Craniocervical Posture Research Articles

Evaluation of craniocervical posture after myofascial pain treatment in adults with bruxism: A randomized clinical trial

BackgroundDespite numerous clinical studies on bruxism management, critical evaluation parameters, including the impact of bruxism pain on quality of life and secondary issues like changes in craniocervical posture, are often disregarded. Research questionEvaluate the effect of two treatments on the craniocervical posture of adult patients with myofascial pain. MethodsThis parallel randomized clinical trial included 60 patients with myofascial pain due to probable bruxism that fulfilled the study requirements. A computer-generated random sequence was used to allocate treatments: botulinum toxin-A or occlusal appliance. Follow-up time was 3 and 6 months. Kyphosis angle (α) and head posture measurement by cervical radiograph were assessed using two-way repeated measures ANOVA (alpha = 0.05). ResultsSixty patients were randomized (mean age 30 ± 7.6) and 6 were excluded from the analysis (did not attend follow-up). No statistically significant difference was observed for the head posture measure (p = 0.98) and kyphosis angle (p = 0.74). Mild pain was reported by one patient after botulinum toxin-A application. SignificanceResults indicate that craniofacial posture does not seem to be influenced by the treatment of pain in bruxers. If a better posture is desired, this should probably be targeted with other therapies. Trial registrationClinical Trials NCT03456154.

ANALYSIS OF THE RELATIONSHIP BETWEEN BODY POSTURE AND TEMPOROMANDIBULAR DISORDERS

The temporomandibular joint (TMJ) is one of the most complex joints in the human body, being responsible for the movement of opening and closing the mouth. Dysfunctions that affect the temporomandibular joint have a multifactorial etiology that includes: the joint itself, the chewing muscles and other structures of the stomatognathic system. In this sense, postural movements can be associated as a predisposing factor for temporomandibular disorder (TMD), when analyzing the negative repercussions of body movements reflected in the TMJ. In this way, it is clear that a better understanding of such conditions would therefore contribute to more accurate diagnoses and more comprehensive, coherent and, consequently, more effective therapeutic approaches. A systematic review of the literature was carried out, with the aim of searching for works that support the impact between craniocervical posture and temporomandibular disorders, using references from scientific articles from the last five years in Portuguese and English. Therefore, it is clear that a better understanding of these conditions would therefore contribute to more accurate diagnoses and more comprehensive, coherent and, consequently, more effective therapeutic approaches.

Linking orthodontic treatment and sleep apnea among adult Indian patients

The differences in the effects of orthodontic treatment on airway and craniocervical posture in patients with OSA (obstructive sleep apnea) having skeletal class II high-angle malocclusion is of interest. Hence, 48 individuals with OSA and skeletal class II high-angle malocclusion were chosen from among all patients in need of orthodontic therapy. Every patients had CBCT (cone beam computed tomography) taken both before and after receiving orthodontic therapy. All parameters were assessed on the lateral cephalogram from CBCT in order to assess the indices of craniocervical posture, hyoid position, skeletal and dental conditions. Parameters of upper airway (position of hyoid) showed statistically significant increase in values after orthodontic treatments. Thus, there was increase in values of dimensions of upper airway, post orthodontic treatment. Hence, orthodontic therapy help improve the upper airway morphology and craniocervical posture in patients of OSA with hyperdivergent skeletal class II malocclusion.

Machine learning models for classifying non-specific neck pain using craniocervical posture and movement

