Skeletal Deviation Research Articles

Comparison of craniomaxillofacial morphology in children with unilateral cleft lip and palate treated with/without presurgical nasoalveolar molding - a retrospective study with a mean age of 5 years.

To three-dimensionally assess differences in craniomaxillofacial skeletal development in patients with operated unilateral cleft lip and palate (UCLP) treated with/without presurgical nasoalveolar molding (PNAM) with a mean age of 5 years. Cone-beam CT radiographs of 30 patients with UCLP who had undergone PNAM and 34 patients with UCLP who did not receive PNAM were analyzed. The data were stored in DICOM file format and were imported into the Dolphin Imaging program for 3D image reconstruction and landmark identification. 33 landmarks, 17 linear and three angular variables representing craniofacial morphology were analyzed and compared by using the Mann-Whitney U tests. The vast majority of linear variables and 3D coordinates of landmark points reflecting craniofacial skeletal symmetry were not significantly different between the two groups. In terms of craniofacial skeletal development, the PNAM group had a significantly smaller anterior nasal spine offset in the midsagittal plane and a greater maxillary length compared to the non-PNAM group. Evaluations performed in early childhood showed that treatment with/without PNAM in the neonatal period was not a major factor influencing craniomaxillofacial hard tissue development in patients with UCLP; moreover, PNAM treatment showed significant correction of skeletal deviation at the base of the nose. Follow-up in early childhood has shown that PNAM treatment administered during the neonatal stage does not impede maxillary development and has benefits in correcting nasal floor deviation. It is a viable option for improving nasal deformity in children with unilateral cleft lip and palate.

The Skeletal Stability of Combined Surgery First Approach and Clear Aligners in Skeletal Class III Malocclusion Correction: A Randomized Controlled Trial

The surgery first approach (SFA) and clear aligners technique can address traditional treatment defects, such as prolonged waiting times for surgery and a less desirable facial appearance due to wire aligners. However, the curative effect of the combination remains uncertain. The randomized controlled study aimed to evaluate the skeletal stability of the SFA compared to the conventional orthodontic first approach (OFA), both of which were applied with clear aligners. A total of 74 participants were randomly allocated to two groups: the SFA group (experimental) and the OFA group (control). The skeletal deviation was calculated using reconstruction models from computed tomography scans taken immediately and 6 months after surgery. The largest median deviations were detected in the y-axis of the mandible for both two groups, separately 1.36 mm in the experimental group and 1.19 mm in the control group. Apart from the maxillary yaw dimension (p = 0.005), there were no significant differences between the two groups in terms of linear and angular deviation. The experimental group had an overall treatment time of 18.05 ± 2.53 months, while the control group took 22.83 ± 3.60 months (p < 0.05). Therefore, the combined surgery-first and clear aligners treatment can achieve comparable skeletal stability to the conventional approach, while also saving significant time.

TREATMENT OF SEVERE CROWDING WITH SELF-LIGATING FIXED ORTHODONTIC APPLIANCE

Introduction: Crowding in orthodontics presents a discrepancy between tooth size and dental arch length. Crowding of teeth is more often diagnosed in mandibular dental arch. Crowding was classified as moderate (-5.1 mm or more of discrepancy), mild (-0.1 and -5 mm) of discrepancy, and no crowding (zero or a positive discrepancy) by W. Proffit. Over the last few years, the use of self-ligating brackets in orthodontics has progressed considerably. According to some authors, selfigating appliances are more ef- fective in treating moderate crowding. Aim: To present the treatment of cevere crowing of both dental arches without premolar extractions, using self-ligating fixed orthodontic appliance. Material and method: Male patient 12 years old was diagnosed with severe crowding in both upper and lower dental arches. Study cast analysis showed severe crowding of 8 mm in the upper and 9 mm in the lower dental arch with dental class I. Lateral cephalometric analysis showed slight mandibular retrogna- thism (SNB 78°) with skeletal class I (ANB 4°). There were no significant vertical skeletal deviations (SpP/ MP 20°, Bjork’s sum 389°, Jarabak 67,7%). Both upper and lower central incisors were retroinclined (I/SpP 102°, IMPA 95°). There were no deviations in maxillar corpus and mandibular corpus and ramus length. Treatment with self-ligating fixed orthodontic appliance was indicated. The active phase of the treatment lasted 26 months. During the treatment, interproximal reduction (IPR) was performed on upper and lower front teeth. Results and conclussion: Stable class I occlusion was acheieved. Both upper and lower dental arches were slightly expanded. Severe crowding was treated successfully Treatment result was stable, with no signs of relapse, with the overjet of 2 mm and overbite of 3 mm. Severe crowding in young patients can be succsess- fully treated without extractions with self-ligating fixed orthodontic appliance in cases of horizontal growth pattern ,with retroinclined upper and lower incisors.

