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PubMed2001

A modified approach for obtaining cephalograms in the natural head position.

Cephalograms taken in the Natural Head Position (NHP), and related to the true vertical and the true horizontal reference planes should logically replace the planes used in conventional cephalometry. This has not happened because of the difficulties in radiographically recording the NHP. This paper presents a modified approach to capture the true vertical reference line on the patients' face itself in NHP, which is then transferred to the conventional lateral cephalogram.

Cephalometry↗

PubMed2002

The craniofacial morphology of the parents of children with orofacial clefting: a systematic review of cephalometric studies.

OBJECTIVE: To systematically review the cephalometric studies investigating the craniofacial morphology of the parents of children with orofacial clefting (OFC). SEARCH STRATEGY: The search strategy was based on the keywords 'parent', cephalometry', and 'cleft', identifying 17 studies, of which 15 'case/control' studies met the inclusion criteria Statistically significant clinically relevant cephalometric variables from univariate statistical tests and multivariate results were collated and presented unweighted. RESULTS/CONCLUSIONS: The parental craniofacial complex in OFC is distinctive in comparison to the non-cleft population. However, there is insufficient consistency in study designs and results to accurately characterize the parents of children with OFC. Although the craniofacial morphology of the parents of children with CL(P) differs to the parents of children with CP, there is insufficient information to accurately localize these differences.

Adult↗

PubMed1989

A comparison between anamnestic, rhinomanometric and radiological methods of diagnosing mouth-breathing.

Three methods of evaluating the mode of breathing were applied in 119 children aged 7-15 years who were to start orthodontic treatment for various malocclusions. The three methods were: the history, rhinomanometric recording of the nasal airflow and determination of the size of the airway on profile and frontal cephalograms. The variables describing the mode of breathing were correlated with the facial morphology and the natural position of the head and the cervical spine as recorded with profile cephalometry. There were no correlations between the results of the evaluation of the mode of breathing obtained with the three methods. Nor were there any correlations between these and the position of the head or the cervical spine. A history of mouth-breathing, the rhinomanometrically determined airflow through the nose and the size of the airway on the profile cephalogram were, however, correlated with the long face morphology characteristic of mouth-breathing. A diagnosis of mouth-breathing should be based on different supplementary methods, the history and the size of the airway on the profile cephalogram being at least as valuable as the rhinomanometric recordina.

Adolescent↗

PubMed2004

Reliability and validity of a modified lateral cephalometric analysis for evaluation of craniofacial morphology and growth in patients with clefts.

In previous intercenter studies on craniofacial morphology in patients with unilateral cleft lip and palate, probable surgical-induced changes in mandibular morphology and spatial position related to posterior vertical maxillary morphology were identified by our group. These changes could not be detected in other cephalometric cleft studies because posterior vertical maxillary height and vertical mandibular ramus length were not measured simultaneously. This study presents a modified digital lateral cephalometric hard and soft tissue analysis (Onyx Ceph software, version 2.5.6.; Image Instruments GmbH, Chemnitz, Germany) to evaluate craniofacial morphology and growth patterns in patients with clefts. Forty controls without clefts were used to evaluate the accuracy, reliability, and validity of this analysis for future cleft research. Measurement error according to the method of Bland and Altman was less than 1.00 degrees and 1.00 mm, whereas squared correlation coefficients (r) according to the method of Sackett et al showed a high reliability. Method comparison tests according to the method of Bland and Altman clearly showed that the modified digital cephalometric analysis ("test") was valid for future cleft research compared with the "gold standard" (conventional cephalometry).

Cephalometry↗

PubMed2000

Long-term results of uvulopalatopharyngoplasty for obstructive sleep apnea syndrome.

