Cranial Base Angle Research Articles

Neurocranial Growth in the OIM Mouse Model of Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is a disorder of type I collagen characterized by abnormal bone formation and weakened bone architecture. Human patients with OI have larger cranial vaults (macrocephaly), altered cranial base morphology including basilar invagination and platybasia (skull base flattening), and midfacial underdevelopment. The neurocranial changes may affect both underlying nervous tissue and growth patterns of the facial skeleton. However, we still do not fully understand how and when these divergent morphologies occur. The aims of this study are: (1) to investigate the integrated development of the skull and the brain in a mouse model of OI; and (2) to identify the developmental trajectories of these structures to facilitate future therapeutic interventions. We hypothesize that compared to unaffected mice, mice with OI will have decreased brain volumes due to an overall reduction in cranial size and decreased cranial base angles (CBA) due to platybasia.To test these hypotheses, we used the osteogenesis imperfecta murine (OIM or B6C3FE a/a‐Col1a2oim/J), a model for the severe type III OI in humans, and unaffected wild‐type (WT) littermates. Mice were imaged using in vivo micro‐computed tomography (micro‐CT) at the juvenile (week 4; 10 OIM/14 WT) and adult (week 16; 9 OIM/11 WT) stages. All measurements were taken in 3D Slicer software. 82 cranial landmarks were used to calculate centroid size, an estimate of overall head size. The segmentations tool was used to create virtual endocasts as a proxy for brain volume. The angle tool was used to measure CBA in the midsagittal plane using three landmarks: foramen cecum, midsphenoidal synchondrosis, and basion. Mann‐Whitney U tests were used to compare centroid sizes, brain volumes, and CBA between the genotypes.Both juvenile (p=0.008) and adult (p=0.003) OIM mice were found to have absolutely smaller brains than WT mice. However, OIM mice also have significantly smaller cranial centroid sizes compared to WT mice (p=0.003, p<0.001). When scaled to cranial size, juvenile mice had relatively larger brain volumes (p=0.016) but adult OIM relative brain volumes were not significantly different from WT. No significant difference was seen in CBA at the juvenile (p=0.065) or adult (p=0.171) stages, however a trend was observed for decreased CBA at the adult stage.These results suggest that neurocranial dysmorphologies in OI may be more severe at earlier stages of postnatal development. Previous analyses of these mice have documented relative skeletal macrocephaly in both juvenile and adults, however here we document an increase in relative endocranial volume only at the juvenile stage. A reduction in CBA during growth, possibly due to platybasia, may underlie this decoupling between external and internal cranial morphology. Future work will investigate the effect of CBA on facial growth and midfacial underdevelopment in these mice. A better understanding of the integration and growth trajectory of the neurocranium is foundational for formulating treatments to manage basicranial instabilities in patients with OI.

Evaluation of the Effects of Distal Malocclusion Activators on the Craniofacial Complex

Introduction: Class II malocclusions are the most commonly seen, and therefore, the most commonly treated type of anomalies. Dental and skeletal factors are involved in the development of Class II malocclusions. The purpose of this study was to investigate whether or not there were any changes in the increased cranial base angle and cranial base dimensions, which have been reported to be among the morphological characteristics of Class II malocclusions, with functional orthopedic treatment and to evaluate effects of these changes on facial structures. Materials and Methods: The study was conducted on hand-wrist radiographs and lateral cephalometric radiographs of 50 patients taken at the beginning and at the end of treatment. The control group comprised 17 patients and the treatment group comprised 17 patients who were treated with a Class II division 1 activator and 16 patients who were treated with a combination of Class II division 1 activator and an Occipital Headgear (Hg). Results: Among the measurements for cranial base dimensions, only the increase in S-N in the treatment group was smaller than that in the control group. No significant differences were found among groups regarding the values of NSBa and NSAr angles, which are known to be cranial base angles. Conclusion: The increase in the S-N dimension being smaller in the treatment group brings about the idea that the activator treatment may influence maxillary development and consequently the nasomaxillary complex.

