Search

Introduction: The anterior nasal spine is a pointed, midline projection of the maxilla. This bony structure dictates the overlying soft tissues providing the phenotypic features of the nose and upper lip and determines the differences in the mid-face morphology. Little data is available on the metric features of the Anterior nasal spine (ANS). This study aimed to perform metric evaluations of the ANS of white and black South African males and females to ascertain if morphological variations exist and if the differences are viable for the use in sex and population identification. Materials and methods: The sample included 100 CBCT images for each population and sex group. Linear and angular measurements of the ANS were recorded in both the sagittal and axial planes. Results: Classification decision trees (pruned) were fitted to ascertain the relationship between population group, sex and the ANS measurements including and excluding age. For population group, all the ANS measurements were statistically significant for females but in males, all the ANS measurements were significant when performed individually. However, when fitted to the classification tree, Sagittal 2 did not show any statistical significance. When considering sex, only 2 of the ANS measurements (Sagittal 2 and Axial 1) were found to be significant. The results did not differ significantly when comparing the decision trees including and excluding age. Conclusions: White South African individuals presented with a longer ANS that produced a more acute angle whereas black South African individuals presented with a shorter ANS and a more obtuse angle. Additionally, males presented with a longer ANS compared to females. ANS measurements were found to be more relevant for population discernment than for sex. [ABSTRACT FROM AUTHOR]

The position and inclination of the incisors play a crucial role in achieving optimal outcomes in orthodontic and orthognathic surgical treatment, given their impact on facial aesthetics. Background/objectives: Due to numerous distorting factors that affect the reliability of the ANB angle, the aim of the present work is to evaluate a more constant parameter over time, the anterior nasal spine (ANS), and explore whether aligning the incisal margin of the upper incisors with the anterior nasal spine could be a reliable indicator for achieving appropriate labial support in pre-surgical orthodontic preparation. Methods: From a pool of 500 cone beam computed tomography (CBCT) scans, 50 CBCT examinations displaying a Class 1 skeletal pattern (ANB = 2° ± 2°) with an intermediate (3.2–4 mm) or mixed (4–6 mm) sagittal maxillary position (MX), as determined by the 3D multiplanar total face approach (TFA), were selected and compared with CBCT examinations randomly chosen from the initial pool. Moreover, 12 landmarks were identified, and measurements were automatically obtained, using software, and recorded. Mean and standard deviation values were calculated for each sample. A comparison was made between the two samples, aligning the results with the morphological analysis of the anterior nasal spine and the sagittal position of the upper maxilla. Results: In Class 1 subjects, the distance between the incisal margin and the plane passed in relation to the anterior nasal spine should range between −1 mm and 1 mm, aligned with or slightly ahead of the anterior nasal spine or slightly ahead of this limit. Conclusions: The anterior nasal spine can serve as a reliable reference point for planning the position of the upper incisors, with excessive proclination or retroclination from this reference point deemed unacceptable. [ABSTRACT FROM AUTHOR]

Background Methods and Results Conclusions Key points Current evidence acknowledges guided bone regeneration (GBR) as a predictable therapeutic modality in the augmentation of a deficient alveolar ridge. Such deficiencies often reveal inadequate bone volume to support implant placement in a position amenable to prosthetic reconstruction. Additionally, an evolving body of literature demonstrates that membrane fixation may lead to improved clinical bone gain through positively influencing blood clot formation, stability, and the eventual osteogenic potential of the defect. Alternative benefits to membrane fixation, such as reduced graft displacement and reduction in wound micromotion, have also been cited as mechanisms for an increased regenerative response.The aim of this report was to present a case, including diagnosis, treatment, and follow‐up for the reconstruction of a horizontal ridge deficiency. The patient's deficiency in ridge volume was found to be a developmental sequelae of lateral incisor agenesis, resulting in an underdeveloped midfacial region of the alveolar process subjacent to sites #7 and #10. The fixation protocol outlined in this report demonstrated adequate horizontal ridge augmentation to facilitate future prosthetic reconstruction with the use of implants.Numerous protocols have been established in an attempt to achieve effective barrier membrane stabilization for bone augmentation procedures. However, some techniques are poorly suited for the anatomically challenging region of the anterior maxilla. A case report describing the utilization of the anterior nasal spine for anchorage of a membrane‐stabilizing suture may present a novel, safe, and effective technique for stabilizing the intended region of augmentation, as well as preventing graft migration beyond the membrane–maxilla interface. Regarding guided bone regeneration (GBR) procedures, micromotion of the membrane or of the underlying particulate graft may negatively influence the volume of the augmented site. The ability to adequately stabilize the graft–membrane interface is recognized as a necessary prerequisite to predictably achieve optimal surgical outcomes. To the authors’ knowledge, there is no clinical or scientific evidence regarding the use of the anterior nasal spine for membrane anchorage in maxillary GBR procedures, and thus a novel approach to membrane stabilization is introduced. Regarding guided bone regeneration (GBR) procedures, micromotion of the membrane or of the underlying particulate graft may negatively influence the volume of the augmented site.The ability to adequately stabilize the graft–membrane interface is recognized as a necessary prerequisite to predictably achieve optimal surgical outcomes.To the authors’ knowledge, there is no clinical or scientific evidence regarding the use of the anterior nasal spine for membrane anchorage in maxillary GBR procedures, and thus a novel approach to membrane stabilization is introduced. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans.

