Soreness and cracking at the corners of the mouth, a condition called angular cheilitis, can be an uncomfortable problem for children after they have surgery to remove their tonsils and adenoids. This study looks at whether applying a moisturizing cream containing dexpanthenol to the corners of the mouth right before the surgery can help prevent this from happening.

The main idea (hypothesis)i the investigators are testing is that this dexpanthenol cream will protect the skin and reduce the number of children who get these painful lip sores after their operation.

To find this out, children who are scheduled to have tonsil and/or adenoid surgery will be invited to join the study. Children (participants) will be randomly placed into one of two groups by chance. One group of children will have the dexpanthenol cream applied to their lip corners just before their surgery. The other group will not have any cream applied to their lip corners before surgery. After the surgery, investigators will check all children to see if they have developed lip corner sores and compare how many children in each group experienced this problem.

The goal of this research is to see if this simple cream application can be an easy way to help children feel more comfortable while they are recovering from their surgery.

Inclusion Criteria:

• Age between 3 and 15 years, inclusive
• Scheduled for adenotonsillectomy (for indications such as obstructive sleep apnea and/or recurrent tonsillitis/adenotonsillitis).
• Written informed consent provided by parents or legal guardians.

Exclusion Criteria:

• Known allergy or hypersensitivity to dexpanthenol or any components of the cream.
• Presence of angular cheilitis at the time of preoperative assessment.
• Use of topical or systemic steroids or antibiotics within 4 weeks prior to surgery that might affect oral healing.
• Participants with known systemic diseases or conditions that might impair wound healing (e.g., uncontrolled diabetes, immunosuppressive disorders).
• Known diagnosis of iron deficiency and/or vitamin B12 deficiency prior to surgery.

A total of 106 participants were initially enrolled and randomized into the study. However, five participants were lost to follow-up and their data were excluded from the final analysis. Therefore, the baseline characteristics are reported for the 101 participants who completed the study and were included in the analysis population.

From the day of surgery to the final study follow-up on the seventh postoperative day.

The systematic assessment was limited to the pre-specified primary outcome (incidence of angular cheilitis) and secondary outcome (postoperative pain). No other adverse events were systematically monitored or recorded as part of the study protocol.

A precise a priori power analysis was not feasible due to limited prior literature. The study's single-center design may limit the generalizability of the findings. The short, seven-day follow-up period does not allow for assessment of long-term effects. Finally, the parent-reported rating scale for the secondary outcome of pain introduces a degree of subjectivity.

The outcome assessor, a senior surgeon responsible for evaluating postoperative angular cheilitis and pain, was blinded to the treatment group allocation of the participants.