The first 3D analysis of the sphenoid morphogenesis during the human embryonic period

The sphenoid has a complicated shape, and its morphogenesis during early development remains unknown. We aimed to elucidate the detailed morphogenesis of the sphenoid and to visualize it three-dimensionally using histological section (HS) and phase-contrast X-ray CT (PCX-CT). We examined 65 specimens using HS and 57 specimens using PCX-CT, and summarized the initial morphogenesis of the sphenoid during Carnegie stage (CS) 17 to 23. The 3D models reconstructed using PCX-CT demonstrated that some neural foramina have the common process of "neuro-advanced" formation and revealed that shape change in the anterior sphenoid lasts longer than that of the posterior sphenoid, implying that the anterior sphenoid may have plasticity to produce morphological variations in the human face. Moreover, we measured the cranial base angle (CBA) in an accurate midsagittal section acquired using PCX-CT and found that the CBA against CS was largest at CS21. Meanwhile, CBA against body length showed no striking peak, suggesting that the angulation during the embryonic period may be related to any developmental events along the progress of stages rather than to a simple body enlargement. Our study elucidated the normal growth of the embryonic sphenoid, which has implications for the development and evolution of the human cranium.

Craniofacial and dentoalveolar morphology in individuals with Prader\u2013Willi syndrome: a case-control study

BackgroundPrader–Willi syndrome (PWS) is a complex multisystem genetic disorder with distinct genetic and clinical features. Among other clinical symptoms, PWS is characterized by severe infantile hypotonia with feeding problems, childhood onset hyperphagia, obesity, scoliosis, short stature combined with growth hormone deficiency and developmental delay. PWS is associated with facial dysmorphology, orofacial dysfunction, oral abnormalities, low salivary flow and subsequent severe tooth wear. Little is known about the craniofacial growth direction or dental and skeletal relationships in individuals with PWS in different ages. The purpose of this study was to assess the craniofacial and dentoalveolar characteristics and to investigate the craniofacial growth direction separately in children, young adults and adults with PWS, using a cephalometric analysis of lateral cephalograms.ResultsLateral cephalograms of 42 individuals with a confirmed genetic diagnosis of PWS were analysed and divided into three groups according to their age: Children (< 12 years), young adults (12–20 years) and adults (> 20 years). Cephalometric variables were compared between PWS patients and controls by age and sex. Significant deviations and distinct craniofacial patterns were found in children, young adults and adults with PWS compared with the control group. Children showed retrognatic mandible with a skeletal class II relationship, posterior growth direction and longer anterior face height. The young adults had smaller cranial base angle, a skeletal class II pattern and a higher anterior lower face than the control group. Adults with PWS had a prognathic mandible, skeletal class III relationship with anterior growth direction, more retroclined lower incisors and proclined upper incisors than the controls. Similar results were found when comparing the three groups with PWS; the adults had a prognathic mandible, skeletal class III pattern and anterior growth direction. Children had a retropositioned mandibula, skeletal class II relationship and posterior growth direction.ConclusionThis study may contribute to a better understanding of the craniofacial growth pattern in children, young adults and adults with PWS and may have a clinical importance when planning dental treatment, such as prosthodontics and/or orthodontics.

Cranial base parameters in adults with skeletal class I and class II skeletal pattern.

OBJECTIVE:Cranial base parameters exhibit wide variations. This study evaluated cranial base morphological characteristics of class II and class I malocclusions to identify risk factors for class II skeletal malocclusions.METHODS:In this cross-sectional study, we recruited 30 class I adults and 30 class II adults and collected their lateral cephalograms. The cranial base length was calculated by measuring the base of the skull by determining the length of sella-to-nasion, basion to pterygomaxillary fissure, and pterygomaxillary fissure to point A. The cranial base angle was measured by the angle formed by the basion, sella, and nasion, and the base of the angle, which connects the basion and nasion, was measured.RESULTS:The independent t-test for combined values showed no significant differences in one angular and five linear measures between groups. However, one angular measurement was positively correlated when men and women in class I and class II groups were analyzed separately.CONCLUSION:Male patients with class II patterns exhibited larger cranial base angles than did those with class I patterns. Our study suggested that cranial base features have a minimal role in the development of class II malocclusions.

Assessment and Evaluation of Soft Tissue Measurements between Various Mandibular Divergences in the South Indian Population: A Cephalometric Study.

