Adenoid hypertrophy is a common cause of pediatric upper-airway obstruction and is suspected to contribute to "adenoid facies", but longitudinal thresholds and causal dose-response relations between the adenoid-nasopharyngeal (A/N) ratio and craniofacial growth indices remain unclear. We performed a two-center longitudinal cohort study of children aged 3-10years who underwent clinically indicated lateral nasopharyngeal or cephalometric radiography between July 2021 and July 2024 at tertiary pediatric hospitals in Shanghai and Chongqing, China. Children with at least two eligible radiographic visits were included. The exposure was the distance-based A/N ratio at the earlier visit. Outcomes were annualized changes in standard cephalometric angles and mesh-based vertex angles, with emphasis on cranial-base and posterior maxillary/nasopharyngeal angles. Thresholds were screened using single-break segmented regression, and causal dose-response functions were estimated using generalized propensity score models stratified by sex and age. A total of 4,271 children contributed 4,907 temporally ordered within-child radiograph visit pairs (each pair links an earlier and a later visit; children with ≥ 3 visits contribute multiple pairs). The median baseline A/N ratio was 0.601 (interquartile range, 0.549-0.652). Across 189 angles, segmented regression identified a reproducible breakpoint band around A/N ≈ 0.62-0.69. Generalized propensity score analyses showed positive, approximately linear dose-response functions for multiple cranial-base and posterior maxillary/nasopharyngeal angles, with global slopes typically 10-25°/year per 1.0 increase in A/N and 80th-20th percentile contrasts of about 1-4°/year. Baseline two-group comparisons showed synchronous reductions of about 3° in SNA (sella-nasion-A angle) and SNB (sella-nasion-B angle) in children with adenoid hypertrophy, with ANB (A-nasion-B angle) largely unchanged. Higher radiographic A/N ratios were associated with threshold-sensitive, age- and sex-dependent craniofacial remodeling. As a 2D radiographic surrogate, A/N does not replace endoscopic or functional assessment. Combining A/N with selected cephalometric angles may help identify children who warrant closer follow-up and endoscopic evaluation during sensitive growth windows.

ObjectiveTo study craniofacial growth and hypodontia in individuals born with Van der Woude syndrome (VWS) and compare with matched controls with and without a cleft.DesignA multicenter retrospective case-control study.SettingIndividuals from three craniofacial centers in Sweden and from a historical archive of Swedish healthy children were included.PatientsSixty individuals, with VWS (n = 20), non-syndromic cleft lip and/or palate (NSCL/P) (n = 20), and healthy controls (CTR) (n = 20), matched for age, gender and cleft type.InterventionsTwo lateral cephalograms per individual, taken at 10 and 16 years of age, were analyzed. Orthopantomograms were used to evaluate hypodontia.Main Outcome MeasuresCraniofacial growth followed longitudinally, with the primary variables SNA, SNB, ANB, NL/ML, and maxillary length. Prevalence of hypodontia was also recorded.ResultsMaxillary length increased 0.3 mm in the VWS group during puberty, compared to 4 mm in the NSCL/P group and 5.5 mm in the CTR group. Both cleft groups had a retruded maxilla at 16 years of age. The change in vertical jaw relation from 10 to 16 years showed a statistically significant difference between the VWS and the CTR group, with a slightly more posteriorly inclined mandible in the VWS group at 16 years. A statistically significant difference in hypodontia is seen between the cleft groups. In the VWS group, 90% had hypodontia compared to 60% in the NSCL/P group.ConclusionIndividuals born with VWS have reduced maxillary growth during puberty and a higher prevalence of hypodontia compared to matched controls in the studied population.

