Cephalometric Measurements Research Articles

Creating Normative Growth Curves for Pediatric Upper Airway Volume

Background: The objective of this study was to create normative growth curves for pediatric upper airway volume using 3D computed tomography with emphasis on the neonatal age group. Methods: We completed a single-institution, retrospective review of all patients with available CT scans between the ages of 0 and 60 months. Patients were excluded if they exhibited any maxillofacial dysmorphism or upper airway pathology or if scans showed the presence of airway appliances or tubes. 3D volumetric upper airway analysis was performed and 2D cephalometric measurements and growth parameters including height, weight and age were recorded for all patients. Linear regression analysis was used to develop a prediction model for airway volume in terms of age adjusting for cephalometric and growth parameters stratified by sex and the resulting model was used to create separate percentile curves for each sex group. Results: The growth curves were created based on CT scans from 217 healthy patients. Mean airway volume was significantly larger in males than females (3.23 ± 1.98 mm3 vs 2.61 ± 1.64 mm3, p = 0.017). Conclusions: Normative growth curves for neonatal and pediatric upper airway volume are a useful tool for tracking changes in airway volume in the growing infant.

Age-related hypertrophy of adenoid and tonsil with its relationship with craniofacial morphology

BackgroundWhen analyzing the relationship between adenotonsillar hypertrophy and craniofacial morphology, researchers generally regarded hypertrophied adenoids and tonsils as a whole. It remains unclear whether different enlarged sites of pharyngeal lymphoid tissue would correlate with multiple craniofacial subtypes. We hypothesized there would be craniofacial subtypes correlated with different locations of hypertrophied adenoid and tonsil.MethodsLateral cephalometric radiographs were obtained from 466 children (171 boys and 295 girls, aged 12.27 ± 2.69 years). They were divided into four groups according to different sites of enlarged pharyngeal lymphoid tissue: adenoid hypertrophy group (AG, n = 126), tonsillar hypertrophy group (TG, n = 59), adenotonsillar hypertrophy group (ATG, n = 69) and control group (CG, n = 212). Five commonly used angles for cephalometric measurements were investigated: SNA (Sella-Nasion-Point A), SNB (Sella-Nasion-Point B), ANB (Point A-Nasion-Point B), mandibular plane angle (MP/SN) and Y-axis angle (SGn/FH).ResultsChildren with isolated tonsillar hypertrophy correlated with increased SNA (unstandardized regression coefficient B = 1.38, p = 0.009) and SNB (B = 1.99, p = 0.001) compared with controls. However, children with isolated adenoid hypertrophy correlated with decreased SNB (B=-0.94, p = 0.036), increased ANB (B = 0.74, p = 0.014) and increased MP/SN (B = 2.22, p < 0.001). Similarly, children with adenotonsillar hypertrophy correlated with decreased SNB (B=-1.36, p = 0.015), increased ANB (B = 1.35, p < 0.001) and increased MP/SN (B = 2.64, p = 0.001).ConclusionsIsolated adenoid hypertrophy correlated with a retrognathic mandible, an increased maxillo-mandibular sagittal discrepancy, and an increased mandibular plane angle. Isolated tonsillar hypertrophy correlated with maxillary and mandibular protrusion. Adenotonsillar hypertrophy did not show a superimposed craniofacial pattern of the above two but showed the same craniofacial pattern as isolated adenoid hypertrophy.

Evaluating the accuracy of automated cephalometric analysis based on artificial intelligence

