Craniofacial morphology in obese adolescents

Craniofacial features of adult obese obstructive sleep apnoea patients in relation to the obesity onset - A pilot study

INTRODUCTION

Obesity and craniofacial structures are aetiologies of obstructive sleep apnoea (OSA). The effect of obesity onset on the craniofacial development and growth of obese OSA subjects has been suggested, but supporting data were lacking. This study aimed to assess the craniofacial features of adult obese OSA patients in relation to their obesity onset.

MATERIALS AND METHODS

A total of 62 adult OSA patients were included in the study, consisting of 12 early-onset (i.e. before puberty), 21 late-onset (i.e. after puberty) and 29 non-obese. All participants underwent a sleep study and cephalometric radiograph. Cephalometric analysis was conducted to measure the craniofacial features among the groups.

RESULTS

The early obesity onset group (n = 12) showed a more prognathic mandible, longer lower facial height, protrusive incisors, a more caudal position of the hyoid bone and a wider lower airway. The late-onset group (n = 21) had more proclined and protrusive upper incisors, a shallower overbite, a more inferiorly positioned hyoid bone and an obtuse craniocervical angle. The overall obese group showed a combination of the findings above, plus a shorter soft palate and shorter airway length. There was no significant difference between early and late obesity onset groups. However, the early group showed a tendency for a shallower or decreased mandibular plane angle and deeper overbite.

CONCLUSIONS

The current pilot study had many limitations but holds important information as a hypothesis generator. Craniofacial features of OSA patients with different obesity onset showed discrepancies and were distinguished from non-obese controls. Adult OSA patients with an early obesity onset showed a tendency for a more hypodivergent growth pattern than those with a late obesity onset.

Effect of body mass index on soft tissues in adolescents with skeletal class I and normal facial height

Background

The evaluation of soft tissues in patients undergoing orthodontic treatment plays a critical role in diagnosis and treatment planning. This study aims to evaluate the effect of body mass index (BMI) on facial soft tissues in skeletal Class I patients with normal vertical growth.

Methods

The study included 72 patients with a normal vertical growth pattern (SN-GoGn 26-38°) and skeletal Class I (ANB 2‒4°) malocclusion. According to their BMI (kg/m2) values, the patients were divided into three groups of 24 individuals each: underweight (>5th percentile) (13 females, 11 males; mean age, 11.58 ± 1.95 years), normal weight (5‒85th percentile) (12 females, 12 males; mean age, 11.54 ± 1.95 years), overweight (85‒95th percentile) (12 females, 12 males; mean age, 11.62 ± 2.01 years). Soft tissue thickness and height measurements were made on lateral cephalometric radiographs.

Results

In all soft tissue thickness measurements, except for the nasion, the overweight weight group had higher values. In comparing the underweight and normal weight groups, statistically significant differences were found in the thickness measurements at the nasion and gnathion (p < 0.05). The differences in thickness measurements at the glabella, labiale superius, stomion, labiale inferius, pogonion, gnathion, and menton are statistically significant between the underweight and overweight groups (p < 0.005). Comparing the normal and overweight groups revealed statistically significant differences the thickness measurements at the glabella, labiale superius, stomion, pogonion and menton (p < 0.05).

Effects of obesity on the rat incisor enamel and dentine thickness, as well as on the hemimandible shape over generations