Craniofacial growth is regulated by a complex interaction of genetic, functional, and systemic metabolic factors. Mechanical loading generated during mastication plays a fundamental role in mandibular development through bone modeling and remodeling mechanisms. In contrast, Type I diabetes mellitus is associated with impaired bone metabolism, which may compromise skeletal growth. Although the independent effects of functional loading and metabolic disorders on bone tissue have been widely investigated, their combined influence on mandibular development remains insufficiently understood. This study primarily aimed to evaluate the effect of Type I diabetes mellitus on mandibular growth in growing rats and, secondarily, to assess the impact of dietary consistency (hard versus soft food) on mandibular development under diabetic and non-diabetic conditions, as well as determine whether diabetes modifies the mandibular adaptive response to increased masticatory loading. An experimental animal study was conducted using twenty-four male Wistar rats aged one month. The animals were randomly allocated into four groups according to metabolic status (control or diabetic) and dietary consistency (hard or soft diet). Type I diabetes mellitus was experimentally induced in the relevant groups using streptozotocin. All animals underwent cone beam computed tomography (CBCT) scanning at baseline (Day 1) and at the end of the experimental period (Day 28). Linear measurements were obtained using specialized software following euthanasia. Two-way ANOVA was used to evaluate the effects of diabetes, diet, and their interaction, using appropriate post hoc tests for multiple comparisons. Categorical variables were analyzed using the chi-square test. A p-value < 0.05 was considered statistically significant. Longitudinal morphometric analysis demonstrated that Type I diabetes mellitus significantly impaired mandibular growth. Diabetic animals exhibited reduced growth rates and smaller final mandibular dimensions compared with controls. Hard diet intake significantly enhanced mandibular development in control animals, reflecting a strong adaptive response to increased functional loading. However, this osteogenic response was markedly attenuated in diabetic rats. Under soft-diet conditions, differences between control and diabetic groups were diminished, indicating that reduced mechanical stimulation limits adaptive growth responses. Significant interaction effects between diabetes and dietary consistency were observed in several morphometric parameters, particularly those related to mandibular body length, ramus height, and condylar position. Type I diabetes mellitus exerts a detrimental effect on mandibular growth in growing rats and compromises the adaptive response of craniofacial structures to mechanical loading. Although a hard diet functions as a potent osteogenic stimulus, its growth-promoting effect is substantially reduced in the presence of metabolic dysfunction.

To compare craniofacial morphology between individuals with isolated cleft lip (CL), cleft lip and palate (CLP), and a matched control group before and after the pubertal growth spurt. Cephalometric data from before and after the growth spurt were collected from 71 anonymized patients, of whom 29 (40.8%) had CLP, 13 (18.3%) had CL and 29 (40.8%) non-cleft control patients presenting Angle Class I malocclusion. Data analysis included raw and standardized mean values along with comparisons using ANOVA and Kruskal-Wallis tests. The significance level was set at 0.05. At baseline, mean ages were comparable across groups: 8.24 ± 0.94 years (control), 8.24 ± 0.94 years (CL), and 8.33 ± 2.44 years (CLP). The cleft groups included a higher proportion of male individuals (CL: 76.9%, CLP: 62.1% vs. 48.3% for control), although not statistically significant. Patients with CL had significantly higher A-Nasion-B angle when compared with CLP and control groups. Individuals with CLP presented significantly lower values of Sella-Nasion-A and Sella-Nasion-B angles and significantly higher values of mandibular plane to Sella-Nasion and gonial angles when compared to the control group. Changes in the maxillo-mandibular relationship were observed in the CLP and CL groups, reaching Class III and Class I relationships after the growth spurt, respectively. Although normal prepubertal maxillary prominence was observed in children with CL, impaired sagittal maxillary growth was recorded in this group during puberty. Individuals with CLP or CL present significant differences in maxillary and mandibular morphology and growth, which should be considered in orthodontic planning and treatment.

To evaluate the association between dietary consistency, masticatory patterns, and the presence of posterior crossbite in growing patients,and to explore potential preventive strategies. Maxillary constriction, frequently associated with posterior crossbite, presents challenges to craniofacial development. Modern dietary habits, characterised by softer food textures, reduce masticatory demand, potentially contributing to maxillary hypoplasia.However, the translational impact of dietary consistency on general health and craniofacial development remains underexplored. A case-control study was conducted with 106 participants divided into two groups: case (posterior crossbite) and control (non-crossbite). Dietary habits were assessed through a validated questionnaire that categorised foods by consistency. Masticatory cycles were analysed using a kinesiograph to identify normal, reverse, and atypical patterns. Statistical analyses included chi-square tests and regression models, with significance set at p < 0.05. This study confirms a significant association between dietary consistency, masticatory patterns, and posterior crossbite. The findings underscore the role of dietary texture in craniofacial development,highlighting the importance of preventive dietary strategies to support both craniofacial growth and general health.Further longitudinal studies are recommended to validate these findings and guidetranslational orthodontic interventions.