ObjectivePhysical therapists and clinicians commonly confirm craniocervical posture (CCP), cervical retraction, and craniocervical flexion as screening tests because they contribute to non-specific neck pain (NSNP). We compared the predictive performance of statistical machine learning (ML) models for classifying individuals with and without NSNP using datasets containing CCP and cervical kinematics during pro- and retraction (CKdPR). DesignExploratory, cross-sectional design. Setting and participantsIn total, 773 public service office workers (PSOWs) were screened for eligibility (NSNP, 441; without NSNP, 332). MethodsWe set up five datasets (CCP, cervical kinematics during the protraction, cervical kinematics during the retraction, CKdPR and combination of the CCP and CKdPR). Four ML algorithms–random forest, logistic regression, Extreme Gradient boosting, and support vector machine–were trained. Main outcome measuresModel performance were assessed using area under the curve (AUC), accuracy, precision, recall and F1-score. To interpret the predictions, we used Feature permutation importance and SHapley Additive explanation values. ResultsThe random forest model in the CKdPR dataset classified PSOWs with and without NSNP and achieved the best AUC among the five datasets using the test data (AUC, 0.892 [good]; F1, 0.832). The random forest model in the CCP dataset had the worst AUC among the five datasets using the test data [AUC, 0.738 (fair); F1, 0.715]. ConclusionML performance was higher for the CKdPR dataset than for the CCP dataset, suggesting that ML algorithms are more suitable than classical statistical methods for developing robust models for classifying PSOWs with and without NSNP.

Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods

The association between craniocervical posture and craniofacial structures in the various sagittal skeletal malocclusion during different growth stages has been the focus of intense interest in fields of orthodontics, but it has not been conclusively demonstrated. Thus, this study aimed to investigate the association between craniofacial morphology and craniocervical posture in patients with sagittal skeletal malocclusion during different growth periods. A total of 150 from a large pool of cephalograms qualified for the inclusion and exclusion were evaluated and classified into three groups according to the Cervical Vertebral Maturation (CVM) by examining the morphological modifications of the second through fourth cervical vertebrae, each group consisted of 50 cephalograms. In each growth period, for the comparison of head and cervical posture differences among various skeletal classes, the radiographs were further subdivided into skeletal Class I (0° < ANB < 5°, n = 16), skeletal Class II (ANB ≥ 5°, n = 18), and skeletal Class III (0° ≤ ANB, n = 16) on the basis of their ANB angle. There was no significant difference in gender (P > 0.05). Some variables were found to be significant during pubertal growth and later in patients with sagittal skeletal malocclusion (P < 0.05). Most indicators describing craniocervical posture were largest in skeletal Class II and smallest in skeletal Class III during the peak growth periods and later. Cervical inclination variables were greater in skeletal Class III than in skeletal Class II. Variables of craniofacial morphology and craniocervical posture are more correlated during the pubertal growth period and later in patients with sagittal skeletal malocclusion. A tendency is an indication of the close interrelationship that a more extended head was in skeletal Class II while a flexed head was in skeletal Class III. Nevertheless, with the considerations of some limitations involved in this study, further longitudinal studies with large samples are required to elucidate the relationship clearly.

Effect of different cranio-cervical positions on abdominal and back muscles activities from different postures: A cross-section study

The aim of this study was to investigate whether changing cranio-cervical postures is associated with changes in abdominal and back muscle activities during bridging and plank positions, and to present the importance of cranio-cervical posture control during trunk stabilization exercises. This was a cross-sectional study that included thirty patients (21 men and 9 women), aged between 18 and 30 years, with no history of previous spinal surgery, other severe musculoskeletal disorders, or neurological disorders, selected from Cairo University's Faculty of Physical Therapy. Every patient was requested to adopt a bridging and a plank position. Surface Electromyography (EMG) was used to assess muscular activation patterns by measuring muscle activity amplitudes. EMG signals of rectus abdominus and lumbar erector spinae in different cranio-cervical postures (extension 25°, neutral, and flexion 25°) were compared. The cranio-cervical posture was controlled utilizing a cervical range of motion device (CROM). Cranio-cervical posture was found to significantly influence trunk muscle activities (p=0.001), with cranio-cervical flexion yielding the highest activity in the rectus abdominus in both bridging (p=0.001) and plank positions (p=0.001), while cranio-cervical extension yielded the highest activity in the lumbar erector spinae in both bridging (p=0.001) and plank positions (p=0.017). Cranio-cervical flexion increased rectus abdominus muscle activity during the bridging and plank positions, while cranio-cervical extension improved lumbar erector spinae muscle activity during the bridging and plank positions. Consideration of cranio-cervical posture is suggested when carrying out trunk stabilization exercises.

