Convexity Angle Research Articles

Craniofacial and upper airway cephalometrics in hypohidrotic ectodermal dysplasia

The aim of this study was to evaluate the craniofacial and upper airway structures in patients with hypohidrotic ectodermal dysplasia (HED). Craniofacial and upper airway dimensions were measured on lateral cephalometric radiographs of ten HED patients (four females and six males) and ten normal class III patients as a control group. 21 dimensional measurements were used for cephalometric assessment. Craniofacial structures were compared with normal values and airway dimensions were compared with those of a control group with a similar skeletal pattern. We found that the SNA degrees, SNB degrees, ANB degrees, SN-GoMe degrees and the distance between the lips and the S-line were lower than those in normal subjects, while soft tissue convexity angles were higher in HED patients. Statistically significant decreases occurred in tongue length, vertical airway length, hyoid bone mandibular plane length, hyoid bone C3 length, middle airway space and inferior airway space, while the soft palate length increased. The characteristic craniofacial features of HED patients are class III malocclusion with maxillary retrusion and deficiency in vertical, transversal and sagittal growth of the jaw and soft tissues. HED patients have smaller pharyngeal and upper airway dimensions, and the hyoid bone is positioned more posteriorly compared with class III control individuals.

Soft-tissue cephalometric norms in Yemeni men

The main purpose of this study was to develop soft-tissue cephalometric standards for Yemeni men and compare them with the cephalometric standards of normal North American white people. Fifty Yemeni men (ages, 20-27 years; mean, 23.1 years) with normal occlusion were selected. With double selection by orthodontists and laypersons, a subsample of esthetically pleasing subjects was selected. Lateral cephalometric radiographs of all subjects were analyzed according to the Legan-Burstone and the Holdaway analyses. The Yemeni esthetically pleasing subjects (YPG) and the remaining subjects (YNG) showed significant differences with respect to mandibular prognathism, lower face-throat angle, nasolabial angle, mentolabial sulcus depth, and interlabial gap, when compared with the Legan-Burstone norms for white Americans; the YPG also had significantly less obtuse facial convexity angle than the YNG. Most values of both Yemeni groups were generally within the range of the values reported by Holdaway, except for 3 variables: skeletal profile convexity, basic upper-lip thickness, and H-angle, which were all significantly larger than those of Holdaway; the YPG showed less skeletal profile convexity than the YNG. These results show that the soft-tissue facial profiles of white Yemenis and Americans are different in certain respects; these racial differences must be considered during diagnosis and treatment planning. These results should serve as a useful reference for orthodontists and maxillofacial surgeons who treat Yemeni patients and also contribute to more satisfactory diagnosis and treatment planning for them.

Photographic soft-tissue profile analysis in children at 6 years of age

Profile photographs can be a valuable, noninvasive tool for early orthodontic diagnosis and treatment planning. Left-side profile photographs were obtained of 181 normal, healthy children at age 6 years. Standardized landmarks were digitized on the photographs, and several linear and angular measurements were computed. The children were divided according to dental class and sex. Comparisons were made by 2-way analyses of variance. Facial convexity (larger in boys than in girls), Sn-N-Sl, and nasolabial and interlabial angles differed significantly (P <.01) between the sexes. Girls had significantly less labial protrusion than boys. Facial height was significantly greater in children with dental Class II, without sex differences. All analyzed angles were significantly influenced by dental class. Facial convexity was smaller in children with dental Class II. Cutaneous class was larger, and lips were more prominent in children with dental Class II than in those with dental Class III. The significant relationship between dental and cutaneous classes has important implications for orthodontic diagnosis and treatment. Dental class can usefully represent facial esthetics, and orthodontic procedures that modify dental occlusion might cause important repercussions to facial soft tissues.