Aim:The aim of this study is to evaluate the association between the mandibular divergent patterns and soft tissue chin (STC) thickness measured at different chin levels in nongrowing patients.Methodology:Pretreatment lateral cephalograms of 400 adult patients were segregated into four groups based on mandibular divergence pattern defined by the mandibular plane to cranial base angle (average 32° ± 5°), Group I with low angle (below 27°), Group II with medium low angle (28°–32°), Group III with medium high angle (33°–36°), and Group IV with high angle (above 37°). STC thickness was measured between Pog-Pog' (pogonion), Gn-Gn' (gnathion), and Me-Me' (menton), thickness and height of the upper and lower lips were also measured. Statistical analysis was done using one-way analysis of variance followed by post hoc Tukey analysis.Results:A significant difference in the STC thickness at Pog, Gn, and Me was observed among all four groups with hyperdivergent patterns, showing decreased STC thickness than the hypodivergent mandibular pattern. Thickness of the upper and lower lips was greater in hypodivergent mandible, whereas height of the lips was greater in hyperdivergent mandible.

Loeys-Dietz and Shprintzen-Goldberg syndromes: analysis of TGF-β-opathies with craniofacial manifestations using an innovative multimodality method

BackgroundElevated transforming growth factor-beta (TGF-β) signalling has been implicated in the pathogenesis of Loeys-Dietz syndrome (LDS) and Shprintzen-Goldberg syndrome (SGS). In this study, we provide a qualitative and quantitative analysis...

Craniofacial and Craniocervical Features in Cartilage-Hair Hypoplasia: A Radiological Study of 17 Patients and 34 Controls.

BackgroundBiallelic mutations in the non-coding RNA gene RMRP cause Cartilage-hair hypoplasia (CHH), a rare skeletal dysplasia in which the main phenotypic characteristic is severe progressive growth retardation.ObjectiveThis study compared the cranial dimensions of individuals with CHH to healthy subjects.MethodsLateral skull radiographs of 17 patients with CHH (age range 10 to 59 years) and 34 healthy individuals (age range 10 to 54 years) were analyzed for relative position of the jaws to skull base, craniofacial height and depth, as well as vertical growth pattern of the lower jaw, anterior cranial base angle, and the relationship between the cervical spine and skull base.ResultsWe found that the length of the upper and lower jaws, and clivus were significantly decreased in patients with CHH as compared to the controls. Anterior cranial base angle was large in patients with CHH. Basilar invagination was not found.ConclusionThis study found no severe craniofacial involvement of patients with CHH, except for the short jaws. Unexpectedly, mandibular deficiency did not lead to skeletal class II malocclusion.Clinical ImpactAlthough the jaws were shorter in patients with CHH, they were proportional to each other. A short posterior cranial base was not associated with craniocervical junction pathology.

Craniomaxillofacial Changes Using High-Pull J-Hook Headgear and Mini-Implant Anchorage in Adolescents: A Structural Superimposition Method.

The aim of this study was to compare the craniomaxillofacial changes when using high-pull J-hook headgear (HPJH) and mini-implants (MIs) as maxillary anchorage in adolescents. 40 female adolescents with dentoalvolar protrusion were divided into 2 groups; the HPJH group (n=20) and the MI group (n=20). Lateral cephalograms taken before treatment (T0) and after anterior tooth retraction (T1) were superimposed on the stable structures and then craniomaxillofacial changes were evaluated. The cranial base angle, SNB, and facial angle decreased in the HPJH group but increased in the MI group. ANB decreased more in the MI group than in the HPJH group. Mandibular plane angle increased in the HPJH group but decreased in the MI group. Facial height index increased in the MI group while it showed no change in the HPJH group. Mandibular true rotation occurred clockwise in the HPJH group and counterclockwise in the MI group. Maxillary central incisors were intruded and retracted more in the MI group than in the HPJH group. Maxillary first molars were extruded in the HPJH group and were intruded in the MI group. Maxillary first molars were protracted more in the HPJH group than in the MI group. Mandibular central incisors were retracted more in the HPJH group than the MI group. Mandibular first molars were extruded more in the MI group than in the HPJH group. More favorable craniomaxillofacial changes occurred in the MI group than in the HPJH group.

