Comparison of Cervical Vertebral Body Volume in Class II Vertical and Class II Horizontal Cases With Class I Cases Using 3D-DVT

The branch of orthodontics has had an interest in the cervical vertebrae wherein cervical spine is used as a reference structure for natural head position, so skeletal age was evaluated by studying variations in the cervical vertebral morphologies. Among all evaluations, very limited data is available wherein comparison between cervical vertebral body volumes between the different malocclusions has been done. This study aimed to compare the differences in the volumes of cervical vertebral bodies of C2, C3, and C4 between skeletal class I and class II malocclusions of both horizontal and vertical growth patterns. In class I the volume was significantly lesser as compared to class II. It was seen that there was statistically no significant difference in the volume between the horizontal and vertical growers. It can be concluded from this study that cervical vertebral body volume has no effect on growth pattern. However, variations in cervical vertebral body volume are seen with different malocclusions.

Cone beam computed tomography evaluation of the relationship between atlantodental interval and skeletal facial morphology in adolescents

Introduction

In the pediatric population, computed tomography examination of the upper cervical spine plays an important role in the diagnosis of neurological injuries involving that region. Due to the interconnected nature of the craniofacial structures, a structural change in one is expected to also cause changes in the other structures.

Objective

The aim of this study was to evaluate relationships between atlantodental interval, cervical vertebral morphology, and facial structure in healthy adolescents using cone beam computed tomography.

Methods

Thirty subjects aged 14–20 years (10 males, mean age: 17.2 years; 20 females, mean age: 17.9 years) were included in the study. The anterior, lateral and posterior atlantodental intervals, and vertical and anteroposterior dimensions of the first and second cervical vertebrae were evaluated from cone beam computed tomography images. Facial morphology was evaluated using 7 parameters on lateral cephalometric cone beam computed tomography images and 6 parameters on posteroanterior images. The Mann–Whitney U test and Wilcoxon test were used for statistical analyses.

Results

Comparisons between males and females showed that most parameters were larger in males, with significant differences in vertical facial dimensions (anterior lower face height: p = 0.05; anterior upper face height: p = 0.001), (distance between the most internal point of the frontozygomatic suture and midsagittal reference plane; p = 0.01), (the distance between the deepest point of the right alveolar maxillar process and midsagittal reference plane; p = 0.001), and C2 vertebral dimensions. The anterior and lateral atlantodental interval values correlated with maxilla position relative to the mandible angle, and the anterior atlantodental interval correlated with lower anterior facial height (p = 0.05). Dimensional measurements of the C1 and C2 vertebrae were correlated with both anterior facial heights and some posteroanterior parameters.

Conclusion

Sagittal, vertical, and transverse facial dimensions and positions were strongly associated with C1 and C2 vertebral dimensions, and the maxillomandibular relationship may affect atlantodental interval. Therefore, including craniofacial features in assessment of the atlantodental area and vertebral distances in adolescents may be beneficial.

Relationship between Cervical Spine and Skeletal Class II in Subjects with and without Temporomandibular Disorders

Aim

To assess changes in the craniocervical structure and in hyoid bone position in skeletal Class II subjects with and without temporomandibular disorders (TMD).

Materials and Methods

The cephalometric analysis of 59 subjects with skeletal Class II was evaluated and compared. The measurements considered were ANB as a parameter of Class II and C0-C1 distance, C1-C2 distance, craniocervical angle, and hyoid bone position for the cervical spine analysis. Patients were divided into patients with TMD (group A) and patients without TMD (group B). TMD were evaluated with Diagnostic Criteria for TMD (DC/TMD). Descriptive statistics and Pearson's and Spearman's correlation analysis, with p value <0,005, were performed.

Results

C0-C1 and C1-C2 distance values and hyoid bone position resulted within the normal range in the majority of patients examined. Craniocervical angle was altered in 33 patients. The reduction of this angle with the increase of the ANB value resulted to be statistically significant in group A, according to Pearson's correlation index. No other data were statistically significant.

Conclusions

The significant relationship between skeletal Class II and cervical spine cannot be highlighted. The alteration of craniocervical angle seems to be mildly present, with backward counterclockwise rotation of the head upon the neck in the sample (groups A and B). The presence of TMD as a key factor of changes in neck posture could explain the different result between the two groups about the relationship between ANB and craniocervical angle. This result should be further analyzed in order to better understand if cervical spine changes could be related to mandibular postural ones in the craniocervical space or to temporomandibular joint retropositioning, more recognizable in Class II with TMD, which could determine functional changes in other structures of this unit; neck posture could be the result of a compensatory/antalgic mechanism in response to TMD.

