Cephalometric Values Research Articles

Rakosi Jarabak Analysis for the South Indian Population - A Cross-Sectional Study

Background: 
 Rakosi jarabak analysis has been proved to be effective in predicting the facial growth pattern, morphological characters, reaction to various orthopedic approaches, and functional alterations. Most of these established cephalometric values are based on average values for the Caucasian population. Whereas cephalometric values vary among different populations and have shown variations among different ethnic groups, gender, and age. The objectives of this paper are to develop Rakosi Jarabak cephalometric norms for the South Indian population and compare the measures to values from other ethnic groups.
 Materials and Method: 
 Facad software was used to track the lateral cephalograms of 100 non-growing patients from the South Indian population who satisfied our inclusion criteria. Nineteen craniofacial parameters of Jarabak’s analysis were measured.
 Result: 
 A comparison between the males and females of the South Indian population showed a significant difference between the three parameters. Comparison of the south Indian male, female values, and overall values with established norms of various ethnic populations showed significant differences among various parameters.
 Conclusion: 
 This study establishes the south Indian ethnic norms for Rakosi Jarabak analysis. The south Indian norms vary from caucasian norms showing significant ethnic .These differences need to be considered when analyzing the cephalogram . These values will help in customizing treatment plans based on ethnic norms.The study concludes that distivariationsnct sets of cephalometric norms should be developed for different ethnic groups in order to aid orthodontists and surgeons in optimising treatment plans based on local norms.

Vowel sound production and its association with cephalometric characteristics in skeletal Class III subjects.

This study aimed to evaluate differences in vowel production using acoustic analysis in skeletal Class III and Class I Japanese participants and to identify the correlation between vowel sounds and cephalometric variables in skeletal Class III subjects. Japanese males with skeletal Class III (ANB < 0°) and Class I skeletal anatomy (0.62° < ANB < 5.94°) were recruited (n = 18/group). Acoustic analysis of vowel sounds and cephalometric analysis of lateral cephalograms were performed. For sound analysis, an isolated Japanese vowel (/a/,/i/,/u/,/e/,/o/) pattern was recorded. Praat software was used to extract acoustic parameters such as fundamental frequency (F0) and the first four formants (F1, F2, F3, and F4). The formant graph area was calculated. Cephalometric values were obtained using ImageJ. Correlations between acoustic and cephalometric variables in skeletal Class III subjects were then investigated. Skeletal Class III subjects exhibited significantly higher/o/F2 and lower/o/F4 values. Mandibular length, SNB, and overjet of Class III subjects were moderately negatively correlated with acoustic variables. This study did not take into account vertical skeletal patterns and tissue movements during sound production. Skeletal Class III males produced different /o/ (back and rounded vowel), possibly owing to their anatomical positions or adaptive changes. Vowel production was moderately associated with cephalometric characteristics of Class III subjects. Thus, changes in speech after orthognathic surgery may be expected. A multidisciplinary team approach that included the input of a speech pathologist would be useful.

Comparison of superior airway dimensions and cephalometric anatomic landmarks between 8-12-year-old children with obstructive sleep apnea and healthy children using CBCT images.

Background. The etiology of obstructive sleep apnea (OSA) syndrome in children significantly differs from adults. In previous studies, only some of the indices have been investigated using CBCT. This study compares all the measurable indices of airway dimensions and anatomical cephalometric landmarks between children with OSA and healthy ones using cone-beam computed tomography (CBCT).Methods. Dimensions of the airway and cephalometric values were measured on CBCT scans of 50 children aged 8–12 (25 patients with OSA and 25 healthy subjects) and then compared between the two groups. The results of this study were analyzed with independent t test using SPSS 17 at a significance level of P<0.05.Results. Area, length, volume, anteroposterior length, and size of the upper airway in subjects with OSA were lower than those in healthy children, while the average values of SNA, SNB, and ANB in the OSA group were higher than those in the healthy group (P=0.366, P=0.012, and P=0.114, respectively). Also, BaSN, PNS/AD1, and PNS/AD2 measurements in subjects with OSA were lower than healthy subjects (P=0.041, P=0.913, and P=0.015, respectively). In addition, the width and anteroposterior length of the upper airway, SNB, BaSN, PNS/AD1, and PNS/AD2 indices were significantly different between the healthy group and those with OSA (P<0.05).Conclusion. Reduced upper airway dimensions, adenoid tissue enlargement, and cranial base flexion might play an important role in OSA development in children. However, most skeletal variables, such as the anteroposterior relationship of jaws and jaw rotation, were not significantly different between the two groups.

