Objective To explore the effect of adenoid hypertrophy on craniofacial morphological aesthetics and quality of life in children and adolescents. Methods A total of 100 children and adolescents with adenoid hypertrophy admitted to our hospital from June 2024 to May 2025 were selected as the observation group, and 100 healthy children and adolescents who underwent physical examination in our hospital during the same period were selected as the control group. All participants underwent X-ray lateral cephalogram, and the sagittal diameter of the upper airway and the linear distance indicators of skeletal facial type were compared between the two groups. The skeletal facial type classiffcation was recorded for the observation group, which underwent adenoidectomy using a plasma radiofrequency scalpel under general anesthesia. The clinical symptom severity and quality of life before and after treatment were compared, and the treatment satisfaction was investigated. Results The adenoid thickness of the observation group was greater than that of the control group, and the PNS-UPW was smaller than that of the control group (P<0.05). There was no statistically signiffcant difference in thebony nasopharyngeal cavity width between the two groups (P>0.05). The mandibular body length of the observation group was shorter than that of the control group, and the anterior facial height was longer than that of the control group (P<0.05). There were no statistically significant differences in ascending ramus height, posterior cranial base length, anterior cranial base length and posterior facial height between the two groups (P>0.05). The proportion of skeletal class Ⅱ in the observation group was the highest, accounting for 61.00%. After treatment, the scores of nasal obstruction, snoring, mouth breathing and OSA-18 in the observation group were lower than those before treatment, and the treatment satisfaction rate reached 99.00%. Conclusion Adenoid hypertrophy can affect the craniofacial morphology and quality of life of children and adolescents, with skeletal class Ⅱ malocclusion being the main type. Adenoidectomy using a plasma radiofrequency scalpel under general anesthesia can improve children's quality of life, alleviate clinical symptoms such as nasal obstruction, snoring and mouth breathing, and achieve higher treatment satisfaction.