Hindawi BioMed Research International Volume 2021, Article ID 5599949, 9 pages https://doi.org/10.1155/2021/5599949 Research Article Analysis of Facial Skeletal Morphology: Nasal Bone, Maxilla, and Mandible Han-Sheng Chen ,1 Szu-Yu Hsiao ,2,3 and Kun-Tsung Lee 4,5 1Dental Department, Kaohsiung Municipal Siao-gang Hospital, Kaohsiung, Taiwan 2School of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan 3Department of Dentistry for Child and Special Needs, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 4Division of Clinical Dentistry, Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan 5Department of Oral Hygiene, College of Dental Science, Kaohsiung Medical University, Kaohsiung, Taiwan Correspondence should be addressed to Kun-Tsung Lee; [email protected] Received 12 February 2021; Revised 29 March 2021; Accepted 4 May 2021; Published 25 May 2021 Academic Editor: Michael YC Chen Copyright © 2021 Han-Sheng Chen et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The growth and development of facial bones are closely related to each other. The present study investigated the differences in the nasomaxillary and mandibular morphology among different skeletal patterns. Cephalograms of 240 participants were divided into 3 groups based on the skeletal pattern (Class I, Class II, and Class III). The dimensions of nasomaxilla (nasal bone length, nasal ridge length, nasal depth, palatal length, and maxillary height) and mandible (condylar length, ramus length, body length, symphysis length, and entire mandibular length) were measured. One-way analysis of variance and Pearson’s correlation test were used for statistical analysis. No significant differences were observed among the skeletal patterns in terms of nasal bone length, palatal length, maxillary height, or condylar length. Class II had a significantly shorter ramus, mandibular body, and entire mandibular length compared with those of Class I and Class III. Nasal ridge length exhibited a significant moderate correlated with nasal bone length (correlation coefficient: 0.433) and maxillary height (correlation coefficient: 0.535). The entire mandibular length exhibited a significant moderate correlated with ramus length (correlation coefficient: 0.485) and body length (correlation coefficient: 0.536). In conclusion, nasal and maxillary dimensions exhibited no significant difference among the 3 skeletal patterns. Mandibular body and entire mandibular lengths were significantly positively correlations with Class III skeletal patterns. 1. Introduction of the nose is supported by the nasal bones that articulate with the frontal bone at the superior border and with the Craniofacial development is regulated by dynamic and com- frontal process of the maxilla at the lateral border. The lower plex mechanisms that involve various signaling cascades and two-thirds of the nose is supported by the lateral nasal carti- gene regulation pathways [1]. Manlove et al. [2] concluded lage [3]. In addition, bone resorption at the inner surface of that the development of the craniofacial skeleton occurs as the nasomaxillary complex enlarges the maxillary sinus. a result of a sequence of normal developmental events in Thus, nasomaxillary growth and development occur by bone the brain, the optic pathway, speech and swallowing func- apposition, bone resorption, and remodeling. [4–6] tion, the pharyngeal airway, muscles, and teeth. The growth Growth centers of the mandible include the mandibular and development of facial bones are closely related processes. body, mandibular angle, condylar process, coronoid process, The nasomaxillary complex comprises numerous bones that symphysis, and alveolar process. Growth of the condylar pro- articulate with each other at sutures. The frontal bone and cess takes place from its tip to the mandibular canal and fora- ethmoid bone meet the maxilla on both sides and protrude men and is affected by the position of the petrous portion of from the upper-middle portion of the face. The upper third the temporal bone. Growth of the mandibular condylar 2 BioMed Research International cartilage increases the mandibular ramus length, entire among the variables in each group. We describe the correla- mandible length, and the bilateral condylar distance. Addi- tion strength for the absolute value of the ratio as follows: tionally, the development of dentition and alveolar bone very weak (0-0.19), weak (0.20-0.39), moderate (0.40-0.59), growth also increases the mandibular body length. Enlow strong (0.60-0.79), and very strong (0.80-1.0). A P value < [5] noted that the forward-downward growth of the max- 0.05 was considered statistically significant. This retrospec- illa and mandible