Background: To infer the optimal angulation and height level of mini-implant insertion in the anterior nasal spine (ANS) region from alveolar bone depth (BD) and labial cortical bone thickness (CBT) through cone-beam computed tomography (CBCT), the influences of sex, age, and growth pattern on BD, CBT, and the starting point of the ANS were examined. Material and methods: BD and CBT were measured on CBCT median sagittal images at specific angles (0, 15, 30, 45, and 60 degrees) to simulate the angulation of insertion. The height level of the first axial image with obvious bone ridge was recorded as the start of ANS. Results: The average height of ANS start was 9.42 mm from the alveolar bone crest between the central incisors. The variations in height level and insertion angle combined, or either of them individually, significantly influenced BD and CBT, demonstrating overall decreasing trends (p < 0.001). BD was not influenced by sex, age, or growth pattern (p > 0.05). However, CBT was found to be correlated with sex and growth pattern, while the height level of ANS start was associated only with growth pattern, particularly in hypodivergent patients (p < 0.05). Conclusion: The recommended insertion height level is 14–16 mm from the alveolar bone crest and the recommended angulation is 30–45°. An innovative inequity in the relationship between a certain height level and the insertion angulation is proposed. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans. [ABSTRACT FROM AUTHOR]

Background: Skull base (SB) injuries happens mostly either in the thinnest or the least resistant part of skull base. The lateral lamella of cribriform plate is one of the common sites of injury during endoscopic anterior skull base surgeries. The anterior ethmoidartery (AEA) visualization is considered as a significant anatomical landmark in such surgeries. Studies correlating their positional relation with morphology of olfactory fossa remain limited. This study aims to look into the relation of AEA to that of SB in different types of olfactory fossa morphology. Materials and methods: A surveying radiological study was conducted on 90 coronal CT images from patients who were exposed to paranasal CT imaging in a tertiary care teaching hospital. The examination included all CT images as well as an indication of sinusitis. The exclusion being changed skull base anatomy as a result of previous surgical intervention, injury, or tumour, and age less than 18 years. RadiAnt Dicom viewer was used to inspect the images. [8] The position of AEA in relation to SB was identified in the bone window of coronal CT scans. On each side, it was divided as at SB or below SB. the longitudinal distance from AEA to SB was evaluated separately. Depending up on the distance of AEA from SB, 3 groups were sectioned as follows: set A - < 2.5 mm, set B – 2.5 to 5 mm and set C - > 5 mm. Result: In our present study of 90 patients, number of male patient was 58 (64.4%) whereas number of female patient was 32 (35.6%) [Table 1]. Age of patient was from 18 years to 80years. anterior ethmoidal artery canal was seen in 30% (27) scan. Most of those were complete type. Anterior ethmoidal foramen was seen in 90% (81) of CT scan. Supraorbital pneumatisation was seen in 40% (36) scan [Table 2]. Conclusion: It was concluded that notch which was present in the medial wall of orbit was a very good landmark to locate anterior ethmoidal artery and it was found in 98% of cases and in 28% of CT scan supraorbital pneumatisation was found which has a very close relationship with visualization of anterior ethmoidal artery canal. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to determine the optimal anterior-posterior (AP) position of upper incisors through Anterior Nasal Spine (ANS) point. Materials and methods: Lateral cephalometric radiographic images of 690 patients were collected and divided into a derivation group and a validation group, and the former were subdivided into a proper AP position (PAP) group and an improper AP position (iPAP) group. The distance from facia-axis (FA) point of upper incisors to the line perpendicular to Frankfort horizontal (FH) plane through ANS (FA-ANS) was measured, and the relationship between FA-ANS and several cephalometric indices were studied through Pearson correlation analysis. Receiver operating characteristic (ROC) curves for different clinical indices were analyzed to evaluate the diagnostic efficiency of optimal AP position of upper incisors. Results: The average value of FA-ANS in PAP group was 0.57±1.99, which was significantly different from FA-ANS in iPAP group. Cephalometric indices such as U1-NA, U1-SN, AB-NPo, UL-TVL, Wits, and ANB were found to be correlated with FA-ANS. The receiver operating characteristic (ROC) curves represented a greater diagnostic efficiency of FA-ANS compared with other clinical indices. Conclusions: ANS point, as a stable skeletal landmark, could be used to access an optimal AP position of upper incisors, providing aids to clinical diagnosis and treatment goal determination for clinical practice. Clinical relevance: A new index FA-ANS, together with other traditional indices, could help determine the optimal position of upper incisors and provide a personalized therapeutic plan. [ABSTRACT FROM AUTHOR]

