Vertical Facial Growth Research Articles

A study of cervical vertebra anomalies among individuals with different sagittal and vertical facial growth patterns.

Objective:The objective was to evaluate the prevalence of cervical vertebra anomalies (CVA) in individuals with different sagittal and vertical skeletal growth patterns of jaws and also to establish the associations of anomalies with the type of growth, if any.Materials and Methods:A total of 293 lateral cephalograms were evaluated for CVA. Based on the Frankfort mandibular plane angle, cephalograms were categorized into three groups: Group I, II, and III. Based on the ANB angle, cephalograms were classified into three classes, Class 1, 2, and 3. Six types of CVA such as partial cleft (PC), block fusion (BF), dehiscence (D), fusion between C2 and C3 (F23), occipitalization (OC), and spina bifida (SB) were identified on lateral cephalograms. Descriptive statistics were applied along with multinomial logistic regression analysis. P = 0.05 was considered as the level of statistical significance.Results:PC was most common in the overall samples (36%). BF was the least common (3.2%) CVA. The frequency of various CVA was comparable between males and females in all the three classes of individuals. The association of vertical growth patterns with CVA was found to be statistically nonsignificant (P > 0.05). Class 2 malocclusion was found to be statistically significantly associated with the D (P = 0.043).Conclusions:PC, fusion, and D were the most frequently found CVA, and SB was found only among the hypodivergent growth pattern individuals. The association of CVA with vertical facial growth patterns was not significant, somewhat influenced by age, sex, and sagittal skeletal malocclusions.

Association of Dysplastic Coronoid Process with Long-Face Morphology

Vertical malocclusion is a developmental condition, resulting from complex interactions among multiple etiological factors during the growth period. As a tricky dentofacial deformity clinically, long-face (LF) morphology is characterized by excessive vertical facial growth with severe disarrangement of jaws and teeth. Since the improvement of LF patients on facial profile and occlusion is often difficult and lacks long-term stability, it becomes important to unravel the etiology of LF pattern formation for early prevention and treatment. In the current studies, we identified a transgenic mouse model that exhibited a dysplastic coronoid process and LF morphology. Although the mutant mice exhibited jaw structures and occlusion comparable to controls at birth, they all acquired typical LF morphology with anterior open bite during postnatal growth, resembling clinical features of the selected skeletal class III patients. Since the coronoid process provides an insertion site for the temporalis attachment, we examined the initial development and differentiation of the temporalis and found identical results in both control and mutant mice before E17.5 when the temporal muscle makes attachment to the coronoid process. However, thereafter, we observed altered orientation and reduced size of the cross-sectional area of the temporalis in mutant mice, which persisted to the weaning stage. Biomechanical analysis and simulation modeling further support the idea that altered morphology of the coronoid process may impair the efficiency of the vertical temporalis contraction and appears to correlate with LF formation. Consistently, we present evidence that a dysplastic mandibular coronoid process was also seen in some human patients with skeletal III LF morphology. Taken together, the results presented in this study establish an association of the craniofacial bony structures with vertical patterning, which will have implications in earlier prediction for clinical precaution and intervention.

Validation of the Vertical Facial Growth Screening Test.

Background. Vertical facial growth has a high prevalence. Nonspecialized professionals have shown low sensitivity to identify patients at risk. In the face of this difficulty, we designed and validated a screening checklist for vertical facial growth. Methods. A multidisciplinary team of 5 members developed the Vertical Facial Growth Screening Test. A sample of 160 evaluations was obtained. We consider as the gold standard the evaluation of 2 specialists in dentofacial orthopedics. Results. Consistency measured with Cronbach α was .675 for 10 items. Test-retest reliability was .956. The interobserver concordance was .886. The receiver operating characteristic curve has .987 area under the curve. Conclusion. This is the first study to design and validate a screening checklist for vertical facial growth for nonexpert evaluators. We think that given its good performance, ease of use, inexpensiveness, and availability, the test could be useful for nontrained professionals dealing with children.

