A Cephalometric Analysis of the Cranial Base and Frontal Part of the Face In
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Strana 534 VOJNOSANITETSKI PREGLED Vojnosanit Pregl 2014; 71(6): 534–541. UDC: 616.314-089.23:616.716.1/.4-007]:[611.714:572.087 ORIGINAL ARTICLE DOI: 10.2298/VSP121212011C A cephalometric analysis of the cranial base and frontal part of the face in patients with mandibular prognathism Kefalometrijska analiza kranijalne baze i prednjeg dela lica kod osoba sa mandibularnim prognatizmom Tatjana ýutoviü*†, Nebojša Joviü†‡, Ljiljana Stojanoviü§, Julija Radojiþiü¶, Irena MladenoviüŒ, Stevo Matijeviü†**, Ružica Kozomara†‡ *Department of Orthodontics, ‡Department of Maxillofacial Surgery, **Department of Oral Surgery, Military Medical Academy, Belgrade, Serbia; †Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia; §Department of Orthodontics, Faculty of Dentistry, University of Belgrade, Belgrade, Serbia; ¶Department of Orthodontics, Faculty of Medicine, University of Niš, Niš, Serbia; ŒDepartment of Prosthodontics, Faculty of Medicine, University of East Sarajevo, Foþa, Bosnia and Herzegovina Abstract relationship analysis indicated a statistically significant negative correlation between the cranial base angle Bacground/Aim. The literature suggests different views (NSAr) and the angles of maxillary (SNA) and mandibular on the correlation between the cranial base morphology (SNB) prognathism, as well as a positive correlation be- and size and saggital intermaxillary relationships. The aim tween the angle of inclination of the ramus to the cranial of this study was to investigate the cranial base morphol- base (GoArNS) and the angle of sagittal intermaxillary re- ogy, including the frontal facial part in patients with man- lationships (ANB). Sella turcica dimensions, its width and dibular prognathism, to clarify a certain ambiguities, in depth, as well as the nasal bone length were significantly opposing viewspoints in the literature. Methods. Cepha- increased in the patients with mandibular prognathism, lometric radiographies of 60 patients were analyzed at the while the other analyzed frontal part dimensions of the Dental Clinic of the Military Medical Academy, Belgrade, face were not changed by the malocclusion in comparison Serbia. All the patients were male, aged 18–35 years, with with the eugnathic patients. Conclusion. This study no previous orthodontic treatment. On the basis of dental shows that the impact of the cranial base and the frontal and sceletal relations of jaws and teeth, the patients were part of the face on the development of profile in patients divided into two groups: the group P (patients with man- with mandibular prognathism is much smaller, but cer- dibular prognathism) and the group E (the control group tainly more complex, so that morphogenetic tests of the or eugnathic patients). A total of 15 cephalometric maxillomandibular complex should be included in further parametres related to the cranial base, frontal part of the assessment of this impact. face and sagittal intermaxillary relationships were meas- ured and analyzed. Results. The results show that cranial Key words: base dimensions and the angle do not play a significant mandible; prognathism; cephalometry; skull; facial role in the development of mandibular prognathism. Inter- bones; sella turcica. Apstrakt kog pola, starosti od 18 do 35 godina koji ranije nisu bili ortodontski leÿeni. Bolesnici su prema dentoskeletnim od- Uvod/Cij. U litetaruri postoje razliÿiti stavovi o povezano- nosima vilica i zuba bili svrstani u dve grupe: grupu P (bole- sti morfologije i veliÿine kranijalne baze i sagitalnih meĀuvi- snici sa mandibularnim prognatizmom) i grupu E (kontrol- liÿnih odnosa. Cilj ovog rada bio je da se ispita morfologija na grupa ili grupa eugnatih bolesnika). Izmereno je i analizi- kranijalne baze, ukljuÿujuýi i prednji deo lica, kod ispitanika rano 15 kefalometrijskih parametara koji su se odnosili na sa mandibularnim prognatizmom da bi se razjasnile nedou- kranijalnu bazu, frontalni deo lica kao i sagitalne meĀuviliÿ- mice donekle suprotnih stavova u literaturi. Metode. Anali- ne odnose. Rezultati. Dobijeni rezultati ukazuju da ni di- zirani su rendgenkefalometrijski snimci ukupno 60 bolesni- menzije kranijalne baze, ni njen ugao ne igraju znaÿajnu ulo- ka Klinike za stomatologiju VMA. Svi bolesnici bili su muš- gu u nastanku mandibularnog prognatizma. Analizom me- Correspondence to: Tatjana þutoviý, Department of Orthodontics, Military Medical Academy, Crnotravska 17, 11 000 Belgade, Serbia. Phone: +381 11 3608 138. E-mail: [email protected] Volumen 71, Broj 6 VOJNOSANITETSKI PREGLED Strana 535 Āuzavisnosti ustanovljeno je da postoji statistiÿki znaÿajna gnate bolesnike. Zakljuÿak. Pokazalo se da je uticaj krani- negativna korelacija