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Hypothesis and Objective: To compare the accuracy of cephalometric landmark identification between Artificial Intelligence (AI) Deep Learning Convolutional Neural Networks YOLOv3 algorithm and Manually Traced (MT) group. Methods: AAOF Legacy Denver collection was used to obtain 110 cephalometric images for this study. Lateral cephalograms were digitized by orthodontic resident in Dolphin Imaging after intra- and inter reliability check. The same images were uploaded to AI software Ceppro DDH Inc. Cartesian system of coordinates with Sela as 0:0 was used to extract x and y coordinate for 16 cephalometric points: Nasion, A point, B point, Menton, Gonion, Upper incisor tip, Lower incisor tip, Upper incisor apex, Lower incisor apex, Anterior Nasal Spine, Posterior Nasal Spine, Pogonion, Pterigomaxillary fissure point, Basion, Articulare and Orbitale. The mean distances were assessed relative to the reference value of 2 mms. Student paired t-tests at significance level of 5 % were used to compare the mean differences in each of the X- and Y-components. SPSS (IBM-vs. 27.0) software was use for the data analysis. Results: The results showed that there is no statistical difference for 12 out of 16 points when analyzing absolute difference between MT and AI group. Success detection rate for AI within 2 mm while comparing MT and AI group was 75 % and 93% within 4 mm. Conclusions: AI could be considered a promising tool to facilitate cephalometric tracing process in routine clinical practice and in research settings. Funding: no funding. IRB and/or ACC Protocol #: 2019-1180. Notice of Determination: activity Does Not Represent Human Subjects Research.

Objective The precision of maxillary repositioning using computer-aided design/computer-aided manufacturing (CAD/CAM)-generated wafers and a surgical navigation system for bimaxillary orthognathic surgery (BMOS) using segmental Le Fort I osteotomy was evaluated. Methods Six participants with jaw deformities who required BMOS incorporating segmental Le Fort I osteotomy were included. The preoperative simulation was performed using a three-dimensional skull model on the simulation software, and a wafer for maxillary repositioning was prepared by CAD/CAM. Using the CAD/CAM-generated wafer and intraoperative navigation system, the maxillary segments were repositioned to agree with virtual surgical planning. The ideal movements of the preoperative simulation were compared with the actual movements after the surgery, and the errors of the ideal movements with reference to the actual movements were evaluated three-dimensionally at seven evaluation points. Results The largest and smallest median errors calculated from the differences between the ideal and actual 3-D movements were, respectively, 0.65 mm at anterior nasal spine, 0.02 mm at posterior nasal spine. There is no significant difference was observed between ideal and actual movements in either 2-D and 3-D. Conclusion The clinical accuracy of maxillary repositioning with the CAD/CAM wafer and an intraoperative navigation system in segmental Le Fort I osteotomy was revealed in the present study.

Purpose To retrospectively evaluate skeletal stability after Le Fort I maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy (BSSO) in high-angle class II patients. Materials and methods Seven female high-angle class II patients who underwent maxillary impaction surgery and mandibular autorotation without bilateral sagittal split osteotomy were included in this study. Surgical changes and relapse were measured on lateral cephalograms taken preoperatively and at 1 month, 6 months and 1 year postoperatively. Results The horizontal movement of the maxilla at point A was 5.8 ± 3.3 mm backward, and the upward movement at the posterior nasal spine was 3.3 ± 1.4 mm. The mean horizontal change at point A during the 1-year follow-up period was 0.1 ± 0.2 mm, and the vertical change at posterior nasal spine was 0.2 ± 1.3 mm, which were not statistically significant. The horizontal surgical change at point B was 4.0 ± 1.8 mm forward and the vertical surgical change at point B was 4.7 ± 1.8 mm upward. Postoperative relapse was 10.9% and 13.7% in the horizontal and vertical directions, respectively. Conclusions Le Fort I maxillary impaction surgery with mandibular autorotation may be 1 of the suitable procedures for high-angle class II patients.

Objective The aim of this retrospective study was to assess the midfacial soft tissue changes following maxillary expansion using micro-implant-supported maxillary skeletal expanders (MSEs) in young adults by cone-beam computerized tomography (CBCT) and to evaluate the correlations between hard and soft tissue changes after MSE usage. Methods Twenty patients (mean age, 22.4 years; range, 17.6–27.1) with maxillary transverse deficiency treated with MSEs were selected. Mean expansion amount was 6.5 mm. CBCT images taken before and after expansion were superimposed to measure the changes in soft and hard tissue landmarks. Statistical analyses were performed using paired t-test and Pearson’s correlation analysis on the basis of the normality of data. Results Average lateral movement of the cheek points was 1.35 mm (right) and 1.08 mm (left), and that of the alar curvature points was 1.03 mm (right) and 1.02 mm (left). Average forward displacement of the cheek points was 0.59 mm (right) and 0.44 mm (left), and that of the alar curvature points was 0.61 mm (right) and 0.77 mm (left) (p < 0.05). Anterior nasal spine (ANS), posterior nasal spine (PNS), and alveolar bone width showed significant increments (p < 0.05). Changes in the cheek and alar curvature points on both sides significantly correlated with hard tissue changes (p < 0.05). Conclusions Maxillary expansion using MSEs resulted in significant lateral and forward movements of the soft tissues of cheek and alar curvature points on both sides in young adults and correlated with the maxillary suture opening at the ANS and PNS.

Introduction The objectives of this study were to evaluate the effects of bicortical engagement by microimplants with maxillary skeletal expanders on pterygopalatine sutures opening and to analyze the postexpansion skeletal changes associated with it. Methods Eighteen subjects treated with maxillary skeletal expanders were examined for pterygopalatine suture openings. Eight subjects who showed no evidence of the suture opening were assigned to the nonsplit group (NG), whereas 10 subjects with opened sutures were assigned to the split group (SG). Preexpansion and postexpansion cone-beam computed tomography images were superimposed for each group, and the changes in the 2 groups were compared. Finally, cone-beam computed tomography volumes were reoriented along the axis of each microimplant to check the bicortical engagement of the 4 microimplants. Results There was a significant correlation between the bicortical engagement of the orthodontic microimplants and the pterygopalatine suture opening (P = 0.0003). In the NG, the average amount of transverse expansion measured at the center of resistance of the maxillary first molars, anterior nasal spine, and posterior nasal spine (PNS) was 4.33 mm, 2.22 mm, and 1.58 mm, respectively, whereas the transverse expansion in the SG was 5.29 mm, 2.21 mm, and 2.46 mm, respectively. The magnitude of transverse expansion at PNS was significantly higher in the SG than in the NG (P = 0.036). The PNS also showed a significant anterior displacement in the SG (0.89 mm) compared with the NG (0.06 mm) (P = 0.033). Conclusions Bicortical microimplant anchorage is essential for pterygopalatine suture opening in microimplant-assisted maxillary skeletal expansion, which may result in further skeletal expansion and forward movement in the posterior part of the palatomaxillary complex.

The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.