Correlation between craniocervical posture and upper airway dimension in patients with bilateral anterior disc displacement

ObjectiveTo investigate the relationship between upper airway dimension and craniocervical posture in adult patients with bilateral anterior disc displacement and to provide some references for clinical diagnosis and plan formulation in orthodontics. MethodsBased on RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorder), 98 Patients were divided into three groups by two experienced TMJ (Temporomandibular Joint) specialists: bilateral disc normal position group (BN), bilateral anterior disc displacement with reduction group (ADDWR) and bilateral anterior disc displacement without reduction group (ADDWoR). Inter-group comparison and correlation analysis were performed after 11 craniocervical posture and 15 upper airway dimension measurements finished with Dolphin and Uceph software in Two or Three-dimensional. ResultsAnterior disc displacement often accompanied with extension of craniocervical posture, as ADDWR and ADDWoR groups have significantly higher cervical curvature and inclination than BN group (P < 0.05). Simultaneously anterior disc displacement often associated with constrained upper airway dimension for the total and each segment upper airway volume were significantly smaller in ADDWR and ADDWoR than BN group (P < 0.05). Correlation analysis revealed that C0-C1 (the distance from the base of the occipital bone (C0) to the posterior arch of the atlas (C1)) is significantly related to the total and each segment upper airway volume reduction (P < 0.05). ConclusionThere exists markedly close correlation between anterior disc displacement and craniocervical posture forward extension, which may be physiologically adaptive cervical extension to keep oropharyngeal airway unobstructed as upper airway dimension constrained by anterior disc displacement. Clinical relevanceThese findings allow us to infer the potential consequences if the treatment of anterior disc displacement would result in an improvement of intervertebral relationships and upper airway constraint.

Correlation between temporomandibular joints and craniocervical posture in patients with bilateral anterial disc displacement

ObjectiveTo study the changes of temporomandibular joints and craniocervical posture in adult patients with bilateral anterior disc displacement, and to explore their correlation, which may provide some clinical value for clinical diagnosis and treatment planning.MethodsNinety-eight adult patients were divided into 3 groups: 29 patients in bilateral disc normal position group (BN), 33 patients in bilateral Anterior Disc Displacement With Reduction group (ADDWR) and 36 patients in bilateral Anterior Disc Displacement Without Reduction group (ADDWoR). Dolphin and Uceph software were used to measure 14 items of temporomandibular joint and 11 items of craniocervical posture for comparison and correlation analysis between groups.ResultsThere were significant differences in bilateral joint space between three groups. Compared with the BN, the anteroposterior diameter of the condyle was significantly reduced, the condyle was significantly displaced posteriorly and superiorly in the ADDWR and ADDWoR, but the joint fossa width and joint fossa depth did not change significantly. Cervical curvature and inclination were greater in patients with anterior disc displacement than BN, indicating that the craniocervical posture of adult patients with anterior disc displacement was extended and protrusive.ConclusionAnterior disc displacement of the temporomandibular joint can displace the condyle upwards and posteriorly and reduce the anteroposterior diameter of condyle, and then make the condyle closer to the wall of articular fossa to induce joint symptoms. Additionally, craniocervical postural position is significantly affected, which may be related to compensate for the effects of airway space.

