phenylephrine-hydrochloride and Malocclusion

Naso-ethmoido-maxillary protrusion (NEMP) is a rare dental and facial dysmorphosis, with excessive growth of basicranium, ethmoid, maxillary, and nasal bones. The clinical presentation includes nasal and upper lip protrusion, telecanthus, a class 2 malocclusion with maxillary protrusion and exoclusion. The craniofacial field is increased in Delaire's analysis. Contrary to isolated maxillary protrusion secondary to membranous ossification dysfunction, NEMP is a constitutional anomaly resulting from an excessive primary growth of the chondrocranium. The therapeutic management of NEMP should take into account these specificities.

Topics: Cephalometry; Ethmoid Bone; Humans; Malocclusion; Malocclusion, Angle Class III; Maxilla; Maxillofacial Abnormalities; Nose; Orthodontics, Corrective; Radiography; Skull

The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 3D Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered breathing for healthcare professionals seeking education in orofacial myology.

Topics: Deglutition; Humans; Malocclusion; Mastication; Mouth Breathing; Myofunctional Therapy; Nose; Patient Care Team; Respiration; Sleep Apnea Syndromes; Tongue Habits

Cause and effect relationships existing between "nasal breathing impairment" and "relapse" have inherited from controversies which have animated the debate between the different schools of orthodontics for more than a century. Those differences of opinion seem to have their origin in the lack of accuracy inherent with the general acceptance of the two concepts of "normal nasal ventilation" and "relapse". Rather than retracing their history, we would like to put forward a few proposals aimed at getting rid of the doubtful trouble the present difficulty confronts us with. We have therefore endeavored: 1. to define most exactly our concepts of "optimal nasal ventilation" and "relapse"; 2. to determine, afterwards, the mechanics responsible for facial shape alterations due to nasal obstruction; 3. hence, to deduce the therapeutic behavior enabling us to master those alterations more extensively. Bearing in mind that, in order to legitimate the risk of a treatment, acknowledge its benefit and justify its cost (which may become prohibitive because of relapse), the clinician has to base his options on a body of consistent arguments.

Topics: Breathing Exercises; Face; Humans; Malocclusion; Maxillofacial Development; Nasal Obstruction; Nose; Pharynx; Posture; Pulmonary Ventilation; Recurrence; Respiration

Patients requiring surgical correction of skeletal dysplasia and malocclusion often present with a co-existing function and/or aesthetic nasal deformity. This article reviews the techniques of nasal surgery, rationale for combined nasal and orthognathic surgery, and timing of corrective nasal and jaw surgery.

Topics: Esthetics, Dental; Face; Female; Humans; Jaw Abnormalities; Male; Malocclusion; Nasal Obstruction; Nose; Orthognathic Surgical Procedures; Patient Care Planning; Patient Selection; Rhinoplasty; Surgery, Plastic; Time Factors

The reliability and validity of four methods of assessing skeletal pattern (Reidel's method, Eastman correction, Ballard's method, and 'Wits' analysis) from cephalometric tracings have been examined, and the levels of agreement between them investigated. The possibility of the Y-axis length and SN-Y-axis angle having a bearing on the skeletal pattern was also examined. Strong correlation was found between the four methods considered. Ballard's method correlated very closely with Reidel's method, and like 'Wits' method, is not as unreliable as previously reported. Measurement of the SN-Y-axis angle was not found to be of benefit to the assessment of the anteroposterior dental base relationship. Reidel's method, which is the easiest to apply, is recommended as the method of choice, and routine application of the Eastman correction is not recommended.

Topics: Cephalometry; Confidence Intervals; Dental Occlusion; Facial Bones; Humans; Incisor; Jaw; Malocclusion; Mandible; Maxilla; Nose; Reproducibility of Results; Sella Turcica

Patients with respiratory tract allergy present certain auditory and visual signs which, when correlated with the history, aid substantially in arriving at a conclusive diagnosis. The physician should be alert to the signs that indicate allergic disease. Early recognition followed by modern allergy management will help to prevent progression of the allergic process.

Topics: Adolescent; Adult; Child; Conjunctiva; Conjunctivitis; Corneal Diseases; Eczema; Eye Diseases; Eye Manifestations; Eyelashes; Eyelids; Female; Gingival Hyperplasia; Glossitis, Benign Migratory; Habits; Humans; Male; Malocclusion; Maxillary Sinus; Mouth Breathing; Nasal Septum; Nose; Oral Manifestations; Pharyngeal Diseases; Polyps; Respiratory Hypersensitivity; Rhinitis, Allergic, Seasonal; Seasons

Topics: Child; Child, Preschool; Environment; Hearing Disorders; Humans; Intellectual Disability; Jaw Abnormalities; Lip; Malocclusion; Mother-Child Relations; Nose; Palate; Pharynx; Respiratory System; Schizophrenia, Childhood; Speech Disorders; Stuttering; Tongue; Voice

Children can well detect and respond to odours in order to have information about food and environment. Rapid Maxillary Expansion seems to improve dental and skeletal crossbite and increase nasal patency correcting oral respiration in children. A previous pilot study suggested that Rapid Maxillary Expansion may lead to improved N-Butanol olfactory thresholds, and peak nasal inspiratory flow values (PNIF). The aim of the present study was to prospectively evaluate olfactory threshold, nasal flows and nasal resistances in children aged from 6 to 11 years before and after Rapid Maxillary Expansion, comparing treated children with a control group of similar age, growth stage (prepubertal) and transversal skeletal deficiency.. N-butanol olfactory thresholds, anterior active rhinomanometry (AAR) and PNIF were measured in 11 children (6-11 years) before (T0), immediately and 6 months after Rapid Maxillary Expansion application (T1 and T2 respectively), and in a control group of 11 children (6-11 years) whose members remained under observation for the period of the study.. Considering the study group, PNIF values improved at T1 respect to the T0 values (p = 0.003), while T2 values were significantly higher than T0 ones (p = 0.0002). N-Butanol Olfactory Threshold significantly improved at each control (p = 0.01, p = 0,01 and p = 0.0003, for T1 vs T0, T2 vs T1, T2 vs T0 respectively). No differences on AAR values were found during the six months follow-up in this group. Considering the control group, no significant differences were found for any of the considered variables during the time of the study. Comparing the two groups, there was a significant increase of PNIF values in the study group compared to the control group (p = 0.003) at T1, which was even more evident six months after Rapid Maxillary Expansion (p = 0.0005). This improvement was not shown by AAR values. N-Butanol Olfactory Threshold showed a significant improvement at T2 respect to T1 (p = 0.002) and T0 (p = 0.0005).. Rapid Maxillary Expansion seems to significantly improve the respiratory capacity of treated patients, at least in terms of PNIF, and their olfactory function, measured by N-Butanol Olfactory Threshold Test. Further studies should be performed to evaluate if also changes in nasal resistances, measured by AAR, could occur, maybe considering a larger group of subjects and possibly using 4-phase rhinomanometry in order to evaluate the effective resistances during the entire breath.

Topics: 1-Butanol; Child; Female; Humans; Male; Malocclusion; Nose; Palatal Expansion Technique; Prospective Studies; Rhinomanometry; Smell; Treatment Outcome

To study the growth and speech outcomes in children who were operated on for unilateral cleft lip and palate (UCLP) by a single surgeon using two different treatment protocols.. A total of 200 consecutive patients with nonsyndromic UCLP were randomly allocated to two different treatment protocols. Of the 200 patients, 179 completed the protocol. However, only 85 patients presented for follow-up during the mixed dentition period (7-10 years of age). The following treatment protocol was followed. Protocol 1 consisted of the vomer flap (VF), whereby patients underwent primary lip nose repair and vomer flap for hard palate single-layer closure, followed by soft palate repair 6 months later; Protocol 2 consisted of the two-flap technique (TF), whereby the cleft palate (CP) was repaired by two-flap technique after primary lip and nose repair. GOSLON Yardstick scores for dental arch relation, and speech outcomes based on universal reporting parameters, were noted.. A total of 40 patients in the VF group and 45 in the TF group completed the treatment protocols. The GOSLON scores showed marginally better outcomes in the VF group compared to the TF group. Statistically significant differences were found only in two speech parameters, with better outcomes in the TF group.. Our results showed marginally better growth outcome in the VF group compared to the TF group. However, the speech outcomes were better in the TF group.

Topics: Child; Cleft Lip; Cleft Palate; Clinical Protocols; Dental Arch; Dentition, Mixed; Female; Follow-Up Studies; Humans; Lip; Male; Malocclusion; Maxilla; Nose; Open Bite; Overbite; Palate, Hard; Palate, Soft; Photography; Prospective Studies; Speech; Speech Disorders; Surgical Flaps; Vomer

In orthognathic surgery aesthetic issues and facial symmetry are vital parameters in surgical planning. Aim of this investigation was to document and analyze the results of orthognathic surgery on the base of a three-dimensional photogrammetric assessment, to assess the soft tissue response related to the skeletal shift and the alterations in facial symmetry after orthognathic surgery.. In this prospective clinical trial from January 2010 to June 2011, 104 patients were examined who underwent orthognathic surgery due to mono- or bimaxillary dysgnathia. The standardized measurements, based on optical 3D face scans, took place one day before orthognathic surgery (T1) and one day before removal of osteosynthesis material (T2).. Soft tissue changes after procedures involving the mandible showed significant positive correlations and strong soft tissue response (p < 0.05). The midfacial soft tissue response after maxillary advancement was only of minor extent (p > 0.05). The facial surfaces became more symmetric and harmonic with the exception of surgical maxillary expansion, but improvement of facial symmetry revealed no statistical significance.. Soft tissue response after orthognathic surgery and symmetry are only partially predictable, especially in the maxillary and midfacial region. Computer programs predicting soft tissue changes are not currently safely reliable and should not be used or with caution to demonstrate a patient potential outcome of surgery.

Topics: Adult; Anatomic Landmarks; Cephalometry; Chin; Face; Facial Bones; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Orthognathic Surgical Procedures; Osteogenesis, Distraction; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Palatal Expansion Technique; Photogrammetry; Prognathism; Prospective Studies; Retrognathia

Aim of this study was to detect the changes in nasal volume due to bone-borne, surgically-assisted rapid palatal expansion (RPE) with the Dresden Distractor using computed tomography (CT).. 17 patients (mean age 28.8) underwent axial CT scanning before and 6 months after RPE. The nasal bone width was examined in the coronal plane. Cross-sectional images of the nasal cavity were taken of the area surrounding the piriform aperture, choanae and in between. Bony nasal volume was computed by connecting the three cross-sectional areas.. All but two patients showed a 4.8% increase in nasal volume (SD 4.6%). The highest value, 33.3% (SD 45.1%), was measured anteriorly at the level of the nasal floor. This correlated with the midpalatal suture's V-shaped opening. There was no significant correlation between an increase in nasal volume and transverse dental arch expansion.. As most of the air we breathe passes the lower nasal floor, an improvement in nasal breathing is likely.

Topics: Adult; Combined Modality Therapy; Female; Humans; Male; Malocclusion; Nose; Oral Surgical Procedures; Organ Size; Osteogenesis, Distraction; Palatal Expansion Technique; Tomography, X-Ray Computed; Treatment Outcome

True unilateral posterior crossbite (TUPC) requires unilateral expansion to prevent nonocclusion at the noncrossbite (NC) side. The recommended osteotomies for TUPC after sutural closure are anterior, lateral, and posterior osteotomies only on the crossbite (C) side and median osteotomy of the midpalatal suture, i.e., unilateral surgically assisted rapid maxillary expansion (SARME). The goal was to assess airway and perinasal soft tissue outcomes after SARME.. Data from 16 patients (8 males, 8 females; mean age 18.38 ± 1.45 years) were retrospectively assessed after unilateral SARME. The expansion (twice daily: 0.5 mm/day) and retention periods comprised 3 weeks and 6 months, respectively. Stereophotogrammetric images were used for soft tissue assessment; cone beam computed tomography (CBCT) was used to evaluate the anterior nasal airway. Statistical analyses were performed.. Using linear measurements, soft tissue distances of the alar base and alare to midsagittal plane (MSP) were significantly increased on the C side. A significant decrease was observed for the distance from the lower nostril point to the MSP on the NC side compared to a significant increase on the C side. Comparing the C and NC sides, the changes were significantly higher on the C side for all parameters except the upper nostril point to the MSP distance. Cheek volume was significantly higher on the C side. Volume changes of the anterior nasal airway (ANA) were significantly increased on the C side, but volume changes between NC and C were not significantly different.. Unilateral SARME led to significant expansion of ANA on the C side, but did not lead to asymmetry in the nasal region or have adverse effects on the airway or perinasal soft tissues. Thus, this novel treatment method may be useful in the treatment of patients with TUPC.. ZIELSETZUNG: Ein echter unilateraler posteriorer Kreuzbiss (TUPC) erfordert eine unilaterale Erweiterung, um eine Nonokklusion auf der Nichtkreuzbisseite (NC) zu verhindern. Die empfohlenen Osteotomien für TUPC nach Nahtverknöcherung sind anteriore, laterale und posteriore Osteotomien nur auf der C(Kreuzbiss)-Seite und eine mediane Osteotomie der Mittelpalatinalnaht, d.h. eine unilaterale chirurgisch assistierte schnelle Oberkieferexpansion (SARME). Ziel war es, die Auswirkungen auf die Atemwege und das perinasale Weichgewebe nach SARME zu beurteilen.. Die Daten von 16 Patienten (8 Männer, 8 Frauen; Durchschnittsalter 18,38 ± 1.45 Jahre) wurden nach unilateraler SARME retrospektiv ausgewertet. Die Expansions- (2-mal täglich, 0,5 mm/Tag) und Retentionszeiträume umfassten 3 Wochen bzw. 6 Monate. Stereophotogrammetrische Bilder wurden zur Beurteilung des Weichgewebes verwendet; zur Beurteilung des vorderen nasalen Atemwegs wurde die DVT (digitale Volumentomographie) eingesetzt. Es wurden statistische Analysen durchgeführt.. Unter Verwendung linearer Messungen waren die Weichteilabstände der Alarbasis und der Alare zur mittleren Sagittalebene (MSP) auf der C‑Seite signifikant erhöht. Für den Abstand vom unteren Nasenflügelpunkt zur MSP wurde eine signifikante Abnahme auf der NC-Seite im Vergleich zu einer signifikanten Zunahme auf der C‑Seite beobachtet. Beim Vergleich von C‑ und NC-Seite waren die Veränderungen auf der C‑Seite für alle Parameter signifikant höher, außer für den Abstand vom oberen Nasenflügelpunkt zur MSP. Das Wangenvolumen war auf der C‑Seite signifikant höher. Die Volumenänderungen des vorderen nasalen Atemwegs waren auf der C‑Seite signifikant erhöht. Die Volumenänderungen zwischen NC und C waren dagegen nicht signifikant unterschiedlich.. Die unilaterale SARME führte zu einer signifikanten Vergrößerung der ANA auf der C‑Seite, nicht aber zu einer Asymmetrie im Nasenbereich und hatte auch keine nachteiligen Auswirkungen auf die Atemwege oder die perinasalen Weichteile. Diese neuartige Behandlungsmethode kann also bei der Behandlung von Patienten mit TUPC nützlich sein.

Topics: Adolescent; Adult; Cone-Beam Computed Tomography; Female; Humans; Male; Malocclusion; Maxilla; Nose; Palatal Expansion Technique; Retrospective Studies; Young Adult

Magazines and television displays are not merely crammed with faces-they are filled with appealing faces, and both men and women are interested in a suitable partner's appearance. This study investigated what makes a face attractive and whether perception-related differences exist between facial attractiveness and facial components.. In this descriptive-analytical study, frontal and lateral view photographs of 18 young adults (9 male and 9 female) in Class I, II, and III malocclusions were assessed by 90 orthodontists, dentists, models, and laypeople using a 7-point Likert scale in terms of attractiveness. Based on scores, attractive and unattractive groups were formed. Using image analysis software, a range of defined length, angles, perimeter, and area for lips, nose, and chin were measured for the attractive group. For statistical analysis, each group was compared using a 1-way analysis of variance. Logistic regression was performed to analyze the factors of different parameters to the attractiveness of facial components.. Overall full-face width, upper lip angle, lip area, and mentolabial angle was significantly different in all the 3 classes (P ≤0.05). In Class I malocclusion, nasolabial angle among orthodontists, nasofrontal angle among dentists, lower lip among models, and full-face width among laypeople were responsible for facial attractiveness variation. In Class II malocclusion, nose to upper lip among orthodontists, Cupid's bow among dentists, wider face among models, and upper lip among layperson were responsible for variation in facial attractiveness. In Class III malocclusion, lower lip angle among orthodontists and dentists, Cupid's bows among models and layperson was responsible for variation in facial attractiveness.. In Class I faces, lips (Cupid's bows, lower lips, lip areas), nose (nasolabial, nasofrontal, and nasomental angles), and chin (lower lip to chin) contributed to the overall attractiveness of the face, while in Class II faces, lips (upper lip length, interbow distance, lower lip angle), nose (full facial convexity), and chin (mentolabial sulcus), as well as a greater full-face width contributed to the overall attractiveness of the face. In Class III faces, lips (lower lip angle, upper lip length), nose (nose tip angle, full facial convexity), and chin (mentolabial sulcus depth) contributed to the overall attractiveness of the face.

Topics: Cephalometry; Chin; Face; Female; Humans; Lip; Male; Malocclusion; Nose; Perception; Young Adult

The objective of this study is quantitative assessment of nasalance for skeletal Class I (normative values), Class II, and III malocclusion in the English language for the North Indian population and to compare the normative values with the nasalance scores obtained from individuals with skeletal Class II and III malocclusion and to evaluate the normative values as a function of gender.. The study was conducted on a total sample of 200 patients with 100, 50, and 50 in group 1 (control group, Skeletal Class I), group 2 (Skeletal Class II), and group 3 (Skeletal Class III), respectively. ANB angle (anteroposterior angle formed by point A, nasion, and point B) measured on lateral cephalogram was used to categorize the patients into 3 groups. The normative nasalance scores were compared for males and females in the control group. The nasalance scores of skeletal Class II and III subjects were compared to the combined normative scores of the control group. The NasalView was used for the objective assessment of nasalance. Oral syllables (/pa/and/pi/), nasal syllables (/ma/and/mi/), and 3 passages (Zoo passage, Rainbow passage, and Nasal sentences) were used to determine the nasalance scores.. The intragroup comparison of nasalance scores in group 1 showed statistically significant differences for different stimuli. The gender-related comparison showed no statistically significant differences in nasalance scores. The intergroup comparison of nasalance scores for skeletal malocclusion showed no statistically significant differences for different stimuli except statistically significant lower nasalance values for nasal sentences in group 3 compared to the control group.. The study concluded that the nasalance scores for nasal sentences in skeletal Class III malocclusion were significantly lower than in the control group and were not statistically significant between the 3 groups for all other stimuli.

Topics: Female; Humans; Language; Male; Malocclusion; Nose; Phonetics

Facial soft tissue esthetics is a priority in orthodontic treatment, and emerging of the digital technologies can offer new methods to help the orthodontist toward an esthetic outcome. This prospective study aimed to assess the soft tissue changes of the face after six months of retention following Rapid Maxillary Expansion (RME). The sample consisted of 25 patients (13 females, 12 males, mean age: 11.6 years) who presented with unilateral or bilateral posterior crossbite requiring RME, which was performed with a Hyrax expander. 3D facial images were obtained before treatment (T

Topics: Child; Face; Female; Humans; Male; Malocclusion; Nose; Palatal Expansion Technique; Prospective Studies

The purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years of age and who had a history of clefts of the lip or palate, or both, from January 1, 2013, to June 30, 2014. The authors compared the concerns of the patients who received cleft-team-based care by a single, multidisciplinary cleft team; multiple multidisciplinary cleft teams; or no formal cleft team. The authors analyzed data for 142 patients. The most common patient concerns were lip aesthetics (64%), nose aesthetics (61%), septal deviations (47%), nasal obstruction (44%), malocclusion (32%), oronasal fistulas (29%), and speech (21%). Oronasal fistulas were more commonly reported in the group of patients who had care by multiple teams (42.9%; P < .001). Malocclusion was more commonly reported in the group of patients who had care by multiple teams (50%; P = .001). The authors found that adult patients who have undergone rehabilitation for cleft lip and palate appear to have a common set of long-term needs. Multidisciplinary cleft-team-based care appears to be the most effective way to address these needs.

Topics: Adolescent; Adult; Aged; Cleft Lip; Cleft Palate; Female; Humans; Male; Malocclusion; Middle Aged; Nose; Oral Fistula; Retrospective Studies; Speech; Time Factors; Treatment Outcome; Young Adult

To compare changes in pharyngeal airway volume and minimal cross-sectional area (MCA) between patients undergoing rapid maxillary expansion (RME) and a matched control group and to identify markers for predicting airway changes using cone-beam computed tomography (CBCT).. Pre- and posttreatment CBCT scans were selected of children who had RME (14 girls and 12 boys; mean age, 12.4 years) along with scans of a control group (matched for chronological age, skeletal age, gender, mandibular inclination) who underwent orthodontic treatment for minor malocclusions without RME. Changes in airway volume and MCA were evaluated using a standardized, previously validated method and analyzed by a mixed-effects linear regression model.. Upper airway volume and MCA increased significantly over time for both the RME and matched control groups (. Tooth-borne RME is not associated with a significant change in upper airway volume or MCA in children when compared with controls. The younger the skeletal age before treatment, the more positive the effect on the upper airway changes. The results may prove valuable, especially in RME of young children.

Topics: Child; Child, Preschool; Cone-Beam Computed Tomography; Female; Humans; Male; Malocclusion; Maxilla; Nose; Palatal Expansion Technique; Pharynx

Discrepancy of the upper dental midline to the facial midline plays an important role in smile aesthetic assessment. This study presents different reference points to quantify the deviation of upper dental midline to the facial midline in 2D frontal photographs. The aim was to find the most accurate, precise, and practical reference points to measure dental midline discrepancy in 2D photographs.. A modified headset with a protractor was developed in order to achieve photographs in nine standardised head positions. Six reference points were used to detect the facial midline in the 2D photographs (eyebrows "EB", inner-canthus of the eyes "ICE", alae of the nose "AN", columella "C", nasolabial folds "NLF", and the philtrum "PH"). The deviation of the maxillary dental midline from the facial midline was measured and compared with clinical measurements.. Standard deviations (SD), Root Mean Square Error (RMSE), Method of Moments' Estimator (MME), 2-way repeated measures ANOVA, and multi-level linear model were used to estimate the true errors.. The different reference points responded significantly differently to changes in head position and all showed measurement errors, which increased with greater head rotation. Alae of the nose showed the least measurement error and the greatest precision in all head positions.. The alae of the nose are the recommended reference points to identify the facial midline in order to quantify dental midline deviation from frontal photographs.

Topics: Anatomic Landmarks; Dental Arch; Esthetics, Dental; Face; Facial Asymmetry; Humans; Incisor; Lip; Malocclusion; Maxilla; Nose; Photography, Dental; Smiling; Tooth Abnormalities

Respiratory system is an important section in development of maxillofacial components and many studies indicated its effect on normal growth of the jaws. The aim of this study is to evaluate upper airway in different skeletal classifications of jaws in lateral cephalogram and its relation to age and gender.. Study samples were 105 digital cephalometric radiographies, 72 females and 33 males. Lateral cephalograms were hand traced and based on Stainer analysis, there were 30 samples in Class I, 30 samples in Class II and 45 samples in Class III subgroup. Vertical linear measurements, horizontal linear measurements, and angular measurement, proportions and space measurements of the airway in the Cephalograms were analyzed by AutoCAD software.. Data were analyzed using SPSS software version 20. Two horizontal linear measurement (the hypo pharyngeal airway depth, the nasopharyngeal airway depth) and one space measurement (soft palate space) were significantly different in skeletal classes. Vertical and horizontal linear measurements in the 3 groups were increased significantly in men rather than women. The developmental age of groups showed some significant differences.. Upper airway dimension is different in different skeletal classes, developmental ages, and gender.

Topics: Cephalometry; Female; Humans; Jaw; Male; Malocclusion; Nasopharynx; Nose; Palate, Soft; Pharynx

Recently, greater emphasis has been placed on smile esthetics in dentistry. Eye tracking has been used to objectively evaluate attention to the dentition (mouth) in female models with different levels of dental esthetics quantified by the aesthetic component of the Index of Orthodontic Treatment Need (IOTN). This has not been accomplished in men. Our objective was to determine the visual attention to the mouth in men with different levels of dental esthetics (IOTN levels) and background facial attractiveness, for both male and female raters, using eye tracking.. Facial images of men rated as unattractive, average, and attractive were digitally manipulated and paired with validated oral images, IOTN levels 1 (no treatment need), 7 (borderline treatment need), and 10 (definite treatment need). Sixty-four raters meeting the inclusion criteria were included in the data analysis. Each rater was calibrated in the eye tracker and randomly viewed the composite images for 3 seconds, twice for reliability.. Reliability was good or excellent (intraclass correlation coefficients, 0.6-0.9). Significant interactions were observed with factorial repeated-measures analysis of variance and the Tukey-Kramer method for density and duration of fixations in the interactions of model facial attractiveness by area of the face (P <0.0001, P <0.0001, respectively), dental esthetics (IOTN) by area of the face (P <0.0001, P <0.0001, respectively), and rater sex by area of the face (P = 0.0166, P = 0.0290, respectively). For area by facial attractiveness, the hierarchy of visual attention in unattractive and attractive models was eye, mouth, and nose, but for men of average attractiveness, it was mouth, eye, and nose. For dental esthetics by area, at IOTN 7, the mouth had significantly more visual attention than it did at IOTN 1 and significantly more than the nose. At IOTN 10, the mouth received significantly more attention than at IOTN 7 and surpassed the nose and eye. These findings were irrespective of facial attractiveness levels. For rater sex by area in visual density, women showed significantly more attention to the eyes than did men, and only men showed significantly more attention to the mouth over the nose.. Visual attention to the mouth was the greatest in men of average facial attractiveness, irrespective of dental esthetics. In borderline dental esthetics (IOTN 7), the eye and mouth were statistically indistinguishable, but in the most unesthetic dental attractiveness level (IOTN 10), the mouth exceeded the eye. The most unesthetic malocclusion significantly attracted visual attention in men. Male and female raters showed differences in their visual attention to male faces. Laypersons gave significant visual attention to poor dental esthetics in men, irrespective of background attractiveness; this was counter to what was seen in women.