OBJECTIVES: Assessment of the long-term effect of uvulopalatopharyngoplasty (UPPP) on snoring, excessive daytime sleepiness, and nocturnal oxygen desaturation index (ODI) in patients with obstructive sleep apnea syndrome. STUDY DESIGN: Evaluation of snoring, excessive daytime sleepiness, and ODI in patients treated by UPPP earlier. MATERIALS AND METHODS: Patients (n = 58) with a follow-up period of 11 to 74 months (median, 34 mo) were included in this study. Snoring and excessive daytime sleepiness were scored on specially designed semiquantitative scales. In all patients ODI was calculated from pulse-oximetry combined with polysomnography at base line and by polygraphy (MESAM 4) during follow-up in 38 patients. Long-term response was compared with 6-month response in the same cohort. RESULTS: There was a long-term improvement of snoring in 63% of patients, no change in 23%, and a deterioration in 14% (P < .00001). Overall snoring increased slightly between 6 months and long-term follow-up. There was an improvement of excessive daytime sleepiness in 38%, no change in 27%, and a deterioration in 35% (P = .80). Excessive daytime sleepiness showed a relapse to preoperative levels between 6 months and long-term follow-up. The median improvement of ODI was -1 (95% interpercentile range, 73-51) and was not significant (P = .35). In 5 of 13 patients in whom ODI at baseline exceeded 20, ODI was reduced to less than 20. In 4 of the 38 patients ODI was reduced to less than 5. The improvement of ODI decreased significantly between 6 months and long-term follow-up (P = .03). No relation was found between body mass index, Mueller maneuver, X-cephalometry, and long-term outcome. An additional finding was that the ODI decreased after UPPP in combination with tonsillectomy, compared with a slight increase after UPPP alone; the difference was significant (P = .008). CONCLUSION: The response to UPPP for obstructive sleep apnea syndrome decreases progressively over the years after surgery. UPPP in combination with tonsillectomy was more effective than UPPP alone.

Adult↗

PubMed2003

Postural cephalometric analysis and nasal resistance in sleep-disordered breathing.

OBJECTIVES: The study was designed to compare upright and supine cephalometric measurements in snorers and to evaluate the effects of mandibular position and nasal resistance on pharyngeal dimensions. Anthropometric, rhinomanometric, and cephalometric measurements were used to investigate predictors of apnea-hypopnea index. STUDY DESIGN: Prospective, cross-sectional. METHODS: Forty consecutive habitually snoring men waiting for nasal surgery (mean age, 44 y; mean body mass index, 28 kg/m2) underwent an overnight polysomnographic, anterior rhinomanometric, and cephalometric analysis in upright and supine positions. RESULTS: Nasal resistance correlated positively with minimal pharyngeal airspace at the level of tongue. The opening of jaws after voluntary relaxation of the mandibular position on lying down correlated with decrease in pharyngeal airway measurements at both velopharyngeal and tongue-base levels. In stepwise multiple regression analysis the overall patient model explained 68% of the variation in apnea-hypopnea index with body mass index as the largest predictor. In the nonobese patients, the model explained 86% of variation in apnea-hypopnea index with change in anteroposterior position of the lower jaw in upright and supine measurements and combined nasal resistance after mucosal decongestion as independent determinants. In selected skeletal subtypes the models predicted 83%, 79%, 61%, and 90% of the variation in apnea-hypopnea index. CONCLUSIONS: In the nonobese patients nasal resistance and change in mandibular position on lying down were found to be independent contributing factors to the apnea-hypopnea index. Further research on supine cephalometry and relaxed mandibular position may improve prediction of sleep-disordered breathing in snorers.

Adult↗

PubMed1982

A comparative study of facial growth following cleft lip repair with or without soft-tissue undermining: an experimental study in rabbits.

The present study was performed in rabbits to test the hypothesis that incisions in the sulcus and soft-tissue undermining at the time of cleft lip repair contribute more to midfacial growth inhibition and aberrations than lip repair only. The design of this study, using three control groups, permitted assessment of the effects of soft-tissue undermining independently of the other surgical procedures. This study revealed that lip repair combined without soft-tissue undermining. Direct cephalometry on the skulls indicated that anteroposterior facial growth was most severely affected mean quantitative assessment revealed that anteroposterior facial growth inhibition was significantly greater when lip repair was combined with soft-tissue undermining than without. Maxillary width was found to be the greatest in groups 3 and 4 compared with the other two groups. Mean quantitative assessment revealed that lip repair with or without soft-tissue undermining was shown to overcorrect normal transversal growth. Significant growth aberrations also were found in maxillary height, posterior facial height, and nasal deflection. Constant high lip pressure can be explained as a result of an interaction of lip repair and scar contraction from soft tissue undermining. Results of this study cannot be readily transferred to the clinical setting, but they present the first documented evidence elucidating the influence of soft-tissue undermining on facial growth. Further experimental and clinical research is needed to determine the extent of growth inhibition that may be related to the use of this procedure.