Objectives To use both absolute anteroposterior maxillary complex length (APMCL) and relative APMCL to investigate the relationship between the maxillary complex, its individual bony segments, and their association to the anterior cranial base. In addition, the relationship between length and position of the maxillary complex was analyzed. Materials and Methods Sixty human skulls were analyzed using cone beam computed tomography. The maxillary complex length was measured between anterior and posterior nasal spine (ans-pns), and the average was used as the cut-off to identify a high- and a low-length group based on absolute APMCL. The length ratio between the maxillary complex and the anterior cranial base (ans-pns/SN) was used to identify the two groups based on relative APMCL. The anterior cranial base length and the lengths of the maxillary complex bones were compared between the high- and low-length groups. Results Based on absolute APMCL, individuals with shorter maxillary complex had shorter anterior cranial base (P = .003), representing normal proportions. Based on relative APMCL, individuals with shorter maxillary complex had longer anterior cranial base and vice versa (P = .014), indicating disproportions. Individuals with shorter maxillary complex exhibited shorter maxilla (Δ = −1.5 mm, P = .014). Conclusions When skeletal deformity of the midface is suspected, individual disproportions in the anteroposterior length of the maxillary complex in relation to the anterior cranial base (relative measurements) should be assessed through radiological imaging. A shorter maxillary complex may be associated with a shorter maxilla, and not with a shorter premaxilla or palatine bone.

Lateral angle (LA) of the internal acoustic canal (IAC) at its opening at the surface of the petrous portion of the temporal bone is known in literature as a dimorphic measurement useful for sex assessment. However, its reliability is still debated. Moreover, no information is available about the possible relationship between LA and shape and size of the IAC. This study aims at assessing breadth, length and lateral angle of IAC on 100 CT scans belonging to subjects aged between 20 and 70 years, equally divided between males and females. Possible differences in the three measurements according to side and sex were assessed through two-way ANCOVA test, using three cranial measurements (distance between anterior and posterior nasal spine, upper facial height, bizygomatic breadth) as covariates (p

Objectives The aim of this study was to define the prenatal ultrasound semiology of cleft palate without cleft lip using 3D visualization of the fetal palate. Methods A prospective longitudinal study was performed in our University Hospital Center from 2011 to 2018. The fetal secondary palate was studied in 3D, starting with 2D axial transverse ultrasound view. We defined a cleft palate as a disruption of the horizontal plate of the palatine bone of the secondary palate. Prenatal findings were correlated to anatomic postnatal examinations performed by a paediatric plastic surgeon. Results Forty-three cases of cleft palate without cleft lip were prenatally diagnosed, of whom 34 were associated with malformations. We defined four types of disruptive appearances: isolated nonvisualization of the posterior nasal spine; partial-disruption or cleft velum; complete disappearance or V-shaped cleft palate; and complete disappearance or U-shaped cleft palate. The adjusted kappa coefficient, between prenatal and postnatal evaluation, was 0.88 (95% CI: 0.79-0.97), corresponding to an excellent agreement. Conclusions Using a strictly axial transverse ultrasound view, visualization of the secondary fetal palate enables to diagnose a cleft palate without cleft lip. This method offers a prenatal anatomic classification of cleft palate with a high level of concordance to postnatal findings.

Purpose This study aims to attain metric data of the velopharyngeal dimensions of healthy subjects as well as patients with velopharyngeal insufficiency using the example of cleft and lip palate (CLP) in order to determine possible differences in the volumes of both groups. Methods Volumes and distances of velopharyngeal areas were analyzed retrospectively using cone beam computed tomography data sets (n = 60). Group 1 included healthy patients receiving dental implants (n = 31). Group 2 was represented by patients with surgically closed cleft lip and palate (n = 29). Results Biggest differences among mean values of both groups were found for: minimum axial area (p = 0.000), airway area caudal (p = 0.000), distance between posterior nasal spine and posterior pharyngeal wall (PPW) (p = 0.014), mean distance between velum and PPW (p = 0.000), length of PPW (p = 0.000) and length of anterior pharyngeal wall (p = 0.000). Conclusion Differences in the shape and geometry of the velopharyngeal area in subjects with a regular velopharyngeal structure and function and patients with cleft palate do exist. The significant differences found here can be categorized into two groups: one reflects distances between the anterior and posterior pharynx, presenting longer distances for patients with CLP. The second significant difference regards values of length in cranio-caudal direction, which is longer in healthy subjects. With regards to these values, one could conclude, that even though total volumes of both groups did not differ in size, group 1 shows three-dimensional velopharyngeal shapes that are longer and narrower, whereas shapes of patients of group 2 tend to be wider and shorter in general.

Objective: to evaluate the dentoskeletal effects of maxillary skeletal expander (MSE) in adult orthodontic patients, using Cone Beam Computed Tomography (CBCT). Patients and Methods: The current study was conducted on 14 adult orthodontic patients (4 males and 10 females), with their age ranged from 18 to 21 years, treated with a special type mini-implant assisted rapid palatal expander called, MSE (Maxillary Skeletal Expander) to correct transverse maxillary deficiency. The CBCT images were performed before the start of the orthodontic expansion (T1) and 3 months after the last activation (T2). Paired t-test, and descriptive statistics were used to evaluate the amount and the pattern of the mid-palatal suture opening, the total amount of maxillary expansion and the change in the inter-molar distance and molar inclination. Results: Four patients were dropped-out for different reasons, so, the statistical analysis was performed only on 10 patients (3 males, 7 females). The midpalatal suture split by 2.96mm and 2.64mm at the anterior nasal spine (ANS) and the posterior nasal spine (PNS) respectively. The maxillary width showed increase by 2.99 mm between the right and left zygomaticomaxillary sutures. The inter-molar distance and the molar inclination showed increase by 5.3 mm and 5.4o respectively. Conclusions: MSE is an efficient appliance for producing rapid palatal expansion and mid-palatal suture opening in adult orthodontic patients and can be used as an alternative to the surgically assisted rapid palatal expansion. MSE expansion affects the involved molars, causing increased inter-molar distance with limited buccal tipping.

Background & objectives Previous studies have found that first premolar extractions during orthodontic treatment may alter the upper airway dimensions. The objective of this study is to investigate the effects of second premolar extraction during orthodontic treatment on the dimensions of the upper airway in a sample of female adults. Methods Twenty-nine female adult patients with ages between 18 and 30 years old and incisor bimaxillary protrusion were included in this study. They were treated with comprehensive orthodontic treatment which included the extraction of four second premolars. Pre and post cephalometric radiographs were analyzed using Dolphin imaging software for changes in tongue length and height, soft palate thickness and length, the superior, middle, and inferior airway space, and vertical airway length. Descriptive statistics were used to characterize measurements. Student’s paired t-test was preformed to compare the pre- and post-test mean values of the dimensions. Results A significant increase in the vertical airway length was observed after the extraction of the second premolars (p = 0.02). The soft palate length showed a tendency towards an increase that did not reach statistical significance (p = 0.053). No other significant changes in the airway soft tissue measurements were observed. The proclination and protrusion of the upper and lower incisors were significantly decreased compared to pre-treatment measurements. Interpretation & conclusions. Orthodontic treatment involving the extraction of all four second premolars in females with bimaxillary protrusion increases the vertical airway length, which is the amount of distance between base of the tongue and posterior nasal spine. No other significant alterations in the upper airway measurements were observed.

Introduction Miniscrew-assisted rapid palatal expansion (MARPE) appliances utilize the skeletal anchorage to expand the maxilla. One type of MARPE device is the Maxillary Skeletal Expander (MSE), which presents four micro-implants with bicortical engagement of the palatal vault and nasal floor. MSE positioning is traditionally planned using dental stone models and 2D headfilms. This approach presents some critical issues, such as the inability to identify the MSE position relative to skeletal structures, and the potential risk of damaging anatomical structures. Methods A novel methodology has been developed to plan MSE position using the digital model of dental arches and cone-beam computed tomography (CBCT). A virtual model of MSE appliance with the four micro-implants was created. After virtual planning, a positioning guide is virtually designed, 3D printed, and utilized to model and weld the MSE supporting arms to the molar bands. The expansion device is then cemented in the patient oral cavity and micro-implants inserted. A clinical case of a 12.9-year-old female patient presenting a Class III malocclusion with transverse and sagittal maxillary deficiency is reported. Results The midpalatal suture was opened with a split of 3.06 mm and 2.8 mm at the anterior and posterior nasal spine, respectively. After facemask therapy, the sagittal skeletal relationship was improved, as shown by the increase in ANB, A-Na perpendicular and Wits cephalometric parameters, and the mandibular plane rotated 1.6° clockwise. Conclusion The proposed digital methodology represents an advancement in the planning of MSE positioning, compared to the traditional approach. By evaluating the bone morphology of the palate and midface on patient CBCT, the placement of MSE is improved regarding the biomechanics of maxillary expansion and the bone thickness at micro-implants insertion sites. In the present case report, the digital planning was associated with a positive outcome of maxillary expansion and protraction in safety conditions.