Arthrogryposis multiplex congenita (AMC) is a diverse group of conditions characterized by multiple joint contractures. Although individually rare, these disorders are estimated to affect 1 in 3000-5000 live births. Their common pathophysiological mechanism is fetal akinesia, a sustained reduction of fetal movement that may arise from intrinsic disturbances-such as central nervous system malformations, motor neuronopathies, neuropathies, neuromuscular junction defects, congenital myopathies, muscular dystrophies, or metabolic diseases-or from extrinsic factors including uterine constraint, maternal illness, infections, or toxic exposures. Reduced fetal motion leads to relatively uniform clinical manifestations, known as the fetal akinesia deformation sequence (FADS), which is characterized by craniofacial anomalies, pulmonary hypoplasia, growth restriction, and contractures. Currently, AMC is classified by clinical features, such as distal arthrogryposis or lethal congenital contracture syndromes. However, advances in molecular genetics have shown wide variability among conditions classified into the same category. Prognosis is widely variable, ranging from lethal perinatal forms to non-progressive mild conditions. This review discusses AMC etiologies from a topographic standpoint, considering the different levels of the motor system involved, by combining current clinical, genetic, and pathophysiological information.

Further studies are needed to better characterize the association between craniofacial growth and feeding methods in infants aged 0-6 months. To evaluate the longitudinal association between feeding modality (exclusive breastfeeding versus mixed feeding) and craniofacial growth in infants aged 0-6 months. Observational, analytical, longitudinal cohort study. A total of 120 infants were evaluated four times. Nine craniofacial variables were assessed: four width, two height, and three depth measurements. Growth increments were estimated by feeding type, and linear mixed models were used to assess associations with craniofacial development. Exclusively breastfed infants showed greater increases in anthropometric and craniofacial measures compared with mixed feeding. Significant differences were observed in total craniofacial height (3.50 ± 0.08 vs. 3.25 ± 0.01 cm; p = 0.046), anterior facial height (2.08 ± 0.40 vs. 1.76 ± 0.07 cm; p = 0.016), maxillary depth (2.33 ± 0.04 vs. 2.21 ± 0.11 cm; p = 0.007), and mandibular depth (2.55 ± 0.02 vs. 2.41 ± 0.12 cm; p = 0.040). Exclusive breastfeeding was associated with greater craniofacial growth from 0 to 6 months compared with mixed feeding, supporting its role in early craniofacial development.

Analysis of surgical timing and treatment patterns in patients with cleft lip and palate using Korean Health Insurance Review and Assessment Service (HIRA) big data.

The management of malocclusion during the mixed dentition is a crucial time for preventive and interceptive orthodontic intervention, given the complex interactions among craniofacial growth, tooth eruption, and orofacial function. Despite widespread use of early orthodontic treatment, uncertainty still remains about the optimal timing, choice of appliance, and long-term stability. This review collates recent evidence and proposes a functional-preventive approach to managing malocclusion in the mixed dentition, emphasizing risk assessment, etiologic control, and individualized treatment planning rather than traditional appliance therapy. A structured literature search was performed across PubMed/MEDLINE, Scopus, and Web of Science, including clinical trials, cohort studies, and systematic reviews on epidemiology, diagnosis, prevention, and interceptive treatment. The existing evidence supports early treatment for certain conditions, such as functional crossbites, developing Class III malocclusion, transverse maxillary deficiency, and space loss due to premature tooth loss. On the other hand, early treatment of Class II malocclusion and vertical discrepancies remains debatable due to limited long-term benefit. Preventive measures like caries prevention, space maintenance, and myofunctional treatment play a critical role in treatment stability. Emerging technologies, such as digital diagnostics, artificial intelligence-assisted analysis, and airway assessment, may enhance patient selection and treatment precision, but their clinical use should be interpreted with caution. In summary, this review shows a shift towards interdisciplinary, evidence- and biology-based decision-making to achieve stable occlusal and balanced craniofacial development.

Craniofacial development in children with cystic fibrosis.

Does the use of costochondral graft in paediatric temporomandibular joint ankylosis result in satisfactory outcomes? A systematic review of the literature.