Rocabado-penning skull-cervical posture in orthodontic patients

The standing balance of the skull on the spine in its cervical portion is a factor of consideration for the diagnosis of cranio-mandibular disorders and alterations in patients of all ages without distinction, that is, it is essential to conceive an accurate diagnosis in children and adults. However, over time, this element had not been taken into account in the differential diagnosis protocol, despite the fact that biomechanical alterations and dysfunctions in both hard and soft tissues are evidenced in a lateral skull teleradiography, essentially requested to initiate treatment. To describe the cranio-cervical posture with the Rocabado-Penning analysis, in patients who come for consultation at the Instituto Latinoamericano de Estudios Superiores (ILES). The study was a cross-sectional descriptive observational study. The anatomical-radiological study was carried out on selected patients from 2012 to 2019 who attended a private institute to undergo orthodontic treatment. Lateral skull radiographs were included where the 7 cervical vertebrae were observed. The sample was made up of 30 patients. 66.7% were female, 96.7% were brachyfacial type, 63.4% had Ricketts skeletal Class I, 63.4% had deep bites, the position of the hyoid bone was low for 63. .4% and the depth of the cervical spine is rectified by 96.7%. No statistically significant relationship was found between skeletal classes and suboccipital distances. In the patients in the sample, class I prevailed, brachyfacial, deep bite, low hyoid bone and rectified cervical spine, the latter could result in pain, tinnitus or other symptoms if not treated in time.

Evaluation of Cervico-vertebral Dimensions and Cranio-cervical Angulations in Adults with Different Vertical Growth Patterns: A Cross-sectional Cephalometric Study

Introduction: The measurement of cervical vertebrae is a valuable diagnostic aid since it provides data on skeletal maturity and potential for growth. Research suggests the existence of a relationship between dentofacial characteristics and craniocervical morphology and posture. This relationship can provide insights into the development and treatment of malocclusions, particularly malocclusions in the vertical dimension. Aim: To compare cervico-vertebral dimensions, morphology, and cranio-cervical postures in subjects with different skeletal growth patterns such as average, horizontal and vertical. Materials and Methods: The study was cross-sectional in design and was conducted for a period of two years between January 2014 and December 2016 at KLE Society’s Institute of Dental Science and Research, Bengaluru, Karnataka, India. A total of 102 lateral cephalograms were taken for the study and classified into three groups according to Frankfurt Mandibular Plane Angle (FMA angle) and Jarabak ratio as Horizontal (HR), Vertical (VR), and Average (AV) groups. Each group comprised 34 subjects (17 males, 17 females). A total of 28 morphological parameters of C3, C4, and C5 in the lateral cephalogram were measured and analysed. Each lateral cephalogram was scanned with a Konica Minolta Bighub Laser printer, and the area measurement was made with IMAGE J software to measure the area of cervical vertebrae. Oneway Analysis of Variance (ANOVA) was used to compare the various parameters between the three groups, and pair-wise comparisons were done using the Least Significant Difference (LSD) test. Student's t-test was done to assess the differences between males and females. A p-value less than 0.05 was considered statistically significant. Results: The mean chronological age of subjects was 21.2±3.14 years for the HR group, 21.3±3.78 years for the VR group, and 21±3.76 years for the AV group. There was a statistically significant difference between the three groups in the measurements of the anterior body height of C3 (ABHC3) (p=0.023), posterior Body Height of C3 (PBHC3) (p=0.007), vertical measurements of C3 (H3) (p=0.010) and (W3) (p=0.013), anterior body height of C4 (ABHC4) (p=0.010), Posterior Body Height of C4 (PBHC4) (p=0.005); H4 (p=0.002); Ratio of H4 and W4 (H4/W4) (p=0.048); area of the third cervical vertebrae (C3) (p=0.039) and area C4 (p=0.024). For cranio-cervical angulation, there were statistically significant differences found for the angle between the Nasion Sella Line (NSL) and the tangent to the Odontoid Process (NSL/OPT) (p&lt;0.001), where the VR group had significantly larger values than the HR and AV groups. There was no significant difference found in fusion anomalies of cervical vertebrae among all three (HR, VR, and AV) groups. Conclusion: The study found that individuals with a horizontal growth pattern tend to have larger cervical vertebral dimensions compared to average and vertical growers. Individuals with a vertical growth pattern exhibited a large cranio-cervical angulation. Overall, males had larger cervical vertebral dimensions compared to females. The studied population did not exhibit any fusion anomalies.

