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[A new 3-dimensional cephalometry model. A new 3-dimensional parameter analysis: the axis of inertia. A new idea: maxillofacial equilibrium].

The authors propose a biomensurativ 3 D method based on the plotting of 8 anatomical landmarks situated on the trigeminal axis and the selection of teeth. In the analysis of this construction, we have employed mathematical tools unusual in developmental biology, the axis of inertia. The 3 D analysis allows to evidence the architectural, structural and functional balance of the dentomaxillofacial complex. This balance must be substituted to the normality concept to directly linked to cultural criterias and to the selection of mean parameters among culturally and ethnically homogeneous populations. Therapy does not have to lead to the normality of mean parameters but to the return or to the discovery of a real balance.

Cephalometry↗

Reliability and validity of the Digigraph 100 in orthodontic diagnosis.

Cephalometric analyses of lateral cephalograms allow important statements to be made on diagnosis and treatment planning. Such radiographs should, however, be taken with a considerable reduction in radiation exposure. With the Digigraph 100 (Dolphin Imaging Systems Inc., USA) a cephalometric technique based on distance measurements of emitted sonic signals is now available. This study was aimed at determining the degree to which this procedure can cope with the requirements of reliability and validity in the field of orthodontics. For this purpose 50 volunteers were examined by conventional cephalometry with manual tracing of lateral cephalograms as well as by sonic cephalometry, with Jarabak analysis in both cases. In addition an option was available for reading lateral cephalograms into the Digigraph by means of a radiograph evaluation program. The 31 evaluated parameters were subjected to modified statistical analysis. Good reliability was recorded in the range between 0.96 and 0.99 for eleven sonic cephalometric measurements, whereas 26 values were between 0.69 and 0.95. The validity was significantly lower in comparison to radiocephalometry. In particular, measurements related to landmarks which were difficult to access or could be only indirectly determined, such as the sella point, the articulare point or the apices of the incisors, proved to be weak points of sonic cephalometry. The device is thus indicated rather in the field of communication with the patient or for intermediate examination without radiation exposure. Cephalometry without radiation exposure would represent decisive progress in orthodontic diagnostics. However, some developmental work on the processing software or even the development of a specific sonic cephalometry which deliberately dispenses with parameters that are difficult to record with this procedure is still needed.

Adolescent↗

Clinical predictors in obstructive sleep apnoea patients with calibrated cephalometric analysis--a new approach.

AIM: Utilization of a new method to accurately quantify differences in cephalometric parameters between obstructive sleep apnoea (OSA) and normal patients, and to identify good predictors for OSA. To illustrate the ethnic differences in cephalometry. METHOD: This prospective study involves 106 South-east Asians. A calibrated catheter is inserted into the upper airway during standard cephalometry to obtain the precise magnification and allow exact measurement of anatomical parameters of cephalometry in both erect and supine positions. RESULTS: The OSA patients have longer lower-facial length, narrower skull base, shorter and receding mandible, smaller posterior airway space (PAS), narrower retropalatal space, longer and thicker soft palate, smaller hard and soft palate angles longer tongue length and more inferiorly displaced hyoid. For the palatal level, retropalatal distance of 11.2 mm cut-off/predictive value for male (receiver operating characteristics (ROC) = 0.8414 with PPV = 77.46, NPV = 90.00) and 5.5 mm for female (ROC = 0.9180 with PPV = 100.00, NPV = 84.21) at erect position were selected. For retrolingual level, erect PAS of 10.1 mm cut-off/predictive value for male (ROC = 0.7000 with PPV = 78.38, NPV = 37.78), 5.3 mm for female (ROC = 0.7227 with PPV = 75.00, NPV = 75.00) were selected. Our study showed that South-east Asians have different cephalometric values compared with White people, Black people and Hispanics. CONCLUSION: This new method of cephalometry using a calibrated catheter provides an accurate and simple method of obtaining precise cephalometric measurements. There is no cephalometric data on OSA from South-east Asia available. These results suggested that surgeons managing OSA patients and using cephalometry as a diagnostic method should have a set of normative and OSA cephalometric values that apply to their local populations.