Obesity has several effects on the general body metabolism. However, little is known about the impact of obesity on the growth and shape of mineralized tissues like mandibles and teeth, as well as if it effects are passed down from generation to next. Therefore, in this study, we aimed to evaluate, over nine generations using the consanguineous mating (inbreeding), the effect of the obesity condition produced by the reduction in the number of rats per litter during the lactation period on the hemimandible shape, dentine, and enamel of the rat incisor. Litters were reduced to two males and two females after birth, and were consanguinity mated in adulthood for nine generations. For all evaluations performed in this investigation, only males were used. The control group was formed by a non-consanguineous litter containing eight males. The parameters evaluated were food consumption, body weight, Lee Index, and bone density of the hemimandible bone. Incisor enamel and dentine thickness were also evaluated. The hemimandible shape was evaluated using geometric morphometry. The results show a significant and progressive increase in food intake, Lee Index, body weight, hemimandible weight, and enamel thickness, and a decrease in dentine thickness. The linear measurements of the length of the ramus ascending hemimandibular segment were found to be shorter, while its height was increased. In contrast, the geometric morphometry shows that the general hemimandible shape changed over the consanguineous obesity generations. We conclude that over generations, obesity increases and maintains the parameters evaluated with significant changes in hemimandible shape as well as in the dimensions of enamel and dentine of incisors, suggesting that enamel and dentine could be used as phenotype biomarkers to detect changes in tooth and craniofacial development related to obesity effects.

The Association Between Nasal Skin Thickness and Body Mass Index in Preoperative Rhinoplasty Patients: A Prospective Study

OBJECTIVES

Skin quality plays a major role in aesthetics, particularly in determining the success of rhinoplasty. Efficient preoperative estimation of nasal skin thickness can improve postoperative results and patient satisfaction. This study aimed to report on the relationship between nasal skin thickness and body mass index (BMI) as a possible tool to measure skin thickness preoperatively among rhinoplasty patients.

METHODS

This prospective cross-sectional study targeted patients who visited a rhinoplasty clinic at King Abdul-Aziz University Hospital, Riyadh, Saudi Arabia, between January 2021 and November 2021, and agreed to participate in the study. Data on age, sex, height, weight, and Fitzpatrick skin types were collected. The participant visited the radiology department and underwent ultrasound nasal skin thickness measurement for the five different nasal points.

RESULTS

The study included 43 participants (16 males and 27 females). The average skin thickness of the supratip area and the tip was significantly higher in males than in females (P < 0.05). The average BMI of the participants was 25.8 ± 5.26 Kg/m2. Participants with a normal BMI or less represented 50% of the study sample, whereas overweight and obese represented one-quarter (27.9%) and one-fifth (21%), respectively.

CONCLUSION

BMI was not associated with nasal skin thickness. Differences in nasal skin thickness were found between the sexes.

Craniofacial form differences between obese and nonobese children

INTRODUCTION

Current evidence suggests that obesity is correlated with differences in craniofacial form in children and adolescents. Here, we sought to test this hypothesis by evaluating the craniofacial form of obese and nonobese preorthodontic patients, using 2D cephalometric data combined with cephalometric and geometric morphometric approaches.

METHODS

Height, weight, age, and lateral cephalometric radiographs were gathered from patients aged 7-16 years before beginning orthodontic treatment at the University of British Columbia. Based on their body mass index, 24 obese patients were age, sex, and Angle classification of malocclusion matched with nonobese controls. Cephalometric radiographs were annotated, and coordinates of landmarks were used to obtain linear and angular cephalometric measurements. Geometric morphometric analyses were performed to determine overall craniofacial form differences between cohorts. Dental maturation index scores and cervical vertebral maturation scores were recorded as an indicator of skeletal maturation.

RESULTS

Cephalometric analysis revealed that the maxillary length and gonial angle are the only marginally larger metrics in obese subjects than in control subjects. However, principal component and discriminant analyses (geometric morphometrics) confirmed that the overall craniofacial form of obese patients differs statistically from that of control patients. Obese patients tend to be slightly mandibular prognathic and brachycephalic. Dental maturation index scores were statistically higher in the obese group than in the control group, with no statistical difference in cervical vertebral maturation scores.

CONCLUSIONS

Our data reveals a subtle but significant difference in cranial skeletal morphology between obese and nonobese children and adolescents, suggesting a correlation between craniofacial form and physiological/metabolic phenotypes of subjects. It is likely that with continued growth, these differences may increase. Recording body mass index as part of the orthodontic records for patients may help in supporting the assessment of craniofacial form.

Evaluation of facial soft-tissue values and craniofacial morphology in obese adolescent patients with different skeletal classes

Objectives:

The purpose of this study was to evaluate the facial soft tissue and craniofacial morphological structures in adolescent obese individuals with different skeletal patterns.