The relationship between myofascial trigger points sensitivity, cervical postural abnormality, and clinical tension-type headache parameters

ABSTRACT Background Myofascial Trigger Points (MTrPs) play a significant role in the pathogenesis of Tension Type Headache (TTH). Abnormal cranio-cervical posture has been linked to various types of headaches. However, the correlation between MTrPs sensitivity, cervical postural alignment, and clinical measures of headache has not been extensively studied in patients with TTH. Objectives To investigate the relationship between MTrPs sensitivity in cervical and pericranial muscles, cervical postural abnormality, and clinical headache parameters in patients with TTH. Furthermore, to investigate the effect of sex on the examined variables and their association with headache type (episodic vs chronic TTH). Methods A total of 72 patients with TTH of both sexes were enrolled in this study. Headache frequency and disability as clinical measures of headache, pressure pain threshold (PPT) of bilateral upper trapezius (UT) and suboccipital (SUB) muscles, cervical lordosis angle (CA), and anterior head translation (AHT) were measured. Results Pericranial MTrPs sensitivity did not demonstrate any correlation with clinical headache parameters or cervical postural abnormality. However, there was a significant correlation between the frequency of headaches and the level of disability (r = 0.32, P < 0.05). In addition, episodic TTH was more prevalent in females who exhibited greater AHT and MTrPs sensitivity of both bilateral UT and right SUB muscles than males. Conclusions There was no correlation found between the frequency of headaches and the level of disability with measures of cervical posture alignment or MTrPs sensitivity in individuals with TTH.. Based on findings, Clinicians should consider sex differences when assessing patients with TTH.

An evaluation of inter-relationship between cervical posture and skeletal malocclusions

Introduction: The growth pattern of the cervical spine and the craniocervical structure are interconnected, inflencing one another both morphologically and functionally. As a result, stretching the head in relation to the cervical spine leads to notable changes, including greater anterior facial height, a shorter sagittal dimension, and a posterior rotation of the jaw. This study was conducted to determine the correlation between cervical curvature in different sagittal skeletal malocclusions and association between cervical lordosis and maxillary and mandibular base. Materials and Method: One hundred fity adults presenting with skeletal Class I, II, and III malocclusion were investigated, irrespective of growth pattern. Three groups were delineated based on the lateral cephalograms of the selected participants: Group 1 (50 skeletal Class I), Group 2 (50 skeletal Class II), and Group 3 (50 skeletal Class III). A comprehensive assessment of cervical posture was conducted through the measurement of manually traced 15 specifi angles, which were carefully chosen to provide a detailed characterization of cervical variations across all three groups. Validity was assessed using Wilk and Kolmogorov-Smirnov tests, and analysis was done using One way Analysis of variance and Post hoc Turkey’s test. Result: Statistically signifiant correlations (P&lt;.05) were found between angles OPT/HOR and CVT/HOR (representing cervical inclination with reference to the true horizontal plane),NSL/CVT, and FH/CVT (indicating middle craniocervical posture), NSL/RL, FH/RL, and NL/RL(reflcting rotation of mandibular ramus). Conclusion: It was proven that changes in head posture and craniofacial development are strongly correlated. The rotation of the mandibular ramus in relation to the cranium was compared between groups, and was found that skeletal Class II malocclusion subjects had more posterior rotation of the ramus in relation to the cranium and extended head compared to those with skeletal Class III and skeletal Class I malocclusion subjects.

The Effect of Cranio-Cervical Position on Core Muscle Activation during the Prone Plank Exercise