Angles of facial convexity in different skeletal Classes

The objective of this study was to investigate whether it is possible to use a lateral (profile) photograph to determine the underlying skeletal Class and which reference points of the angle of convexity are most suitable for this purpose. Profile photographs and lateral cephalographs included in the baseline data for 180 orthodontic patients were retrospectively evaluated. The subjects were assigned to skeletal Classes based on Wits values obtained by radiolographic analysis. The Class I subjects were 58 patients (22 males, 36 females) with an average age of 13.63 +/- 2.1 years, the Class II subjects 60 patients (37 males, 23 females) with an average age of 13.60 +/- 2.6 years, and the Class III subjects 62 patients (28 males, 34 females) with an average age of 11.65 +/- 3.3 years. The angles measured were A'OrB' (=POrA'-POrA'), A'N'B', and the angle of convexity with its variants (N'SnPog', N'A'Pog', TrSnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). These angles were statistically evaluated using a two-sided t-test and linear discriminant analysis. Class II and Class III subjects exhibited highly significant differences (P < 0.001) for all angles. Class I and Class III exhibited highly significant differences (P < 0.001) for almost all angles, and significant differences for A'N'B' (P < 0.05). Class I and Class II differed significantly (P < 0.05) only for some angles (N'SnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). The error within the linear discriminant analysis was smallest for N'SnPog', GlA'Pog', and TrA'Pog' angles. However, the method error according to Dahlberg yielded rather high values for all angles (1.07-1.17 degrees). Discrimination between skeletal Class I and Class III was easier than that between Class I and Class II. One of the reasons may be that the subclasses division I and division II were not distinguished within the Class II subjects.

Computer Imaging Software for Profile Photograph Analysis

To describe a novel calibration technique for photographs of different sizes and to test a new method of chin evaluation in relation to established analysis measurements. A photograph analysis and medical record review of 14 patients who underwent combined rhinoplasty and chin correction at an academic center. Patients undergoing concurrent orthognathic surgery, rhytidectomy, or submental liposuction were excluded. Preoperative and postoperative digital photographs were analyzed using computer imaging software with a new method, the soft tissue porion to pogonion distance, and with established measurements, including the cervicomental angle, the mentocervical angle, and the facial convexity angle. The porion to pogonion distance consistently increased after the chin correction procedure (more in the osseous group). All photograph angle measurements changed toward the established normal range postoperatively. Surgery for facial disharmony requires artistic judgment and objective evaluation. Although 3-dimensional video analysis of the face seems promising, its clinical use is limited by cost. For surgeons who use computer imaging software, analysis of profile photographs is the most valuable tool. Even when preoperative and postoperative photographs are of different sizes, relative distance comparisons are possible with a new calibration technique using the constant facial landmarks, the porion and the pupil. The porion-pogonion distance is a simple reproducible measurement that can be used along with established soft tissue measurements as a guide for profile facial analysis.

Análise facial numérica do perfil de brasileiros Padrão I

OBJETIVO: o objetivo do presente estudo foi determinar as medidas do perfil facial de brasileiros portadores de equilíbrio facial, denominados Padrão I. METODOLOGIA: a amostra foi constituída por 50 indivíduos (32 femininos e 18 masculinos), brasileiros, adultos, leucodermas, com idade média de 23 anos. Fotografias padronizadas do perfil foram obtidas. Sobre essas foram executados os traçados por dois avaliadores, que verificaram: 1) ângulo nasolabial; 2) ângulo mentolabial; 3) ângulo interlabial; 4) ângulo de convexidade facial; 5) ângulo de convexidade facial total; 6) ângulo do terço inferior da face; 7) proporção entre a altura facial anterior média e a altura facial anterior inferior e 8) proporção do terço inferior da face. RESULTADOS E CONCLUSÕES: não houve diferença estatística relevante entre as duas medidas realizadas. Os valores de média, desvio-padrão, valores máximos e mínimos obtidos para cada variável estudada foram: 1) ângulo nasolabial: 108,13° ± 9,75° (81° a 127°); 2) ângulo do sulco mentolabial: 132,37° ± 9,82° (110,5° a 152°); 3) ângulo interlabial: 135,35° ± 11,14° (116,5° a 159,5°); 4) ângulo de convexidade facial: 12,32°± 3,93° (4° a 19,5°); 5) ângulo de convexidade facial total: 137,85° ± 4,08° (129,5° a 147,5°); 6) ângulo do terço inferior da face: 103,41° ± 8,12° (88° a 124°); 7) proporção entre os terços médio e inferior da face: 0,93 ± 0,10 (0,80 a 1,21) e 8) proporção do terço inferior da face: 0,45 ± 0,06 (0,30 a 0,67). Propõe-se esse conjunto de medidas como um padrão de referência para avaliação facial numérica de adultos, brasileiros, brancos.