Materials and Methods:

The study was carried out on 292 adolescents examined under three groups based on their body mass indexes (BMIs) as obese, healthy, and overweight. The subjects were also categorized based on skeletal classes as Class I, Class II, and Class III.

Results:

The glabella, nasion, labiale inferius, labiomentale, and pogonion values of the female patients were significantly higher in obese group. In the obese and overweight groups, effective midfacial and mandibular length, anterior and posterior facial heights, and SN values of the females were higher than males. In the obese group, the mean effective midfacial and mandibular length (Co-A and Co-Gn), anterior and posterior facial heights (S-Go and N-Me), and anterior cranial base (SN) values were significantly higher than other groups.

Conclusion:

Soft-tissue thicknesses increase as BMI value increases. Craniofacial morphology reveals significant differences between BMI groups.

Childhood obesity may accelerate timing of human facial growth

OBJECTIVE

We hypothesize that childhood obesity influences both facial and mandibular size and form in children and adolescents.

DESIGN

Pre-treatment records of patients (n = 181; 86 males, 95 females) from the Department of Orthodontics at the University of Illinois at Chicago representing six different ancestry groups (Asian, African-American, Caucasian Non-Hispanic, Hispanic, Multiracial, Unknown) were reviewed retrospectively. Body mass index (BMI) scores and categories were calculated using the Center for Disease Control and Prevention (CDC) guidelines. Twenty-two landmarks were collected on lateral cephalometric radiographs. The landmark dataset was analyzed as a whole (facial shape) and a subset of landmarks was also used to study mandibular shape in isolation.

RESULTS

Evidence of allometry (size related shape differences) was detected. Principal Component Analyses (PCA) were performed on the allometric regression residuals. Overall facial shape did not correlate with BMI. A series of one-way ANOVA tests on PC1-6 on a mandible-only subset of the landmarks using BMI category (normal, overweight, obese) showed PC5 and PC6 were significant (p = 0.003; p = 0.027). Centroid size was positively correlated with BMI when controlling for age (facial: p = 0.011, r = 0.196; mandibular: p < 0.001, r = 0.256).

CONCLUSIONS

Our results mostly did not support a relationship between high BMI and facial shape. However, we found larger facial skeletal sizes in high BMI children, providing tentative evidence that childhood obesity may lead to accelerated timing of facial growth.

Effect of body mass index percentile on skeletal maturation of cervical vertebrae and hand-wrist and dental maturation

Objective: The aim of this study was to evaluate the relationship between age- and gender-specific body mass index (BMI) percentile and skeletal and dental maturation in Turkish adolescents.Materials and methods: A sample of 429 patients (171 males, 258 females aged between 7 and 17 years) was selected. Skeletal maturation was identified in the hand-wrist radiography by Björk, Grave and Brown (BGB), and the cervical vertebrae maturation (CVM) method defined by Hassel and Farman in lateral cephalometric radiography. Dental maturation was determined by the Demirjian method. BMI was calculated by reference curves used for Turkish children. A regression model was used for the relationship between BMI percentile and skeletal and dental maturation.Results: There was no significant correlation between BMI and skeletal maturation of cervical vertebrae and dental maturation. A one-percentile increase in BMI percentile accelerates the increase of period (likelihood of being post-pubertal period) to 1.016 times (p < .05). Skeletal maturation of hand-wrist and cervical vertebrae and dental maturation were more prominent in females compared to males (p < .05). Males and females were not statistically significantly different in BMI percentile (p = .52).Conclusions: BMI may be considered before deciding to estimate the skeletal and dental maturation in an individual by the relevant methods.

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies

Objectives:

To assess the impact of increased body mass index (BMI) on orthodontic tooth movement (OTM) and related parameters in children and adolescents.

Search sources:

A search of six electronic databases and manual searching were performed up to June 2019 without language and time restrictions.