Background Nonnutritive sucking can turn into a continuous behavior practiced unconsciously, leading to a deleterious oral habit. Digit-sucking habits are an important etiological factor for malocclusion. Aim To investigate the effect of the digit-sucking habit on dentofacial structures by employing a cephalometric analysis. Materials and methods Selected 120 children were grouped as 60 with the digit-sucking habit and 60 without the digit-sucking habit in the age ranging between 6 and 12 years without gender discrimination. All were subjected to the standardized cephalometric technique, radiographs were traced by a single operator on a standard matte acetate tracing paper in a darkened room, and a total of 8 linear and 11 angular variables were measured for each patient in both the groups. Statistical analysis The unpaired Student's t-test was used to compare the mean difference between the two groups. Results The digit-sucking group showed significant difference in linear skeletal measurements such as value from anterior nasal spine (ANS) to posterior nasal spine (PNS), condylon to gnathion, nasion to ANS, sella to basion, and angular measurements such as angle between maxillary incisor to cranial plane, mandibular incisors to mandibular plane, sella nasion to point A, sella nasion to point B, and mandibular plane to cranial plane, when compared to the control group. Conclusion Within the confined parameters, digit sucking has led to significant variations in certain dental and skeletal cephalometric measurements. How to cite this article Singh TS, Sridevi E, Sai Sankar AJ, et al. Cephalometric Assessment of Dentoskeletal Characteristics in Children with Digit-sucking Habit. Int J Clin Pediatr Dent 2020;13(3):221-224.

Objective: (a) To evaluate intra- and inter-observer reliability in landmarks placement along the three planes of space on cone-beam computed tomography (CBCT) data sets; (b) To evaluate whether the reliability of each landmark differs in CBCT scans characterized by two different voxel dimension and quality. Setting and Sample Population: A total of 84 scans were used in this study: 49 scans were taken with the NewTom 3G, and 35 scans were taken with the NewTom 5G. The scans were characterized by an isotropic voxel dimension of 0.36 and 0.30 mm for the NewTom 3G and the NewTom 5G, respectively. Methods: A total of 13 landmarks were placed according to the corresponding definitions in 3D, also presented in this study: Foramen Spinosum (R/L), Nasion, Sella, Gonion (R/L), Pogonion, Menton, A point, Anterior nasal spine, Posterior nasal spine, Basion, Cribriform Plate (CR). Intra- and inter-observer reliability and Intra-class correlation coefficients (ICC) ICC for landmarks identification were assessed. Five reference and registration planes based on the above-mentioned landmarks were also presented. Results: ICC both for the intra- and inter-observer measurements had a score larger than 0.9 in all directions, except in the sagittal direction for CR. Regarding intra- and inter-observer reliability, only N, S, and Ba scored well in all directions. Conclusions: Most of the landmarks analysed displayed a high reliability along at least 2 directions. The choice of landmarks to define registration and superimposition planes must be carefully selected, as the reliability of these planes is inherited from the one of the landmarks defining them.

Vomeral malformation may lead to a posteroinferior septal defect (PISD). It is usually found incidentally, without any characteristic symptoms. The purpose of this study was to evaluate its clinical implications. In this study, we included 18 patients with PISD after reviewing paranasal sinus computed tomography scans and medical records of 2655 patients. We evaluated the shape of the hard palate and measured the distances between the anterior nasal spine (A), the posterior end of the hard palate (P), the posterior point of the vomer fused with the palate (V), the lowest margin of the vomer at P (H), and the apex of the V-notch (N). None of the PISD patients had a normal posterior nasal spine (PNS). Six patients lacked a PNS or had a mild depression (type 1 palate), and 12 had a V-notch (type 2 palate). The mean A–P, P–H, and P–V distances were 44.5 mm, 15.3 mm, and 12.4 mm, respectively. The average P–N distance in patients with type 2 palate was 7.3 mm. There were no statistically significant differences between the types of palates in A–P, P–H, or P–V distances. In patients with type 2 palate, there was a significant correlation between P–V and P–N distances (r = 0.664, p = 0.019). PISD due to vomeral malformations was identified in 0.7% of the cases in this study. None of the subjects had a normal PNS, which suggests that the development of the vomer is closely related to that of the hard palate.

Purpose To determine skeletal and occlusal surgical changes and long-term stability outcomes for patients diagnosed with juvenile idiopathic arthritis (JIA) after TMJ reconstruction with TMJ Concepts patient-fitted total joint prostheses (TJP) and concomitant maxillary orthognathic surgery. Material/Methods A retrospective cohort study was conducted of all patients diagnosed with JIA, receiving TJP, and concomitant maxillary orthognathic surgery between 1991 and 2019, at Baylor University Medical Center treated by 1 surgeon. Patient evaluations presurgery (T1), immediate postsurgery (T2), and at longest follow-up (LFU) (T3) were analyzed using 20 cephalometric landmarks to compute 29 linear and angular measurements to determine surgical changes, long-term skeletal and occlusal stability, as well as oropharyngeal airway changes. Comparative data were tested for significance (α = 0.05) using paired and unpaired t tests. Results Forty-two patients met the JIA inclusion criteria, with a median age of 17.5 years and median postsurgical follow-up of 26 months. There were significant surgical changes (T1-T2) (P ≤ .05) for all parameters associated with mandibular linear and angular surgical changes, except for the horizontal position of posterior nasal spine and the vertical/horizontal position of gonion, indicating highly stable surgical outcomes. There were significant improvements in the oropharyngeal airway dimensions. Conclusions This study suggests that TMJ Concepts patient-fitted TJP for TMJ reconstruction in conjunction with maxillary orthognathic surgery for counterclockwise rotation of the maxillo-mandibular complex for the JIA patients provides long-term skeletal and occlusal stability as well as dimensional improvement in the oropharyngeal airway.

Our aims were to evaluate the reliability of three-dimensional (3D) cephalometric landmark identification in 3D images, and to propose an improved protocol for determining these landmarks. Computed tomographic (CT) images of 13 landmarks were obtained. One that did not show any artifacts, asymmetry in maxillofacial structures, or bony defects, was selected. Two orthodontic practitioners identified 3D cephalometric landmarks 10 times at one-week intervals. The distances of 26 landmarks were measured on the basis of three reference planes (coronal, horizontal, and sagittal). Ten mean (SD) measurements from each examiner were calculated, and the maximum and minimum values and the difference from the 10 measurements of each one were measured at a 95% confidence interval. Interexaminer differences for the three planes were found in the upper right first molar, point A, both gonions, left orbitale, and both porions. The lower right first molar, foramen magnum, gnathion, nasion, and pogonion showed interexaminer differences in two planes. Menton, basion, posterior nasal spine, upper and lower left first molar, and right mental foramen showed interexaminer differences in only one plane. With reference to intraexaminer differences, poor repeatability was observed for gonion, orbitale, condylion, and porion. Reliable 3D landmarks are the meeting point of sutures, distinct structures at converging planes, landmarks positioned in the midline, distinct anatomical structures such as the mental foramen, and teeth using multiplanar views.