Anquilose intencional dos caninos decíduos como reforço de ancoragem para a tração reversa da maxila: estudo cefalométrico prospectivo

OBJETIVO: o presente trabalho de pesquisa analisou os efeitos da tração reversa da maxila associada à anquilose intencional dos caninos decíduos superiores, mediante o emprego da cefalometria. METODOLOGIA: o protocolo de tratamento incluiu: 1) anquilose intencional dos caninos decíduos superiores; 2) expansão rápida da maxila e 3) tração reversa da maxila, imediatamente após o término da fase ativa da expansão. A amostra foi composta de 18 crianças nos estágios de dentadura decídua e dentadura mista, com idade média inicial de 7 anos e 1 mês. O intervalo médio de tratamento com a tração reversa da maxila foi de 1 ano e 1 mês. As telerradiografias laterais foram obtidas na documentação inicial e após a correção da Classe III. RESULTADOS E CONCLUSÕES: os resultados demonstram que os ângulos representativos da convexidade facial, NAP e ANB, aumentaram de 0º para 6,6º e 3,5º, respectivamente. Isso significa dizer que a face transformou-se de reta ou côncava, peculiar na Classe III, para uma face convexa, característica de normalidade no estágio avaliado. Essa melhora na convexidade facial é atribuída ao avanço da maxila, registrado tanto na região alveolar (ângulo SNA e as distâncias Co-A e NPerp-A) como na região basal (ângulo SN.ENA). A maxila deslocou-se para frente, enquanto a redução do ângulo SNB de 80,56º para 79,61º demonstrou um retroposicionamento mandibular. Além da mudança no sentido sagital, houve rotação da mandíbula no sentido horário, com aumento dos ângulos SN.GoGn e SN.Gn. Somado aos efeitos ortopédicos, houve inclinação vestibular dos incisivos superiores.

Distraction Osteogenesis in Adolescents with Maxillary Arch Deficiency and Dental Crowding: A 3-Year Follow-Up

In this study, the authors evaluated the long-term results after using anterior segmental osteotomy and distraction osteogenesis for the correction of sagittal maxillary deficiency associated with dental crowding. Six young adolescents (four boys and two girls) underwent surgery and distraction at a mean age of 11.2 years (range, 10 to 12 years) and were followed up for 3 years. A tooth-borne distraction device was used for interdental distraction. The evaluation consisted of hard- and soft-tissue profile analysis and dental arch measurements before, immediately after, and 3 years after distraction. The results showed that the facial profile, the occlusion, and the dental crowding could be successfully corrected and that the results were stable after 3 years' follow-up. The mean facial convexity angle was changed from 1 to 8 degrees. The average advancement at point A was 4 mm and the SNA increased by an average of 4 degrees. Lengthening of the dental arch by an average of 4 mm created approximately 8 mm of new space, sufficient to resolve the dental crowding in all patients, thus avoiding an extraction of healthy teeth. The results of this study demonstrated that anterior segmental maxillary osteotomy combined with distraction osteogenesis offers an alternative for the treatment of adolescents suffering from sagittal maxillary deficiency with dental crowding.