BackgroundThe purpose of this study was to evaluate the accuracy of automatic cephalometric landmark localization and measurements using cephalometric analysis via artificial intelligence (AI) compared with computer-assisted manual analysis.MethodsReconstructed lateral cephalograms (RLCs) from cone-beam computed tomography (CBCT) in 85 patients were selected. Computer-assisted manual analysis (Dolphin Imaging 11.9) and AI automatic analysis (Planmeca Romexis 6.2) were used to locate 19 landmarks and obtain 23 measurements. Mean radial error (MRE) and successful detection rate (SDR) values were calculated to assess the accuracy of automatic landmark digitization. Paired t tests and Bland‒Altman plots were used to compare the differences and consistencies in cephalometric measurements between manual and automatic analysis programs.ResultsThe MRE for 19 cephalometric landmarks was 2.07 ± 1.35 mm with the automatic program. The average SDR within 1 mm, 2 mm, 2.5 mm, 3 and 4 mm were 18.82%, 58.58%, 71.70%, 82.04% and 91.39%, respectively. Soft tissue landmarks (1.54 ± 0.85 mm) had the most consistency, while dental landmarks (2.37 ± 1.55 mm) had the most variation. In total, 15 out of 23 measurements were within the clinically acceptable level of accuracy, 2 mm or 2°. The rates of consistency within the 95% limits of agreement were all above 90% for all measurement parameters.ConclusionAutomatic analysis software collects cephalometric measurements almost effectively enough to be acceptable in clinical work. Nevertheless, automatic cephalometry is not capable of completely replacing manual tracing. Additional manual supervision and adjustment for automatic programs can increase accuracy and efficiency.

Evaluation of facial profile characteristics of aesthetically pleasing Iranian faces.

The objective of this study was to assess the soft and hard tissue cephalometric indexes of facial profiles perceived as attractive. A total of 360 individuals (180 females and 180 males) with well-balanced faces and no history of orthodontic or cosmetic procedures were selected. Twenty-six raters (13 females and 13 males) rated the attractiveness of profile view photographs of the enrolled individuals. According to the total score, the rated top 10% of photographs were selected as attractive. Overall, 81 (40 soft tissue and 41 hard tissue) cephalometric measurements were made on traced cephalograms of the attractive faces. The obtained values were compared with orthodontic norms and attractive Whites using Bonferroni-corrected t tests. They were also analyzed regarding age and sex effects using a two-way ANOVA test. Significant differences were found between the cephalometric measurements of attractive profiles and orthodontic norms. Among the most important parameters were greater H angle and basic upper lip thickness in attractive males, and greater facial convexity and smaller nose prominence in attractive females. Also, attractive male participants had greater soft tissue chin thickness and subnasale perpendicular to the upper lip compared with attractive females. According to the results, males with a normal profile and thicker protruded upper lips were perceived as more attractive. Also, females with a slightly convex profile, deeper mentolabial sulcus, less prominent nose, and shorter maxilla and mandible were perceived as more attractive.

Computerized three-dimensional cephalometric template for Thai adults

Cephalometry is essential in several fields of study. These include health science, anthropology, and forensic studies. Furthermore, cephalometric norms are essential for numerous disciplines in the health sciences, such as clinical anatomy, plastic surgery, pediatrics, pediatric dentistry, orthodontics, oral and maxillofacial surgery, and forensic medicine. Three-dimensional (3D) cephalometric templates offer an advanced but simple method for these specialties. This study aimed to establish cephalometric norms by developing 3D templates for Thai adults, based on cephalometric landmark coordinates obtained from skull cone-beam computed tomography (CBCT) scans of individuals with normal skeletal patterns. Full-head CBCT scans of 45 individuals (20 men and 25 women) were obtained from the archive. All had a Class I molar relationship with minor crowded teeth. The scans were captured in a normal head position, and the coordinates of 21 important cephalometric landmarks were identified using Slicer 4.10.2 software. Manual affine transformation of all landmarks was used to transfer medical image coordinates (Digital Imaging and Communications in Medicine [DICOM] or Right-Anterior-Superior [RAS] systems) to Cartesian universal coordinates. Intraclass correlation coefficients (ICC) and Bland-Altman (BA) plots were used to assess inter- and intra-examiner reliability (ICC = 0.961–1.000, BA mean errors = −0.1 mm). Important cephalometric measurements were compared to the most relevant and recent study with a sample size of 200. Most measurements showed no statistical difference (one-sample t-test, p > 0.05). Independent samples t-tests revealed that there was no statistically significant difference in the X and Y axes; however, most mean coordinates between men and women in the Z-axis coordinates were statistically significant. Consequently, 3D cephalometric templates were generated separately for adult Thai men and women using landmark coordinates. Although they are available for all disciplines at no cost through QR codes, these templates should be used with care, especially for the upper and lower incisor angulation. The application and future development of each specialty are also described here.