Trigeminal neuralgia is a painful condition, usually treated through surgical procedures focusing on the foramen ovale (FO). A detailed localization of FO relative to reference landmarks is therefore crucial to avoid possible complications.The present study aims at assessing the position of FO according to the surrounding bone structures: 100 CT-scans of patients, equally divided between sexes, aged between 18 and 86 years were examined. From each subject, the 3D models of FO and the maxillary bones, the zygomatic bones and the zygomatic process of the temporal bones were segmented through ITK-SNAP software. The distance between the center of the FO and subnasale, zygion, and the upper edge of the zygomatic bone at the origin of the frontal process were measured on 3D models. On CT-scans three cranial measurements were taken as well (distance between anterior and posterior nasal spine, upper facial height and bizygomatic breadth).Statistically significant differences in the three distances according to side and sex were assessed through two-way ANCOVA test, using the three cranial measurements (ANS-PNS, NP, ZZ) as covariates (P

Transverse maxillary deficiency currently affects 8–23% of adults. One of the most widely used orthodontic treatments today in patients with transverse maxillary defects is the maxillary skeletal expander (MSE). This was a retrospective observational imaging study regarding structural bone changes that may occur during healing after the placement of micro-implant assisted rapid palatal expanders (MARPE) in combination with cortico-puncture (CP) therapy. Regarding the magnitude of the mid-palatal suture opening, the mean split at the anterior nasal spine (ANS) and the posterior nasal spine (PNS) was 3.76 and 3.12 mm, respectively. The amount of split at the PNS was smaller than at the ANS, approximately 85% of the distance, showing that the opening of the midpalatal suture was almost parallel in the sagittal plane. On average, one-half of the anterior nasal spine (ANS) moved more than the contralateral by 0.89 mm. In the present study, we show that MARPE associated with CP therapy had a positive outcome on the midpalatal suture opening. This occurred in safe conditions, without post-surgery bleeding, and showing healing at the corticotomy level, with no signs of swelling or sepsis, which are side effects usually associated with more complex surgical treatments. Our results suggest that non-surgical palatal expansion, assisted by MARPE and CP, is achievable and predictable in young adults.

Background: The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients. Methods: Cephalograms of thirty-one (31) North Indian children (18 boys and 13 girls) with a unilateral cleft lip and palate, who were recommended for orthodontic treatment, were selected. After a thorough analysis of peer-reviewed articles, 20 difficult-to-trace landmarks were selected, and their reliability and reproducibility were studied. These were subjected to landmark identification to evaluate interobserver variability, the coordinates for each point were traced separately by three different orthodontists (OBA, OBB, OBC). Statistical analysis was performed using descriptive and inferential statistics with paired t-tests to compare the differences measured by the two methods. Real-scale data are presented in mean ± SD. A p-value less than 0.05 was considered as significant at a 95% confidence level. Results: When comparing, the plotting of points posterior nasal spine (PNS) (p &lt, 0.05), anterior nasal spine (ANS) (p &lt, 0.01), upper 1 root tip (p &lt, 0.05), lower 1 root tip (p &lt, 0.05), malare (p &lt, 0.05), pyriforme (p &lt, 0.05), porion (p &lt, 0.01), and basion (p &lt, 0.05) was statistically significant. Conclusion: In patients with a cleft lip and palate, the interobserver identification of cephalometric landmarks was significantly more precise and reproducible with cone beam computed tomography -derived cephalograms vis-a-vis digital lateral cephalograms.

Background: Based on low-dose radiation Cone-bean computed tomography (CBCT) images, ThisThe study aims of this study was to establish a space coordinate system, which offers more precise and comparable evaluation on changes of maxillary third molars influenced by orthodontic treatment with premolar extraction in adults. The system suggests promising application prospect in future studies related to CBCT superimposition and evaluation for its feasibility and efficiency.evaluate the changes in position, angulation, and rotation of maxillary third molars in adults after orthodontic treatment with premolar extraction using a space coordinate system based on Cone-bean computed tomography (CBCT) images. Methods: Forty-nine maxillary third molars from 27 patients (mean age, 20.78 years) were included in the study. CBCT images were obtained before and after orthodontic treatment with premolars extracted (mean treatment duration, 31.47 months). The changes in the position, angulation, and rotation of the third molars were evaluated with a space coordinates system using four landmarks: anterior nasal spine (ANS), posterior nasal spine (PNS), left and right orbitales. Results: After orthodontic treatment, the third molars moved forward (adjusted mean, 1.44 mm) (p < 0.001) and downward (adjusted mean, 2.87 mm) (p < 0.001) accompanied by outward rotation (mean, 5.38°) of the crowns (adjusted mean, 5.38°) (p = 0.001), whilebut the changes in angulation were insignificant.Conclusions: This was the first study to systematically investigate the spatial position change of maxillary third molars in adult patients who received orthodontic treatment with premolar extraction. During the process, maxillary third molars moved downward and forward accompanied by outward rotation of the crowns. Orthodontists should take tooth movement potential into consideration when making extraction plans.

To evaluate the radiological anatomy of the pharyngeal recess (PR) by gender and age. Images of patients who underwent cone-beam computed tomography (CBCT) were analyzed retrospectively. A total of 600 PRs (140 male, 160 female) were examined. PR depths, distances between the posterior nasal spine (PNS) and the posterior wall of the pharynx, right and left torus levatorius lengths, and distances between the right and left torus levatorius were measured on the axial plane passing through the PNS–basion point. PR depths differed significantly between age groups (right p = 0.030, left p = 0.047). The PR depths of individuals under 35 years of age were significantly higher than those of individuals aged 35 and over. Further, the distances between the PNS and the posterior wall of the pharynx differed significantly between age groups and between gender groups. The distances between the PNS and the posterior wall of the pharynx were shorter in patients under 35 years of age (p = 0.000). In terms of gender, these distances were significantly longer in males (p = 0.014). The distances between the right and left torus levatorius were also significantly longer in males (p = 0.029). The PR is the region in which nasopharyngeal carcinoma originates most frequently and is very important for early diagnosis. The present results indicated that this region can be examined with CBCT.

Knowledge of the morphometry and types of pterygomaxillary junction (PMJ) during Le-Fort I osteotomy is an important consideration in the reduction of intraoperative complications. The PMJ is known to display population variations and with the recent increase in these surgical interventions in Kenya, a detailed description of the PMJ is warranted. Computed tomography scan images of PMJ obtained from 63 patients were analyzed at the level of the posterior nasal spine to assess types and the morphometry of the PMJ. A fissure type of PMJ was present in 65.9% (83/126 sides) while a synostosis type was present in 34.1% (43/126). Bilateral fissures were found in 58.73% (37/63), bilateral synostosis in 26.98% (17/63), and an asymmetric PMJ in 15.25% (9/63). The average height, width, and thickness of the PMJ were 17.45 ± 5.26 mm, 10.24 ± 1.97 mm, and 6.40 ± 1.97 mm respectively. Males had a significantly greater height (P = 0.003) and width (P = 0.000). The average width was greater in cases with a synostosis as compared with those with a fissure (P = 0.019). Average distance of greater palatine canal was 40.41 ± 2.28 mm and 7.19 ± 2.20 mm from the piriform rim and the pterygoid fossa respectively. The PMJ among Kenyans is characterized by a higher occurrence of synostosis, greater height, and thickness compared with previous findings from other populations. The results of this study can be helpful for surgeons in selecting the most appropriate techniques to achieve successful pterygomaxillary disjunction and minimize avoid attendant complications such as vascular and nerve injuries.