Ethnic differences in craniofacial and upper spine morphology in children with skeletal Class II malocclusion

OBJECTIVES

To analyze differences in upper cervical spine and craniofacial morphology, including posterior cranial fossa and growth prediction signs, between Danish and South Korean pre-orthodontic skeletal Class II children and to analyze associations between upper cervical spine morphology and craniofacial characteristics.

MATERIALS AND METHODS

One hundred forty-six skeletal Class II children-93 Danes (54 boys and 39 girls, mean age 12.2 years) and 53 Koreans (27 boys and 26 girls, mean age 10.8 years)-were included. Upper spine morphology, Atlas dimensions, and craniofacial morphology, including posterior cranial fossa and growth prediction signs, were assessed on lateral cephalograms. Differences and associations were analyzed by multiple linear and logistic regression analyses adjusted for age and gender.

RESULTS

Significant differences between the ethnic groups were found in the sagittal and vertical craniofacial dimensions ( P < .001), mandibular shape ( P < .01), dental relationship ( P < .01), posterior cranial fossa ( P < .05), and growth prediction signs ( P < .001). No significant differences were found in upper spine morphology and Atlas dimensions between the groups. Upper spine morphology/dimensions were significantly associated with the cranial base angle ( P < .01), sagittal craniofacial dimensions ( P < .001), posterior cranial fossa ( P < .001), and growth prediction signs ( P < .05).

CONCLUSIONS

Upper spine morphology/dimensions may be valuable as predictive factors in treatment planning for growing Class II children.

Cone beam computed tomography incidental findings of the cervical spine and clivus: retrospective analysis and review of the literature

OBJECTIVE

The aim of this study was to analyze and describe incidental findings in the cervical spine (C-spine) and the clivus encountered in cone beam computed tomography (CBCT) imaging. The wide range of possible anatomic variants and pathoses is discussed in the context of the medical and dental literature to clarify their radiographic appearance and clinical implications as a guide for the oral and maxillofacial radiologist.

STUDY DESIGN

A retrospective analysis of radiographic reports was conducted based on CBCT images from 2 oral and maxillofacial imaging centers. Reports documenting incidental findings in the C-spine or the clivus were selected. Data on patient age and sex were collected, and each incidental finding was categorized as degenerative, congenital, or developmental/pathologic. Each finding is discussed with clinical importance and is pictorially presented.

RESULTS

From a total of 7689 CBCT reports, there were 732 incidental findings (9.5%) in the C-spine or the clivus. Most findings were in the C-spine (92.3%), were degenerative in nature (78.7%), and occurred in females in their sixth decade. Logistic regression analysis showed that the odds of presenting with a degenerative incidental finding in the C-spine or the clivus did not differ based on sex but were 5.5 times (95% confidence interval, 3.77-8.04) higher if the patient was aged 50 years or older.

CONCLUSIONS

This review is the largest and the first to characterize incidental findings in the C-spine and the clivus. Such findings were reported in 9.5% of radiographic reports. Several presented as uncommon congenital variants that are not usually spotlighted during oral and maxillofacial radiology training.

Nanocrystalline hydroxyapatite intervertebral cages induce fusion after anterior cervical discectomy and may be a safe alternative to PEEK or carbon fiber intervertebral cages

PURPOSE

Nanocrystalline hydroxyapatite (nHA) cages have emerged as a new alternative to carbon fiber or polyether ether ketone (PEEK) devices to promote intervertebral fusion. No evidence has been published to date regarding rates of fusion for these devices after anterior cervical discectomy and fusion (ACDF).

METHODS

Eight patients underwent one- or two-level ACDF with nHA intervertebral cages (Nanoss^®-Cervical, Pioneer^® Surgical Technology, Inc., Marquette, MI). Radiographs, neck disability index (NDI) and visual analog scores (VAS) for pain were taken preoperatively and at a minimum of 19 months postoperatively.

