{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T04:05:48Z","timestamp":1784261148386,"version":"3.55.0"},"reference-count":45,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"The Application of Modified PMTC (Professional Mechanical Tooth Cleaning, PMTC) Technique in the Clinical Process of Orthodontic Fixed Appliance Treatment","award":["QYYL2022X014"],"award-info":[{"award-number":["QYYL2022X014"]}]},{"name":"New Technologies and Projects of Chongqing Medical University Affiliated Stomatological Hospital","award":["QYYL2023X001"],"award-info":[{"award-number":["QYYL2023X001"]}]},{"name":"The Postdoctoral Fellowship Program of CPSF","award":["GZC20251082"],"award-info":[{"award-number":["GZC20251082"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82170936"],"award-info":[{"award-number":["82170936"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82370973"],"award-info":[{"award-number":["82370973"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82371018"],"award-info":[{"award-number":["82371018"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82571106"],"award-info":[{"award-number":["82571106"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Science and Technology Research Project of Chongqing Education Commission","award":["KJQN202200434"],"award-info":[{"award-number":["KJQN202200434"]}]},{"name":"Educational Teaching Research Project of Stomatology School of Chongqing Medical University in 2024","award":["KQJ202417"],"award-info":[{"award-number":["KQJ202417"]}]},{"name":"Medical Young Top Talent Program of Chongqing Health Commission","award":["YXQN202433"],"award-info":[{"award-number":["YXQN202433"]}]},{"name":"Joint Project of Chongqing Health Commission and Science and Technology Bureau","award":["2024MSXM049"],"award-info":[{"award-number":["2024MSXM049"]}]},{"name":"Joint Project of Chongqing Health Commission and Science and Technology Bureau","award":["2026MSXM069"],"award-info":[{"award-number":["2026MSXM069"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["DIGITAL HEALTH"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This proof-of-concept study aimed to develop and preliminarily validate a hybrid artificial intelligence (AI) model that combines 2D facial photographs with clinical variables for non-invasive pediatric adenoid hypertrophy (AH) screening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>11,465 full-face photographs (2,097 children, 6\u201314 years) were retrospectively collected and labeled by adenoid-to-nasopharyngeal ratio (&gt;0.6 was defined as AH). A multi-stage optimization framework was employed to develop a photo-based deep learning model (AHDNet). Subsequently, features from AHDNet were integrated with clinical variables to construct a hybrid model (HM). Comprehensive model evaluation was performed using multiple metrics and interpretability methods. AHDNet\u2019s performance was also benchmarked against 21 clinicians of varying experience. To support further model optimization, an open-access testing platform was provided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For preliminary screening, AHDNet achieved an area under the receiver operating characteristic curve (AUC) of 0.669 (95% confidence interval [CI] 0.584\u20130.748), showing a discriminatory ability comparable to that of human raters. The HM exhibited improved performance with an AUC of 0.712 (95% CI 0.630\u20130.784) and more favorable calibration. Decision curve analysis (DCA) revealed that the HM maintained positive net benefit within the threshold range of 0.133 to 0.429. Interpretability analysis highlighted the eyes and mandibular angle as key discriminative regions and identified narrow maxillary dental arches and strained lip closure as significant clinical risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>As a proof-of-concept, the hybrid AI model may serve as a non-invasive tool to assist with preliminary screening for pediatric AH, potentially facilitating timely detection and reducing the risk of subsequent maxillofacial deformities associated with AH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20552076261469753","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T14:39:28Z","timestamp":1784039968000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Photo-based deep learning for detection of pediatric adenoid hypertrophy"],"prefix":"10.1177","volume":"12","author":[{"given":"Nannan","family":"Huang","sequence":"first","affiliation":[{"name":"The Affiliated Stomatological Hospital of Chongqing Medical University"},{"name":"Chongqing Key Laboratory of Oral Diseases, Chongqing Medical