Quantitative analysis of the morphology of the lips according to different anteroposterior and vertical skeletal patterns

Objectives: The aim of this study was to compare the differences in the morphology of the lips according to anteroposte-rior dentoskeletal patterns and facial divergence.Materials and Methods: The samples were composed of the frontal facial photographs of 117 adult patients who satisfied all the cephalometric measurements for six groups (Class I or II or III and normodivergent or hyperdivergent). The morphol-ogy of the lips was evaluated on the frontal facial photographs and the measurements were compared between the groups.Results: In the normodivergent groups, the height-to-width ratio of the lip vermilion was significantly greater in the Class II group than in the Class I group, and the labrale superius angle and upper lip convexity of the Class II group was smaller than that of the Class I group. In the hyperdivergent groups, the stomion inferius angle of the Class III group was smaller than that of the Class II group. Lower facial height and the interlabial gap in the hyperdivergent groups tended to be larger than those in the normodivergent groups. The height-to-width ratio of the lip vermilion and the commissure height were larger in the hyperdivergent groups than in the normodivergent groups. However, the upper lip height and philtrum height did not differ between the hyperdivergent and normodivergent groups.Conclusion: The morphological characteristics of the lip vermilions on the frontal view differed according to the sagittal dentoskeletal relationship and facial divergence.

Clinical Outcomes of Bilateral Cleft Lip and Palate Repair with Nasoalveolar Molding and Gingivoperiosteoplasty to Facial Maturity.

The long-term effects of nasoalveolar molding (NAM) on patients with bilateral cleft lip and palate (BCLP) are unknown. The authors report clinical outcomes of facially mature patients with complete BCLP who underwent NAM and gingivoperiosteoplasty (GPP). A single-institution retrospective study of nonsyndromic patients with complete BCLP who underwent NAM between 1991 and 2000 was performed. All study patients were followed to skeletal maturity, at which time a lateral cephalogram was obtained. The total number of cleft operations and cephalometric measures was compared with a previously published external cohort of patients with complete and incomplete BCLP in which a minority (16.7%) underwent presurgical orthopedics before cleft lip repair without GPP. Twenty-four patients with BCLP comprised the study cohort. All patients underwent GPP, 13 (54.2%) underwent alveolar bone graft, and nine (37.5%) required speech surgery. The median number of operations per patient was five (interquartile range, two), compared with eight (interquartile range, three) in the external cohort ( P < 0.001). Average age at the time of lateral cephalogram was 18.64 years (1.92). There was no significant difference between our cohort and the external cohort with respect to sella-nasion-point A angle (SNA) [73 degrees (6 degrees) versus 75 degrees (11 degrees); P = 0.186] or sella-nasion-point B angle (SNA) [78 degrees (6 degrees) versus 74 degrees (9 degrees); P = 0.574]. Median ANB (SNA - SNB) was -3 degrees (5 degrees) compared with -1 degree (7 degrees; P = 0.024). Twenty patients (83.3%) underwent orthognathic surgery. Patients with BCLP who underwent NAM and GPP had significantly fewer total cleft operations and mixed midface growth outcomes at facial maturity compared with patients who did not undergo this treatment protocol. Therapeutic, III.

Comparison of Facial Growth Between Two Nasoalveolar Molding Techniques in Unilateral Complete Cleft Lip Patients: A Randomized, Prospective, Single-blind Trial.

Nasoalveolar molding (NAM) has become standard treatment in our Craniofacial Center. Two types of pre-surgical NAM, Grayson technique and Figueroa technique, co-exist. We previously found no differences in number of clinic visits, cost and 6 months post-operative outcome between the two techniques. Since Figueroa's method involves passive, whilst Grayson's method involves active, alveolar molding, we extended the previous study to evaluate facial growth between these two groups. This randomized, prospective, single-blind study, conducted between May 2010 and March 2013, recruited 30 patients with unilateral complete cleft lip and palate patients and randomized them for Grayson or Figueroa pre-surgical NAM. Their standard lateral cephalometric measurements at 5 years were used to determine facial growth. Twenty-nine patients completed 5 years of follow-up. There were no statistical differences in facial cephalometric measurements between the two groups. Pre-surgical NAM using either passive or active NAM technique produced similar facial growth patterns after unilateral cleft lip and palate repair.