Data selection:

Eligibility criteria were as follows: (1) longitudinal controlled clinical studies; (2) children and adolescents undergoing orthodontic therapy (OT); (3) no systemic diseases; (4) experimental group: patients with increased BMI; and (5) control group: patients with normal BMI.

Data extraction:

Screening, study selection and data extraction were performed; bias within studies was assessed using the Risk of Bias In Non-randomised Studies (ROBINS-I) tool.

Results:

Seven studies were included. One study showed that an increased BMI is associated with less wear-time of removable orthodontic appliances and one study found no significant association. One study showed that an increased BMI is associated with less cooperation during OT; however, not with the treatment results. One study reported higher pain experience during OT in adolescents with than without increased BMI. Two studies showed that increased BMI in adolescents is related to OTM, one with increased and one with decreased rates of OTM, respectively. One study reported an association between increased BMI and incidence of white spot lesions and gingivitis during OT. The ROBINS-I tool showed low to moderate risk of bias within studies.

Conclusions:

The influence of BMI on OTM and related parameters in children and adolescents remains debatable.

Association of obesity with the eruption of first and second permanent molars in children: a systematic review

BACKGROUND

Eruption timing of permanent teeth, particularly first and second molars, is of great importance due to its influence on occlusion, caries risk and timing of preventive and orthodontic intervention.

AIM

To evaluate the evidence assessing the correlation between obesity and eruption time of first and second permanent molars in children under 16 years of age as compared to normal-weight children. A secondary aim was to assess the total number of erupted teeth in both groups.

METHODS

A systematic search of databases including PubMed, MEDLINE, EMBASE, Scopus and Web of Science was conducted. Studies that assessed the effect of body mass index (BMI), adjusted BMI or z scores on dental eruption were included. National Institute of Health 'Quality Assessment Tool for Observational Cohort and Cross-sectional Studies' was used to assess the quality of included papers. A random-effects model with its 95% confidence intervals (CIs) was considered for meta-analysis.

RESULTS

A total of 381 papers were screened following duplicate removal. Twenty-six papers were read in full text, of which 19 were excluded. Seven studies were included in this review; one was longitudinal, and six were cross-sectional in design. A positive association of dental eruption with obesity was noted in six studies. Two studies were included in the explorative meta-analysis, the results of which indicated that obese, 12-year-olds are likely to have one more erupted tooth than their counterparts with a mean difference (MD) of (0.99, 95% CI 0.628-1.352).

CONCLUSION

There appears to be a positive correlation between obesity and dental eruption including the eruption timing of first and second permanent molars. Main risk of bias arises from the cross-sectional nature of included studies and lack of control of potential confounders. Further high-quality evidence is required to elucidate this association. Registration PROSPERO (CRD42017084368).

REGISTRATION

PROSPERO (CRD42017084368).

The relationship of obesity to the timing of permanent tooth emergence in Czech children

BACKGROUND

The aim of this study was to investigate the influence of BMI on the timing of permanent tooth emergence in Czech children.

OBJECTIVES

In this cross-sectional study, 1370 Czech children were examined. The age, gender, weight, height, all emerged permanent teeth (except third molars) of each child were all recorded. A tooth is defined as having emerged when at least any part of it has penetrated the gingiva.

METHODS

A logistic regression model was used to calculate the median emergence age per tooth for both genders separately and BMI was used as a factor variable to detect statistically significant differences in the times of tooth emergence within pairs of BMI groups. The data were statistically processed using IBM SPSS Statistics 23 (SPSS Inc., Chicago, IL).

RESULTS

Statistically significant differences were found for the following permanent teeth (using the FDI two-digit system): 13, 14, 15, 16, 17, 41, 44, 45, 46, 47, 33, 35, 37, 21, 24, 25, 26, 27 for girls and 12, 13, 14, 15, 16, 41, 43, 44, 45, 22, 25, 32, 34, 35, 36 for boys. These teeth were observed to emerge earlier in obese children. A similar correlation (although not statistically significant) was observed between the time of emergence of the remaining teeth and the BMI of the child.