Managing the nasal septum (NS) position is crucial in septorhinoplasty. The analysis and the preparation of the anterior nasal spine and the quadrangular cartilage as well as the strategy defined to efficiently stabilize the septum will dictate considerably the success of the result. Moreover, what we see in the surgical table can suffer modifications during the healing process because of poor fixation or the cheese-wire effect of the cartilage. We will present a logical sequence and tools to achieve a proper and stable position of the NS and the nasal pyramid. The sublaminar (supraperichondral) dissection of the quadrangular cartilage as an option to the subperichondral one and the use of cable and mirror sutures to three-dimensionally positioning and stabilizing the NS will be described. [ABSTRACT FROM AUTHOR]

Purpose: The anterior ethmoidal artery is a major surgical landmark that is susceptible to iatrogenic injury during surgery of the anterior ethmoidal sinus, frontal sinus, and skull base. The present study aimed to define the location of the anterior ethmoidal artery in relation to specific anatomical landmarks using radiological imaging and endoscopic dissection. Methods: Eighty-six anterior ethmoidal arteries were assessed using computed tomography scans (bilateral analyses) and forty anterior ethmoidal arteries were assessed using cadaveric specimens (bilateral analyses). The skull base, anterior nasal spine, anterior axilla of the middle turbinate, and nasal axilla were morphometrically analysed to determine their reliability as anterior ethmoidal artery landmarks. Results: Distances to the skull base, anterior nasal spine, and nasal axilla displayed statistically significant differences between sexes and sides (p < 0.05). All landmarks demonstrated excellent reliability as anatomical landmarks for the localisation of the anterior ethmoidal artery, radiologically and endoscopically (ICC values ranged from 0.94 to 0.99). Conclusion: The middle turbinate axilla was the most reliable landmark, due to the lack of statistically significant differences according to sex and laterality, and the high inter-rater agreement between measurements. Anatomical knowledge of variations and relationships observed in the present study can be applied to surgeries of the anterior ethmoidal sinus, frontal sinus, and skull base to improve localisation of the anterior ethmoidal artery, preoperatively and intraoperatively, and avoid iatrogenic injury of the vessel. [ABSTRACT FROM AUTHOR]

Objective: To study anterior nasal spine fractures, including the incidence, missed diagnosis rates, and relationship with shapes using computed tomography (CT). Methods: Two hundred cases of axial CT images performed for maxillofacial trauma were reviewed. The incidence, correct, and missed diagnosis rates of anterior nasal spine fractures were studied. The relationship between the fracture and the shape of the anterior nasal spine was also analyzed. Results: The rate of anterior nasal spine fractures was 22.00% (44 of 200). The diagnostic accuracy was 4.55% (2 of 44) and the missed diagnosis rate was 95.45% (42 of 44). The fracture rates of the double rod, single rod, triangle, and irregular anterior nasal spine were 33.85% (22 of 65), 32.26% (10 of 31), 12.24% (12 of 98), and 0.00% (0 of 6), respectively. The double and single rod types of anterior nasal spine were most likely to be fractured than the type of triangle (χ2 = 11.05, 6.67, P <.0167). No fracture was found in the irregular type of anterior nasal spine. Conclusion: Anterior nasal spine fractures are not rare and the high missed diagnostic rate results from unfamiliarity with the structure. Double and single rod types of anterior nasal spines are easy to fracture. Bony reconstruction and thin thickness of CT images are necessary for diagnosis. [ABSTRACT FROM AUTHOR]