Adult↗

[Utility of three-dimensional soft tissue facial morphometry and conventional cephalometrics in people with normal occlusion].

OBJECTIVE: The purpose of this study was to compare the data of three-dimensional soft tissue obtained by using a three-dimensional digital photogrammetry and the two-dimensional data obtained by using a conventional cephalometry. METHODS: Three-dimensional characters of facial soft tissue were obtained by using four digital cameras. The authors developed necessary hardware and software systems and applied in stereophotogrammetry to obtain the data of three-dimensional facial soft tissues. A total of 40 people with normal occlusion, including 20 males and 20 females, were examined with both three-dimensional soft tissue facial morphometry and cephalometry. Three-dimensional soft tissue facial morphometry was performed, and their relations with facial cephalometry were analyzed. RESULTS: Significant correlations were found between 6 pairs of linear measurements, 4 pairs of angular measurements and 3 pairs of linear distant ratio measurements. The data obtained by three-dimensional facial soft tissue morphometry and two-dimensional cephalometry was identical. CONCLUSION: There was a correlation between the three-dimensional soft tissue facial morphometry and facial cephalometry. The data obtained by the three-dimensional soft tissue facial morphometry can partially represent facial hard tissue.

Adult↗

Relation between intracranial volume and the surface area of the foramen magnum.

Several investigators have estimated the intracranial volume (ICV) in the past which indirectly reflects the brain volume. Most of these studies have been made on the dry skulls using linear dimensions, packing methods or occasionally radiological methods. It is also reported that the etiology of cerebellar tonsillar herniation is closely related to the size of the foramen magnum (FM). In the present study the ICVs have been estimated in 28 dry skulls using filling water method and the surface area of FMs were measured planimetry method. The estimated mean ICV was 1,311 +/- 133 cm. Surface area of FM was 760 +/- 144 mm. Antero-posterior and lateral direct roentgenograms of the skulls were also taken and the width, height and length (WHL) of the skull were measured by means of the cephalometry on radiograms. The relationship between the ICV, WHL and surface area of FM were analyzed statistically. The ICV, WHL and surface area of FM was correlated well (r = 0.271, P < 0.005; r = 0.265, P < 0.005, respectively) and a regression formula was proposed. Our results showed that skulls with larger ICV and WHL have larger FM surface area. We also suggested a regression formula that could be used to predict the surface area of FM regarding to the ICV and WHL values. In the next step, we took roentgenograms of skulls and obtain ICV measuring the width, length and height of skulls by means of cephalometry and investigate the relation between the findings of cephalometry and surface area of FM. The cephalometry could apply on living subjects and, thereby, our findings could provide some data to evaluate the etiology of Arnold Chiari malformation and achondroplasia for living subjects.

Adult↗

[Digital cephalometrics].

There are different methods to produce digital head films and all have advantages and disadvantages. With a digital head film and a computer programme for digital cephalometry an analysis can be performed easily. All existing computer programmes for digital cephalometry use reference values to compare with the patient's values. However, the magnification factors of the two data sets, which are compared, must be known and correction to the same magnification must be possible within the programme. Furthermore, the reference values should be age, gender, and population related. Many commercially available programmes do not fulfil these criteria. A well-designed programme for digital cephalometry should have the possibility to calculate age and gender-related reference values based on values of the target population. Furthermore it should have the possibility to analyse several longitudinal head films at the same time and to present the data graphically. A national survey among Dutch orthodontists by the end of 2000 demonstrated that 35% of Dutch orthodontists used digital cephalometry in their office. The most commonly used analysis was the Steiner-Tweed analysis, which was performed by nearly 60% of the orthodontists.

Age Factors↗

3D CT-based cephalometric analysis: 3D cephalometric theoretical concept and software.

INTRODUCTION: We present an original three-dimensional cephalometric analysis based on a transformation of a classical two dimensional topological cephalometry. METHODS: To validate the three-dimensional cephalometric CT based concept we systematically compared the alignments of anatomic structures. We used digital lateral radiography to perform the classical two-dimensional cephalometry, and a three-dimensional CT surface model for the three-dimensional cephalometry. RESULTS: Diagnoses based on both two-dimensional and three-dimensional analyses were adequate, but the three-dimensional analysis gave more information such as the possibility of comparing the right and left side of the skull. Also the anatomic structures were not superimposed which improved the visibility of the reference landmarks. CONCLUSION: We demonstrated that three-dimensional analysis gives the same results as two-dimensional analysis using the same skull. We also present possible applications of the method.