Alterações esqueléticas do eixo axial e de membros inferiores em crianças e adolescentes com excesso de peso

To evaluate the presence of axial skeletal deviations in children and adolescents and to relate them to body mass index (BMI), age and sex. 101 patients aged 7 to 17 years old were included in this study; exclusion criteria were primary orthopedic diseases and syndromes or treatments that affect growth. Patients were grouped according to their BMI Z-score: eutrophic (n=29), overweight (n=18) and obese (n=54). They underwent static clinical inspection was made by simetrographic technique. Intermaleolar distance was obtained, Adam's forward bend and tiptoe tests were performed. When comparing obese and eutrophic patients, changes in the cervical spine (p<0.01), spine (p<0.001), hip (p<0.01) and shoulders (p<0.001) were present in more than half of the obese patients (62.5%, 62.2%, 79.9% and 55.4%, respectively). Changes in the knees were more frequent among obese (p<0.001) when compared to eutrophic patients. There was no variation regarding age or sex (p>0.05). being overweight influences skeletal deviations in children and adolescents.

Effects of different surgical techniques and displacement distances on the soft tissue profile via orthodontic-orthognathic treatment of class II and class III malocclusions

BackgroundOrthognathic surgery can be carried out using isolated mandibular or maxillary movement and bimaxillary procedures. In cases of moderate skeletal malocclusion, camouflage treatment by premolar extraction is another treatment option. All these surgical procedures can have a different impact on the soft tissue profile.MethodsThe changes in the soft tissue profile of 187 patients (Class II: 53, Class III: 134) were investigated. The treatment approaches were differentiated as follows: Class II: mandible advancement (MnA), bimaxillary surgery (MxS/MnA), upper extraction (UpEX), or Class III: maxillary advancement (MxA), mandible setback (MnS), bimaxillary surgery (MxA/MnS), and lower extraction (LowEX) as well as the extent of skeletal deviation (moderate Wits appraisal: − 7 mm to 7 mm, pronounced: Wits <− 7 mm, > 7 mm, respectively). This resulted in five groups for Class II treatment and seven groups for Class III treatment.ResultsIn the Class II patients, a statistically significant difference (p ≤ 0.05) between UpEX and moderate MnA was found for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), and mentolabial angle (Pog’-B′-Li). In the Class III patients, a statistically significant differences (p ≤ 0.05) occurred between LowEX and moderate MxA for facial profile (N′-Prn-Pog’), soft tissue profile (N′-Sn-Pog’), upper and lower lip distacne to esthetic line (Ls/Li-E-line), and lower lip length (Sto-Gn’). Only isolated significant differences (p < 0.05) were recognized between the moderate surgical Class II and III treatments as well between the pronounced Class III surgeries. No statistical differences were noticed between moderate and pronounced orthognathic surgery.ConclusionsWhen surgery is required, the influence of orthognathic surgical techniques on the profile seems to be less significant. However, it must be carefully considered if orthognathic or camouflage treatment should be done in moderate malocclusions as a moderate mandibular advancement in Class II therapy will straighten the soft tissue profile much more by increasing the facial and soft tissue profile angle and reducing the mentolabial angle than camouflage treatment. In contrast, moderate maxillary advancement in Class III therapy led to a significantly more convex facial and soft tissue profile by decreasing distances of the lips to the E-Line as well as the lower lip length.

Endoscopy-Assisted 1-Stage Correction of the Crooked Nose Airway Function and Aesthetic Morphology.