CONCLUSION

The data in this research highlight significant differences in emergence times of permanent teeth due to the influence of BMI in Czech children. These findings are important for dental treatment planning.

Analysis of facial soft tissue values and cranial skeletal widths in different body mass index percentile adolescent subjects

OBJECTIVE

The purpose of this study was to analyze facial soft tissue thickness and cranial skeletal transverse widths in adolescent subjects with different body mass index (BMI) percentiles.

METHODS

The 80 subjects were divided into three groups according to BMI percentile: normal-weight, overweight, and obese adolescent subjects. Facial soft tissue linear and cranial skeletal transversal width measurements were performed on lateral and postero-anterior cephalometric radiographs.

RESULTS

Glabella, nasion, pogonion, and gnathion soft tissue thicknesses were significantly different among normal-weight, overweight, and obese subjects (p < 0.05). However, other facial soft tissue thickness parameters were not statistically significantly different among the groups (p > 0.05). Moreover, there were no significant differences in cranial skeletal transversal widths among groups (p > 0.05).

CONCLUSION

Nasion soft tissue thickness was thicker in overweight subjects; whereas, glabella, pogonion and gnathion soft tissue thickness was thicker in obese subjects. All measured cranial skeletal widths were similar in normal-weight, overweight, and obese subjects.

A Contemporary Examination of First and Second Permanent Molar Emergence

The emergence of first permanent molars (FPMs) and second permanent molars (SPMs) is an important developmental milestone influencing caries risk and the timing of sealant placement. Emergence times have been shown to vary by sex and race/ethnicity, while recent reports suggest a positive association with adiposity. Amid the changing demographics of the US population and the rising rates of pediatric overweight/obesity, we sought to examine the association of body mass index (BMI) with FPM/SPM emergence in a representative sample of US children and adolescents. We used cross-sectional data from 3 consecutive cycles of the National Health and Nutrition Examination Survey (2009 to 2014). The FPM analysis included ages 4 to 8 y ( n = 3,102 representing ~20 million children), and the SPM analysis included ages 9 to 13 y ( n = 2,774 representing ~19 million children/adolescents). The Centers for Disease Control and Prevention's growth chart data were used to calculate age- and sex-specific BMI percentiles, as measures of adiposity. Initial data analyses relied on descriptive statistics and stratified analyses. We used multivariate methods, including survey linear and ordinal logistic regression and marginal effects estimation to quantify the association between pediatric overweight/obesity and FPM/SPM emergence, adjusting for age, sex, and race/ethnicity. Forty-eight percent of 6-y-olds and 98% of 8-y-olds had all FPMs emerged, whereas SPM emergence varied more. Blacks (vs. whites) and females (vs. males) experienced earlier emergence of FPMs and SPMs. Overweight/obesity was associated with earlier FPM emergence, particularly among black females. Obesity but not overweight was associated with earlier SPM emergence. Overall, overweight/obesity accounted for 6 to 12 mo of dental acceleration. This study's results emanate from the most recent US-representative data and affirm that FPM/SPM emergence varies by race/ethnicity and sex and is positively influenced by BMI. Future research should further elucidate these associations with detailed eruption data and examine the implications of this variation for clinical care.

Lateral facial profile may reveal the risk for sleep disordered breathing in children--the PANIC-study

OBJECTIVE

To evaluate the lateral view photography of the face as a tool for assessing morphological properties (i.e. facial convexity) as a risk factor for sleep disordered breathing (SDB) in children and to test how reliably oral health and non-oral healthcare professionals can visually discern the lateral profile of the face from the photographs.

