Underhill, Rosemary A.; Beazley, John M.; Campbell, Stuart
The accuracy of predicting fetal maturity by ultrasound cephalometry, radiology, and liquor studies in patients with unknown confinement dates has been compared. The best prediction was given by ultrasound cephalometry. Liquor studies were least helpful. PMID:4106479
Mansani, F E; Serventi, G; Verrelli, D; Condemi, V; Ferrari, F
The value of sonor biparietal cephalometry and serum oxytocinase that we have obtained with weekly simultaneous determinations in 14 females with normal pregnancy and in 5 with pathological pregnancy, from 24th to 39th week, show a statical positive relation. Serum oxitocinase determination against hormonal tests of the phetoplancental function (urinary oestriol, pregnandiol, serum HCS, ecc.) give advantages: it is the easyer, faster and less espandove determination. Therefore we think that it is helpful to determin togheter serial values of sonar biparietal cephalometry and serum oxytocinase to anticipate the endouterine fetal growth retardation.
Ritzel, Rodrigo Agne; Berwig, Luana Cristina; da Silva, Ana Maria Toniolo; Corrêa, Eliane Castilhos Rodrigues; Serpa, Eliane Oliveira
Summary Introduction: Hyperplasia of the pharyngeal tonsil is one of the main causes of mouth breathing, and accurate diagnosis of this alteration is important for proper therapeutic planning. Therefore, studies have been conducted in order to provide information regarding the procedures that can be used for the diagnosis of pharyngeal obstruction. Objective: To verify the correlation between nasopharyngoscopy and cephalometric examinations in the diagnosis of pharyngeal tonsil hyperplasia. Method: This was a cross-sectional, clinical, experimental, and quantitative study. Fifty-five children took part in this study, 30 girls and 25 boys, aged between 7 and 11 years. The children underwent nasofibropharyngoscopic and cephalometric evaluation to determine the grade of nasopharyngeal obstruction. The Spearman's rank correlation coefficient at the 5% significance level was used to verify the correlation between these exams. Results: In the nasopharyngoscopy evaluation, most children showed grade 2 and 3 hyperplasia of the pharyngeal tonsil, which was followed by grade 1. In the cephalometry assessment, most children showed grade 1 hyperplasia of the pharyngeal tonsil, which was followed by grade 2. A statistically significant regular positive correlation was observed between the exams. Conclusion: It was concluded that the evaluation of the pharyngeal tonsil hyperplasia could be carried out by fiber optic nasopharyngoscopy and cephalometry, as these examinations were regularly correlated. However, it was found that cephalometry tended to underestimate the size of the pharyngeal tonsil relative to nasopharyngoscopy. PMID:25991937
Leveno, K J; Santos-Ramos, R; Duenhoelter, J H; Reisch, J S; Whalley, P J
Sonar measured biparietal diameter (BPD) differences of twin paires were examined in 123 twin pregnancies at or beyond 28 weeks' gestation. Among 117 liveborn sets, the risk of a twin infant being small for gestational age was threefold greater when paired BPD differences were 5 mm or more compared to 4 mm or less. The incidence of fetal death increased from 2.7% for twin pairs with 0 to 6 mm BPD differences to 20% when the difference was 7 mm or more. Sonar cephalometry may be helpful in the antepartum evaluation of twin pregnancies, although detection of BPD discordancy does not preclude normal twin outcome.
Noguchi, N; Tsuji, M; Shigematsu, M; Goto, M
A method for simulating the movement of teeth, jaw and face caused by orthognathic surgery is proposed, characterized by the use of 3D cephalometric data for 3D simulation. Computed tomography data are not required. The teeth and facial data are obtained by a laser scanner and the data for the patient's mandible are reconstructed and integrated according to 3D cephalometry using a projection-matching technique. The mandibular form is simulated by transforming a generic model to match the patient's cephalometric data. This system permits analysis of bone movement at each individual part, while also helping in the choice of optimal osteotomy design considering the influences on facial soft-tissue form.
Perez, Ivan; Chavez, Allison K.; Ponce, Dario
Background: The Ricketts' posteroanterior (PA) cephalometry seems to be the most widely used and it has not been tested by multivariate statistics for sex determination. Objective: The objective was to determine the applicability of Ricketts' PA cephalometry for sex determination using the logistic regression analysis. Materials and Methods: The logistic models were estimated at distinct age cutoffs (all ages, 11 years, 13 years, and 15 years) in a database from 1,296 Hispano American Peruvians between 5 years and 44 years of age. Results: The logistic models were composed by six cephalometric measurements; the accuracy achieved by resubstitution varied between 60% and 70% and all the variables, with one exception, exhibited a direct relationship with the probability of being classified as male; the nasal width exhibited an indirect relationship. Conclusion: The maxillary and facial widths were present in all models and may represent a sexual dimorphism indicator. The accuracy found was lower than the literature and the Ricketts' PA cephalometry may not be adequate for sex determination. The indirect relationship of the nasal width in models with data from patients of 12 years of age or less may be a trait related to age or a characteristic in the studied population, which could be better studied and confirmed. PMID:27555732
Xia, J J; Gateno, J; Teichgraeber, J F; Yuan, P; Li, J; Chen, K-C; Jajoo, A; Nicol, M; Alfi, D M
Three-dimensional (3D) cephalometry is not as simple as just adding a 'third' dimension to a traditional two-dimensional cephalometric analysis. There are more complex issues in 3D analysis. These include how reference frames are created, how size, position, orientation and shape are measured, and how symmetry is assessed. The main purpose of this article is to present the geometric principles of 3D cephalometry. In addition, the Gateno-Xia cephalometric analysis is presented; this is the first 3D cephalometric analysis to observe these principles.
Lateral cephalometric radiography is commonly used as a standard tool in orthodontic assessment and treatment planning. The aim of this study was to evaluate the available scientific literature and existing evidence for the validation of using lateral cephalometric imaging for orthodontic treatment planning. The secondary objective was to determine the accuracy and reliability of this technique. We did not attempt to evaluate the value of this radiographic technique for other purposes. A literature search was performed using specific keywords on electronic databases: Ovid MEDLINE, Scopus and Web of Science. Two reviewers selected relevant articles, corresponding to predetermined inclusion criteria. The electronic search was followed by a hand search of the reference lists of relevant papers. Two reviewers assessed the level of evidence of relevant publications as high, moderate or low. Based on this, the evidence grade for diagnostic efficacy was rated as strong, moderately strong, limited or insufficient. The initial search revealed 784 articles listed in MEDLINE (Ovid), 1,034 in Scopus and 264 articles in the Web of Science. Only 17 articles met the inclusion criteria and were selected for qualitative synthesis. Results showed seven studies on the role of cephalometry in orthodontic treatment planning, eight concerning cephalometric measurements and landmark identification and two on cephalometric analysis. It is surprising that, notwithstanding the 968 articles published in peer-reviewed journals, scientific evidence on the usefulness of this radiographic technique in orthodontics is still lacking, with contradictory results. More rigorous research on a larger study population should be performed to achieve full evidence on this topic. PMID:24325757
Denolf, Petra L; Vanderveken, Olivier M; Marklund, Marie E; Braem, Marc J
Obstructive sleep apnea syndrome (OSAS) is the most common sleep disordered breathing disorder (SDB) in adults and is characterized by a recurrent partial or complete collapse of the upper airway during sleep. This can be caused by many factors, sometimes interacting, such as skeletal malformations, soft tissue crowding, respiratory instability and the various effects of aging, obesity and gender that dictate craniofacial and upper airway anatomy. Research has demonstrated that the majority of patients exhibit at least one anatomical component such as retrognathia or a narrow posterior airway space that predisposes to the development of OSAS. Within the predisposing elements for OSAS many seem to point to anatomical characteristics. A standardized and relatively simple radiologic technique to evaluate anatomical craniofacial relationships is cephalometry. This has been used already for a long time in orthodontics, but is now gradually being introduced in OSAS treatment to envisage optimal treatment selection as well as to predict treatment outcomes. The purpose of the present review is to evaluate the contribution of cephalometry in the prediction of outcomes from OSAS treatments that depend on the upper airway morphology in their mechanisms of action such as oral appliances that advance the mandible as well as various surgical methods. In addition, an overview of imaging modalities and methods that currently are being used in cephalometric analysis in OSAS patients is provided. The findings indicate that isolated cephalometric parameters cannot be used to reliably predict treatment outcomes from mandibular advancement devices and surgical methods for OSAS. Extreme or outlying values of cephalometric parameters may rather be used as contra-indicators or 'red flags' instead of predictors.
Oh, Suseok; Kim, Ci-Young
Objectives The aim of this study was to verify the concordance of the measurement values when the same cephalometric analysis method was used for two-dimensional (2D) cephalometric radiography and three-dimensional computed tomography (3D CT), and to identify which 3D Frankfort horizontal (FH) plane was the most concordant with FH plane used for cephalometric radiography. Materials and Methods Reference horizontal plane was FH plane. Palatal angle and occlusal plane angle was evaluated with FH plane. Gonial angle (GA), palatal angle, upper occlusal plane angle (UOPA), mandibular plane angle (MPA), U1 to occlusal plane angle, U1 to FH plane angle, SNA and SNB were obtained on 2D cephalmetries and reconstructed 3D CT. The values measured eight angles in 2D lateral cephalometry and reconstructed 3D CT were evaluated by intraclass correlation coefficiency (ICC). It also was evaluated to identify 3D FH plane with high degree of concordance to 2D one by studying which one in four FH planes shows the highest degree of concordance with 2D FH plane. Results ICCs of MPA (0.752), UOPA (0.745), SNA (0.798) and SNB (0.869) were high. On the other hand, ICCs of gonial angle (0.583), palatal angle (0.287), U1 to occlusal plane (0.404), U1 to FH plane (0.617) were low respectively. Additionally GA and MPA acquired from 2D were bigger than those on 3D in all 20 patients included in this study. Concordance between one UOPA from 2D and four UOPAs from 3D CT were evaluated by ICC values. Results showed no significant difference among four FH planes defined on 3D CT. Conclusion FH plane that can be set on 3D CT does not have difference in concordance from FH plane on lateral cephalometry. However, it is desirable to define FH plane on 3D CT with two orbitales and one porion considering the reproduction of orbitale itself. PMID:25045639
Cung, Winnie; Friedman, Laura; Khan, Nicholas E.; Romberg, Elaine E.; Gardner, Pamela J.; Bassim, Carol W.; Baldwin, Andrea M.; Widemann, Brigitte C.; Stewart, Douglas R.