Topics: Adult; Analysis of Variance; Attention; Beauty; Esthetics, Dental; Eye; Face; Humans; Index of Orthodontic Treatment Need; Male; Malocclusion; Mouth; Nose; Reproducibility of Results; Sex Factors; Smiling; Young Adult

To evaluate the nasolabial soft tissue change three-dimensionally after orthognathic surgery, using a structured light scanner.. Thirty-two malocclusion patients, who underwent orthognathic surgery, were evaluated. CBCT and 3D facial scans were obtained before surgery and 3 months after surgery. The 3D changes in the 26 landmarks, and the relative ratio of the soft tissue movement to the bony movement, were evaluated.. In the Le Fort I advancement patients, the nasal tip moved 17% forward, compared to the maxillary bony movement, but the nasal prominence decreased 15%. The alar width increased 4 mm after the advancement, and the width decreased 4.7 mm after Le Fort I setback. The relative ratio of the soft tissue movement to the bony movement after bilateral sagittal split osteotomy was about 66% at the Li point in the anteroposterior direction, and it was 21% in the Le Fort I advancement and 14% in Le Fort I setback at the Ls point.. Alar cinch suturing may not be sufficient to overcome the effect of the maxilla advancement compressing the nasal complex. Alar width widening was prevented in Le Fort I setback. However, it is uncertain that the alar cinch suturing was solely responsible. The soft tissue around the mandible tends to accompany the bony movement more than the maxillary area. In addition, structured light scanning system proved to be a useful tool to evaluate the nasolabial soft tissue.

Topics: Adolescent; Adult; Cone-Beam Computed Tomography; Connective Tissue; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Malocclusion; Nose; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Young Adult

To investigate the effect of maximum anchorage on upper airway in adolescent patients with bimaxillary protrusion and extraction from three-dimensional direction on cone-beam computed tomography(CBCT).. A retrospective evaluation was carried out on pre- and post-orthodontic treatment records of 50 adolescents with bimaxillary protrusion treated by maximum anchorage extraction. The changes on upper airway pre- and post-treatment were measured. The data were analyzed using SPSS 17.0 software package.. It was found that the volume, mean cross-section area, minimum cross-section area of oropharyngeal and hypopharyngeal airway were significantly decreased after treatment (P<0.001). The cross-section morphology of oropharyngeal and hypopharyngeal airway showed more ellipsoid(P<0.001). Pearson's correlation analysis indicated that the lower incisor retraction and hyoid retraction was correlated with mean cross-section area of hypopharyngeal airway (P<0.05). There was significant correlation in the upper and lower incisor retraction and hyoid retraction(P<0.01).. The upper airway dimension should be given serious consideration on the decision when closing the space with maximum anchorage in adolescent patients.

Topics: Adolescent; Cephalometry; Cone-Beam Computed Tomography; Humans; Incisor; Malocclusion; Nose; Retrospective Studies

BACKGROUND Persons with class II division 2 malocclusion are characterized by a very specific dento-skeletal and soft-tissue profile (a profile in which a protruding nose and chin, retruding lips, concave and shortened lower third of the face, and gummy smile are dominant), which is the opposite of the currently modern profiles (convex profile of protruding lips and small chin). The aim of this research was to determine the differences in parameters of harmonies of facial profiles between persons with class II division 2 malocclusions and class I, and to establish the significance of those differences. MATERIAL AND METHODS For this study, 50 patients with class II division 2 malocclusions and 50 patients with class I were selected; profile photos were recorded and a photometric analysis was done: a type of profile according to Schwarz, the shape of a nose, the prominence of chin, biometrical field, the position of lips in relation to the tangent Sn-Pg, S-line (Steiner), E-line (Riketts) and a facial angle according to Arnett. RESULTS The significant differences in profiles of persons with class II division 2 compared to class I were: position and prominence of the chin, the position of the lower and upper lip in relation to the S-line, and smaller value of a facial angle in relation to persons with class I. CONCLUSIONS The differences seen in skeletal profiles were not associated with significant differences in the profiled facial contours of the examined groups. The compensatory role of the fullness of soft tissues of the lips is probably the reason why there were not significant deviations in all the examined parameters.

Topics: Adolescent; Adult; Case-Control Studies; Cephalometry; Chin; China; Face; Female; Humans; Lip; Male; Malocclusion; Malocclusion, Angle Class II; Nose; Young Adult

Facial attractiveness is an important factor in our social interactions. It is still not entirely clear which factors influence the attractiveness of a face and facial asymmetry appears to play a certain role. The aim of the present study was to assess the association between facial attractiveness and regional facial asymmetries evaluated on three-dimensional (3D) images.. 3D facial images of 59 (23 male, 36 female) young adult patients (age 16-25 years) before orthodontic treatment were evaluated for asymmetry. The same 3D images were presented to 12 lay judges who rated the attractiveness of each subject on a 100mm visual analogue scale. Reliability of the method was assessed with Bland-Altman plots and Cronbach's alpha coefficient.. All subjects showed a certain amount of asymmetry in all regions of the face; most asymmetry was found in the chin and cheek areas and less in the lip, nose and forehead areas. No statistically significant differences in regional facial asymmetries were found between male and female subjects (P > 0.05). Regression analyses demonstrated that the judgement of facial attractiveness was not influenced by absolute regional facial asymmetries when gender, facial width-to-height ratio and type of malocclusion were controlled (P > 0.05).. A potential limitation of the study could be that other biologic and cultural factors influencing the perception of facial attractiveness were not controlled for.. A small amount of asymmetry was present in all subjects assessed in this study, and asymmetry of this magnitude may not influence the assessment of facial attractiveness.

Topics: Adolescent; Adult; Anatomic Landmarks; Attitude to Health; Cheek; Chin; Esthetics, Dental; Face; Facial Asymmetry; Female; Forehead; Humans; Imaging, Three-Dimensional; Judgment; Male; Malocclusion; Nose; Photogrammetry; Reproducibility of Results; Young Adult

Our objectives are to analyse and to compare the stress distribution and displacement of the craniofacial structures, following the application of forces from quad-helix and Nickel Titanium Palatal Expander-2 (NPE2) using finite element analysis.. Three-dimensional finite element models of young dried human skull, quad-helix appliance and NPE2 were constructed, and the initial activation of the expanders was stimulated to carry out the analysis and to evaluate the Von Misses stresses and displacement.. Both the models demonstrated the highest stresses at the mid-palatal suture, with maximum posterior dislocation. The second highest stress was recorded at the fronto-zygomatic suture. The pattern of stress distribution was almost similar in both the groups, but NPE2 revealed lower magnitude stresses than quad-helix. The only exception being quad-helix model showed high stress levels around pterygo-maxillary suture whereas minimal stress around pterygo-maxillary suture was noticed after NPE2 activation. The cusp of the erupting canine and the erupting mesiobuccal cusp of the second molar showed outward, backward and downward displacement signifying increase in their eruption pattern following maxillary expansion.. Maxillary expansion using quad-helix and NPE2 can be used in posterior crossbite correction in cases where maximum skeletal changes are desirable at a younger age; it is furthermore effective in treating young patients with impacted or displaced teeth. Quad-helix and NPE2 produced acceptable forces for orthopaedic treatment even after being orthodontic appliances; their clinical application should be correctly planned as the effects of these appliances are largely age dependent.

Topics: Alloys; Child; Computer Simulation; Computer-Aided Design; Cranial Sutures; Cuspid; Dental Arch; Dental Stress Analysis; Finite Element Analysis; Humans; Malocclusion; Maxilla; Models, Anatomic; Models, Biological; Molar; Nasal Bone; Nose; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Orthodontic Appliances; Palatal Expansion Technique; Palate; Palate, Hard; Skull; Tomography, X-Ray Computed; Zygoma

To evaluate the effects of rapid maxillary expansion (RME) on nocturnal enuresis (NE) related to the nasal airway, nasal breathing, and plasma osmolality (as an indicator for antidiuretic hormone).. Nineteen patients with monosymptomatic primary NE, aged 6-15 years, were treated with RME for 10-15 days. To exclude a placebo effect of the RME appliance, seven patients were first treated with a passive appliance. Computed tomography of nasal cavity, rhinomanometric, and plasma osmolality measurements were made 2-3 days before and 2-3 months after the RME period. RME effects on NE were followed for three more years.. Two to three months after the expansion there were significant improvements in the breathing function and a decrease in the plasma osmolality. NE decreased significantly in all patients after the RME period, and all patients showed full dryness after 3 years.. This study demonstrates that RME causes complete dryness in all patients, with significant effects on pathophysiological mechanisms related to NE.

Topics: Adolescent; Airway Resistance; Blood Glucose; Blood Urea Nitrogen; Child; Female; Follow-Up Studies; Humans; Male; Malocclusion; Mouth Breathing; Nasal Cavity; Nocturnal Enuresis; Nose; Osmolar Concentration; Palatal Expansion Technique; Pulmonary Ventilation; Respiration; Rhinomanometry; Snoring; Sodium; Tomography, X-Ray Computed; Vasopressins

Orthognathic surgery aims to improve both the function and facial appearance of the patient. Translation of the maxillomandibular complex for correction of malocclusion is always followed by changes to the covering soft tissues, especially the nose and lips. The purpose of this study was to evaluate the changes in the nasal region and upper lip due to orthognathic surgery using combined cone beam computed tomography (CBCT) and three-dimensional (3D) stereophotogrammetry datasets. Patients who underwent a Le Fort I osteotomy, with or without a bilateral sagittal split osteotomy, were included in this study. Pre- and postoperative documentation consisted of 3D stereophotogrammetry and CBCT scans. 3D measurements were performed on the combined datasets and analyzed. Anterior translation and clockwise pitching of the maxilla led to a significant volume increase in the lip. Cranial translation of the maxilla led to an increase in the alar width. The combination of CBCT DICOM data and 3D stereophotogrammetry proved to be useful in the 3D analysis of the maxillary hard tissue changes, as well as changes in the soft tissues. Measurements could be acquired and compared to investigate the influence of maxillary movement on the soft tissues of the nose and the upper lip.

Topics: Adolescent; Adult; Anatomic Landmarks; Cone-Beam Computed Tomography; Facial Bones; Female; Humans; Imaging, Three-Dimensional; Lip; Male; Malocclusion; Middle Aged; Nose; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Photogrammetry; Treatment Outcome

Long-term soft tissue response to extraction orthodontic treatment has been a subject of interest for years. The purposes of this study were to investigate long-term soft tissue profile changes in an extraction sample and to compare them with profile changes in an untreated sample.. A premolar extraction-treated sample (n = 47) and an untreated control sample (n = 57) were studied. Descriptive statistics were collected, and individual t tests were used for comparison and contrast of the treated and untreated samples.. We found that the untreated soft tissue profile changed in the downward and forward direction. The treated soft tissue profile change was similar, but with more of a forward component than in the untreated sample. Most noteworthy was the finding that the soft tissue profiles of both the untreated and the treated samples were similar at the end point.. The following conclusions were derived from the study. (1) There was no substantive difference in the soft tissue profiles of the samples, but there were some differences in the directional changes between them. (2) The changes for the untreated sample were the greatest for the lips and the chin, with the change occurring in the downward and forward direction. (3) The soft tissue profiles of the extraction sample also had the greatest measurable changes in the lips and the chin, but the changes had more of a forward component than they did in the untreated sample. (4) Extraction treatment does not adversely impact soft tissue profile changes over time.

Topics: Adult; Bicuspid; Case-Control Studies; Cephalometry; Chin; Face; Follow-Up Studies; Humans; Incisor; Lip; Longitudinal Studies; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Maxilla; Middle Aged; Nose; Orthodontics, Corrective; Tooth Extraction

We investigated how laypeople perceive persons with straight teeth and nose, mild to moderate modification of the nose, and mild to moderate modification of the teeth. The objectives were to determine: (1) how modification of the nose or teeth affects others' perceptions of target persons' facial attractiveness, (2) whether these evaluations are affected by the target persons' or raters' gender, (3) whether the frontal view or three-quarter view has any effect on the ratings.. Survey data were collected from 226 college students at Seton Hill University (49% male, 51% female; age range, 18-25 years) who rated, on a 100mm VAS, photos of subjects with straight teeth and nose (control), mild to moderate modification of the nose, and mild to moderate modification of the teeth from the frontal and three-quarter views.. Male and female target photos with teeth modification were considered the least attractive. Both male and female target photos showed that female raters evaluated both control and nose modification conditions more positively than did male raters. For male and female target photos, the frontal view was less esthetically pleasing under teeth modification.. Both male and female evaluators judged teeth modification as the least attractive compared to nose modification. It is recommended for rhinoplasty patients with malaligned teeth that it may be beneficial for cosmetic surgeons to establish an interdisciplinary approach working with orthodontists.

Topics: Adolescent; Adult; Attitude to Health; Beauty; Dentition; Face; Female; Humans; Male; Malocclusion; Nose; Nose Diseases; Photography; Sex Factors; Visual Analog Scale; Young Adult

The objectives of this paper are to (1) study use of soft tissue analyses advocated by Steiner, Ricketts, Burstone, Sushner and Holdway to develop soft tissue cephalometric norms as baseline data for sagittal lip position in Northeast Chinese adult population, (2) compare the sagittal lip positions in different skeletal malocclusions and (3) compare the sagittal lip positions in Northeast Chinese adults with other reported populations.. Lateral cephalometric radiographs of subjects were taken in natural head position. Radiographs were manually traced and five reference lines - Sushner, Steiner, Burstone, Holdway and Ricketts, were used. The linear distance between the tip of the lips and the five reference lines were measured. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) 21. Descriptive analysis was done for each variable for each subject. Coefficient of variation between lip positions as assessed by reference lines was determined. Post hoc Tukey's test was used for comparison of the mean cephalometric values of three skeletal malocclusions. The level of significance for the analysis was set at p < 0.05.. The findings showed significant difference in the sagittal lip positions in different skeletal malocclusions. There was variation in consistent reference line in each skeletal malocclusion. The S2 line was the most consistent reference line in skeletal class I and class II group. The B line was the most consistent line in skeletal class III. In skeletal class II group, upper lips were the most protrusive and lower lips were retrusive than in skeletal class I and class III groups. In case of skeletal class III group, upper lips were retrusive and lower lips were more protrusive than in skeletal class I and class II groups.. The sagittal lip positions were found to be associated with the skeletal malocclusion pattern. Northeast Chinese population has protrusive upper and lower lip in comparison to Caucasians. Each skeletal malocclusion group showed different preferable reference lines for analysis of sagittal lip position.

Topics: Adolescent; Adult; Anatomic Landmarks; Asian People; Cephalometry; Chin; China; Humans; Lip; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Maxilla; Nasal Bone; Nose; Retrospective Studies; White People; Young Adult

To ensure optimal results, we must do our utmost to achieve targets based on order, symmetry and precision, our ultimate aim being to strive towards the desired harmony, planned contrast and exact proportions. Orthodontic-surgical treatments require specific finishing procedures, which most often call for multidisciplinary, or even transdisciplinary, collaboration. Finishing will involve the dental arches just as much as the orofacial environment. Above all, treatment of this kind demands a highly targeted approach in combination with well-defined and perfectly executed techniques. To finish a case satisfactorily, reasonable targets should be aimed for to ensure they are achieved. One must be ambitious and yet wise. A tight alliance of surgeon and orthodontist will nurture convincing and achievable projects and good, lifelong outcomes. Following the consolidation phase, roughly 4 to 6 weeks post-surgery, we can initiate the final orthodontic treatment, which, in effect, constitutes a mini-treatment in its own right. "Details make perfection, but perfection is not a detail" (Leonardo Da Vinci). "A lucid mind is the ante-chamber of intelligence" (Léo Ferré). In the order of life, every form of unity is always unique, and if each of us is unique, it is because everyone else is too. Ambition, wisdom, lucidity and efficiency will guarantee a successful result, the successful result. We must not be mere observers of our treatments, but the architect, project manager and site foreman at one and the same time. One could talk ad infinitum about finishing orthodontic-surgical cases because everything else leads up to the case-finishing and even the fullest description could never be exhaustive.

Topics: Adult; Communication; Dental Implants; Dentist-Patient Relations; Esthetics; Female; Gingivoplasty; Humans; Lip; Male; Malocclusion; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandibular Advancement; Maxillary Osteotomy; Nose; Orthodontic Space Closure; Orthodontics, Corrective; Orthognathic Surgical Procedures; Patient Care Planning; Patient Care Team; Periodontal Diseases; Rhinoplasty; Smiling; Tooth Extraction; Treatment Outcome

Maxillary hypoplasia is a common sequela of cleft lip and palate. Its surgical treatment consists in a maxillary advancement by distraction or by conventional orthognathic surgery but morphological results are unpredictable. Our goal in this study was to see if the esthetical results (on the lip and the nose) of maxillary advancement were correlated to the preservation of lateral incisor space of the cleft side.. This retrospective study included 38 patients operated between 2002 and 2013. Unilateral clefts were studied independently from bilateral clefts. Profile aesthetics was evaluated independently and subjectively by two surgeons and scored on an 8-point scale. The result was classified as "good" if the score was superior or equal to 6. The score was correlated to the following parameters: amount of maxillary advancement, upper incisor axis, preservation of the missing lateral incisor space.. In the "good result" group, the space of the lateral incisor was less often preserved. The nasolabial angle was more open and the upper central incisor axis more vertical. These results were more pronounced in bilateral clefts, but also found in unilateral clefts.. Under reservation of the subjective evaluation and of the small number of patients, it seemed that lateral incisor space closure improved the profile of patients treated by maxillary advancement for cleft lip and palate sequelae.

Topics: Adolescent; Adult; Child; Cleft Lip; Cleft Palate; Esthetics; Female; Humans; Lip; Male; Malocclusion; Maxilla; Maxillary Osteotomy; Nose; Orthognathic Surgical Procedures; Plastic Surgery Procedures; Retrospective Studies; Young Adult

The purposes of this study were to evaluate and compare the dentoskeletal changes concurrent with 4-point bone-borne and tooth-borne rapid maxillary expanders in growing children.. The study was conducted with 20 growing girls (ages, 12 ± 0.6 years) with posterior crossbite. They were divided into 2 equal groups; patients in one group were treated with a tooth-borne maxillary hyrax expander (TBME), and those in the other group received a bone-borne maxillary hyrax expander (BBME) anchored directly to the palatal bone. Changes were assessed using cone-beam computed tomography. Images were taken before and immediately after expansion.. Superimpositions of the 3-dimensional palatal images showed significant increases in skeletal widths at the canine, first premolar, and first molar areas in both groups. The TBME group had greater nasal width expansion. Regarding the transverse dentolinear measurements, significant increases were seen in both groups, whereas the TBME group showed a greater increase than the BBME group. Significant increases in the dentoangular measurements were seen in the TBME group only and were significantly greater than in the BBME group at the first premolars.. There were significant increases in facial and maxillary widths for the BBME group and in nasal width for the TBME group. Both expanders produced basal bone expansion at the level of the hard palate. The TBMEs produced more dental expansion, buccal rolling, and a greater increase in nasal width than did the BBMEs.

Topics: Bicuspid; Cephalometry; Child; Cone-Beam Computed Tomography; Cuspid; Dental Arch; Female; Humans; Imaging, Three-Dimensional; Malocclusion; Maxilla; Molar; Nose; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Palatal Expansion Technique; Palate

To assess the volumetric changes and the maxillary response of the naso-maxillary complex (NMC) following rapid maxillary expansion (RME).. Thirty consecutive patients (14 males and 16 females) with a mean age at first observation of 9.5 ± 1.8 years for males and of 11.8 ± 1.7 years for females, presenting a posterior unilateral or bilateral crossbite and requiring RME, were selected for the study. Each patient underwent expansion to correct the transverse occlusal relationships. Computed tomography scans were taken before RME (T1) and at the end of the active expansion phase (T2). Measurements were performed on scanned images. The Kolmogorov-Smirnov test was performed; the mean differences between measurements at T1 and T2 were compared using the t-test (α = .05).. All volumetric, maxillary, transverse skeletal anterior and posterior variables as well as all dental anterior and posterior linear and angular variables representing the NMC displayed statistically highly significant increases after RME (P < .001).. After RME the total volume of the NMC increased by 12%, the nasal volume by 17%, and the maxillary volume by 10.6%. The maxillary and the nasal contributions represented 69.75% and 30.25%, respectively.

Topics: Anatomic Landmarks; Cephalometry; Child; Female; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Incisor; Male; Malocclusion; Maxilla; Molar; Nasal Bone; Nose; Orthodontic Appliance Design; Palatal Expansion Technique; Palate; Tomography, X-Ray Computed

This study aimed to compare facial morphologies of an adult African-American population to an adult Caucasian-American population using three-dimensional (3D) surface imaging.. The images were captured using a stereophotogrammetric system (3dMDface(TM) system). Subjects were aged 19-30 years, with normal body mass index and no gross craniofacial anomalies. Images were aligned and combined using RF6 Plus Pack 2 software to produce a male and female facial average for each population. The averages were superimposed and the differences were assessed.. The most distinct differences were in the forehead, alar base and perioricular regions. The average difference between African-American and Caucasian-American females was 1·18±0·98 mm. The African-American females had a broader face, wider alar base and more protrusive lips. The Caucasian-American females had a more prominent chin, malar region and lower forehead. The average difference between African-American and Caucasian-American males was 1·11±1·04 mm. The African-American males had a more prominent upper forehead and periocular region, wider alar base and more protrusive lips. No notable difference occurred between chin points of the two male populations.. Average faces were created from 3D photographs, and the facial morphological differences between populations and genders were compared. African-American males had a more prominent upper forehead and periocular region, wider alar base and more protrusive lips. Caucasian-American males showed a more prominent nasal tip and malar area. African-American females had broader face, wider alar base and more protrusive lips. Caucasian-American females showed a more prominent chin point, malar region and lower forehead.

Topics: Adult; Black or African American; Cephalometry; Chin; Eye; Face; Female; Forehead; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Male; Malocclusion; Nasal Cartilages; Nose; Photogrammetry; Photography; Sex Factors; United States; White People; Young Adult; Zygoma

To objectively classify the nose-lip-chin profiles of adult women and identify any associations between the nose-lip-chin profile patterns and dentoskeletal patterns.. Lateral facial photographs and lateral cephalograms were obtained for 229 Japanese women who were being assessed for orthodontic treatment.. A feature vector that was effective in distinguishing differences in nose-lip-chin profiles was extracted for each photograph. To categorize the records into an optimum number of subclasses according to nose-lip-chin profile configurations, a vector quantization method was applied to the feature vectors of all samples. Dentoskeletal patterns that corresponded to the nose-lip-chin profile subclasses were compared.. Eight profile patterns were identified, and the differences among patterns were notably maximized by the nasolabial angle, configuration and vertical length of the subnasal region, vertical thickness of the lip vermilion borders, sagittal position of the upper- and lower-lip vermilion borders and their relation to each other, labiomental angle, depth of the labiomental sulcus, degree of prominence of the chin, and degree of protrusion of the mandible. The dentoskeletal patterns showed significant differences between the classified profile patterns (p < 0.01).. A method to objectively classify the nose-lip-chin profiles of adult women was established, and the nose-lip-chin profile patterns were found to be associated with the dentoskeletal patterns.

Topics: Adolescent; Adult; Anatomic Landmarks; Cephalometry; Chin; Female; Frontal Bone; Humans; Lip; Malocclusion; Mandible; Maxilla; Middle Aged; Nasal Bone; Neck; Nose; Photography; Prognathism; Retrognathia; Vertical Dimension; Young Adult

The aim of this cephalometric study was to evaluate the influence of the sagittal skeletal pattern on the 'Y-axis of growth' measurement in patients with different malocclusions.. Lateral head films from 59 patients (mean age 16y 7m, ranging from 11 to 25 years) were selected after a subjective analysis of 1630 cases. Sample was grouped as follows: Group 1 - class I facial pattern; group 2 - class II facial pattern; and Group 3 - class III facial pattern. Two angular measurements, SNGoGn and SNGn, were taken in order to determine skeletal vertical facial pattern. A logistic regression with errors distributed according to a binomial distribution was used to test the influence of the sagittal relationship (Class I, II, III facial patterns) on vertical diagnostic measurement congruence (SNGoGn and SNGn).. RESULTS show that the probability of congruence between the patterns SNGn and SNGoGn was relatively high (70%) for group 1, but for groups II (46%) and III (37%) this congruence was relatively low.. The use of SNGn appears to be inappropriate to determine the vertical facial skeletal pattern of patients, due to Gn point shifting throughout sagittal discrepancies. Clinical Significance: Facial pattern determined by SNGn must be considered carefully, especially when severe sagittal discrepancies are present.

Topics: Adolescent; Adult; Anatomic Landmarks; Cephalometry; Child; Facial Bones; Female; Humans; Image Processing, Computer-Assisted; Lip; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Nasal Bone; Nose; Photography; Sella Turcica; Vertical Dimension; Young Adult

This clinical report describes the use of a mandibular repositioning splint and the subsequent prosthodontic treatment of a unilateral dislocated condyle fracture for a patient whose injury resulted in significant mandibular deviation and malocclusion. The use of a mandibular repositioning splint considerably reduced the mandibular deviation, and a stable mandibular position was maintained with the definitive prosthesis.