Profile Changes in Class III Malocclusion using Protraction Facemask in Indonesian Young Patients (Cephalometric Study)

Background: The prevalence of Class III malocclusion is highest in Southeast Asia. In countries such as Malaysia and Indonesia, the prevalence is as high as 15.80%. Treatment timing and options are very important in treating Class III malocclusion. A protraction facemask or also known as reverse headgear is one of the most used appliances as an interceptive tool for Class III malocclusion in young patients. Objectives: This study aims to evaluate the profile changes in treating Indonesian young patients using a protraction facemask. Methods: The sample consisted of 63 subjects, 25 males and 38 females. Lateral cephalograms were traced and analyzed using CephaloMetrics AtoZ™ ver. 12 (Yasunaga Computer Systems, Co. Inc., Hanando-Minami, Fukui, Japan). A total of 16 traditional cephalometric measurements (13 skeletal measurements and 3 dental measurements) were used to describe changes between pretreatment and posttreatment cephalograms. All recorded data were analyzed using IBM SPSS version 21 (IBM Corporation, Armonk, New York, USA). Results: SNA (p˂0.030), ANB (p=0.000), and Wits appraisal values (p=0.000) showed significant differences out of all measurements. FMA and occlusal plane also showed changes and indicated that a facemask is helpful with treatment. Conclusion: Timing, duration, and patient compliance are very important in the management of Class III skeletal malocclusion using a protraction facemask. The use of facemask therapy among Indonesian pediatric patients resulted in an anterior and downward movement of the maxilla, backward rotation of the mandible, and a better orthopedic response.

Evaluation of reliability &amp; reproducibility of cephalometric measurements obtained from computerised software (CS8100SC) compared with manual tracing

This study has been done to compare fourteen cephalometric measurements collected from computerized tracing of digital radiographs followed by manual tracing of the same to check their reliability and reproducibility.Pretreatment lateral cephalograms of fifty subjects were taken, on which fourteen cephalometric measurements were traced. Ten randomly selected cephalograms were retraced by the same operator both manually and digitally.Out of fourteen parameters, eight parameters (N-ANS, S-N, A-Pog, Facial angle, FMA, SNA, SNB and ANB) showed statistically significant differences between the two techniques but were clinically acceptable whereas six parameters did not show any significant differences. Digital measurements obtained from CS8100SC software were reliable for all except ANB. Reproducibility between both the tracing was good except for ANB, Facial axis, Facial angle and FMIA.CS8100SC Imaging software program can be brought into play for cephalometric measurements.

Evaluation of edema formation and salivary EGF related to 810 nm diode laser and conventional surgery after frenectomy

The surgical procedure that lessens edema formation after frenectomy surgery is important.Re-epithelialization with lasers occurs differently from conventional surgery, and this can affect the salivary EGF level. The aim of this study was to determine edema caused by frenectomy surgery and compare the amount of EGF in saliva. Conventional and 810 nm diode laser surgery performed with thirty-four patients. Laser parameters were 400 µm fiber with 2.5 W output energy, in continuous mode.3D face scan data was obtained with a Planmeca Proface Mid device and analyzed with the 3D metrology method using the CloudCompare V2 software. Cephalometric analysis was performed using 2D profile photographs with Geogebra software. Edema measurements were repeated on day 1 (T1), day 3 (T2) and day 14 (T3). All saliva samples were collected at T1 and T3 and salivary EGF concentration was determined using the ELISA method. In conventional surgery, a significant difference was found between ΔT2-T1 and ΔT3-T1 in 3D metrology measurements (p=0.0046). In 2D cephalometric measurements there was significant differences in Angle A T2-T1 vs. Angle A T3-T1 (p=0,0014) and vs. Angle B T2-T1 (p=0,0017) and vs. Angle B T3-T1 (p=0,0087) in conventional surgery. There were no significant changes in edema measurements of laser surgery. The laser frenectomy does not produce edema significantly (p=0,1232). There were no significant changes between groups in salivary EGF measurements (p&amp;#62;0.999). The 810 nm laser surgery produced less edema than conventional surgery. The 810 nm diode laser does not significantly affect salivary EGF.

In Utero Exposure to Maternal Electronic Nicotine Delivery System use Demonstrate Alterations to Craniofacial Development.

