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PubMed1992

The Eastman Standard Incisor Angulations: are they still appropriate?

The Eastman Standard values for cephalometry were first described almost 40 years ago and their derivation is not clear. The present study examines the rationale for the Standard and considers the way it was originally described. Based on a sample of 30 cases of Class I occlusions with normally related skeletal bases the mean incisor angulations were found to be exactly on the Eastman Standard, which, therefore, still remains appropriate as a basis for assessment and treatment planning in orthodontics.

Cephalometry↗

PubMed1996

Relationship between body mass index, age and upper airway measurements in snorers and sleep apnoea patients.

Anatomical pharyngeal and craniofacial abnormalities have been reported using upper airway imaging in snorers with or without obstructive sleep apnoea (OSA). However, the influences of the age and weight of the patient on these abnormalities remain to be established. The aim of this study was, therefore, to evaluate in a large population of snorers with or without OSA, the relationship between body mass index (BMI), age and upper airway morphology. One hundred and forty patients were referred for assessment of a possible sleep-related breathing disorder and had complete polysomnography, cephalometry and upper airway computed tomography. For the whole population, OSA patients had more upper airway abnormalities than snorers. When subdivided for BMI and age, however, only lean or younger OSA patients were significantly different from snorers as regards their upper airway anatomy. The shape of the oropharynx and hypopharynx changed significantly with BMI both in OSA patients and snorers, being more spherical in the highest BMI group due mainly to a decrease in the transverse axis. On the other hand, older patients (> 63 yrs), whether snorers or apnoeics, had larger upper airways at all pharyngeal levels than the youngest group of patients (< 52 yrs). For the total group of patients, upper airway variables explained 26% of the variance in apnoea/hypopnoea index (AHI), whereas in lean (BMI < 27 kg.m-2) or youngest (age < 52 yrs) subjects upper airway variables explained, respectively 69 and 55% of the variance in AHI. In conclusion, in lean or young subjects, upper airway abnormalities explain a major part of the variance in apnoea/hypopnoea index and are likely to play an important physiopathogenic role. This study also suggests that the shape of the pharyngeal lumen in awake subjects is more dependent on body mass index than on the presence of obstructive sleep apnoea. Further investigation looking at upper airway imaging for surgical selection in obstructive sleep apnoea should focus on lean and young patients.

Age Factors↗

PubMed1999

Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case-control study.

Habitual snoring and obstructive sleep apnoea in children, which are frequently associated with adenotonsillar hypertrophy, may begin early in life and in relation with orocraniofacial features. The aim of this study was to detect the presence of early bone craniofacial modifications in young children with a long history of habitual snoring. Twenty-six habitually snoring children (mean age 4.6 yrs) were studied by nocturnal portable recording or diurnal polysomnography, cephalometry and orthodontic evaluation. A comparison of cephalometric findings was made between the studied group and 26 age-matched children (mean age 5.1 yrs) with no history of snoring or respiratory problems during sleep. The cephalometric analyses showed a significant increase in craniomandibular intermaxillar, lower and upper goniac angles with a retroposition and posterior rotation of the mandible (high angle face) and a reduction in the rhinopharynx space caused by higher thickness of adenoids in habitually snoring children compared with controls. Cross-bites and labial incompetence as well as daytime symptoms and familiarity for habitual snoring were found in most of the studied group of snorers compared with controls. The results indicate that upper airway obstruction during sleep is associated with mild but significant cephalometric and craniofacial modifications in children complaining of habitual snoring. Whether this skeletal conformation is genetically determined or influenced by the early onset of habitual snoring remains to be assessed.

Case-Control Studies↗

PubMed1994

Cephalometric changes after gradual lengthening of the mandible: an experimental study in sheep.

Gradual distraction after osteotomy has been used both clinically and experimentally to lengthen the mandible. In this experimental study in sheep, the changes in dimensions after osteotomy and gradual distraction were analysed by means of cephalometry. There was a strong correlation between the amount and duration of distraction and the increase in length of the mandible. The difference in length between the operated and control sides persisted for up to 1 year. It was concluded that new bone was deposited and that the increase in length of the mandible was real and permanent.