Analysis of Treatment Period on the Intraoral Removable Appliance Utilizing Vertical Facial Growth on Class Ⅲ Malocclusion

본 연구의 ëª©ì ì€ 혼합치열기 초기에 ⠢급 ë¶€ì •êµí•©ì„ 보이는 어린이에서 수직성장을 ìœ ë„í•˜ëŠ” ⠢급 ê³ ë¬´ì¤„ì„ 걸 수있도록 ê³ ì•ˆëœ 구강내 ê°€ì² ì‹ìž¥ì¹˜ë¥¼ 사용하여 반대교합을 치료시, ê·¸ êµ¬ì²´ì ì¸ 치료기간을 ì•Œì•„ë³´ê³ , 이에 영향을 주는 변수를 확인하는 것이다.본 소아치과에 ⠢급 ë¶€ì •êµí•©ì„ 주소로 내원하여 구강내 ê°€ì² ì‹ 장치로 치료를 완료한 56ëª ì˜ 환자를 대상으로 치료개시 ì—°ë ¹, 치료기간 및 ì¹˜ë£Œìœ í˜•, 수평피개량, 수직피개량 등의 자료를 수집하였다.환자군의 êµì •ê°œì‹œ ì—°ë ¹ì€ 8.75ì„¸ì´ì—ˆê³ , 교합이 넘어갈때까지 3.31개월, 이후 ì •ìƒ 피개까지 1.90개월이 소요되어, 대부분이 개시 6개월 이내에 ê°œì„ ë˜ì—ˆë‹¤. ì „ì²´ 치료기간은 21.79ê°œì›”ì´ì—ˆê³ í™˜ìžì˜ 협조도(p = 0.000)와 ê³ ì •ì‹ êµì •ìž¥ì¹˜ì˜ 여부(p = 0.032)가 치료기간에 ìœ ì˜í•˜ê²Œ 영향을 주었다. ê²°ë¡ ì ìœ¼ë¡œ 본 연구의 ê°€ì² ì‹ìž¥ì¹˜ëŠ” ìˆ˜ë „ê°„ 장시간 장착하며 ì• ì •í˜•ë ¥ì„ 주는 구강외 장치에 비해서 ê·¸ 치료기간이 6개월 이내로 짧으며, 혼합치열기 ⠢급 ë¶€ì •êµí•© 어린이에서 íš¨ê³¼ì ìœ¼ë¡œ ì´ìš©í• ìˆ˜ 있다.

Are pediatricians and otolaryngologists well prepared to identify early signs of vertical facial growth?

BackgroundThe prevalence of vertical facial growth is very high in the developed world. Most authors agree that mouth breathing is its main cause. Even though care is mainly conducted by odontologists, the professionals who first see these patients are pediatricians and otolaryngologists. The objective of this study is to analyze the ability of pediatricians and otolaryngologists to identify early signs of vertical facial growth among children. Methods60 participant aged 4.1–13.7 years were analyzed subjectively by 9 otolaryngologists, 9 pediatricians and two specialists in dentofacial orthopedics. They were also assessed objectively with cephalometric analysis. ResultsOtolaryngologists showed 34.78% sensitivity, 92.86% specificity and 48.33% efficiency. Pediatricians showed 13.04% sensitivity, 100% specificity and 33.33% efficiency. Using a linear regression model compared against the objective measurements we found a weak positive correlation both for otolaryngologists and pediatricians. ConclusionThe sensitivity was very low for both groups. We believe it is of paramount importance to increase the awareness and the ability of otolaryngologists and pediatricians to recognize signs of disrupt facial growth.

Mesiodistal angulation of posterior teeth in orthodontic patients with different facial growth patterns.

Background. Mesiodistal and buccolingual angulations of teeth are variable in different malocclusion classes. This study aimed to assess the mesiodistal angulation of posterior teeth in orthodontic patients with vertical, normal, and horizontal facial growth patterns. Methods. This descriptive, cross-sectional study evaluated 150 lateral cephalograms of orthodontic patients. According to cephalometric analysis, facial growth patterns were divided into three groups of normal, horizontal, and vertical (n=50). The angulation of maxillary and mandibular posterior teeth was then measured. Data were analyzed using SPSS 22. Results. The results showed an increase in the mean angle of maxillary and mandibular posterior teeth relative to palatal and mandibular planes in patients with a vertical facial growth pattern. Conversely, their angulation decreased relative to the bisected occlusal plane (BOP). The angulation of posterior teeth decreased relative to palatal and mandibular planes and increased relative to the occlusal plane with an increase in overbite. The mean angle of all maxillary teeth relative to the palatal plane was significantly greater in open bite patients compared to normal and deep bite patients. This value in patients with normal bite was significantly greater than that in deep bite patients (P<0.05). Conclusion. The current results revealed that in patients with a vertical growth pattern, all the posterior teeth had a forward inclination. Conversely, in patients with a horizontal growth pattern, the teeth had a backward inclination.