Animals↗

PubMed1982

The influence of two-flap palatoplasty on facial growth in beagles.

This study was designed to test the hypothesis that palate repair in beagles inhibits overall facial growth, primarily in the transversal dimension. Direct cephalometry of the skulls at 28 weeks postoperatively showed that two-flap palatoplasty did not inhibit overall facial growth in animals with surgically created cleft lip, alveolus, and palate. In many cases, facial growth in animals with palate repair was indistinguishable from that in unoperated control animals. The unexpected finding in this study was that two-flap palatoplasty seemed to stimulate intensive new bone formation in the surgically created alveolar and palatal defects. Bony remodeling may be responsible for the enhanced anteroposterior and transversal facial growth in animals with palate repair (group 3). The results of this study validate findings from our previous studies in the rabbit model; yet caution should be employed in extrapolation of these findings to the clinical setting. For the first time, evidence is presented that in normal beagles with surgically created alveolar and palatal defects, two-flap palatoplasty stimulated substantial and, significant new bone formation in the site of the defects. Studies should be designed to determine the nature and time course of bony palatal wound healing.

Animals↗

PubMed1986

Experimental unilateral coronal synostosis in rabbits.

Immobilization of the coronal suture was produced unilaterally in 9-day-old rabbits to determine its effect on subsequent craniofacial development. The suture was immobilized unilaterally by the topical application of methylcyanoacrylate adhesive. Subsequent growth effects on the cranial vault, base, and facial skeleton were assessed by serial radiographic cephalometry. Unilateral coronal suture immobilization resulted in significantly decreased bone growth at the coronal suture (mean 0.95 mm +/- 0.35 SE) when compared to sham-treated control animals (mean 5.06 mm +/- 0.20 SE). Frontonasal suture bone growth contralateral to the immobilized half of the coronal suture, however, was significantly increased. The anterior cranial base became significantly shortened, and orbital asymmetry developed. The pattern of induced abnormalities simulates unilateral coronal synostosis in humans.

Animals↗

PubMed1986

Skull expansion in experimental craniosynostosis.

Bilateral coronal suture immobilization was performed in 9-day-old rabbits to simulate the brachycephaly deformity characteristic of coronal synostosis. Growth abnormalities were documented by serial radiographic cephalometry. A "corrective" linear craniectomy procedure was performed on the rabbits with an immobilized coronal suture at 60 days of age. The degree of amelioration of the induced abnormalities by the surgery in these animals was compared with a similar group of animals that had the same surgery plus supplemental implantation of a spring expansion device at the coronal suture craniectomy site. The mean marker separation at the coronal suture was significantly greater (5.61 mm +/- 0.52 SE versus 2.53 mm +/- 0.38 SE; p less than 0.05) following spring expander implantation than with linear craniectomy alone. Similarly, induced anterior cranial base shortening and distortion of craniofacial cephalometrics were more significantly improved by the additional use of the spring expansion device.

Animals↗

PubMed1988

Cephalometric and anthropomorphic observations of Binder's syndrome: a study of 19 patients.

Binder's syndrome (maxillonasal dysplasia) is a disorder characterized by nasomaxillary hypoplasia. To ascertain the extent of underdevelopment of the midfacial skeleton and soft tissues, 19 of 29 patients with Binder's syndrome were retrospectively evaluated, both with cephalometry and anthropometry. Ten females and nine males were placed collectively into three age groups: 6 years, 10 years, and 16 to 17 years. Cephalometric measurements disclosed a short anterior cranial base (S-N), a normal length of the vertical maxilla (SE-PNS), a decreased horizontal maxilla (PNS-A, Co-A), a recessed orbitale (SNO), and a high-normal mandibular length (Co-Gn). Anthropometry revealed a large nasofrontal angle, acute nasal inclination and nasolabial angle, decreased nasal prominence (Sn-Prn), a decreased columellar length (C-Sn), and a normal vertical nose (N-Sn) and upper lip (Sn-Sto) length.

Adolescent↗

PubMed1992

Osseous expansion of the cranial vault by craniotasis.