has an expanding V configuration and tive study was approved by a human investigation review defined such growth pattern as relocation. The extent committee (KMUHIRB-E(II)-20180200). and direction of bone growth varies among individuals. Changes in the pattern and rate of bone growth can lead 3. Results to abnormal bone morphology and malocclusion. The present study investigated the parameters of nasomaxillary Table 1 presents the results of the analysis of the 3 skeletal and mandibular bone morphologies and their correlations. patterns (Class I, Class II, and Class III). Intergroup compar- The null hypothesis was that no difference exists in the ison revealed no significant correlation between age and skel- nasal, maxillary, or mandibular dimensions among differ- etal pattern (P = :216). Furthermore, no significant difference ent skeletal patterns. in nasal bone length, nasal ridge length, nasal depth, palatal length, or maxillary height was noted among the skeletal 2. Materials and Methods patterns. Intergroup comparisons of condylar length and symphysis length among the 3 skeletal patterns revealed no Cephalograms of 240 individuals (120 male and 120 female) significant differences. However, the patients in Class II had were obtained for this study. Participants were selected on a significantly shorter ramus length (52.8 mm), mandibular the basis of the availability of cephalograms and whether they body length (59.8 mm), and entire mandibular length were 18 to 39 years old. The cephalograms were divided into (117.9 mm) than those of the patients in Class I (55.7, 62.4, 3 groups according to the skeletal pattern based on the A and 125.1 mm, respectively) and Class III (55.8, 66.1, and point–nasion–B point (ANB) angle as follows: Class I maloc- 131.7 mm, respectively). Therefore, the null hypothesis was ° ° ° clusion (0 < ANB < 4 ), Class II malocclusion (ANB ≥ 4 ), accepted for the nasal and maxillary morphology and ° and Class III malocclusion (ANB < 0 ). Each group consisted rejected for the mandibular morphology. of 80 participants (40 males and 40 females). The following As indicated in Table 2, no significant intergroup differ- participants were excluded from the study: (1) those with a ences were observed in the nasomaxillary, condylar, or sym- pathologic disease in the facial bone, (2) those that had physis lengths among male patients. However, among the undergone craniofacial surgery, and (3) those with a history male patients, those in Class II had significantly shorter man- of maxillofacial trauma. dibular ramus, body, and entire lengths than those in Class We followed the methods proposed by Hsiao et al. [7] in III. Among the female patients, those in Class II had greater 2020. The following landmarks (Figure 1) were identified on maxillary lengths than those in Class III (Table 3). Analysis the cephalogram: nasion (N); orbitale (Or); porion (Po); rhi- of all skeletal patterns revealed no significant difference nion (R); the most anterior and inferior point on the tip of among female patients in terms of condylar and symphysis the nasal bone; frontomaxillary nasal suture (MS); the lengths. However, female patients in Class II had a signifi- superior-most point of the suture where the maxilla articu- cantly shorter ramus length than those in Class I and a signif- lates with the frontal and nasal bone; pronasale (Prn); ante- icantly shorter mandibular body and entire mandible length rior nasal spine (ANS); point A; posterior nasal spine than those in Class III. (PNS); prosthion (Pr); infradentale (Id); point B; condylion Table 4 lists the nasomaxillary and mandibular lengths (Cd); antegonial notch (Ag); sigmoid notch (SIG); and men- for each skeletal classification compared using Pearson’s cor- ton (Me). Nasal dimensions were calculated according to the relation coefficient. Age exhibited no significant correlation nasal bone length (N to R), nasal ridge length (N to Prn), and with maxillary or mandibular lengths. The mandibular body nasal depth (Prn vertical to the MS-Pr line). Maxillary length (correlation coefficient: 0.279) and entire length (cor- dimensions were calculated according to the palatal length relation coefficient: 0.236) exhibited a significant positive (ANS to PNS) and maxillary height (MS to Pr). Mandibular correlation with skeletal classification; for example, an indi- dimensions were calculated according to the condylar length vidual with a Class III skeletal pattern had a longer mandib- (the longest distance from Cd to a line parallel to Or-Po line ular body and entire lengths. A significant negative through SIG), ramus length (SIG to Ag), body length (Ag to correlation was noted between variations