ORIGINAL RESEARCH article
Front. Dent. Med.
Sec. Pediatric Dentistry
Volume 6 - 2025 | doi: 10.3389/fdmed.2025.1550033
This article is part of the Research TopicAdolescent Oral, Mental and Sexual WellnessView all 7 articles
Association Between Craniofacial Features and Adenoid Hypertrophy Severity: A Cross-Sectional Study Based on Lateral Photography
Provisionally accepted
- 1Shanghai Ninth People's Hospital, shanghai, China
- 2Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Shanghai, China
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objective This study aimed to investigate the association between adenoid hypertrophy (AH) severity and craniofacial morphology in prepubertal children by analyzing angular and proportional measurements from standardized lateral craniofacial photographs, which would contribute to identify AH-associated craniofacial phenotypes and develop predictive models for severe AH based on distinctive craniofacial features. Methods A cross-sectional study was conducted at the Department of Otolaryngology Head and Neck Surgery, Shanghai Ninth People's Hospital, from August 2023 to August 2024, enrolling children aged 3-14 years. Standardized lateral craniofacial photographs and demographic information were systematically collected. Participants were randomly allocated into training and validation groups in a 7:3 ratio, with both groups further stratified according to AH severity: no AH, mild/moderate AH, and severe AH. 13 craniofacial angles and 6 ratios were evaluated using photogrammetric analysis, and significant craniofacial parameters were identified through univariate regression modeling. Prediction models were subsequently developed based on training data using logistic regression and evaluated on validation data via receiver operating characteristic (ROC) curve analysis. Results The study totally enrolled 159 children (mean age: 7.96 ± 2.67 years), comprising training (n=107) and validation (n=52) groups. Comparative analysis revealed significant differences between the no/moderate AH and severe AH groups across five clinical aspects: sleep positioning, breathing patterns, rhinitis prevalence, snoring intensity, and tonsillar hypertrophy (p < 0.05), alongside eight distinctive craniofacial indices (6 angles and 2 ratios, p < 0.05). Furthermore, severe AH cases was associated with an age-dependent progression of adenoid facies (r=0.62, p<0.001). After adjusting for confounding clinical and baseline factors, univariate analyses identified significant trends in craniofacial morphology associated with AH severity, an increasing lip protrusion ratio (UL-GSL/TGSL), alongside decreasing angles for maxillary protrusion (Tra-Na-Po) and upper lip protrusion (Sna-UpLip-Na-SGn) (p<0.01) with increasing AH. The predictive model combining these parameters achieved an area under the curve (AUC) of 0.843 in the training group, with external validation confirming robust discriminative capacity (AUC = 0.884). Conclusion Photogrammetric analysis of craniofacial parameters provides an effective method for predicting severe AH in prepubertal children. Severe AH is associated with an age-dependent, progressive development of midfacial retrusion, labial prominence, and reduced mandibular proportions
Keywords: Adenoid hypertrophy, Prepubertal childrenPediatric, Craniofacial abnormalatiesabnormalities, Digital photo, PreditionPrediction model
Received: 22 Dec 2024; Accepted: 08 Aug 2025.
Copyright: © 2025 Wang, Zhang, zhou, TAN, guo, Liu and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Huan Jia, Shanghai Ninth People’s Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, Shanghai, China
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