Aims: Knowledge of the location of infraorbital foramen (IOF) is important to avoid injuries to neurovascular structure which passes through it, as it may occur in surgical procedures such as rhinoplasty, Caldwell-Luc surgical procedures, tumor surgery, orbita basis reduction, malar region fractures, and Le Fort type-1 osteotomy. Hence, this foramen should be approached carefully to avoid damage. Methods: Ninety dried skull bones of unknown sex, obtained from the clinic of anatomy, MVJ Medical College and Research Hospital, were used to study the shape, size, relation to maxillary tooth, presence of accessory foramen and distance of IOF from surface landmarks and results were analyzed statistically. Results: The vertical and horizontal diameters of IOF were 3.29±0.82 mm and 3.77±0.85 mm on the right side, and 3.37±0.81 mm and 3.90±0.96 mm on the left side, respectively. Oval shape was more common. The distance between IOF and infraorbital margin was 6.34±1.63 mm on the right side and 6.40±1.48 mm on the left side; alveolar margin of maxilla was 27.82±4.13 mm on the right and was 28.40±3.40 mm on the left side; zygomatico-maxillary suture was 14.11±2.23 on the right side and 13.87±3.59 mm on the left side; and anterior nasal spine was 32.21±3.07 mm on the right side and 32.26±2.29 mm on the left side. Accessory foramen was seen in 7 (7.7%) skulls. The location of foramen was along 1st premolar tooth on the right side and towards the 2nd premolar tooth on the left side. Conclusions: This study makes it possible to identify the exact position of IOF and its application in various surgical procedures. [ABSTRACT FROM AUTHOR]

Background: Deviation of the anterior nasal spine (ANS) is a common cause of caudal nasal septal deviation. In our experience, relocation of the deviated ANS is a useful technique in the correction of the caudal septal deviation. Objectives: To describe our experience with the ANS relocation technique in isolation and in combination with other techniques for correction of caudal septal deviation. Methods: A retrospective chart review was performed on cases of ANS relocation. Results: A total of 378 patients underwent ANS relocation over 4 years. Complete straightening of the septum occurred in 312 cases (82.5%), and significant improvement with mild remnant deviation occurred in 66 cases (17.5%). No patients had severe remnant deviation. None of the patients requested for revision surgery. A total of 351 patients (92.9%) experienced significant subjective improvement in bilateral nasal airflow, while 27 patients (7.1%) experienced mild improvement in bilateral nasal airflow. None of the patients had worsened airflow after surgery. Conclusion: The ANS relocation technique is a useful and effective technique which can be used in isolation or in combination of other techniques for the correction of caudal septal deviation. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements ( p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements ( p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans.

The aim of the study was to evaluate the nasal soft tissue changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different surgical approaches. Thirty-two patients were included in the study, and divided into two groups according to the type of surgical approach: in group A (n = 17), SARME performed with standard Le Fort I circumvestibular approach with alar base cinch and anterior nasal spine (ANS) exposure; and in group B (n = 15) operations were performed with the same standard Le Fort I circumvestibular approach with only alar base cinch. Measurements of height and width of the philtrum, nasal and subnasal width, and columella width were taken from three-dimensional facial images obtained before surgery (T1), after the distraction phase (T2) and 6 months postoperatively (T3). The mean maxillary expansion was 7.3 ± 0.7 mm for group A and 7.5 ± 1.5 mm for group B, without any significant difference between groups (P = 0.59). Both groups presented an increase in all vaules in T2 and T3. The approach used in group A resulted in smaller changes in the columella width. The results of the present study show that there is no need for intraoperative releasing of the soft tissues around the anterior nasal spine during SARME if columella width is sufficient. However, further randomized studies based on large patient groups are needed before final conclusions on this topic can be reached. [ABSTRACT FROM AUTHOR]