This study aimed to investigate the influence of head position on the electromyographical activity of the core muscles during the prone plank exercise. Twenty healthy participants were enrolled in this study. Muscle activation was registered using surface electromyography in the rectus abdominis, external oblique, internal oblique, and the lumbar portion of erector spinae. Three plank conditions were randomly evaluated, varying the position of the cranio-cervical segment during the plank performance (neutral, flexion and extension). The activation of each individual examined muscle and the overall core muscle activity (Total Intensity), as well as the ratings of perceived exertion were analysed with statistical significance set at p &lt; 0.05. Flexion revealed significantly higher Total Intensity values compared to neutral and extension (p &lt; 0.001; effect size (ES) &gt; 0.90). The rectus abdominis presented larger activation in flexion compared to the other variations (p &lt; 0.05; ES &gt; 0.70). Flexion elicited a greater response for both sides of external oblique when compared to neutral and extension, and also for both sides of internal oblique compared to the other conditions (p &lt; 0.05; ES &gt; 0.70). Both flexion and extension reported higher exertion rating values compared to neutral (p &lt; 0.05; ES &gt; 0.90). Head position influenced the electromyographical activation of core musculature, showing highest values when performing the plank in a head flexion.

Three-dimensional evaluation of upper pharyngeal airway, hyoid bone, and craniocervical changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation: A retrospective study

ObjectiveThis study aimed primarily to analyze the three-dimensional (3D) changes in the pharyngeal airway (PA), and secondarily, the hyoid bone (HB) and the craniocervical (CC) following stabilization splint (SS) therapy in adult patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD). MethodsThirty-five adult patients with TMD and MD, who were treated using SS with a mean age of 25.14 ± 6.11 years, were enrolled in this retrospective clinical study. Pre- and post-therapeutic cone-beam computed tomography (CBCT) scans were analyzed. PA dimension,nasopharyngeal, oropharyngeal, hypopharyngeal, sub-hypopharyngeal, and total pharyngeal airway spaces were measured in surface area, volume, minimum constricted area (MCA) and width, HB position, and CC posture were analyzed three-dimensionally using InVivo 6.0.3 and Dolphin 11.95 software. Wilcoxon rank-sum or Paired t-test was conducted, and P < 0.05 was considered significant. ResultsSS therapy was administered for a period of 9.49 ± 4.02 months. The oropharyngeal airway space showed a significant decrease in sagittal width. The hypopharyngeal surface area, volume, MCA, and sagittal width decreased significantly. In terms of HB, hyoid–mandibular plane (H-MP), retrognathia–third vertebra's most inferior–anterior (RGN-C3ia), and retrognathia–Sella (RGN-S) distances significantly decreased. The Nasion–Sella line and the line that passes through C2ip to the odontoid process posterior tangent (NSL-OPT) angle in CC posture also decreased significantly. ConclusionSS therapy in TMD patients with MD mainly results in narrowing of the hypopharyngeal region, no change in HB position and improvement in head posture. These results undoubtedly assist in diagnosis and treatment of clinical conditions.

Differences in the effects of orthodontic treatment on airway-craniocervical functional environment in adult and adolescent patients with skeletal class II high-angle: a retrospective pilot study

IntroductionThis retrospective cohort study aimed to compare the change in upper airway and craniocervical posture after orthodontic treatment between adolescent and adult patients with Class II high-angle malocclusion.MethodsA total of 12 adolescent (mean ± standard deviation age = 13.0 ± 2.0 years) and 12 adult patients with Class II high-angle malocclusion (mean ± standard deviation age = 23.7 ± 6.4 years) were selected in this study. The lateral cephalograms and cone beam computed tomography images of adolescent and adult patients were taken before and after treatment, which can be employed to evaluate the variables of craniofacial morphology, upper airway, and craniocervical posture through paired t tests, respectively. An independent sample t test was performed to observe the differences between two groups after orthodontic intervention. For adults and adolescents, the correlation between craniofacial morphology, upper airway, and craniocervical posture was determined through Pearson correlation analysis.ResultsIn all subjects, the improvements in vertical and sagittal facial morphology after treatment were observed. Anterior and inferior movements of the hyoid bone, an increase of upper airway dimension, posterior tipping of the head and a reduction of cervical inclination in the lower and middle segments post-treatment were identified in adolescence (P < 0.05). Adults displayed anterior movements of the hyoid bone, whereas no significant difference was observed in upper airway dimension and craniocervical posture (P < 0.05). Notable differences were identified in the change of hyoid position and airway volume between two groups (P > 0.05). Mandibular plane inclination, growth pattern, occlusal plane inclination, and chin position were all significantly correlated with craniocervical posture in adolescent patients. Besides, the mandibular growth pattern and chin position in adult patients were significantly correlated with craniocervical posture (P < 0.05).ConclusionsOrthodontic treatment is capable of enhancing the facial profile of patients with skeletal class II high-angle while improving their upper airway morphology and craniocervical posture, where adolescents and adults differ substantially in that the former exhibit a more favorable alteration in the airway-craniocervical functional environment.

