Aims: To explore the effect of sleep disordered breathing in early childhood on face shape at age 15 years and to evaluate the effect of adenoidectomy and tonsillectomy on face shape.

Hypothesis: Sleep disordered breathing in early childhood, tonsillectomy and adenoidectomy have no effect on face shape in late adolescence.

Background: Sleep disorder breathing manifesting as mouth breathing, snoring and sleep apnoea has been of interest to orthodontists for decades as restricted nasal breathing tends to result in significant facial changes particularly increased face height with retrusive chin. However, removal of adenoids and tonsils has been reported as having a significant effect on obstructive breathing and if conducted early will normalise dentofacial morphology. Most of the previous studies have involved small samples (less than 20) and the facial parameters determined by lateral skull radiographs. The ALSPAC resource provides the opportunity to explore a longitudinal data set with detailed facial morphometry measures in late childhood on a large, representative sample of children.

We will explore the effect of sleep disordered breathing at ages 0-6 years on three-dimensional face shape at 15 years of age.

The principal outcome measures will be changes in upper and lower face heights as well as prominence of the nose maxilla and mandible. Differences in the 22 facial landmarks (x, y and z) between the various groups will be evaluated as well as comparison of mean three-dimensional facial shells for each subgroup. This should provide a comprehensive evaluation of the effects of sleep disorder breathing and removal of adenoids and tonsils on face shape.