Background Neurofibromatosis type 1 (NF1) is a common, autosomal dominant tumor-predisposition disorder that arises secondary to mutations in the tumor suppressor gene NF1. Cephalometry is an inexpensive, readily available and non-invasive technique that is under-utilized in studying the NF1 craniofacial phenotype. An analysis of NF1 cephalometry was first published by Heervä et al. in 2011. We expand here on that first investigation with a larger cohort of adult and pediatric patients affected with NF1 and sought objective insight into the NF1 facies, said to feature hypertelorism and a broad nasal base, from cephalometric analysis. Methods We obtained cephalograms from 101 patients with NF1 (78 adults and 23 children) from two NF1 protocols at the National Institutes of Health. Each subject had an age-, gender- and ethnicity-matched control. We used Dolphin software to make the cephalometric measurements. We assessed the normality of differences between paired samples using the Shapiro-Wilk test and evaluated the significance of mean differences using paired t-tests and adjusted for multiple testing. We explored the relationship between the cephalometric measurements and height, head circumference and interpupillary distance. Results In this dataset of American whites with NF1, we confirmed in a modestly larger sample many of the findings found by Heerva et al. in an NF1 Finnish cohort. We found a shorter maxilla, mandible, cranial base, (especially anteriorly, p = 0.0001) and diminished facial height in adults, but not children, with NF1. Only one adult exhibited hypertelorism. Conclusions The cephalometric differences in adults arise in part from cranial base shortening and thus result in a shorter face, mid-face hypoplasia, reduced facial projection, smaller jaw, and increased braincase globularity. In addition, we suggest that NF1 sphenoid bone shortening, a common event, is consistent with an intrinsic NF1 bone cell defect, which renders the bone more
Optimizing Hybrid Occlusion in Face-Jaw-Teeth Transplantation: A Preliminary Assessment of Real-Time Cephalometry as Part of the Computer-Assisted Planning and Execution Workstation for Craniomaxillofacial Surgery
Murphy, Ryan J.; Basafa, Ehsan; Hashemi, Sepehr; Grant, Gerald T.; Liacouras, Peter; Susarla, Srinivas M.; Otake, Yoshito; Santiago, Gabriel; Armand, Mehran; Gordon, Chad R.
Background The aesthetic and functional outcomes surrounding Le Fort–based, face-jaw-teeth transplantation have been suboptimal, often leading to posttransplant class II/III skeletal profiles, palatal defects, and “hybrid malocclusion.” Therefore, a novel technology—real-time cephalometry—was developed to provide the surgical team instantaneous, intraoperative knowledge of three-dimensional dentoskeletal parameters. Methods Mock face-jaw-teeth transplantation operations were performed on plastic and cadaveric human donor/recipient pairs (n = 2). Preoperatively, cephalometric landmarks were identified on donor/recipient skeletons using segmented computed tomographic scans. The computer-assisted planning and execution workstation tracked the position of the donor face-jaw-teeth segment in real time during the placement/inset onto recipient, reporting pertinent hybrid cephalometric parameters from any movement of donor tissue. The intraoperative data measured through real-time cephalometry were compared to posttransplant measurements for accuracy assessment. In addition, posttransplant cephalometric relationships were compared to planned outcomes to determine face-jaw-teeth transplantation success. Results Compared with postoperative data, the real-time cephalometry–calculated intraoperative measurement errors were 1.37 ± 1.11 mm and 0.45 ± 0.28 degrees for the plastic skull and 2.99 ± 2.24 mm and 2.63 ± 1.33 degrees for the human cadaver experiments. These results were comparable to the posttransplant relations to planned outcome (human cadaver experiment, 1.39 ± 1.81 mm and 2.18 ± 1.88 degrees; plastic skull experiment, 1.06 ± 0.63 mm and 0.53 ± 0.39 degrees). Conclusion Based on this preliminary testing, real-time cephalometry may be a valuable adjunct for adjusting and measuring “hybrid occlusion” in face-jaw-teeth transplantation and other orthognathic surgical procedures. PMID:26218382
Sabbagha, R E; Hughey, M
At present a large number of different charts are used for prediction of gestational age from sonar biparietal diameter (BPD). In this report the reasons for these observed differences are presented. Additionally, the usefulness of all these charts is questioned because a) the mean differences in 7059 BPDs derived by the B-scan from four large fetal population studies are not significantly different from zero and b) BPDs obtained by B scan are statistically comparable to gray-scale or real-time BPDs if medium gain is used. Thus, it is our suggestion that a chart showing the composite mean BPD values of all four studies be used universally for prediction of fetal age. Finally, the guidelines of using sonar BPD as an index of gestational age are presented and the role of the obstetrician in interpreting BPD data is emphasized.
Ritzel, Rodrigo Agne; Berwig, Luana Cristina; da Silva, Ana Maria Toniolo; Corrêa, Eliane Castilhos Rodrigues; Serpa, Eliane Oliveira
Introdução: A hiperplasia de tonsila faríngea é uma das principais causas da respiração oral. O diagnóstico preciso desta alteração é importante para o correto planejamento terapêutico. Em vista disso, estudos têm sido desenvolvidos a fim de fornecer subsídios quanto aos procedimentos que podem ser utilizados para o diagnóstico de obstrução faríngea.Objetivo: Verificar a correlação entre os exames de nasofibrofaringoscopia e cefalometria no diagnóstico de hiperplasia de tonsila faríngea.Método: Estudo transversal, clínico e experimental. Participaram deste estudo 55 crianças, 30 meninas e 25 meninos, com idades entre 7 e 11 anos. As crianças foram submetidas à avaliação nasofibrofaringoscópica e cefalométrica para a determinação do grau de obstrução da nasofaringe. Para verificar a correlação entre esses exames foi utilizado o coeficiente de correlação de Spearman ao nível de significância de 5%.Resultados: Na nasofibrofaringoscopia a maioria das crianças apresentou hiperplasia de tonsila faríngea graus 2 e 3, seguidas de grau 1. Na cefalometria a maior parte das crianças apresentou hiperplasia de tonsilas faríngeas grau 1, seguida de grau 2. Na correlação entre os exames, evidenciou-se correlação regular e positiva.Conclusão: A avaliação da hiperplasia de tonsilas faríngeas pode ser realizada pela nasofibrofaringoscopia e pela cefalometria, pois estes exames apresentam uma relação regular e positiva. No entanto, verificou-se que a cefalometria tende a subestimar o tamanho da tonsila faríngea em relação à nasofibrofaringoscopia.
Santos-Ramos, R; Duenhoelter, J H; Reisch, J S
The fetal biparietal diameter was measured simultaneously with B-scan bistable and gray scale techniques and subsequently with real-time ultrasonography. Measurements were made from outer table to outer table with the bistable technique, which has been proven to be accurate and reliable. With the gray scale and real-time modalities, distances were measured between several landmarks from the same image. Off all measurements taken from gray scale and realtime images, those between the centers of each band outlining the fetal skull showed the best correlation and the closest values to measurements using the standard bistable technique. Discrepancies exceeded 2 mm in only 5% with the gray scale and in 2% with the real-time technique. Using the measurement between outer and inner aspects of the cephalic band, the percentages of discrepancies exceeding 2 mm were 7% with gray scale and 6% with real time.
Leveno, K J; Santos-Ramos, R; Duenhoelter, J H; Reisch, J S; Whalley, P J
In 123 normal twin pregnancies, 589 biparietal diameter (BPD) measurements were obtained between 16 and 40 weeks' gestation and mean values for each week were computed. A table of BPDs for normal twin pregnancies based on these data is proposed. Mean twin BPDs were consistently smaller than those of singletons, the difference averaging 3.5 mm between 16 and 40 weeks' gestation. The development of a twin BPD table now permits a more accurate assessment of twin gestational age and fetal growth.
Frongia, Gianluigi; Bracco, Pietro; Piancino, Maria Grazia
The aims of this work were (1) to describe a method to identify new skeletal landmarks useful to define the reference system to orient the skull in a new position after cone-bean computed tomographic scan and (2) to demonstrate the reliability of this new method.Ten orthognathic patients (5 male, 5 female; mean [SD] age, 18.9 [1.2] years) underwent the cone-bean computed tomographic scan before surgery. Seven 3-dimensional skeletal measurements derived from 4 skeletal point of construction (C) (right, left, and median orbital C, and sella C) have been used for this study. Reliability has been calculated using Pearson correlation coefficient tests.Intraobserver reliability was 0.9999 for operator A (T1-T2) and 0.9999 for operator B (T1-T2); interobserver reliability was 0.9999 between the first (T1-T1) measurement and 0.9999 between the second (T2-T2).The original method is able to reduce the variability of landmark identification due to the variability of the human anatomy and the influence of the human error in cephalometric analysis. The innovation of this new method is the real possibility to use the anatomical structures in a 3-dimensional way, enhancing the reliability of the reference points.
Mansani, F E; Condemi, V; Verrelli, D; Serventi, G; Chiavazza, F; Ceruti, M
The normal range of serum cystine-amino-peptidase (C.A.P.) in 54 cases of uncomplicated pregnancies was established. 21 patients whose pregnancies were though to be "at risk" were serially monitored by sonar biparietal cephalometry and serum cystine-amino-peptidase determination. The results show that exists a correlation between C.A.P. and biparietal cephalometry values. Furthermore the "predictive power" towards neonatal conditions (by birth weight and Apgar score determination) was of 77,55% for the biparietal cephalometry and 76,10% for C.A.P.