Background and objectives Micro-implant-assisted expanders have shown significant effects on the mid-face, including a degree of asymmetry. The aim of this study is to quantify the magnitude, parallelism, and asymmetry of this type of expansion in non-growing patients. Methods A retrospective study on a sample of 31 non-growing patients with an average age of 20.4 years old, with cone beam computed tomography images taken before and right after expansion using maxillary skeletal expander (MSE) were assessed for skeletal expansion at three landmarks bilaterally. Results Average magnitude of total expansion was 4.98 mm at the anterior nasal spine (ANS) and 4.77 mm at the posterior nasal spine (PNS) which showed statistical significance using a paired t test with p < 0.01. Average expansion at the PNS was 95% of that at the ANS. The sample was divided into symmetric (n = 15) and asymmetric (n = 16) based on the difference in expansion at the ANS, with 16 out of 31 patients exhibiting statistically significant asymmetry. Conclusions MSE achieves distinctly parallel expansion in the sagittal plane but can exhibit asymmetrical expansion in the transverse plane.

Introduction This study's goal was to determine normal maxillary development on a fetal cadaver. Materials and methods This study was carried out on 45 fetuses aged between the 17th - 40th weeks of gestation (24 male, 21 female). The distance between the widest left and right points of the maxillary dental arch (MDA) on the transverse plane, the distance of the papilla incisiva (PI) to the widest left and right points of the maxillary dental arch (MDAW), and the PI and posterior nasal spine (PNS) were measured. The average arch forms of the MDA were created according to trimester groups using the MATLAB program. The one-way ANOVA test was used to make a comparison between trimester groups, and ANOVA followed by post hoc analysis using the Bonferroni test was applied for comparisons. Pearson's correlation analysis was used for correlation analysis. Results The data in the present study did not differ between genders. In the comparison between trimester groups, we did not find any difference between the 3rd trimester and full-term groups only in the PI-MDAW measurement. Other parameters increased with age. In the correlation analysis, the measurement values by age showed a strong positive correlation. The MDAW exhibited the best correlation with age (rweek = 0.919). When the average MDA forms created using the MATLAB program were evaluated, it was observed that the PI-MDAW of the average MDA in the 3rd trimester and full-term intersected. Conclusions This study provides a basis for a better understanding of fetal maxillary growth processes and can be useful to standardize the detection of malformations or intrauterine growth restrictions.

Complicated craniofacial malformations interfacing with multiple intracellular regulatory mechanisms, lead to ambiguous growth patterns in Apert syndrome. This study aims to explore the chronology and pathogenesis of the development of craniofacial anatomic relationships and to verify the positional correlates between skull and facial structures in Apert syndrome. Fifty-four computed tomography scans (Apert, n = 18; control, n = 36) were included and divided into 3 age subgroups. Craniofacial 3-dimensional cephalometries were analyzed by Materialize software. The angle between sella-nasion plane and maxillary plane widens 7.74° (P = 0.003) prior to 6 months of age; thereafter, this widening increases by 10.36° (P < 0.001) in 6 months to 2 years of age, and remains increased by 8.9° (P = 0.046) throughout childhood. The angle between Frankfort horizontal plane and maxillary plane widens 5.17° (P = 0.022) before 6 months. Angles SNA, SNB, and ANB showed decreases, averaging 12.23° (P < 0.001), 5.19° (P = 0.004), and 6.72° (P = 0.001), respectively. The linear measurements showed synchronicity and continuing deformity into adulthood. Between 6 months to 2 years of age, the distance from sella to nasion (S-N), anterior nasal spine (S-ANS), and posterior nasal spine (S-PNS) decreased 8% (P = 0.006), 16% (P < 0.001), and 19% (P = 0.002), respectively, and remained shortened into adulthood. The angulation changes occur earlier in development than linear distance reduction in Apert syndrome patients compared with controls. Angular adjustments were not sufficient to maintain normal cranial base length. Facial deformity of Apert syndrome temporally begins with the midface, and affects orbit and mandible later in life.

Introduction The pharyngeal airway, tongue, and hyoid bone are correlated. The hyoid bone is connected to the pharynx, mandible, and cranium through muscles and ligaments and its position with respect to them determines the tongue posture and function. It also plays an important role in maintaining the airway and upright natural head position. Different skeletal patterns have different morphologies and shapes of the mandible, which might be affected by the position of the hyoid bone and the pharyngeal airway depth. This cephalometric study was conducted to relate the pharyngeal airway depth and the hyoid bone position of different skeletal patterns in sagittal dimension, and it determines and compares the linear parameters of the pharyngeal airway depth in Class I, II, and III malocclusion groups and anteroposterior, vertical, and angular positions of the hyoid bone positions in Class I, II, and III malocclusion groups. Materials and methods Lateral cephalometric radiographs selected for study were divided into three groups of 30 samples each based on ANB angle and β angle into skeletal Class I, Class II, and Class III, respectively. Five linear measurements for the pharyngeal airway depth, four linear measurements for anteroposterior position, two linear measurements for vertical position, and one angular measurement for angular hyoid bone position were made. Results The pharyngeal airway depth was found to show no statistically significant difference between Class I and Class III malocclusions. The pharyngeal airway depth in Class II malocclusion was found to be statistically smaller at D1 as compared to that in Class I and Class III malocclusions, whereas it remained the same at the rest of the locations measured, i.e., D2, D3, D4, and D5. The Class III malocclusion group showed a significant statistical difference in the anteroposterior hyoid bone position at all levels (i.e., H1, H2, H3, and H4) as compared to the Class II malocclusion group, whereas it showed a statistically significant difference as compared to the Class I malocclusion group at H1 and H3. The angular inclination of the hyoid bone in the Class II malocclusion group showed a statistically significant difference with the Class I and Class III malocclusion group but the Class III malocclusion group showed no significant difference statistically when compared to the Class I malocclusion group. Conclusion The pharyngeal airway depth in the Class II malocclusion group was also found to be narrower at the superiormost level measured at the posterior nasal spine from the posterior pharyngeal wall. The hyoid bone position was variable in angular and anteroposterior dimensions among different malocclusion groups. How to cite this article Chauhan R, Bagga DK, et al. Radiographic Evaluation of the Hyoid Bone Position and Pharyngeal Airway Depth in Anteroposterior Dysplasia. Int J Clin Pediatr Dent 2019;12(2):101–106.

The purpose of this study was to analyze the stability of Le Fort I maxillary advancement in the vertical and horizontal directions using a combination of wire and rigid fixation in patients undergoing surgery to treat obstructive sleep apnea (OSA). Wire osteosynthesis can be performed quicker and at a reduced cost. The lateral cephalograms of 21 patients were evaluated preoperatively (T0), immediately postoperatively (T1), and at least 6 months postoperatively (T2). Four cephalometric points were used to measure movement in the horizontal and vertical directions. Mean values were determined, and data were statistically analyzed by ANOVA to determine differences between time points. Of the four points analyzed, the average maxillary advancement in the horizontal direction was 7.48 mm and the relapse was 0.56 mm with absence of statistically significant differences between the measurements taken (T1) and (T2). There was a 5% probability of error in the vertical movements at the points I and posterior nasal spine. The combination of two pre-bent plates in piriform aperture with osteosynthesis using surgical steel wires in the zygomatic buttress in patients undergoing maxillary surgery for OSA stabilized the large horizontal maxillary advancements and enhanced vertical stability in the first molar and A point regions.