Develop a model for the study of Electronic Nicotine Device (ENDS) exposure on craniofacial development. Experimental preclinical design followed as pregnant murine dams were randomized and exposed to filtered air exposure, carrier exposure consisting of 50% volume of propylene glycol and vegetable glycine (ENDS Carrier) respectively, or carrier exposure with 20 mg/ml of nicotine added to the liquid vaporizer (ENDS carrier with nicotine). Preclinical murine model exposure using the SciReq exposure system. C57BL6 adult 8 week old female pregnant mice and exposed in utero litters. Exposure to control filtered air, ENDS carrier or ENDS carrier with nicotine added throughout gestation at 1 puff/minute, 4 h/day, five days a week. Cephalometric measures of post-natal day 15 pups born as exposed litters. Data suggests alterations to several facial morphology parameters in the developing offspring, suggesting electronic nicotine device systems may alter facial growth if used during pregnancy. Future research should concentrate on varied formulations and exposure regimens of ENDS to determine timing windows of exposures and ENDS formulations that may be harmful to craniofacial development.

Preciseness of artificial intelligence for lateral cephalometric measurements.

The aim of the study was to assess the accuracy and efficiency of anew artificial intelligence (AI) method in performing lateral cephalometric radiographic measurements. A total of 200lateral cephalometric radiographs were assessed for quality and included. Three methods were used to perform the cephalometric measurements: (1) the AI method using WebCeph software (AssembleCircle Corp., Gyeonggi-do, Republic of Korea), (2)the modified AI method using WebCeph software after manual modification of the landmarks' position, and (3)using OnyxCeph software (Image Instruments GmbH, Chemnitz, Germany) by manual landmark identification and digital measurements generation. The results of the measurements produced by the three methods were compared, in addition to comparing the time required for the measurements' generation required for each method. Statistically significant differences were detected between the measurements resulting from the three used methods. Fewer differences were detected between the modified AI method and the OnyxCeph method. The AI method produced the measurements the fastest followed by the modified AI method and then the OnyxCeph method. Considering the used AI software, AI followed by manual tuning of the landmarks' position might be an accurate method in lateral cephalometric analysis. AI alone is still not fully reliable at locating the different landmarks on the lateral cephalometric radiographs.

Association between the severity of hypodontia and the characteristics of craniofacial morphology in a Chinese population: A cross-sectional study.

To investigate craniofacial differences in individuals with hypodontia and explore the relationship between craniofacial features and the number of congenitally missing teeth. A cross-sectional study was conducted among 261 Chinese patients (males, 124; females, 137; age, 7-24 years), divided into four groups (without hypodontia: no teeth missing, mild: one or two missing teeth, moderate: three to five missing teeth, severe: six or more missing teeth) according to the number of congenitally missing teeth. Differences in cephalometric measurements among the groups were analyzed. Further, multivariate linear regression and smooth curve fitting were performed to evaluate the relationship between the number of congenitally missing teeth and the cephalometric measurements. In patients with hypodontia, SNA, NA-AP, FH-NA, ANB, Wits, ANS-Me/N-Me, GoGn-SN, UL-EP, and LL-EP significantly decreased, while Pog-NB, AB-NP, N-ANS, and S-Go/N-Me significantly increased. In multivariate linear regression analysis, SNB, Pog-NB, and S-Go/N-Me were positively related to the number of congenitally missing teeth. In contrast, NA-AP, FH-NA, ANB, Wits, N-Me, ANS-Me, ANS-Me/N-Me, GoGn-SN, SGn-FH (Y-axis), UL-EP, and LL-EP were negatively related, with absolute values of regression coefficients ranging from 0.147 to 0.357. Further, NA-AP, Pog-NB, S-Go/N-Me, and GoGn-SN showed the same tendency in both sexes, whereas UL-EP and LL-EP were different. Compared with controls, patients with hypodontia tend toward a Class III skeletal relationship, reduced lower anterior face height, flatter mandibular plane, and more retrusive lips. The number of congenitally missing teeth had a greater effect on certain characteristics of craniofacial morphology in males than in females.