MATERIALS AND METHODS

The present study sample consisted of 382 children 6-8 years of age who were participants in the Physical Activity and Nutrition in Children (PANIC) Study. Sleep was assessed by a sleep questionnaire administered by the parents. SDB was defined as apnoeas, frequent or loud snoring or nocturnal mouth breathing observed by the parents. The facial convexity was assessed with three different methods. First, it was clinically evaluated by the reference orthodontist (T.I.). Second, lateral view photographs were taken to visually sub-divide the facial profile into convex, normal or concave. The photos were examined by a reference orthodontist and seven different healthcare professionals who work with children and also by a dental student. The inter- and intra-examiner consistencies were calculated by Kappa statistics. Three soft tissue landmarks of the facial profile, soft tissue Glabella (G`), Subnasale (Sn) and soft tissue Pogonion (Pg`) were digitally identified to analyze convexity of the face and the intra-examiner reproducibility of the reference orthodontist was determined by calculating intra-class correlation coefficients (ICCs). The third way to express the convexity of the face was to calculate the angle of facial convexity (G`-Sn-Pg`) and to group it into quintiles. For analysis the lowest quintile (≤164.2°) was set to represent the most convex facial profile.

RESULTS

The prevalence of the SDB in children with the most convex profiles expressed with the lowest quintile of the angle G`-Sn-Pg` (≤164.2°) was almost 2-fold (14.5%) compared to those with normal profile (8.1%) (p = 0.084). The inter-examiner Kappa values between the reference orthodontist and the other examiners for visually assessing the facial profile with the photographs ranged from poor-to-moderate (0.000-0.579). The best Kappa values were achieved between the two orthodontists (0.579). The intra-examiner Kappa value of the reference orthodontist for assessing the profiles was 0.920, with the agreement of 93.3%. In the ICC and its 95% CI between the two digital measurements, the angles of convexity of the facial profile (G`-Sn-Pg`) of the reference orthodontist were 0.980 and 0.951-0.992.

CONCLUSION

In addition to orthodontists, it would be advantageous if also other healthcare professionals could play a key role in identifying certain risk features for SDB. However, the present results indicate that, in order to recognize the morphological risk for SDB, one would need to be trained for the purpose and, as well, needs sufficient knowledge of the growth and development of the face.

Association between malocclusion and headache among 12- to 15-year-old adolescents: a population-based study

OBJECTIVES

Headaches are a common problem among adolescents, and malocclusion is a possible risk factor. The purpose of this study was to investigate the association between malocclusion and headache among Japanese adolescents aged 12-15 years using a population-based sample.

METHODS

A total of 938 adolescents (94.7% of the target population in Koshu City) participated. A modified version of the Index of Orthodontic Treatment Need (IOTN) was used by orthodontists to evaluate occlusal characteristics, and the frequency of headaches (none, rarely, sometimes) was assessed via questionnaire (N = 938). Ordered logistic regression analyses were used to analyze the association between malocclusion and headache.

RESULTS

The prevalence of malocclusion diagnosed using the modified version of the IOTN was 44.9%. Multiple ordered logistic regression analyses showed that the odds ratio (OR) of having malocclusion for headache was 1.38 (95% confidence interval [CI]: 1.06-1.80), after adjustment for demographics, lifestyle, and dental status including orthodontic treatment history and tooth size. Moreover, among occlusal traits, lower crowding was independently associated with headache (OR: 1.64, 95% CI: 1.07-2.51).

CONCLUSIONS

We found that malocclusion, especially lower crowding, was associated with headache in a population-based sample of adolescents aged 12-15 years in Japan. Further study is needed to elucidate the mechanisms by which malocclusion affects headache.

A population-based cross-sectional study of the association between facial morphology and cardiometabolic risk factors in adolescence

OBJECTIVE

To determine whether facial morphology is associated with fasting insulin, glucose and lipids independent of body mass index (BMI) in adolescents.

DESIGN

Population-based cross-sectional study.

SETTING

Avon Longitudinal Study of Parents and Children (ALSPAC), South West of England.

PARTICIPANTS

From the ALSPAC database of 4747 three-dimensional facial laser scans, collected during a follow-up clinic at the age of 15, 2348 white British adolescents (1127 males and 1221 females) were selected on the basis of complete data on cardiometabolic parameters, BMI and Tanner's pubertal stage.