Our aim was to evaluate the accuracy of two midsagittal planes (MSP) to provide a better reference plane for studying the 3-dimensional structural symmetry in patients with skeletal mandibular deviation. Thirty adult patients with facial asymmetry were admitted to the Department of Orthodontics, Hospital of Stomatology, between January 2015 and 2017. The DICOM data were collected and reconstructed using ProPlan CMF® 2.0 (Materialise). Two sets of reference planes were set up. In the orbital margin plane group, the plane crossing the nasion (N) point and perpendicular to the frontozygomatic (FZ) suture line was used as the MSP. In the skull base plane group, the MSP was established using the sella turcica (S), N, and basion (Ba). The distances from the craniofacial skeletal and soft tissue midline landmarks to the two MSP were separately measured, and the significance of differences between measurements corresponding to two reference planes were assessed using the paired t test. Except for the posterior nasal spine (PNS)-MSP, the distances from other soft and hard tissue landmarks to the MSP in the orbital margin plane group were significantly shorter than those in the skull base plane group. In the 3-dimensional measurement analysis, the skeletal and soft tissue anatomical midline landmarks were closer to the MSP in the orbital margin plane group. The MSP crossing point N, perpendicular to the FZ suture line, was more accurate and suitable.

Objective The aim of this study was to determine the effects of maxillomandibular movements by orthognathic surgery on nasal and oronasopharyngeal airway morphologies and nasal respiratory function. Methods The subjects were 32 patients in whom jaw deformities were corrected by two jaw surgery. The amount of jaw movements was evaluated on cephalograms taken before surgery and more than six months after surgery, and morphological changes were evaluated using helical computed tomography (CT), and nasal airway resistance (NAR) for the objective evaluation of nasal respiratory function was measured by anterior rhinomanometry. The results showed that the volume of the nasal cavity and NAR was not changed significantly after surgery. However, the change of NAR was negatively correlated with changes of nasopharyngeal volume and the cross-sectional area in the palatal section (P-CSA). The change of NAR correlated with horizontal movement at B-point. Furthermore, the amount of vertical movement of the maxilla at the posterior nasal spine (PNS) was significantly correlated with reductions in the volume of the oropharynx upper region. Conclusion There was little association of changes in maxillomandibular position or nasal and oronasopharyngeal airway morphologies with nasal respiratory function. This might be because of compensatory biomedical action to maintain nasal respiratory function.

Objective: The purpose of this study was to quantify the growth of the various craniofacial and velopharyngeal structures and examine sex and race effects. Methods: Eight-five healthy children (53 white and 32 black) with normal velopharyngeal anatomy between 4 and 9 years of age who met the inclusion criteria and successfully completed the magnetic resonance imaging (MRI) scans were included in the study. Results: Developmental normative mean values for selected craniofacial and velopharyngeal variables by race and sex are reported. Facial skeleton variables (face height, nasion to sella, sella to basion, palate height, palate width) and velopharyngeal variables (levator muscle length, angle of origin, sagittal angle, velar length, velar thickness, velar knee to posterior pharyngeal wall, and posterior nasal spine to levator muscle) demonstrated a trend toward a decrease in angle measures and increase in linear measures as age increased (with the exception of posterior nasal spine to levator muscle). Only hard palate width and levator muscle length showed a significant sex effect. However, 2 facial skeleton and 6 velopharyngeal variables showed a significant race effect. The interactions between sex, race, and age were not statistically significant across all variables, with the exception of posterior nasal spine to posterior pharyngeal wall. Conclusion: Findings established a large age- and race-specific normative reference for craniofacial and velopharyngeal variables. Data reveal minimal sexual dimorphism among variables used in the present study; however, significant racial effects were observed.

Purpose Orthognathic surgeries, such as bilateral sagittal split ramus osteotomy (BSSO) and genioplasty, can influence the pharyngeal airway space (PAS) and this has been supported by previous studies. The purpose of this study was to assess changes of the PAS in patients with a high body mass index (BMI) likely to have narrow airways before and after setback BSSO with or without advancement genioplasty surgery by 3-dimensional computed tomography. Materials and Methods Thirty-five adults with a BMI of at least 24.0 kg/m2 were treated from 2010 to 2016. Samples were grouped mandibular setback (group A; n = 11), advancement genioplasty (group B; n = 12), and mandibular setback plus advancement genioplasty (group C; n = 12). Computed tomograms were obtained 1 week preoperatively (T0), 1 week postoperatively (T1), and at least 1 year postoperatively (T2). The area of the posterior nasal spine and posterior plane (PPA), the soft palate plane (SPA), the plane of the most posterior point of the tongue base (PTA), the plane of the root of the epiglottis (EA), and the volumes of the palatopharyngeal part (VP), oropharyngeal part (VO), glossopharyngeal part (VG), and laryngeal part (VL) were measured and compared within groups using analysis of variance. The P value was set at .05. Results In group A, all results showed statistically significant differences (P Conclusion In adults with a high BMI, mandibular setback BSSO could decrease the PAS, whereas advancement genioplasty could enlarge the PAS, after surgery. Therefore, undergoing advancement genioplasty concurrently with mandibular setback BSSO could help in lessening the negative effects of a PAS decrease.

Pharyngeal volume is important in anesthesiology for correctly assessing intubation procedures. However, most of studies are based on patients in upright position and do not assess possible relationships between pharyngeal volume and cranial size. This study aims at measuring pharyngeal volume in CT-scans and to assess possible statistically significant differences according to sex.Eighty healthy subjects (40 males and 40 females) aged between 21 and 86 years were retrospectively chosen from a hospital database of maxillofacial CT-scans; 3D segmentation was performed separately for naso-, oro- and laryngopharyngeal portion through ITK-SNAP software, and their volume was calculated. Three cranial measurements were obtained: distance between anterior and posterior nasal spine, upper facial height (nasion-prosthion) and biorbital breadth (ectoconchion-ectoconchion distance).The effect of sex on volume for each pharyngeal portion was assessed through one-way ANCOVA test using each of the 3 cranial measurements as covariate (P < 0.05).On average, the volume of nasopharynx, oropharynx and laryngopharynx was 7.2 ± 2.7 cm, 7.5 ± 4.2 cm, 3.5 ± 2.2 cm respectively in males, and 6.4 ± 2.9 cm, 5.2 ± 2.1 cm, 3.0 ± 1.8 cm in females. Statistically significant differences according to sex were found only for oropharyngeal volume, independently from cranial measurements (P < 0.05).This study provides data concerning volume of pharyngeal air space in supine subjects: these reference standards can be useful for anaesthesiologic procedures.

Objective To investigate the effects of the long-term use of a maxillary protraction facemask with miniplate (FM-MP) on pharyngeal airway dimensions in growing patients with cleft lip and palate (CLP). Methods The study included 24 boys with CLP (mean age, 12.2 years; mean duration of FM-MP therapy, 4.9 years), divided into two groups according to the amount of A point advancement to the vertical reference plane (VRP): Group 1, > 4 mm; Group 2, < 2 mm; n = 12/group. After evaluating the skeletodental and airway variables using lateral cephalograms acquired before and after FM-MP therapy, statistical analyses were performed. Results Group 1 showed greater forward and downward displacements of the posterior maxilla (posterior nasal spine [PNS]-horizontal reference plane [HRP]; PNS-VRP), greater increase in ANB, more forward tongue position (tongue tip-Pt vertical line to Frankfort horizontal plane), and greater increase in the oropharynx (superior posterior airway space [SPAS]; middle airway space [MAS]) and upper nasopharynx (PNS-adenoid2) than did Group 2. While maxillary advancement (A-VRP and PNS-VRP) correlated with increases in SPAS, MAS, and PNS-adenoid2, downward displacement of the PNS (PNS-HRP) correlated with increases in SPAS, MAS, PNS-adenoid1, and PNS-adenoid2, and with a decrease in vertical airway length (VAL). Mandibular forward displacement and decrease in mandibular plane correlated with increases in MAS. Conclusions FM-MP therapy had positive effects on the oropharyngeal and nasopharyngeal airway spaces without increases in VAL in Group 1 rather than in Group 2. However, further validation using an untreated control group is necessary.