The aims of the study were to explore the application of endoscopy in the correction of septal deviation and nasal skeletal deviation in crooked nose deformity and, using multiple evaluation methods, to investigate the effect of endoscopy-assisted 1-stage surgery in restoring crooked nose airway function and aesthetic morphology. From March 2015 to March 2018, 45 patients with nasal septum and skeletal deviation were treated with endoscopy-assisted septoplasty simultaneously with rhinoplasty. The follow-up period was at least 8 months. Treatment effects were evaluated both objectively and subjectively using various methods. All cases showed certain degree of airway function and nose morphology improvement. In patients with abnormal nasal ventilation, the volume and minimal cross-sectional area increased significantly after the surgery (t = 2.470 and 3.134, respectively, P < 0.05). External nose deviation distance measured on 3-dimensional models decreased significantly from 3.230 ± 1.661 mm to 1.997 ± 1.037 mm after the surgery (t = 3.772, P < 0.05). Patients visual analog scale score of nasal patency and nose morphology were significantly improved (t = 5.795 and 7.187, respectively, P < 0.05). Overall patient satisfaction was 100%, and no complication (nasal septal perforation, nasal cavity synechia, etc) was reported. Septal deviation combined with external nose deflection can be corrected by endoscopy-assisted rhinoplasty and septoplasty simultaneously, to achieve 1-stage improvement of crooked nose morphology and nasal airway function. This approach has the advantages of minimal invasion, clear surgery vision, less pain, and shorter recover time. It has fewer complication and better outcomes and worth clinical promotion and application.

Three-Dimensional Dynamic Analysis of the Facial Movement Symmetry of Skeletal Class III Patients With Facial Asymmetry

Dynamic asymmetry has not been as rigorously evaluated as static asymmetry for patients with skeletal deformity but could well be even more important. The aim of the present study was to evaluate the dynamic facial movement of Class III patients with facial asymmetry using a 3-dimensional (3D) motion capture system. The present cross-sectional study recruited patients with skeletal Class III malocclusion with and without facial asymmetry. A 3D facial motion capture system was used to record the expression process of a maximal smile. Eleven orofacial landmarks were selected to analyze and calculate the cumulative distance and average speed of each landmark during smiling. The predictor variable was mandibular symmetry. The outcome variables consisted of the measurements of each soft tissue landmark and the absolute differences for the paired landmarks between 2 sides. Other variables consisted of descriptive data, including the age and gender of each patient. The data were analyzed using independent ttests and paired t tests. Bonferroni's adjustment was used to control for multiple comparisons. A total of 63 patients were divided into 2 groups, an asymmetric group (n=46) and a control group (n=17), according to the degree of skeletal deviation. The difference in the cumulative distance of the bilateral cheilions was statistically significant between the 2 groups (P=.002). The difference for the asymmetric and control groups was 2.06±1.78mm and 1.00±0.79mm, respectively. In the asymmetric group, a comparison of the deviated side with the nondeviated side revealed statistically significant differences in the magnitude of motion for the cheilion (P<.01) and midlateral lower lip (P<.01). The patients with skeletal asymmetry also showed asymmetry in soft tissue functions while smiling. The magnitude of movement in the nondeviated side was greater than that in the deviated side.

Prevalence and dimensions of sella turcica bridging in Japanese female orthodontic patients

PurposesThe purposes of this study were to examine the prevalence of sella turcica bridging; to evaluate age-related differences in sella turcica dimensions and the prevalence of sella turcica bridging; and to clarify the associations of sella turcica dimensions and bridging with maxillofacial skeletal patterns and dental anomalies, such as tooth agenesis and impaction, in Japanese female orthodontic patients. Materials and methodsLateral cephalograms and panoramic radiographs of 232 Japanese female orthodontic patients, aged 7–35 years, were examined. In addition to conventional cephalometric measurements, sella turcica diameter (STD), interclinoid distance (ICD), and degree of ICL calcification [(STD ICD) to STD ratio] were evaluated. ResultsSella turcica bridging occurred in 5.6% of all subjects. The mean values of STD, ICD, and degree of ICL calcification were 9.8mm, 3.9mm, and 60.0%, respectively. STD and degree of ICL calcification were larger and ICD was smaller in the ≥19-year-old group than in the 7–12-year-old group. No significant difference in sella turcica dimension or bridging prevalence was found in the anteroposterior or vertical skeletal pattern. Subjects with tooth impaction showed shorter ICDs and greater degrees of ICL calcification than did those without tooth impaction. ConclusionsThe prevalence of sella turcica bridging was 5.6%, and STD, ICD and degree of ICL calcification increased with age, in Japanese female orthodontic patients. In addition, sella turcica morphology and bridging were associated with tooth impaction, but not with maxillofacial skeletal deviations.