MAIN OUTCOME MEASURES

Fasting insulin, glucose and lipids (triglycerides, high-density lipoprotein cholesterol (HDLc) and low-density lipoprotein cholesterol (LDLc)).

RESULTS

On the basis of the collection of 63 x, y and z coordinates of 21 anthropometric landmarks, 14 facial principal components (PCs) were identified. These components explained 82% of the variation in facial morphology and were used as exposure variables. With adjustment for age, gender and pubertal stage, seven PCs were associated with fasting insulin, none with glucose, three with triglycerides, three with HDLc and four with LDLc. After additional adjustment for BMI, four PCs remained associated with fasting insulin, one with triglycerides and two with LDLc. None of these associations withstood adjustment for multiple comparisons.

CONCLUSIONS

These initial hypotheses generating analyses provide no evidence that facial morphology is importantly related to cardiometabolic outcomes. Further examination might be warranted. Facial morphology assessment may have value in identifying other areas of disease risk.

Morphometry of the soft tissues of the orbital region in Northern Sudanese persons

The orbital region plays a predominant role in the evaluation of the craniofacial complex. No current normative data exist for Northern Sudanese subjects. In the current study information about normal sex- and age-related dimensions of the orbital region was provided. The three-dimensional coordinates of ten landmarks on the orbital soft tissues were obtained using a hand-held laser scanner in 654 healthy Northern Sudanese subjects aged 4-30 years. From the landmarks, biocular and intercanthal widths, paired height and inclination of the orbit relative to both the true horizontal (head in natural head position) and Frankfurt plane, length and inclination of the eye fissure, the relevant ratios, were calculated, and averaged for age and sex. Comparisons were performed by factorial analysis of variance. All analysed linear soft-tissue orbital dimensions, except intercanthal width and left orbital height, were significantly larger in men than in women (p<0.01). A significant sexual dimorphism was found also for the height-to-width ratios (larger in women in most age groups), the orbital inclinations vs. the true horizontal and Frankfurt plane (both measurements were almost always larger in men than in women), and the right side inclination of the eye fissure vs. the true horizontal (larger in women than in men), while no sex-related differences were observed for the left side inclination of the eye fissure vs. the true horizontal. All measurements but the right side inclination of the eye fissure vs. the true horizontal underwent significant modifications as a function of age, with several significant age×sex interactions. Biocular and intercanthal widths, orbital height, length of the eye fissure, all increased from childhood to young adulthood; in the second decade of life all age-related increments were larger in men than in women. Overall, when compared to literature data for African and Caucasoid subjects, several differences were found, pointing to the necessity of ethnic-specific data. Data collected in the present investigation could serve as a database for the quantitative description of human orbital morphology during normal growth and development. Forensic applications (evaluations of traumas, craniofacial alterations, teratogenic-induced conditions, facial reconstruction, ageing of living and dead people, personal identification) may also benefit from age- and sex-based data banks.

Associations between craniofacial morphology, head posture, and cervical vertebral body fusions in men with sleep apnea

INTRODUCTION

The aim of this study was to analyze craniofacial profiles and head posture in patients with obstructive sleep apnea (OSA) subgrouped according to cervical column morphology.

METHODS

Seventy-four white men aged 27 to 65 years (mean, 49.0 years) diagnosed with OSA in sleep studies by using overnight polysomnography were included. Only patients with apnea-hypopnea index scores between 5.1 and 92.7 (mean, 36.4) were included. Lateral profile radiographs in standardized head posture were taken, and cephalometric analyses of sagittal and vertical jaw relationships were made. The patients were divided into 4 groups according to fusion in the cervical vertebrae: group I, no fusions (42 subjects); group II, fusion of cervical vertebrae 2 and 3 (15 subjects); group III, occipitalization (10 subjects); and group IV, block fusion (11 subjects). Mean differences of craniofacial dimensions between the groups were assessed by unpaired t tests.

RESULTS

No significant differences were seen between groups I and III. Between groups I and II, significant differences were seen in jaw relationship (P < 0.05). Between groups I and IV, anterior face height and mandibular length deviated significantly. No significant differences were seen in head posture.