A study of cranial vault lengthening using a custom expandable fixation-distraction (craniotatic) appliance was performed in the young-adult rabbit model. Ten 24-week-old rabbits underwent circumferential suturectomy plus expansion (expanded group), 10 underwent circumferential suturectomy without expansion (sham control group), and 10 served as normal controls. The appliance was lengthened at a rate of 2.5 mm per week for 5 weeks. Serial lateral cephalometry, comparative dry-skull anthropometric measurements, and histologic examinations were performed. The expanded group demonstrated a significantly longer skull, cranial vault, anterior cranial base, posterior face, and orbit as compared with the control groups (p less than 0.05). Callus bone filled the distracted suturectomy and united the frontofacial complex to the posterior cranium. In conclusion, skull lengthening by distraction osteogenesis is possible in the rabbit model and offers a new technique for future investigation in the treatment of coronal synostosis.

Analysis of Variance↗

PubMed1996

Craniofacial growth in rabbits after rigid or semi-rigid fixation of the frontonasal suture.

Treatment of craniofacial dysostosis involves complex remodeling of the cranium and facial bones. Maintenance of the newly positioned segments may be achieved by rigid fixation using plates; however, there is concern that, over time, these plates may interfere with normal growth. The purpose of this study was to test a method of "semi-rigid" fixation of an osteotomy of the frontonasal suture in juvenile rabbits by comparing standardized parameters of craniofacial growth after conventional suture plating with the experimental plating method and with growth after sham operation. Forty-five, 6-week-old, weanling rabbits were divided into three groups of 15 each (12 for cephalometry, 3 for histological examination): (group 1) control, sham operated; (group 2) rigid fixation; (group 3) semi-rigid fixation. Rabbits were maintained for 14 weeks. Craniofacial growth was assessed using three-dimensional image analysis techniques. Measurements were subjected to statistical analysis (one-way analysis of variance) to compare the three treatment groups. Pairwise comparison of means between the treatment groups was done using Bonferroni's method at the 0.05 significance level. Semi-rigid fixation permitted significantly more normal growth of the developing rabbit head than rigid fixation in total snout length, total vault length, left and right midface height, and left orbital length. Both semi-rigid and rigid fixation significantly restricted growth compared with sham operated animals in left and right posterior midface height, right orbital length, right and left nasal bone length, and left parietal width. There were no significant differences in the growth of all other parameters measured.

Animals↗

PubMed2005

Associated factors to predict outcomes of uvulopharyngopalatoplasty plus genioglossal advancement for obstructive sleep apnea.

OBJECTIVES: This study aimed to evaluate the effectiveness of uvulopharyngopalatoplasty (UPPP) plus genioglossal advancement (GA) for severe obstructive sleep apnea (OSA) patients and to determine the predictive factors for surgical success. STUDY DESIGN: Prospective case series. METHODS: Patients with apnea-hypopnea index greater than 40/hour during an overnight sleep study and who were reluctant to receive nasal continuous positive airway pressure (nCPAP) therapy were included. Basic data were obtained along with physical examination, cephalometric measurements, and Epworth Sleepiness Score (ESS) questionnaire. All patients received UPPP plus GA under general anesthesia. Overnight sleep study was repeated at least 3 months after operation along with cephalometry and ESS questionnaire. RESULTS: Forty-four patients with severe OSA were enrolled in this study. The overall success rate was 52.3%. Preoperative apnea index (AI) was the only significant predictor for the success of operation (P = .007). Furthermore, patients with AI less than 25/hour had a higher success rate than those with AI 25/hour or greater (odds ratio 13.1). CONCLUSION: Patients with AI less than 25/hour unwilling to receive nCPAP therapy could be more suitable for UPPP plus GA in terms of the success rate.

Adolescent↗

PubMed2005

A novel method for measuring and monitoring monobloc distraction osteogenesis using three-dimensional computed tomography rendered images with the 'biporion-dorsum sellae' plane. Part I: Precision and reproducibility.