Topics: Crowns; Facial Asymmetry; Humans; Joint Dislocations; Male; Malocclusion; Mandibular Condyle; Mandibular Fractures; Maxillary Sinus; Middle Aged; Nose; Occlusal Splints; Palate, Hard; Zygomatic Fractures

Surgically Assisted Rapid Maxillary Expansion (SARME) is frequently used to treat skeletal maxillary transverse deficiency (MTD) in skeletally mature and non-growing individuals. Despite previous research in the field, questions remain with respect to the long-term stability of SARME and its effects on hard and soft tissue. The overall aim of the present doctoral work was to achieve a greater understanding of SARME, using modern image technology and a multidisciplinary approach, with special reference to effects on the hard and soft tissues and respiration. A more specific aim was to evaluate the long-term stability in a retrospective sample of patients treated with SARME and orthodontic treatment and to compare the results with a matched, untreated control group. The studies in this doctoral project are thus based on two different samples and study designs. The first sample, Study I (Paper I), is a retrospective, consecutive, long-term follow-up material of study models from 31 patients (17 males and 14 females) treated with SARME and orthodontic treatment between 1991 and 2000. The mean pre-treatment age was 25.9 years (SD 9.6) with a mean follow-up time of 6.4 years (SD 3.3). Direct measurements on study models were made with a digital sliding caliper at reference points on molars and canines. To evaluate treatment outcome and long-term stability, the results were compared with study models from an untreated control group, matched for age, gender and follow-up time. The second sample, Study II (Papers II-IV), is a prospective consecutive, longitudinal material of 40 patients scheduled to undergo SARME and orthodontic treatment between 2006 and 2009. In Paper II, one patient was excluded because of a planned adenoidectomy. The final sample comprised 39 patients (16 males and 23 females). The mean age at treatment start was 19.9 years (range 15.9 - 43.9). Acoustic rhinometry, rhinomanometry and a questionnaire were used to assess the degree of nasal obstruction at three time-points; pre-treatment, three months after expansion and after completed treatment (mean 18 months). In Papers III-IV, three patients declined to participate and two had to be excluded because their CT-records were incomplete. The final sample comprised 35 patients (14 males and 21 females). The mean age at treatment start was 19.7 years (range 16.1 - 43.9). Helical CT-images were taken pre treatment and eighteen months' post-expansion. 3D models were registered and superimposed at th

Topics: Adolescent; Adult; Case-Control Studies; Cephalometry; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Malocclusion; Maxilla; Middle Aged; Nasal Bone; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Respiration; Tooth; Young Adult

This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid maxillary expansion on the volumes of the nose and nasal airway 2 yr after maxillary expansion. This prospective cohort study included 32 patients with transverse maxillary hypoplasia. Expansion was performed with a tooth-borne distractor (Hyrax) in 19 patients and with a bone-borne distractor [transpalatal distractor (TPD)] in the remaining 13. Cone beam computed tomography scans and three-dimensional (3D) photographs of the face were acquired before treatment and 22 ± 7 months later, and were used to evaluate the volumes of the nose and nasal airway. Nasal volume increased by 1.01 ± 1.6% in the Hyrax group and by 2.39 ± 2.4% in the TPD group. Nasal airway volume increased by 9.7 ± 5.6% in the Hyrax group and by 12.9 ± 12.7% in the TPD group. Changes in the nasal volume and in the nasal airway volume between the pre- and post-treatment measurements were statistically significant, whereas differences between the treatment groups were not; 22 months after surgically assisted rapid maxillary expansion, the increases in the nasal volume and in the nasal airway volume were comparable between tooth-borne and bone-borne devices.

Topics: Adolescent; Adult; Cephalometry; Cohort Studies; Cone-Beam Computed Tomography; Female; Humans; Imaging, Three-Dimensional; Male; Malocclusion; Maxilla; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Prospective Studies; Tooth

The association between pediatric sleep-disordered breathing caused by upper airway obstruction and craniofacial morphology is poorly understood and contradictory. The aims of this study were to evaluate the prevalence of children at risk for sleep-disordered breathing, as identified in an orthodontic setting by validated screening questionnaires, and to examine associations with their craniofacial and upper airway morphologies. A further aim was to assess the change in quality of life related to sleep-disordered breathing for affected children undergoing rapid maxillary expansion to correct a palatal crossbite or widen a narrow maxilla.. A prospective case-control study with children between 8 and 17 years of age (n = 81) at an orthodontic clinic was undertaken. The subjects were grouped as high risk or low risk for sleep-disordered breathing based on the scores from a validated 22-item Pediatric Sleep Questionnaire and the Obstructive Sleep Apnea-18 Quality of Life Questionnaire. Variables pertaining to a screening clinical examination, cephalometric assessment, and dental cast analysis were tested for differences between the 2 groups at baseline. Ten children who underwent rapid maxillary expansion were followed longitudinally until removal of the appliance approximately 9 months later with a repeated Obstructive Sleep Apnea-18 Quality of Life Questionnaire. All data were collected blinded to the questionnaire results.. The frequency of palatal crossbite involving at least 3 teeth was significantly higher in the high-risk group at 68.2%, compared with the low-risk group at 23.2% (P <0.0001). Average quality of life scores in the high-risk group indicated reduced quality of life related to sleep-disordered breathing by 16% compared with children in the low-risk group at baseline (P <0.0001). Cephalometrically, mean inferior airway space, posterior nasal spine to adenoidal mass distance, and adenoidal mass to soft palate distance were reduced in the high-risk group compared with the low-risk group by 1.87 mm (P <0.03), 2.82 mm (P <0.04), and 2.13 mm (P <0.03), respectively. The mean maxillary intercanine, maxillary interfirst premolar, maxillary interfirst molar, mandibular intercanine, and mandibular interfirst premolar widths were reduced in the high-risk group compared with the low-risk group by 4.22 mm (P <0.0001), 3.92 mm (P <0.0001), 4.24 mm (P <0.0001), 1.50 mm (P <0.01), and 1.84 mm (P <0.01), respectively. Children treated with rapid maxillary expansion showed an average improvement of 14% in quality of life scores in the high-risk group compared with the low-risk group, which showed a slight worsening in quality of life related to sleep-disordered breathing by an average of 1% (P <0.04), normalizing the quality of life scores in the high-risk children to the baseline scores compared with the low-risk group.. Children at high risk for sleep-disordered breathing are characterized by reduced quality of life, reduced nasopharyngeal and oropharyngeal sagittal dimensions, palatal crossbite, and reduced dentoalveolar transverse widths in the maxillary and mandibular arches. No sagittal or vertical craniofacial skeletal cephalometric predictors were identified for children at high risk for sleep-disordered breathing. In the short term, rapid maxillary expansion might aid in improvement of the quality of life for children with a narrow maxilla in the milder end of the sleep-disordered breathing spectrum.

Topics: Adolescent; Case-Control Studies; Cephalometry; Child; Female; Humans; Male; Malocclusion; Maxilla; Nose; Palatal Expansion Technique; Palate; Pharynx; Prevalence; Prospective Studies; Quality of Life; Risk Factors; Sleep Apnea Syndromes; Surveys and Questionnaires

Hemimandibular hyperplasia (HH) and hemimandibular elongation (HE) anomalies present with facial asymmetry and deranged occlusion. Currently, diagnosis and assessment of the facial dysmorphology is based on subjective clinical evaluation, supported by radiological scans. Advancements in objective assessments of facial asymmetry from three-dimensional (3D) facial scans facilitate a re-evaluation of the patterns of facial dysmorphology. Automated, robust and localised asymmetry assessments were obtained by comparing a 3D facial scan with its reflected image using a weighted least-squares superimposition. This robust superimposition is insensitive to severe asymmetries. This provides an estimation of the anatomical midline and a spatially dense vector map visualising localised directional differences between the left and right hemifaces. Analysis was conducted on three condylar hyperplasia phenotypes confirmed by clinical and CT evaluation: HH; HE; and hybrid phenotype. The midline extraction revealed chin point displacements in all cases. The upper lip philtrum and nose tip deviation to the affected side and a marked asymmetry of the mid face was noted in cases involving HE. Downward and medial rotation of the mandible with minor involvement of the midface was seen in the HH associated deformity. The hybrid phenotype case exhibited asymmetry features of both HH and HE cases.

Topics: Adult; Cephalometry; Chin; Facial Asymmetry; Female; Humans; Hyperplasia; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lip; Malocclusion; Mandible; Mandibular Condyle; Maxilla; Nose; Open Bite; Orbit; Phenotype; Rotation; Tomography, X-Ray Computed; Young Adult

Few studies have evaluated the relationship between morphological and functional characteristics of the masticatory apparatus in young subjects. Thus, the aim of this study was to evaluate masticatory performance (MP), maximal bite force (BF), orthodontic treatment need and orofacial dysfunction in children and adolescents.. The sample consisted of 316 subjects of both genders, with an age range 6-16years divided into 4 groups: early mixed, intermediate mixed, late mixed and permanent dentition. MP was evaluated by the individual's ability to comminute a chewable test material in order to determine median particle size (X(50)) and distribution of particles in different sieves ("b"). BF was determined using a digital gnatodynamometer with fork strength of 10mm. Orofacial function and orthodontic treatment need were screened using the Nordic Orofacial Test-Screening (NOT-S) protocol and Index of Orthodontic Treatment Need (IOTN), respectively. The results were submitted to descriptive statistics, normality test, analysis of variance and stepwise multiple linear regression to test relationship between MP and studied independent variables.. Variance of X(50) and b between groups was statistically significant. But evaluation of variables that significantly contributed to MP variation showed that age, body mass index (BMI), BF and the presence of sleep bruxism were negatively related to X(50) and the NOT-S clinical exam scores showed a positive relationship with X(50).. In the studied sample, age, BMI, BF and the presence of sleep bruxism were related to better MP; but the increase in NOT-S scores was significantly related to poorer MP.

Topics: Adolescent; Age Factors; Bite Force; Body Mass Index; Case-Control Studies; Child; Dentition, Mixed; Face; Facial Expression; Female; Humans; Index of Orthodontic Treatment Need; Male; Malocclusion; Mastication; Mouth; Muscle Strength Dynamometer; Nose; Particle Size; Respiration; Sleep Bruxism; Speech

Orthognathic surgery is a recognised way of correcting dentofacial deformities and it is common practice to treat problems that affect the chin simultaneously, while deferring or not treating nasal deformities. There is inadequate published information about the prevalence of nasal deformities in such patients, and our aim was to remedy this. We retrospectively studied 75 patients with dentofacial deformities to find out if there was an association between nasal and dentofacial abnormalities. Forty-six of the 75 patients (61%) had mild to prominent cosmetic nasal problems, of whom 27 had deformities of the nasal bridge, 22 of the lobule of the nasal tip, 20 of nasal width, 14 in the width of the alar base, and 11 of the columella; 8 presented with deviation of the nose, and 6 with abnormal nasal length. Skeletal classes II and III had only slightly varied emphasis on nasal deformities. In comparison 14 patients (19%) had problems with the chin that required, or had already had, genioplasty. We also studied 9 patients who had had corrective bimaxillary surgery with simultaneous rhinoplasty. We set no formal questionnaire, but all patients expressed satisfaction with the postoperative results.

Topics: Adolescent; Adult; Cephalometry; Chin; Female; Humans; Male; Malocclusion; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Middle Aged; Nasal Bone; Nasal Cartilages; Nasal Septum; Nose; Open Bite; Orthognathic Surgical Procedures; Osteotomy, Le Fort; Osteotomy, Sagittal Split Ramus; Patient Satisfaction; Photography; Retrospective Studies; Rhinoplasty; Young Adult

The aim of this study was to assess the three-dimensional soft tissue changes following anterior segmental maxillary osteotomy, in terms of magnitude and direction in correlation to hard tissue changes, using cone beam computed tomography (CBCT). The study included 6 patients (age range 17-35 years) suffering from dental maxillary protrusion that required surgical correction by anterior segmental maxillary osteotomy. For each patient, preoperative and postoperative CBCT, photographs, and orthodontic casts were taken before and 6 months after operation to analyse soft tissue changes, in terms of magnitude and direction in correlation to hard tissue changes, using linear and angular measurements. Hard and soft tissue changes were only observed in the maxillary region, upper lip area and nasal tip. Soft tissue mean change included 53% backward displacement of the labrale superius in relation to bone displacement and 18.7% mean increase in the naso-labial angle. The highest correlation coefficient was obtained between the hard and soft tissue changes in the upper lip region. Anterior segmental maxillary osteotomy might be recommended as the treatment modality of choice in patients with maxillary or dento-alveolar protrusion, the technique is simple, safe, and postoperative complications are minimal.

Topics: Adolescent; Adult; Alveolar Process; Cephalometry; Cone-Beam Computed Tomography; Face; Female; Follow-Up Studies; Humans; Imaging, Three-Dimensional; Incisor; Lip; Malocclusion; Maxilla; Models, Dental; Nasal Septum; Nose; Orthognathic Surgical Procedures; Osteotomy; Palate; Photography; Young Adult

The aim of the present study was to evaluate the dimensions of the pharyngeal airway space (PAS) in awake, upright children with different anteroposterior skeletal patterns using cone beam computed tomography (CBCT). The volume, area, minimum axial area and seven linear measurements of PAS were obtained from the CBCT images of 50 children (mean age 9.16 years). The patients were divided in two groups according to the ANB angle (group I 2° ≤ ANB ≤ 5°; group II ANB > 5°). Means and standard deviations of each variable were compared and correlated using independent t-test and Pearson's correlation test. There were statistically significant differences in the following parameters: angle formed by the intersection between NA and NB lines (p<0.001), angle formed by the intersection between SN and NB lines (p<0.05), Minimal pharyngeal airway space between the uvula and the posterior pharyngeal wall (p<0.05), airway volume (p<0.01), airway area (p<0.01) and minimum axial area (p<0.05). The anteroposterior cephalometric variable SNB had positive correlation with the variables PAS-UP (p<0.01), Minimal pharyngeal airway space between the uvula tip and the posterior pharyngeal wall (p<0.05), Pharyngeal airway space on mandibular line (p<0.05), Minimal pharyngeal airway space between the back of the tongue and the posterior pharyngeal wall (p<0.05), volume airway (p<0.05), airway area (p<0.05) and minimum axial area (p<0.05). The vertical cephalometric variables angle formed by the intersection between SN and GoGn lines (p<0.05) and angle formed by the intersection between FH and mandible plane (p<0.05) showed negative correlation with PAS-UT. These results showed that PAS was statistically larger in group I than group II, indicating that the dimensions of the PAS are affected by different anteroposterior skeletal patterns.

Topics: Anatomic Landmarks; Cephalometry; Child; Cone-Beam Computed Tomography; Epiglottis; Female; Humans; Imaging, Three-Dimensional; Male; Malocclusion; Mandible; Maxilla; Nose; Palate, Hard; Pharynx; Sella Turcica; Tongue; Uvula

Williams-Beuren syndrome is a rare congenital disorder involving the cardiovascular system, mental retardation, distinctive facial features, and tooth anomalies. The aim of the present report is to show a 10-year-old girl with Williams-Beuren syndrome, her general and orofacial clinical characteristics and the dental management.

Topics: Child; Craniofacial Abnormalities; Dental Enamel Hypoplasia; Female; Humans; Hypertelorism; Lip; Malocclusion; Nose; Retrognathia; Tooth Abnormalities; Williams Syndrome

In this article, we report the successful use of miniscrews in a patient with an Angle Class III malocclusion, lateral open bite, midline deviation, and severe crowding. Simultaneously resolving such problems with conventional Class III treatment is difficult. In this case, the treatment procedure was even more challenging because the patient preferred to have lingual brackets on the maxillary teeth. As a result, miniscrews were used to facilitate significant asymmetric tooth movement in the posterior and downward directions; this contributed to the camouflage of the skeletal mandibular protrusion together with complete resolution of the severe crowding and lateral open bite. Analysis of the jaw motion showed that irregularities in chewing movement were also resolved, and a stable occlusion was achieved. Improvements in the facial profile and dental arches remained stable at the 18-month follow-up.

Topics: Adult; Bone Screws; Cephalometry; Chin; Female; Follow-Up Studies; Humans; Incisor; Lip; Malocclusion; Malocclusion, Angle Class III; Mandible; Mandibular Condyle; Mastication; Nose; Open Bite; Orthodontic Anchorage Procedures; Orthodontic Appliance Design; Orthodontic Brackets; Patient Care Planning; Prognathism; Range of Motion, Articular; Tooth Movement Techniques; Treatment Outcome

Our objective was to evaluate the nasal passage (NP) and oropharyngeal (OP) volumes of patients with different dentofacial skeletal patterns.. The study sample consisted of 140 patients (70 boys, 70 girls), divided into 3 groups as Class I (1 ≤ ANB ≤ 3), Class II (ANB > 3), and Class III (ANB < 1), and then further divided into 4 groups as SNA angle ≥ 80°, SNA angle <80°, SNB angle ≥78°, and SNB angle < 78° to evaluate how the positional changes in the maxilla and the mandible affect the OP and NP variables. Differences between groups were determined by using the Kruskal-Wallis test. Correlations between the variables were tested with the Spearman correlation coefficient. The linear multiple regression test was applied to create a model for the airway volumes separately.. The OP volume of the Class II subjects (n = 50) was significantly lower when compared with that of the Class I (n = 46) and Class III subjects (n = 44). The only statistically significant difference for NP volume was observed between the Class I and Class II groups. The mean OP airway volume of subjects with retruded mandibular positions was statistically significantly smaller when compared with the subjects with higher SNB angles. The area of the most constricted region at the base of the tongue (minAx) had a high potential in explaining the OP volume, whereas the NP volume models were not as successful as the OP counterpart. However, minAx was also entered into the NP volume equations as an explanatory variable.. The OP airway volumes of Class II patients were smaller when compared with Class I and Class III patients. It was observed that mandibular position with respect to cranial base had an effect on the OP airway volume. The only significant difference for the NP volume was between the Class I and Class II groups, with a smaller volume observed for the Class II group.

Topics: Adolescent; Cephalometry; Cone-Beam Computed Tomography; Female; Humans; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Maxilla; Nasal Bone; Nose; Organ Size; Oropharynx; Sella Turcica; Skull Base; Software; Tongue

Because of limited available reference data, this study described the vertical growth changes that occur in untreated adolescents 10 to 15 years of age and evaluated the validity of measurements commonly used to classify patients' vertical growth tendencies.. The sample consisted of 228 subjects (119 boys, 109 girls) between 10 and 15 years of age with normal occlusions or malocclusions who had lateral cephalograms (n = 1303) taken annually. Based on 6 landmarks, 3 angles (PPA, MPA, PP/MPA) and 2 proportions (PFH:AFH and UFH:LFH) were calculated. To reduce errors, each subject's growth curve was estimated by using multilevel modeling procedures, and the estimated values were analyzed.. Growth changes between 10 and 15 years for each of the 5 measurements followed relatively simple (linear or quadratic) polynomial models. On average, PPA and PFH:AFH increased, and MPA and PP/MPA decreased. The UFH:LFH ratio increased during the first few years and then decreased. MPA, PP/MPA, and PFH:AFH showed moderately high intercorrelations; PPA displayed moderate to moderately low correlations with UFH:LFH; UFH:LFH showed a moderate correlation with PP/MPA. Approximately 75% to 86% of the subjects classified as hyperdivergent or hypodivergent at 10 years maintained their classification. Subjects classified as hyperdivergent at 15 years of age showed significantly greater growth changes than did those classified within normal limits, who, in turn, showed greater changes than did the hypodivergent subjects.. Measurements typically used to classify vertical growth tendencies changed significantly during adolescence, with boys generally showing greater changes than girls. Although MPA, PFH:AFH, and PP/MPA measured the same phenotypic attribute, PPA and UFH:LFH were relatively independent of the other 3 measurements. Most subjects maintained their vertical facial types, but some worsened, and others improved.

Topics: Adolescent; Cephalometry; Child; Chin; Dental Occlusion; Female; Humans; Longitudinal Studies; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nose; Palate; Quebec; Sella Turcica; Sex Factors; Skull Base; Vertical Dimension

Different devices are available to aid surgically-assisted maxillary expansion. In this study we have evaluated the changes to the anchoring teeth, the hard palate, and the lower nasal passage made by tooth-borne distraction devices. Thirty-one patients (mean (SD) age 28 (2) years) with deficiencies in the transverse width of the maxilla were examined by computed tomography and cone beam scans before and after operation. The data were analysed with the help of Wilcoxon's signed rank test and Spearman's r correlation. The mean (SD) distraction width was 6.5 (2.3) mm. All anchorage teeth were tilted (p<0.01). The axes changed by a mean (SD) of 4.8 (0.9)° in the first premolar and 3.1 (0.8)° in the first molar. The nasal isthmus increased by a mean (SD) of 2.5 (0.3) mm. The hard palate adjacent to the anchoring teeth increased anteriorly by a mean (SD) of 2.8 (0.4) mm and posteriorly by 2.7 (0.4) mm. The hard palate was lowered by 1.2 (0.8) mm. There was a significant correlation in the distraction width, with changes in the intercoronal and interapical distances of the anchoring premolars (p<0.05) and with the interapical distance of the anchoring molars (p<0.01). There was also a correlation between the distraction width and the overall gain in width of the lower nasal passage (p<0.05). The results suggested that surgically-assisted maxillary expansion with tooth-borne devices has significant effects on the anchoring teeth, the nasal floor, and the hard palate. Both tilting of the teeth and an evenly distributed movement of the segments were seen.

Topics: Adult; Alveolar Process; Bicuspid; Cephalometry; Cone-Beam Computed Tomography; Dental Arch; Female; Follow-Up Studies; Humans; Male; Malocclusion; Maxilla; Molar; Nasal Cavity; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Palate, Hard; Retrospective Studies; Tomography, X-Ray Computed; Tooth; Tooth Apex; Tooth Root

The aim of this study was to investigate and compare changes in the nasomaxillary complex substructures following orthopaedic rapid maxillary expansion (RME) and surgically assisted RME (SARME). 10 patients received RME, 10 patients received SARME, and 10 patients served as an untreated control group. Lateral and posteroanterior cephalograms were obtained for each individual at pre-expansion/pre-control (T1) and post-expansion/post-control (T2). Descriptive parameters and transversal measurements on maxillo-mandibular dentoalveolar structures and skeletal bases, right and left nasal cavity angles (NC/Lom/VL and CN/Lom/VL, respectively), total nasal cavity angle (NC/Lom/CN), nasal cavity width (NC-CN) and nasal septum angle (sn/Lom/VL) were also calculated. Paired t-tests were used to evaluate changes within groups following treatment/control. Analysis of variance (ANOVA) and Duncan's tests were used to compare changes between groups. With the exception of nasal septum deviation, all nasal parameters significantly increased following RME and SARME. The increases in the SARME group were greater than in the other groups, but no statistically significant differences were recorded between the RME and SARME groups. Neither RME nor SARME created positional changes in the nasal septum.

Topics: Adolescent; Adult; Case-Control Studies; Cephalometry; Dental Arch; Female; Follow-Up Studies; Humans; Male; Malocclusion; Mandible; Maxilla; Nasal Cavity; Nasal Septum; Nose; Orthodontic Appliance Design; Osteotomy; Palatal Expansion Technique; Skull Base; Young Adult

To evaluate and compare the nasal airway changes following rapid maxillary expansion (RME) and fan-type RME using acoustic rhinometry (AR).. The study sample consisted of three groups. The RME group comprised 15 subjects with maxillary transverse discrepancies and posterior crossbites. The fan-type RME group comprised 15 subjects, who had an anteriorly constricted maxilla with a normal intermolar width. The third group included 15 patients who had an ideal occlusion and received no orthodontic treatment and served as the control group. AR was used to measure nasal volume and the minimal cross-sectional area (MCA) before expansion (T1), after expansion (T2), and 6 months after expansion (T3). Each AR recording was performed with and without the use of a decongestant. Two-way analysis of variance was used to determine differences among the groups and three-way analysis of variance was used for the differences between groups. If evidence of statistically significant differences was found, a Bonferroni test was used.. The results showed that nasal volume and MCA were significantly increased with RME and fan-type RME immediately after expansion (P < .05). At the end of retention, nasal volume and MCA values of RME showed significant differences with both expansion fan-type RME and control groups (P < .05).. RME and fan-type RME had similar effects on the nasal airway immediately after expansion. The increase in nasal volume and MCA was more stable in the RME group than in the fan-type RME group at the end of the retention period.

Topics: Airway Resistance; Anatomy, Cross-Sectional; Child; Cuspid; Dental Arch; Female; Follow-Up Studies; Humans; Male; Malocclusion; Maxilla; Molar; Nasal Cavity; Nasal Decongestants; Nose; Orthodontic Appliance Design; Orthodontic Retainers; Palatal Expansion Technique; Pulmonary Ventilation; Recurrence; Rhinometry, Acoustic

The purposes of this study were to detect, locate, and examine the changes in transverse nasal width, area, and volume from bone-borne, surgically assisted rapid maxillary expansion (SARME) with the Dresden distractor by using computer tomography (CT).. Sixteen patients (average age, 28.7 years) underwent axial CT scanning before and 6 months after SARME. They also underwent CT fusion on specific bony structures. The nasal bone width was examined in the coronal plane. The cross-sectional images of the nasal cavity were taken of the area surrounding the apertura piriformis, the choanae, and in between. We calculated cross-sectional areas and nasal volume according to these data.. All but 2 patients had an increase in nasal volume of at least 5.1% (SD, 4.6%). The largest value of 35.3% (SD, 45.8%) was measured anteriorly on the nasal floor, decreasing cranially and posteriorly. This correlated with the V-shaped opening of the sutura palatina. There was no significant correlation between increase in nasal volume and transversal expansion.. Because most of the air we breathe passes over the lower nasal floor, SARME is likely to improve nasal breathing.

