especially in peritubaric and superior nasopharynx regions. In the last years different surgical techniques have been proposed to reduce surgical risk and morbidity, such as electrocautery adenoidectomy, microdebrider adenoidectomy and coblation adenoidectomy. Intranasal or transoral endoscopes enabled a great control of surgical field and a complete removal of adenoid tissue.

Adenoid is a secondary lymphoid organ located in the nasopharynx. Its location plays an important role in the host defence of the upper respiratory tract. Adenoid hypertrophy is common in children of age 8–15 which cause symptoms ranging from mouth breathing, hyponasal speech, snoring, obstructive sleep apnoea long term sequelae of which could be neurocognitive abnormalities like learning difficulties and below-average intelligent quotient (adenoid facies----idiotic look), and a higher risk of cardiovascular morbidity(e.g.: decreased right ventricular ejection fraction, left ventricular hypertrophy). To name a few more patients with adenoid hypertrophy are more susceptible to get symptoms suggestive of chronic sinusitis, recurrent otitis media. Tonsils and Adenoids are usually larger in children but the trend to shrink as age progresses, making it all the more a reason to be conservative in the management of treating adenoid hypertrophy by employing corticosteroid nasal sprays.

Orthodontics often comes across mouth-breathing patients whose cause of upper airway obstruction consists of hypertrophy of the pharyngeal or adenoid tonsils and/or palatine tonsils. The effects of mouth breathing on craniofacial growth are characterized by maxillary atresia with the deep palate and the expression of preponderant growth in the vertical direction, and anterior open bite and mandibular retrusion may occur. After the referral and the evaluation/performance of the otorhinolaryngologist, the procedure of rapid expansion of the maxilla is indicated, in addition to the other procedures according to the orthopedic/orthodontic problem presented. Often, the performance of the speech therapist becomes necessary and important for the maintenance of the results obtained with the treatment performed by orthodontics. However, despite conducts already readily established in the daily life of orthodontic professionals, this chapter deals with a health condition that may be associated with the mouth-breathing child, which is Obstructive Sleep Apnea and Hypopnea Syndrome (OSAHS) and that many professionals are still unfamiliar with. Disease screening allows for a more efficient and complete approach to the patient's problem by all professionals involved.