Relationship Between Craniocervical Posture and Vertical Face Pattern in Class II Division 1 Malocclusion

Objectives: To evaluate the cervical inclination and craniocervical posture (CCP) in a sample of Class II Division 1 malocclusion with different vertical patterns among adult population in Lahore. Methods: A total of 70 adult skeletal Class II division 1 cases (ANB0 &gt; 4) with Dental Class II malocclusion (molar relation half cusp or full cusp Class II) and Overjet &gt; 5mm, were enrolled in this study. Clinical examination and lateral cephalograms taken in natural head position were traced to classify the malocclusion, determine vertical pattern and evaluation of craniocervical posture Results: Results of the study showed that extended craniocervical posture (forward cervical inclination with backward head rotation) was found in 47.1 % of the study group and was significantly correlated to the vertical pattern of the face (r = 0.496, p =0.000). This indicated that the CCP is not only related to sagittal craniofacial relations but also vertical pattern of the face and as the vertical pattern of face increased the cervical spine inclined forward and the head rotated backwards on spine. Flexed head posture was found to be the least prevalent. Subjects with high vertical pattern of facial development had extended CCP whereas subjects with normal vertical pattern mainly had normal CCP Conclusion: Results of this study suggest a significant relationship between Type of malocclusion and craniocervical posture. There was a moderately strong relationship between vertical pattern of the patient and cervical inclination and craniocervical posture which was highly significant.

Evaluation and Comparison of Cervical Spine Posture in Class II Division I Patients Treated with Twin Block Appliances, Forsus Appliances, and Bilateral Sagittal Split Osteotomy: A Cephalometric Study.

It has been speculated that a change in cervical spine posture occurs due to forward repositioning of the mandible. Therefore, this study aimed to evaluate and compare the cervical spine posture in Class II division one patient treated with three different treatment modalities. A retrospective cohort study was conducted using pre and post-treatment lateral cephalograms of Class II Division one patients who have undergone orthodontic therapy using twin block appliance, Forsus, and bilateral sagittal split osteotomy (BSSO). This study included a total of 57 subjects comprising 19 subjects in each group. Seven cervical, three sagittal, and one vertical parameters were compared within and between each group. The data were tested using the Dependent t-test, One-way analysis of variance, and Tukey's post hoc test. A significant difference existed between the pre- and post-treatment angular measurements within the three groups showing a change in the cervical spine posture with forward positioning of the mandible. A comparison of mean changes in angular measurements between the three groups showed a significant difference in SNA, SNB, ANB, and odontoid process tangent-cervical vertebral tangent (OPT-CVT), indicating a change in the cervical posture. OPT-CVT angle predicts a change in cervical spine posture after treatment with a significant difference in the Twin Block group (P = 0.029) compared to Forsus and BSSO groups. Thus, the twin block group results in a more upright craniocervical posture than the other two treatment groups.

Is Neck Pain Related to Sagittal Head and Neck Posture?: A Systematic Review and Meta-analysis.