Topics: Adolescent; Adult; Female; Humans; Imaging, Three-Dimensional; Male; Malocclusion; Nasal Bone; Nasal Cavity; Nasopharynx; Nose; Osteogenesis, Distraction; Palatal Expansion Technique; Palate, Hard; Tomography, Spiral Computed; Young Adult

To determine the effect of mouth breathing during childhood on craniofacial and dentofacial development compared to nasal breathing in malocclusion patients treated in the orthodontic clinic.. Retrospective study in a tertiary medical center.. Clinical variables and cephalometric parameters of 116 pediatric patients who had undergone orthodontic treatment were reviewed. The study group included 55 pediatric patients who suffered from symptoms and signs of nasal obstruction, and the control group included 61 patients who were normal nasal breathers.. Mouth breathers demonstrated considerable backward and downward rotation of the mandible, increased overjet, increase in the mandible plane angle, a higher palatal plane, and narrowing of both upper and lower arches at the level of canines and first molars compared to the nasal breathers group. The prevalence of a posterior cross bite was significantly more frequent in the mouth breathers group (49%) than nose breathers (26%), (P = .006). Abnormal lip-to-tongue anterior oral seal was significantly more frequent in the mouth breathers group (56%) than in the nose breathers group (30%) (P = .05).. Naso-respiratory obstruction with mouth breathing during critical growth periods in children has a higher tendency for clockwise rotation of the growing mandible, with a disproportionate increase in anterior lower vertical face height and decreased posterior facial height.

Topics: Adolescent; Cephalometry; Child; Dental Arch; Female; Humans; Male; Malocclusion; Mandible; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Radiography; Retrospective Studies; Surveys and Questionnaires

The aim of this prospective study was to describe the morphological and functional changes of the upper airways and the middle ears after rapid maxillary expansion (RME). Thirteen patients comprised the original study sample, of these three patients dropped out. Of the remaining 10 subjects, seven (two females, five males; average age, 8.7 years) underwent orthodontic RME with a Hyrax screw and three (one female, two males; average age, 8.3 years) served as the controls. Inclusion criteria for the study group were a uni- or bilateral crossbite with the evidence of a maxillary deficiency. Exclusion criteria were acute or chronic respiratory disease, allergies, cleft lip and palate, or absence of adenoids. An ear, nose, and throat (ENT) examination, lateral cephalometry, anterior rhinomanometry, tympanometry, and posterior rhinoscopy were carried out for each child at baseline (E1) and after 6 months (E2). Descriptive statistics were calculated for all diagnostic variables and correlations between the study and control group were evaluated. Rhinomanometry showed a correlation (r=0.57) between the size of the nasal pharyngeal area and nasal airflow, but only at 150 daPa. The size of the adenoids measured on the lateral cephalograms was correlated with the endoscopic findings. The size of the adenoids remained the same after RME. Patients with maxillary constriction had the largest adenoids and showed a negative pressure in the middle ear. However, this was reduced after RME. The results suggest a possible impact of maxillary deficiency on otorhinological structures. RME may lead to otorhinological changes. Further interdisciplinary investigations are needed to corroborate these findings.

Topics: Acoustic Impedance Tests; Adenoids; Cephalometry; Child; Ear, Middle; Endoscopy; Eustachian Tube; Female; Follow-Up Studies; Humans; Male; Malocclusion; Nasopharynx; Nose; Orthodontic Appliance Design; Palatal Expansion Technique; Pharynx; Pilot Projects; Pressure; Prospective Studies; Rhinomanometry

Three-dimensional (3D) laser surface scanning analysis has taken hold in orthodontics, as well as craniomaxillofacial and plastic surgery as a new tool that can navigate away from the limitations of conventional two-dimensional methods. Various techniques for 3D reconstruction of the face have been used in diagnosis, treatment planning and simulation, and outcomes follow-up. The aim of the current prospective study was to present some technical aspects for the assessment of facial changes after orthodontic and orthognathic surgery treatment using 3D laser surface scanning. The technique proposed for facial surface shape analysis represented three-dimensionally the expected surgical changes, and the reduction of the postoperative swelling was verified. This study provides technical information from the data collection to the 3D virtual soft-tissue analysis that can be useful for diagnostic information, treatment planning, future comparisons of treatment stability or facial postoperative swelling, and soft-tissue profile assessment.

Topics: Cheek; Chin; Face; Facial Asymmetry; Facial Muscles; Female; Follow-Up Studies; Holography; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lasers; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Orthodontics, Corrective; Patient Care Planning; Prospective Studies; User-Computer Interface

Children with severe congenital absence of teeth present uncommon morphologies and therapeutic challenges. This study was designed to investigate the characteristic skeletal and dental features of this group.. A group of 28 children with at least 10 congenitally missing teeth (excluding third molars) was examined roentgenographically. The data were collected from their intraoral series or panoramic views and lateral cephalograms. The results of their cephalometric analyses were compared with classic cephalometric norms and with local population norms.. Specific patterns of incisor, premolar, and third molar absence emerged. The cephalometric parameters of the children with severe absence differed from the classic norms in bimaxillary retrognathism, chin angle, and maxillary incisor inclination. These children differed from the Israeli norms in almost all parameters examined.. Patients with severe congenital absence of teeth have unique dental and skeletal patterns.

Topics: Adolescent; Anodontia; Bicuspid; Cephalometry; Child; Chin; Facial Bones; Frontal Bone; Humans; Incisor; Lip; Malocclusion; Maxilla; Molar, Third; Nose; Orbit; Radiography, Panoramic; Retrognathia; Sella Turcica; Sphenoid Bone; Tooth

The aim of the study was to evaluate the relationship between malocclusion with cross-bite and permeability of the upper airways, and to observe the cephalometric changes of the rhinopharyngeal space after rapid palatal expansion therapy.. The sample consisted of 17 patients (age 9-12) of which 10 were males, followed up for a period of 1 year at the Department of Paediatric Dentistry of the Dental Clinic of the University of Pisa. Clinical, radiographical and otolaryngological examinations were carried out before treatment with palatal expansor. After expansor activation, each patient underwent an otolaryngological and orthodontic evaluation followed by rhinomanometry, and, in the cooperating children, endoscopy was also performed. After 6 and 12 months from the beginning of the treatment, each patient was examined again and the radiographic examination was repeated.. The cephalometric analysis exhibited an increase of the rhinopharyngeal space in 16 children. Furthermore all the 17 patients showed, after therapy, an increase of the transverse dimension of the upper jaw, measured on the postero-anterior teleradiography. On the other hand, the otolaryngological examination, and in particular rhinomanometry, exhibited an improvement of the flow and of right and left nasal resistance only in 3 children, while in 6 children the graph remained unchanged, and in 8 children it worsened. The results show that the rapid palatal expansion produces an improvement of the transversal skeletal discrepancy, and an improvement of the permeability of the upper airways. To make a correct diagnosis lateral and postero-anterior teleradiography, and a cephalometric analysis are needed; instead the otolaryngological examination in our opinion it is not an essential diagnostic examination for this kind of pathology.

Topics: Airway Resistance; Cephalometry; Child; Endoscopy; Exhalation; Female; Follow-Up Studies; Humans; Inhalation; Male; Malocclusion; Maxilla; Mouth Breathing; Nasopharynx; Nose; Palatal Expansion Technique; Pulmonary Ventilation; Rhinomanometry

The aims of this study were (1) to establish standards for Arnett soft tissue cephalometric analysis of Anatolian Turkish young adults and (2) to identify possible gender differences between males and females. After analysing the cephalometric radiographs of 350 individuals, 133 subjects (67 males, mean age 22.6 +/- 2.2 years, and 66 females, mean age 22.1 +/- 2.6 years) with normal antero-posterior and vertical skeletal relationships were selected. The true vertical line was established. The landmarks were marked and soft tissue facial analysis was performed. For statistical evaluation, an independent-samples t-test was used. The lower lip thickness of the Turkish population was lower and menton thickness was greater than Arnett's norms. Turkish subjects have depressed orbital rims, cheek bones, subpupils, upright and thin upper and lower lips, retruded incisors, and pogonion and point B. Most of the Turkish mean harmony values were within the range of Arnett's harmony standards. Soft tissue thicknesses were greater and facial lengths, except upper incisor exposure, were longer in Turkish males than females. These differences between ethnic groups should be taken into consideration when formulating orthodontic/orthognathic treatment plans for patients with dentofacial deformity.

Topics: Cephalometry; Chin; Ethnicity; Eye; Face; Female; Humans; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Orbit; Patient Care Planning; Sex Factors; Turkey; Vertical Dimension; Young Adult; Zygoma

The aim of this study was to investigate a method which minimizes the effects of geometric distortion on various cephalometric measurements used to determine sagittal discrepancy, such as ANB angle, Wits appraisal, AB plane angle, projections on the palatal plane, Frankfort horizontal (FH) plane, the mandibulomaxillary bisector, and the SN line, in an attempt to optimize the correlation between them. This was accomplished by superimposing the Bolton 12-year male-female averaged template on a patient's tracing using Procrustes analysis and performing measurements while exchanging the patient's reference landmarks/planes (point N, the mandibulomaxillary bisector, FH plane, occlusal plane, palatal plane, and SN line) with those of the template. The normalized measurements were then compared with their classic counterparts using correlation coefficients. The above cephalometric analyses, classic and normalized, were applied to 71 patients [26 males: mean age 13.1 years, standard deviation (SD) 1.1 years and 45 females: mean age of 14.6 years, SD 8.2 years]. Spearman's rank correlation coefficient was calculated between the classic measurements and their normalized counterparts, resulting in a consistent increase in the correlation between the normalized measurements in comparison with the classic ones. This increase varied in absolute value from 0.052 to 0.405. All normalized measurements were highly correlated (P > 0.742, absolute value). Although correlation calculations do not represent a true measure of diagnostic performance, it is hoped that improving their correspondence heightens the possibility of the different tests agreeing on the patient's sagittal discrepancy, decreasing the possibility of differing, or even totally opposing diagnostic outcomes resulting from their application to (clear-cut) Class I, II, and III patients.

Topics: Adolescent; Adult; Algorithms; Cephalometry; Child; Female; Humans; Incisor; Male; Malocclusion; Mandible; Maxilla; Nose; Palate; Radiographic Image Enhancement; Sella Turcica; Sex Factors; Statistics, Nonparametric; Young Adult

To evaluate the feasibility of anterior maxillary segmental distraction (AMSD) to correct maxillary hypoplasia and severe dental crowding in cleft lip and palate (CLP) patients, 7 patients (average age 16.4 years) with maxillary hypoplasia, shortened maxillary dental arch length and severe anterior dental crowding secondary to CLP were selected for this study. After anterior maxillary segmental osteotomy, 3 patients were treated using bilateral internal distraction devices, and 4 patients were treated using rigid external distraction devices. Photographs and radiographs were taken to review the improvement in facial profile and occlusion after distraction. An average 10.25 mm anterior maxillary advancement was obtained in all patients after 10-23 days of distraction and 9-16 weeks of consolidation. The sella-nasion-point A (SNA) angle increased from 69.5 degrees to 79.6 degrees. Midface convexity was greatly improved and velopharyngeal competence was preserved. The maxillary dental arch length was greatly increased by 10.1 mm (P<0.01). Dental crowding and malocclusion were corrected by orthodontic treatment. These results show that AMSD can effectively correct the hypoplastic maxilla and severe dental crowding associated with CLP by increasing the midface convexity and dental arch length while preserving velopharyngeal function, and dental crowding can be corrected without requiring tooth extraction.

Topics: Adolescent; Cephalometry; Cleft Lip; Cleft Palate; Dental Arch; External Fixators; Feasibility Studies; Female; Humans; Internal Fixators; Male; Malocclusion; Mandible; Maxilla; Nasal Cavity; Nose; Osteogenesis, Distraction; Osteotomy; Osteotomy, Le Fort; Photography, Dental; Sella Turcica; Tooth Movement Techniques; Velopharyngeal Sphincter; Young Adult

Topics: Adolescent; Adult; Aging; Biomechanical Phenomena; Child; Chin; Esthetics, Dental; Face; Female; Humans; Incisor; Lip; Male; Malocclusion; Nose; Open Bite; Orthodontic Appliance Design; Orthodontics, Corrective; Patient Care Planning; Smiling

Traditionally, lateral and frontal cephalograms are used with facial photographs to evaluate a patient's maxillofacial skeletal and facial soft-tissue morphology. However, the enlargement and distortion of 2-dimensional radiography made it difficult to accurately conceptualize the patient's anatomy. The purpose of this article was to introduce a new method for comparing 3-dimensional (3D) standard values of the maxillofacial skeletal and facial soft-tissue morphology before and after orthognathic surgery.. Normative 3D standard values of the maxillofacial skeletal and facial soft-tissue morphology were calculated from normal women. The pre- and postoperative morphology of one woman who underwent orthognathic surgery was compared with the normative data.. This 3D analysis has clinical value to evaluate patients before and after surgical treatment.. This quantitative assessment of 3D maxillofacial morphology can evaluate the area and degree of displacement and rotation of the facial skeleton and facial soft tissues. This method is sufficiently useful for routine clinical applications.

Topics: Adult; Cephalometry; Chin; Cranial Sutures; Face; Facial Bones; Female; Frontal Bone; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Jaw Abnormalities; Malocclusion; Mandible; Mandibular Condyle; Maxilla; Nasal Bone; Nose; Orbit; Osteotomy; Parietal Bone; Tomography, X-Ray Computed; Zygoma

The purpose of this study was to determine the relationship between the changes of soft and hard tissues after modified anterior segmental osteotomy on the maxilla and mandible and to evaluate unintended facial changes using cephalometric and photometric analyses.. The subjects included 29 women and 1 man (22 to 50 years of age) who were diagnosed as bialveolar or bimaxillary protrusion and underwent modified anterior segmental osteotomy on the maxilla and mandible. Lateral cephalograms and lateral and frontal photographs taken preoperatively and postoperatively were analyzed.. There was a significant change in all soft and hard tissue parameters except the labiomental angle. The ratio of upper lip to maxillary incisor retraction was 0.67:1 and the ratio of lower lip to mandibular incisor retraction was 0.89:1. Nasolabial angle and philtrum length were increased, and vermilion length and lip width were decreased. Nasal change could be kept as small as possible, although slight widening of the nasal width and anti-tip rotation of the nasal tip were observed.. Anterior segmental osteotomy might be recommended as the treatment modality of choice in patients with bimaxillary and/or dentoalveolar protrusion. Because the technique is simple, postoperative complications are minimal, relapse is limited, and soft tissue changes in response to surgery are more predictable.

Topics: Adult; Cephalometry; Face; Female; Humans; Lip; Male; Malocclusion; Mandible; Maxilla; Middle Aged; Nose; Osteotomy; Photometry; Retrospective Studies; Statistics, Nonparametric; Time Factors; Tooth Extraction; Treatment Outcome

To determine the head posture and cephalometric characteristics in oral breathing children.. Lateral cephalograms taken in natural head posture of 35 oral breathing patients (OB) (mean age 8.8 +/- 2.2 years SD; range 5-13 years) and of 35 patients with varied malocclusions and physiological breathing (PB) (mean age 9.7 +/- 1.6 years SD; range 7-13 years) were examined.. A Student's t-test showed that an increase in angles NSL/OPT (P = .000), NSL/CVT (P = .001), FH/OPT (P = .000), FH/CVT (P = .005), and NSL/VER (P = .000); a decrease in the distance MGP-CV1p (P = .0001); and a decrease in the angles MGP/OP (P = .000) and OPT/ CVT (P = .036) were found in the OB group. A low position of the hyoid bone (H-MP, P = .009), a major skeletal divergence (ANS-PNS/Go-Me, P = .000), and an increased value of the ANB angle (P = .023) were present in OB patients. To ascertain if the changes in posture were connected with posterior obstruction of the upper respiratory airways, the OB group was divided into two subgroups based on the distance Ad2-PNS being greater than or less than 15 mm. No significant differences were found between these two groups.. Our data suggest that OB children show greater extension of the head related to the cervical spine, reduced cervical lordosis, and more skeletal divergence, compared with PB subjects.

Topics: Adolescent; Airway Resistance; Cephalometry; Cervical Vertebrae; Child; Child, Preschool; Female; Head; Humans; Hyoid Bone; Male; Malocclusion; Mandible; Maxilla; Mouth Breathing; Nose; Posture; Respiration; Sella Turcica

To investigate which hard and soft tissue factors relate with the amount of buccal corridor area (BCA) during posed smiling.. The samples consisted of 92 adult patients (19 men and 73 women; 56 four first bicuspids extraction and 36 nonextraction treatment cases; mean age = 23.5 years), who were treated only with a fixed appliance and finished with Angle Class I canine and molar relationships. To eliminate the crowding effect on the buccal corridor area, lateral cephalograms, dental casts, and standardized frontal posed smile photographs were obtained at debonding stage and 28 variables were measured. Pearson correlation analysis, multiple linear regression analysis, and independent t-test were used to find variables that were related with buccal corridor area ratio (BCAR).. Among the lateral cephalometric and dental cast variables, FMA, lower anterior facial height, upper incisor (U1) exposure, U1 to facial plane, lower incisor (L1) to mandibular plane, L1 to N-B, Sn (subnasale) to soft tissue menton (Me'), Sn to stomodium superius (stms), stms to Me', and interpremolar width were significantly negatively correlated with BCAR. Occlusal plane inclination and buccal corridor linear ratio did not show any significant correlation with BCAR. Multiple linear regression analysis generated a three-variable model: Sn to Me', U1 exposure, and sum of tooth material (STM) (R(2) = 0.324). There was no significant difference in BCAR between extraction and nonextraction groups.. To control the amount of BCA for achieving a better esthetic smile, it is necessary to observe the vertical pattern of the face, amount of upper incisor exposure, and sum of the tooth material.

Topics: Adult; Bicuspid; Cephalometry; Cheek; Chin; Dental Arch; Dental Occlusion, Centric; Esthetics, Dental; Face; Female; Humans; Incisor; Male; Malocclusion; Mandible; Maxilla; Models, Dental; Nose; Photography, Dental; Serial Extraction; Smiling; Vertical Dimension

To investigate the laterality of the normal asymmetry of the human face, examining differences in laterality in relation to sex, growth stage, and skeletal classification.. A total of 1800 Japanese subjects (651 males and 1149 females; mean age, 15 years 3 months; range, 4 years 2 months to 59 years 11 months) were selected. Individuals in the sample were categorized according to sex, one of three growth stages, and one of three skeletal patterns. Differences in length between distances from the points at which ear rods were inserted to the facial midline and the perpendicular distance from the soft-tissue menton to the facial midline were measured on a frontal facial photograph. Subjects with a discrepancy of more than 3 standard deviations of the measurement error were categorized as having left- or right-sided laterality.. Of subjects with facial asymmetry, 79.7% had a wider right hemiface, and 79.3% of those with chin deviation had left-sided laterality. These tendencies were independent of sex, age, or skeletal jaw relationships. In this regard, during pubertal growth, the proportion of subjects with wider right hemiface decreased (P < .0001), whereas the proportion of those with a wider left hemiface increased (P < .01), despite a consistent tendency for right-sided dominance.. These results suggest that laterality in the normal asymmetry of the face, which is consistently found in humans, is likely to be a hereditary rather than an acquired trait.

Topics: Adolescent; Adult; Bone Development; Cephalometry; Child; Child, Preschool; Chin; Face; Facial Asymmetry; Female; Growth; Humans; Iris; Japan; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Middle Aged; Nose; Photography; Puberty; Sex Factors

The purpose of this study was to compare nasal volume changes using acoustic rhinometry (AR) and computed tomography (CT). The subjects were 10 children (6 girls and 4 boys, with an age range of 12-14 years) who required rapid maxillary expansion (RME) on the basis of their individual malocclusion. All patients were found to have normal nasal cavities following anterior rhinoscopic examination. AR and CT were undertaken at the start of treatment (t(1)) and 6 months after expansion (t(2)). Volume changes due to expansion were evaluated using Wilcoxon's test, and the correlation between the two methods was assessed with correlation analyses. Both methods demonstrated that nasal volume significantly increased following the use of RME (P<0.05). Correlation analyses showed no difference in volume (P>0.05) using either of the two methods.

Topics: Adolescent; Cephalometry; Child; Female; Humans; Male; Malocclusion; Nose; Palatal Expansion Technique; Rhinometry, Acoustic; Statistics, Nonparametric; Tomography, X-Ray Computed

The objective of this study was to investigate whether it is possible to use a lateral (profile) photograph to determine the underlying skeletal Class and which reference points of the angle of convexity are most suitable for this purpose. Profile photographs and lateral cephalographs included in the baseline data for 180 orthodontic patients were retrospectively evaluated. The subjects were assigned to skeletal Classes based on Wits values obtained by radiolographic analysis. The Class I subjects were 58 patients (22 males, 36 females) with an average age of 13.63 +/- 2.1 years, the Class II subjects 60 patients (37 males, 23 females) with an average age of 13.60 +/- 2.6 years, and the Class III subjects 62 patients (28 males, 34 females) with an average age of 11.65 +/- 3.3 years. The angles measured were A'OrB' (=POrA'-POrA'), A'N'B', and the angle of convexity with its variants (N'SnPog', N'A'Pog', TrSnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). These angles were statistically evaluated using a two-sided t-test and linear discriminant analysis. Class II and Class III subjects exhibited highly significant differences (P < 0.001) for all angles. Class I and Class III exhibited highly significant differences (P < 0.001) for almost all angles, and significant differences for A'N'B' (P < 0.05). Class I and Class II differed significantly (P < 0.05) only for some angles (N'SnPog', TrA'Pog', Gl'SnPog', and Gl'A'Pog'). The error within the linear discriminant analysis was smallest for N'SnPog', GlA'Pog', and TrA'Pog' angles. However, the method error according to Dahlberg yielded rather high values for all angles (1.07-1.17 degrees). Discrimination between skeletal Class I and Class III was easier than that between Class I and Class II. One of the reasons may be that the subclasses division I and division II were not distinguished within the Class II subjects.

Topics: Adolescent; Cephalometry; Child; Chin; Face; Facial Bones; Female; Forehead; Humans; Lip; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Maxilla; Nasal Bone; Nose; Orbit; Photography, Dental; Retrospective Studies

Evaluation of facial proportions and shape is one of the most important steps in determining treatment options and outcomes for the orthodontist and maxillo-facial surgeon. Balancing the position of the lips in relation to the nose and chin has a direct relationship with the patient's aesthetic preference.. The purpose of this study was to analyse the soft tissue profile preferences in a sample of South African Blacks and to establish a Profile Index for bimaxillary protrusion.. An earlier study by Beukes, Dawjee and Hlongwa was undertaken to determine facial profile perceptions by a group of South African Black evaluators. Adjudicators were drawn from Black students from Medunsa campus, University of Limpopo, the Holy Trinity secondary school and the Mphwe secondary school, and had to evaluate silhouetted facial profiles of 30 bimaxillary dento-alveolar protrusive patients. After an initial group of 128 Black evaluator chose 13 profiles as the most attractive and most unattractive, a second group of 605 Black evaluators (also drawn from the same academic institutions) chose three profiles as acceptable and four profiles as unacceptable. From this final selection, a soft tissue analysis was undertaken to evaluate the nasolabial angle, nasofacial angle, the facial contour angle, the lower lip-chin-throat angle and the lower and upper lip prominence in relation to the Burstone "B"- line. A Fisher exact test was done to determine the statistical difference between the mean values for the acceptable and unacceptable profiles.. The three acceptable profiles, which were chosen by more than 69% of the evaluators, had a lip prominence of 5 to 6mm more than their African American counterparts. The angular measurements of the nose, lip and chin were in close proximity to the values given by Naidoo and Miles and Flynn et al. The three acceptable profiles had normal overjet, overbite, minimal incisor visibility and efficient lip function.. A "Profile index for bimaxillary protrusion" has been concluded from this study and proposes acceptable soft tissue values for bimaxillary protrusive Black South Africans.

Topics: Black People; Cephalometry; Chin; Face; Humans; Lip; Malocclusion; Nose; South Africa

Rapid maxillary expansion (RME) has been shown to increase nasal permeability and reduce nasal airway resistance. A number of studies have examined the relationship between RME and the change in airway resistance, or the relationship between airway resistance and natural head position (NHP). Few studies, to date, have examined the relationship between RME and the change in NHP resulting from the consequent change in airway resistance. A sample of 43 adolescent patients with uni- or bilateral crossbite in the permanent dentition underwent RME as part of normal orthodontic treatment. Cephalograms in NHP were taken before, immediately after expansion, and one year after RME. No significant changes in the craniofacial angles were observed immediately after expansion. One year post-expansion, however, NSL/VER had reduced by 3.14 degrees (P < 0.01), OPT/HOR by 2.13 degrees (P < 0.05), and CVT/HOR by 2.55 degrees (P < 0.05). The results of this study suggest an ongoing change in head posture possibly due to a change in the mode of breathing from oral to nasal as a result of RME, thereby contributing to a change in craniofacial development, supporting and adding to the soft tissue stretching hypothesis.