Soft Tissue Facial Angles in Individuals with Ectodermal Dysplasia: A Three-Dimensional Noninvasive Study

To supply quantitative information about the facial soft tissues of patients with hypohidrotic ectodermal dysplasia. Prospective assessment. National meetings of hypohidrotic ectodermal dysplasia patients and families. Facial and mandibular corpus convexities in the horizontal plane; facial convexity in the sagittal plane; interlabial, naso-labial, nasal convexity, and left and right soft tissue gonial angles were calculated from the three-dimensional coordinates of 11 soft tissue facial landmarks obtained in 18 male and 17 female hypohidrotic ectodermal dysplasia patients aged 3 to 41 years and in 504 reference healthy individuals. In addition, z-scores were computed and the patients were grouped by cluster analysis. Male and female z-scores did not differ. In the pooled group, facial convexities in the horizontal and sagittal planes were significantly (Student's t, p < .01) increased (flatter) in hypohidrotic ectodermal dysplasia patients, compared with normal controls. The naso-labial angle was significantly reduced (more acute). Upper and lower facial convexity and mandibular corpus convexity in the horizontal plane deviated less from the norm with increasing age. Facial convexity in the horizontal and sagittal planes, soft tissue gonial angles, and naso-labial and interlabial angles deviated less from the norm with increasing number of teeth present in the mouth. Cluster analysis identified three homogeneous groups, all characterized by a peculiar facial phenotype. Modifications in facial convexity and gonial and interlabial angles differentiated each cluster. Patients with hypohidrotic ectodermal dysplasia had flatter faces in the horizontal and sagittal planes than normal controls had. Cluster analysis revealed patterned differences in facial phenotype.

Cephalometric norms for the Saudi children living in the western region of Saudi Arabia: a research report

BackgroundPrevious studies have established specific cephalometric norms for children with different ethnic backgrounds, showing different facial features for each group. Up till now, there is a paucity of information about the cephalometric features of Saudi children living in the western region of Saudi Arabia, who have distinct social and climatic characteristics. The aim of the present study was to establish cephalometric norms for children living in the western region of Saudi Arabia.MethodsA total of 62 lateral cephalometric radiographs of Saudis (33 females and 29 males; aged 9–12 years) having good facial proportions and Class I dental occlusion, were traced and analyzed. Using the t-test, the mean value, standard deviation and the range of 20 angular and linear variables were calculated and compared to norms of adult Saudis living in the Western region of Saudi Arabia using the t-test. Male and female groups were also compared using the t- test.ResultsSaudi children tend to have a significantly shorter and lower face height, a larger angle of convexity, and more proclined and protruded incisors when compared with adult Saudis (P < 0.05). There were no statistically significant differences between male and female groups.ConclusionSaudi children have distinct cephalometric features, which should be used as a reference in the orthodontic treatment of young Saudi patients.

Determinants of successful chincup therapy in skeletal class III malocclusion

The purpose of this study was to investigate skeletal characteristics that determine successful chincup therapy in patients with skeletal Class III malocclusions by using longitudinal follow-up data of 40 patients (18 male, 22 female). Lateral cephalometric radiographs were taken before chincup therapy (T0), after chincup therapy (T1), and after fixed orthodontic treatment and retention (T2). From the measurements at T2, the patients were classified into group 1, showing good retention results (n = 21; 9 male, 12 female), or group 2, showing poor results (n = 19; 9 male, 10 female). The differences at each stage and during T0 to T1 and T1 to T2 between the 2 groups were compared by t tests. The major effect of chincup therapy was backward rotation of the mandible in both groups; however, the amount of rotation was greater in group 2. After retention, group 2 showed more forward rotation and forward growth of the mandible than group 1. Cephalometric measurements that showed significant differences in skeletal and dental morphology between the 2 groups at T0 were L1 to occlusal plane ( P < .001), upper gonial angle, AB to occlusal plane angle, AB to mandibular plane angle, ANB, anteroposterior dysplasia indicator, Wits appraisal ( P < .01), articular angle, gonial angle, facial convexity angle, AB to facial plane angle, and L1 to A-Pog ( P < .05). These factors apparently contributed to the difference of long-term results in the 2 groups. It is necessary to evaluate these items in the diagnosis and treatment planning of skeletal Class III malocclusion in growing patients when chincup therapy is being considered.