3D Cephalometric Normality Range: Auto Contractive Maps (ACM) Analysis in Selected Caucasian Skeletal Class I Age Groups.

The objective of this paper is to define normal values of a novel 3D cephalometric analysis and to define the links through an artificial neural network (ANN). Methods: One hundred and fifteen CBCTs of Class I young patients, distributed among gender-adjusted developmental groups, were selected. Three operators identified 18 cephalometric landmarks from which 36 measurements were obtained. The repeatability was assessed through the ICC. Two-dimensional values were extracted by an automatic function, and the mean value and standard deviation were compared by paired Student’s t-tests. Correlation coefficient gave the relationships between 2D and 3D measurements for each group. The values were computed with the ANN to evaluate the parameters normality link and displayed by Pajek software. Results: The ICC assessed an excellent (≥0.9) repeatability. Normal values were extracted, and compared with 2D measurements, they showed a high correlation on the mid-sagittal plane, reaching 1.00, with the lowest 0.71 on the lateral plane. The ANN showed strong links between the values with the centrality of the go-sagittal plane compared to the rest. Conclusions: The study provides a set of 3D cephalometric values obtained by the upper and lower 95% CI for the mean divided into the developmental stage subgroups. The two-dimensional measurements showed variable concordance, while the ANN showed a centrality between the parameters.

Current Trends in Skeletal Borderline Patients: Surgical versus Orthodontic Treatment Decisions—What Is the Evidence?

Background: The aim is to assess the current evidence-based knowledge about treatment decisions for skeletal malocclusion in adult borderline patients. Methods: A literature search was conducted through three databases. Inclusion criteria were restricted to systematic reviews, prospective, retrospective, and control studies. Only articles comparing orthodontic camouflage and orthognathic surgical treatment for Class II and Class III malocclusions in adult patients were selected to be reviewed. Results: Seven articles concerning Class II and nine concerning Class III met the inclusion criteria. Scientific evidence was poor due to low methodological quality. Conclusions: Surgical treatment was found to better improve skeletal and soft-tissue cephalometric values, whereas camouflage treatment mainly involved dentoalveolar movements. Aesthetic changes, as perceived by the patient, were not significantly different in the two groups. Recently improved surgical techniques, differing from those described in the analyzed articles, may provide similar or more stable outcomes compared with orthodontic-only treatment. Although some cephalometric variables can be helpful, the most important parameters for treatment selection are the patient’s presenting complaint and their self-image perception. Further studies with larger sample sizes and similar pretreatment conditions, and considering patient self-evaluation of esthetics and function, should be undertaken.

Cephalometric evaluation of patients with unilateral and bilateral complete cleft lip and palate.

This study aimed to evaluate craniofacial cephalometric morphology in patients with unilateral clefts (UCLP) and in those with bilateral clefts (BLCP). The lateral radiographs of 129 patients with UCLP or BCLP referred to San Bortolo Hospital in Vicenza between January 2010 and January 2019 were retrospectively evaluated. Fourteen cephalometric hard tissue landmarks per radiographs were digitized and fifteen measurements (eight angle measurements, six linear measurements, and one ratio measurement) were calculated. Statistical analyses were carried using Chi-squared test (P<0.05). The analysis included 33 patients (25%) with BCLP, 41 (32%) with right UCLP and 55 (43%) with left UCLP. Adjusting for age and sex, left UCLP was associated with lower gonial angle (mean difference [MD] -2.7, 95% CI 5.2 to -0.0), lower upper gonial angle (MD -2.2, 95% CI -3.9 to -0.6) but higher posterior facial height (MD 2.4, 95% CI 0.3 to 4.4) with respect to right UCLP. Adjusting for age and sex, BCLP was associated with lower articular angle (MD -2.8, 95% CI -5.5 to -0.2) but higher SNA (MD 2.6, 95% CI 0.6 to 4.6) and higher ANB (MD 3.2, 95% CI 1.3 to 5.0) with respect to UCLP. Differences between the two groups were found in relation to three cephalometric values: articular angle, that is bigger in UCLP patients; SNA, that is bigger in BCLP patients; ANB, that is bigger in BCLP patients. This different craniofacial morphology can influence the treatment plan in cleft lip and palate patients.