Anthropometric Study of Three-Dimensional Facial Morphology in Malay Adults.

ObjectivesTo establish the three-dimensional (3D) facial soft tissue morphology of adult Malaysian subjects of the Malay ethnic group; and to determine the morphological differences between the genders, using a non-invasive stereo-photogrammetry 3D camera.Material and MethodsOne hundred and nine subjects participated in this research, 54 Malay men and 55 Malay women, aged 20–30 years old with healthy BMI and with no adverse skeletal deviation. Twenty-three facial landmarks were identified on 3D facial images captured using a VECTRA M5-360 Head System (Canfield Scientific Inc, USA). Two angular, 3 ratio and 17 linear measurements were identified using Canfield Mirror imaging software. Intra- and inter-examiner reliability tests were carried out using 10 randomly selected images, analyzed using the intra-class correlation coefficient (ICC). Multivariate analysis of variance (MANOVA) was carried out to investigate morphologic differences between genders.ResultsICC scores were generally good for both intra-examiner (range 0.827–0.987) and inter-examiner reliability (range 0.700–0.983) tests. Generally, all facial measurements were larger in men than women, except the facial profile angle which was larger in women. Clinically significant gender dimorphisms existed in biocular width, nose height, nasal bridge length, face height and lower face height values (mean difference > 3mm). Clinical significance was set at 3mm.ConclusionFacial soft tissue morphological values can be gathered efficiently and measured effectively from images captured by a non-invasive stereo-photogrammetry 3D camera. Adult men in Malaysia when compared to women had a wider distance between the eyes, a longer and more prominent nose and a longer face.

Unilateral and bilateral dental transpositions in the maxilla-dental and skeletal findings in 63 individuals.

This was to elucidate dental and skeletal findings in individuals with unilateral and bilateral maxillary dental transpositions. The sample comprised of radiographic materials from 63 individuals with maxillary dental transpositions from the Departments of Odontology at the Universities of Copenhagen and Aarhus and by the Danish municipal orthodontic service. The cases were divided into three groups: unilateral transposition of the canine and first premolar (Type 1U), bilateral transposition of canine and first premolar (Type 1B), and unilateral transposition of canine and lateral incisor (Type 2). The dentitions were analysed regarding agenesis and dental morphological anomalies on panoramic radiographs, and craniofacial aspects were cephalometrically analysed on profile images The results were statistically evaluated. All groups demonstrated increased occurrences of agenesis (Type 1U and Type 1B: 31 agenesis in 15 patients; and Type 2 three agenesis in three patients). Taurodontic root morphology was most dominant in Type 1U. Peg-shaped lateral incisors showed an increased occurrence, though not in Type 1U. Skeletally, Type 1B and Type 1U demonstrated maxillary retrognathia (more pronounced in Type 1B). Type 2 showed a significant posterior inclination of the maxilla. Transpositions of maxillary canines involve dental and skeletal deviations. Dental deviations were predominantly taurodontic root morphology and agenesis. Regarding skeletal deviations, bilateral transpositions of the canines and the first premolars are associated with skeletal changes. Unilateral transpositions are possibly a localised deviation with minor or no skeletal involvements. The results indicate a possible difference in the aetiologies of unilateral and bilateral transpositions.