Cephalometric evaluation in children presenting adapted swallowing during mixed dentition

The tongue trust and anterior projection through the dental arcades during swallowing is known as Adapted Swallowing (AS) and is a common finding during mixed dentition. The authors studied the morphologic dentofacial characteristics through cephalometric measures in 38 girls and 35 boys, aged seven to nine years, presenting AS, as determined by the speech therapist evaluation. Cephalometric evaluation was obtained by Radiocef 2.0 software. The measurements studied were the mandibular and maxillary relations to the cranial base, the nasolabial angle, and the upper airway patency, as proposed by McNamara Jr (1984), and the convexity and facial axis angles and maxillary height from Ricketts (1960; 1981). Results, analyzed in relation to sex and racial group, showed an association of Class II facial convexity with the African Brazilian children with dark black skin. This classification does not reflect an abnormality as all African Brazilians studied were classified as class II, due to the fact that the standard measurements are based in the white American population. These findings point to the need of specific racial normative standard for evaluating orofacial and dental structures.

Three-dimensional nasal morphology in cleft lip and palate operated adult patients.

Nasal morphology was assessed three-dimensionally in 18 cleft lip and palate operated patients aged 19 to 27 years, and in 161 sex- and age-matched control subjects. Comparisons were performed by Student t and Watson-Williams' tests. No differences were found in nasal volume or surface. Nasal width, alar base width, and inferior width of the nostrils were significantly larger in male patients than in the reference men. The nasal bridge was shorter. Similar differences were found in the female patients. In addition, the right nostril was larger and the nasal height shorter. In men, the nasolabial and the nasal tip angles were smaller in the patients than in the reference subjects, whereas the facial convexity angle was larger in the patients. In conclusion, the nose of adult operated cleft lip and palate patients differed from that of normal control subjects. Surgical corrections of the cleft lip and palate failed to provide a completely normal appearance. The methods might be used to indicate where additional procedures might be performed to approximate a reference population.

Long-term results of the two-stage palatoplasty/Hotz’ plate approach for complete bilateral cleft lip, alveolus and palate patients

Purpose: To investigate the effects of the two-stage palatoplasty combined with the Hotz’ plate on craniofacial development in patients with bilateral complete clefts. Material and methods: Lateral and frontal cephalograms of two-stage palatoplasty/Hotz’ plate group ( n=10), one-stage palatoplasty group ( n=11), and a non-cleft group ( n=11), were evaluated at 6, 8, 10 and 12 years of age. The unpaired Student's t-test and Scheffe's F test ( p<0.05) were applied. Results: At 6 years the posterior upper facial height (PUFH) and PUFH/PFH ratio were greater in the two-stage group. At 10 years the PUFH, maxillary depth, convexity and ANB angle were greater in the same group. At 12 years, maxillary depth and ANB angle were also greater in this group. In the one-stage group, the L1/Mp. angle, PUFH and PUFH/PFH ratio were smaller when compared with the non-cleft group, whereas the palatal plane/SN angle was greater. In both cleft groups, the I.I. angle and tongue-PTM′ distance were greater, and the U1/SN angle was smaller when compared with non-clefts. The UC–UC′ and the ratios UC/MAX and UC/LC of both cleft groups were also smaller when compared with non-clefts. The ratio UM/MAX of the one-stage group was smaller when compared with the non-cleft group. Conclusion: The two-stage palatoplasty in combination with application of the Hotz’ plate had good effects on the maxillary growth up to the age of 12 years.