Taub DI, Jacobs JMS, Jacobs JS. Anthropometry, cephalometry, and orthognathic surgery. In: Neligan PC, ed. Plastic Surgery . 3rd ed. Philadelphia, PA: Elsevier Saunders; 2013:chap 16. Whyte MP. Hereditary ...
Gateno, Jaime; Xia, James J.; Teichgraeber, John F.
Two basic problems are associated with traditional 2-dimensional ((2D) cephalometry First, many important parameters cannot be measured on plain cephalograms; and second, most 2D cephalometric measurements are distorted in the presence of facial asymmetry. Three-dimensional (3D) cephalometry, which has been facilitated by the introduction of cone beam computed tomography scans, can be solved these problems. However, before this can be realized, fundamental problems must be solved. They are the unreliability of internal reference systems and some 3D measurements, and the lack of tools to assess and measure symmetry. In this manuscript, the authors present a new 3D cephalometric analysis that uses different geometric approaches to solve the fundamental problems previously mentioned. This analysis allows the accurate measurement of the size, shape, position and orientation of the different facial units and incorporates a novel method to measure asymmetry. PMID:21257250
Rathee, Pooja; Jain, Pradeep; Panwar, Vasim Raja
Introduction Conventional cephalometry is an inexpensive and well-established method for evaluating patients with dentofacial deformities. However, patients with major deformities and in particular asymmetric cases are difficult to evaluate by conventional cephalometry. Reliable and accurate evaluation in the orbital and midfacial region in craniofacial syndrome patients is difficult due to inherent geometric magnification, distortion and the superpositioning of the craniofacial structures on cephalograms. Both two- and three-dimensional computed tomography (CT) have been proposed to alleviate some of these difficulties. Aims and objectives The aim of our study is to compare the reliability of anatomic cephalometric points obtained from the two modalities: Conventional posteroanterior cephalograms and 3D CT of patients with facial asymmetry, by comparison of intra- and interobserver variation of points recorded from frontal X-ray to those recorded from 3D CT. Materials and methods The sample included nine patients (5 males and 4 females) with an age range of 14 to 21 years and a mean age of 17.11 years, whose treatment plan called for correction of facial asymmetry. All CT scans were measured twice by two investigators with 2 weeks separation for determination of intraobserver and interobserver variability. Similarly, all measurement points on the frontal cephalograms were traced twice with 2 weeks separation. The tracings were superimposed and the average distance between replicate points readings were used as a measure of intra- and interobserver reliability. Intra-and interobserver variations are calculated for each method and the data were imported directly into the statistical program, SPSS 10.0.1 for windows. Results Intraobserver variations of points defined on 3D CT were small compared with frontal cephalograms. The intraobserver variations ranged from 0 (A1, B1) to 0.6 mm with the variations less than 0.5 mm for most of the points. Interobserver variations
Chalmers, I; Lawson, J G; Turnbull, A C
The obstetric management and results obtained by two obstetric teams working in the Cardiff Maternity Hospital over a five-year period are compared. One team had a more active approach to induction of labour and antepartum monitoring with urinary oestrogen assay and serial ultrasound cephalometry than the other. After controlling for differences in the attributes of the two groups of patients treated, it was not possible to show any striking advantage or disadvantage of the more active approach. PMID:1009031
Faria, A C; Xavier, S P; Silva, S N; Trawitzki, L V Voi; de Mello-Filho, F V
Cephalometry has been used to measure hard and soft facial tissues, as well as the pharyngeal air space for the diagnosis of obstructive sleep apnea (OSA). The changes occurring in the pharynx due to maxillo-mandibular advancement (MMA) have not been established or quantified. The objective of this study was to identify the anatomical changes of the pharynx and of hard tissues that occur in patients with OSA after MMA. 19 patients with a polysomnographic diagnosis of OSA were submitted to cephalometric analysis before and 6 months after surgery in order to evaluate the changes produced by MMA in the pharynx and soft tissues. Cephalometry was standardized in order to obtain descriptive measurements of the dimensions of the airways, the position of the hyoid bone, and maxilla-mandibular relations. The modifications of the pharynx due to MMA showed a significant relation obtained by cephalometry. For each millimeter of maxillary and mandibular bone advancement there was a 0.76mm increase in the retropalatal region and a 1.2mm increase in the pharynx in the retrolingual region. In addition, MMA promoted a significant repositioning of the hyoid bone in the cranial direction.
Reimão, R; De Gouveia, M M; Pestana, M C; Lopes, S R; Papaiz, E G; Papaiz, L F
The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS) is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS). Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.
Paul, S J
The objective of current aesthetic dental treatments are to enhance the patient's smile by improving the overall dental appearance. A detailed analysis of the patient's face as it relates to the three-dimensional position, shape, and color of the teeth is required to improve this appearance. A full frontal and lateral evaluation of the patient's facial form is required to successfully complete on aesthetic smile evaluation. Additional considerations include cephalometry and a thorough dental analysis. This article demonstrates a comprehensive smile analysis technique and its communication to the dental technician.
Sabbagha, R E; Turner, J H; Chez, R A
Serial sonar fetal cephalometry was performed on 67 pregnant monkeys (Macaca ulatta) with known breeding dates. A normal biparietal diameter (BPD) growth curve was constructed along four percentile divisions; namely, the 10th to the 24th, 25th to the 49th, 50th to the 74th, and the 75th to the 90th. It is shown that under normal conditions fetuses initially positioned in any one of these divisions will continue to grow within the confines of that same percentile range. This biologic phenomenon has not been previously reported. It is significant because it leads to a more precise separation of normal vs. suboptimal intrauterine growth.
Narayanan, Anila; Faizal, Bini
Objective. To study the correlation between lateral cephalogram, flexible laryngoscopy, and sleep study in patients diagnosed with obstructive sleep apnea (OSA). Background. Screening tools should be devised for predicting OSA which could be performed on an outpatient basis. With this aim we studied the skeletal and soft tissue characteristics of proven OSA patients. Methods. A prospective study was performed in patients diagnosed with obstructive sleep apnea by sleep study. They were evaluated clinically and subjected to lateral cephalometry and nasopharyngolaryngoscopy. The findings were matched to see if they corresponded to AHI of sleep study in severity. An attempt was made to see whether the data predicted the patients who would benefit from oral appliance or surgery as the definitive treatment in indicated cases. Results. A retropalatal collapse seen on endoscopy could be equated to the distance from mandibular plane to hyoid (MP-H) of lateral cephalometry and both corresponded to severity of AHI. At the retroglossal region, there was a significant correlation with MP-H, length of the soft palate, and AHI. Conclusion. There is significant correlation of lateral cephalogram and awake flexible nasopharyngolaryngoscopy with AHI in OSA. In unison they form an excellent screening tool for snorers. PMID:26689652
Ayesha Thabusum, Dharmavaram; Bhavana, Sujana Mulk
Oral submucous fibrosis (OSMF) is a chronic insidious disease affecting mucosa and submucosa of oral cavity and soft palate. The present study aimed to evaluate the morphology of soft palate in normal individuals and OSMF patients using lateral cephalometry and to compare and correlate these variants of soft palate with different stages of OSMF. 100 subjects were included in the study, who were divided into two groups. Group I included 50 subjects with clinical diagnosis of OSMF and Group II included 50 normal subjects (control group). Using digital lateral cephalometry, velar length and width were measured and soft palatal patterns were categorized based on You et al.'s classification. Leaf and rat-tail patterns of soft palate were predominant in control group, whereas butt and crook shaped variants were more in study group. Anteroposterior (A-P) length of soft palate was significantly greater in stage I OSMF, while superoinferior (S-I) width was greater in stage III OSMF. Interestingly, a negative correlation was observed in staging of OSMF and A-P dimensions. As the staging of OSMF advances, the A-P length of soft palate decreases, but S-I width increases. PMID:27034975
Lee, S-H; Kil, T-J; Park, K-R; Kim, B C; Kim, J-G; Piao, Z; Corre, P
The aim of this study was to present a systematic sequence for three-dimensional (3D) measurement and cephalometry, provide the norm data for computed tomography-based 3D architectural and structural cephalometric analysis, and validate the 3D data through comparison with Delaire's two-dimensional (2D) lateral cephalometric data for the same Korean adults. 2D and 3D cephalometric analyses were performed for 27 healthy subjects and the measurements of both analyses were then individually and comparatively analyzed. Essential diagnostic tools for 3D cephalometry with modified definitions of the points, planes, and measurements were set up based on a review of the conceptual differences between two and three dimensions. Some 2D and 3D analysis results were similar, though significant differences were found with regard to craniofacial angle (C1-F1), incisal axis angles, cranial base length (C2), and cranial height (C3). The discrepancy in C2 and C3 appeared to be directly related to the magnification of 2D cephalometric images. Considering measurement discrepancies between 2D and 3D Delaire's analyses due to differences in concept and design, 3D architectural and structural analysis needs to be conducted based on norms and a sound 3D basis for the sake of its accurate application and widespread adoption.
Oberoi, Snehlata; Vargervik, Karin
Three siblings and their mother are reported who all had cytogenetically proven velocardiofacial syndrome (VCFS). One boy had normal dental and craniofacial findings, except for an increased cranial base angle. His sister had only one central incisor in the maxilla. One central incisor had also been missing in the primary dentition. She had no labial frenulum present. Cephalometry showed a small maxillary unit length indicating mild maxillary hypoplasia, an increased anterior face height, steep mandibular plane angle, retruded chin, and a large cranial base angle. Dental measurements showed retroclined lower incisors and increased interincisal angle. A second sister had a cleft of the secondary palate. All permanent teeth were present with the exception of a missing central incisor in the lower jaw: the single lower central incisor was situated in the midline. Her cephalometry showed similar findings as in her sister. All three siblings required palate surgery for speech. Mother was not available for detailed dental and other oral investigations. A single maxillary central incisor has previously been reported in VCFS, but to our knowledge a single central incisor in the mandible has not been reported previously in this entity.