Animals↗

PubMed1990

A family study of sleep apnea. Anatomic and physiologic interactions.

The distribution of symptoms, physiologic responses, and upper airway structure in members of one family with three generations of subjects with sleep apnea (SA) is reported. Questionnaire data were obtained from ten family members (ages 7 to 66 years), overnight sleep studies were performed in nine subjects, and ventilatory responses to hyperoxic hypercapnia and to eucapnic hypoxia and cephalometry were obtained in five subjects. All ten family members reported habitual snoring or nighttime snorting/gasping; five of ten family members also reported excessive daytime sleepiness. All studied subjects except for a pregnant woman had greater than ten apneas/hypopneas per hour. Ventilatory responses to hypoxia were markedly reduced in all five subjects studied (less than or equal to 0.51 L/min/SaO2); hypercapnic responses were reduced in three of five subjects (less than or equal to 0.61 L/min/mm Hg CO2). No subject was morbidly obese (body mass index less than 29 kg/m2) or demonstrated retrognathia. The posterior airway space was reduced in three subjects, and the mandibular to hyoid distance was increased in four subjects. The two subjects with the longest soft palates and the most inferiorly displaced hyoids had the most severe sleep disorder. Sleep apnea was present, albeit less profound, in the one subject with normal anatomy who had an abnormal hypoxic ventilatory response. The distribution of these physiologic and anatomic measurements in this family provides further support for a genetic basis for SA, and suggests that the disorder may occur as a result of interactions between ventilatory control abnormalities and anatomic risk factors.

Adult↗

PubMed2001

Craniofacial abnormalities and their relevance for sleep apnoea syndrome aetiopathogenesis in acromegaly.

OBJECTIVE: To explain the effect of craniofacial relations on the development of the sleep apnoea syndrome (SAS) in acromegaly, and to elucidate how the activity of acromegaly affects the severity of SAS. DESIGN: Prospective observational study. METHODS: Cephalometry and sleep ventilation measurements were performed in 26 acromegalic men and in 96 men with SAS. RESULTS: SAS was found in 20 acromegalic men. Compared with non-acromegalic men with SAS, patients with acromegaly and SAS were found to have: enlargement of almost all linear dimensions; increased angle indicating mandibular protrusion; increased difference between maxillary and mandibular protrusion; articular angle decrease; soft palate lengthening; and pharyngeal airway space (PAS) enlargement in the palatal and uvular-tip planes. A comparison of acromegalic men with and without SAS revealed no significant difference in the craniofacial skeleton, although there was a narrowing of the minimal PAS (MinPAS) and of PAS in the uvular-tip plane in patients with SAS. SAS was more frequent in the patients with active acromegaly. MinPAS in the patients with active acromegaly was narrower than in those without disease activity. CONCLUSION: Skeletal abnormalities in acromegalic men with SAS were different from those in SAS patients without acromegaly. Upper airway narrowing due to changes in pharyngeal soft tissues takes a more relevant share in the development of SAS in acromegalic men than skeletal anomalies.

Acromegaly↗

PubMed1994

Obstructive sleep apnea treatment with dental appliance.

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.

Adult↗

PubMed2004

Early craniofacial morphology and growth in children with bilateral complete cleft lip and palate.