Cephalometrically analysis of the convexity angle

The convexity angle of facial bone structures ( N-A: A-Pg) expresses the sagittal protrusion of the maxillary part of the face compared to facial profile (the convex or concave face).The convexity angle is defined as the angle colligated by the lines N-A and A-Pg. The aims of the present study were: to analyse the convexity angle in participants with natural teeth skeletal class I, to cephalometrically evaluate the reconstructing angle of hard facial profile structures of edentulous patients skeletal class I, to compare examined variables between individuals with natural teeth and edentulous patients. The control group consisted of 30 lateral cephalometric radiographs of participants with natural teeth skeletal class I. The experimental group consisted of 30 lateral cephalometric radiographs of edentulous patients, with models of complete dentures after clinical methods of determining the vertical and horizontal intermaxillary relation. Analysis of the convexity angle was done in cephalometric radiographs by Downs metod. The results showed the facial bone structure convexity angle span a range between -13? and 10? (X= 0.45?) in subjects with natural teeth. In edentulous patients the values of facial bone structure convexity angles span a range between -5? and 10? (X=1.7?). The results of t-test proved that there were no statistically significant differences in examined variables between persons with natural teeth and edentulous patients (p&gt;0.05). The conclusion is that clinical methods of determining the sagittal protrusion of the maxillary part of the face against the facial profile of edentulous patients used in the designing procedures of complete dentures were reliable enough in reconstruction of examined angles of hard facial profile structures.

Cephalometrically analysis of the convexity angle

The convexity angle of facial bone structures ( N-A: A-Pg) expresses the sagittal protrusion of the maxillary part of the face compared to facial profile (the convex or concave face).The convexity angle is defined as the angle colligated by the lines N-A and A-Pg. The aims of the present study were: to analyse the convexity angle in participants with natural teeth skeletal class I, to cephalometrically evaluate the reconstructing angle of hard facial profile structures of edentulous patients skeletal class I, to compare examined variables between individuals with natural teeth and edentulous patients. The control group consisted of 30 lateral cephalometric radiographs of participants with natural teeth skeletal class I. The experimental group consisted of 30 lateral cephalometric radiographs of edentulous patients, with models of complete dentures after clinical methods of determining the vertical and horizontal intermaxillary relation. Analysis of the convexity angle was done in cephalometric radiographs by Downs metod. The results showed the facial bone structure convexity angle span a range between -13° and 10° (X= 0.45°) in subjects with natural teeth. In edentulous patients the values of facial bone structure convexity angles span a range between -5° and 10° (X=1.7°). The results of t-test proved that there were no statistically significant differences in examined variables between persons with natural teeth and edentulous patients (p>0.05). The conclusion is that clinical methods of determining the sagittal protrusion of the maxillary part of the face against the facial profile of edentulous patients used in the designing procedures of complete dentures were reliable enough in reconstruction of examined angles of hard facial profile structures.

Cephalometric Soft Tissue Profile Analysis Between Two Different Ethnic Groups: A Comparative Study

The aim of this investigation was to study and compare the cephalometric soft tissue profile analysis between Saudis and Caucasian Americans. The study was carried out using standardized cephalometric radiographs of 56 Saudi subjects (30 males and 26 females) with pleasant and balanced facial profiles, competent lips, normal overjet and overbite, and showing no craniofacial deformities. Subject ages ranged from 22 to 23 years. One skeletal and thirteen soft tissue variables were investigated. F-test, two samples t-test, Mann-Whitney, and Wilcoxon tests were used for data analysis. The results showed no statistical significant differences between the Saudi males and females except for the angle of total facial convexity, soft tissue facial plane angle, lower lip length, sagittal nasal tip to the most protrusive lip distance, and also sagittal chin to the most protrusive lip distance. The Saudi females had a greater angle of total facial convexity and soft tissue facial plane angle than the males. In addition, the females had a shorter lower lip. They also had a short distance between the nasal tip and chin to the most protrusive lip. These results reveal significant differences in most of the soft tissue variables when comparing Saudis with Caucasian Americans as well as in other ethnic groups. Most of these variables are essential for the diagnosis and treatment planning of cases requiring orthodontics and orthognathic surgery.

