Study of craniofacial alterations and of the importance of the rapid maxillary expansion after tonsillectomy

Abstract

Obstructive hypertrophy of the tonsils and/or adenoids is associated with mouth breathing and can lead to facial imbalances. Adenotonsillectomy is not enough to treat the anatomic changes. Facial orthopedic techniques aid in morphological and functional recovery. This prospective longitudinal clinical study aimed to observe craniofacial changes after adenotonsillectomy and to verify the importance of linking rapid maxillary expansion to treatment. Method: Fifty-three children of both genders, aged 6 to 12 years, were allocated to: Group 1, 20 children with nasal breathing; and group 2, 33 children with obstructive hypertrophy of pharyngeal and/or palate undergoing adenotonsillectomy. After surgery, this group was subdivided into Group 2A, 16 patients not treated with rapid maxillary expansion; and Group 2B, 17 patients treated with maxillary rapid expansion. Frontal and lateral cephalometric measurements were made prior to surgery and after 14 months. Statistical analysis used the Kruskal-Wallis and Wilcoxon tests - significance level of 5%. Results: Adenotonsillectomy balanced transversal, sagittal and vertical growth in both groups, and was more effective in the group undergoing combined treatment. Conclusions: Adenotonsillectomy improved the facial growth of children with obstructive hypertrophy, which was more evident when associated with rapid maxillary expansion.