A CBCT Evaluation of the Proximity of Mandibular Molar Roots and Lingual Cortical Bone in Various Vertical Facial Patterns and Factors Related to Root-Cortical Bone Contact

The objective of this study was to assess the proximity of the mandibular molar roots and the lingual cortical bone in patients with various vertical facial patterns and determine factors related to root-cortical bone contact. A total of 145 patients (84 males, 61 females, mean age: 22.0 ± 1.76 years) were assigned to hypodivergent (36 patients), normovergent (80 patients) and hyperdivergent (29 patients) groups based on their facial height ratio. Cone-beam computed tomography (CBCT) images were used to measure the distance between the mandibular molar roots and the lingual cortical bone, and any instances of root-cortical bone contact were identified. The study investigated the correlation between the contact of the mandibular molar roots with the lingual cortical bone and several variables, including sex and cephalometric measurements. The distance between the mandibular molar roots and the lingual cortical bone was significantly shorter in the hyperdivergent group than in the hypodivergent group (p &lt; 0.05). Of the total root-cortical bone contact, 87.6% was observed in the mandibular second molars, and the distal roots of the mandibular second molars had the highest contact rate at 43.1% in the hyperdivergent group (p &lt; 0.05). Among the evaluated variables, only the distance between the distal root apex of the mandibular second molar and the mandibular plane was found to be associated with contact of the mandibular molar roots with the lingual cortical bone. An increase of 1 mm in this distance was associated with a 22% decrease in the likelihood of contact between the mandibular second molar roots and lingual cortical bone (p &lt; 0.001). Given the proximity and high contact ratio between the mandibular molar roots and lingual cortical bone, it is recommended that these structures be evaluated using CBCT before planning molar distalization or intrusion in hyperdivergent patients.

Evidencia de la efectividad del uso de aparatología ortopédica prequirúrgica en pacientes con labio y paladar hendido: revisión sistemática.

This review article aimed to evaluate the evidence on the use of a presurgical orthopedic appliance (POP) in patients with cleft lip and palate. The search was conducted using Medline/PubMed, Scholar Google, Clinical Trails, ProQuest, Scopus, and Web of Science databases. During the search, 7,926 records were found, of which 105 full-text articles were analyzed, and 23 studies included analysis in patients with the use of POP, and their control groups without the use of POP prior to the same type of surgery. The devices most used for POP in the management of LPH were: the passive palate (Hotz palate), the nasolaveolar moulding (NAM), the McNeil device, and finally, the T-traction. The primary outcomes evaluated were: facial aesthetics and nasal appearance; the evaluation of cephalometric measurements, upper airways, nasal fissure width, as well as anatomical references such as inter-canine and inter-tuberosity distances. In addition, studies that evaluated occlusion and phonation were found. The evidence from this literature suggests that the use of active appliances had a better effect than passive appliances in terms of facial aesthetics and approximation of the maxillary seg-ments for the closure of the fissure. However, the heterogeneity, the risk of bias, and the low quality of the studies do not allow to state firm conclusions.

Mandibular advancement devices used with morning occlusal guides for treating obstructive sleep apnea-changed incisor inclination and its associated factors.

Mandibular advancement devices (MADs) effectively treat patients withobstructive sleep apnea (OSA). Although the use of morning occlusal guides (MOGs) along with MADs is recommended to prevent dental side effects, there is no evidence to support this. The aim of this study was to evaluate the change in incisor inclination in patients withOSA treated with MADs and MOGs, and to identify its predictive factors. Patients with OSA who received MAD and MOG therapy and had a reduction in their apnea-hypopnea index greater than 50% were analyzed. Cephalometric measurements were performed at baseline and at a 1-year follow-up or longerto assess the dentoskeletal side effects of MAD/MOG treatment. Multivariable linear regression analysis was used to assess the association between the change in incisor inclination and the independent variables that may cause the observed side effects. Among 23 patients enrolled in the study, there was significant upper incisor retroclination (U1-SN: 2.83° ± 2.68°, U1-PP: 2.86° ± 2.46°; P < 0.05) and significant lower incisor proclination (L1-SN: 3.04° ± 3.29°, L1-MP: 1.74° ± 3.13°; P < 0.05). However, no significant skeletal changes were observed. Multivariable linear regression revealed that advancement ≥ 95% of the patients' maximal mandibular protrusion was associated with greater upper incisor retroclination. Increased treatment duration was alsoassociated with increased upper incisor retroclination. No \measured variables were associated with the change in lower incisor inclination. Dental side effects occurred in patients who used MADs with MOGs. The amount of mandibular protrusion by MADs and treatment duration were predictive factors associated with upper incisor retroclination.