Background: Pediatric mandibular reconstruction requires restoration of mandibular continuity while accounting for craniofacial growth, dental development, and long-term functional outcomes. Although vascularized osseous free flaps are widely used, the influence of defect characteristics and patient age on donor-site selection remains unclear. This study evaluated patterns of flap selection in relation to mandibular defect classification and patient age. Methods: This retrospective single-center cohort study included 75 patients aged 1–18 years who underwent microvascular mandibular reconstruction between 2011 and 2025. Donor sites included the fibula, iliac crest, and medial femoral condyle. Mandibular defects were classified according to the Brown classification. Associations between defect class, age, donor-site selection, and flap loss were analyzed. Results: The fibula flap was used most frequently (52.0%), followed by the iliac crest (44.0%) and medial femoral condyle (4.0%). Donor-site selection was significantly associated with Brown defect classification (p < 0.001). Age differed across donor-site groups, with fibula flaps used more often in younger patients and iliac crest flaps in older patients. However, after stratification by defect class, age-related differences were not statistically significant. Overall flap survival was 93.3%, and age was not associated with total flap loss. Conclusions: Donor-site selection showed a stronger association with defect characteristics than with patient age. Observed age-related patterns likely reflect differences in defect morphology. These findings support the clinical relevance of a defect-oriented framework for pediatric mandibular reconstruction; however, flap selection remains individualized and influenced by multiple patient- and surgeon-related factors.

Temporomandibular disorders (TMD) are increasingly recognized in children and adolescents, yet their diagnosis and clinical management remain less clearly defined than in adult populations. Despite evidence that TMD symptoms often emerge during critical periods of craniofacial growth and that TMD-related pain in adolescence substantially increases the risk of persistence into adulthood, pediatric TMD remains underrepresented in research, clinical guidelines, and professional education. The review synthesizes emerging consensus on age-appropriate screening tools and diagnostic frameworks based on adaptations of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for children and adolescents; highlights the importance of interdisciplinary, biopsychosocial approaches for early identification, prognosis, and management of pediatric TMD; and identifies key gaps in epidemiology, diagnostic validation, and longitudinal outcomes. When pediatric-specific evidence is available, this review summarizes practical approaches to screening, clinical examination, and psychosocial assessment that are feasible in primary care and pediatric dental settings. Gaps in the validation of diagnostic tools and thresholds across developmental stages are identified as pressing research priorities, as they directly influence epidemiological estimates, clinical decision-making, and care pathways.

Background: Reconstruction of maxillary defects in pediatric patients presents unique challenges related to craniofacial growth, functional rehabilitation, and long-term treatment planning. Although microvascular free-flap reconstruction is established in pediatric head and neck surgery, maxilla-specific data remain limited. This study aimed to describe donor-site selection patterns in pediatric maxillary microvascular reconstruction and to explore their relationship with patient age. Methods: This retrospective observational study included pediatric patients (aged 1–18 years) who underwent microvascular free-flap reconstruction of the maxilla between August 2011 and September 2025 at a single tertiary referral center. Clinical variables included age, defect characteristics, reconstruction timing, donor-site, and total flap loss. Donor-site selection patterns were analyzed in relation to patient age using nonparametric statistical methods. Results: Fifty-five patients were included. Overall flap survival was 81.82% (45/55). Donor-site selection demonstrated a significant association with patient age (p < 0.05). Younger children were more frequently reconstructed using soft-tissue flaps, whereas osseous flaps were more commonly used in older children and adolescents. No significant relationship was found between age and defect extent or reconstruction timing. Conclusions: In this single-center experience, pediatric maxillary reconstruction followed an age-adapted pattern, with soft-tissue flaps preferentially used in younger patients and osseous flaps more frequently selected in older children. These findings reflect differences in reconstructive priorities across developmental stages and support individualized planning in pediatric maxillary reconstruction. Age alone was not associated with total flap loss; however, this analysis was limited by the small number of flap loss events.