RESULTS

At an average follow-up of 21 months, all eight patients (100%) achieved fusion as assessed by plain radiographs. Reduction in preoperative symptomology was comparable to previously published data with a mean reduction of neck VAS of 3, arm VAS of 6 and NDI reduced by 27%. Radiographs showed clear evidence of bridging bone.

CONCLUSIONS

This series provides evidence that nHA intervertebral cages can successfully promote fusion after ACDF and may provide an alternative to carbon fiber and PEEK cages.

Influence of skeletal class in the morphology of cervical vertebrae: A study using cone beam computed tomography

OBJECTIVES

To quantify the prevalence of cervical vertebrae anomalies and to analyze any association between them and skeletal malocclusions or head posture positions in the same study.

MATERIALS AND METHODS

Two hundred forty patients who were attending the Department of Orthodontics of the University of Valencia for orthodontic treatment were selected and divided into three groups: skeletal Class I (control group, 0° <ANB < 4°), Class II (ANB ≥ 4°), and Class III (ANB ≤ 0°) according to ANB Steiner angle. The morphology of the first five cervical vertebrae was analyzed with cone beam computed tomography to identify any anomalies. Intra- and interobserver error methods were calculated.

RESULTS

Dehiscence and fusion of one unit (both 23.3%) and partial cleft (11.7%) were the most frequent anomalies, while occipitalization was the least common (3.3%). Dehiscence anomaly was observed when the control group was compared with Classes II and III and partial cleft anomaly when Class I was compared with Class III. Furthermore, NSBa and ss-N-sm/ANB angles were associated with partial cleft anomaly, while NSL/NL angle and extended head posture were associated with fusion anomaly.

CONCLUSIONS

Fusion, dehiscence, and partial cleft were the most frequent cervical vertebrae anomalies. Dehiscence and partial cleft were found to present statistically significant differences between Class I and Classes II and III. Cervical vertebrae anomalies and head posture were associated with fusion.

Incidental Findings on Cone Beam Computed Tomography Studies outside of the Maxillofacial Skeleton

Objective. To define the presence and prevalence of incidental findings in and around the base of skull from large field-of-view CBCT of the maxillofacial region and to determine their clinical importance. Methods. Four hundred consecutive large fields of view CBCT scans viewed from January 1, 2007, to January 1, 2014, were retrospectively evaluated for incidental findings of the cervical vertebrae and surrounding structures. Findings were categorized into cervical vertebrae, intracranial, soft tissue, airway, carotid artery, lymph node, and skull base findings. Results. A total of 653 incidental findings were identified in 309 of the 400 CBCT scans. The most prevalent incidental findings were soft tissue calcifications (29.71%), followed by intracranial calcifications (27.11%), cervical vertebrae (20.06%), airway (11.49%), external carotid artery calcification (10.41%), lymph node calcification (0.77%), subcutaneous tissue calcification and calcified tendonitis of the longus colli muscle (0.3%), and skull base finding (0.15%). A significant portion of the incidental findings (31.24%) required referral, 17.76% required monitoring, and 51% did not require either. Conclusion. A comprehensive review of the CBCT images beyond the region of interest, especially incidental findings in the base of skull, cervical vertebrae, pharyngeal airway, and soft tissue, is necessary to avoid overlooking clinically significant lesions.

The distribution of cervical vertebrae anomalies among dental malocclusions

Aims:

The aims of our study were to investigate the distribution of cervical vertebrae anomalies (CVAs) among dental Angle Class I, II, and III malocclusions in Turkish population and whether a correlation between CVA and dental malocclusion.

Materials and Methods:

The study was performed on lateral cephalometric radiographs which were taken at the Department of Orthodontics, Faculty of Dentistry, Kirikkale University. The final sample of 318 orthodontic patients was included in the study. Dental malocclusions were performed according to Angle classification. CVAs were categorized: (1) fusion and (2) posterior arch deficiency (PAD). The Chi-square test was used to the analysis of the potential differences among dental malocclusions.

Results:

The final sample of 318 patients was examined. CVA was observed in 42 individuals (of 26 [8.17%] had fusion and 16 [5.03%] had PAD), with a frequency of 13.2%. Of the 26 fusion defect, 8 (30.7%) had Angle Class I, 8 (30.7%) had Angle Class II, and 10 (38.4%) had Angle Class III malocclusion. Of the 16 PAD, 8 (50%) had Angle Class I, 8 (50%) had Angle Class II but no patients with Angle Class III malocclusion was observed. The distribution of dental malocclusions regarding CVA was not statistically significant (P = 0.076). Of these 42 individuals with CVA, 52.3% (15 fusions and 7 PAD) were females and 47.7% (11 fusions and 9 PAD) were males.