PURPOSE: Analysis of craniofacial morphology and growth in children with bilateral complete cleft lip and palate (BCCLP), compared with a control group with unilateral incomplete cleft lip (UICL), before any treatment as well as 20 months after lip closure. MATERIAL: The children were drawn from a group representing all Danish children with cleft born 1976 to 1981. Sixty-four children were included in the study (19 BCCLP and 45 UICL). The ages were 2 and 22 months at examinations 1 and 2, respectively. METHOD: The method of investigation was infant cephalometry in three projections. The craniofacial morphology was analyzed using linear, angular, and area variables. Growth was defined as the displacement vector from the coordinate of the corresponding landmark in the x-ray at examination 1 to its coordinate at examination 2, corrected for x-ray magnification. The growth of an anatomical region in a patient was assessed by investigating the growth pattern formed by a collection of individual growth vectors in that region. RESULTS: The BCCLP group differed significantly from the UICL group. The most striking findings in BCCLP were an extremely protruding premaxilla; markedly increased posterior maxillary width; increased width of the nasal cavity; short maxilla with reduced posterior height; short mandible; bimaxillary retrognathia; severe reduction in the size of the pharyngeal airway; and a more vertical facial growth pattern. CONCLUSION: Our findings indicate that a facial type including a wide and posterior short maxilla, short mandible, and bimaxillary retrognathia might be a liability factor that increases the probability of developing cleft lip and palate.

Case-Control Studies↗

PubMed2005

Long-term effects of palate repair on craniofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: To identify the long-term effects of palate repair on craniofacial growth in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective cross-sectional study. SETTING: Sri Lankan Cleft Lip and Palate Project. SUBJECTS: Forty-eight adults with nonsyndromic unilateral cleft lip and palate, 29 men and 19 women, had lip repair only (LRO group). Fifty-eight adults with nonsyndromic unilateral cleft lip and palate, 35 men and 23 women, had lip and palate repairs by the age of 9 (LPR group). MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine craniofacial morphology. RESULTS: In the lip and palate repair group, the depth of the bony pharynx (Ba-PMP), the maxillary length at the alveolar level (PMP-A), the effective length of the maxilla (Ar-IZ, Ar-ANS, Ar-A), the maxillary protrusion (S-N-ANS, SNA), the anteroposterior jaw relation (ANS-N-Pog, ANB), and the overjet were smaller than in the lip repair only group. There were no significant differences in the maxillary length at the basal level (PMP-IZ, PMP-ANS) and the anterior and posterior maxillary heights (N-ANS and R-PMP, respectively) in the two groups. CONCLUSION: Palate repair inhibits the forward displacement of the basal maxilla and anteroposterior development of the maxillary dentoalveolus in patients with unilateral cleft lip and palate. Palate repair has no detrimental effects on the downward displacement of the basal maxilla or on palatal remodeling in patients with unilateral cleft lip and palate.

Adolescent↗

PubMed2005

Long-term effects of clefts on craniofacial morphology in patients with unilateral cleft lip and palate.

OBJECTIVE: To identify the long-term effects of clefts (intrinsic and functional) on craniofacial growth and to evaluate the possible association between the sizes of the cleft maxillary segment (intrinsic) and alveolar cleft (functional) and the craniofacial morphology in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective case-control study. SETTING: Sri Lankan Cleft Lip and Palate Project. SUBJECTS: Thirty unoperated adult patients with UCLP and 52 normal controls. MAIN OUTCOME MEASURES: Maxillary dental cast was used to measure the sizes of the cleft maxillary segment and alveolar cleft. Cephalometry was used to determine craniofacial morphology. RESULTS: Patients with UCLP had shorter height of the basal maxilla, shorter posterior length of the basal maxilla, and less protruded basal maxilla at the zygomatic level than did control subjects. In patients with UCLP, the posterior height of the basal maxilla was related to the size of the cleft maxillary segment, and there was a tendency toward significant association between the anterior height of the basal maxilla and the size of the alveolar cleft. CONCLUSION: The adverse effects of clefts on the growth of the maxilla in patients with UCLP are restricted to the basal maxilla in size. This growth inhibition is major in height and minor in length. The reduced posterior height of the basal maxilla in unoperated patients with UCLP might be primarily attributed to intrinsic effects, whereas the reduced anterior height of the basal maxilla might be attributed to functional effects.

Adult↗

PubMed2006

Hard palate repair timing and facial morphology in unilateral cleft lip and palate: Before versus after pubertal peak velocity age.