Cephalometry↗

Obstructive sleep apnea in a referral population in India.

There are few published studies of obstructive sleep apnea in the Asian subcontinent. The objectives were to describe the syndrome and evaluate the utility of computed tomography (CT) cephalometry in patients found to have obstructive sleep apnea (OSA) by polysomnography. This article reports on a retrospective case series in a referral population. A total of 880 patients (560 males and 320 females) were seen in a referral center in Hyderabad, South India, during the last 7 years. All patients with suspected obstructive sleep apnea were evaluated with 16-channel polysomnogram by overnight sleep study; 600 subjects (68%; 480 males and 120 females) underwent evaluation with CT cephalometry. Mean age was 51.4 +/- 9.5 years (standard deviation). The mean apnea-hypopnea index (AHI) was 27.93 +/- 3.8. The majority of patients had more than 10 AHI; mean percentage of sleep efficiency was 80.62 +/- 15.38; mean percentage of rapid eye movement (REM) sleep was 13.79 +/- 7.89; mean awake arterial oxygen saturation (SaO2) was 90%; mean sleep SaO2 was 84% +/- 4.4%; mean Epworth Sleepiness Scale (ESS) score was 12.3 +/- 2.8. The tongue base area (TBA) was found to be significantly associated with obstructive sleep apnea (OSA), with mean TBA 1032.8 +/- 427 mm2 compared with normal controls at 561.1 +/- 197.6 mm2 (p < 0.001). Mean gonion-gnathion-hyoid angle (Go-Gn-H) was 28.5 +/- 10.5 in OSA and 16 +/- 16.7 in controls; uvula area was 452.5 +/- 145.8 mm2 in OSA and 221.4 +/- 49.85 mm2 in controls; uvula diameter was 13.8 +/- 2.74 mm in OSA and 10.1 +/- 1.72 mm in controls. A total of 704 patients with OSA (80%) were found to be hypertensive, with daytime mean blood pressure of 160/100 +/- 8.5/4.8 mm Hg. Mean duration of reported hypertension was 2 years. The present study showed moderate to severe OSA in a majority of suspected cases referred for polysomnogram. Mild disease was seen in 20.45% of patients (n = 180). On CT cephalometry, the TBA correlated significantly with OSA; hypertension is common in patients with OSA.

Cephalometry↗

Development of a non-radiographic cephalometric system.

The purpose of the present study was to develop a three-dimensional (3D) non-radiographic cephalometric system based on Simon's three planes. In pursuit of cephalometry without irradiation of patients, readiness of data and simplicity of the system, a portable 3D computer-aided, contact-method cephalometric system, equipped with newly developed cephalometric software for chairside use, was developed. The feasibility of its clinical use was examined based on comparison of the measurements obtained with those from conventional radiographic cephalometry on a human dry skull, as well as on three living subjects. From a total of nine measurements, a statistically significant difference was seen in six measurements: FMPA, U1/FH, FMIA, ANB, IMPA, and A-Np for the dry skull; in four measurements: FPA, FMPA, U1/FH, and Pog-Np for subject A; in five measurements: FMPA, U1/FH, FMIA, AN/FH, and A-Np for subject B; and in seven measurements: FMA, FMPA, U1/FH, FMIA, ANB, IMPA, and AN/FH for subject C. A clinically significant difference was found only in one measurement, U1/FH for the dry skull, in four measurements FPA, FMPA, U1/FH, and Pog-Np for subject A, in one measurement AN/FH for subject B, and in three measurements U1/FH, FMIA, and AN/FH for subject C. While demonstrating workability as a chairside tool and whilst there is a need for further refinement in measurement accuracy, this newly developed cephalometric system shows potential applicability, not only in the clinic as an auxiliary to or as a substitute for existing radiographic cephalometry, but also outside the clinic as an epidemiological tool.