Relationship between oro and nasopharynx permeability and the direction of facial growth.

Most scientific literature relates vertical growth to individuals with decreased upper airway permeability. However, we often find subjects with a long face and a normal breathing pattern, most likely caused by other aetiological factors. And, frequently, we also find decreased upper airway permeability with horizontal growth. The aim of the study was to compare the cephalometric measurements of the oro and nasopharynx permeability with the facial growth direction and to identify the most common facial growth direction in individuals with decreased upper airway permeability. Cephalometric analysis was carried out in 158 pre-adolescent patients at the Orthodontic appointment, using facial profile teleradiographs. Parameters used were Jabarak's ratio and measurement of oro-nasopharynx space. Data collected were submitted to statistical treatment. This study points to the presence of an intermediate growth in individuals with diminished oro and nasopharynx permeability, either simultaneous or separate. The number of individuals with diminished permeability and vertical growth is close to the number of individuals with horizontal growth. The individuals with diminished permeability of the upper airway present an intermediate growth direction, representing the most frequent type. In the less common growth directions, there is a slight tendency to horizontal facial growth verified in individuals with diminished nasopharynx permeability. Also, a light tendency to vertical facial growth is present when oropharynx permeability is reduced.

Determinants of maxillary canine impaction: Retrospective clinical and radiographic study.

BackgroundThe aim of this study is to evaluate determinants of maxillary canine impaction taking into account both canine position related variables and the pattern of facial growth.Material and MethodsA retrospective clinical and radiographic analysis was carried out on 109 patients aged between 9 and 10 years at the time of first evaluation. At baseline, SN-GoMe angle, the interincisal angle, the canine angle α and the canine distance d were used to characterize canine location and vertical facial growth. At the end of a two years follow up period the eruption state of each canine of each patient was recorded and accordingly classified as erupted or impacted on a clinical and radiographic basis. Univariate and multivariate statistical analyses were performed, including correlation among the studied variables and principal components analysis; several machine learning methods were also used in order to built a predictive model.ResultsAt the end of the two years follow up period after the first examination, 54 (24.77%) canines were classified as impacted. Except for Angle α values, there were no statistically significant differences between impacted and erupted canines. The studied variables were not significantly correlated, except for the SN-GoMe Angle and the distance d in the impacted canine group and the angle α and the distance d in erupted canines group. All variables, except for SN-GoMe Angle in erupted canines, have a partial communality with the first two principal components greater than 50%. Among the learning machine methods tested to classify data, the best performance was obtained by the random forest method, with an overall accuracy in predicting canine eruption of 88.3%.ConclusionsThe studied determinants are easy to perform measurements on 2D routinely executed radiographic images; they seems independently related to canine impaction and have reliable accuracy in predicting maxillary canine eruption. Key words:Canine impaction, Determinants, Facial growth.

Etiology and treatment options of anterior open bite in growing patients: a narrative review

Anterior open bite represents a malocclusion that is still under study because of the still lacking evidence about etiology and best treatment options in growing subjects according to success rate and stability. Etiology involves the interaction of environmental factors such as prolonged sucking habits, mouth breathing, tongue or lip thrusting, tongue dimension, eruption disturbances with a genetically determined vertical facial growth pattern. The treatment options for the early treatment of anterior open bite are still controversial. The aim of this study was to evaluate the actual available evidence on treatments of anterior open bite in the mixed dentition in order to assess the effectiveness of the early treatment in reducing open bite, the most efficacious treatment strategy and the stability of the results.

Evaluation of the Relationship between Airway Volumes and Vertical Facial Growth Patterns in Adult Patients

Evaluation of the Relationship between Airway Volumes and Vertical Facial Growth Patterns in Adult Patients

Relationship between the vertical craniofacial disproportions and the cervicovertebral morphology in adult subjects.