Topics: Adolescent; Airway Resistance; Cephalometry; Cervical Vertebrae; Child; Female; Follow-Up Studies; Head; Humans; Male; Malocclusion; Maxillofacial Development; Nasal Bone; Nose; Palatal Expansion Technique; Posture; Sella Turcica; Skull; Vertical Dimension

The neonatal respiratory distress observed in the event of a solitary median maxillary central incisor compels us to reconsider some of the traditional concepts relative to the transverse growth of the nasal level of the face. The "container-contents" connections associating maxillary incisor odontogenesis with the development of the premaxillary and facial envelopes draw the attention to the significant geometrical and mechanical expression of this morphogenesis. They require attributing to the maxillary incisors an important motor role in this development. They lead to granting the ontogenetic bonds, between malocclusions and disturbed nasal breathing, the place they deserve, taking into account the morphological integration combining them. They eventually open a new therapeutic prospect: the optimization of the development of the growing face, with regard to the various tissue mechanics and physiologies, becoming the best guarantor for the prevention of relapse after dentofacial orthopedics.

Topics: Animals; Anodontia; Cranial Sutures; Face; Humans; Incisor; Malocclusion; Maxilla; Maxillofacial Development; Nasal Obstruction; Nose; Orthodontics, Interceptive; Recurrence

To develop a cephalometric determination of anteroposterior skeletal occlusion on the basis of a clinically rational "gold standard" and objectively determined cut points.. Pretreatment cephalograms from 10- to 18-year-old Caucasian patients with a normal vertical face dimension were digitized. Facial profile line drawings were judged by orthodontist raters as Class I, II, or III. Subjects who met all inclusion criteria were divided into Class I, Class II, and Class III on the basis of the matched skeletal (facial) and dental occlusion and comprised our gold standard for anteroposterior skeletal occlusions. Cephalometric variables included ANB angle, McNamara analysis, Harvold unit differential, anteroposterior dysplasia index (APDI), and Wits analysis. Half the sample was used to derive skeletal classification norms using receiver operator characteristic (ROC) curves, and half the sample was used to test for diagnostic ability and to compare the diagnoses based on traditional cephalometric norms with the new norms.. Results of the study showed that ANB and McNamara analysis performed well with traditional and ROC-derived norms, whereas Wits, Harvold unit differential, and APDI showed fewer errors in diagnosis with ROC norms compared with traditional norms.. The use of a single set of diagnostic norms for each analysis to distinguish between the skeletal classifications for the 10- to 18-year-age group proved to be highly successful for each of the analyses and performed as well or better than when using traditional norms based on age and sex.

Topics: Adolescent; Cephalometry; Child; Face; Female; Humans; Image Processing, Computer-Assisted; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Maxilla; Nose; Palate; Reference Standards; Reproducibility of Results; ROC Curve

To examine the variation in the precise skeletal characteristics and the treatment outcomes of five Japanese Robin sequence cases.. The birth histories and orthodontic records of five Japanese Robin sequence patients were collected and analyzed.. All cases had a retrognathic appearance with small SNA and SNB angles. They had significantly steep mandibular planes with lingual tipped incisors in both arches. The gonial angles in two cases were within the Japanese norm, whereas the remaining three showed significantly enlarged angles. Moreover, all cases showed a significantly shorter ramus length, but the mandibular body was short in only two cases. All had moderate or severe crowding in both arches, and therefore extraction of lateral dentition or lateral incisors was performed in conjunction with orthodontic treatment. An edgewise multibracket appliance was placed, and labial tipping of the lower incisors was performed in all cases. All obtained normal functional occlusion after active treatment, but the retrognathic appearance remained in most cases.. The present cases with Robin sequence showed variation in the gonial angle and mandibular body length, although all commonly exhibited smaller SNA and SNB angles with significantly steep mandibular planes. Significant labial tipping of the lower incisors was required during the active treatment, and all cases finally obtained functional occlusion, indicating the relatively good prognosis on the occlusion of this sequence.

Topics: Cephalometry; Child; Facial Bones; Female; Follow-Up Studies; Humans; Incisor; Japan; Male; Malocclusion; Mandible; Maxilla; Nose; Orthodontics, Corrective; Pierre Robin Syndrome; Retrognathia; Sella Turcica; Tooth Movement Techniques; Treatment Outcome

Topics: Cephalometry; Chin; Humans; Lip; Malocclusion; Nose

The study was carried out on 69 mentally challenged individuals. They were subjected to detailed clinical evaluation for dentofacial abnormalities and oral health status. Of the 69 mentally handicapped individuals 27 had Downs syndrome and 42 had cerebral palsy. Characteristic facial abnormalities were seen in children with Downs syndrome. In cerebral palsy, fracture maxillary anteriors were more evident. All the Downs syndrome cases had abnormal TMJ movements but in cerebral palsy only 35.7% of individuals had abnormal TMJ movements. In both the groups, submandibular lymph adenopathy was reported. Present study revealed dental caries in 56.0% of the individuals. Fair clinical level of oral hygiene in 60% of the individuals was seen.

Topics: Adolescent; Cerebral Palsy; Child; Craniofacial Abnormalities; Dental Caries; Disabled Children; Down Syndrome; Health Status; Humans; Hypertelorism; Incisor; Lymphatic Diseases; Malocclusion; Nose; Oral Health; Oral Hygiene; Palate, Hard; Persons with Mental Disabilities; Speech Disorders; Temporomandibular Joint Disorders; Tooth Abnormalities

To examine the three-dimensional morphology of internal structures of the craniofacial region and present the orthodontic problems in an unusual case with nasal aplasia.. The patient was an 11.5-year-old boy with aplasia of the nose and nasal cavity with extremely constricted nasopharyngeal airway. He did not have mental or somatic retardation. The patient had dacryostenosis. The morphology of the craniofacial structures was characterized by absence of septal structures, including cribriform plate, perpendicular plate of ethmoid bone, vomer, and septal cartilage; bony hypotelorism; midface hypoplasia; short and retrognathic maxilla with Class III jaw relationship; average mandibular plane angle; high arched palate; severe anterior open bite with bilateral posterior crossbites; and dental anomalies (agenesis of four maxillary permanent teeth, microdontia, taurodontism, and short roots). Thus, the patient had characteristic dentofacial phenotype, which might be caused by a combination of the primary anomaly and the functional disturbances secondary to the nasal obstruction.

Topics: Cephalometry; Child; Craniofacial Abnormalities; Humans; Male; Malocclusion; Mouth Breathing; Nasal Cavity; Nose; Tomography, X-Ray Computed; Tooth Abnormalities

Topics: Child; Cognition Disorders; Humans; Malocclusion; Maxillofacial Development; Mouth Breathing; Nasal Obstruction; Nose; Sleep Wake Disorders

The purpose of this study was to evaluate nasal airway resistance (NAR) during rapid maxillary expansion (RME) using acoustic rhinometry (AR). The sample comprised 22 children (13 girls and nine boys) with maxillary constriction. The mean age was 12.9 +/- 1.54 years and all patients were found to have normal nasal cavities following anterior rhinoscopic examination. A modified bonded splint type RME appliance was used for expansion. AR was used to measure NAR before (T1), during (T2) and after (T3) expansion, and at the end of retention (T4). Each AR recording was performed, for each patient, with and without the use of a decongestant. Subjective evaluation of reported changes in nasal breathing were also undertaken at T3. The results showed that NAR was significantly reduced with the use of RME, with the main decrease observed during expansion (P < 0.05). The use of a decongestant was not found to have any effect on the results. Subjective evaluation showed that 59 per cent of patients considered that their nasal breathing had improved following RME.

Topics: Adolescent; Airway Resistance; Child; Endoscopy; Female; Follow-Up Studies; Humans; Male; Malocclusion; Maxillary Diseases; Nasal Cavity; Nasal Decongestants; Nose; Orthodontic Appliance Design; Palatal Expansion Technique; Patient Satisfaction; Respiration; Rhinometry, Acoustic

This study verified the influence of chronic mouth breathing on dentofacial growth and developmental in pre-school children. The study evaluated 73 children, both sexes, ranging from 3 to 6 years of age. After the otorhinolaryngological breathing diagnosis, 44 mouth-breathing children and 29 nasal-breathing children were compared according to facial and occlusal characteristics. The skeletal pattern measurements SN.GoGn, BaN.PtGn, PP.PM, Ar-Go, S-Go indicated a tendency to mouth-breathing children presenting a dolicofacial pattern. According to occlusal characteristics, only the intermolar distance showed a significant correlation with a narrow maxillary arch in mouth-breathing subjects. Based on the results of this study, mouth-breathing can influence craniofacial and occlusal development early in childhood.

Topics: Analysis of Variance; Cephalometry; Chi-Square Distribution; Child; Child, Preschool; Chin; Dental Arch; Dental Occlusion; Female; Humans; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Molar; Mouth Breathing; Nose; Respiration; Sella Turcica

The relations between the mode of breathing and the development of the malocclusions were the subject of many studies causing polemic sometimes (2, 3, 7, 9, 20). In fact the impact of the mode of breathing on occlusion is not clarified yet. The goal of this study is to quantify the dental characteristics, which constitute the malocclusion according to the mode of breathing. 100 African melanoderme children old from 6 to 15 years were subjected to a rhinologic evaluation based on the nostril reflex of GUDIN and the test of ROSENTHAL (12). Of this examination these children were left again in a group of 50 nasal respirators and in another group of 50 mouth breathers. Each child underwent a radiographic examination which was used to make a cephalometric analysis and a meeting of catch of dental prints. The statistical analysis of the data recorded on the dental casts and the layouts cephalometric (test t of student) indicate that the mode of breathing is not associated standard initial malocclusion. But, when the facial divergence, which is characteristic of mouth breathing increases, the initial malocclusion becomes significant.

Topics: Adolescent; Cephalometry; Child; Female; Humans; Male; Malocclusion; Mouth Breathing; Nose

Twenty patients with unilateral cleft lip and palate, orthodontically treated from the full primary or early transitional dentition stages until retention and dismissal, were recalled later in adult life to evaluate the status of their occlusion and facial appearance.. Cephalometric radiographs, photographs, and casts were attained as final records. In several instances, final records were obtained by orthodontic colleagues at the patient's current residence. Evaluation of the longitudinal records provided retrospective insight pertinent to the growth and positional relationships of the jaws' contiguous structures and the dentition.. Orthodontic results are linked with observations related to the nasomaxillary complex: the anterior cranial base, tissue deficiency, the maxillary and mandibular dentition, and time modifications in skeletal facial growth. At adult ages, the patients with unilateral cleft lip and palate had acceptable facial profiles and acceptable alignment of the anterior dentition. Variances noted in mandibular pattern of growth explain attainment of acceptable relationships. In many cases, tissue deficiency in the anterior cleft region was compensated for with fixed partial dentures and removable prosthetic appliances. Posterior crossbites, although few in number, were proportionately more prevalent in this unilateral cleft lip and palate patient population than was anticipated; possible reasons are presented, taking into consideration congenital contingencies and therapeutic overlays.

Topics: Adult; Cephalometry; Cleft Lip; Cleft Palate; Dental Occlusion; Denture, Partial, Fixed; Denture, Partial, Removable; Face; Female; Humans; Longitudinal Studies; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Models, Dental; Nose; Orthodontics, Corrective; Photography, Dental; Retrospective Studies; Skull Base

Topics: Female; Humans; Infant; Malocclusion; Maxillary Fractures; Maxillofacial Development; Maxillofacial Injuries; Nose

Topics: Cephalometry; Chin; Head; Humans; Incisor; Malocclusion; Mandible; Maxilla; Nose; Posture

The children with bimaxillary dentoalveolar protrusion in early mixed dentition were compared with the normal occlusion children. The bimaxillary dentoalveolar protrusion children had significant smaller inter-incisal angle and greater convexity, A-B plane, and ANB angles than the normal children. Maxillary and mandibular growths of the bimaxillary dentoalveolar protrusion girls were greater than those of normal girls. The direction of the mandibular growth of the bimaxillary dentoalveolar protrusion boys showed a tendency of downward and backward.

Topics: Cephalometry; Child; Dental Arch; Dental Occlusion; Dentition, Mixed; Female; Humans; Incisor; Male; Malocclusion; Mandible; Maxilla; Nose; Sex Factors; Statistics as Topic; Statistics, Nonparametric; Taiwan; Vertical Dimension

The intention of this paper is to compile Chinese cephalometric norms for a more objective orthodontic diagnosis of Chinese patients so that their orthodontic treatment may be better planned. Studies on cephalometric norms of Chinese and subjects of Chinese descent were reviewed. Some important studies were available only in the Chinese journals and they were especially procured and translated for this purpose. A normal range of anteroposterior apical base differences, concomitant nterincisal inclinations and locations, were derived from different Chinese groups and were tabulated. The differences between Chinese and Caucasian norms are discussed. A distinctive craniofacial and dental pattern of the people of Chinese origin was found and is reflected in the cephalometric measurements. Compared with Caucasian norms, Chinese norms have skeletal, dental and soft-tissue variations. The Chinese have a shorter cranial base and a larger ANB. The Chinese dentition demonstrates greater bimaxillary-alveolar protrusion, with a decreased interincisal angle. The Chinese soft-tissue profile shows a less prominent nose, with a less obtuse nasolabial angle, and more protrusive lips.

Topics: Adolescent; Adult; Age Factors; Asian People; Cephalometry; Child; China; Face; Female; Humans; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Patient Care Planning; Reference Values; Sex Factors; Skull Base; White People

Data acquired by means of color Doppler ultrasound very explicitly suggest what the role of the fetal ventilation and nasal capsules in the morphogenesis of the maxillary prognathism, turbinates, nasal valves and nasopharynx could be. Furthermore, the dysmorphologies observed in Apert or Crouzon craniosynostosis, achondroplasia or unilateral cleft lip would also testify that the influence of the fetal ventilatory dynamics goes beyond the limits of the face and extends to the cranial base and the cranium. The wealth of raised hypothesis thanks to the contribution of this imaging system could question the validity of some conceptions of the fetal craniomaxillary morphogenesis.

Topics: Achondroplasia; Acrocephalosyndactylia; Cleft Lip; Craniofacial Dysostosis; Embryonic and Fetal Development; Facial Bones; Fetus; Humans; Malocclusion; Maxilla; Morphogenesis; Nasal Cavity; Nasal Septum; Nasopharynx; Nose; Respiratory Physiological Phenomena; Skull; Skull Base; Turbinates; Ultrasonography, Doppler, Color; Ultrasonography, Prenatal

This study was designed to investigate the changes in a number of facial proportions as a result of combined orthodontic/orthognathic surgical treatment. According to some authors, in beautiful faces, the values of the proportions measured are likely to approximate the divine proportion (1.618:1). The hypothesis for this study was that, as a result of treatment, the faces of patients in the sample would be more esthetic and therefore the measured proportions would be closer to the divine proportion than they were before treatment. Forty-six patients were included in the sample. Pre- and posttreatment photographs were each given a score (out of a possible 100) by 12 judges using a visual analog scale. Judges were shown frontal and profile views simultaneously. Ten ratios were measured from pre- and posttreatment lateral cephalograms, and 11 were measured from the frontal photos. Pearson's correlation coefficient was used to determine the correlation between changes in esthetic rating and changes in the measured proportions. No correlations were found between changes in esthetic ratings and changes in the proportions. While most subjects were considered more esthetic after treatment than before, the proportions were equally likely to move away from or toward the divine proportion. For this reason, if it is to be used as an aid to orthodontic/orthognathic treatment planning, the divine proportion should perhaps be used along with other methods of anteroposterior and vertical cephalometric and facial assessment.

Topics: Adolescent; Adult; Analysis of Variance; Cephalometry; Chin; Esthetics; Face; Female; Humans; Incisor; Male; Malocclusion; Mandible; Mathematics; Maxilla; Middle Aged; Nose; Observer Variation; Orthodontics, Corrective; Palate, Hard; Photography; Reproducibility of Results; Skull Base; Statistics as Topic; Temporal Bone; Vertical Dimension

First, to evaluate possible orofacial morphologic differences between sleep bruxers and non-bruxers, and second, to determine possible correlations between morphologic factors and striatal D2 receptor expression in persons with sleep-related oromotor activities.. Twenty subjects were included in this study; half of them had polysomnographically confirmed oromotor values above the cutoff points for sleep bruxism. For all participants, 26 standard occlusal measures were recorded clinically and from dental study casts. In addition, 25 standard angular and linear measures were taken from standardized cephalometric films, and variables were derived to evaluate dental and skeletal relationships. Fourteen of the 20 participants had also participated in a previous study that included iodine-123-iodobenzamide (I-123-IBZM) and single-photon emission-computed tomography (SPECT). For them, the side-to-side difference in striatal D2 receptor binding was determined as the neurochemical outcome measure.. Following the classical Bonferroni adjustment for multiple testing, no morphologic differences were found between the sleep bruxers and the non-bruxers. In addition, none of the morphologic variables were significantly associated with the neuroimaging data.. Taking into account the low power of this retrospective, exploratory study, the results suggest that the orofacial morphology of sleep bruxers does not differ from that of non-bruxers. In addition, morphologic factors are probably not involved in the asymmetry in striatal D2 receptor distribution that was previously observed in association with sleep bruxism.

Topics: Adult; Cephalometry; Chi-Square Distribution; Corpus Striatum; Dental Arch; Dental Occlusion; Facial Bones; Female; Humans; Iodobenzenes; Male; Malocclusion; Mandible; Maxilla; Models, Dental; Nose; Polysomnography; Radiopharmaceuticals; Receptors, Dopamine D2; Retrospective Studies; Sella Turcica; Sleep Bruxism; Statistics as Topic; Statistics, Nonparametric; Tomography, Emission-Computed, Single-Photon; Vertical Dimension

Controlling the vertical dimension of high-angle patients without the benefit of compliance can be a challenging aspect of orthodontic treatment. This retrospective study examines the skeletal and dental effects of a modified transpalatal bar, dubbed the vertical holding appliance (VHA), which was used in an attempt to control the vertical dimension of high-angle patients. Two cephalometrically similar groups of high-angle patients (16 patients each) were compared to determine advantages from using the VHA. Group I (n = 16, pretreatment age 13.4 +/- 1.6 years) was treated with 4 premolar extractions in conjunction with the VHA cemented in place for 17.4 +/- 6.1 months. Group II (n = 16, pretreatment age 13.4 +/- 1.9 years), which was matched for age and pretreatment skeletal pattern, was treated with the Tweed technique and 4 premolar extractions. Lateral cephalometric radiographs were taken before the placement of the VHA, as well as at the end of treatment. The results showed that although y-axis increased significantly in group II (P <.05), it remained the same in group I. Within group I, the Frankfort mandibular plane angle and gonion gnathion/sella nasion angle decreased, whereas both of these values increased in group II. However, these changes were statistically insignificant. Lower anterior face height increased more in group II than in group I (P <. 05). The percentage of lower anterior face height to total anterior face height decreased in group I, whereas it increased in group II. The difference between the 2 groups was determined to be significant (P <.01). Eruption of the maxillary first molar within group I was less than in group II. No significant differences were found between groups I and II for changes in overbite.

Topics: Adolescent; Bicuspid; Case-Control Studies; Cephalometry; Chin; Evaluation Studies as Topic; Facial Bones; Female; Follow-Up Studies; Humans; Male; Malocclusion; Mandible; Nose; Orthodontic Appliance Design; Orthodontic Appliances; Retrospective Studies; Sella Turcica; Serial Extraction; Tooth; Tooth Movement Techniques; Vertical Dimension

Oral respiration associated with an obstructed nasal airway is common in orthodontic patients. For several years chronic oral respiration has been implicated as a prime causative factor in the development of "adenoid facies or the "long-face syndrome. The animal experiment reported here begins a series designed to study, as separate variables, the 2 components of chronic oral respiration: (1) chronic absence of active nasal respiration and 2) chronic mouth opening to find out what dentofacial changes can be attributed to chronic absence of active nasal respiration alone. In this pilot study, 5 growing dogs underwent tracheotomy so that significant active nasal respiration was not possible and oral respiration was not essential.

Topics: Animals; Cephalometry; Chronic Disease; Dental Arch; Disease Models, Animal; Dogs; Facial Bones; Facies; Female; Male; Malocclusion; Mandible; Maxilla; Mouth Breathing; Nasal Obstruction; Nose; Palate; Pilot Projects; Respiration; Skull; Syndrome; Tracheotomy; Zygoma

We present four clinical cases to show the usefulness of superelastic shape-memory NiTi alloy wires in orthodontics. Martensitic and austenitic states of the alloy facilitate wire insertion in the bracket slot, creating a gently continuous force to move the tooth whatever the deformation of the wire. Use of a more physiological force lessens the risk of therapeutic errors due to misevaluated dysfunction and/or underlying dysmorphism.

Topics: Adult; Elasticity; Facial Asymmetry; Female; Humans; Jaw Abnormalities; Male; Malocclusion; Malocclusion, Angle Class II; Nickel; Nose; Orthodontic Space Closure; Orthodontic Wires; Orthodontics, Corrective; Titanium

A thirteen-year-old boy presented with a Class III skeletal tendency in association with severe crowding in both the upper and lower arches. Whilst there was not a frank posterior crossbite, it was felt that the upper arch was narrow and that the lower arch was similarly constricted. Taking this into account along with the fact that his upper lip was flat and the nasolabial angle obtuse, it was decided to pursue a non-extraction treatment, with the aim of providing by expansion an extra 16 mm of space in the upper arch and 8 mm in the lower arch to accommodate the full dentition, and with a view to extracting third molar teeth later. This proved to be successful, albeit over an extended period of time, with active treatment taking nearly three and a half years. A realistic alternative would have been to remove four bicuspid teeth and pursue an orthodontic/surgical approach to treatment. In retrospect, and with the benefit of reviewing his records without surgical intervention, the treatment plan decided upon has been well justified.

Topics: Adolescent; Bicuspid; Cephalometry; Humans; Lip; Male; Malocclusion; Malocclusion, Angle Class III; Mandible; Maxilla; Nose; Orthodontics, Corrective; Palatal Expansion Technique; Patient Care Planning; Serial Extraction; Time Factors; Treatment Outcome

Topics: Adolescent; Cephalometry; Chin; Computer Simulation; Face; Female; Follow-Up Studies; Forecasting; Humans; Image Processing, Computer-Assisted; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Osteotomy; Photography; Statistics as Topic

Previous research has suggested that a relationship exists between craniofacial morphology and tooth wear. The primary objective of this study was to determine whether an individual's craniofacial morphology during childhood is related to the degree of tooth wear that occurs in that same individual's adult dentition. Pretreatment orthodontic records taken during the mixed dentition (T1) and follow-up records taken an average of 20 years later (T2) were available for 165 orthodontic patients. Incisal/occlusal tooth wear was measured on a tooth-by-tooth basis from T1 and T2 casts using a four-category scoring system. Measures of craniofacial morphology were made from the T1 lateral cephalometric radiograph. Multiple regression analysis indicated that adult wear was associated with the T1 cephalometric measures of ANB (p = 0.017) and the interaction between ramal height and sex (p = 0.039). These results suggest that the craniofacial morphology observed during childhood has a small but significant relationship to adult tooth wear.

Topics: Adult; Age Factors; Cephalometry; Child; Dentition, Mixed; Facial Bones; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Malocclusion; Mandible; Maxilla; Nose; Regression Analysis; Sex Factors; Tooth Attrition

The purpose of this investigation was to test for an association between the craniofacial morphologies of bruxers and nonbruxers. The sample for this retrospective descriptive comparative study consisted of 28 Caucasian dental school subjects. Sixteen were bruxers and 12 were nonbruxers. The determination of bruxism was based on a six-item questionnaire as well as objective measures of the severity of tooth wear as analyzed from dental casts. Craniofacial morphology was determined directly using anthropometric spreading calipers. Craniofacial measurements included glabella-opiscranion, euryon-euryon, nasion-gnathion, zygoma-zygoma, and gonion-gonion. From these measurements, the following indices were calculated: cephalic (Gla-Op/Eu-Eu), facial (Na-Gla/Zy-Zy), gonial (Zy-Zy/Go-Go), and gonial height (Na-Gla/Go-Go). This study found no differences in the craniofacial morphologies of bruxers and nonbruxers, nor was there a difference in overbite. There was, however, a statistically significant difference in the bizygomatic (Zy-Zy) and cranial (Eu-Eu) widths of bruxers compared with nonbruxers.

Topics: Adult; Analysis of Variance; Bruxism; Cephalometry; Chin; Facial Bones; Humans; Incisor; Malocclusion; Mandible; Models, Dental; Multivariate Analysis; Nose; Occipital Bone; Orbit; Reproducibility of Results; Retrospective Studies; Skull; Temporal Bone; Zygoma

The aim of this prospective study was to evaluate changes in the transverse plane following use of an acrylic bonded rapid maxillary expansion (RME) appliance in growing individuals during the active phase of treatment. The sample comprised 14 consecutively treated orthodontic patients (11 girls, 3 boys) who required the use of an RME device on the basis of their individual treatment plans. The mean patient age at the start of treatment was 12.8 years, and the mean overall treatment time was 3.08 years. Seven posteroanterior cephalometric and two dental cast measurements were assessed. Repeated measure analysis of variance and Duncan's multiple range test were used to assess treatment changes. Lower nasal and maxillary base widths and angles, and upper intermolar width increased significantly during RME treatment. Upper intermolar and intercanine widths measured from the dental casts also increased significantly. Except for upper intercanine width, all measurements remained constant at the end of orthodontic treatment. The results of this study suggest that dentoskeletal changes in the transverse dimension following the use of an acrylic bonded RME are maintained satisfactorily at the end of fixed appliance therapy.