Background: Investigation of craniofacial growth and maturation, particularly of structures such as the spheno-occipital synchondrosis (SOS) and mandibular condyle cortication (MCC), provides valuable insight into late adolescent development. These markers may serve as valuable tools in age assessment, especially in legal and forensic contexts, where accurate determination of the 18-year threshold is critical. In addition, understanding their maturation can support more accurate assessment of skeletal development and improve clinical decision-making in growth-related dental treatments. Methods: This retrospective observational cross-sectional study was conducted to evaluate the stage of SOS and MCC maturation on a group of 230 individuals aged 14–22 years. Data was acquired from the mid-sagittal and sagittal sections of CBCT images representing, respectively, the SOS and the condyles. MCC was assessed bilaterally using a three-type system (Types I–III), and SOS fusion was evaluated using a four-stage system (Stages 0–3). Statistical analysis was performed to evaluate the association and correlation between the variables. Results: The Kruskal–Wallis test showed statistically significant differences in the age distribution of right and left MCC types, as well as SOS fusion stages (p < 0.001). Statistically significant differences were found in age distributions between all four SOS fusion stages in the MCC Type II groups of both condyles in both sexes, as well as Type III groups of the right condyle in both sexes and the left condyle in females (p < 0.001). Statistically significant differences were not observed in the MCC Type I group of the right and left condyle in both sexes and in the Type III group of the left condyle in males (p > 0.05). Spearman’s correlation analysis showed that the correlation between SOS fusion stages and MCC types was positive and statistically significant both between the parameters and with chronological age between sexes (rs = 0.461–0.534, p < 0.001). Conclusions: This study revealed a statistically significant association and correlation between the maturation of the SOS, the MCC and chronological age. Simultaneous MCC Type III and SOS Stage 3 maturation was predominantly observed in individuals aged 18 years or older, although a small number of cases were identified below this threshold. SOS fusion and MCC may serve as skeletal parameters for age assessment; thus, they could be used as an adjunct method in a multifactorial age assessment procedure.

Correction to: Non-invasive ventilation treatment and craniofacial growth in children: A scoping review.

Research linking pediatric craniofacial growth, airway physiology, and sleep-disordered breathing has expanded rapidly in recent years. However, a structured overview of global research trends in this interdisciplinary field remains limited. This study aimed to map publication patterns, international collaboration networks, and evolving thematic structures in pediatric craniofacial growth and airway research between 2020 and 2024. A bibliometric analysis was conducted using records retrieved from the Web of Science Core Collection. Original research articles and reviews published between 2020 and 2024 were included. Annual publication trends, international collaboration networks, keyword co-occurrence, and thematic evolution were analyzed using Bibliometrix and VOSviewer. A total of 1214 publications were included. Annual output showed a positive but non-significant upward trend over time. China, Italy, and the United States were the most productive countries, with the United States also occupying a central position in the international collaboration network. Keyword mapping revealed major thematic clusters related to airway function and OSA, craniofacial growth, congenital anomalies, surgical adaptation, and three-dimensional imaging. Thematic evolution analysis demonstrated a shift from broadly anatomical growth-focused research toward clinically oriented and disease-specific topics in the later years of the study period. Contemporary pediatric craniofacial research is characterized by expanding global collaboration and a progressive shift toward integrative physiologic and clinically focused frameworks linking dentofacial development with respiratory function. These findings highlight clinical priorities and may inform future interdisciplinary research directions in pediatric airway management and growth-related orthodontics.

Background: Skeletal deep bite malocclusion (Angle Class II division 2) represents a common vertical skeletal discrepancy characterized by excessive anterior overbite and a hypodivergent craniofacial growth pattern. The contribution of cranial base morphology to mandibular growth direction during early development remains incompletely understood. Objective: To evaluate the relationship between cranial base morphology and maxillofacial growth patterns in children with skeletal deep bite, using a longitudinal cephalometric approach. Materials and Methods: This retrospective longitudinal cohort study included 96 prepubertal patients aged 7–10 years (54 with skeletal deep bite, 42 Angle Class I dentoalveolar controls). Skeletal deep bite was defined by overbite > 4 mm and mandibular plane angle (FMA) < 22°. A total of 298 standardized lateral cephalometric radiographs (2–4 per subject; mean follow-up 24 ± 4 months) were analyzed. Twenty-two cephalometric parameters were assessed. Longitudinal changes were evaluated using repeated-measures analysis, and predictors of deep bite severity were identified using multiple linear regression. Results: Compared with controls, the deep bite group exhibited significantly reduced mandibular plane angle (18.5° vs. 24.0°), smaller gonial angle (104.3° vs. 111.0°), and decreased lower anterior facial height (86.3 mm vs. 92.0 mm; all p < 0.001). Differences in cranial base morphology were modest, including reduced anterior cranial base length (58.6 mm vs. 60.0 mm; p = 0.031). Regression analysis identified gonial angle and lower anterior facial height as significant predictors (R2 = 0.58). Longitudinal analysis suggested early tendencies toward forward mandibular rotation and reduced vertical growth rate over the observation period. Conclusions: In prepubertal children, skeletal deep bite is associated with early tendencies toward reduced vertical facial development and forward mandibular rotation. Cranial base morphology appears to be associated with mandibular growth direction as a secondary modulatory factor rather than a primary determinant. Early identification of hypodivergent growth indicators may facilitate timely interceptive orthodontic strategies.