Algorithms↗

Upper airway and its surrounding structures in obese and nonobese patients with sleep-disordered breathing.

OBJECTIVES/HYPOTHESIS: The objective was to understand the pathophysiological relationship between obesity and sleep-disordered breathing by using cephalometry with the Muller maneuver. STUDY DESIGN: A prospective study. METHODS: One hundred habitually snoring men were evaluated for sleep-disordered breathing at the Sleep Center of Chang Gung Memorial Hospital (Taipei, Taiwan). Each subject received overnight polysomnography and two lateral cephalograms at the end-expiration phase (L1) and the Muller maneuver (L2), respectively, to evaluate the facial skeleton and the upper airway and its surrounding structures (soft palate, tongue, epiglottis, and hyoid bone). After excluding 14 patients from the study because of jaw opening during cephalometry, 86 (39 nonobese and 47 obese) patients with sleep-disordered breathing were enrolled. RESULTS: Patients with varying degrees of obesity significantly differed in terms of the facial skeleton and the structure and function of the upper airway and its surrounding structures. The Muller maneuver caused dynamic changes in the hypopharyngeal airway and position of the tongue, and these dynamic changes were related to the pathogenesis of sleep-disordered breathing for the two groups (nonobese and obese patients). The regression model generated for the nonobese group revealed that the apnea hypopnea index was significantly related to the pharyngeal length (L2) and the soft palate thickness (L1). In contrast, the regression model generated for the obese group revealed that the apnea hypopnea index was significantly related to the soft palate (length [L1] and dynamic position change), the hyoid position (vertical [L1] and horizontal [L2]), the tongue (dynamic position change), and body mass index. CONCLUSION: Cephalometry with the Muller maneuver may provide further insight into the pathogenesis of sleep-disordered breathing for the two groups of patients (nonobese and obese patients).

Adult↗

Detection of the small-for-dates twin fetus by ultrasound.

As methods for identifying the small-for-dates fetus in twin pregnancies, serial ultrasonic cephalometry and a new two-stage ultrasound examination schedule have been evaluated and compared. Serial cephalometry is associated with technical and interpretative problems, and only 24 (56 per cent) of 43 small-for-dates fetuses in 66 retrospectively studied twin pregnancies showed detectably abnormal biparietal diameter growth. The two-stage schedule comprises an accurate assessment of gestational age in early pregnancy, and determination of the product of the crown-rump length and trunk area at 34 to 36 weeks; this identified all 15 small-for-dates fetuses in 21 prospectively studied twin pregnancies, and the method offers several other advantages over serial cephalometry.

Anthropometry↗

Snoring is not relieved by nasal surgery despite improvement in nasal resistance.

OBJECTIVES: In the present study, we evaluated the effect of nasal surgery on snoring time, snoring intensity, and sleep-disordered breathing. The role of abnormal cephalometry in treatment outcome was assessed. DESIGN: A cross-sectional prospective study. SETTING: University teaching hospital. PATIENTS: Forty consecutive snoring men who were referred to ENT Hospital because of a snoring problem or suspicion of sleep apnea. INTERVENTIONS: The patients underwent anterior rhinomanometry and polysomnography (PSG) with recording of snoring before and after operative treatment of nasal obstruction. Cephalometric radiographs were obtained before surgery. RESULTS: Nasal resistance decreased significantly in the overall patient group. Snoring time, snoring intensity, nocturnal breathing, and sleep architecture did not change after nasal surgery. Cephalometry did not predict operative outcome in these patients. Snoring intensity was found to be significantly higher during non-rapid eye movement (NREM) sleep than during rapid eye movement sleep. CONCLUSIONS: Operative treatment of mainly structural nasal obstruction did not seem to decrease snoring intensity, snoring time, or sleep-disordered breathing in an objective assessment by PSG performed after surgery. The effect of treating inflammatory nasal changes during nocturnal breathing, as well as the role of cephalometry in the prediction of treatment outcome will need further evaluation. Higher snoring intensity related to NREM sleep may add to the sleep disturbance of a bed partner in the evening.

Adult↗

Cephalometric analysis in patients with obstructive sleep apnea syndrome.