OBJECTIVE: To investigate whether timing of hard palate repair, before versus after pubertal peak velocity age, had a significant effect on facial growth in patients with unilateral cleft lip and palate. DESIGN: Retrospective cross-sectional study. SETTING: Sri Lankan Cleft Lip and Palate Project. PATIENTS: A total of 125 adult patients with nonsyndromic unilateral cleft lip and palate were recruited and their last cephalometric radiographs were used. MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology. RESULTS: The patients who had hard palate repair after pubertal peak velocity age had a deeper bony pharynx (Ba-PMP), a longer alveolar maxilla (PMP-A), a longer effective length of the maxilla (Ar-ANS, Ar-A), and as a result had a more favorable anteroposterior jaw relation (ANS-N-Pog, ANB, NAPog) and larger overjet, compared with those who had hard palate repair before pubertal peak velocity age. CONCLUSION: Timing of hard palate repair significantly affects the growth of the maxilla in patients with unilateral cleft lip and palate. Hard palate repair after (versus before) pubertal peak velocity age has a smaller adverse effect on the forward growth of the maxilla. This timing affects the forward displacement of the basal maxilla and the anteroposterior development of the maxillary dentoalveolus.

Adolescent↗

PubMed2006

Hard palate repair timing and facial growth in unilateral cleft lip and palate: a longitudinal study.

OBJECTIVE: To investigate whether timing of hard palate repair had a significant effect on facial growth in patients with unilateral cleft lip and palate (UCLP). DESIGN: Retrospective longitudinal study. SETTING: Sri Lankan Cleft Lip and Palate Project. PATIENTS: A total of 104 patients with nonsyndromic UCLP who had hard palate repair by age 13 years, with their 290 cephalometric radiographs taken after lip and palate repair. MAIN OUTCOME MEASURES: Clinical notes were used to record surgical treatment histories. Cephalometry was used to determine facial morphology and growth rate. RESULTS: Timing of hard palate repair had a significant effect on the length and protrusion of the alveolar maxilla (PMP-A and SNA, respectively) and the anteroposterior alveolar jaw relation (ANB) at age 20 years but not on their growth rates. CONCLUSION: Timing of hard palate repair significantly affects the growth of the maxilla in patients with UCLP. Late hard palate repair has a smaller adverse effect than does early hard palate repair on the growth of the maxilla. This timing effect primarily affects the anteroposterior development of the maxillary dentoalveolus and is attributed to the development being undisturbed before closure of the hard palate.

Adolescent↗

PubMed1990

A preliminary study of facial growth and morphology in unoperated male unilateral cleft lip and palate subjects over 13 years of age.

This paper investigates the effects of surgery on facial growth and morphology in Sri Lankan males with unilateral cleft lip and palate who were over 13 years of age at the time of study with cephalometry and dental study models. Three separate subgroups were analyzed: those who had totally unrepaired cleft lip and palate, those who received lip repair in infancy but not palatal repair, and those who had lip and palate repair in infancy. Twenty-three healthy noncleft Sri Lankan males over 13 years formed a control group from the same racial background. The results show that subjects who had no surgery had a potential for normal maxillary growth. Subjects who have had lip repair in early infancy show relatively normal maxillary growth, but maxillary hypoplasia is common when the palate has also been repaired early.

Adolescent↗

PubMed1990

Trigonocephaly: clinical and cephalometric assessment of craniofacial morphology in operated and nontreated patients.

Craniofacial parameters were studied clinically and by cephalometry in 11 trigonocephalic patients from infancy to 4 years of age. Six of the most severe patients had surgery between 6 and 18 months of age. Analysis of morphology indicated that bony interorbital distance was reduced in patients selected for surgery and hypotelorism persisted at final examination. All patients demonstrated orbital width measurements above the mean for the norm, while orbital height was essentially normal. All but one of the patients had a variably prominent forehead bony ridge that was eliminated or reduced as a result of surgery and/or growth. However, the forehead of most patients, whether operated or not, was too narrow when compared to normal skulls. Thus, although some of the striking features of trigonocephaly are eliminated, minor characteristics of the anomaly still persevere at 4 years of age.

Cephalometry↗

PubMed1991

Postnatal craniofacial skeleton development following a pushback operation of patients with cleft palate.