Neck pain (NP) is common in all age groups and adversely affects the patients' entire lifestyle. There exists inconclusive evidence relating faulty craniocervical posture with pain-related disability. This review aims to determine whether sagittal head and neck posture differs in NP and pain-free subjects, to critically appraise the correlation of posture with NP. Of 3796 articles identified at primary search from CINAHL, PubMed, Google Scholar, EMBASE, 26 were included based on eligibility criteria. Mean pooled difference (MPD) and effect size (ES) were calculated to establish relationship among studies, to assess postural correlation with NP measures [Visual Analogue Scale (VAS), Numeric Pain Rating Scale (NPRS), neck disability index (NDI), Northwick Park NP Questionnaire (NPQ)] and for age- and gender-wise variation. Risk of bias was assessed using Newcastle-Ottawa Quality Assessment Scale. Craniovertebral angle (CVA) had a significant MPD of -2.93(95% CI -4.95 to -0.91). Sagittal head angle (SHA) and forward head posture (FHP) had an insignificant MPD of 1.15 (95% CI -1.16 to 3.46) and -0.26 (95% CI -1.89 to 1.36), respectively. Age- and gender-wise CVA difference was found to be 2.36° and 2.57°, respectively. ES was significant for correlation between CVA and pain intensity [NPRS: -0.44 (95% CI -0.61 to -0.26); VAS: -0.31 (95% CI -0.46 to -0.16)], and between CVA and disability [NDI: -0.18 (95% CI -0.31 to -0.05); NPQ: -0.47 (95% CI -0.61 to -0.320)]. CVA differs for age, gender, and pain vs pain-free subjects, and correlates negatively with NP measures. Other surrogate measures (SHA, cranial and cervical angles, FHP) warrant further research. PROSPERO 2021 CRD42021275485.

Cone-Beam Computed Tomographic Evaluation of Hyoid Bone Positioning in Temporomandibular Joint Management – A Pilot Study

Background: Hyoid bone plays an important role in craniomandibular functions through its unique interaction with other structures. The effects of temporomandibular disorder (TMD) on the craniocervical posture and position of hyoid bone were considered, although the results endure inconclusive. Objective: The objective is the comparison of the position of the hyoid bone in patients with the temporomandibular joint disorder of pre- and post-neuromuscular orthotics utilizing cone-beam computed tomography (CBCT). Treatment using ultra-low-frequency transcutaneous electric nerve stimulation was administered, and a myocentric bite was registered, with which an orthotic was fabricated and delivered to the patient for full-time wear. Materials and Methods: The hyoid bone position of 14 TMD patients of pre- and post-treatment was observed using CBCT, and symptom severity score, joint pain, joint sounds, and limited mouth opening were studied pre- and post-treatment clinically. Results: All patients had relief of symptom severity score post treatment and no significant improvement in the anteroposterior direction of hyoid bone with no statistical significance with P value &lt; 0.001. The majority of the patients had an inferiorly positioned hyoid bone post intervention with a P value less than 0.001. Conclusion: Neuromuscular orthotics resulted in a decrease in the symptom severity score of the patients along with an anteriorly and inferiorly positioned hyoid bone.

Cephalometric assessment regarding craniocervical posture in orthodontic patients

A major factor that contributes to dental malocclusions is represented by the positioning of the mandible. Considering the existing interconnections between the craniocervical and craniomandibular systems it is interesting to assess how changes in one system can influence the other, thus establishing a pattern in terms of certain cephalometric landmarks that orthodontists could consider when diagnosing and evaluating an orthodontic case. Therefore, the aim of this study was to investigate the connections between cervical posture, head position, hyoid bone position in orthodontic patients with different skeletal patterns. 45 lateral cephalometric radiographs were analyzed. Skeletal class and vertical growth were the main elements that were considered when classifying patients. Craniofacial and Cervical landmarks were determined on the cephalograms, from which lines and angles resulted which were considered relevant in our study. Correlations between cephalometric variables of the patients were determined. there were some statistically significant changes identified concerning craniocervical posture and hyoid bone position between the patients in the following parameters: H-Rgn, OPT/HOR, CVT/HOR, OPT/SN, CVT/SN, H-SN. The results obtained allowed us to conclude that there were some differences at the skeletal level of the sample of patients studied. The findings are indicating that there is a close relationship between, mandible position, cervical- and head posture and the hyoid bone. The information obtained in this study could help to better understand the development of malocclusions, and to improve the orthodontic diagnostic and treatment plan.