The importance of a straight and stable central framework is beyond dispute. Many authors allude to technical aspects how to achieve the above-mentioned requirements. Far less is said about the contact zones of the framework and how to achieve a long-lasting and solid fixation. In the authors' patient group, they found the need to work on the septum/the central framework in approximately 84% of the cases. In 61% of the patients, the authors had to operate on the fixation point. Of course, there is a great variety of anatomical findings. So the required techniques differ immensely. The surgeon must be prepared for all kinds of different situations. Especially the dorsal fixation and the anchoring on the maxilla without having a standard anterior nasal spine can be a great challenge. In their daily routine, suture techniques (e.g., the transcutaneous transosseous cerclage suture) have become the authors' working horse for these complex fixation situations. [ABSTRACT FROM AUTHOR]

Introduction: The facial skeleton comprises facial bones that may contribute to the formation of the skull. There are 14 bones contribute to the formation of the facial skeleton. Measurement of facial skeleton either in the living subjects, dry skulls, or cephalograms is commonly used in the investigation of growth and development of face, jaw, and dentition. With this, the present study aimed to analyze the upper facial skeleton using morphometric technique in South Indian dry skull. Materials and Methods: A total of 30 dry human skulls from the Department of Anatomy in Saveetha Dental College and Hospitals were used to carry out this study. The morphometric parameters were measured using digital Vernier caliper. The data are collected and represented in graphs. Results: The present study has observed that the average distance between nasion to the anterior nasal spine (ANS) was 53.9 mm ± 3.1 mm, nasion to prosthion 67.8 ± 5.8 mm is, ANS to prosthion was 16.88 mm ± 3.5 mm, intermolar distance of maxilla was 60.1 ± 3.6, bizygomatic distance was 104.6 mm ± 4.8 mm, right and left zygomatic prominence to nasion was 67.7 mm ± 4.4 mm and 68.6 mm ± 3.1 mm, and right and left prosthion to zygomatic prominence was 66.2 mm ± 5 mm and 65.8 mm ± 3.7 mm. Conclusion: The present study, thus, concluded that the morphometric knowledge of the upper facial skeleton is very important in anthropological, evolutionary studies, sex determination, and surgeries. [ABSTRACT FROM AUTHOR]

The nasolacrimal apparatus is intimately associated with the lateral nasal wall and may be approached using an endoscopic technique. This study was undertaken to describe in detail the gross anatomy of the nasolacrimal duct orifice in relation to various landmarks of the lateral nasal wall to improve the safety and efficiency of endoscopic surgical procedures. The study was conducted on 25 sagittal sections of adult cadavers in the Department of Anatomy, Kasturba Medical College, Manipal. The parameters measured were the distance from nasolacrimal duct orifice (NO) to the anterior end of middle concha (MC), distance from NO to the anterior nasal spine (ANS), distance from NO to the nasal floor (NF), distance from NO to anterior end of the inferior concha (AIC), and distance from NO to posterior end of the inferior concha (PIC). The shape of the NO was also observed and classified as oval, round and slit. The distance from NO to ANS was 2.73± 0.26 cm, the distance from NO to NF was 1.19± 0.34 cm, the distance between NO to MC, NO to AIC and PIC were 2.55 ±0.28 cm, 1.85±0.3 cm and 3.4±0.36 cm respectively. We also observed 3 types of shapes of NO, majority were slit like followed by oval and round. Knowledge of the anatomy of the nasolacrimal apparatus is essential for the surgeon during the performance of endonasal cystorhinostomies and maxillary osteotomies. [Med-Science 2014; 3(2.000): 1241-8]

Objectives: The incidence of pituitary pathology requiring surgery is on the increase. The transnasal approach to anterior skull base is a technique which demands a thorough knowledge of the surgical anatomy. There is a dearth of knowledge on reference values for transnasal surgery on subjects of African descent. Thus the aim of this study is to ultimately improve visualisation of the surgical corridor, minimize surgical risks and improved maneuverability of surgical instruments during transnasal microsurgery (ergonomics). Methods & Materials: A total of 11 cadavers of Nigerian descent were employed in this study. Using the 3 piece caliper set (Big Horn Corporation®,India), an indirect measurement of the Subnasio-sella distance was obtained. Subsequently, a direct measurement was obtained from sagittal sections of the same skulls. Result: All randomly selected cadavers employed in the study were adult males of Sub-saharan descent. The mean indirect (distance from the anterior nasal spine i.e. subnasal point to the sella floor in an intact skull), direct A (subnasio-sella distance in a sagitally transected skull) and sella thickness measurements were found to be 8.6cm ± 0.38 cm, 8.7 cm ± 0.37 cm and 0.2 cm±0.05 cm respectively ,at 95% confidence interval. Comparison of the indirect and the direct A measurements showed statistical significance (p