Statistical and individual characteristics-based reconstruction for craniomaxillofacial surgery.

In craniomaxillofacial (CMF) surgery planning, a preoperative reconstruction of the CMF reference model is crucial for surgical restoration, especially the reconstruction of bilateral defects. Current reconstruction algorithms mainly generate reference models from the image analysis aspect, however, clinical indicators of the CMF reference model mostly consider the distribution of anatomical landmarks. Generating a reference model with optimal clinical evaluation helps promote the feasibility of an algorithm. We first build a dataset with 100 normal skull models and then calculate a statistical shape model (SSM) and the distribution of normal cephalometric values, which indicate the statistical features of a population. To further generate personalized reference models, we apply non-rigid registration to align the SSM with the defect skull model. An evaluation standard to select the optimal reference model considers both global performance and anatomical evaluation. Moreover, we develop a landmark detection network to improve the automatic level of the algorithm. The proposed method performs better than methods including Iterative Closest Point and SSM. From a global evaluation aspect, the results show that the RMSE between the reference model and the ground truth is [Formula: see text]mm, the percentage of vertices with error below 2mm is [Formula: see text]% and the average faces distance is [Formula: see text]mm (better than the state-of-the-art method). From the anatomical evaluation aspect, the target registration error between the landmark pairs is [Formula: see text]mm. In addition, the clinical application confirms that the reference model can meet clinical requirements. To the best of our knowledge, we propose the first CMF reconstruction method considering the global performance of reconstruction and anatomically local evaluation from clinical experience. Simulated experiments and clinical cases prove the general applicability and strength of the method.

A 3D CBCT Analysis of Airway and Cephalometric Values in Patients Diagnosed with Juvenile Idiopathic Arthritis Compared to a Control Group

Introduction: The temporomandibular joint (TMJ) is affected in 30–45% of juvenile idiopathic arthritis (JIA) patients, with all JIA subtypes at risk for TMJ involvement. JIA patients with TMJ involvement may present with altered craniofacial morphology, including micrognathia, mandibular retrognathia, a hyperdivergent mandibular plane angle, and skeletal anterior open bite. These features are also commonly present and associated with non-JIA pediatric patients with obstructive sleep apnea (OSA). Materials and Methods: The study was comprised of a group of 32 JIA patients and a group of 32 healthy control subjects. CBCT images were taken for all patients and were imported into Dolphin Imaging software. The Dolphin Imaging was used to measure the upper airway volumes and the most constricted cross-sectional areas of each patient. Cephalometric images were rendered from the CBCT data for each patient, and the following cephalometric values were identified: SNA angle, SNB angle, ANB angle, anterior facial height (AFH), posterior facial height (PFH), mandibular plane angle (SN-MP), FMA (FH-MP), overjet (OJ), and overbite (OB). Airway volumes, the most constricted cross-sectional area values, and cephalometric values were compared between the JIA and control groups. Results: For airway values, statistically significant differences were seen in the nasopharynx airway volume (p = 0.004), total upper airway volume (p = 0.013), and the most constricted cross-sectional area (p = 0.026). The oropharynx airway volume was not statistically significant (p = 0.051). For cephalometric values, only the posterior facial height showed a statistically significant difference (p = 0.024). Conclusions: There was a significant difference in airway dimensions in the JIA patients as compared to the control patients. In addition, the posterior facial dimensions seem to be affected in JIA patients. The ODDs ratio analysis further corroborated the findings that were significant.