izmeĀu ugla kranijalne baze (NSAr) i jalne baze i prednjeg dela lica na ispoljavanje profila kod uglova maksilarnog (SNA) i mandibularnog (SNB) progna- bolesnika sa mandibularnim prognatizmom mnogo manji ali tizma, kao i pozitivna korelacija izmeĀu ugla nagiba ramusa svakako složeniji, pa bi u dalja istraživanja trebalo ukljuÿiti prema kranijalnoj bazi (GoArNS) i ugla sagitalnih meĀuvili- morfogenetska ispitivanja maksilomandibularnog kompleksa ÿnih odnosa (ANB). Dimenzije sedlaste jamice (sella turcica), kod ocenjivanja ovog uticaja. njena širina i dubina, kao i dužina nosne kosti statistiÿki su znaÿajno poveýane kod bolesnika sa mandibularnim prog- Kljuÿne reÿi: natizmom, dok ostale analizirane dimenzije prednjeg dela li- mandibula; prognatizam; kefalometrija; lobanja; lice, ca nisu bile izmenjene kod ove malokluzije u odnosu na eu- kosti; sela turcika. Introduction termaxillary sagittal and vertical relationships dominate, primarely as a result of overdevelopment of the mandible. The cranial base plays an important role in the devel- There are still dilemmas, whether the cranial base really opment of face, especially in achieving sagittal and vertical plays such a decisive role in etiology, as the authors have intermaxillary relationships, primarily because of the differ- often reported. In mandibular prognathism, the cranial base ent ways of ossification of its synchondrosis. It also repre- angle is sharper and the cranial base is shorter in comparison sents a central skeletal axis which achieves its final size very with skeletal Class I patients, while the case of skeletal Class early – long before the face. II patients is completely opposite 3, 5, 6, 10. All the bones that form the cranial base (apart from Some authors believe that the temporomandibular joint temporal) are of cartilaginous origin and created by encho- is placed in more anterior position precisely because of the dral ossification which already begins prenatally and ends in reduction of the cranial base angle, which results in a pro- early childhood (especially the growth of sphenoethmoidal gnathic facial profile. However, Singh et al. 6, 7, 9 and Proff et and sphenofrontal synchondroses ends early), following the al. 5 have demonstrated in their extensive studies that the growth of sphenooccipital synchondroses which is completed biological basis of anterior positioning of the temporoman- approximately at the age of 12–16, so that the length of the dibular joint lies in the posterior cranial base. The same frontal cranial base becomes defined in a very early pe- authors suggest that the reason could be the premature ces- riod 1, 2. In postnatal period, especially in puberty, the frontal sation of the growth of petro-spheno-occipital complex, in sinus enlargement and remodelling of its frontal surface oc- other words, that a premature synostosis is responsible for cur, which also influence the nasal bone 3. deficient orthocephalization (horizontalization) of the cranial The opinions, that the growth, dimensions and shape base angle in Class III malocclusion. Therefore, the reduced of the cranial base influence the middle face growth have posterior part of the cranial base can be a primary factor in been accepted. Apposition and remodelling of the cranial skeletal Class III etiology. base sutures until the age of 5 affect the growth and posi- Consequently, the shape of cranial base could deter- tion of the maxilla, thus forming the maxillary sagittal po- mine facial profiles and represent the key factor in develop- sition to the cranial base very early. Afterwards, when the ing skeletal class malocclusions. Is this really true since that growth of the cranial base sutures stops, it is replaced by MP is a developmental disorder, which reaches its full mani- the growth of the sutures connecting the maxilla with the festation until after puberty, and the cranial base ossification cranial base, thus moving the maxilla forward and down- occurs in early childhood? wards. According to another theory, the growth of the en- In almost all cephalometric analyses of the neurocranium tire cranial complex gradually decreases from the age of 3– and the viscerocranium, sella turcica (ST) takes a central place. 7 years, when remains active only in the mandibular con- More precisely, the cental point (sella point – S) is a part of dyle, so that the mandible grows smoothly, changing par- many reference planes by which other structures are oriented. tially its sagittal position to the cranial base until general Thus, ST shape, dimensions and position in relation to the sur- somatic growth is completed 4. ronding structures are of great importance. For a long time, Anatomically speaking, the middle face is set in such a authors have had a tendency to determine ST dimensions as pre- way that the maxilla