This study evaluated the effect of maxillary advancement surgery on the size of the pharyngeal airway space (PAS). Lateral cephalometric radiographs were collected for 90 patients (29 men and 61 women; average age, 27.2 ± 8.1 years) before (T1) and 1 year after (T2) maxillary advancement surgery. Horizontal and vertical changes in the maxilla and PAS were measured and classified by distance. The maxilla was advanced horizontally by 2.9 ± 1.7 mm and vertically by 2.7 ± 1.4 mm. Upward maxillary movement of ≥4 mm significantly increased PAS (mean change in PAS, 2.6 mm), and upward maxillary movement significantly decreased the posterior nasal spine to the P-point. Only patients with vertical advancement ≥4 mm and horizontal advancement of 3 mm had significant increases in all three PAS parameters. Although forward maxillary movement is believed to have a large effect on PAS, it is suggest that upward vertical movement is more effective for improving PAS. Both the extent and direction of maxillar movement should be considered. Future studies should use cone-beam computed tomography to evaluate the effect of axial direction and differences in PAS.

BACKGROUND Considerable craniofacial features of Crouzon syndrome are attributed to the dysmorphology of the cranial base. As cephalometric studies have focused mainly on the facial deformity, rather than the cranial base, the underlying cause of deformity is not as well understood. Therefore, the authors compared the cranial base development of Crouzon syndrome to controls to trace the timing of deformity in the cranial base and face, to analyze their temporal correlation. METHODS Ninety computed tomographic scans were included (Crouzon, n = 36; controls, n = 54) and divided into five age subgroups. Craniofacial cephalometric measurements were analyzed by Materialise software. RESULTS The overall cranial base length in Crouzon syndrome compared with controls decreased 8 percent (p = 0.014) on average. The posterior cranial fossa shortening accounted for most of this reduction. The cranial base displaced with the distances from basion, sella, and ethmosphenoid to posterior nasal spine shortened by 21%, 18%, and 16%, respectively (all p < 0.01) during life. Although the cranial base angle on intracranial surface remains normal, the angles on facial surface narrowed were reduced. CONCLUSIONS The cranial base deformity of Crouzon syndrome consists of the whole skull base and particularly anterior skull base shortening early, leading to a compensatory widened anterior skull base. However, when this widening did not compensate fully for the rapid enlargement of the brain, the posterior skull base displaced inferiorly and became kyphotic. The cranial base deformity develops sequentially anterior to posterior in a probable cascade of influence pattern. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.

Objective This study is aimed at assembling, through a systematic review and meta-analysis, scientific evidence related to the effects of mandibular setback (MdS) surgery and bimaxillary surgery for the correction of Class III malocclusion on the cross-sectional area (CSA) and volume of the upper airway as assessed using CT. Methods An electronic search was conducted on Cochrane Library, EMBASE, PubMed, Scopus and Web of Science up to June 20, 2016. The inclusion criteria were prospective or retrospective studies, with the aim of comparing the impact on the upper airway space of orthognathic surgery for the treatment of the skeletal class III malocclusion. The methodological index for non-randomized studies (MINORS) was chosen as the evaluation instrument and Revman5.3 was used for the meta-analysis. Results A total of 1213 studies were retrieved, of which only 18 met the eligibility criteria. The results of meta-analysis showed that the mean decrease in the upper airway volume after MdS surgery was 3.24 cm 3 [95%CI (−5.25,-1.23), p = 0.85]; the mean decrease in minimum CSA after a combined surgery of maxillary advancement with mandibular setback (MdS + MxA) was 27.66 mm 2 [95%CI (−52.81,−2.51), p = 0.51], but there was no significant decrease in upper airway volume (mean 0.86 cm 3 ); comparison between MdS + MxA and isolated MdS showed significant differences in the CSA of the posterior nasal spine plane (PNS) and epiglottis plane (EP); statistically significant differences in nasopharynx volume (P Conclusion The results of this study suggest that bimaxillary surgery promotes less decrease on the upper airway than mandibular setback surgery alone for the correction of the skeletal class III malocclusion.

Introduction The purpose of this study was to morphometrically investigate the growth pattern of the adenoids in growing subjects with hyperdivergent and hypodivergent vertical craniofacial features. Methods In this retrospective study, we used a longitudinal sample of lateral cephalometric radiographs of 28 hyperdivergent and 30 hypodivergent subjects from 4 to 13 years of age. The radiographs were obtained from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection. Measurements were made using digital tracings of the lateral cephalograms and point distribution models. Mixed-model analyses were used for statistical analysis. Results The mean distance between the sphenoid bone and the posterior nasal spine increased up to 5.3 mm over a 9-year span (95% CI, 4.1-6.5 mm; P

Introduction The purpose of this study was to determine, by statistical shape analysis of original and mirrored skeletal landmarks, the optimal landmark-based midsagittal reference plane for evaluation of facial asymmetry. Methods The study sample comprised 69 patients with facial asymmetry (36 men, 33 women; mean age, 23.0 ± 4.1 years). All landmarks were obtained with cone-beam computed tomography using a 3-dimensional coordinate system. For identifying the landmark-based midsagittal reference plane, the 3 landmarks nearest to the symmetric midsagittal reference plane were selected by ordinary and generalized Procrustes analyses. To verify the 3-landmark-based midsagittal reference plane's compatibility with the symmetric midsagittal reference plane, asymmetry measurements were calculated and tested for each. Results The 3 nearest landmarks (nasion, anterior nasal spine, and posterior nasal spine) were selected for the 3-landmark-based midsagittal reference plane. The averages of the sums of the squared Euclidean distance and the squared Procrustes distance differences between the 2 configurations and shapes fabricated by the symmetric and landmark-based midsagittal reference planes, respectively, were calculated as 0.121 ± 0.241 mm and 1.69 × 10 −6 ± 3.25 × 10 −6 . The testing results for the symmetric and landmark-based midsagittal reference planes were almost the same. Conclusion The results indicated that a 3-dimensional midsagittal reference plane constructed of nasion, anterior nasal spine, and posterior nasal spine could be a valuable tool for the evaluation of patients with facial asymmetry.