Orthodontic diagnosis includes the interpretation of the relations between the craniofacial and cervical system, given the potential impact of the irregularities from one system to another. The aim of this study was to examine morphological characteristics of the cervical spine, depending on the parameters of the vertical craniofacial growth and gender in adult subjects. The sample comprised lateral cephalograms of 120 subjects with different vertical facial growth, aged 17.5-35 years. Measured parameters were the following: anterior and posterior vertebral body height (ABHC2-C5, PBHC2-C5), anterior and posterior intervertebral space (AISC2-C5, PISC2-C5), distance between vertebrae and point sella (SC2, SC3, SC4), pterygomaxillare (PmC2), gonion (GoC2) and basion (BaC4); cervical spine angulation (OPT/CVT) and inclination (OPT/HOR, CVT/HOR). Results showed that subjects with anterior facial growth rotation have greater values for BaC4, OPT/HOR, CVT/HOR, OPT/CVT, anterior and posterior vertebral body heights and intervertebral spaces, and lower values for GoC2 and PmC2. Higher values in males were found for anterior and posterior vertebral body heights, distances SC2, SC3, SC4, and BaC4. In females, the greater values were found for GoC2 and OPT/CVT. Subjects with anterior facial growth rotation have greater cervical spine inclination and angulation, higher cervical vertebrae and intervertebral spaces, longer upper cervical spines and shorter distances GoC2 and PmC2. Males show smaller cervical column curvature, but higher cervical vertebrae and greater length of the upper cervical spine.

Cone-beam computed tomography evaluation of dentoskeletal effects produced by the bonded expander and hyrax: a pilot study

The dentoskeletal effects produced by the bonded expander, principally the vertical ones, are controversial in the literature when compared with the effects produced by the hyrax, and have also been scarcely studied by means of cone-beam computed tomography (CBCT). This study aimed to evaluate the horizontal and vertical dentoskeletal effects produced by the bonded expander and by the hyrax using CBCT. The study sample consisted of ten patients, divided equally into two groups according to facial and cephalometric features: group 1, vertical facial growth pattern (two males, three females; mean age, 7.7 years) and group 2, normal facial growth pattern (three males, two females; mean age, 8.3 years), treated by bonded expander and hyrax, respectively. The patients were subjected to a CBCT scan before expansion and another scan four months after the end of the activations, when the expander was removed. Within each group and between the groups the horizontal and vertical effects were assessed using Student’s t -test. The sample size was predetermined, and 5 patients were needed in each group to detect the differences at P 0.05). Comparing the two groups there were no statistical differences for any assessed change ( P > 0.05). Considering there were no differences of the effects between the appliances, the bonded expander produced no greater vertical control compared to the hyrax. Nevertheless, further study is recommended in a larger sample size using CBCT.

Influence of maxillary posterior discrepancy on upper molar vertical position and facial vertical dimensions in subjects with or without skeletal open bite.

To determine the influence of maxillary posterior discrepancy on upper molar vertical position and dentofacial vertical dimensions in individuals with or without skeletal open bite (SOB). Pre-treatment lateral cephalograms of 139 young adults were examined. The sample was divided into eight groups categorized according to their sagittal and vertical skeletal facial growth pattern and maxillary posterior discrepancy (present or absent). Upper molar vertical position, overbite, lower anterior facial height and facial height ratio were measured. Independent t-test was performed to determine differences between the groups considering maxillary posterior discrepancy. Principal component analysis and MANCOVA test were also used. No statistically significant differences were found comparing the molar vertical position according to maxillary posterior discrepancy for the SOB Class I group or the group with adequate overbite. Significant differences were found in SOB Class II and Class III groups. In addition, an increased molar vertical position was found in the group without posterior discrepancy. Some variables closely related with the individual's intrinsic craniofacial development that could influence the evaluated vertical measurements were not considered. Overall maxillary posterior discrepancy does not appear to have a clear impact on upper molar vertical position or facial vertical dimensions. Only the SOB Class III group without posterior discrepancy had a significant increased upper molar vertical position.

Longitudinal relationship between insulin-like growth factor-1 levels and vertical facial growth.

Facial growth in the vertical dimension is the last to be completed and can often be detrimental to the success of dental implants, orthodontic treatment, and orthognathic surgery that young individuals undergo. The purpose of this study was to evaluate the longitudinal relationship between changes in total anterior facial height and insulin-like growth factor-1 (IGF-1) levels measured using blood-spot samples. Our sample included 25 orthodontic patients from whom we had access to annual lateral cephalometric radiographs and IGF-1 measurements. Each subject was observed between 2 and 6 times, resulting in 43 annual intervals from a total of 77 observations. We noted a significant moderate positive correlation (+ 0.48) between the percentage of change in blood-spot IGF-1 levels and the percentage of change in total anterior face height (p = 0.01). Longitudinal changes in IGF-1 levels can be used to predict a patient's vertical facial growth. There was no significant correlation between changes in vertical facial development and a single cross-sectional IGF-1 measurement.