Craniofacial growth in untreated skeletal Class II subjects: A longitudinal study

Eighty-five (45 male and 40 female) skeletal Class II untreated subjects with low (< 27°), average (27°- 36°), and high (> 36°) mandibular plane angles (MP-SN) were selected from the Bolton-Brush and the Burlington Growth Studies. Cephalograms of each subject at ages 9 and 18 were traced, and 28 parameters were measured. The difference in each parameter from ages 9 to 18 was calculated, and comparisons were made between the groups with low, average, and high angles. Results showed that for children at age 9, the high-angle group showed greater convexity, larger Y-axis and gonial angles, and greater anterior facial height, and the low-angle group had larger SNA and SNB angles, and greater posterior cranial base, mandibular body, ramus height, and posterior facial height. From ages 9 to 18, all the low-, average-, and high-angle groups showed a decrease of convexity (more flattened face) and a mandibular forward rotation (decreased MP-SN). The low-angle group displayed significantly more facial flattening and more mandibular forward rotation than did the high-angle group. Moreover, the mandibular incisors became more retroclined in the low-angle group and more proclined in the high-angle group with age. Comparisons between males and females showed similar skeletal growth patterns in angular measurements. However, a significant sex difference was noted in some linear measurements. (Am J Orthod Dentofacial Orthop 2002;122:619-26)

Role of cranial base flexure in developing sagittal jaw discrepancies

The aim of this longitudinal cephalometric study was to investigate skeletal features in patients with small and large cranial base angles. Two groups of untreated subjects were formed on the basis of a small and large cranial base angle N-S-Ar at the age of 5 years: the large cranial base angle group (n = 22) consisted of subjects with an N-S-Ar angle larger than 125° (mean, 128.1°), and the small cranial base angle group (n = 20) included subjects with an N-S-Ar angle of less than 120° (mean, 117.6°). Cephalometric data of the 2 groups were analyzed at subject ages 5 and 12 years. At both ages, the groups showed significant differences of the variables SNA, SNB, individualized ANB, and Y axis. The unadjusted ANB angle and the angle of convexity N-A-Pg were not significantly different between the 2 groups. According to the individualized norm of the ANB angle, subjects with a large cranial base angle in the primary dentition demonstrated a skeletal Class II tendency both at the initial observation and at the longitudinal follow-up. On the basis of cephalometric variables at 12 years of age, it was possible to classify 88.1% of the initial large and small cranial base angle individuals, indicating a constancy of the skeletal pattern during the longitudinal follow-up. The relationship between cranial base flexure and skeletal pattern of the jaws seems to be established before the age of 5 years. (Am J Orthod Dentofacial Orthop 2002;122:386-91)

The Soft-Tissue Facial Profile of Patients with Unilateral Clefts of the Lip, Alveolus, and Palate Compared with Healthy Adults

In this study the soft-tissue profile of 84 patients aged between 16 and 29 years after complete rehabilitation of a unilateral cleft of the lip, alveolus, and palate was compared on lateral cephalograms with that of 58 adult probands with no cleft formation. In the patient group, the thickness at nasion, the subnasal thickness, the upper alveolabial sulcus thickness, the upper lip prominence, and the mental thickness were less pronounced than in the control group. In contrast, the patients showed significantly higher values in the prominence and thickness of the lower lip. These results indicate a less dominant development of the upper lip and a more voluminous lower lip in comparison to the control group. In contrast, the length of the upper lip did not differ significantly between patients and controls. In both groups the facial integument was thicker in males than in females. The soft-tissue anb-angle, the soft-tissue Holdaway II angle, and the nasolabial angle were significantly smaller in the patients than in the controls. Furthermore, the patients showed a distinctly more concave soft-tissue profile than the controls in measurements of the soft-tissue convexity angle. Thus, it is important for all surgeons involved in the rehabilitation of these patients to pay attention not only to an adequate length of the cleft-sided upper lip, but also to attaining a physiological alignment and reconstruction of the muscles, since the orbicularis oris muscle represents the most important component in the form and function of the lip. In addition, discontinuous muscular slings in the facial area may lead to severe midface growth disturbances.