CONCLUSIONS

OSA patients with block fusions in the cervical vertebrae and fusion of 2 vertebrae differed significantly in craniofacial profile from other OSA patients.

Analyse des implications du tissu graisseux dans la morphologie faciale, à partir d'une revue de la littérature et de dissections de dix hémifaces

The morphological implications of the fatty tissue of the face are unequal. We study these with a review of the literature and an anatomical study with dissections of 10 half-faces. The sub-cutaneous fat, over the superficialis fascia, have got the most important implications on the morphology. These depend of the localisations on the face and the age and the weight of each subject. We can observe modifications of the positions of this fatty layer on old subjects, but also a diminution of its volume. The sub-fascial fatty tissue, above the SMAS is represented by few fat pads and seems ,to bee less concerned by modifications of its volumes.

Obesity in adolescence: Implications in orthodontic treatment

The incidence of obesity is increasing in the United States and around the world, and it is likely that obese patients will present for orthodontic therapy in greater numbers in the future. The implications of obesity for psychosocial well-being, bone metabolism, craniofacial growth, and pubertal growth must be assessed in treating obese orthodontic patients. This review article focuses on the relevant issues concerning obesity in regard to orthodontic therapy.

Craniofacial development in obese adolescents

The purpose of this study was to investigate craniofacial morphology in obese adolescents and to compare the morphological data with those of normal adolescents. The study was based on measurements of lateral cephalometric roentgenograms of adolescents who had been diagnosed as obese. Linear and angular measurements were obtained from cephalometric tracings of 27 females (mean age 15.6 +/- 0.83 years) and 23 males (mean age 13.9 +/- 0.98 years). The data were compared with corresponding measurements of gender and age matched controls. The results showed that both males and females in the obesity group exhibited significantly larger mandibular and maxillary dimensions than the controls. On average, mandibular length (Cd-Pgn) was 10 mm greater in males and 8 mm greater in females. Maxillary length (Pm-A) was 3.5 mm greater in males and 3 mm greater in females. When considering vertical dimensions, lower anterior (Ans-Gn) and posterior (S-Go) face height were 4 and 5 mm greater in the obese males, respectively, while in the obese females both these distances were 4 mm greater compared with the controls. Both maxillary (SNA) and mandibular (SNB, SNPg) prognathism were more pronounced in the obesity group than in the control group. This also influenced the average soft tissue profile, which was less convex in the obesity groups. The mandibular plane angle (ML/SN) was smaller in the obesity group than in the control group. Craniofacial morphology differs between obese and normal adolescents. In general, obesity was associated with bimaxillary prognathism and relatively greater facial measurements.

Childhood obesity and hormonal abnormalities associated with cancer risk

There is growing evidence that overweight and obesity increase the risk of certain cancers. Studies in adults support the role of insulin-like growth factors (IGFs) and oestrogens in the pathogeneses of several cancers. We propose that hormone alterations described as risk factors for cancer in obese adults are present in prepubertal obese children. A group of obese children aged 6-9 years (n=40), and control group paired for age and sex, were used for the study. The obese children presented a significantly high level of IGF-I (P=0.0173) and insulin (P=0.0250), with a drop in sex hormone-binding globulin (SHBG) (P=0.0282). The 17 beta-oestradiol (E2)/SHBG ratio increase in obese subjects was marginally significant (P=0.0635). Grouping together all the children in quartiles for insulin and body mass index, the upper quartiles showed a rise in IGF-I and E2/SHBG. In a multivariant correlation analysis, only height (partial r=0.2464) and insulin (partial r=0.3002) were independent prediction variables for IGF-I concentration. The only variables statistically correlated with the E2/SHBG ratio were insulin (r=0.2879) and IGF-I (r=0.4140). The obese children in our study showed hormone changes described as risk factors for cancer in obese adults. These changes were significantly associated with the hyperinsulinaemia. We hypothesize that this potential risk should be taken into account given the long period of exposure involved in the presence of hormone alterations at such early ages.