Cephalometric Norms of Bangladeshi Young Children Based on McNamara’s Analysis

Objective: To evaluate the cephalometric norms of Bangladeshi young children using McNamara’s analysis. Methods: It was a descriptive cross-sectional study carried out in the Department of Orthodontics, BSMMU among the dental patients visiting Dental OPD of BSMMU. The test sample was 40 Cephalometric radiographs of patients of which 20 were boys (group I) and 20 were girls (group II). The study respondents were of Bangladeshi origin, aged between 11 and 18 years at the time of cephalometric radiograph taken. A randomized sampling technique was followed to collect samples. Results: The mean cephalometric values of McNamara variables were measured and compared with the Caucasian children and Bangladeshi adults. The p values of all variables for Group I (boys) and Group II (girls) were more than 0.05 which was not significant. So it was interpreted that there was no significant difference in the values of McNamara variables between Bangladeshi boys and girls. But in comparison to Caucasian children the p-value of all the variables was significant (&lt;0.05) except Pogonion to Nasion perpendicular. This result suggested that the McNamara variables for Bangladeshi children were significantly different from Caucasian children. Conclusion: The values observed by this study can be used in Bangladeshi children irrespective of gender because there is no statistically significant gender difference. It was also observed that the maxilla of the Bangladeshi children was slightly protrusive but the mandible was retrusive than the Caucasian children and both upper and lower incisors were found proclined. Update Dent. Coll. j: 2022; 12(1): 22-26

Variables Associated with Clinical Decision Making in the Treatment of Class I Malocclusion Patients

Background: To achieve treatment goals in orthodontics, the decision to extract or not extract premolars meets with debate. This includes cephalometric findings and study-cast analysis as influencing factors. This research aimed to identify variables that aid in clinical decision-making in the treatment of Class 1 malocclusion patients. Methods: This was a retrospective study conducted on pre-treatment records of Class I patients. All patients had a Class I dental and skeletal malocclusion. A sample of n=80 patients was included (40 extraction cases, 40 non-extraction). Cephalometric values and study-cast analysis for tooth-arch size discrepancy were performed and binary logistic regression was applied to run the univariate and multivariable analysis to investigate the association of different variables with extraction and non-extraction treatment. Odds ratio (OR) and 95% confidence intervals were reported and p &lt;0.05 was considered statistically significant. Results: Univariate logistic regression showed that mandibular and maxillary crowding (p&lt;0.001), overjet (p&lt;0.001), SNGo (p= 0.01), nasolabial angle (NL) (p= 0.02), lower anterior facial height (LAFH) (p= 0.03) and upper lip in plane (ULE) (p= 0.05) had a significant association with the extraction and non-extraction groups. Hence, final multivariable logistic regression revealed that crowding (p&lt; 0.01, 0.02), overjet (p= 0.009) and NL angle (p= 0.56) showed significant difference between the groups treated with and without extraction (p &lt;0.05). Conclusion: The level of crowding in both the arches, the incisal overjet, and the nasolabial angle aid in the clinical decision-making for Class I malocclusion patients in choosing an extraction or non-extraction plan. Keywords: Extraction; Non-Extraction; Class I; Malocclusion; Patients; Orthodontics.

Reference values for Down’s cephalometric analysis in Papuans

The asessment of cranio-facial structures forms a part of orthodontic diagnosis and treatment. One of the most frequently used cephalometric analysis is the Down’s analysis. It consists of 10 parameters of which 5 are skeletal and 5 are dental. Down has based his findings on 20 Caucasians, which have physical characteristic differences with Papuans. Indigenous Papuans are people of Melanesian descent consisting of indigenous tribes in Papua province and/or people who are accepted and recognized as Papuans by indigenous Papuans.The use of cephalometric values in different racial types, may result in the incorrect orthodontic diagnosis and treatment plan. According to those, the objectives of this study are to determine reference values for Down’s cephalometric analysis in papuans, to evaluate the differences exists between Papuan adult male and female, and also to compare the mean difference between persent study and established value of Down’s norms. A study was conducted on 16 lateral cephalograms of Papuans that have been selected based on inclusion criteria. The Down’s method was used for the cephalometric analysis. The data obtained was processed statistically to determine the mean, standart deviation, and minimum-maximum value, and presented in the form of frequency, table, or diagram. The result showed that the normal cephalometric values of papuans different from the normal values used in the Down’s analysis. The values obtained in this research is expected to be a reference in conducting Down’s cepahlometric analysis in Papuans for orthodontic treatment purposes.