McDonagh, S; Moss, J P; Goodwin, P; Lee, R T
The aim of this study was to evaluate the effect of different functional appliances on the soft tissues as assessed by cephalometry and optical surface scanning. Forty-two patients were randomly allocated to Bass, Twin Block (TB), and Twin Block + Headgear (TB + Hg) groups. Lateral cephalograms and optical surface scans were recorded before and after the 10-month study period. ANOVA was used to test the cephalometric variables for differences at the 5 per cent level. The optical surface scanning and cephalometric results were consistent in the sagittal dimension. In the vertical dimension, however, the optical surface scans consistently recorded a greater increase compared with cephalometric values. No differences were detected with regard to cephalometric values at the 5 per cent level. However, the Bass appliance produced greater forward positioning of soft tissue pogonion as assessed by optical surface scanning.
Stewart, Randall F.; Edgar, Heather; Tatlock, Charles; Kroth, Philip J.
The science of cephalometry has been invaluable for guiding orthodontic diagnosis, treatment planning, and outcomes tracking. Though software packages easily calculate most cephalometric measurements, the ability to exchange cephalometric data between software packages is poorly developed. Hindering this effort is the lack of an agreed-upon standard for electronic exchange of cephalometric measurements. Unlike more technological issues, the problem of creating such a standard is one of formalizing decisions already established through historical precedent. Solving this problem will require education, cooperation, and consensus in order to reap the potential improvements to patient care, dental education, and research. The first step in overcoming these remaining issues is awareness. This article reviews those factors that place cephalometric measurements in an excellent position for standardization, outlines those decisions that must be made in order to realize the goal of electronic exchange of cephalometric information, and describes some of the options for these decisions as well as some advantages and disadvantages of each. PMID:18768441
Stewart, Randall F; Edgar, Heather; Tatlock, Charles; Kroth, Philip J
The science of cephalometry has been invaluable for guiding orthodontic diagnosis, treatment planning, and outcomes tracking. Though software packages easily calculate most cephalometric measurements, the ability to exchange cephalometric data between software packages is poorly developed. Hindering this effort is the lack of an agreed-upon standard for electronic exchange of cephalometric measurements. Unlike more technological issues, the problem of creating such a standard is one of formalizing decisions already established through historical precedent. Solving this problem will require education, cooperation, and consensus in order to reap the potential improvements to patient care, dental education, and research. The first step in overcoming these remaining issues is awareness. This article reviews those factors that place cephalometric measurements in an excellent position for standardization, outlines those decisions that must be made in order to realize the goal of electronic exchange of cephalometric information, and describes some of the options for these decisions as well as some advantages and disadvantages of each.
Yamada, K; Saito, I; Hanada, K; Hayashi, T
Temporomandibular joint (TMJ) osteoarthritis (OA) is a potential cause of craniofacial deformity. If TMJ OA appears during orthodontic treatment, the mandible usually rotates posteriorly, resulting in an unsatisfactory profile, especially in patients with pre-treatment mandibular retrusion. Although it is important to confirm the kind of TMJ pathosis at the start of orthodontic treatment, the relationship between TMJ OA, condylar remodelling and changes in craniofacial morphology remains unclear because of a lack of longitudinal studies. Elucidating this relationship might allow better prediction of post-treatment craniofacial morphology. In the present case reports, helical computed tomography and cephalometry were used to analyse relationships between the pattern and location of condylar remodelling and the changes in craniofacial morphology in three patients with TMJ OA. PMID:15089933
Verma, Sanjeev Kumar; Maheshwari, Sandhya; Gautam, Sanjay N; Prabhat, KC; Kumar, Shailendra
The Frankfort horizontal is a useful compromise for studying skulls but not for orienting the natural head position (NHP) in the living because it is normally distributed around a true extracranial horizontal. Nonetheless, orthodontists dealing with living subjects, rather than inert crania, have used this Frankfort horizontal faithfully in cephalometry. Because the cant or inclination of all intracranial reference lines is subjected to biologic variation, they are unsuitable for meaningful cephalometric analysis. Registration of head posture in its natural position has the advantage that an extracranial vertical or a horizontal perpendicular to that vertical can be used as reference line for cephalometric analysis. Purpose of this paper is to provide an updated review of various methods to reproduce and record the NHP. PMID:25756032
Cibrián, Rosa; Gandia, Jose L.; Paredes, Vanessa
Objectives: To analyse the ANB and Wits values and to study correlations between those two measurements and other measurements in diagnosing the anteroposterior maxilo-mandibular relationship with CBCT. Study Design: Ninety patients who had previously a CBCT (i-CAT®) as a diagnostic register were selected. A 3D cephalometry was designed using one software package, InVivo5®. This cephalometry included 3 planes of reference, 3 angle measurements and 1 linear measurement. The means and standard deviations of the mean of each measurement were assessed. After that, a Pearson´s correlation coefficient has been performed to analyse the significance of each relationship. Results: When classifying the sample according to the anteroposterior relationship, the values obtained of ANB (Class I: 53%; Class II: 37%; Class III: 10%) and Wits (Class I: 35%; Class II: 56%; Class III: 9%) did not coincide, except for the Class III group. However, of the patients classified differently (Class I and Class II patients) by ANB and Wits, a high percentage of individuals (n=22; 49%), had a mesofacial pattern with a mandibular plane angle within normal values. A correlation has been found between ANB and Wits (r=0,262), occlusal plane angle and ANB (r=0,426), and mandibular plane angle and Wits (r=0,242). No correlation was found between either Wits or ANB in relation with the age of the individuals. Conclusions: ANB and Wits must be included in 3D cephalometric analyses as both are necessary to undertake a more accurate diagnosis of the maxillo-mandibular relationship of the patients. Key words:Cone beam computed tomography, ANB, Wits, cephalometrics. PMID:23722136
Kim, Jin Kyung; Park, Gi-Young
Objective To compare a new ultrasound measurement method with calliper cephalometry in infants with deformational plagiocephaly (DP) and to assess the differences of two methods according to the severity of DP. Methods Fifty-two infants with DP were divided into two groups according to the degree of cranial vault asymmetry (CVA); group 1 included 42 infants with CVA over 10 mm, and group 2 included 10 infants with CVA under 10 mm. Cranial vault asymmetry index (CVAI) and occipital angle ratio (OAR) were measured by using calliper and ultrasound measurements, respectively. The occipital angle was defined as the angle between the lines projected along the lambdoid sutures of the skull. Results The occipital angles of the affected sides were significantly greater than those of unaffected sides in both groups. The CVAI and OAR were significantly greater in group 1 than in group 2 (CVAI, 9.3%±2.3% vs. 4.6%±1.5%; OAR, 1.05±0.4 vs. 1.01±0.0; p<0.05). The OAR was positively correlated with the CVAI in all infants (r=0.789) and in group 1 (r=0.784; p<0.05). Conclusion Our study revealed that OAR using the new ultrasound measurement was positively correlated with the CVAI in infants with DP. Therefore, the occipital angle measurement using ultrasound combined with cephalometry could provide better understanding about the characteristics of the overall cranial bone and lambdoid suture complex in infants with DP. PMID:25229033
Llamas, José M.; Cibrián, Rosa; Gandia, José L.; Paredes, Vanessa
Objectives: Cone Beam Computerized Tomography (CBCT) allows the possibility of modifying some of the diagnostic tools used in orthodontics, such as cephalometry. The first step must be to study the characteristics of these devices in terms of accuracy and reliability of the most commonly used landmarks. The aims were 1- To assess intra and inter-observer reliability in the location of anatomical landmarks belonging to hard tissues of the skull in images taken with a CBCT device, 2- To determine which of those landmarks are more vs. less reliable and 3- To introduce planes of reference so as to create cephalometric analyses appropriated to the 3D reality. Study design: Fifteen patients who had a CBCT (i-CAT®) as a diagnostic register were selected. To assess the reproducibility on landmark location and the differences in the measurements of two observers at different times, 41 landmarks were defined on the three spatial axes (X,Y,Z) and located. 3.690 measurements were taken and, as each determination has 3 coordinates, 11.070 data were processed with SPSS® statistical package. To discover the reproducibility of the method on landmark location, an ANOVA was undertaken using two variation factors: time (t1, t2 and t3) and observer (Ob1 and Ob2) for each axis (X, Y and Z) and landmark. The order of the CBCT scans submitted to the observers (Ob1, Ob2) at t1, t2, and t3, were different and randomly allocated. Multiple comparisons were undertaken using the Bonferroni test. The intra- and inter-examiner ICC´s were calculated. Results: Intra- and inter-examiner reliability was high, both being ICC ≥ 0.99, with the best frequency on axis Z. Conclusions: The most reliable landmarks were: Nasion, Sella, Basion, left Porion, point A, anterior nasal spine, Pogonion, Gnathion, Menton, frontozygomatic sutures, first lower molars and upper and lower incisors. Those with less reliability were the supraorbitals, right zygion and posterior nasal spine. Key words:Cone Beam
Zinser, Max J; Mischkowski, Robert A; Dreiseidler, Timo; Thamm, Oliver C; Rothamel, Daniel; Zöller, Joachim E
There may well be a shift towards 3-dimensional orthognathic surgery when virtual surgical planning can be applied clinically. We present a computer-assisted protocol that uses surgical navigation supplemented by an interactive image-guided visualisation display (IGVD) to transfer virtual maxillary planning precisely. The aim of this study was to analyse its accuracy and versatility in vivo. The protocol consists of maxillofacial imaging, diagnosis, planning of virtual treatment, and intraoperative surgical transfer using an IGV display. The advantage of the interactive IGV display is that the virtually planned maxilla and its real position can be completely superimposed during operation through a video graphics array (VGA) camera, thereby augmenting the surgeon's 3-dimensional perception. Sixteen adult class III patients were treated with by bimaxillary osteotomy. Seven hard tissue variables were chosen to compare (ΔT1-T0) the virtual maxillary planning (T0) with the postoperative result (T1) using 3-dimensional cephalometry. Clinically acceptable precision for the surgical planning transfer of the maxilla (<0.35 mm) was seen in the anteroposterior and mediolateral angles, and in relation to the skull base (<0.35°), and marginal precision was seen in the orthogonal dimension (<0.64 mm). An interactive IGV display complemented surgical navigation, augmented virtual and real-time reality, and provided a precise technique of waferless stereotactic maxillary positioning, which may offer an alternative approach to the use of arbitrary splints and 2-dimensional orthognathic planning.