University, Chongqing, China"},{"name":"Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University, Chongqing, China"},{"name":"Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Zeng","sequence":"additional","affiliation":[{"name":"Chongqing Medical University"},{"name":"Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Chongqing University of Posts and Telecommunications"},{"name":"Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaqiao","family":"Wang","sequence":"additional","affiliation":[{"name":"The Affiliated Stomatological Hospital of Chongqing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"The Affiliated Stomatological Hospital of Chongqing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzhou","family":"Li","sequence":"additional","affiliation":[{"name":"The Affiliated Stomatological Hospital of Chongqing Medical University"},{"name":"Chongqing Key Laboratory of Oral Diseases, Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongchao","family":"Wang","sequence":"additional","affiliation":[{"name":"Chongqing University of Posts and Telecommunications"},{"name":"Chongqing Key Laboratory of Image Cognition, Chongqing University of Posts and Telecommunications, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-7170-2309","authenticated-orcid":false,"given":"He","family":"Zhang","sequence":"additional","affiliation":[{"name":"Chongqing Medical University"},{"name":"The Affiliated Stomatological Hospital of Chongqing Medical University"},{"name":"Chongqing Municipal Health Commission Key Laboratory of Oral Biomedical Engineering, Chongqing Medical University, Chongqing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2017.06.001"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2214"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjpo-2022-001710"},{"key":"e_1_3_7_5_2","first-page":"220345251361796","article-title":"Mandibular advancement device versus CPAP in severe obstructive sleep apnea","author":"Colpani JT","year":"2025","unstructured":"Colpani JT, Ou Y-H, Kosasih AM, et al. Mandibular advancement device versus CPAP in severe obstructive sleep apnea. J Dent Res 2025: 220345251361796.","journal-title":"J Dent Res"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.14219\/jada.2013.31"},{"key":"e_1_3_7_7_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1109\/JBHI.2025.3527403","article-title":"Non-invasive detection of adenoid hypertrophy using deep learning based on heart-lung sounds","author":"Xiao S","year":"2025","unstructured":"Xiao S, Zhang X, Lu Y, et al. Non-invasive detection of adenoid hypertrophy using deep learning based on heart-lung sounds. IEEE J Biomed Health Inform 2025: 1\u201313. https:\/\/doi.org\/10.1109\/jbhi.2025.3527403","journal-title":"IEEE J Biomed Health Inform"},{"key":"e_1_3_7_8_2","first-page":"18","article-title":"Mouth breathing: adverse effects on facial growth, health, academics, and behavior","volume":"58","author":"Jefferson Y","year":"2010","unstructured":"Jefferson Y. Mouth breathing: adverse effects on facial growth, health, academics, and behavior. Gen Dent 2010; 58: 18\u201325, quiz 26\u201327, 79\u201380.","journal-title":"Gen Dent"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000002188"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00106-023-01299-6"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering9070273"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa640"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-02180-9"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2024.102550"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/00220345221106676"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1177\/00220345241253186"},{"key":"e_1_3_7_17_2","doi-asserted-by":"crossref","unstructured":"Hu X Zhang Q-Y Yang J-J et al. Photographic Analysis and Machine Learning for Diagnostic Prediction of Adenoid Hypertrophy. In: 2019 IEEE 16th International Conference on Networking Sensing and Control (ICNSC) Banff AB Canada IEEE pp. 7\u201311.","DOI":"10.1109\/ICNSC.2019.8743276"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/00220345211020265"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.identj.2022.09.002"},{"key":"e_1_3_7_20_2","doi-asserted-by":"crossref","unstructured":"Lei Y Qin H Li X et al. A Strategy for Aided Diagnosis of Obstructive Sleep Apnea in Children Based on Graph Neural Network. In: 2023 IEEE 47th Annual Computers Software and Applications Conference (COMPSAC) Torino Italy IEEE pp. 1513\u20131518.","DOI":"10.1109\/COMPSAC57700.2023.00233"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2023-078378"},{"key":"e_1_3_7_22_2","doi-asserted-by":"crossref","unstructured":"Deng