Background : Upper airway morphology is associated with facial development and occlusion. Treatment of maxillofacial and occlusal disorders requires sufficient knowledge of related functional variables, including upper airway morphology. In order to determine upper airway obstruction and its exact site, three-dimensional (3D) reconstruction of the airway can be beneficial. The aim of the current study was to determine the age-related changes of upper airway morphology. Materials : The pharyngeal area of 87 patients was assessed using Cone Beam Computed Tomography (CBCT), and no artifacts were detected. The subjects were within the age range of 6-60 years, with normal body mass index (BMI) of 18-25 kg/m 2 . In the CBCTs, in addition to volumetric measurements of nasopharynx, oropharynx, and hypopharynx, distances between pharyngeal wall and posterior nasal spine, uvula, or valcula in anteroposterior and horizontal planes were measured (2D measurement). In addition, the shortest distance between tongue base and posterior pharyngeal wall was calculated in the anteroposterior plane. Data were analyzed in three age groups of 6-20, 21-40, and 41-60 years old via SPSS analysis. Results : Various values of upper airway and variables which measure anteroposterior dimensions of pharynx were significantly higher in the 21-40 years old group, compared to 6-20 years old group. Although these variables were higher in the 21-40 years old group, compared to the 41-60 years old group, the difference was statistically insignificant. The transverse variables had the highest value in the 21-40 years old group, but the difference with the other two groups was insignificant. No significant difference was observed between males and females. Conclusion : According to the results of the current study, upper airway changes in 2D and 3D models may be age-dependent and become more significant by the age of 20 years. In addition, gender has no effect on the development of upper airways. Bangladesh Journal of Medical Science Vol.15(1) 2016 p.78-83

Background: Obstructive sleep apnea (OSA) is a common sleep disorder and is characterized by airway collapse at multiple levels of upper airway. The effectiveness of nasal surgery has been discussed in several studies and shows a promising growing interest. In this study, we intended to evaluate the effects of nasal surgery on the upper airway dimensions in patients with OSA using three-dimensional (3D) reconstruction of cone-beam computed tomography (CT). Methods: Twelve patients with moderate to severe OSA who underwent nasal surgery were included in this study. All patients were diagnosed with OSA using polysomnography (PSG) in multi sleep health centers associated with Massachusetts General Hospital, Massachusetts Eye and Ear Infirmary and the Partners Health Care from May 31, 2011 to December 14, 2013. The effect of nasal surgery was evaluated by the examination of PSG, subjective complains, and 3D reconstructed CT scan. Cross-sectional area was measured in eleven coronal levels, and nasal cavity volume was evaluated from anterior nasal spine to posterior nasal spine. The thickness of soft tissue in oral pharynx region was also measured. Results: Five out of the 12 patients were successfully treated by nasal surgery, with more than 50% drop of apnea-hypopnea index. All the 12 patients showed significant increase of cross-sectional area and volume postoperatively. The thickness of soft tissue in oral pharynx region revealed significant decrease postoperatively, which decreased from 19.14 ± 2.40 cm 2 and 6.11 ± 1.76 cm 2 to 17.13 ± 1.91 cm 2 and 5.22 ± 1.20 cm 2 . Conclusions: Nasal surgery improved OSA severity as measured by PSG, subjective complaints, and 3D reconstructed CT scan. 3D assessment of upper airway can play an important role in the evaluation of treatment outcome.

The aim of this study was to evaluate the maxillary stability in patients who had undergone Le Fort I osteotomy with propeller graft and mandibular sagittal split ramus osteotomy for correction of maxillary asymmetry. This was a retrospective study on 15 facial asymmetry patients (7 men, 8 women: 22.2 years) requiring surgical correction at the preoperative (T0), immediately postoperative (T1) and 6 months after surgery (T2) stages. To evaluate the skeletal stability, computed tomography (CT) superimposition was used, and skeletal landmarks were measured and compared from the superimposed images according to an x, y, z coordinate system. The skeletal changes at each stage (ΔT1-T0 and ΔT2-T1) were compared by paired t-test (P

Few reports have so far evaluated the maxillary stability after LeFort I osteotomy (L-1) for pitch correction. In the current study, the authors assessed the SN-PP (palatal plane) to evaluate the skeletal stability after osteotomy with clockwise or counter-clockwise rotation and investigated the effects of anterior nasal spine (ANS) and posterior nasal spine (PNS) movement on the stability of the SN-PP. The SN-PP and the positions of ANS, PNS, and point A were measured on lateral cephalograms before surgery (T1), immediately after surgery (T2), and more than 1 year after surgery (T3). All measured angle and points were stable in 4 cases of counterclockwise rotation. In the 16 cases of clockwise rotation, T3-T2 of SN-PP, ANS, and point A was ?2.058 ?2.56 mm, and ?1.64 mm, when the SN-PP increased more than 48 after osteotomy. When the ANS moved downward more than 3 mm, the ANS and point A relapsed significantly by 2.75 and 2.31 mm, while the SN-PP relapsed 1.618 more than 1 year after surgery. When the SN-PP increased by more than 48 or the ANS moved downward by more than 3 mm, the authors suggest shifting the PNS upward instead of moving the ANS downward., The Journal of Craniofacial Surgery, 26(6), pp.e481-e485; 2015

Surgically assisted rapid maxillary expansion (SARME) is the treatment of choice to adult patients even with severe transversal maxillary discrepancies. However, the adequate retention period to achieve the bone remodeling, thus assuring treatment stability, is controversial.Objective To evaluate the opening pattern and bone neoformation process at the midpalatal suture in patients submitted to surgically assisted (SARME) through cone beam computed tomography (CBCT).Material and Methods Fourteen patients were submitted to SARME through subtotal Le Fort I osteotomy. Both the opening pattern and the mean bone density at midpalatal suture area to evaluate bone formation were assessed pre- and post-operatively (15, 60 and 180 days) through CBCT.Results Type I opening pattern (from anterior to posterior nasal spine) occurred in 12 subjects while type II opening pattern (from anterior nasal spine to transverse palatine suture) occurred in 2 individuals. The 180-day postoperative mean (PO 180) of bone density value was 49.9% of the preoperative mean (Pre) value.Conclusions The opening pattern of midpalatal suture is more related to patients’ age (23.9 years in type I and 33.5 years in type II) and surgical technique. It was not possible to observe complete bone formation at midpalatal suture area at the ending of the retention period studied (180 days).

The aim of this study was to evaluate the two-dimensional (2D) and three-dimensional (3D) changes in the pharyngeal airway space (PAS) in 20 class III patients who underwent mono- or bimaxillary surgery using cone-beam computed tomography (CBCT). CBCT examination was obtained before surgery (T1) and at least 3 months after surgery (T2). The pharyngeal airway of each patient was studied at three levels: the level of the posterior nasal spine, the level of the most inferior point of the soft palate, and the level of the top of the epiglottis. At each of these levels, the anteroposterior and lateral dimension as well as cross-sectional area were measured. The volume of the whole PAS and volume between each cross section were also measured. The area and anteroposterior dimensions at the level of the most inferior point of the soft palate significantly decreased in patients who underwent monomaxillary surgery. The volume of the PAS decreased in both groups, but decreased significantly only in the monomaxillary group. The upper volume decreased in the mono- and increased in the bimaxillary group. The lower volume significantly decreased in the monomaxillary group. However, results showed that PAS decreased more after mono-than after bimaxillary surgery.

Aim To study the anthropometric measurements of UA in patients of OSA and assess the relation between UA anatomy and severity of OSA. Introduction Anatomical and nonanatomical factors are implicated in OSA in which repetitive collapse of UA occurs. Scarcity of data regarding UA anhropometry in OSA exist especially in Indian population. Materials and Methods A prospective observational case control study was carried in which 60 OSA (mild:n=20, moderate:n=20, severe:n=20) and control group (n=20) underwent MRI and lateral cephalometry of UA. Linear Regression analysis (univariate and multivariate linear regression) of various parameters was done to find out the factors correlated with OSA. Results In MRI, distance between hyoid bone and posterior nasal spine (H-PNS) and hyoid and posterior pharynx wall near vertebral column (H-COL) was found to be statistically significant (mild=60.23 mm, moderate=68.72 mm, severe=77.26 mm: control=60.23 mm:p=0.001) and (mild=14.8 mm, mod=15.2 mm, severe=19.09 mm: control=11.5 mm:p Conclusion In OSA ,significant alteration of anthropometry of upper airway occurs and is associated with severity of OSA.