Evaluation and Comparisons of Steiner's Analyses in Class I, Class II, and Class III Patients of Central India as an Aid in Orthodontic Treatment Plan

Background: Cephalometric values particular to one ethnic group may not be applicable to others. Purpose: The purpose of the study was to evaluate and compare Steiner's analyses in Class I, Class II, and Class III patients of Central India in two different age groups. Materials and Methods: Sample size comprised 240 patients belonged to Central India. Patients were divided into two main groups: Group I comprised 120 young children in age of 12–16 years and Group II comprised 120 young adults in age of 18–22 years. Steiner's analysis was done from the data collected to assess skeletal and dental parameters. Results: Central Indian patients had bimaxillary dentoalveolar protrusion, particularly predominant in Class I and Class II males and Class III females. Central Indian patients had predominant retrognathic jaws in comparison to Caucasian norms. Conclusions: The differences of skeletal and dental parameters indicate that Caucasian norms cannot be truly adhered to Central India patients during orthodontic treatment. Incisors were normally more proclined in Central Indian patients and their overretraction during orthodontic treatment would cause flattening of facial profile and therefore should be avoided.

A Study to Evaluate Cephalometric Hard Tissue Profile of Maharashtrian Population for Orthognathic Surgery

Aim: Variability exists in the ethnic groups that are separated by culture and geographic boundaries. The aim of this study was to evaluate hard tissue profile of well-balanced and clinically acceptable Maharashtrian population. Furthermore, compare the cephalometric values of Maharashtrian population with the established norms of Caucasians. Materials and Methods: Lateral cephalogram of 100 patients (50 males and 50 females) in the age group of 20–30 years, were taken in the natural head position. Cephalometric analysis was performed on them and compared to the values of the Caucasians. Results: Statically significant differences were obtained in the between the Maharashtrian population and the Caucasians. Maharashtrian males have a straighter profile, reduced vertical height, and reduced mandibular divergence compared to Caucasian males. Maharashtrian females have a convex profile, reduced vertical height and reduced mandibular divergence. Conclusion: Since significant differences were found in the Maharashtrian population compared to the Caucasians. These values should be taken into consideration when assessing the Maharashtrian patient with facial deformity to obtain optimal results.

The Influence of Maxillary Incisor Labiolingual Inclination on Smiling Profile Esthetics Among Saudis.

ObjectivesThe study aimed to (1) determine the impact of maxillary incisor inclination on profile view esthetic perception, (2) determine the most esthetic inclination and correlate it with a profile view, and (3) evaluate the difference in the perception of orthodontists, dentists, and laypeople toward incisor inclination attractiveness in Saudi Arabia.Materials and methodsA well-balanced smiling photograph of a male adult who fulfilled the criteria for soft tissue and cephalometric values was taken from a profile view. The photograph was modified to stimulate three inclinations toward the labial and palatal side each. The most retroclined photograph showed −15° inclination, and the most proclined photograph showed +15° inclination, with the originally taken photograph being neutral at 0° inclination. Thus, we obtained seven photographs with 5° of difference between each. All photographs were randomly distributed in a questionnaire form filled by 135 participants.ConclusionThe most attractive reported inclination was −5° inclination, while the least attractive inclination was +15° inclination. Excessive proclination has been less desirable than retroclination. The profile smiling view is very useful in evaluating the inclination of the labial face tangent and should be considered a standard view for orthodontic photographic records.