Background and Objectives: Childhood obesity is a major global health concern and is increasingly recognized as a factor influencing skeletal development. Emerging evidence suggests that excess adiposity may alter craniofacial growth patterns, with potential implications for orthodontic diagnosis and treatment planning. However, the extent to which obesity affects craniofacial morphology in growing individuals remains incompletely understood. This study aims to evaluate the association between body mass index (BMI) and craniofacial morphology in children and adolescents using selected sagittal and linear parameters, and to assess the independent effects of age and sex. Materials and Methods: This cross-sectional orthodontic study included 130 subjects aged ≤ 19 years. Anthropometric measurements were recorded, and BMI was used to classify participants as normal weight, overweight, or obese. Standardized lateral cephalometric radiographs were analyzed using skeletal and soft-tissue parameters. Statistical analyses included normality testing, one-way ANOVA with post hoc comparisons, and multivariate modeling. Results: Obesity was significantly associated with increased sagittal skeletal dimensions. Mandibular body length, mandibular unit length, SNB angle, and maxillary unit length demonstrated progressive increases across BMI categories (p < 0.05). In contrast, vertical growth parameters showed no significant differences. Soft-tissue analysis revealed reduced facial convexity and lower facial height ratios in obese subjects. Age was strongly associated with increases in linear jaw dimensions, whereas sex differences were limited primarily to skeletal size rather than morphological relationships. Conclusions: Childhood obesity is associated with enhanced sagittal craniofacial growth, particularly involving mandibular structures, while vertical skeletal patterns remain largely unaffected. These findings highlight the importance of incorporating BMI assessment into orthodontic evaluation and suggest that obesity may influence growth timing, facial morphology, and airway-related risk factors.

Background/Objectives: This cross-sectional study aimed to estimate the Locally Estimated Scatterplot Smoothing (LOESS)-smoothed percentiles for growth trajectories and evaluate age-related tendencies across groups using visual cross-sectional graphs. Methods: A total of 1147 patient records were analyzed, including 648 females and 469 males aged 5–20 years, with a mean age of 11.9 (SD ± 3.8) years. Twenty-seven cephalometric variables were organized into six measurement domains: cranial base, maxillary complex, mandibular complex, occlusal plane, vertical relationship, and sagittal relationship. Percentile curves were generated using LOESS regression across an age range of 5–20 years. Results: The LOESS-smoothed curves showed age-related trends across age groups. An upward trend in the curves was observed for the anterior and posterior cranial bases between 5 and 12 years of age, a plateau indicating reduced age-related change across groups during mid-adolescence. Maxillary measurements showed a similar pattern, with a clear upward tendency during childhood and reduced age-related change after approximately 12 years. Mandibular length and projection showed increasing trends during childhood, followed by a plateau or reduced slope across later age groups. The occlusal plane and vertical dimensions showed consistent patterns that approached a plateau around 12 years, indicating minimal age-related differences between groups. Changes in the ANB angle and Wits appraisal reflected a progressive forward tendency of the mandible across childhood age groups, followed by reduced age-related change during adolescence. Conclusions: These findings suggest that many craniofacial measurements show an upward trend during childhood followed by a plateau or reduced age-related change across age groups between approximately 12 and 14 years. The percentile-based growth curves presented here offer a practical reference for clinicians to evaluate craniofacial growth trajectories as population-level approximations derived from cross-sectional data in the pediatric population.