Topics: Acrylic Resins; Adolescent; Analysis of Variance; Cephalometry; Child; Cuspid; Dental Arch; Female; Follow-Up Studies; Humans; Male; Malocclusion; Maxilla; Maxillofacial Development; Models, Dental; Molar; Nose; Orthodontic Appliance Design; Orthodontic Appliances; Palatal Expansion Technique; Palate; Prospective Studies

My objective is to present a cephalometric-based facial analysis to correlate with an article that was published previously in the American Journal of Orthodontic and Dentofacial Orthopedics. Eighteen facial or soft tissue traits are discussed in this article. All of them are significant in successful orthodontic outcome, and none of them depend on skeletal landmarks for measurement. Orthodontic analysis most commonly relies on skeletal and dental measurement, placing far less emphasis on facial feature measurement, particularly their relationship to each other. Yet, a thorough examination of the face is critical for understanding the changes in facial appearance that result from orthodontic treatment. A cephalometric approach to facial examination can also benefit the diagnosis and treatment plan. Individual facial traits and their balance with one another should be identified before treatment. Relying solely on skeletal analysis, assuming that the face will balance if the skeletal/dental cephalometric values are normalized, may not yield the desired outcome. Good occlusion does not necessarily mean good facial balance. Orthodontic norms for facial traits can permit their measurement. Further, with a knowledge of standard facial traits and the patient's soft tissue features, an individualized norm can be established for each patient to optimize facial attractiveness. Four questions should be asked regarding each facial trait before treatment: (1) What is the quality and quantity of the trait? (2) How will future growth affect the trait? (3) How will orthodontic tooth movement affect the existing trait (positively or negatively)? (4) How will surgical bone movement to correct the bite affect the trait (positively or negatively)?

Topics: Adolescent; Adult; Cephalometry; Child; Chin; Dental Occlusion; Esthetics; Esthetics, Dental; Face; Facial Bones; Female; Humans; Lip; Male; Malocclusion; Neck; Nose; Orthognathic Surgical Procedures; Patient Care Planning; Tooth; Tooth Movement Techniques; Treatment Outcome; Vertical Dimension

Lateral cephalograms and study casts of 55 patients were evaluated to determine if any relationships exist among incisal positions and angulations, changes in positions and angulations, and long-term occlusal stability. No significant relationships could be found between long-term changes occurring in a number of commonly used incisal measurements and end-of-treatment incisal positions, changes in incisal positions during treatment, or long-term changes in the facial axis angle, ANB angle, or weighted PAR score. Long-term incisal changes occurring in individual patients were not necessarily associated with negative occlusal changes. Since incisal positions usually change in the long-term, it is suggested that the use of published norms or recommended absolute goals for end-of-treatment incisal positions be used more as general functional and esthetic clinical guides, rather than as predictors of stability.

Topics: Adolescent; Cephalometry; Dental Occlusion; Esthetics, Dental; Face; Female; Follow-Up Studies; Forecasting; Humans; Incisor; Longitudinal Studies; Male; Malocclusion; Maxilla; Models, Dental; Nose; Orthodontic Appliances; Recurrence; Sella Turcica; Tooth Movement Techniques

Previous studies on the effects of surgical and rapid palatal expansion have been largely based on general skeletal and dental findings ascertained from radiographs and casts. The aim of this study was to measure and compare the soft tissue changes of the face during the expansion process and to determine the stability of any changes 1 year later. The sample consisted of 44 patients with unilateral or bilateral posterior crossbites. Twenty-four of the patients required a surgically assisted expansion procedure, and a second group of 20 patients were treated with orthopedic expansion. Ten measurements were made from standardized frontal facial photographic slides at 5 intervals of treatment: initial, bond appliance, stop expansion, debond appliance, and 1 year retention. Differences over time between the surgical and nonsurgical groups were analyzed by a 2 way multivariate analysis of variance (MANOVA) and post hoc t tests. Differences between initial and 1 year retention were found in the nasal widths (P <.001) of both surgical and nonsurgical groups. Other significant changes and trends were discussed.

Topics: Adolescent; Adult; Analysis of Variance; Animals; Face; Female; Humans; Lip; Malocclusion; Maxilla; Mice; Nose; Orbit; Osteotomy, Le Fort; Outcome Assessment, Health Care; Palatal Expansion Technique; Photography; Reproducibility of Results

Would a surgeon always draw the same aimed-at profile when planning the correction of a face with evidently malpositioned jaws? The same 10 profile lines were given to seven maxillofacial surgeons on two occasions at intervals of 6 months. The differences in absolute and proportional vertical measurements were compared. It is shown that the variations between first and second drawing were quite large for individual values. However, even the mean differences per measurement vary between surgeons from 0 to 10%. The drawings for the whole group corresponded reasonably well with the ratios given by Farkas and Munro (1987) but were rather divergent from the 'golden dimensions' proposed by Brons and Mulié (1993). Considering the sometimes significant differences, one is advised not to draw profiles 'off the cuff' but to use a construction system for planning osteotomies.

Topics: Cephalometry; Chin; Face; Humans; Lip; Malocclusion; Mandible; Nose; Osteotomy; Patient Care Planning; Reproducibility of Results; Surgery, Oral; Vertical Dimension

The purpose of this investigation was to test the hypothesis that the mandible rotates around the same point during maxillary impaction surgery as during initial jaw opening. This point, called the center of mandibular autorotation (CAR), could then be used to predict mandibular position and to decide whether only maxillary impaction would be needed to correct the occlusion and the facial profile.. Preoperatively, two lateral cephalograms were obtained from a consecutive series of 20 patients who underwent maxillary impaction without concomitant mandibular ramus osteotomy. One cephalogram was taken with the mandible in centric relation using a wax bite wafer and another with a jaw opening of 10 mm using a fabricated acrylic bite block with the mandible manipulated to its most retruded position. The CAR was calculated before and after jaw opening using the Rouleaux method on the lower incisor and gonion point. A third lateral cephalogram was taken within 2 days postoperatively. The postoperative lower incisal point was then transferred to the first cephalogram using cranial base superimposition.. When the preoperative and postoperative distances between CAR and incisal point were compared, there was no significant difference between these distances, proving the hypothesis.. The method used is a practical and precise way to determine the center of mandibular autorotation on an individual basis. The center of rotation during initial jaw opening is the same as during impaction surgery.

Topics: Acrylic Resins; Adolescent; Adult; Analysis of Variance; Centric Relation; Cephalometry; Chin; Dental Occlusion; Female; Forecasting; Humans; Incisor; Jaw Relation Record; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Prospective Studies; Rotation; Waxes

Developing standardized outcomes and algorithms of treatment is a constantly evolving task. This article examines four variables in this process: cleft type, operative technique, surgical experience, and timing. Input from international cleft lip and palate programs regarding techniques and treatment modalities provide a dynamic tool for assessment and the development of guidelines in the treatment of the cleft lip and palate patient.

Topics: Adolescent; Age Factors; Algorithms; Alveoloplasty; Bone Transplantation; Child; Cleft Lip; Cleft Palate; Female; Humans; Infant; Male; Malocclusion; Nose; Orthognathic Surgical Procedures; Palatal Obturators; Plastic Surgery Procedures; Surgical Flaps; Time Factors; Treatment Outcome; Velopharyngeal Insufficiency

The present study evaluated how 2 widely used cephalometric sagittal analyses, ANB angle and WITS appraisal, classify skeletal classes I, II, and III in a random selection of 497 Finnish boys aged 4-20 years. This distribution was also compared with the visual inspection of cephalometric structures judged by 2 university instructors in orthodontics. The results showed remarkable differences and even sparked controversy concerning classification of the sagittal jaw relationships. The ANB angle and the WITS appraisal emphasized the role of class II based on a failure to distinguish the proportion of class I. The low-angle influence skewed the distribution of the ANB pattern in the class III direction, and the WITS pattern, conversely, towards class II. High- or low-angle influence had only minor effects on the visual inspection of cephalometric structures. This cross-sectional study showed an age-related decreasing mean value for the ANB angle and increasing mean value for the WITS appraisal, thus explaining the remarkable difference in the distribution of sagittal classes. However, the findings of age-related changes makes the use of the fixed norms questionable. For extreme or controversial cephalometric interpretations, visual inspection provides an essential aid in diagnosis and skeletal classification.

Topics: Adolescent; Adult; Age Factors; Cephalometry; Child; Child, Preschool; Chin; Cross-Sectional Studies; Dentition, Mixed; Evaluation Studies as Topic; Humans; Image Processing, Computer-Assisted; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Maxilla; Maxillofacial Development; Nose; Orthodontics; Radiography; Regression Analysis; Sella Turcica; Vertical Dimension

This study was undertaken to determine the effect of a bone graft in the piriform aperture on the nasal deformity and orthodontic treatment of the cleft side teeth in isolated cleft lip patients.. All primary cleft lip repair was done 3 months after birth. Nine patients, four female and five male, with a mean age of 12.5 years (range, 8.2 to 24.8 years) and with a repaired cleft lip, were bone grafted between 1992 and 1996. The mean postoperative period was 2 years (range, 1 to 4 years). An iliac crest bone graft was placed in the piriform aperture deformity on the side of the cleft lip. The improvement in the nasal symmetry and angulation of the cleft side teeth were evaluated. The eight growing cleft lip patients (mean age, 11 years; range, 9 to 13 years) were compared with a control group of eight healthy growing children (mean age, 11 years; range, 9 to 13 years). The improvement of nasal symmetry was measured by the formula of the lobule portion of the columella index preoperatively and postoperatively.. The mean lobule portion of the columella index preoperatively was 41.8% (SD, 4.4%; SE of Mean, 1.5%) and postoperatively was 44.2% (SD, 4.9%; SE of Mean, 1.6%) (P > .006, t-test for paired samples). The angulation of the cleft side teeth was improved by orthodontic treatment.. Bone grafting the piriform aperture deformity results in a stable result and improves nasal symmetry and the angulation of the cleft side teeth.

Topics: Adolescent; Adult; Bone Transplantation; Case-Control Studies; Child; Cleft Lip; Evaluation Studies as Topic; Female; Follow-Up Studies; Humans; Ilium; Male; Malocclusion; Maxillofacial Development; Nasal Cavity; Nose; Nose Deformities, Acquired; Orthodontics, Corrective; Radiography, Panoramic; Tooth

The conotruncal anomaly face syndrome (CTAF) comprises congenital heart disease and dysmorphic face, and is frequently associated with cleft palate or hypernasality. There have been many discussions about the overlap with velocardiofacial syndrome (VCF). The aim of this study was to clarify the craniofacial characteristics of CTAF patients by clinical examination, and photogrammetric and cephalometric analyses, and to clarify the differences compared to published data on VCF.. The facial features of CTAF included hypertelorism, small palpebral fissures, upward slanting of palpebral fissures, bloated eye lids, low nasal bridge, small mouth, open mouth at rest, and malformed auricles. Cephalometric features included bialveolar protrusion, small gonial angle, backward rotation of the mandibular ramus, and labial inclination of the maxillary incisors. An acute cranial base angle was also noted. These results differed from those of VCF. There were, however, no obvious pathognomonic findings for the differential diagnosis between CTAF and VCF.. Considering these findings, use of CATCH 22, the inclusive classification of cardiac anomalies, cleft palate, and dysmorphic face may be of value for the clinical understanding in these patients.

Topics: Alveolar Process; Cephalometry; Child; Child, Preschool; Cleft Palate; Craniofacial Abnormalities; Diagnosis, Differential; Ear, External; Eyelid Diseases; Eyelids; Female; Heart Defects, Congenital; Humans; Hypertelorism; Incisor; Male; Malocclusion; Mandible; Maxilla; Mouth Abnormalities; Nose; Photogrammetry; Rotation; Skull Base; Speech Disorders; Syndrome

The purpose of this retrospective study was to investigate the accuracy of two video imaging systems, Orthognathic Treatment Planner (OTP) and Prescription Portrait (Portrait), in predicting soft tissue profile changes after maxillary impaction surgery. Computer-generated line drawing predictions were compared with actual postsurgical profiles. Neither program was very accurate with vertical measures and lower lip contour. Portrait was more accurate at pronasale, inferior labial sulcus, and pogonion in the y-axis direction (P < 0.05). Video image predictions produced from the presurgical photographs were rated by orthodontists, surgeons, and lay people, who compared the predictions with the actual postsurgical photographs using a visual analog scale. Portrait's prediction images were scored higher than OTP's for five of eight areas. Orthodontists were most critical of the lips and the overall appearance. Lay people were most critical of the chin and submental areas.

Topics: Adult; Analysis of Variance; Attitude; Cephalometry; Chin; Evaluation Studies as Topic; Face; Female; Forecasting; Humans; Image Processing, Computer-Assisted; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Photography; Reproducibility of Results; Retrospective Studies; Video Recording

Cephalometric radiography is an important diagnostic aid in orthodontics. Mesh analysis is a proportionate cephalometric method of graphically assessing disharmonies of the craniofacial complex. Original norms for this analysis were created from a white, European American sample. Norms for black Americans of African descent were developed in another study. The purposes of this investigation were: (1) to develop a standard mesh diagram from a Puerto Rican American population; (2) to compare the diagram with previously established data from the white sample; (3) to develop linear and angular means for the Legan, Burstone, Ricketts, DiPaolo, and Steiner analyses for a Puerto Rican American population; and (4) to assess the use of a panel for selecting esthetically pleasing faces. The subjects in the study had no previous orthodontic treatment, had Class I occlusion with 6 mm or less of crowding per dental arch, and had two parents and two sets of grandparents who were were born in Puerto Rico. Sixty-nine patients met the study criteria, and 50 of those patients (20 males and 30 females) were selected as having esthetically pleasing faces by the panel. Male and female norm diagrams were created and these were compared with those developed previously. Linear and angular measurements were also compared. Significant differences between the ethnic groups were found in the dentoalveolar region. Similarities were noticed in the upper face height and anterior cranial base length. The panel selection results showed no agreement within the sexes, occupations, or ethnic groups.

Topics: Adolescent; Attitude; Cephalometry; Esthetics; Ethnicity; Face; Facial Bones; Female; Hispanic or Latino; Humans; Male; Malocclusion; Malocclusion, Angle Class I; Mandible; Maxilla; Nose; Occupations; Puerto Rico; Radiography; Sella Turcica; Sex Factors; Skull Base; White People

This retrospective study was undertaken to describe and compare frontal craniofacial dimensions in alveolar-bone-grafted and nongrafted complete unilateral cleft lip and palate (CUCLP) patients and in noncleft subjects with normal occlusions and good facial balance. Clinical data were obtained from the files of the Hospital for Sick Children, Toronto. Patients were eligible for inclusion if they had posteroanterior cephalograms (PA) taken at adulthood and no congenital anomalies other than CUCLP. A total of 86 adult Caucasian CULCP patients were studied, including 58 who had not received grafts, 28 who had received secondary alveolar bone grafts, and, for comparison, 60 noncleft Caucasian adults. The PA cephalometric radiographs were traced, digitized, and measured. Analysis of variance (ANOVA) was used to test for among-groups differences in the means of the ratios, proportions, and angular measures. Tukey-Kramer HSD procedure was used to conduct post-hoc pairwise comparisons following significant (p < or = 0.05) F-ratios from ANOVA. Sexual dimorphism was a common finding, with males demonstrating greater facial width. Despite primary surgical repairs, the anterior nasal spine in the nongrafted CUCLP patients was deviated to the noncleft side, and the alar base was depressed on the cleft side. The maxillary incisors close to the cleft site were irregularly inclined, and this irregularity was more severe in the nongrafted CUCLP patients. The long-term effects of secondary alveolar bone grafting on transverse craniofacial growth appears to be minimal and limited to the immediate area of the cleft.

Topics: Adolescent; Adult; Alveoloplasty; Analysis of Variance; Bone Transplantation; Cephalometry; Cleft Lip; Cleft Palate; Face; Female; Humans; Image Processing, Computer-Assisted; Incisor; Male; Malocclusion; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Retrospective Studies; Sex Characteristics

A method for the quantitative and qualitative analysis of the facial soft-tissue profile has been developed, and applied to analyze the pretreatment lateral head films of 240 orthodontic patients aged 8 to 14 years.. Patients were subdivided for sex, age, and skeletal class. To standardize for different facial sizes, soft-tissue profiles from nasion to pogonion were traced in polar coordinates without modifications of facial shape, and standardized for an equal skeletal vertical dimension.. The method allowed a simple and rapid quantitative evaluation of soft-tissue profiles during facial growth. An approximate evaluation of the soft-tissue thickness at nose, lips, and chin was also possible. No particular mathematical knowledge was required at any step of the analysis.. Facial soft-tissue size and shape were influenced by age and sex, and to a minor extent by skeletal class.

Topics: Adolescent; Aging; Cephalometry; Child; Chin; Face; Facial Bones; Female; Humans; Lip; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Orthodontics, Corrective; Sex Characteristics; Vertical Dimension

Topics: Adolescent; Adult; Cephalometry; Child; Chin; Female; Humans; Lip; Male; Malocclusion; Malocclusion, Angle Class II; Nose; Retrognathia; Vertical Dimension

The longitudinal growth and development of the soft tissue drape for boys and girls with long and short vertical patterns was examined from age 7 to 17 years. The sample was taken from the Denver Growth Study and consisted of 32 subjects who were selected on the basis of their percentage of lower anterior vertical face height. All subjects were of northern European ancestry, and none had undergone orthodontic treatment. The sexual dimorphism was evident as anticipated for several soft tissue measurements. The boys showed continued growth through age 16 years in contrast to the girls who attained the adult size of the soft tissue integument around 14 years. A significant difference between vertical facial patterns was reported for all soft tissue variables with the exception of the soft tissue thickness at A point and the upper lip height. The boys and girls with long vertical patterns exhibited a thicker and longer soft tissue drape for the most variables when compared with those with short facial patterns. These soft tissue differences are believed to be compensatory mechanisms in long-face subjects, which may attempt to mask the vertical dysplasia, thereby producing a more normal facial profile. Individual growth assessments revealed that the perioral soft tissues follow a pattern similar to that of the mean group patterns. The subjects with long vertical facial patterns experienced their pubertal growth spurt earlier than the short-face subjects. This may have clinical implications in the timing of orthodontic intervention and treatment.

Topics: Adolescent; Analysis of Variance; Cephalometry; Child; Chin; Face; Female; Humans; Lip; Longitudinal Studies; Male; Malocclusion; Maxillofacial Development; Mouth; Nose; Orthodontics, Corrective; Puberty; Sex Characteristics; Vertical Dimension; White People

Superimposition on the lower border of the mandible has been severely criticized. It has allegedly been responsible for causing chaos and confusion in the literature. This report indicates that this is not true and that superimposition on the lower border of the mandible is valid. We have shown that changes resulting from superimposing on implants are a part of the sella-nasion superimposition. The implant changes are contained within the sella-nasion superimposition and are a part of it. The gonion angle grows approximately parallel to the mandibular plane. The lower border of the mandible is a part of the big picture all through the growing period, always containing the implant changes. The mandibular plane changes its inclination as the relation of vertical to horizontal growth changes. Examples are shown to illustrate the "give and take" between vertical and horizontal growth, and its effect on the facial complex. Objective evidence is shown that seems to indicate that the implant changes may have been counted and then counted again. This new analysis places a different interpretation on the implant studies.

Topics: Adolescent; Adult; Cephalometry; Child; Child, Preschool; Chin; Face; Facial Bones; Female; Follow-Up Studies; Humans; Male; Malocclusion; Mandible; Mandibular Condyle; Maxillofacial Development; Nose; Prostheses and Implants; Reproducibility of Results; Rotation; Sella Turcica; Tooth; Vertical Dimension

Interactions between upper airway structure and posture in relation to obesity were studied in a sample of 61 adult Class I skeletal type male patients with obstructive sleep apnea (OSA) and 10 homologous control subjects. A pair of upright and supine lateral cephalometric films were taken for each subject. A Pearson correlation analysis identified significant r values for several demographic variables in patients with OSA such as apnea and hypopnea index, percentage of predicted neck circumference, minimum arterial oxygen saturation, and body mass index (BMI). The difference between cephalometric variables identified in upright and supine subjects was calculated. When patients with OSA changed their posture from upright to supine, significant correlations were observed between the cranial base to upper cervical column angle and the hypopharynx cross-sectional area and BMI. Moreover, the mandibular plane angle and the sella-nasion plane was significantly correlated with BMI. This occurred along with a significant positive correlation between the sella-nasion plane angle and BMI and a significant inverse correlation between the mandibular plane angle in reference to the absolute vertical and horizontal planes, with BMI after the positional change. Such correlations were not observed in control subjects. No correlations were observed between the variables related to the position of the hyoid bone with BMI in either patients with OSA or control subjects after the change in posture. On the basis of these findings, we propose that when patients with OSA change their body position from upright to supine (1) the patient's neck is more extended, and (2) the hyoid bone moves more anterosuperiorly in conjunction with an upward and forward rotation of the mandible. This change in craniofacial structure may be a compensatory geometrical change in the upper airway to secure its patency.

Topics: Adult; Airway Obstruction; Body Mass Index; Cephalometry; Cervical Vertebrae; Humans; Hyoid Bone; Hypopharynx; Male; Malocclusion; Mandible; Mouth; Neck; Nose; Obesity; Oxygen; Pharynx; Posture; Sella Turcica; Skull; Sleep Apnea Syndromes; Supine Position; Vertical Dimension

Mandibular length is measured on cephalographs to depict changes during growth and after orthodontic treatment, and is often defined between condylion (Co, most posterior superior point on the condylar outline) and pogonion (Pog, most anterior point on the chin). The aim of this study was to assess the accuracy of identifying condylar anatomy, thus the validity of using Co-Pog to evaluate mandibular growth. The sample included 34 children from a prospective study on the early treatment of distoclusions. Two lateral head films were taken of each child, the first with the mouth closed (MC), the second with the mouth open (MO). Three examiners, two orthodontists (U.H. and K.H.) and a dental radiologist (R.B.), rated the condyle as identifiable, nonidentifiable, and interpreted. The rating was applied to the left (L) and right (R) condyles, or to only one outline (O) when the R and L structures appeared superimposed and were not distinguished separately. Besides Co-Pog, the orthodontists traced sella-nasion (SN) and incisor tip-menton (I-Me) to evaluate variability in measurements that do not include Co. One operator (J.G.) measured all distances. Agreement among the three examiners was best in rating the MO radiographs (50%): 4.1% identifiable, 5.9% nonidentifiable or interpreted; in the MC films, they agreed in 32.3% of the cases, but only one of the ratings was identifiable (2.9%). The highest agreement was in identifying the left condyle on the MO film (35.3%). Intraclass correlation coefficients for CO-Pog ranged from r = 0.73 (L side) to r = 0.92 (O) for one orthodontist, and for the other from r = 0.76 (O) to r = 0.85 (L). Both orthodontists had high correlations for SN and I-Me between MC and MO (0.94 < r < 0.98). The variability between examiners in recognizing condylar anatomy, particularly on radiographs taken with the mouth closed, suggests that the identification of condylar anatomy must be rated in studies of mandibular growth. Researchers measuring mandibular length in investigations of mandibular growth after orthodontic therapy should differentiate between cases where the condyle is readily identified, and those where condylar anatomy is interpreted.

Topics: Cephalometry; Child; Chin; Dental Research; Guidelines as Topic; Humans; Incidence; Incisor; Malocclusion; Mandible; Mandibular Condyle; Nose; Observer Variation; Orthodontics, Corrective; Prospective Studies; Radiography; Reproducibility of Results; Sella Turcica

In part I of this study, a method for the objective evaluation of profile nasal esthetics was presented and applied to establish normative values for young adult white males and females. Male and female nasal profile esthetics were found to be virtually identical. In part II, the data from the preoperative lateral cephalograms of 13 young adult white female patients with vertical maxillary excess (VME) were compared to the normative data established for females in part I. Results showed a distinct nasal profile in patients with VME. In this part of the study, the postoperative lateral cephalograms of the 13 female patients from part II were analyzed after surgical correction of their vertical maxillary dysplasia to determine if returning the maxilla to a more normal position effected similar changes in nasal profile esthetics. All patients had superior repositioning of the maxilla for which the magnitude of movement was greatest in the superior direction, with the mean movement being 2.3 mm superiorly. The results revealed that surgical correction of VME effected normalization of most of the nasal profile esthetic characteristics.

Topics: Adolescent; Adult; Cephalometry; Esthetics; Face; Facial Bones; Female; Humans; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nose; Osteotomy, Le Fort; Reference Values; Treatment Outcome; Vertical Dimension

In part I of this study, a method for the objective evaluation of profile nasal esthetics was detailed, and normative values for males and females were presented. In part II, identical methodology was applied to the preoperative lateral cephalograms of 13 female patients with vertical maxillary excess to determine how the nasal profile esthetics of these patients varies from the norm. This data was compared to the normative data established for females in part I. Results determined that patients with vertical maxillary excess have increased nasal length caused by a more superiorly positioned soft tissue nasion, decreased thickness of soft tissue at rhinion, increased nasal form angle, and increased absolute nasal tip angle related to an increased inclination of the cranial base, increased forward projection of the anterior nasal spine (tip support), and decreased incidence of supratip break. These findings suggest a characteristic appearance similar to the type II nasal characteristic (aquiline form) established in part I.

Topics: Adolescent; Adult; Cephalometry; Esthetics; Face; Facial Bones; Female; Humans; Male; Malocclusion; Maxilla; Maxillofacial Development; Nose; Reference Values; Syndrome; Vertical Dimension

The purpose of this investigation was to determine changes in soft tissue profile of African-Americans following orthodontic treatment involving extraction of four premolars. The sample consisted of pretreatment and postreatment lateral cephalometric radiographs of 30 males and 30 females of African-American descent exhibiting bimaxillary protrusion. The age of the patients ranged between 10 years 4 months and 17 years 6 months at the start of treatment. Average time between pretreatment and postreatment radiographs was 2 years 11 months in the male group and 3 years 3 months in the female group. Changes in the dentofacial complex and facial soft tissue as a result of treatment and growth were evaluated with cephalometric analysis. Student's t-tests were performed to compare differences. Nasolabial angle increased 9.1 degrees in males and 7.1 degrees in females. Upper lip procumbency relative to SnPg' decreased 1.5 mm in males and 1.7 mm in females. Lower lip retraction relative to SnPg' was 2.7 mm in males and 2.5 mm in females.