Useful Genioplasty for Repeated Recurrent Sleep Apnea of Congenital Anomalies and Its Evaluation.

Six patients were included: three with syndromic craniosynostosis, two with Treacher-Collins syndrome, and one with micrognathia by Goldenhar syndrome. Patients who had recurrence of sleep apnea after previous maxillomandibular osteotomies, or advancement and orthodontic treatment, received genioplasty for genioglossus muscle advancement. The patients were evaluated by body mass index, simple polysomnography, hyoid bone position on cephalogram, and the airway area on computed tomography images pre- and postoperatively. Polysomnography showed a significant improvement in the apnea-hypopnea index. Cephalometric measurement showed significant results of the hyoid bone position from point B and the ramus plane. However, no significant results were obtained in the airway area assessment. Genioplasty for genioglossus muscle advancement can improve apnea-hypopnea index by moving the hyoid bone forward. Genioplasty was useful in patients with congenital anomalies who had a recurrence of sleep apnea after several procedures.

Comparison of three-dimensional maxillary growth across spheno-occipital synchondrosis maturation stages

BackgroundThis study aimed to three-dimensionally compare the maxillary growth among the spheno-occipital synchondrosis (SOS) maturation stages in both genders.MethodsThis is a cross-sectional study of a retrospective type in which cone-beam computed tomography (CBCT) images of 500 patients aged 6 to 25 years (226 males and 274 females) were analyzed. The SOS was evaluated using the four-stage scoring system; completely open, partially fused, semi-fused, or completely fused. The SOS scoring and three-dimensional cephalometric measurements were analyzed by Invivo 6.0.3 software. Descriptive and analytical statistics were performed and a P-value < 0.05 was considered statistically significant.ResultsThere was a statistically significant difference in maxillary measurements among SOS maturation stages in both genders (P < 0.05). The mean differences in the maxillary growth among the SOS maturation stages between SOS stages 2 and 3 were higher than those between stages 1and 2 and stages 3 and 4 for maxillary length and height in both genders. However, the mean difference in the maxillary width was higher between SOS stages 1 and 2 than those stages 2 and 3 and stages 3 and 4. On other hand, there may be lesser maxillary growth between SOS stages 3 and 4 for maxillary width, length (in males), and height. The growth curves showed high active growth of the maxilla as the SOS was still fusing (especially stage 2 and 3) than those of the fused (stage 4). Moreover, the acceleration of growth occurred earlier in females than males regarding chronological age but not for SOS maturation stages.ConclusionsThe SOS maturation stages are valid and reliable maxillary skeletal maturation indicators for three-dimensional maxillary growth in both genders.

The Lower Lip Profile Change During Total Distalization of the Mandibular Dentition

Objectives: This study aimed to determine the factors influencing the lower lip profile during Class III lower total arch distalization camouflage treatment. Methods: The cohort included 45 patients diagnosed with skeletal class III malocclusion. These patients underwent camouflage orthodontic treatment with lower arch total distalization. Lateral cephalograms were taken at the pretreatment and posttreatment stages. Cephalometric measurements were analyzed to unravel the influencing factors of the lower lip profile. This study defined new variables, i.e., CK and CKA, for detailed soft tissue analysis. Results: Novel soft tissue measurements presented in this study showed statistically significant changes after treatment. The CK angle and L1 to A Pog, L1 to NB, and IMPA were statistically correlated. Simple regression analysis was performed between variables. The formula was ΔCKA = 0.79(Δ L1 to NB) -1.6, and multiple regression resulted in ΔCKA = 0.5(Δ L1 to NB) – 0.42 (‘LL to Eline’, before treatment). Conclusion: The present study provided evidence that the lower lip evaluations, including the novel CKA and CKHA, were significantly related to the mandibular incisor position during total distalization of the mandibular dentition. The results demonstrated that clinically significant lip retraction could be obtained. Therefore, non-extraction with distalization must be suggested as the first treatment option in mild skeletal class III malocclusion patients.