Mortimore, I. L.; Kochhar, P.; Douglas, N. J.
BACKGROUND: There is evidence to suggest that chronic continuous positive airway pressure (CPAP) therapy may produce reversible changes in upper airway morphology and function in patients with sleep apnoea/hypopnoea. This study was designed to examine the effect of chronic CPAP therapy on upper airway calibre. METHODS: Twenty four men with the sleep apnoea/hypopnoea syndrome (mean (SE) apnoea/hypopnoea index 37 (5)) underwent lateral cephalometry with measurement of posterior airway space performed before and at least three months after initiation of CPAP therapy. RESULTS: There was no weight change between the two assessments and mean CPAP use was 4.8 (0.4) hours per night. Posterior airway space (PAS) was measured in erect and supine postures. PAS supine increased with CPAP therapy from a mean (SE) of 11.8 (0.8) mm to 13.4 (0.8) mm, but PAS erect did not. Correlation of the change in PAS (dPAS) before and after CPAP therapy showed an increase with increasing CPAP compliance measured as machine run time both for dPAS supine (r = 0.68) and dPAS erect (r = 0.47). CONCLUSIONS: Patients with the sleep apnoea/hypopnoea syndrome regularly using CPAP for more than four hours per night all showed an increase in dPAS supine. The use of chronic CPAP increases PAS supine probably by a reduction in upper airway oedema, and the change in size is dependent on CPAP use. PMID:8711654
Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael
In this article, we discuss the development of methods for computer-aided jaw surgery, which allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training, and assessing the difficulties of the surgical procedures before the surgery. Computer-aided surgery can make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases.
Naikmasur, Venkatesh G; Shrivastava, Rahul; Mutalik, Sunil
Skeletal components play significant role in sex determination in forensic and anthropological fields. Skull is considered second best, after pelvis, in determination of sex. Methods based on morphological characteristics and morphometry are already in use with reasonable accuracy. Standardized radiographic techniques like cephalometry have advantages of being more precise and objective when compared to morphologic methods. The present study aimed at obtaining and comparing the reliability of cranio-mandibular parameters in South Indian and Indian immigrant of Tibetan populations using lateral and postero-anterior (PA) cephalograms. A total of 11 cephalometric parameters were traced on lateral and PA cephalograms manually. Functions to aid in the sex determination were developed by subjecting the cephalometric parameters to discriminant analysis. Among the chosen parameters bizygomatic width, ramus height, depth of face contributed most for sexual dimorphism in both the populations. Upper facial height was the additional parameter for sexual dimorphism in immigrant Tibetan population. The discrimination accuracy in South Indian population was 81.5% while that of immigrant Tibetan population was 88.2%. With the current study it can be concluded that cephalometric cranio-mandibular parameters can be used to discriminate the sex using discriminant function analysis and similar cranio-mandibular parameters contribute to sex prediction across populations.
Nanda, R; Sugawara, J
The purpose of this study was to investigate the growth and remodeling changes of the mandible following superior anterior surgical repositioning (Le Fort I) of the maxilla in adolescent Macaca fascicularis monkeys. Eight adolescent monkeys served as controls, and seven monkeys underwent surgical procedures. All monkeys received tantalum implants on both sides of certain facial bones for stereometric and conventional cephalometry. The animals were followed up to 24 months postoperatively. Analysis of cephalometric head films taken at monthly intervals shows that both the maxillas and the mandibles of the experimental monkeys grew harmoniously, although the amount and direction of growth showed significant changes compared to the controls. The mandibles of experimental monkeys that underwent autorotation immediately following the surgical procedures showed 36 to 60 percent less growth as measured from condylion to menton, condylion to gonion, and gonion to menton. Similarly, the anterior dental-alveolar-symphyseal height showed 75 percent less increase as compared to the controls. The results show that, although the surgical procedure was performed on the maxilla, the mandibular growth showed significant modulation to adapt to the surgically changed maxillary environment. The role of occlusion and function is discussed in the context of the present findings.
Sonnesen, Liselotte; Nolting, Dorrit; Engel, Ulla; Kjaer, Inger
On profile radiographs of adults, an association between fusions of cervical vertebrae, deviations in the cranial base and mandibular retrognathia has been documented radiographically. An elaboration of this association on a histological level is needed. In human triploid fetuses severe mandibular retrognathia and deviations in the cranial base have previously been described radiographically (without cephalometry) and cervical column fusions radiographically as well as histologically. Therefore, triploid fetuses were chosen to elucidate the cranial base cephalomterically and histologically. In the present study, eight triploid fetuses were analyzed radiographically and histologically focusing especially on the cranial base, which borders to the spine and to which the jaws are attached. A histological analysis of the cranial base has not previously been performed in triploid cases. An enlarged cranial base angle and a retrognathic position of the mandible were documented cephalometrically on radiographs of all cases. Histologically, malformations were observed in the cranial base as well as in the spine. These are new findings indicating the association between the occipital bone and the uppermost vertebra in the body axis. As the notochord connects the cervical column and the cranial base in early prenatal life, molecular signaling from the notochord may in future studies support the notochord as the developmental link between abnormal development in the spine and the cranial base.
Safavi, Seyed Mohammadreza; Beikaii, Hanie; Hassanizadeh, Raheleh; Younessian, Farnaz; Baghban, Alireza Akbarzadeh
Background: Correlation between chronological age at different stages of cervical vertebral maturation (CVM) is important in clinical orthodontic practice. The objective of this study was to evaluate the correlation between CVM stage and chronological age in a group of Iranian female patients. Materials and Methods: This study was conducted on 196 digital lateral cephalometry of female patients with the age ranged 9-14 years. The CVM stage was determined with two calibrated examiners, using the method developed by Baccetti and its correlation with mean chronological age was assessed by the Spearman rank-order. The intra and inter-agreements were evaluated by weighted Kappa statistics in overall diagnosis of stages, in addition to determination of presence or absent of concavities at the lower border of second, third and fourth cervical vertebrae and the shapes of the third and fourth vertebrae. P < 0.05 was considered as significant. Results: The correlation coefficient between CVM stages and chronological age was relatively low (r = 0.62). The least amount of inter-observer agreement was determined to be at the clinical decision of the shape of the fourth vertebra. Conclusion: Regarding the low reported correlation, the concomitant usage of other skeletal indicators seems necessary for precise determination of physiological age of the patients. PMID:26604958
Taylor, B A; Brace, M; Hong, P
The objective of this paper is to systematically review the airway outcomes following distraction osteogenesis of midface with the goal of (1) deriving clinically oriented insights and (2) identifying gaps in knowledge to stimulate future research. Medline, EMBASE and Cochrane databases were searched and studies were included if subjects of any age had midface retrusion/hypoplasia and underwent midface distraction osteogenesis. Outcome measures of interest were any respiratory or airway associated measures, and reports of adverse events. A total of 368 abstracts were generated from the literature searches; 16 studies met the criteria for data extraction and analysis. All 16 studies were observational. Generally, midface distraction osteogenesis was reported to improve respiratory status and was well tolerated. Specifically, favorable outcomes in cephalometry (9 studies), polysomnography (9 studies), and decannulation rates (8 studies) were reported. In conclusion, upper airway status was improved in most patients who underwent midface distraction osteogenesis, yet long-term results and consistent objective measures are lacking. Studies reviewed were retrospective case series and details regarding patients who did not improve were deficient. A standardized prospective multicenter cohort trial with long-term patient follow up is required.