Topics: Adolescent; Bicuspid; Black or African American; Black People; Cephalometry; Child; Chin; Face; Facial Bones; Female; Humans; Incisor; Lip; Male; Malocclusion; Maxillofacial Development; Nose; Orthodontics, Corrective; Serial Extraction

A clinical and cephalometric standardized study of surgical correction of open bite deformity was performed on 19 individuals. The mode of fixation of the maxilla after surgical correction was by direct wires in 9 of the patients combined with suspension wires to the infraorbital rim and in 10 patients plate fixation. The follow-up time was 18 months and the results in both groups were clinically and cephalometrically stable in the short (2 and 6 months) and medium terms (18 months). No statistically significant difference was found between the groups regarding tendency to relapse. It was, however, concluded that the advantages of plate fixation both on clinical grounds and for patient comfort are factors in favour of using miniplates for maxillary surgical procedures.

Topics: Adolescent; Adult; Bone Plates; Bone Wires; Cephalometry; Female; Follow-Up Studies; Humans; Incisor; Internal Fixators; Lip; Male; Malocclusion; Maxilla; Nose; Osteotomy; Vertical Dimension

Esthetic evaluation of a photographic profile slide of a random sample of 130 adult white women was made by six judges. The esthetic evaluation included vertical and anteroposterior evaluation and an attractiveness score on a visual analog scale. Additionally, the judges were asked to give specific reasons for their scores. Profiles with increased vertical features or convex or Class II tendency profiles were judged as being the most unattractive. Judgment of facial appearance was consistently related to certain regions of the face: the chin, upper lip, and nose having the greatest effect on the overall judgment of appearance. Orthodontic and surgical treatment planning should focus primarily on these regions to obtain the best esthetic result.

Topics: Adolescent; Adult; Analysis of Variance; Beauty; Chin; Face; Female; Humans; Lip; Malocclusion; Nose; Observer Variation; Surveys and Questionnaires; Vertical Dimension

The short-term (6 weeks postoperative) and long-term (12 months postoperative) skeletal stability of combined maxillary and mandibular advancement was evaluated by cephalometric analysis in 15 patients. The mean horizontal advancement of the maxilla was 5.84 mm. 6 weeks later a mean relapse of 0.03 mm (0.5%) was identified. The mean relapse at long-term follow-up was 0.59 mm (10.1%). The mean horizontal advancement of the mandible was 12.35 mm at menton and 12.65 mm at pogonion. At 6 weeks, mean horizontal relapse, respectively at the above landmarks, was 0.11 mm and 0.21 mm (1.3%). The mean relapse at long-term follow-up was respectively 2.19 mm and 1.98 mm (16.9%). Subjectively and objectively improvements were seen in facial aesthetics and dental occlusion. The results indicated that rigid fixation of osteotomies undertaken to correct 'horizontal facial deficiency' is a surgically predictable and relatively stable procedure when reviewed up to 12 months after surgery.

Topics: Adolescent; Adult; Cephalometry; Chin; Esthetics; Female; Follow-Up Studies; Humans; Male; Malocclusion; Mandible; Maxilla; Nose; Orthodontics, Corrective; Osteotomy; Recurrence; Serial Extraction

Roentgencephalometry was used for the assessment of the development of clinically important facial characteristics in complete unilateral cleft lip and palate during the prepubertal and pubertal period. Thirty-one patients aged 8 and 11 years and 30 patients aged 11 and 14 years were examined repeatedly. All of them were operated upon and orthodontically treated with the same methods. An unfavorable development of facial convexity, sagittal jaw relations, configuration of the soft profile, and of the prominence of the upper lip occurred during both periods. An improvement of overjet that was attained during the prepubertal period showed a renewed impairment during the period of puberty. The impairment was not caused by the higher facial growth rate, but was attributable to the exhaustion of the compensation and adaptation mechanisms of the dentoalveolar component of the upper jaw produced by the preceding orthodontic therapy. The development of sagittal jaw relations and of facial rotation was not related to the initial patterns of these characteristics, but the possibility of an improvement of the inclination of upper incisors and of overjet was influenced by their initial pattern. During the prepubertal period the development of overjet was not related to the development of sagittal jaw relations or of mandibular growth rotation, as was the case during puberty.

Topics: Adolescent; Cephalometry; Child; Chin; Cleft Lip; Cleft Palate; Female; Humans; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nose; Orthodontic Appliances, Removable; Orthodontics, Corrective; Palatal Expansion Technique; Puberty; Rotation

Besides nose obstruction other etiological factors can be advanced to explain the development of oral respiration: malformation of the face (Binder's syndrome, Bimler's microrhinodysplasia, Apert's and Crouzon's syndrome); alterations or deviations of the tongue (Robin's syndrome, macroglossia, ankyloglossia); lip closure problems.

Topics: Child; Child, Preschool; Facial Bones; Humans; Infant; Macroglossia; Malocclusion; Mouth Breathing; Nose; Syndrome; Tongue

Management of common problems of nasal airway obstruction in cleft and noncleft patients by the subnasal approach through the maxillary Le Fort I osteotomy are discussed. The effects of maxillary surgical repositioning on the esthetics of the nose and upper lip are presented, as well as the sequencing and timing of orthognathic surgery and nasal reconstruction in the cleft patient. Case presentations illustrate the results of this treatment approach.

Topics: Adenoidectomy; Adolescent; Cleft Lip; Cleft Palate; Humans; Jaw Abnormalities; Male; Malocclusion; Maxilla; Maxillary Sinus; Nasal Obstruction; Nasal Septum; Nose; Orthognathic Surgical Procedures; Osteotomy; Time Factors; Turbinates

Three children suffering from facial asymmetry were observed annually using facial stereophotogrammetry before, during, and after their general skeletal adolescent growth spurt. Stereophotogrammetry allows accurate three-dimensional measurements between identifiable facial landmarks. Five pairs of bilateral parameters connecting external canthi and angles of the mouth to alae and tip of nose, and to each other, allowed a positive sign (right-side larger) or a negative (left-side larger) assessment of parameter asymmetry. Their total, taking sign into account, assessed mid-facial asymmetry. Serial observation showed that: (1) in patient no. 1 suffering from post-traumatic condylar hypoplasia, the facial asymmetry resolved; (2) in patient no. 2 suffering from unilateral facial hypoplasia, the asymmetry, which was severe, reduced with adolescence, but did not resolve; (3) in patient no. 3 suffering from fibro-osseous dysplasia of left maxilla, the asymmetry was reduced by surgery, but the full effects of the surgery were not measurable until over 1 year after operation; subsequently, the asymmetry began to increase again.

Topics: Adolescent; Age Factors; Cephalometry; Child; Face; Facial Asymmetry; Female; Fibrous Dysplasia of Bone; Humans; Male; Malocclusion; Mandibular Condyle; Maxillary Diseases; Maxillofacial Development; Mouth; Nose; Photogrammetry

The author endeavours to make a detailed description of the clinical examination of the face, which, if performed systematically, allows establishing an accurate diagnosis of the lesions in dysmorphosis and thus locating the latter's seat. The precise modalities of the surgical procedure are defined on the basis of cephalometry and of casts. Cephalometry does not define the site of surgery; it merely confirms it. In our opinion, the esthetic study of the face with the detailed clinical examination remains the key element for the assessment of dysmorphosis.

Topics: Chin; Esthetics; Esthetics, Dental; Face; Female; Humans; Jaw; Jaw Abnormalities; Lip; Male; Malocclusion; Nose; Orthognathic Surgical Procedures; Zygoma

This study was performed to elucidate quantitatively upper lip-tooth-jaw relativity in the vertical dimension. Values for five linear dentolabial measurements were generated from male (n = 42) and female (n = 46) reference samples. In addition, three vertical skeletofacial dimensions and two vertical dental dimensions were recorded. A significant sexual dimorphism was found in the vertical lip-tooth-jaw relationship: the upper lip of the female subjects was positioned on average 1.5 mm more superiorly at maximum smile than the upper lip of the male subjects (p less than 0.01). High smile lines appeared to be a female lineament, and low smile lines appeared to be a male lineament. There was a significant sex difference in upper lip length: the male subjects exhibited a longer upper lip than the female subjects (p less than 0.001). The mean difference was 2.2 mm. A similarly significant male-female difference was seen in the skeletal maxillary height measurement: the male sample showed a 2.2 mm mean vertical maxillary increase over the female sample (p less than 0.001). Furthermore, a significant difference was found between the clinical crown height of the maxillary central incisors in the male and female subjects of comparable ages: the male group had longer central incisor crowns (p less than 0.01).

Topics: Adolescent; Cephalometry; Female; Humans; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Nose; Palate; Sex Characteristics; Smiling; Vertical Dimension

The aim of this study was to make a detailed evaluation of the changes in the dentofacial structures that could be effective in the elimination of skeletal open bite. The study was performed on 32 skeletal open bite cases which were treated with Begg technique, Edgewise technique, and functional appliances and findings were analysed by multivariate statistical methods. Open bite was significantly reduced in all of the treatment groups. Apart from minor differences, similar changes were observed with Begg and Edgewise technique treatments. During fixed appliance therapy marked increases in the upper and lower posterior dentoalveolar height were observed, and the mandible rotated backwards. On the other hand, with the functional appliances vertical growth of the posterior upper and lower dentoalveolar region was depressed, and the mandible was rotated forwards and upwards with the centre at the premolars. These findings were confirmed by regression analysis: rotational changes in the maxillary and mandibular bases explained 46 per cent of variance of the reduction of open bite in the functional group, while 28 and 16 per cent of variance was explained in the Edgewise and Begg groups, respectively.

Topics: Activator Appliances; Adolescent; Alveolar Process; Cephalometry; Child; Extraoral Traction Appliances; Humans; Incisor; Malocclusion; Mandible; Maxilla; Nose; Orthodontic Appliances; Regression Analysis; Reproducibility of Results; Tooth Movement Techniques

In this study, cephalometric and dental cast variables relating to 30 male and 20 female children, 8 to 13 years old with chronic nasal mucosal swelling, were compared with those relating to age- and sex-method controls. These controls were orthodontically untreated subjects with no histories of airway obstruction. The children with chronic nasal mucosal swelling had been referred because of chronic difficulties with nasal breathing to the Department of Otolaryngology Airflow Laboratory at the Hospital for Sick Children in Toronto. Previously active posterior rhinomanometry with a head-out volume displacement plethysmograph had been used to measure nasal resistance in 1000 consecutive subjects. Participants in the study reported here were selected from subjects whose nasal resistance fell markedly following administration of a decongestant spray. The subjects selected were found to have significantly (p less than 0.001) more mandibular incisor crowding, significantly (p less than 0.01) smaller mandibular arch widths than the controls, and significantly (p less than 0.001) smaller maxillary arch widths than the controls. The male subjects had significantly (p less than 0.01) smaller mandibular arch widths than the male controls.

Topics: Adolescent; Airway Resistance; Child; Chronic Disease; Dental Arch; Female; Humans; Incisor; Male; Malocclusion; Mandible; Maxilla; Nasal Decongestants; Nasal Mucosa; Nasal Obstruction; Nose; Pulmonary Ventilation; Rhinitis

Reduced nasal airflow can be the result of enlarged adenoids, hypertrophic turbinates, severely deviated nasal septum, or even narrow nasal cavities. The question of whether the width of the nasal cavity may influence certain facial dimensions examined on the postero-anterior cephalometric X-ray was evaluated through the study of two different groups of subjects. Possible intercorrelations between some other frontal dimensions were also examined in these subjects. The first group consisted of 15 males and 22 females aged from 17 to 25 years diagnosed as having an anterior open bite of at least 2 mm. The second group consisted of 20 males and 16 females aged from 19 to 25 years with a normal Class I skeletal and dental pattern. Postero-anterior cephalometric X-rays were taken for all individuals and the following dimensions were measured: facial width, nasal width, maxillary width, mandibular width, nasal height, and lower facial height. Statistical analysis was performed for the primary linear measurements as well as for certain ratios. Nasal height and lower facial height were found to be significantly increased in both males and females of the open bite group. The ratios of nasal width to lower face height, as well as nasal width to nasal height, were found to differ significantly only between open bite and normal females, being higher in the latter group.

Topics: Adolescent; Adult; Cephalometry; Child; Cranial Sutures; Female; Humans; Malocclusion; Mandible; Maxilla; Nasal Cavity; Nose; Reproducibility of Results; Sex Factors; Vertical Dimension; Zygoma

Topics: Adolescent; Child; Child, Preschool; Esthetics; Esthetics, Dental; Face; Female; Humans; Infant; Lip; Male; Malocclusion; Maxillofacial Development; Nose; Orthodontic Appliances; Orthodontics, Corrective; Tooth

Integrated electromyographic activity of masseter and anterior temporal muscles was recorded using bipolar surface electrodes in 33 young adults. Subjects were skeletally classified according to ANB angle reading corrected both for maxillary position and rotation of the jaw. Postural activity for both muscles was higher in Class III subjects than in Class I and Class II, whereas in Class I and II subjects activity was similar. During swallowing, masseter muscle activity in Class III subjects was higher than Classes I and II, whereas anterior temporal muscle activity was not different between Classes III and I. During maximal voluntary clenching, activity was not different among classes. High correlations between electromyographic activity and corrected ANB angle as well as with overjet were observed. Skeletal classification used in the present study may have clinical relevance regarding treatment and prognosis, as well as in the assessment of the relationship between muscular activity and craniofacial characteristics.

Topics: Adolescent; Adult; Cephalometry; Deglutition; Electromyography; Face; Female; Humans; Male; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Mandible; Masseter Muscle; Maxilla; Nose; Temporal Muscle; Vertical Dimension

The purpose of this study was to assess the effects of rapid maxillary expansion on nasal airflow studies and mouth breathing habit. 15 children aged from 5 to 12 years underwent rapid palatal expansion for orthodontic abnormalities. Otolaryngologic evaluation, computerized active anterior rhinomanometric measurements and oral myo-functional disorder examination were obtained before treatment, 2 months after expansion and after a retention period of approximately 10/12 months. Based on this multidisciplinary judgment and confirmed by the rhinomanometric values two groups could be distinguished: a group of predominantly mouth breathers where the nasal airway resistance had an average decrease of 34% and a group of predominantly nasal breathers where the nasal airway resistance had an average decrease of less than 5%. From the initial 8 predominantly mouth breathers before treatment only 2 remained clinically unchanged. From these results it was concluded that for the 15 children involved in this study rapid maxillary expansion affected the nasal airway patency in a way tailored to the initial deficiency and had a significative effect on the respiratory mode.

Topics: Airway Resistance; Child; Child, Preschool; Female; Humans; Male; Malocclusion; Maxilla; Nose; Palatal Expansion Technique

In order to test the assumption of an association between the anatomy of the first cervical vertebra, the atlas, and dentofacial build, roentgen-cephalograms of 78 young adults with either a markedly high or a low atlas dorsal arch were analysed with regard to head posture, and cervicovertebral and dentofacial anatomy. The high and low dorsal arch groups each comprised 22 women and 17 men. The head was more extended in the low arch groups and particularly so among the women, in whose low arch group there was a tendency for the cervical spine to be inclined more forward. Both the dorsal arch and the dens of the second vertebra were vertically smaller in the low arch groups, and more so among the men. Vertebral length was reduced more in the women, however. The clival plane was more parallel to the foraminal plane in the low arch groups and the gonial angle was more obtuse. Furthermore, the women with low arches showed a steepened mandibular plane, a backward-rotated condylar head, a decrease in the ratio of posterior to anterior face height, smaller vertical overbite and reduced proclination of the lower incisors. The prevalence of severe malocclusions was higher than in the corresponding high arch group.

Topics: Adult; Axis, Cervical Vertebra; Cephalometry; Cervical Atlas; Facial Bones; Female; Head; Humans; Incisor; Male; Malocclusion; Mandible; Mandibular Condyle; Nose; Posture; Sex Factors; Skull; Vertical Dimension

Topics: Activator Appliances; Child; Esthetics; Esthetics, Dental; Face; Female; Humans; Lip; Male; Malocclusion; Nose; Patient Care Planning; Serial Extraction; Tooth Movement Techniques; Vertical Dimension

This work is about perceptions of "professionals" in projection of part of nose, lips and chin relations in well-balanced facial profile achievement and change in facial profile during the growth between 7 and 18 years. It's the first part of our research.

Topics: Adolescent; Adult; Attitude of Health Personnel; Cephalometry; Child; Chin; Dentists; Esthetics; Face; Female; Humans; Lip; Male; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Models, Anatomic; Nose; Sex Characteristics; Sphenoid Bone

The study of a population treated according to orthodontico-surgical process with only a LE FORT I osteotomy allowed us to determinate the moderate influence on each element of curtain profile (nose, lips and chin). The comparison between relative moving of maxillary and the one of each cutaneous structures enable us to define the sagittal and vertical displacement's ratios of curtain profile.

Topics: Adolescent; Adult; Cephalometry; Chin; Esthetics; Face; Female; Humans; Incisor; Lip; Male; Malocclusion; Mandible; Maxilla; Middle Aged; Nasal Bone; Nose; Osteotomy; Vertical Dimension

The authors measured nasal resistance in 53 children aged 5 to 13 years treated for bite disorders. Comparison of the results with a normal control group of children of the same age demonstrated that major nasal incompetence was 4 times more common in the group of children with orthodontic abnormalities. Nasal incompetence with permanent buccal respiration leads to disordered growth and modification of the morphogenesis of the naso-ethmoid-maxillary unit. Adaptation of deglutition and phonation to these new conditions produces modifications in the tension of the velo-pharyngo-facial and pharyngo-hyoglossal musculo-aponeurotic bands with a tendency to produce more vertical mandibular growth in children. The prevention of nasal incompetence in children and its treatment are important for coherent facial growth and guarantee the stability of the results of orthodontic treatment.

Topics: Adolescent; Airway Resistance; Child; Child, Preschool; Humans; Malocclusion; Manometry; Mouth Breathing; Nasal Obstruction; Nose; Pulmonary Ventilation

The purpose of this study was to assess the effects of quantitatively determined breathing patterns on dentofacial development in growing children. Forty-nine subjects ranging in age from 10 to 16 years participated in the breathing pattern assessment portion of this project. Oral, nasal, and total airflow were measured at separate times by means of a head-out body plethysmograph technique and the values were compared with the subjects' and parents' subjective perceptions of their breathing modes. These breathing pattern measurements also were compared to nasal airway resistance and nasal power. Temporal variation and cyclic respiration, which may play important roles in quantitative evaluations of childrens' breathing patterns, also were addressed. In addition, objective assessments of possible associations between dentofacial structure and respiration were made on 45 of these children. Most subjects' exhibited was either an oronasal or a completely nasal respiratory pattern. However, significant variation in breathing measures was evident among a number of subjects whose breathing was measured twice on the same day and on different days. No significant correlations were found between objectively measured and subjectively determined impressions of respiratory patterns. In addition, there was no association between nasal airway resistance or nasal power and plethysmograph recordings of percent of mouth breathing. Comparisons of measured breathing modes and dentofacial characteristics revealed a weak tendency among mouth breathers toward a Class II skeletal pattern and retroclination of maxillary and mandibular incisors. In contrast, subjective perception of mouth breathing was associated with increased anterior facial height and greater mandibular plane angles. Nasal power and resistance were not correlated with either dental or skeletal variables. This study presents evidence that determination of respiratory pattern is a complex issue for which methods must be refined and performed longitudinally.

Topics: Adolescent; Airway Resistance; Cephalometry; Chi-Square Distribution; Child; Female; Humans; Male; Malocclusion; Maxillofacial Development; Mouth Breathing; Nose; Plethysmography, Whole Body; Pulmonary Ventilation; Regression Analysis; Surveys and Questionnaires; Tooth

Topics: Airway Obstruction; Airway Resistance; Child; Humans; Malocclusion; Mouth Breathing; Nose; Respiration

The traditional orthodontic and/or orthognathic surgical management of the Class II deep-bite case with a low mandibular plane angle has often been difficult; optimal esthetic results have not always been achieved, and long-term stability was often unpredictable. Many of these patients may benefit functionally and esthetically from appropriate orthodontic treatment and double-jaw surgical intervention to reorient the occlusal plane toward normal (8 degrees +/- 5 degrees to Frankfort horizontal) by moving the posterior maxilla and mandible superiorly and correcting into a Class I skeletal and occlusal relationship. As the occlusal plane angulation is increased, the upper incisor angulation decreases, the lower incisor angulation increases, the chin rotates down and backward relative to the lower incisor occlusal plane tips, and the mandibular plane angle increases. The principle of changing the occlusal plane has provided a means to improve the functional and esthetic results for the correction of this type of facial deformity, as well as many others.

Topics: Adolescent; Adult; Cephalometry; Child; Chin; Face; Female; Humans; Incisor; Lip; Malocclusion; Malocclusion, Angle Class II; Mandible; Maxilla; Nose; Osteotomy; Tooth Movement Techniques

There has been some controversy over the post-operative changes that may take place in tooth position following orthognathic surgery. The present study was designed to observe the changes that take place in the position of the incisors following surgery to correct class III skeletal discrepancies. It was found that the postoperative changes that occur in the axial inclination of the lower incisors are small enough to be clinically insignificant, provided an adequate overbite has been established. Any changes that do occur will probably be associated with a small increase in the mandibular maxillary planes angle, with possibly some upper incisor proclination and reduction of overbite.

Topics: Adult; Cephalometry; Female; Humans; Incisor; Male; Malocclusion; Malocclusion, Angle Class III; Mandible; Maxilla; Nose; Recurrence; Vertical Dimension

The appearance of results of injury to the columella, the nasal septum, and the nasal bones, in particular, has been well described. Anomalies of the maxilla and global facial balance secondary to nasomaxillary injury are less well known. Three cases involving children, aged 11, 14, and 17 years, who had suffered nasomaxillary injury at least 8 years earlier as a result of physical beating, were studied with the use of photographs and architectural craniofacial lateral cephalometric radiographic analysis. The architectural craniofacial analysis of Delaire produced a graphic representation of the resultant maxillofacial deformities rather than a description of the deformities in terms of deviation from a statistical mean. Traumatic injury to the nasomaxillary complex provides an experimental model that implicates the role of the cartilaginous nasal septum and local functional conditions in the growth of the nasomaxillary complex. The importance of the functional premaxillary skeletal unit in balanced facial growth allows better understanding of the pathophysiology of malformation of this region.

Topics: Adolescent; Child; Child Abuse; Female; Humans; Male; Malocclusion; Maxillofacial Development; Maxillofacial Injuries; Nose; Nose Deformities, Acquired

Binder's syndrome or maxillonasal dysplasia is a malformation characterized by an extremely flat and retruded nose. Severe cases of the syndrome do also have a retrognatic maxilla often combined with an open bite deformity which demands a combined surgical solution with both maxillary osteotomy and secondary nose correction. The two-stage surgical procedure in the advanced cases of maxillonasal dysplasia has in our opinion been preferable to a Le Fort II osteotomy. Two cases with severe Binder's syndrome where the two-stage procedure has been performed will be presented and the surgical approach discussed.

Topics: Adolescent; Bone Transplantation; Female; Humans; Male; Malocclusion; Maxilla; Nasal Septum; Nose; Osteotomy

This study was designed to test the hypothesis that simultaneous lip and palate repair results in more severe craniofacial growth aberrations than lip repair or palate repair performed separately. Seventy-six purebred beagles were divided into five groups. Two of these groups were controls (unoperated and unrepaired animals); the three remaining groups were experimental (in one group only the lip was repaired, in another only the palate was repaired, and in the last the lip and palate were repaired simultaneously). Cephalometric measurements were analyzed using univariate and multivariate statistical techniques. In multivariate analysis, stepwise multiple regression and discrimination were applied to precisely assess the effects of the various surgical procedures. The results of this study indicate that simultaneous lip and palate repair results in more severe craniofacial growth aberrations than lip repair or palate repair performed separately.

Topics: Animals; Cephalometry; Cleft Lip; Cleft Palate; Dogs; Malocclusion; Mandible; Maxilla; Maxillofacial Development; Nose

Topics: Adolescent; Cephalometry; Child; Face; Female; Humans; Incisor; Male; Malocclusion; Malocclusion, Angle Class II; Nose; Serial Extraction; Tooth Movement Techniques

Topics: Adolescent; Adult; Cephalometry; Child; Face; Female; Humans; Longitudinal Studies; Male; Malocclusion; Maxilla; Maxillofacial Development; Nose; Syndrome

Topics: Adolescent; Cephalometry; Child; Chin; Female; Humans; Male; Malocclusion; Malocclusion, Angle Class II; Mandible; Mandibular Condyle; Nose; Skull

Topics: Airway Obstruction; Child; Craniofacial Dysostosis; Humans; Malocclusion; Nose

Topics: Airway Obstruction; Child; Humans; Malocclusion; Mouth Breathing; Nose; Orthodontics, Corrective

This article investigates the relationship of skeletal facial pattern and soft-tissue nasal form. The case sample comprises 123 white female subjects, aged 11.0 to 20.6 years, with no histories of pathology, trauma, surgical intervention, or orthodontic treatment. Measurements were made from cephalometric radiographs, posteroanterior radiographs, and the physioprint photographs. Skeletal classifications were based on the relationship of the maxilla to the mandible; the three classifications were straight profile, retrusive chin profile, and prognathic profile. Pearson product--moment correlation coefficients were used to test intercorrelations of all quantitative variables (including age) with each other. Correlations were highly significant for age, the three profile measurements, and two of the frontal measurements. Hence, noses and skeletal structures showed, as expected, increases with age. Also, profile measurements were highly significantly correlated; larger noses were larger in all profile dimensions. A stepwise discriminant analysis was used to study nonquantitative categories of nasal shape (straight, convex, and concave). This analysis indicated that more than 86% of patients in the sample of 123 demonstrated a correlation of nasal shapes with specific skeletal groupings. Patients with straight profiles tended to have straight noses; convex profiles accompanied convex nasal shapes; and concave profiles were found with concave nasal shapes. The clinical significance of this research is to emphasize the importance of total facial harmony (especially nasal shape) during orthodontic diagnosis and treatment planning.

