Controversies regarding the consequences of nasal obstruction and reduction of nasopharyngeal space (adenoids) in craniofacial growth have stimulated much research. Presently, it is unanimous that chronic nasal obstruction associated with mouth breathing interferes with harmonious facial development leading to malocclusions and deviations of facial growth.


The structures that contribute most to nasal obstruction in children are the presence of very enlarged adenoids (a type of tonsils located in the back of the nose), enlarged inferior turbinates (rhinitis) and nasal septum deviations.

Sleep apneas are often associated with reduced nasal ventilation.

In cases of paediatric nasal obstruction, breathing will occur through the mouth. Oral breathing obligatory changes the tongue’s position from its normal position (held in the mouth ceiling, the palate) and promotes the narrowing of the hard palate; giving way to subsequent teeth issues and malocclusions. Consequently, the child develops a vertical facial growth, which can be restored to normality after re-establishing nasal permeability (with surgery and, in certain cases, orthodontic specialized rehabilitation).

It is very important to be aware of children’s facial growth because very simple procedures may prevent facial changes that can become impossible to correct in the adult age or only after very invasive surgery (orthognathic surgery) and a long process of orthodontic rehabilitation. It is important to keep present the benefits that good nasal permeability will have in the proper development of the child, in addition to facial growth.