Determination of craniofacial relation among the subethnic Indian population: A modified approach (vertical evaluation)

To measure the vertical linear cephalometric dimensions of the anterior and posterior segments of the craniofacial complex and establish ratios between vertical linear dimensions in subjects with normal occlusion, pleasing profile, and facial harmony. Department of Orthodontics, Saveetha University. Lateral cephalograms of 120 subjects of both sexes in the age group of 17-28 years with normal occlusion belonging to Chennai, India. The vertical segments measured are anterior maxilla, posterior maxilla, and ramus-cranial floor vertical. The facial heights were measured in the anterior and posterior region of the craniofacial complex. Establish ratios and proportions between the vertical segments and different facial heights. In both the sexes, the ratio between anterior maxilla, posterior maxilla, and ramus-cranial floor vertical is 1:1:1, PTFH:ATFH is 1:1, AUFH:ATFH is 2:5, ALFH:ATFH is 3:5, PUFH:PTFH is 1:2, PLFH:PTFH is 1:2, AUDH:ALDH is 2:3, and facial depth is 2:1. PUDH:PLDH is 7:9 in females and 3:4 in males. There was a statistically significant difference in posterior total facial height:anterior total facial height ratio between the two sexes with a "P" value of 95%. Thus, the anterior maxilla, posterior maxilla, and cranial floor-ramus vertical composite are in dimensional balance in subjects with normal occlusion and facial harmony. This analysis helps to identify skeletal deviations in size and position in the vertical dimension and allows the clinician to outline an appropriate treatment.

A study of respiration‐correlated cone‐beam CT scans to correct target positioning errors in radiotherapy of thoracic cancer

There is increasingly widespread usage of cone-beam CT (CBCT) for guiding radiation treatment in advanced-stage lung tumors, but difficulties associated with daily CBCT in conventionally fractionated treatments include imaging dose to the patient, increased workload and longer treatment times. Respiration-correlated cone-beam CT (RC-CBCT) can improve localization accuracy in mobile lung tumors, but further increases the time and workload for conventionally fractionated treatments. This study investigates whether RC-CBCT-guided correction of systematic tumor deviations in standard fractionated lung tumor radiation treatments is more effective than 2D image-based correction of skeletal deviations alone. A second study goal compares respiration-correlated vs respiration-averaged images for determining tumor deviations. Eleven stage II-IV nonsmall cell lung cancer patients are enrolled in an IRB-approved prospective off-line protocol using RC-CBCT guidance to correct for systematic errors in GTV position. Patients receive a respiration-correlated planning CT (RCCT) at simulation, daily kilovoltage RC-CBCT scans during the first week of treatment and weekly scans thereafter. Four types of correction methods are compared: (1) systematic error in gross tumor volume (GTV) position, (2) systematic error in skeletal anatomy, (3) daily skeletal corrections, and (4) weekly skeletal corrections. The comparison is in terms of weighted average of the residual GTV deviations measured from the RC-CBCT scans and representing the estimated residual deviation over the treatment course. In the second study goal, GTV deviations computed from matching RCCT and RC-CBCT are compared to deviations computed from matching respiration-averaged images consisting of a CBCT reconstructed using all projections and an average-intensity-projection CT computed from the RCCT. Of the eleven patients in the GTV-based systematic correction protocol, two required no correction, seven required a single correction, one required two corrections, and one required three corrections. Mean residual GTV deviation (3D distance) following GTV-based systematic correction (mean ± 1 standard deviation 4.8 ± 1.5 mm) is significantly lower than for systematic skeletal-based (6.5 ± 2.9 mm, p = 0.015), and weekly skeletal-based correction (7.2 ± 3.0 mm, p = 0.001), but is not significantly lower than daily skeletal-based correction (5.4 ± 2.6 mm, p = 0.34). In two cases, first-day CBCT images reveal tumor changes-one showing tumor growth, the other showing large tumor displacement-that are not readily observed in radiographs. Differences in computed GTV deviations between respiration-correlated and respiration-averaged images are 0.2 ± 1.8 mm in the superior-inferior direction and are of similar magnitude in the other directions. An off-line protocol to correct GTV-based systematic error in locally advanced lung tumor cases can be effective at reducing tumor deviations, although the findings need confirmation with larger patient statistics. In some cases, a single cone-beam CT can be useful for assessing tumor changes early in treatment, if more than a few days elapse between simulation and the start of treatment. Tumor deviations measured with respiration-averaged CT and CBCT images are consistent with those measured with respiration-correlated images; the respiration-averaged method is more easily implemented in the clinic.

