Adenoid facies

Adenoid facies, also known as the long face syndrome, refers to the long, open-mouthed face of children with adenoid hypertrophy. Hypertrophy of the nasopharyngeal pad of lymphoid tissues (adenoids) is the most common cause of nasal obstruction in children. The mouth is always open because upper airway congestion has made patients obligatory mouth breathers. Persistent mouth breathing due to nasal obstruction in childhood may be associated with the development of craniofacial anomalies such as the adenoid facies. The most common presenting symptoms are chronic mouth breathing and snoring. The most dangerous symptom is sleep apnea.

The characteristic facial appearance consists of:

  • underdeveloped thin nostrils
  • short upper lip
  • prominent upper teeth
  • crowded teeth
  • narrow upper alveolus 
  • high-arched palate
  • hypoplastic maxilla

 Adenoid facies is also typical of recurrent upper respiratory tract allergies. Its diagnostic features are:

  • Dennie's lines: horizontal creases under the lower eyelids (first described by the American physician Charlies Dennie)
  • a nasal pleat: the horizontal crease just above the tip of the nose produced by the recurrent upward wiping of nasal secretions
  •  allergic shiners: bilateral shadows under the eyes produced by chronic venous congestion.

Adenoid facies can be part of Cowden syndrome


Enlarged adenoids are not easily identified on physical examination. A lateral radiograph of the nasopharynx provides a simple and cost-effective method for assessing the size of adenoids and the amount of post-nasal airway space remaining. Another radiation-free method is direct endoscopic visualization with a laryngoscope.

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Article information

rID: 7051
System: Head & Neck
Synonyms or Alternate Spellings:
  • Long face syndrome

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