Differences in the heritability of craniofacial skeletal and dental characteristics between twin pairs with skeletal Class I and II malocclusions.

ObjectiveTo investigate differences in the heritability of skeletodental characteristics between twin pairs with skeletal Class I and Class II malocclusions.MethodsForty Korean adult twin pairs were divided into Class I (C-I) group (0° ≤ angle between point A, nasion, and point B [ANB]) ≤ 4°; mean age, 40.7 years) and Class II (C-II) group (ANB > 4°; mean age, 43.0 years). Each group comprised 14 monozygotic and 6 dizygotic twin pairs. Thirty-three cephalometric variables were measured using lateral cephalograms and were categorized as the anteroposterior, vertical, dental, mandible, and cranial base characteristics. The ACE model was used to calculate heritability (A > 0.7, high heritability). Thereafter, principal component analysis (PCA) was performed.ResultsTwin pairs in C-I group exhibited high heritability values in the facial anteroposterior characteristics, inclination of the maxillary and mandibular incisors, mandibular body length, and cranial base angles. Twin pairs in C-II group showed high heritability values in vertical facial height, ramus height, effective mandibular length, and cranial base length. PCA extracted eight components with 88.3% in the C-I group and seven components with 91.0% cumulative explanation in the C-II group.ConclusionsDifferences in the heritability of skeletodental characteristics between twin pairs with skeletal Class I and II malocclusions might provide valuable information for growth prediction and treatment planning.

Cranial Base Angle in Patients With Cleft Lip and Palate-A Systematic Review and Meta-Analysis.

Background: Diverse findings have been reported for the cranial base angle (CBA) in patients with CLP (cleft lip and palate) and non-CLP controls. Objective: The aim of this study is to assess and evaluate the CBA in patients with CLP and non-CLP controls. Methods: Data from PubMed, OVID Technologies, Inc., Cochrane, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science, and EMBASE for Excerpta Medica dataBASE (EMBASE) with relevant terms was extracted until December 31, 2020. Inclusion criteria were data of patients with non-syndromic unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). In the case of UCLP and BCLP, patients with craniofacial syndromes were excluded. The study proposal was registered with PROSPERO (Registration number: CRD42021228632). Results: Fifteen studies with a total of 2032 participants were included for the systematic review and 14 studies with a total of 1972 participants were included for the meta-analysis. The risk of bias was assessed using the Modified Newcastle Ottawa scale under seven domains by two authors. Thirteen studies were graded as "good" and two as "satisfactory." The CBA in patients with CLP were greater than the non CLP Class I controls in six of the 15 studies. CBA was greater in patients with CLP than non-CLP controls by 1.21° (95% CI of 0.19-2.22). Meta-analysis reported considerable heterogeneity (I2 = 86%). Anterior (ACB) and posterior cranial base (PCB) lengths were shorter in patients with CLP than in the non-cleft Class I controls by 2.14 mm (95% CI of 0.99-3.30) and 2.06 mm (95% CI of 1.52-2.60), respectively. Conclusion: Most studies were graded as good. Patients with CLP had greater CBA and shorter ACB and PCB lengths when compared to non-CLP controls.

Reduced tongue mobility: an unrecognized risk factor of childhood obstructive sleep apnea.

Childhood obstructive sleep apnea (OSA) is an important and prevalent disease. A short lingual frenulum is a risk factor for OSA, but whether tongue mobility also plays a role in OSA etiology remains unknown. This study aimed to examine tongue mobility in children with and without OSA. We hypothesized that reduced tongue mobility was associated with OSA. We also evaluated the relationship between tongue mobility and craniofacial profile. This was a cross-sectional case-control study. Prepubertal Chinese children aged 5-12 years, suspected to have OSA were recruited from our sleep disorder clinic. All subjects underwent overnight polysomnography. The lingual frenulum was evaluated based on tongue mobility and free tongue length. Craniofacial measurements were assessed by lateral cephalometry. Eighty-two subjects (mean age: 8.32 ± 1.70 years, 57 males) were recruited. The mean tongue mobility was 58.2 (±19)% and 67.4 (±15)% (p = 0.019) in subjects with and without OSA, respectively. Tongue mobility was inversely correlated with OAHI (r = -0.218, p = 0.049). In multivariate logistic regression, low tongue mobility was independently associated with a higher risk of OSA after adjustment for age, sex, body mass index z-score, presence of large tonsils and turbinates, and nocturnal oral breathing (odds ratio = 3.65, 95% CI = 1.22 to 11.8). Tongue mobility was found to correlate with the cranial base angle (Ba-S-N) (r = 0.262, p = 0.018), which determines the relative position of the mandible. In prepubertal children, reduced tongue mobility is associated with the occurrence and severity of OSA. Assessing tongue mobility is recommended in childhood OSA management.