Determination of treatment options for Class III malocclusions in adult patients based on cephalometric values: a systematic review

Abstract Objective The present systematic review aimed to determine cephalometric values that may be used as a guide in deciding between orthodontic camouflage and orthognathic surgery to treat a Class III malocclusion in adults. In addition, a secondary aim was to identify treatment complications and aesthetic perceptions by laypersons/orthodontists. Methods Without a language restriction, an electronic search of six databases and a hand search of three orthodontic journals were performed until September 2021. All studies comparing orthodontic camouflage and orthognathic surgery in Class III malocclusion patients, were included. Data extraction was carried out independently by two authors with disagreement resolved by a third author. The risk of bias related to individual studies was appraised using a modified version of the STROBE checklist. The results were summarised qualitatively, and no meta-analysis was undertaken due to the high heterogeneity between the studies. Results With the quality of evidence ranging from moderate to high, six retrospective studies were included. A cephalometric analysis comprising the Holdaway angle, overjet, the Wits appraisal, lower incisor inclination, the maxillary-mandibular ratio, overbite, gonial angle and an additional combination were used as a guide. No treatment complications were reported. One study examined the perception of facial profile attractiveness in borderline surgical Class III malocclusions and found no difference in outcome and significant improvements in both camouflage and surgical groups. Conclusion The existing evidence is insufficient to identify a cephalometric parameter threshold in deciding between orthodontic camouflage and orthognathic surgery. PROSPERO database protocol no. CRD42020165164.

The perception of attractiveness of the facial profile among people of Telangana ethnicity

Background: The success of orthodontic treatment to a significant extent is largely dependent on the patient's and lay peoples' perception. Treatment can influence the soft tissue profile of the face, which is why, it is important for orthodontists to perceive what is considered attractive and unattractive amongst locals, and further, incorporate this knowledge in their diagnosis and treatment planning for population-specific groups.Aim: To evaluate differences in perception of attractiveness of the human face (in profile view) among ethnic Telangana subjects when compared to ideal Caucasian facial profile attractiveness standards.Methods: Profile silhouettes of ethnic Telangana subjects with straight, convex and concave facial profiles were rated by 10 adult laypersons (ethnic Telangana origin) and scored from least to most attractive. Fifteen relevant soft-tissue parameters from the Ricketts, Legan-Burstone, Steiner's and Z-Merrifield analysis were then evaluated on lateral cephalometric radiographs of the highest scoring subjects (considered most attractive) and sample t test statistical analysis was done in order to investigate differences between obtained values of the 'attractive' group as compared to standard values given in these analyses.Results: Of 15 parameters compared, significant differences from standard cephalometric values were evident for- vertical lip-chin ratio, lower lip protrusion, mento-labial sulcus and Z- angle. These measurements were smaller in the evaluated population group as compared to orthodontic norms.Conclusion: People of ethnic Telangana origin considered a shorter and less prominent lower lip and chin and a shallower mento-labial sulcus to be more attractive, as compared to standard orthodontic cephalometric norms of Caucasian populations.

Gingivosupraperiosteoplasty following Presurgical Maxillary Orthopedics Is Associated with Normal Midface Growth in Complete Unilateral and Bilateral Cleft Patients at Mixed Dentition.

Passive orthodontic appliances and gingivosupraperiosteoplasty are adjuncts that can be used by surgeons at the time of primary cleft lip repair. These treatments, along with the surgical technique of cleft lip and palate repair, may impact midface growth. The objective of this study was to describe the authors' protocol for unilateral and bilateral cleft lip repair and to evaluate midfacial growth in a cohort of patients at mixed dentition who had undergone presurgical passive orthodontic appliance therapy and gingivosupraperiosteoplasty at the time of unilateral and bilateral cleft lip repair. Fifteen complete unilateral and 15 complete bilateral cleft lip and palate patients underwent passive orthodontic appliance treatment and primary lip repair with gingivosupraperiosteoplasty. Lateral cephalograms were analyzed by three blinded reviewers. Mean cephalometric measurements at mixed dentition were compared to cephalometric values for noncleft patients, unilateral cleft lip and palate patients who did not undergo gingivoperiosteoplasty or presurgical treatment, and unilateral cleft lip and palate patients who underwent gingivoperiosteoplasty/nasoalveolar molding with independent samples t tests. Mean cephalometric values were within age-specific normal values for sella-nasion-A point, sella-nasion-B point, A point-nasion-B point, and facial axis. Eighty-seven (13/15) percent of unilateral cleft lip and palate patients and 93 percent (14/15) of bilateral cleft lip and palate patients did not exhibit skeletal class III malocclusion. There was no significant difference between cephalometric values for our patients and patients who did not receive gingivosupraperiosteoplasty or presurgical treatment or who underwent the gingivoperiosteoplasty/nasoalveolar molding protocol. Presurgical passive orthodontic appliances, combined with gingivosupraperiosteoplasty at the time of lip repair, leads to normal maxillary development in most patients at mixed dentition. Assessment of midface growth at skeletal maturity is required. Therapeutic, IV.