Bansal, Pankaj; Singh, Virender; Anand, S. C.; Bansal, Sumidha
Purpose: We tried to find out the relevance of anterior mandibular body ostectomy in deformities of the mandible specially prognathism, which is primarily limited to anterior part only. Patients and Methods: Ten patients with skeletal deformity along with malocclusion, which was limited to anterior body of mandible were selected. Selected patients had proper molar interdigitation (even if class 3) and in general had anterior crossbite (except one). All patients had crossed their growth spurts and had no hormonal influence on facial deformity. Specific protocol, including cephelometric analysis cephalometry for orthognathic surgery, prediction tracing and model surgeries were devised. Pre and post-surgical orthodontics and body ostectomy were performed in all patients along with 18-month post-op follow-up. Results: There was significant reduction in prognathism and horizontal dysplasia in all ten patients. Anterior crossbite as well as axis of incisiors over mandibular plane was corrected in all patients due to decrease in length of mandibular body. All patients showed decreased facial height and better lip competence with intact posterior occlusion and no (negligible or transient) sensory loss. Conclusions: Our study could confirm that people whose deformity is limited to the anterior part of mandible with reasonable occlusion posteriorly can get satisfactory cosmetic and functional results through body ostectomy alone rather than going for surgical procedure in the ramal area, which is liable to cause sensory and occlusal disturbances. PMID:24163554
Alió-Sanz, Juan J.; Iglesias-Conde, Carmen; Lorenzo-Pernía, Jose; Iglesias-Linares, Alejandro; Mendoza-Mendoza, Asunción; Solano-Reina, Enrique
Objectives: The purpose of this study was to assess cranial base and maxillary growth in patients with Class II-type I malocclusions when treated with Frankel’s functional regulator (FR-1b). Study Design: The treatment group was made up of 43 patients that were divided into two groups: prepubescent (n: 28), and pubescent (n: 15). The control group included 40 patients who did not receive any kind of treatment and were likewise divided into a prepubescent group (n: 19), and a pubescent group (n: 21). A computerized cephalometric study was carried out and superimpositions were done in order to assess the antero-posterior, vertical and rotational movement of the maxilla. Results: The results indicate that anterior cranial length is not affected by the regulator but the cranial deflection of the treatment group was diminished. Although a slight counterclockwise rotation effect on the upper jaw was observed due to treatment, no growth restriction of the maxilla in a vertical or antero-posterior direction was observed compared to other non-treated Class II-type I malocclusion patients. Conclusion: The functional regulator does not have any effect on anterior cranial length, but it does affect the angulation of the cranial base. According to our results, the appliance has demonstrated a flattening effect of the cranial base (p<0.05) in the treated sample. The functional regulator induces counterclockwise rotation rather than vertical or sagittal changes in the maxilla. Key words:Orthodontics, frankel regulator, class II treatment, cephalometry, superimposition. PMID:22322486
Silvestri, A; Incisivo, V; Mariani, G
A case of hyperplasia of the mandibular condyle in a growing-up subject, observed at the Department of Maxillo-Facial Surgery of the University of Rome "La Sapienza", is described. Hyperplasia of the mandibular condyle is a facial asymmetry due to the unilateral overdevelopment of the mandibular bone. In this study the authors underline how bone scintigraphy, 3D tomography and electrognatographic analysis, associated with standard radiography and cephalometry, are important methods of diagnosis in order to make an early diagnosis of hyperplasia of the mandibular condyle and differential diagnosis with other pathologies. In particular, bone scintigraphy is a useful screening procedure to detect if the pathology is in an active phase or not. The 3D tomography is used in pre-surgery to evaluate precisely morphological and structural alterations of the craniofacial bones on a tridimentional base. Finally, the electrognatographic test records the mandibular activity both in physiological and pathological conditions. All these instrumental techniques allow to make a diagnosis and lead to a possible therapeutical approach. PMID:11268938
Della Marca, G.; De Corso, E.; Dittoni, S.; Di Nardo, W.; Meucci, D.; Bastanza, G.; Gallus, R.; Losurdo, A.; Testani, E.; Paludetti, G.
SUMMARY The aim of this study was to verify if hyoid myotomy without hyoid suspension is effective in surgical treatment of obstructive sleep apnoea syndrome (OSAS). We recruited six patients with OSAS, aged between 34 to 60 years, with retropalatal and retrolingual upper airway obstruction, non-obese (BMI < 27) and non-compliant to continuous positive airway pressure therapy. Pre-surgical clinical and instrumental evaluations included clinical examination, cephalometry, polysomnography (PSG) and sleep endoscopy. Surgical treatment included nasal surgery, uvulopalatopharyngoplasty, tonsillectomy and hyoid myotomy without hyoid suspension. Follow-up evaluations were performed with serial PSGs, performed early (one week after surgery), and at 1, 6 and 18 months after surgery. We observed that surgery was followed by immediate normalisation of breathing parameters evaluated by PSG that persisted after 18 months. Thus, hyoid myotomy without suspension combined with nasal and palatal surgery may be considered a valid treatment of non-obese OSAS patients with retrolingual and retropalatal collapse. Furthermore, we suggest that hyoid bone suspension, binding it to mandibular or to thyroid cartilage, might be unnecessary in selected cases. PMID:25709152
Singh, Parmjit; Davies, Terence Ian
Traditionally, cephalometric analysis has been carried out using a hand-tracing manual method. In imaging, picture archiving and communication systems (PACS) are information management systems used for the capture and measurement of medical and dental radiographs. Although not customized for lateral cephalometry, this study aimed to evaluate the cephalometric measurements made on screen using PACS compared with the conventional hand-tracing method. Six angular and four liner parameters were measured on five radiographs of four females and one male with an age range of 14-20 years. Analysis was completed using the Wilcoxon rank-sum test. For the electronic method, SNB (P=0.04) and lower incisor angle (P=0.05) were the only parameters found to be significantly different between the two operators. There was no significant difference between operators 1 and 2 for the hand-tracing method for any measurement. All measurements were comparable between the two methods. This preliminary study would suggest that using PACS may be an acceptable method for obtaining cephalometric measurements for treatment planning; however, further evaluation is necessary with a larger sample size. PMID:20923935
Iglesias-Conde, Carmen; Lorenzo-Pernía, José; Iglesias-Linares, Alejandro; Mendoza-Mendoza, Asunción; Solano-Reina, Enrique
Objectives: The aim of this study is to test the possible orthopedic effects of cervical headgear on the cranial base and maxilla. Study design: a sample consisting of 79 subjects with skeletal class II malocclusion was divided into two groups. The experimental group was made up of 41 patients all treated with cervical headgear. The control group included a total of 38 non-treated patients. Each one of these groups was then subdivided according to age into one of three groups: prepubescent, pubescent or post-pubescent. Cephalometric parameters were compared in both groups in order to measure the cranial base angle and the vertical and sagittal position of the maxilla. Additionally, cephalometric superimpositions taken at the beginning and end of the study were compared. Results: results revealed significant differences in the cranial base angle and in the SNA angle (p<0.05). However, no differences were observed in the variables that measure the maxillomandibular relationship. While no changes were noted in the palatal plane slope, a flattening of the cranial base was found caused by the cervical headgear, in addition to a retrusion of point A that does not mean there was a reduction in the maxillomandibular relationship. Conclusions: cervical headgear treatment induces cephalometric flattening of the cranial base and a decrease of the SNA angle. Key words:Orthodontics, cervical headgear, class II treatment, cephalometry, superimposition. PMID:22322499
Alió-Sanz, Juan; Iglesias-Conde, Carmen; Pernía, José-Lorenzo; Iglesias-Linares, Alejandro; Mendoza-Mendoza, Asunción; Solano-Reina, Enrique
This study has been designed to evaluate the vertical and sagittal changes in the maxilla due to growth. A sample group was chosen of 38 individuals with normal occlusion, composed of 16 females and 22 males between the ages of 8 and 18. The total sample was divided into three groups: prepubescent (8-11 years), pubescent (12-14 years) and post-pubescent (15-18 years). A series of cephalometric angle parameters (SNA, maxillary height, slope of the palatal plane and maxillary depth) and lineal parameters (effective maxillary length, palatal plane length, middle third of the face height and convexity) were traced. Superimpositions of the initial and final cephalometries in the Ba-N plane and in the Nasion fixed point were carried out to measure growth. An analytic statistical analysis was applied using a Student t test for independent samples in order to evaluate the differences found according to sex. An analysis of variance followed by Duncan's multiple range test was done to study the evolution of each variable throughout the duration of the experiment. In light of the results obtained, we have come to the following conclusions: sagittal growth of the maxilla is constant from the age of 8 to 18 years with an average increase of 0.2 mm/year. Vertical growth, as well as general maxillary growth, is greater in the prepubescent group.
Kouga, Takeshi; Tanoue, Koji; Matsui, Kiyoshi
Syndromic craniosynostosis is associated with a high rate of respiratory difficulty, due mainly to midfacial hypoplasia. Nasopharyngeal airway establishment has been reported as the first-line approach to airway obstruction and may obviate the need for a highly invasive tracheotomy. No previous studies have compared airway obstruction status in syndromic craniosynostosis between cases requiring and not requiring airway managements. We focus on nasopharyngeal airway use and airway status outcomes to assess respiratory difficulty in patients with syndromic craniosynostosis. A retrospective data analysis of 51 cases with syndromic craniosynostosis was carried out. We divided 30 of the 51 cases with lateral pharyngeal x-rays taken before operations affecting airway diameters into 2 groups, one with neither nasopharyngeal airway insertion nor tracheotomy and the other with one or both of these interventions, and the mean diameters for 8 indices related to the pharyngeal space were compared. Cases with respiratory difficulty due to nasopharyngeal stenosis and requiring airway managements comprised a significantly higher proportion of those with Pfeiffer syndrome than patients with Crouzon or Apert syndrome. Comparative examination of lateral x-ray cephalometry between cases with neither nasopharyngeal airway insertion nor tracheotomy and cases with one or both revealed oropharyngeal diameters tended to be smaller in those with interventions. Cases requiring nasopharyngeal airway insertion were able to continue nasopharyngeal airway use for more than 1 year and a considerable number avoided tracheotomy. It may be worth considering an oropharyngeal-bypass nasopharyngeal airway before performing a tracheotomy. PMID:24820706
Kolokitha, Olga-Elpis; Topouzelis, Nikolaos
Over the past decade the growing number of adult patients seeking for orthodontic treatment made orthognathic surgery popular. Surgical and orthodontic techniques have developed to the point where combined orthodontic and surgical treatment is now feasible to manage dentofacial deformity problems very satisfactorily. The prediction of orthognathic treatment outcome is an important part of orthognathic planning and the process of patient' inform consent. The predicted results must be presented to the patients prior to treatment in order to assess the treatment's feasibility, optimize case management and increase patient understanding and acceptance of the recommended treatment. Cephalometrics is a routine part of the diagnosis and treatment planning process and also allows the clinician to evaluate changes following orthognathic surgery. Traditionally cephalometry has been employed manually; nowadays computerized cephalometric systems are very popular. Cephalometric prediction in orthognathic surgery can be done manually or by computers, using several currently available software programs, alone or in combination with video images. Both manual and computerized cephalometric prediction methods are two-dimensional and cannot fully describe three-dimensional phenomena. Today, three-dimensional prediction methods are available, such as three-dimensional computerized tomography (3DCT), 3D magnetic resonance imaging (3DMRI) and surface scan/cone-beam CT. The aim of this article is to present and discuss the different methods of cephalometric prediction of the orthognathic surgery outcome.