Is there a correlation between skull base flexure and palatal anomalies in patients with 22q11 deletion syndrome and velopharyngeal dysfunction?

The study aimed at assessing the relationship between skull base morphology, represented by skull base and nasopharyngeal angles, and palatal anatomy among patients with 22q11DS and velopharyngeal dysfunction.Retrospective analysis of patients with 22q11DS and velopharyngeal dysfunction. Age, sex, severity of velopharyngeal dysfunction, type of cleft (overt cleft palate, submucous cleft palate, occult submucous cleft palate, or no-CP, and cephalometric skull base angles were reviewed. Correlations between type of palatal anomaly and the angles were assessed.Among 132 patients, 71 were male (53.8%) and 61 were female (46.2%), ages 3.3–40.0 years (mean 8.3 ± 6.10). No difference in the mean cranial-base angle (P = 0.353) or in the distribution of the three types of cranial base angle sizes was found among the palatal anomaly groups (P = 0.137). More men had normal cranial base angles and more women had acute angulation (P = 0.008). A positive correlation was found between the skull base and nasopharyngeal angles (P = 0.001, r = −0.590).No direct correlation was found between cranial base morphology and palatal anomalies in patients with 22q11DS, and velopharyngeal dysfunction. This is probably because skull base and palate morphology contribute independently to velopharyngeal dysfunction.

Three-Dimensional Assessment of Craniofacial Features in Patients With Down Syndrome During the Mixed Dentition Period: A Case-Control Study.

Down syndrome (DS) is a common congenital chromosomal disorder related to trisomy 21. Lateral cephalometric radiography studies have shown that patients with DS have characteristic craniofacial morphology; however, no 3-dimensional analysis studies have been performed to investigate the craniofacial features, including volumetric aspects, of patients with DS. The present study was performed to evaluate the craniofacial features, including volumetric aspects, of patients with DS and to compare these findings with control participants using cone beam computed tomography (CBCT). The study sample consisted of 12 patients with DS and 12 control participants. All participants were examined by means of CBCT; the resulting images were used for evaluation of maxillary and mandibular volume, cranial base, and craniofacial measurements. Differences between patients with DS and control participants were statistically analyzed using Student t test. Compared to control participants, patients with DS exhibited statistically significant reductions in maxillary and mandibular volumes. Both sagittal and axial cranial base linear measurements were shorter in patients with DS than in control participants. In contrast, the cranial base angle was enhanced in patients with DS, compared with control participants. Moreover, condylion (Co)-gnathion, anterior nasal spine-menton, and Co-subspinale (point A) measurements were shorter in patients with DS than in control participants; the sella-nasion-mandibular plane angle was significantly reduced in patients with DS, compared with control participants. Our results suggest that patients with DS have distinct skeletal volume and craniofacial morphology features, relative to individuals without DS.

Lip Thickness with Tongue Space Area Assessment By Cephalometric Analysis for Iraqi Adult Sample with Class II Dental and Skeletal Pattern

Background: With different skeletal classes, there may be some variability among the lip thickness andtongue space area that could be the causative factor for skeletal malrelationship so that this study was aimedto determine the tongue and the available boundary space area with lip thickness and correlate them togetherin sample with class II skeletal pattern.Methods: Seventy Iraqi adult subjects (32 males and 38 females) with cl II skeletal pattern who haveincreased over jet and ANB angle greater than four degrees. The cephalometric measurements include upperand lower lip thicknesses with height and length of tongue and position of tongue base and hyoid bonefrom the cervical line. The cephalograms were analyzed using AutoCAD program to measure demandedareas. Results: This study revealed that a significant gender difference was found between T-Area, V-TT,TH, V-FP, AH-CL, AH-FP, and upper and lower lip thickness in which higher mean value in males thanfemales. The correlation between all the measured variables of present sample with SNA, SNB and ANBangles a non-significant difference was found except for V-CL which shows significant difference. Strongcorrelation was found among the T-Area with V-TT, TH, V-FP, AH-CL, AHFP, upper lip thickness and lowerlip thickness.Conclusions: In skeletal class II, the associated cranial base angles shows independent association from theboundary soft tissues so that these variations not always contribute to be the causative factor for skeletaldisharmony