The results of craniofacial and orthognathic surgery have traditionally been monitored using lateral cephalometry. In the age of computed tomography (CT) and magnetic resonance imaging (MRI), newer methods of measuring surgical outcome have arisen. This has been further enhanced by the use of computer software to render CT images in a three-dimensional format. The authors present a novel method of measuring the outcome of monobloc distraction osteogenesis advancement using the biporion-dorsum sellae plane. The perpendicular distance of eight facial skeletal points to this plane were made automatically using the Vworks 4.0 program. A total of 10 measurements were made against six planes of reference. Planes 1, 2, 3, 1+2 degrees, and 1-2 degrees were constructed, and measurements were made by observer 1. Plane 6 was constructed and measurements were made by observer 2. Plane 1 was used as the denominator on which calculations were made. The results revealed a mean intra- and interobserver percentage difference from plane 1 of less than 5%. In addition, the overall mean intraobserver variance of all eight points from observer 1 was 0.91%, and the mean interobserver variance between observer 1 and 2 was 0.73%. In summary, based on the authors' method, repeated measurements made from the biporion-dorsum sellae plane have proven precision and reproducibility.

Cephalometry↗

PubMed2005

Virtual planning of composite mandibular reconstruction with free fibula bone graft.

Functional mandibular reconstruction after tumor resection is challenging. Currently, voxel-based craniofacial surgery and virtual planning of craniofacial surgical procedures are becoming increasingly popular. We report on a 56-year-old patient with an infiltrating recurrent squamous cell carcinoma of the mandible and buccal mucosa. Virtual resection of the mandible was accomplished using virtual reality techniques. Based on virtual geometric data, a metal template was configured for optimal contouration of a fibular bone graft while it was still pedicled in the donor field. Our operative procedure demonstrates the usefulness of voxel-based three-dimensional cephalometry in virtual planning of microsurgical bone transfer for mandibular reconstruction.

Bone Transplantation↗

PubMed1995

Nocturnal breathing abnormalities in acromegaly after adenomectomy.

OBJECTIVE: The incidence of sleep apnoea is increased in acromegaly. The aim of the study was to determine the occurrence of nocturnal breathing abnormalities and upper airway morphology in acromegalic patients some years after adenomectomy. DESIGN: A case-control study. PATIENTS: Eleven patients with treated acromegaly and two control groups: (1) sleep studies: 197 subjects randomly selected from the population, (2) cephalometry: 27 healthy subjects and 17 patients with obstructive sleep apnoea. MEASUREMENTS: Nocturnal breathing was monitored with a static charge-sensitive bed. The upper airway soft tissues and bone morphology were assessed by cephalometric X-ray photography. The upper airway collapsibility was investigated with dynamic nasopharyngoscopy. Endocrinological investigations were also performed. RESULTS: Nocturnal breathing abnormalities were present in all but one acromegalic patient (91%), which was far more frequent than in the general population (29.4%, P < 0.0001). Treated acromegaly was the most powerful predictor of breathing abnormalities, independent of the other significant predictors, age and body mass index. The predominant breathing abnormality was periodic breathing with symmetrically waxing and waning respiratory effort without a major body movement component. Episodes of complete obstruction with repetitive arousals were rare. Except for the longer soft palate, the cephalometric findings were similar to normal. In comparison to obstructive sleep apnoea, the treated acromegalic patients had rather prognathic than retrognathic mandibles. Fibreoptic endoscopy in the acromegalic patients revealed collapsible upper airways at the level of the soft palate, whereas at the base of the tongue little, if any, dynamic narrowing was observed. CONCLUSION: Our study confirms that nocturnal breathing abnormalities are common in treated acromegaly, and may persist years after the removal of the GH secreting tumour. The breathing abnormalities and the upper airway morphology in acromegalic patients after adenomectomy are different from those observed in primary obstructive sleep apnoea, suggesting a different pathophysiology of the airway obstruction.

Acromegaly↗

PubMed1981

Oral rehabilitation of functional mesio-occlusion.

Functional mesio-occlusion is thought to be uncommon, but, as observed in dental clinics, it may be sometimes mistaken for a true anterior cross-bite, and unfortunately patients are left without any treatment or they are treated improperly. This may result in mandibular dysfunction and unattractive appearance. There are some clinical methods for the diagnosis of functional malocclusion. They include occlusal analysis on an articulator, radiographic cephalometry, temporomandibular joint radiography, mandibular kinesiography, electromyography and so on. In this article, functional mesio-occlusion is illustrated using these scientific methods and based on clinical cases to complete oral rehabilitation.

Adult↗