Frontal sinus dimensions can differ significantly between individuals within a monozygotic twin pair, indicating environmental influence on sinus sizes

Conclusion: The study showed that the size of the frontal sinus is not determined solely by genotype, but that other factors, e.g. environment, seem to affect the size as well. Environmental factors may include, for example diseases, trauma, allergies, acquired conditions, nutrition or medicine use. Objectives: The purpose of the study was to compare sinus dimensions between individuals within a monozygotic twin pair. Methods: Profile radiographs were obtained from 42 pairs of monozygotic twins, 18 male and 24 female pairs (aged 18–23 years) with no known skeletal deviations in the cranium or general diseases. For each individual the size of the frontal sinus was analyzed on a profile radiograph and compared with the sinus size of the corresponding twin. The variation between twins was estimated using a random effects model for each gender. Results: The sinus sizes varied considerably between twins. The standard deviation between female pairs was 2.98 mm and between male pairs 5.36 mm. The variations in sinus sizes between females and males within twin pairs were not significantly different (p = 0.86 for height and p = 0.83 for width, F test). Still, within one female twin pair and within two male twin pairs, sinus sizes varied significantly between the two individuals.

Asymmetry of the lips of orthognathic surgery patients

Introduction The purpose of this study was to examine asymmetry of the lips in patients with jaw deformity and facial asymmetry. Methods Pretreatment and posttreatment frontal facial photographs of 17 patients who had mandibular prognathism with facial asymmetry were analyzed. Linear and angular measurements were made on the photographs to assess the asymmetry of the lips. The upper and lower vermilion borders of the lips were divided into quadrants according to the y-axis, and each was measured. In addition, skeletal deviation (position of menton) was determined from the frontal cephalograms. Results The pretreatment linear and angular measurements showed asymmetry of the lips, but this significantly improved after treatment, and the lip form was almost symmetrical. The areas of vermilion border in the upper and lower lips became almost even during treatment. The ratio of the areas on the 2 sides was nearly 1.00. There was little correlation between the horizontal skeletal changes of menton and lip form. Conclusions Asymmetry of the lips caused by deviation of the mandible can be almost completely corrected by orthognathic treatment.

Asymmetry of the lips of orthognathic surgery patients

The purpose of this study was to examine asymmetry of the lips in patients with jaw deformity and facial asymmetry. Pretreatment and posttreatment frontal facial photographs of 17 patients who had mandibular prognathism with facial asymmetry were analyzed. Linear and angular measurements were made on the photographs to assess the asymmetry of the lips. The upper and lower vermilion borders of the lips were divided into quadrants according to the y-axis, and each was measured. In addition, skeletal deviation (position of menton) was determined from the frontal cephalograms. The pretreatment linear and angular measurements showed asymmetry of the lips, but this significantly improved after treatment, and the lip form was almost symmetrical. The areas of vermilion border in the upper and lower lips became almost even during treatment. The ratio of the areas on the 2 sides was nearly 1.00. There was little correlation between the horizontal skeletal changes of menton and lip form. Asymmetry of the lips caused by deviation of the mandible can be almost completely corrected by orthognathic treatment.

Bone Assessment in Children: Clinical Relevance and Interpretation

The assessment of bone in children is more difficult than in adults mainly due to the effect of growth and/or puberty. Despite this, there is an increasing body of evidence showing that measurement of different components of bone is of clinical relevance. Fracture incidence peaks during the early teenage years, and dual energy X-ray absorptiometry (DXA) has been shown to predict fractures in children, especially those of the upper limb, in four prospective studies. Case control and cross-sectional studies have also shown similar associations for peripheral quantitative computed tomography (pQCT), heel ultrasound, metacarpal index, and skeletal age deviation. In some cases, these latter results are additive to DXA suggesting a multifaceted approach to bone assessment in children will lead to greater information. Size or age adjusted Z scores are mandatory for the interpretation of DXA in children. However, other modalities such as heel ultrasound are less affected by growth. Lastly, children have very high bone turnover in comparison to adults but markers of bone turnover also have clinical utility for linear growth, assessment of the impact of vitamin D deficiency and assessment of short term influences on bone such as diet.