Dentofacial and skeletal pattern in African descendants from southeastern Brazil: clinical prospective study.

ABSTRACTObjective: The aim of this study was to evaluate characteristics of African-Brazilians young adults with excellent dental occlusion, including bimaxillary protrusion; compare them to European-American Caucasian standards, and determine whether there is sexual dimorphism in the display of this phenotype. Methods: Lateral cephalometric radiographs were obtained from 43 African-Brazilians within military personnel (28 males and 15 females, average age 22.4 ± 3.4 years) with normal occlusion, selected from a group of 394 volunteers. Thirty-one angular and linear measurements were evaluated. Student’s t-test for independent samples was used to compare results with those established by European-American standards, previously described in the literature. Results: Considering the dentoalveolar pattern, seven angular and six linear measurements showed statistically significant differences (p< 0.001) when compared to Caucasian cephalometric standards. African-Brazilians’ subjects showed lower cranial base angle (SNAr = 119.87 ± 5.66º) and anterior cranial base length (SN-distance = 68.63 ± 4.50 mm) (p< 0.001). The maxilla (SNA = 88.51 ± 3.23º) and the mandible (SNB = 85.06 ± 3.24º) were protruded in relation to the SN line (p< 0.001). Sexual dimorphism was significant for L1.NB (degrees) (p< 0.01), and interincisal angle (U1.L1) (p< 0.05). Conclusion: African-Brazilian young adults presented differences regarding dental and craniofacial characteristics, when compared to European-American norms. It can be stated that Caucasian cephalometric norms should not be applied to African-Brazilian faces.

Retrognathic maxilla in individuals born with oral clefts is due to intrinsic factors and not only due to early surgical treatment

To determine if the skeletal form of individuals born with oral clefts was associated with maxillary position. Lateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III). When comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group. There are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.

Effect of Obstructive Sleep Apnea on Condylar Malformation, Vertebral Column, and Head Posture: A Cephalometric Evaluation.

Aims and objectivesObstructive sleep apnea (OSA) is by far the most common sleep-related breathing disorder, affecting 2–4% of the adult population. The present study aims to compare the descriptive morphology of the cervical column in subjects with normal craniofacial morphology with those having condylar hypoplasia with OSA and to evaluate a positive correlation between the cervical columns, the cranial base angle, and the posture of the head and neck in subjects of condylar hypoplasia.Materials and methodsThe present study comprised of lateral cephalogram of 40 subjects divided into two equal groups—control groups (n = 20) and OSA with condylar hypoplasia (n = 20).Results and observationThe condylar hypoplasia group has fusion anomalies of 65% and 35% has a posterior arch deficiency. The cervical lordosis, inclination of the cervical column is found to have a positive statistically significant correlation in condylar hypoplasia subjects.ConclusionMorphological deviations and deviation pattern of the cervical column occurred significantly more often in subjects with condylar hypoplasia as compared with normal craniofacial morphology which can be verified by the increased cranial base angle, cervical lordosis, the inclination of the upper cervical spine, and cranial base angle were positively correlated with a fusion of cervical column.Clinical significanceSpecific types of craniofacial morphology and head postures such as a reduced posterior airway space, an abnormally long soft palate, a low position of the hyoid bone, and an extended head posture are considered predisposing factors of OSA. As posture of the head and neck is considered to be associated with OSA, OSA may be associated with fusion of the cervical column. Hence, to know the result of malformation in the cervical column prove to be important with regard to phenotypical subdivision, diagnosis, and treatment of OSA.How to cite this articleDivya, Navit P, Singh R, et al. Effect of Obstructive Sleep Apnea on Condylar Malformation, Vertebral Column, and Head Posture: A Cephalometric Evaluation. Int J Clin Pediatr Dent 2020;13(S-1):S64–S68.

