Abstract : The nasopharyngeal tonsil also known as “adenoids” are located at the superior posterior quadrant of nasopharynx. Adenoid hypertrophy is an actual increase in size in the adenoid tissue. Thirty-two pre-molar teeth and cranial nerves are affected and has great effects on mode of breathing and facial skeleton development. This paper seeks to establish the relationship between adenoid hypertrophy and modes of breathing and facial skeleton. A cross sectional questionnaire based study was carried out among the patients of adenoid hypertrophy visiting Medical Teaching Institution Bacha Khan Medical Complex Swabi. 100 participants were involved in the study, majority had mouth breathing complaint (84%), 62% were having high arched palate, toneless voice and overcrowded teeth and only 30% were having pinched nose. This study reveals the impacts of adenoid hypertrophy on breathing mode and development of facial skeleton.