Ask Dr. Marla: Tonsil Talk

By Dr. Marla Shapiro on April 19, 2010

Click here to submit your question for consideration by Dr. Marla.

The dentist told us that our daughter's tonsils and adenoids would have to be removed if she were to get a palatal expander pre-orthodontic appliance. She said they were enlarged and could make breathing difficult. We consulted our family physician who disagreed, so we decided against the electric surgery and the palatal expander all together. Is this a good reason to remove adenoids and tonsils?

A. The tonsils are located at the back of the mouth on each side and the adenoids are located in the back of the nose. Both have a limited role as part of the immune system. Some children with enlarged tonsils and adenoids can have obstructed breathing during sleep, constant nasal obstruction
and congestion or recurrent infection. As well, the enlargement can lead to chronic mouth breathing, which may result in abnormal facial development, misalignment of the teeth and tooth discolouration. For children who are mouth breathers, the jaws are apart more often than nose breathers. As a result it is possible the back teeth over-erupt, leading to a space between the upper and lower front teeth called an anterior open bite. In speaking with my dental colleagues, there are differing opinions on the need for removal of tonsils and adenoids to either prevent these problems or to assist with dental appliances. I imagine your dentist feels that with removal of the tissue, there would be better breathing through the nose and that potentially could help with normal facial and dental development.

Potential risks of tonsillectomy include bleeding and less common risks such as teeth injury and taste disturbance. The potential complications of adenoidectomy include a change in the voice quality, which usually resolves. Tonsils and adenoids are largest at around six years of age and get smaller with time.
It is important to weigh the potential benefits of the surgery with the potential risks. The issue that must be determined is the impact on quality of life and outcome should you decide to wait for the condition to improve with age, which might not necessarily happen. I would suggest that you ask your doctor for a consult with an ear, nose and throat doctor to best assess treatment for your child.

Published May 2010

Click here to submit your question for consideration by Dr. Marla.

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