Bassim, CW; Gautam, P; Domingo, DL; Balog, JZ; Guadagnini, JP; Gahl, WA; Hart, TC
Objectives Cystinosis is a rare autosomal recessive lysosomal storage disorder with developmental and mineralization anomalies as part of its clinical presentation. The objective of this study was to provide the first systematic assessment of the craniofacial and dental characteristics associated with cystinosis. Study Design Oral and radiographic evaluations were performed on 73 patients with cystinosis. Analyses of cephalometry (n=20), taurodontism (n=47), caries (n=47), enamel defects (n=48), soft tissue anomalies (n=48), and dental age (n=41) were performed on the cystinosis group, and compared with age- and sex- comparable controls or standards. Results Cystinosis patients manifested relative mandibular deficiency, an increased facial height, and a reduced airway space. Taurodontism and enamel defects were significantly more prevalent in cystinosis patients compared with controls (p<0.0001 and p=0.027, respectively). Children (aged < 15 years) with cystinosis also demonstrated a significant delay, of almost 9 months, of their dental development (p<0.001). Conclusion Novel craniofacial and dental features are associated with cystinosis. Craniofacial deficiencies may influence the swallowing and respiratory complications seen in cystinosis. Renal pathology and associated mineral imbalance may explain the dental root and enamel anomalies found in cystinosis patients; the developmental delays in cystinosis include delayed dental formation. PMID:20233313
Kawashima, Shigeto; Ueda, Koichiro; Shinohara, Mitsuyo; Mano, Mikiko; Kanegae, Haruhide; Namaki, Shunsuke
Background The purpose of this study was to evaluate the relationship between facial morphology using cephalometry and chronologic age in preschool children with obstructive sleep apnea (OSA). Materials and Methods From a group of lateral cephalometric radiographs taken of 35 children with OSA for diagnostic purposes, 15 were selected for the present investigation based on head position. The subjects consisted of preschool children with both OSA and primary dentition, all of them with a lowest documented SpO2 <90% and a lowest 0
Guarda-Nardini, Luca; Manfredini, Daniele; Mion, Marta; Heir, Gary; Marchese-Ragona, Rosario
Aims: The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identified by cephalometry, for the efficacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA). Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate. Conclusions: The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account. Citation: Guarda-Nardini L, Manfredini D, Mion M, Heir G, Marchese-Ragona R. Anatomically based outcome predictors of treatment for obstructive sleep apnea with intraoral splint devices: a systematic review of cephalometric studies. J Clin Sleep Med 2015;11(11):1327–1334. PMID:25979102
Chi, Luqi; Comyn, Francois-Louis; Mitra, Nandita; Reilly, Muredach P.; Wan, Fei; Maislin, Greg; Chmiewski, Lauren; Thorne-FitzGerald, Matthew D.; Victor, Uduak N.; Pack, Allan I.; Schwab, Richard J.
The alteration of craniofacial structures has been associated with obstructive sleep apnea (OSA). We hypothesized that 1) a smaller mandible is a risk factor for OSA; and 2) the previously observed inferiorly positioned hyoid bone in apneics is associated with enlarged tongue volume. This is a case-control study using three-dimensional MRI cephalometry. 55 apneics and 55 controls were matched for age, gender and race. The analysis was stratified by gender and controlled for age, race, height, neck visceral fat, skeletal type and tongue volume. We found that a 1-SD increase in mandibular length and depth were associated with decreased risk of sleep apnea (odds ratio[OR]=0.52, 95% confidence interval[CI]:0.28-0.99, OR=0.46, 95%CI:0.23-0.91, respectively) in men but not in women. Greater hyoid to nasion (OR=2.64, 95%CI:1.19-5.89 in men; OR=5.01, 95%CI:2.00-12.52 in women) and supramentale-to-hyoid (OR=2.39, 95%CI:1.12-5.14 in men; OR=3.38, 95%CI:1.49-7.68 in women) distances were associated with increased risk of OSA. The difference between apneics and controls for hyoid position was lost after controlling for tongue volume. Enlargement of tongue is likely to be the pathogenic factor for inferior-posterior positioning of hyoid. A small and shallow mandible is an independent risk factor for obstructive sleep apnea in men but not in women. PMID:21233264
Zinser, Max; Zoeller, Joachim
Advances in computers and imaging have permitted the adoption of three-dimensional (3D) planning protocols in orthognathic surgery, which may allow a paradigm shift when the computer-assisted planning can be transferred properly. The purpose of this investigation was to introduce an innovative clinical protocol using computer-aided designed and computer-aided manufactured (CAD/CAM) surgical splints for surgical transfer of 3D orthognathic planning compared with the classic technique using arbitrary occlusal splints. The clinical protocols consisted of computed tomography (CT) or cone-beam CT (CBCT) maxillofacial imaging, bone segmentation, 3D diagnosis, computer-assisted surgical treatment planning, and CAD/CAM surgical splints (group A) and manufacture of arbitrary occlusal splints (group B) for intraoperative surgical planning transfer. The observed patients underwent bimaxillary osteotomies and, if necessary, an additional genioplasty. Both techniques were evaluated by applying 13 hard tissue parameters to compare the 3D orthognathic planning (T0) with the postoperative result (T1) using 3D cephalometry. The CAD/CAM splints showed significant better precision for the maxilla (ΔT < 0.23 mm) and mandible (ΔT < 0.33 mm) compared with a maxillary deviation of 1.3 mm and a mandibular deviation of 1.8 mm when using the arbitrary splints. Computer-assisted diagnosis and preoperative surgical planning provide clinicians with valuable tools and allow 3D imagination. CAD/CAM splints provide a reliable, innovative, and precise approach for the transfer of 3D orthognathic planning, which is more precise compared with the conventional arbitrary occlusal splints.
Chi, L; Comyn, F-L; Mitra, N; Reilly, M P; Wan, F; Maislin, G; Chmiewski, L; Thorne-FitzGerald, M D; Victor, U N; Pack, A I; Schwab, R J
The alteration of craniofacial structures has been associated with obstructive sleep apnoea (OSA). We hypothesised that: 1) a smaller mandible is a risk factor for OSA; and 2) the previously observed inferiorly positioned hyoid bone in apnoeics is associated with enlarged tongue volume. This is a case-control study using three-dimensional magnetic resonance imaging cephalometry. 55 apneics and 55 controls were matched for age, sex and race. The analysis was stratified by sex and controlled for age, race, height, neck visceral fat, skeletal type and tongue volume. We found that a 1-sd increase in mandibular length and depth were associated with decreased risk of sleep apnoea (OR 0.52, 95% CI 0.28-0.99 and OR 0.46, 95% CI 0.23-0.91, respectively) in males but not in females. Greater hyoid-to-nasion (OR 2.64, 95% CI 1.19-5.89 in males and OR 5.01, 95% CI 2.00-12.52 in females) and supramentale-to-hyoid (OR 2.39, 95% CI 1.12-5.14) in males and OR 3.38, 95% CI 1.49-7.68 in females) distances were associated with increased risk of OSA. The difference for hyoid position between apnoeics and controls was lost after controlling for tongue volume. Enlargement of tongue is likely to be the pathogenic factor for inferior-posterior positioning of hyoid. A small and shallow mandible is an independent risk factor for OSA in males but not in females. PMID:21233264
Piccin, Chaiane Facco; Pozzebon, Daniela; Scapini, Fabricio; Corrêa, Eliane Castilhos Rodrigues
Introduction Obstructive Sleep Apnea (OSA) is characterized by repeated episodes of upper airway obstruction during sleep. Objective The objective of this study is to verify the craniofacial characteristics and craniocervical posture of OSA and healthy subjects, determining possible relationships with the apnea/hypopnea index (AHI). Methods This case-control study evaluated 21 subjects with OSA, who comprised the OSA group (OSAG), and 21 healthy subjects, who constituted the control group (CG). Cephalometry analyzed head posture measurements, craniofacial measurements, and air space. Head posture was also assessed by means of photogrammetry. Results The groups were homogeneous regarding gender (12 men and 9 women in each group), age (OSAG = 41.86 ± 11.26 years; GC = 41.19 ± 11.20 years), and body mass index (OSAG = 25.65 ± 2.46 kg/m2; CG = 24.72 ± 3.01 kg/m2). We found significant differences between the groups, with lower average pharyngeal space and greater distance between the hyoid bone and the mandibular plane in OSAG, when compared with CG. A positive correlation was found between higher head hyperextension and head anteriorization, with greater severity of OSA as assessed by AHI. Conclusion OSAG subjects showed changes in craniofacial morphology, with lower average pharyngeal space and greater distance from the hyoid bone to the mandibular plane, as compared with healthy subjects. Moreover, in OSA subjects, the greater the severity of OSA, the greater the head hyperextension and anteriorization. PMID:27413397
Cossellu, Gianguido; Biagi, Roberto; Sarcina, Michele; Mortellaro, Carmen; Farronato, Giampietro
Obstructive sleep apnea syndrome (OSAS) represents a frequent and common respiratory disease characterized by repeated episodes of complete and/or partial obstruction of upper airways during sleep, normally associated with reduction of oxygen saturation in blood. The oral appliances (OAs) are considered to be an effective treatment modality thanks to the upper airway enlargement. Lateral cephalometry has been used for the 2-dimensional evaluation of upper airway form with several limits. We obtained an accurate 3-dimensional (3D) volume analyses with cone beam computed tomography (CBCT) scans to confirm the effects of OA on the upper airway in patients with OSAS. Ten Italian patients with moderate or severe OSA (3 males and 7 females, 53.4 ± 11.3 years of age, and BMI 24.5 ± 2.7), who cannot tolerate continuous positive air pressure therapy and rejected a surgical approach, were treated with non-adjustable customized OAs and evaluated with CBCT and polysomnography. Upper airway form was examined in the presence and absence of OA and the volume was measured and compared in 2 different areas. Specific planes have been considered to match the data and calculate the benefit obtained with therapy. Nine out of ten patients showed an improvement of total upper airway volume and an improvement in apnea-hypopnea index. Volume increased both in the posterior soft palate region and in the posterior tongue region. In the inferior area, we observed greater differences. 3D image reconstruction accurately confirmed morphological changes in the upper airway during OA therapy. The use of this 3D evaluation is expected to improve the results of OA therapy in the future. PMID:25974784
Dotan, Y; Golibroda, T; Oliven, R; Netzer, A; Gaitini, L; Toubi, A; Oliven, A
Chronic stimulation of the hypoglossus nerve may provide a new treatment modality for obstructive sleep apnoea (OSA). In previous studies we observed large differences in response to stimulation of the genioglossus (GG). We hypothesised that both individual patient characteristics and the area of the GG stimulated are responsible for these differences. In the present study, we compared the response to GG electrical stimulation at the anterior area (GGa-ES), which activates the whole GG and the posterior area (GGp-ES), which activates preferentially the longitudinal fibres. Studies were performed in 14 propofol-sedated OSA patients. The parameters evaluated included cephalometry, pressure-flow relationship and pharyngeal shape and compliance assessed by pharyngoscopy. Compared with GGa-ES, GGp-ES resulted in significantly larger decreases in the critical value of end-expiratory pressure (P(crit)) (from 3.8 ± 2.2 to 2.9 ± 3.3 and -2.0 ± 3.9 cmH(2)O, respectively (p<0.001)). Both tongue size and velopharyngeal shape (anteroposterior to lateral ratio) correlated significantly with the decrease in P(crit) during GGp-ES (R = 0.53 and -0.66, respectively; p<0.05). In the patients with the larger tongue size (n = 7), the decrease in P(crit) reached 8.0 ± 2.2 cmH(2)O during GGp-ES. We conclude that directing stimulation to longitudinal fibres of the GG improves the flow-mechanical effect. In addition, patients with large tongues and narrow pharynx tend to respond better to GGp-ES.