Relationship between the Goslon Yardstick and Lateral Cephalometric Analysis Values after Palatoplasty in Unilateral Cleft Lip and Palate Patients

Relationship between the Goslon Yardstick and Lateral Cephalometric Analysis Values after Palatoplasty in Unilateral Cleft Lip and Palate Patients

A Posterior-Anterior Cephalometric Study of Skull Symmetry in Patients With Neurofibromatosis Type 1.

Neurofibromatosis type 1 (NF1) is a tumor predisposition syndrome. Bone findings make a significant contribution to the clinical diagnosis of NF1. It has been suggested that there are characteristic skeletal features of the NF1 patients' skull that cause a specific 'NF1 facies'. To test this thesis, skull examinations were carried out on NF1 patients. The posteroanterior (PA) cephalograms of 76 patients with NF1 were analyzed using defined measuring points. Patients with confirmed facial plexiform neurofibromas (PNF) were excluded from the study. A special interest of the investigation was the symmetry of the measuring points defined as the distance to the median sagittal plane. NF1 patients have a slightly larger distance to the Z-plane than controls at the zygomatic arch and mastoid measurement points (p=0.027 and 0.028, respectively). In contrast, the distances of the juga and antegonion measurement points from the horizontal reference plane are larger in the control group (p=0.002 and 0.480, respectively). The transverse development of the midface at the level of the zygomatic arch showed no differences from the control group (p=0.841). The transverse diameter of the skull at the mastoid and juga measurement points is smaller in the NF1 group compared to the control group (p=0.010 and 0.002, respectively). There is a statistically significant left-right (LR) asymmetry of the distances to the median sagittal plane in favor of the left side in the patient group (p=0.002 to 0.037). However, the numerical deviations from the control group are small overall. Considering the natural, biological deviations of cephalometric measurements of the individual from idealized geometric norms, the facial skeleton of NF1 patients is symmetrically developed. It is unlikely that the calculated LR asymmetry of the patients has a visible effect. In comparison to cephalometric values of a normal population, no characteristic facial skeleton of the NF1 patient in the PA projection of the skull can be derived from these findings. Clear asymmetries of the facial skeleton should give rise to further diagnosis to clarify the suspicion of facial PNF.

Obstructive sleep apnea syndrome in obese, non-obese and control children

Obstructive sleep apnea syndrome (OSAS) in children is a highly prevalent disorder. Adenotonsillectomy is considered the first line of treatment. The aim of this study is to assess the effect of adenotonsillectomy on the apnea-hypopnea index (AHI), on the cephalometric values and on arch width measurements in obese and non-obese children with OSAS, and to compare the arch width measurements with a control group. A quasi-experimental prospective study was performed. Children aged between 2 and 12 years were recruited. The sample was divided into three groups: 1. Obese children with OSAS (n=15), 2. Non-obese children with OSAS (n=117), 3. Matched control group (n=106). A child was considered obese when the body mass index was higher than 95 th percentile. All subjects underwent anthropometric measurements and alginate impressions. A polysomnography and teleradiography were taken only in both experimental groups. These records were also taken after one year. Kruskal-Wallis and Wilcoxon test were used to compare the quantitative variables. Regarding the arch width variables, there were statistically significant differences (p-value <0.05) between both OSAS group and control group. However, there were no statistically significant differences between the cephalometric and arch width variables between obesity and non-obesity group. After adenotonsillectomy AHI improved in non-obese OSAS group (p-value <0.001), but no statistical differences in AHI were found in the obese OSAS group. The dentofacial characteristics were similar in both obese and non-obese OSAS children. However, adenotonsillectomy improved the AHI in non-obese children more than in obese children.