Upper and lower pharyngeal airway space in West-Tamil Nadu population.

Aim:To compare the upper and lower pharyngeal airway (LPA) width in Class II malocclusion patients with low, average, and high vertical growth patterns.Study Design:Cross-sectional analytical study.Materials and Methods:Pretreatment lateral cephalometric films of 90 Class II subjects were used to measure the upper and LPAs. The inclusion criteria were subjects of West-Tamil Nadu, aged between 14 and 25 years, only skeletal Class II subjects of either gender and no pharyngeal pathology at initial visit. The sample comprised a total of 90 Class II subjects divided into three groups according to the vertical facial pattern: Normodivergent (n = 30), hypodivergent (n = 30), and hyperdivergent (n = 30). The assessment of upper and LPAs was done according to McNamara's airway analysis.Statistical Analysis:The intergroup comparison of the upper and LPAs was performed with one-way analysis of variance and the Tukey test was used to compare among the various vertical patterns.Results:Skeletal Class II subjects with hyperdivergent facial pattern showed statistically significant narrow upper pharyngeal width when compared to normodivergent and hypodivergent facial patterns. No statistically significant difference was found in the lower pharyngeal width in all three vertical facial growth patterns.Conclusion:Subjects with Class II malocclusions and hyperdivergent growth pattern have significantly narrow upper pharyngeal airway space when compared to other two vertical patterns. Narrow pharyngeal airway space is one of the predisposing factors for mouth breathing and obstructive sleep apnea.

Growth hormone, gender and face shape in prader–willi syndrome

Prader-Willi syndrome is a neurodevelopmental disorder resulting from the absence of expression of paternally expressed gene(s) in a highly imprinted region of chromosome 15q11-13. The physical phenotype includes evidence of growth retardation due to relative growth hormone deficiency, small hands and feet, a failure of normal secondary sexual development, and a facial appearance including narrow bifrontal diameter, almond-shaped palpebral fissures, narrow nasal root, and thin upper vermilion with downturned corners of the mouth. Anecdotally, the face of individuals with PWS receiving hGH treatment is said to "normalize." We used dense surface modelling and shape signature techniques to analyze 3D photogrammetric images of the faces of 72 affected and 388 unaffected individuals. We confirmed that adults with Prader-Willi syndrome who had never received human growth supplementation displayed known characteristic facial features. Facial growth was significantly reduced in these adults, especially in males. We demonstrated that following human growth hormone (hGH) supplementation, vertical facial growth of affected individuals falls within the normal range. However, lateral and periorbital face shape and nose shape differences in affected children who have received hGH therapy remain sufficiently strong to be significantly discriminating in comparisons with age-sex matched, unaffected individuals. Finally, we produced evidence that age at initiation and length of treatment with hGH do not appear to play a role in normalization or in consistent alteration of the face shape of affected individuals. This is the first study to provide objective shape analysis of craniofacial effects of hGH therapy in Prader-Willi syndrome.

Patterns of vertical facial growth in Korean adolescents analyzed with mixed-effects regression analysis

To understand the growth patterns of skeletal open bite and deepbite, we present observations from 9 years of pure longitudinal data based on lateral cephalometric radiographs using mixed-effects regression model analysis. In total, 51 children (14 years old) with extreme values for the ratio of lower anterior facial height to total anterior facial height were assigned to 1 of 2 groups: a skeletal open-bite group (11 boys, 14 girls) or a skeletal deepbite group (14 boys, 12 girls). Measurements of total anterior facial height, upper anterior facial height, lower anterior facial height, total posterior facial height, ramus height, and ratio of lower anterior facial height to total anterior facial height were obtained for all subjects. All data were analyzed and interpreted using a mixed-effects regression model analysis with random effects. From these 4 groups at 14 years old, statistically significant differences were observed between the groups when subjects of the same sex were compared; however, statistical significance was not reached between subjects of opposite sexes in each group. Morphologic differences were clearly evident from the start and became more pronounced with age. There were statistical significances in the initial values and increases with age in all 6 variables except for increases with age in the ratio of lower anterior facial height to total anterior facial height. Statistical significance was also reached for morphologic differences between the annual increases in the ratio of lower anterior facial height to total anterior facial height and lower anterior facial height. In general, individual random variability was high in all variables when compared with the annual changes over time. Divergent patterns were established early and became more pronounced with age, with anterior facial height dimensions primarily contributing to these differences. Individual variations were so pronounced that caution is recommended for all clinical decisions.