Cibrián, Rosa; Gandia, Jose L.; Paredes, Vanessa
Objectives: CBCT systems, with their high precision 3D reconstructions, 1:1 images and accuracy in locating cephalometric landmarks, allows us to evaluate measurements from craniofacial structures, so enabling us to replace the anthropometric methods or bidimensional methods used until now. The aims are to analyse cranio-facial relationships in a sample of patients who had previously undergone a CBCT and create a new 3D cephalometric method for assessing and measuring patients. Study Design: 90 patients who had a CBCT (i-Cat®) as a diagnostic register were selected. 12 cephalometric landmarks on the three spatial planes (X,Y,Z) were defined and 21 linear measurements were established. Using these measurements, 7 triangles were described and analysed. With the sides of the triangles: (CdR-Me-CdL); (FzR-Me-FzL); (GoR-N-GoL); and the Gl-Me distance, the ratios between them were analysed. In addition, 4 triangles in the mandible were measured (body: GoR-DB-Me and GoL-DB-Me and ramus: KrR-CdR-GoR and KrL-CdL-GoL). Results: When analyzing the sides of the CdR-Me-CdL triangle, it was found that the 69.33% of the patients could be considered symmetric. Regarding the ratios between the sides of the following triangles: CdR-Me-CdL, FzR-Me-FzL, GoR-N-GoL and the Gl-Me distance, it was found that almost all ratios were close to 1:1 except between the CdR-CdL side with respect the rest of the sides. With regard to the ratios of the 4 triangles of the mandible, it was found that the most symmetrical relationships were those corresponding to the sides of the body of the mandible and the most asymmetrical ones were those corresponding to the base of such triangles. Conclusions: A new method for assessing cranio-facial relationshps using CBCT has been established. It could be used for diverse purposes including diagnosis and treatment planning. Key words:Craniofacial relationship, CBCT, 3D cephalometry. PMID:23524427
Pendlebury, S. T.; Pepin, J. L.; Veale, D.; Levy, P.
BACKGROUND: Obstructive sleep apnoea (OSA) is associated with increased morbidity and mortality. It has remained unclear whether or not it is progressive. The evolution of OSA was examined in a retrospective case note study of 55 unselected patients of mean (SD) age 55.8 (10) years with mild to moderate disease untreated by interventional methods such as continuous positive airway pressure (CPAP) or surgery. Correlations between clinical and functional variables, upper airway anatomy, and change in disease severity were also investigated. METHODS: Patients underwent full polysomnography on two occasions (T0 and Tx) at a mean interval of 77 (50) weeks (range 17-229). In addition, upper airway imaging with computed tomographic scanning or cephalometry had been performed in 43 patients at T0. Morbidity before, during, and after the study period was assessed by questionnaire, as was smoking history and alcohol and sedative intake. RESULTS: The apnoea hypopnoea index (AHI) for the group as a whole increased from 21.8 (11.5) to 33.4 (21.3) (p = 0.0001). Using a 25% change in AHI to divide patients into worsened, stable, and improved groups showed that, although most of the patients deteriorated, 25 patients improved or remained stable. The change in AHI was not correlated with body mass index which remained stable at 29.7 (5.4) kg/m2 versus 29.7 (5.6) kg/m2. There was a trend for apnoea duration to increase. No patient reported increased alcohol consumption and only one patient reported increased use of sedatives between T0 and Tx. No correlation was found between change in AHI and age, time between recordings, anatomical measurements of the upper airway, respiratory function, oximetry, or arterial blood gas tensions. Total cardiovascular and cerebrovascular morbidity was high: hypertension (26 patients, 46%), cardiac arrhythmia (17 patients, 33%), angina (12 patients, 23%), myocardial infarction (10 patients, 19%), and stroke (10 patients, 19%). Twenty nine patients (52
Naughton, Matthew T.; Monteith, Brian D.; Manton, David J.; Dever, Paul; Schachter, Linda M.; O'Brien, Paul E.; Dixon, John B.
Rationale: Obesity is a major risk factor towards the development of obstructive sleep apnea, while significant weight loss (both conservatively managed and surgically assisted) has a variable effect upon its severity. Differences in the effect of weight loss on obstructive sleep apnea may be due to underlying craniofacial characteristics. Objectives: To determine whether craniofacial characteristics can predict OSA treatment response to significant weight loss. Methods: We analyzed craniofacial measurements from lateral cephalograms performed at baseline on 57 patients enrolled in a previously reported 2-year randomized clinical weight loss trial (laparoscopic adjustable gastric band surgery versus conservatively [dietician and very low calorie diet] treated). Group mean weight loss was ∼ 13% (mean weight loss 131 to 114 kg), with corresponding reduction in mean apnea-hypopnea index (AHI) from 61 to 41 events/h. Computer assisted lateral cephalogram analysis was undertaken by three trained staff blinded to treatment. We analyzed lateral cephalogram and demographic data at baseline (cross-sectional) and change over two years (interventional) in 54 patients. Measurements and Main Results: Baseline cross-sectional analysis indicated no cephalometric measurement correlated significantly with baseline AHI when corrected for neck circumference. The percentage change in AHI over 2 years correlated with a shorter menton-gonion distance (i.e., mandibular body length). The % change in AHI correlated with the % weight change (R2 = 0.25, p < 0.001) and mandibular body length (R2 = 0.19, p = 0.002). The % change in AHI correlated with combined weight change and mandibular body length (combined R2 = 0.31, p < 0.001). Conclusions: Weight loss as a therapeutic option for severe OSA with severe obesity may be predicted by shorter mandibular body length as measured by lateral cephalometry. Citation: Naughton MT, Monteith BD, Manton DJ, Dever P, Schachter LM, O'Brien PE, Dixon JB
Choi, Jong Woo; Lee, Jang Yeol; Oh, Tae-Suk; Kwon, Soon Man; Yang, Sung Joon; Koh, Kyung Suk
Although two dimensional cephalometry is the standard method for analyzing the results of orthognathic surgery, it has potential limits in frontal soft tissue analysis. We have utilized a 3 dimensional camera to examine changes in soft tissue landmarks in patients with skeletal class III dentofacial deformity who underwent two-jaw rotational setback surgery. We assessed 25 consecutive Asian patients (mean age, 22 years; range, 17-32 years) with skeletal class III dentofacial deformities who underwent two-jaw rotational surgery without maxillary advancement. Using a 3D camera, we analyzed changes in facial proportions, including vertical and horizontal dimensions, facial surface areas, nose profile, lip contour, and soft tissue cheek convexity, as well as landmarks related to facial symmetry. The average mandibular setback was 10.7 mm (range: 5-17 mm). The average SNA changed from 77.4° to 77.8°, the average SNB from 89.2° to 81.1°, and the average occlusal plane from 8.7° to 11.4°. The mid third vertical dimension changed from 58.8 mm to 57.8 mm (p = 0.059), and the lower third vertical dimension changed from 70.4 mm to 68.2 mm (p = 0.0006). The average bigonial width decreased from 113.5 mm to 109.2 mm (p = 0.0028), the alar width increased from 34.7 mm to 36.1 mm (p-value = 0.0002), and lip length was unchanged. Mean mid and lower facial surface areas decreased significantly, from 171.8 cm(2) to 166.2 cm(2) (p = 0.026) and from 71.23 cm(2) to 61.9 cm(2) (p < 0.0001), respectively. Cheek convexity increased significantly, from 171.8° to 155.9° (p = 0.0007). The 3D camera was effective in frontal soft tissue analysis for orthognathic surgery, and enabled quantitative analysis of changes in frontal soft tissue landmarks and facial proportions that were not possible with conventional 2D cephalometric analysis.