Topics: Adolescent; Adult; Age Factors; Cephalometry; Child; Cross-Sectional Studies; Face; Facial Bones; Female; Humans; Malocclusion; Mandible; Nose; Orbit; Palate; Tooth

Nasal respiratory function and its relationship to growth development of the craniofacial structure has been a subject of interest and controversy for over 100 years. The otolaryngologist as the primary physician with responsibility of managing the upper respiratory tract is obviously most intimately involved with diagnosis and treatment of upper respiratory tract problems. To further evaluate the evidence regarding causes of craniofacial growth, a study was done involving pretreatment orthodontic subjects and their manifestation of classic signs of adenoid facies ("long-face syndrome"). Randomly selected were 106 subjects, ranging in age from 6 to 13 years, for evaluation of the facial features and medical history associated with long-face syndrome. No conclusive proof was found that nasal respiratory obstruction alters facial growth development. Studies of the nasal respiratory function need to be done utilizing clear definitions of respiratory mode and objective; reproducible techniques of measuring respiratory modes must be employed. Highly selected orthodontic patients can benefit from adenoidectomy and/or tonsillectomy.

Topics: Adolescent; Airway Obstruction; Cephalometry; Child; Facial Bones; Female; Humans; Male; Malocclusion; Maxillofacial Development; Mouth Breathing; Nose; Random Allocation; Respiration; Syndrome

A review of the surgical management of adult patients with cleft lip and palate is presented together with the anatomical relationship to surgical procedures. There is still a much higher tendency to relapse after maxillary osteotomy in cleft patients compared to non-cleft patients. However relapse can be reduced by prolonged cranio-maxillary fixation or by direct skeleton fixation with bone plates. Techniques which mobilise the badly scarred palate and avoid dragging it forward with the osteotomy also reduces relapse.

Topics: Adult; Alveolar Process; Cleft Lip; Cleft Palate; Female; Humans; Male; Malocclusion; Maxilla; Maxillofacial Development; Nose; Osteotomy

The variation of the ANB angle was studied in a sample which consisted of 138 orthodontically untreated children 7 to 15 years of age with Class I, Class II, or Class III (Angle) malocclusion. A regression analysis was used in order to describe the proportion of the distorting variation caused by some usual changes in the cranial and facial skeleton. The results revealed that a part of the variation of the ANB angle could be attributed to factors other than the actual apical base difference, among these factors being the rotation of the S-N plane, the relative length of the S-N plane, and the rotation of the jaws. Because the ANB angle can vary without any marked abnormalities in the sagittal jaw relationship, the use of the so-called normal limits for the ANB angle is not justified. It would be better to replace the ANB angle with a more accurate indicator.

Topics: Adolescent; Cephalometry; Child; Face; Humans; Malocclusion; Mandible; Maxilla; Nose

Topics: Adolescent; Child; Deglutition Disorders; Facial Bones; Female; Humans; Lip; Male; Malocclusion; Nasopharynx; Nose; Oropharynx; Otorhinolaryngologic Diseases; Tongue Habits

The position of the lips and the soft tissues overlying points A and B seem to be substantially related to the horizontal positions of the upper and lower incisors and to the angulation of the upper incisor. The angulation of the lower incisor is much less important than its spatial position. The A-N-B angle is strongly related to the overlying soft tissue outline. Point A convexity is a very important factor in soft tissue form. The Ricketts E line, the Steiner S line and the soft tissue facial plane all seem to be equally acceptable bases for assessment of the soft tissues of the profile.

Topics: Cephalometry; Chin; Dental Occlusion; Face; Facial Bones; Female; Humans; Incisor; Lip; Malocclusion; Nose

Craniofacial growth in 100 patients treated with the functional regulator of Fränkel for about 24 months was compared with craniofacial growth seen in a matched group of untreated persons with Class II malocclusion. Both conventional and geometric cephalometric analyses were used to evaluate the skeletal and dental adaptations. This study shows several clear effects of treatment in either of two age ranges considered. The principal skeletal effect was advancement of the mandible along the direction of the facial axis. This advancement resulted in increases in mandibular length and in vertical facial dimensions. There was little effect of treatment upon maxillary skeletal structures with the exception of point A, which moved slightly posteriorly. Dentoalveolar adaptations due to treatment included a decrease in the normal forward movement of the upper molar and an increase in the normal vertical movement of the lower molar. There was a 2-mm posterior movement of the tip of the upper incisor but minimal anterior tipping of the lower incisor.

Topics: Activator Appliances; Cephalometry; Child; Facial Bones; Female; Humans; Male; Malocclusion; Malocclusion, Angle Class II; Mandible; Maxilla; Maxillofacial Development; Nasal Bone; Nose; Orthodontic Appliances, Removable; Sella Turcica; Tooth; Tooth Movement Techniques; Vertical Dimension

Topics: Adolescent; Child; Face; Female; Follow-Up Studies; Humans; Male; Malocclusion; Maxillofacial Development; Nose

Residual deformities of the lip and nose in individuals with repaired unilateral and bilateral clefts may very in severity depending on the state of the original defect, the care taken in the initial surgical procedure, the pattern of the patient's facial growth, and the effectiveness of interceptive orthodontic techniques. Because each patient has a unique combination of deformities, their surgical reconstruction usually requires the modification and combination of several surgical techniques. In this article, a summary of various reconstructive techniques is presented, beginning with an evaluation of secondary cleft defects.

Topics: Alveoloplasty; Cicatrix; Cleft Lip; Cleft Palate; Dentures; Humans; Lip; Malocclusion; Nose; Postoperative Complications; Rhinoplasty; Surgery, Plastic; Suture Techniques

Topics: Adolescent; Bone Transplantation; Cleft Lip; Female; Humans; Male; Malocclusion; Maxilla; Nose; Osteotomy

The purpose of this paper is to present a 5-year experience using a comprehensive surgical approach to reconstruct what we have chosen to call the "end-stage cleft lip and palate deformity." The deformity consists of varying degrees of midface retrusion, malocclusion, nasal deformity, and lip deformity. Most of the patients afflicted had unacceptable upper lip anatomy characterized by tightness and lack of cupid's bow and bulk. All had severe palatal scarring with resulting arch collapse and severe malocclusion. Most had had multiple surgical attempts to improve nasal aesthetics using standard rhinoplasty techniques with little or no improvement. The procedure involves splitting the upper lip with incisions extending into the upper buccal sulcus and rim of the nose allowing wide skeletalization of the maxilla and osteocartilagenous nasal skeleton. LeFort I or II maxillary advancement, nasal reconstruction, and upper lip modification (with Abbé flap if indicated) are done. The jaws are placed in intermaxillary fixation for 6 to 8 weeks. This comprehensive approach has been used in 16 patients, aged 15 to 29 years, with follow-up of up to 5 years. Excellent functional and aesthetic improvement has occurred in all patients, and complications have been minimal.

Topics: Adolescent; Adult; Cleft Lip; Cleft Palate; Face; Female; Humans; Male; Malocclusion; Maxilla; Nose; Surgery, Plastic

To evaluate the effect of maxillary superior movement via Le Fort I osteotomy on nasal airway resistance, eleven Caucasian patients whose surgical orthodontic treatment included Le Fort I impaction (range 2 to 8 mm, mean 5.3 mm) were selected. Nasal airway resistance in these patients was determined a few days before and approximately 8 weeks after the Le Fort I surgical procedure. Nasal airway resistance was determined by means of a uninasal active mask rhinomanometric technique. Contrary to the predicted negative effects of maxillary superior movement on nasal airway function, there was a statistically significant improvement in nasal airway resistance (P less than 0.01) after maxillary superior movement. This rather unexpected finding can be explained by examining the effect of maxillary superior movement on the nasal valve area in the anterior nose. The nasal valve area is a teardrop-shaped area bordered by the nasal septum, the caudal end of the upper lateral nasal cartilage, the floor of the nose, and the soft fibrofatty tissue on the lateral aspect of the nose. The apex of the teardrop-shaped area (the angle between the nasal septum and the upper lateral cartilage) is called the nasal valve. In the Caucasian type of nose, the nasal valve accounts for most of the inspiratory resistance to airflow. Maxillary superior movement increases the alar width. It is proposed that this increase in alar width is transmitted at least partially to the nasal valve angle, causing it to widen slightly, paradoxically reducing nasal airway resistance while reducing skeletal intranasal dimensions.

Topics: Adolescent; Adult; Airway Resistance; Cephalometry; Female; Humans; Male; Malocclusion; Manometry; Maxilla; Nose; Osteotomy; Pulmonary Ventilation

The relative influence on profile preference of the anteroposterior maxillomandibular relation, the lower facial height, and the form of the dorsum of the nose is a source of interesting controversy. In order to obtain more information on this subject, twenty-seven shadow profile photographs were artificially constructed to represent the main characteristics of the nine profile types proposed by Sassouni combined with three different kinds of nose dorsum. Each series of nine profiles was ranked according to the personal esthetic preference of 249 adults (mean age, 23 years). One group of test persons (40 females and 91 males) had no orthodontic background, while another group (49 females and 69 males) had received some orthodontic teaching. Chi-square tests of significance showed no significant difference between male and female participants in esthetic preference for the sex of a profile. Also, the difference in orthodontic knowledge had no significant effect on esthetic preference. Nose dorsum changes induced significant differences only in Class II normal profiles; convex noses were less appreciated. Calculation of average preference values revealed that Class I normal profile types were clearly the favored ones, followed by Class I deep profiles. Open profile types, on the contrary, were obviously the least appreciated. This sequence indicates that, in profile evaluations, vertical profile characteristics could be more important than anteroposterior features and that a lengthening of the soft-tissue profile is not desirable in most cases. Seven weeks after the first ranking of male profiles, 193 persons were retested. The rank correlation values according to Kendall showed that one out of four persons ranked profiles significantly different in the retest.

Topics: Adult; Esthetics, Dental; Face; Female; Humans; Jaw; Lip; Male; Malocclusion; Nose; Sex Factors

Topics: Adult; Cephalometry; Face; Humans; Malocclusion; Nasal Bone; Nose

This paper describes a method of cephalometric analysis which is currently used by the author in the evaluation and treatment planning of orthodontic and orthognathic surgery patients. In the analysis of a single film, the positions of the maxilla and mandible are related to cranial structures and to each other. Criteria for evaluation of the anteroposterior and vertical positions of the upper and lower incisors are provided, as is the documentation of the standards for each of the measures. In addition, the analysis of serial films is considered and a step-by-step outline of the cephalometric procedure is presented.

Topics: Adolescent; Adult; Cephalometry; Child; Face; Female; Humans; Incisor; Male; Malocclusion; Mandible; Maxilla; Nose; Pharynx; Skull; Tooth; Vertical Dimension

An approach to correction of nasomaxillary dysplasia is described. Where midfacial hypoplasia is managed by surgical anteropositioning of the affected skeletal parts, this technique permits management of the associated nasal dysmorphia as well. The one-stage correction is performed with the midfacial skeleton entirely degloved, under direct vision. Details are described, and diagnostic and treatment considerations of two patients are given.

Topics: Adult; Face; Female; Humans; Malocclusion; Maxilla; Nose; Osteotomy

This article presents a soft-tissue analysis which demonstrates the inadequacy of using a hard-tissue analysis alone for treatment planning. The material and methods used to develop this technique came from years of observation and description of patients from the private practice of the author. The findings indicate that, in general, for adolescents the normal or usual thickness of the soft tissue at point A is 14 to 16 mm. As point A is altered by tooth movement, headgear, etc., the soft tissue will follow this point and remain the same thickness. When there is taper in the maxillary lip immediately anterior to the incisor, as in protrusive dentures, the tissue will thicken as the incisors are moved lingually until the tissue approaches the thickness at point A (within 1 mm. of the thickness at point A). When the lip taper has been eliminated, further lingual movement of the incisor will now cause the lip to follow the incisors in a one-to-one ratio. These concepts are predictable in adolescents when the lip thickness at point A is within the normal range. Some exceptions are as follows: Even if there is lip taper, if the tissue thickness at point A is very thin (for example, 9 to 10 mm.), the lip may follow the incisor immediately and still retain the taper. If the tissue at point A is very thick (for example, 18 to 20 mm.), the lip may not follow incisor movement at all. Adult tissue reaction is similar to the first exception. Even though there may be lip taper, the lips will usually follow the teeth immediately. Cases are presented to demonstrate these concepts and to illustrate a normal or acceptable range of variation for facial harmony related to variations in skeletal convexity.

Topics: Adolescent; Adult; Cephalometry; Child; Esthetics, Dental; Face; Facial Bones; Female; Humans; Lip; Male; Malocclusion; Nose; Patient Care Planning; Tooth Movement Techniques

Topics: Airway Obstruction; Female; Humans; Male; Malocclusion; Maxillofacial Development; Nose; Rhinitis, Allergic, Perennial

Topics: Adolescent; Adult; Child; Humans; Malocclusion; Mouth Breathing; Nose; Palatal Expansion Technique; Respiration; Respiratory Function Tests

Topics: Black People; Cephalometry; Child; Child, Preschool; Cranial Fossa, Posterior; Dental Arch; Face; Humans; Jaw; Malocclusion; Malocclusion, Angle Class I; Malocclusion, Angle Class II; Malocclusion, Angle Class III; Nose; White People

Topics: Adult; Child; Face; Female; Humans; Interferometry; Lip; Male; Malocclusion; Malocclusion, Angle Class II; Nose; Photogrammetry; Photography

Topics: Child; Eustachian Tube; Hearing Loss; Hearing Loss, Conductive; Humans; Male; Malocclusion; Maxilla; Nose; Palatal Expansion Technique

Topics: Adolescent; Adult; Cephalometry; Child; Child, Preschool; Female; Humans; Male; Malocclusion; Maxilla; Maxillofacial Development; Nose; Syndrome

Topics: Adolescent; Adult; Cephalometry; Diagnosis, Differential; Female; Humans; Lip; Male; Malocclusion; Malocclusion, Angle Class II; Middle Aged; Nose; Patient Care Planning; Prognathism

Topics: Child; Child, Preschool; Cleft Lip; Cleft Palate; Facial Muscles; Humans; Lip; Malocclusion; Nose

Topics: Adolescent; Adult; Cephalometry; Child; Dental Arch; Ethmoid Bone; Face; Female; Humans; Malocclusion; Mandible; Maxillofacial Development; Molar; Nose; Orthodontic Appliances; Palate; Tooth Movement Techniques

Topics: Adult; Bone Transplantation; Child; Child, Preschool; Female; Humans; Male; Malocclusion; Nose; Rhinoplasty; Transplantation, Autologous

The treatment of Binder's maxillonasal dysostosis raises many problems and difficulties of both orthodontic and surgical natures. Orthodontic therapy should be conducted as early as possible and include, principally, an advancement of the maxilla by heavy extra-oral postero-anterior traction on an orthodontic mask. If good occlusion is obtained the patient can then be treated to improve the anatomical conditions of the muscles of the nose and upper lip. Maxillary, and more rarely mandibular osteotomies are indicated in cases with poor occlusion. When occlusion is reasonably good the hypoplasia has to be compensated for by using large portions of ilac bone to reconstruct the ridge and point of the nose. A preseptal graft on the ridge and secondarily, revisions of the point of the nose are often essential to ensure the best results.

Topics: Adolescent; Adult; Age Factors; Bone Transplantation; Child; Craniofacial Dysostosis; Extraoral Traction Appliances; Female; Humans; Infant, Newborn; Male; Malocclusion; Maxilla; Nose; Orthodontics, Corrective; Rhinoplasty

Eleven patients with Binder's syndrome (nasomaxillary hypoplasia) have been treated by the Toronto Craniofacial Team from 1972 to 1977. The treatment has consisted of onlay bone and cartilage grafts to the nose and perialar region for young children, or when the occlusion is normal. However, cases with severe malocclusion were treated by a Le Fort I and/or Le Fort II osteotomy when the children were older. When the malocclusion was less severe, interceptive orthodontics have been useful. The nose can be significantly lengthened and enlarged through a frontal craniotomy incision connected with an upper buccal sulcus incision, without any incision on the face.

Topics: Adolescent; Adult; Age Factors; Cartilage; Cephalometry; Child; Child, Preschool; Dermatologic Surgical Procedures; Female; Humans; Ilium; Male; Malocclusion; Malocclusion, Angle Class III; Maxilla; Maxillofacial Development; Nose; Ribs; Surgery, Plastic; Syndrome; Transplantation, Autologous

Serial cephalometric radiographs of 165 children have been used to analyze age-associated changes in the saddle angle (Ba-S-N). There are mean decreases in this angle of about 5 degrees from birth to 2 years in those with either a Class I or a Class II occlusion; later changes are slight. The mean values tend to be slightly smaller in Class I boys than in those with Class II. Generally, the means are slightly larger in boys than girls but in adults this sex difference is in the reverse direction while remaining slight. It is reasonable to conclude that change is dominant in the first two years. Even after pubescence the angle is not constant but the changes are much smaller. The variability of the angle is greater for Class II than Class I individuals and its variability is greater in girls than boys after 12 years. Almost all the median increments are negative; that is, the flexure of the cranial base decreases with age particularly if the increments begin at the first available radigraph. This tendency is more marked in Class II then Class I occlusion. The increments are markedly variable in each occlusion group with large changes occurring in some individuals. Correlations between the saddle angles at different ages are high; this shows a marked constancy of the relative levels for individuals. The correlations between increments are small; presumably this reflects the small sizes of these increments relative to error terms. In the present group the saddle angle is positively correlated with Ba-N length, but the correlation between the saddle angle and either cranial vault length of stature are near zero. These findings show that there is marked constancy within individuals after the age of 2 years although, as noted earlier, there is marked variability in the size of the angle at particular ages and the serial data for some unusual individuals show large changes that are generally decreases.

Topics: Adolescent; Adult; Age Factors; Cephalometry; Child; Child, Preschool; Female; Humans; Infant; Male; Malocclusion; Maxillofacial Development; Nose; Occipital Bone; Sella Turcica; Sex Factors

Nasal problems in children are very common. The factors that affect the embryologic development have been discussed. Injuries that occur in prenatal, natal, and postnatal periods affect normal development. Prompt treatment of minor injuries is necessary to prevent airway problems later. The "wait and see" attitude toward nasal deformity is ill advised. X-ray findings are not conclusive, as the nasal pyramid in a child is largely cartilaginous. Obstructive nasal breathing can result in facial asymmetry, malocclusion, and cardiopulmonary problems. Allergy and sinusitis are frequently causes of obstruction.

Topics: Acute Disease; Adolescent; Airway Obstruction; Birth Injuries; Cartilage; Child; Child, Preschool; Facial Injuries; Female; Humans; Infant; Infant, Newborn; Male; Malocclusion; Nasal Bone; Nasal Septum; Nose; Nose Deformities, Acquired; Pregnancy; Sinusitis; Skull Fractures; Wounds, Nonpenetrating; Wounds, Penetrating

The "Wits" appraisal is intended as a diagnostic aid to be used in conjunction with other analyses. Whereas the popularly used ANB angular reading is a simple method of measuring degree of jaw disharmony, there are many instances in which this reading is suspect. The "Wits" appraisal permits easy identification of these shortcomings and substitutes a reasonably reliable means of measuring extent of anteroposterior jaw disharmony.

Topics: Cephalometry; Humans; Jaw; Malocclusion; Nose; Rotation

The intention of this work was to describe the nose morphology in individuals with different craniofacial patterns which dentally were characterized by Angle Class I, Class II div. 1, and Class III occlusions. The material comprised male adults (age 20--30 years), and the results are based on measurements on tracings of lateral cephalograms. Generally, the inclination of the nose in relation to the nasion-sella-line was similar in all groups, and so was the nose length as well. The depth of the nose, when related to the hard and soft tissue facial planes was, however, significantly different, apparently due to the different sagittal position of the chin.

Topics: Adolescent; Adult; Cephalometry; Humans; Male; Malocclusion; Nose; Vertical Dimension

Topics: Abnormalities, Multiple; Cephalometry; Chin; Esthetics, Dental; Face; Female; Humans; Jaw Abnormalities; Malocclusion; Maxillofacial Development; Methods; Nose; Preoperative Care; Surgery, Oral; Surgery, Plastic

Topics: Anesthesia, Local; Eating; Facial Bones; Fracture Fixation, Internal; Fracture Fixation, Intramedullary; Humans; Hygiene; Malocclusion; Mandibular Fractures; Maxilla; Methods; Nose; Orthopedic Equipment; Palpation; Skull Fractures; Splints; Surgery, Plastic; Surgical Instruments; Suture Techniques; Tomography, X-Ray; Zygomatic Fractures

Topics: Animals; Cleft Palate; Disease Models, Animal; Female; Haplorhini; Macaca; Male; Malocclusion; Maxillofacial Development; Nasal Septum; Nose; Nose Deformities, Acquired

Topics: Cephalometry; Dental Occlusion; Eye Abnormalities; Female; Head; Humans; Male; Malocclusion; Mandibulofacial Dysostosis; Maxillofacial Development; Mouth Abnormalities; Nose; Radiography; Somatotypes

Topics: Cephalometry; Cleft Palate; Humans; Infant; Male; Malocclusion; Nose; Orthodontic Appliances; Patient Care Planning; Periosteum; Splints; Time Factors; Tooth, Deciduous

Topics: Adolescent; Cephalometry; Child; Chin; Face; Humans; Lip; Malocclusion; Mandible; Maxillofacial Development; Nose; Orthodontics, Corrective

Topics: Adult; Facial Injuries; Fracture Fixation, Internal; Fractures, Ununited; Humans; Male; Malocclusion; Mandibular Fractures; Maxillofacial Injuries; Nose; Osteotomy; Postoperative Complications; Trismus

Topics: Dental Arch; Humans; Jaw Abnormalities; Malocclusion; Nose; Orthodontic Appliances; Orthodontics, Corrective; Palate

Topics: Adult; Asian People; Dental Occlusion; Face; Female; Humans; Incisor; Japan; Male; Malocclusion; Mandible; Nose

Topics: Child; Face; Female; Humans; Malocclusion; Maxillofacial Development; Nose; Orthodontics, Corrective; Patient Care Planning; Rhinoplasty

Topics: Dental Arch; Habits; Humans; Malocclusion; Maxillofacial Development; Mouth Breathing; Nose

Topics: Adaptation, Physiological; Adolescent; Cephalometry; Child; Esthetics, Dental; Face; Female; Humans; Male; Malocclusion; Nose; Orthodontics, Corrective; Patient Care Planning; Rhinoplasty

Topics: Adolescent; Child; Female; Humans; Jaw Abnormalities; Male; Malocclusion; Maxilla; Nose; Orthodontic Appliances; Respiratory Function Tests; Respiratory Insufficiency

Topics: Adolescent; Cephalometry; Child; Female; Humans; Male; Malocclusion; Masks; Maxillofacial Development; Mouth; Nose; Oscillometry; Respiration; Respiratory Function Tests; Transducers

Topics: Animals; Body Weight; Cephalometry; Face; Malocclusion; Mastication; Maxillofacial Development; Nasal Septum; Nasopharyngeal Diseases; Nose; Prognathism; Rabbits; Suppuration; Tooth Eruption

Topics: Child; Child, Preschool; Conjunctivitis; Eye Manifestations; Facial Expression; Female; Fingersucking; Glossitis, Benign Migratory; Humans; Male; Malocclusion; Nail Biting; Nose; Oral Manifestations; Pharyngeal Diseases; Pulmonary Emphysema; Respiratory Hypersensitivity; Rhinitis

Topics: Animals; Facial Bones; Jaw Abnormalities; Malocclusion; Maxillofacial Development; Nasal Septum; Nose; Prognathism; Rabbits

Topics: Child; Consanguinity; Ear; Eye Abnormalities; Female; Humans; Malocclusion; Mandibulofacial Dysostosis; Nose; Retrognathia

Topics: Adult; Female; Fracture Fixation; Frontal Bone; Humans; Malocclusion; Maxilla; Maxillofacial Injuries; Nose; Osteotomy; Zygoma

Topics: Adolescent; Cephalometry; Child; Humans; Malocclusion; Nose; Prognathism

Topics: Anatomy, Comparative; Animals; Cephalometry; Dental Occlusion; Ethnology; Humans; Malocclusion; Nose; Primates

Topics: Adolescent; Cephalometry; Child; Craniofacial Dysostosis; Female; Follow-Up Studies; Humans; Male; Malocclusion; Maxillofacial Development; Models, Dental; Nose; Osteochondrodysplasias; Prognathism; Radiography, Dental

Topics: Cleft Lip; Cleft Palate; Humans; Jaw Abnormalities; Malocclusion; Models, Dental; Nose; Orthodontic Appliances; Orthodontics, Corrective; Radiography, Dental; Skull

Topics: Bone Transplantation; Child; Cleft Lip; Cleft Palate; Humans; Malocclusion; Maxilla; Nose; Orthodontics; Osteotomy; Plastics; Skin Transplantation; Surgery, Plastic

Topics: Humans; Malocclusion; Nose; Orthodontics; Respiration; Tooth

Topics: Congenital Abnormalities; Humans; Malocclusion; Maxilla; Nose; Nose Deformities, Acquired; Orthodontics; Palate; Respiratory Insufficiency; Surgery, Oral

Topics: Humans; Malocclusion; Nasal Septum; Nose; Open Bite; Tooth