Rhinitis, sinusitis and ocular disease – 2097. Dentomaxilofacial disorders in children with allergic rhinitis

Children with allergic rhinitis were phenotypically characterized by rings (92%, p= 0.03), vertical facial plane growth (25%, p = 0.016), nasal fold (78%, p = 0.00) and retrognathia (17%, p = 0.057). In risk analysis found that mouth breathing increased 47.5 times the risk of allergic rhinitis. Children with persistent rhinitis and asthma had more mouth breading, snoring and jaw compression than children only with rhinitis. Conclusions Children with allergic rhinitis had higher prevalence of facial, tooth and jaw disorders than children without rhinitis. We recommend a multidisciplinary assessment to identify dentomaxilofacial alterations in this high risk groups and provide early treatment.

Mouth breathing children and cephalometric pattern: Does the stage of dental development matter?

ObjectiveTo test the hypothesis that there is no difference in the cephalometric pattern between mouth breathing children with primary dentition and mixed dentition. MethodsCephalometric measurements of 126 mouth breathing children (MB) were compared to 126 nasal breathing controls (NB). Both groups were divided into deciduous dentition (mean age 4 years, 8 months) and mixed dentition (mean age 7 years, 9 months) groups. ResultsA statistically significant difference was observed in the dentofacial patterns of MB children compared to NB children. The total length of the mandible was smaller in MB compared to NB children. However, this difference was found only in subjects with mixed dentition. The length of the mandibular corpus is similar in MB and NB children, although older MB children with mixed dentition had significantly smaller measurements. The lower anterior facial height was higher in MB compared to NB children, but this difference was evident only in younger children with primary dentition. Mandibular plane angle, Y-axis angle and lower anterior facial height to total anterior facial height ratio were greater, and posterior facial height to total anterior facial height ratio was smaller in MB than NB children, indicating that mouth breathers had a more vertical facial growth pattern. However, no differences were found in the vertical growth pattern associated with the stage of dental development. The ANB angle was not associated with the maturational status of occlusion. Linear measurements and the gonial angle were significantly different between children with primary and mixed dentition, but such differences were associated with normal vertical growth. ConclusionsThe present investigation rejected the null hypothesis and showed significant cephalometric differences between primary and mixed dentition MB children. Mouth breathing children in the mixed dentition have a smaller mandible (in terms of total length and corpus length) than nasal breathers. In children with primary dentition, the lower anterior facial height is higher in MB than in NB children. There was no significant association between the stage of dental development of mouth breathing children (either in the primary or mixed dentition) and the other cephalometric patterns.

Facial Growth in Patients with Apert and Crouzon Syndromes Compared to Normal Children

To evaluate vertical and sagittal facial growth in children with Apert and Crouzon syndromes and compare it to the growth patterns of a nonsyndromic control group. Case-control study. Department of Orthodontics, Children's Hospital Erasmus Medical Centre, Sophia, Rotterdam, The Netherlands. Sixty-two patients (37 patients with Crouzon syndrome and 25 patients with Apert syndrome) born between 1971 and 2001 (age range 3.9 to 32 years) and 482 nonsyndromic children as a control group. Lateral cephalograms performed prior to any midfacial surgery of 62 patients and 482 nonsyndromic children were traced and horizontal and vertical measurements were digitized. Cephalometric measurements of SNA, SNB, ANB, NSMe, and SN/palatal plane angles and lower facial height ratio. Horizontal measurements for the syndromic groups showed no change in SNA angle during growth. SNA angles were lower in patients with Apert syndrome compared to patients with Crouzon syndrome. The syndromic groups showed smaller values for ANB angles compared to the nonsyndromic group. Vertical measurements showed increased lower facial height ratios for the syndromic groups compared to control subjects. There was an increasing counterclockwise rotation of the palatal plane in relation to the anterior cranial base in syndromic patients. NSMe angles among the three groups were not significantly different. Based on the growth differences identified, the sagittal and vertical jaw relationships differ in patients with Crouzon syndrome, patients with Apert syndrome, and control subjects. Syndromic patients show aggravation of midfacial underdevelopment and anterior rotation of the mandible.