Correlation Between Cranial Base Morphology and Skeletal Maloclusion in a Sample of Sudanese Orthodontic Patients

Objective: This study aimed to evaluate the relationship between the cranial base and jaw base in a sample of Sudanese orthodontic patients. Material and methods: one hundred and twenty lateral Cephalograms from university of Khartoum orthodontic department archive 60 males, 60 females, age 18.3 ± 4.3 years old, were classified into 3 sagittal malocclusion groups (40 individuals each) according to their ANB angle. A cephalometric analysis of the study variables of the cranial base (NSBa, N-S, S-Ba, N-Ba) and jaws bases (SNA, SNB, ANB, A-Co, Gn-Co) was carried out, the morphological characteristics of the cranial and jaw bases in the three groups were compared using One-way ANOVA test and Pearson’s coefficient correlation analysis. Results: Cranial base angle and cranial base lengths did not show significant differences between the main classes of malocclusion studied. However, jaw size was statistically significant different between the 3 groups, longer maxilla was found in Class II group and the mandible was longer in Class III group. Strong significant relation was found between SNA, SNB and NSBa in the three groups. Positive correlation was found between cranial base lengths and maxillary and mandibular lengths among the three groups. Conclusion: Cranial base angulation and lengths has no major role in developing malocclusion.

Racial Disparity of Crouzon Syndrome in Skull and Orbit Morphology, and Their Spatial Relationships

BACKGROUND: Racial disparity in pathological consequences in skull and orbit growth may impact the treatment plan for different patient populations. This study explores skull anatomy for potential differences between Asian and Caucasian cranial morphology in Crouzon syndrome. METHOD: Ninety-one computed tomographic scans were included (Asian Crouzon, n = 12; Asian controls, n = 22; Caucasian Crouzon, n = 16; Caucasian controls, n = 41), and measured using Mimics and 3-matics software. Unique cephalometric measurements related to the orbit were designed. RESULTS: The entire cranial base length was reduced 11.92 mm (P = 0.004) in Asian Crouzon patients, and 14.58 mm (P < 0.001) in Caucasian Crouzon patients, compared with respective controls. The cranial base angle on the facial side of basicranium was more narrowed in Crouzon syndrome in both races, with similar changes of degrees (9.61°, P = 0.002, in Asian Crouzon; 9.20°; P = 0.019, in Caucasian Crouzon). However, the intracranial side was statistically more narrowed only in the Asian group (9.86°; P = 0.003). Both Asian and Caucasian Crouzon patients developed reduced posterior fossa volume, by 15% (P = 0.034) and 17% (P = 0.004), respectively. However, Caucasian Crouzon patients developed a more shortened anterior and middle cranial base than that of Asian patients. The separation of lateral pterygoids was only significantly increased in Caucasian patients (5.49°; P < 0.001). The orbital roof anteroposterior length of Caucasian Crouzon syndrome patients was shortened by 4.03 mm (P = 0.009) compared with Caucasian controls. However, this dimension in Asian patients developed normally. The orbital anteroposterior floor length significantly reduced in both Asian and Caucasian Crouzon syndrome patients, to a similar extent. The medial horizontal angle of single orbit was narrower in Asian patients, compared with Asian controls (19.24°; P = 0.002), yet only insignificantly reduced in Caucasian patients. The visual axes of Caucasian Crouzon syndrome patients had more inferior rotation, by 5.21° (P = 0.005) than in Caucasian controls but did not achieve a statistically significant difference in other comparison pairs. A widened ethmoid sinus is the major shortening in the restricted orbit cone angle in Asian Crouzon syndrome patients, while statistically significant widening of the sphenoid is noted only in Caucasian patients. CONCLUSION: The influence of Crouzon syndrome on cranial and orbital malformation is race influenced. Asian Crouzon patients developed more kyphotic basicranium evaluated intracranially, whereas Caucasian Crouzon patients developed more widened lateral pterygoid bones. The unaffected orbital roof length and shortened orbital floor in Asian Crouzon syndrome patients indicates the Lefort III osteotomy probably is more beneficial in this group of patients than in monobloc advancement.