Cephalometry is useful as a screening test for anatomical abnormalities in patients having obstructive sleep apnea syndrome. In this study, various conventional parameters in cephalometry, such as the distance and angles determining the oropharyngeal space, and the areas of the soft palate, oral cavity, tongue and pharynx in both posterior-anterior and lateral view X-ray films, were measured before and after surgery in order to evaluate the preoperative predictability and usefulness of uvulopalato-pharyngoplasty and/or midline laser glossectomy (MLG) for the purpose of preoperative assessment and evaluation of surgical treatment. As test subjects, American adult patients with disturbed respiration in sleep observed at Oakland Otology and Apnea Clinic during 1989-1992 and Japanese patients with the same problems observed at Kitasato Univ. Hospital during 1992-1994 were used. The results were as follows: i) cephalometry revealed morphological abnormalities in the skull, and the measurement of soft tissue in the oropharynx provided useful anatomical data to assess the space of the upper airway in each patient before operation; ii) the areas of the soft palate, the whole tongue and the lower half of the tongue were significantly enlarged, and the lengths of MPH, SPL and PNS-H were longer in the apnea group than in the snoring group; iii) in MLG patients, increases in the area of the oral cavity and pharyngeal cavities and a decrease in the area of the upper half of the tongue were observed.

Adult↗

[Comparison of cephalometric parameters in patients with sleep apnea syndrome and normal individuals].

BACKGROUND: Craniofacial abnormalities which predispose to pharyngeal obstruction can be detected by cephalometry. The aim of the present study was to compare cephalometric findings of the patients with sleep apnoea syndrome (SAS) with those of healthy population. METHODS AND RESULTS: The SAS patients (23 females, 96 males) and normal population (36 females, 50 males) were examined by cephalometry. In the group of females with SAS following significant differences were observed: elongation of the soft palate (p < 0.001), narrowing pharyngeal airway space (p < 0.001), mandibular retrognathism (p < 0.05), micrognathism of the mandible (p < 0.001), dorsocaudal rotation of the mandible (p < 0.01), increased lower gonion angle (p < 0.001) and the articular angle (p < 0.05), increased anterior facial height (p < 0.05), narrowing the depth of bony framework of the nasopharynx (p < 0.001), decreased depth of the upper face (p < 0.01) and decreased length of the cranial base (p < 0.01). In the group of males with SAS, following significant differences were observed: elongation of the soft palate (p < 0.001), narrowing pharyngeal airway space (p < 0.001), decreased depth of the maxilla (p < 0.001), decreased angle of the cranial base (p < 0.01), decrease saddle angle (p < 0.01), decreased depth of the upper face (p < 0.01), increased lower gonion angle (p < 0.01), increased articular angle (p < 0.001) and increased anterior and posterior facial height (p < 0.001). CONCLUSIONS: There are important differences in orofacial skeleton and soft tissue of the nasopharynx measured by cephalometry in the patients with sleep apnoea compared to normal population.

Adult↗

The diagnosis and management of intrauterine growth retardation.

Twenty-eight pregnant patients exhibiting subnormal fetal growth patterns by serial ultrasonic cephalometry were studied. Only 12 (43%) delivered small-for-gestational-age (SGA) infants indicating a poor correlation between the prenatal assessment of intrauterine growth retardation (IUGR) by ultrasonic cephalometry and the neonatal evaluation of the newborn as SGA. The most important factors in the evaluation of the fetus with subnormal serial ultrasonic cephalometry were: 1) the type of ultrasonic growth pattern ("late flattening" vs "low growth profile"), 2) the presence or absence of maternal high-risk factors, and 3) the gestational age of the fetus at the time of detection of the growth abnormality. A pregnancy showing a late flattening type of growth pattern by serial ultrasound in the presence of maternal high-risk factors and with the growth abnormality being detected before 35 weeks of gestation, almost certainly will terminate with the birth of a SGA infant. On the contrary, serial plasma free estriol determinations were not useful in predicting the fetal status at birth. All but 4 of these patients were delivered at term and there was neither perinatal mortality nor significant morbidity. It is suggested that the existence of an abnormal cephalometric pattern is not an indication for early delivery unless fetal distress is detected by means of an oxytocin challenge test.

Cephalometry↗