J Guo J Ververas E et al. RetinaFace: single-shot multi-level face localisation in the wild. In: 2020 IEEE\/CVF Conference on Computer Vision and Pattern Recognition (CVPR) Seattle WA USA 13-19 June 2020 pp. 5202\u20135211.","DOI":"10.1109\/CVPR42600.2020.00525"},{"key":"e_1_3_7_23_2","unstructured":"He K Zhang X Ren S et al. Deep residual learning for image recognition. Epub ahead of print 10 2015. https:\/\/doi.org\/10.48550\/arXiv.1512.03385"},{"key":"e_1_3_7_24_2","unstructured":"Mehta S Rastegari M. MobileViT: light-weight general-purpose and mobile-friendly vision transformer. Epub ahead of print 4 March 2022. https:\/\/doi.org\/10.48550\/arXiv.2110.02178"},{"key":"e_1_3_7_25_2","article-title":"Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study","volume":"24","author":"Tse KL","unstructured":"Tse KL, Savoldi F, Li KY, et al. Prevalence of adenoid hypertrophy among 12-year-old children and its association with craniofacial characteristics: a cross-sectional study. Prog Orthod; 24. https:\/\/doi.org\/10.1186\/s40510-023-00481-4, Epub ahead of print 11 September 2023.","journal-title":"Prog Orthod"},{"key":"e_1_3_7_26_2","first-page":"S08895406250017","article-title":"Is adenotonsillar hypertrophy associated with dentofacial morphology? A systematic review and meta-analyses","author":"Zhao T","year":"2025","unstructured":"Zhao T, Wang M, Ngan P, et al. Is adenotonsillar hypertrophy associated with dentofacial morphology? A systematic review and meta-analyses. Am J Orthod Dentofacial Orthop 2025: S0889540625001726.","journal-title":"Am J Orthod Dentofacial Orthop"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11263-019-01228-7"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/00220345211009474"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2022.11.011"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1002\/lio2.837"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2014.06.013"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfca.2025.107850"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jfca.2025.108843"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjm055"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1494517"},{"key":"e_1_3_7_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12903-024-04932-0"},{"key":"e_1_3_7_37_2","first-page":"243","article-title":"Growth of the nasopharynx and adenoid development from one to eighteeen years","volume":"46","author":"Handelman CS","year":"1976","unstructured":"Handelman CS, Osborne G, Handelman CS. Growth of the nasopharynx and adenoid development from one to eighteeen years. Angle Orthod 1976; 46: 243\u2013259. https:\/\/doi.org\/10.1043\/0003-3219(1976)046<0243:GOTNAA>2.0.CO;2","journal-title":"Angle Orthod"},{"key":"e_1_3_7_38_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmet.2024.05.012"},{"key":"e_1_3_7_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.landig.2025.03.002"},{"key":"e_1_3_7_40_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40463-016-0161-3"},{"key":"e_1_3_7_41_2","doi-asserted-by":"publisher","DOI":"10.1111\/jep.70295"},{"key":"e_1_3_7_42_2","first-page":"659","article-title":"Do not ignore mouth breathing syndrome: respiratory functions are affected in early childhood","volume":"62","author":"Atar BS","year":"2024","unstructured":"Atar BS, Ozdemir O, Tuncerler G, et al. Do not ignore mouth breathing syndrome: respiratory functions are affected in early childhood. Rhinology 2024; 62: 659\u2013668.","journal-title":"Rhinology"},{"key":"e_1_3_7_43_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-025-06731-3"},{"key":"e_1_3_7_44_2","doi-asserted-by":"publisher","DOI":"10.4274\/jpr.galenos.2024.73558"},{"key":"e_1_3_7_45_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10439-023-03227-9"},{"key":"e_1_3_7_46_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-024-51172-5"}],"container-title":["DIGITAL HEALTH"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261469753","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20552076261469753","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20552076261469753","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T03:48:51Z","timestamp":1784260131000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20552076261469753"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":45,"alternative-id":["10.1177\/20552076261469753"],"URL":"https:\/\/doi.org\/10.1177\/20552076261469753","relation":{},"ISSN":["2055-2076","2055-2076"],"issn-type":[{"value":"2055-2076","type":"print"},{"value":"2055-2076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]},"article-number":"20552076261469753"}}