Differences of body composition, physical fitness, and exercise-mediated changes following to skeletal age deviation in prebubertal children

Differences of body composition, physical fitness, and exercise-mediated changes following to skeletal age deviation in prebubertal children

Determinants of Skeletal Age Deviation in a Cross-Sectional Study

Skeletal age deviation (SAD) is associated with bone mass and fracture risk in children, but factors determining this are unknown. The aim of this population-based cross-sectional study was to describe the factors associated with SAD. A convenience sample of 640 male and female children aged 7-17 yr was studied. All were assessed for body composition (dual-energy x-ray absorptiometry), diet, strength, dexterity, habitual physical activity, sunlight exposure, smoking, and medication use. Skeletal age was assigned using the Tanner-Whitehouse-2 method. Subjects with a SAD greater than the 75th percentile had significantly higher height, weight, and Tanner stage compared with all other subjects. Bone-free lean mass, fat mass, and grip strength were positively associated with SAD. In multivariate analysis, ever smoking and use of inhaled corticosteroids were negatively associated with SAD, whereas milk drinking was positively associated with SAD. There was no significant association between sunlight exposure, television watching, light, or strenuous exercise and SAD. The results of this study should be regarded as hypothesis generating but are biologically plausible and suggest that body composition, strength, diet, ever smoking, and inhaled corticosteroid use may be determinants of bone maturity relative to age and thus affect fracture risk in children. However, more studies are necessary to explore other determinants of SAD such as genetic and perinatal factors and whether SAD influences peak bone mass.

The Influence of Craniofacial Growth in a Case of Transverse Facial Cleft

This report presents the case of a female patient bearing a right-side transverse facial cleft. She has received interdisciplinary treatment since birth. At regular intervals, dental casts were made, and profile and full-face photographs, lateral and postero-anterior cephalograms were taken during the course of orthodontic treatment and maxillofacial surgery. We evaluated her diagnostic records with the intent of documenting the effects of growth and therapy on the skeletal structures of the facial cranium and on occlusion, and to show the influence on facial esthetics. Her facial morphology and occlusion were manifest at birth and in the primary dentition. The maxilla and mandible deviated from the midsagittal plane toward the cleft side, with the mandible considerably more affected, revealing a markedly posterior position. The lateral skeletal deviation of both jaws increased slightly during growth, yet the midline deviation of the dental arches and malocclusion clearly worsened. The increasing deviation was not obvious in full-face photographs. Especially in the primary and mixed dentition, the mandible shifted to the anterior, which was visible in both the lateral cephalograms and profile photographs. On the whole, however, no noteworthy alteration in the character of the craniofacial morphology occurred by the time growth was complete, despite functional jaw-orthopedic and maxillofacial surgical treatment consisting of two distraction osteogenesis procedures.

Cross-Sectional Study of the Length of the Nasal Bone in Cleft Lip and Palate Subjects

The purpose of this study was to analyze the human nasal bone length in newborns and male adults with cleft lip (CL), cleft palate (CP), and unilateral cleft lip and palate (UCLP) and to compare the results to previous findings in prenatal material. This study was a radiographic profile cephalometric cross-sectional analysis. Profile radiographs from 60 newborns with a male-to-female ratio of 1:1 in each group (20 CL, 20 CP, and 20 UCLP) and 60 male adults (20 CL, 20 CP, and 20 UCLP) were randomly selected among radiographs, taken for optimizing the treatment planning. The nasal bone lengths (n-na) were measured with a digital caliper on the profile radiographs. To compare the nasal bone lengths in the different cleft groups, Student's t tests at a significant level at 5% were performed. Nasal bone length was significantly shorter in male adult patients with CL compared with patients with CP. Furthermore, the nasal bone length was significantly shorter in newborns with CL (2 months) compared to newborns with UCLP (2 months). A borderline significance was seen in the comparison of patients with CL and UCLP in male adults. There was no significant difference in the nasal bone length between the patients with CP and UCLP, in either the newborns or the male adults. Nasal bone length was significantly shorter in subjects with CL compared with subjects in whom the palate was clefted. The results show that the clefted lip in CL is associated with a subjacent skeletal deviation in the upper midface.