A longitudinal growth study of the craniofacial skeleton in 52 (19 males, 33 females) Danish individuals with cleft palates was performed. Thirty (13 males, 17 females) had clefts of the soft palate only or clefts extending into the posterior third of the hard palate. Twenty-two (6 males, 16 females) had more extensive clefts including up to two-thirds of the hard palate. The cleft was closed with a pushback operation at 22 months of age. Orthodontic treatment was included in the early mixed dentition. Lateral cephalometries were obtained at 5, 8, 12, 16, and 21 years of age. Twenty-four variables were digitized and analyzed. The results indicated that patients with more extensive clefts demonstrated significantly smaller anterior cranial base length (N-S), total cranial base length (N-Ba), maxillary dentoalveolar base length (A-PMP), mandibular length (Cd-Pgn), upper anterior and posterior facial heights (N-ANS and P-PMP), and total facial height (N-Gn). Patients with the more extensive clefts reached maximum growth spurt later than patients with less extensive clefts in all dimensions except the A-PMP and the lower and total facial heights.

Adolescent↗

PubMed1992

A six-center international study of treatment outcome in patients with clefts of the lip and palate: Part 2. Craniofacial form and soft tissue profile.

The craniofacial morphology and the soft tissue profile were evaluated in this part of the intercenter study of the European Cleft Lip and Palate Research Group. The sample was comprised of cephalometric x-rays of the full cohort of 151 cases from the six European cleft palate centers. The facial morphology in complete unilateral cleft lip and palate patients was evaluated by means of roentgen cephalometry. Approximately 25 consecutive cases from each of six European cleft palate centers were compared. Only one center showed notable and consistent differences from the others. A contributing factor for these differences may be an inconsistent treatment regimen with many surgeons involved. Analysis of the soft tissue profile between the centers showed more pronounced differences than analysis of the skeletal profile. The treatment outcome in centers with more complex or expensive programs was no better than those centers using simpler management approaches.

Analysis of Variance↗

PubMed1993

Craniofacial morphology of adult unoperated complete unilateral cleft lip and palate patients.

The craniofacial morphology of 26 white unoperated complete unilateral cleft lip and palate patients (13 males, 13 females) was analyzed with cephalometry and compared with a control (normal) group. The results show that in the cleft group, the maxilla is smaller and more protruded, the lower anterior facial height is much larger, and the mandible shows well-defined differences (body, ramus, gonial angle, and mandibular plane angle).

Adolescent↗

PubMed1994

Facial growth and development in unilateral cleft lip and palate during the period of puberty: comparison of the development after periosteoplasty and after primary bone grafting.

X-ray cephalometry was used in studies of facial growth and development carried out in 32 males with complete unilateral cleft lip and palate. They underwent primary periosteoplasty and were examined at the ages of 10 and 15 years. The results were compared with the development of the face in a longitudinal study of 20 males with the same type of cleft who were operated with a primary bone graft. The series with periosteoplasty showed a more marked proclination of the upper dentoalveolar component with the restoration of a positive overjet, as compared to a persistent anterior crossbite in the males with bone grafts. The lower jaw showed a larger protrusion, while individuals with bone grafts were characterized at the ages of 10 and 15 years by a larger posterior rotation of the mandible. The growth of the maxilla did not differ between series. In both series, there was a marked reduction in the growth of maxillary depth and of upper lip height, while the highest growth rate showed parameters of nasal prominence. An increasing mandibular protrusion and maxillary retrusion resulted in an impairment of sagittal jaw relations and in the flattening of the face, both of which occurred in almost all patients. The rotation of the lower jaw was not correlated with either the convexity of the face, sagittal jaw relations, or an overjet. The independence of developmental changes of selected characteristics at their initial state documented the impossibility of predicting the development of the face on the basis of a single x-ray examination at a given stage of development. Fixed appliances promoted a more marked proclination of upper incisors and the alveolar process than removable appliances, but they exerted no direct action on the other facial parameters studied.

Adolescent↗