Conclusion:

In our study, the prevalence of fusion and PAD were found 8.1% and 5.0% in Turkish population, respectively. Besides, no statistically significant correlation between CVA and Angle Class I, II, and III malocclusions were found. Our findings support the studies showing no gender dimorphism.

The frequency and nature of incidental findings in large-field cone beam computed tomography scans of an orthodontic sample

Background

The aim of this study is to evaluate the nature and frequency of incidental findings in large-field maxillofacial cone beam computed tomography (CBCT).

Methods

A total of 427 consecutive CBCT radiologic reports obtained for orthodontic purposes were retrospectively reviewed. Findings were summarized and categorized into six anatomic categories.

Results

A total of 842 incidental findings were reported in the 427 CBCT scans (1.97 findings/scan). The most prevalent findings were those located in the airway (42.3%), followed by the paranasal sinuses (30.9%), dentoalveolar (14.7%), surrounding hard/soft tissues (4.0%), temporomandibular joint (TMJ) (6.4%), and cervical vertebrae (1.3%) regions. Non-odontogenic findings, defined as those located outside the dentition and associated alveolus, represented 718 of the 842 (85.3%) findings.

Conclusions

This study confirms the high occurrence of incidental findings in large-field maxillofacial CBCT scans in a sample of orthodontically referred cases. The majority are extragnathic findings, which can be normally considered outside the regions of interest of many dental clinicians. Specifically, incidental findings in the naso-oropharyngeal and paranasal air sinuses are the most frequent. This underscores the need for comprehensive review of the entire data volume and the requisite to properly document all findings, regardless of the region of interest.

Electronic supplementary material

The online version of this article (doi:10.1186/s40510-014-0037-x) contains supplementary material, which is available to authorized users.

Cervical vertebral column morphology and head posture in preorthodontic patients with anterior open bite

INTRODUCTION

Cervical vertebral column morphology and head posture were examined and related to craniofacial morphology in preorthodontic children and adolescents with anterior open bite.

METHODS

One hundred eleven patients (ages, 6-18 years) with an anterior open bite of more than 0 mm were divided into 2 groups of skeletal or dentoalveolar open bite. The skeletal open-bite group comprised 38 subjects (19 girls, 19 boys). The dentoalveolar open-bite group comprised 73 subjects (43 girls, 30 boys). Visual assessment of the cervical column and measurements of craniofacial morphology and head posture were made on profile radiographs.

RESULTS

Deviations in the cervical vertebral column morphology occurred in 23.7% of the subjects in the skeletal open-bite group and in 19.2% in the dentoalveolar open-bite group, but the difference was not significant. Head posture was significantly more extended in the skeletal open-bite group compared with the dentoalveolar open-bite group (craniovertical angle [Mx/VER], P <0.05; craniocervical angles [Mx/OPT, Mx/CVT], P <0.01. Only head posture was associated with craniofacial morphology: extended posture was associated with a large cranial base angle (P <0.01, P <0.001), large vertical craniofacial dimensions (P <0.05; P <0.01; P <0.001), and retrognathia of the jaws (P <0.001).

CONCLUSIONS

Cervical column morphology is described for the first time in children and adolescents with open bite. No significant differences in the cervical vertebral column's morphologic deviations were found between the skeletal and the dentoalveolar open-bite groups. Significant differences were found in head posture between the groups and with regard to associations with craniofacial dimensions. This might indicate a respiratory etiologic component in children with anterior open bite.

Upper spine morphology in hypophosphatemic rickets and healthy controls: a radiographic study

BACKGROUND/OBJECTIVES

The aim of this study was to describe upper spine morphology in adult patients with hypophosphatemic rickets (HR) compared with controls to assess differences in spine morphology in terms of severity of skeletal impact and to study associations between spine morphology and craniofacial morphology.

MATERIAL/METHODS

The study population comprised 36 HR patients and 49 controls. The atlas and axis dimensions were measured on cephalograms, and the differences between the groups were estimated by regression analysis. The upper spine morphology was visually assessed to estimate the prevalence of cervical vertebral anomalies.

RESULTS

The dimensions of the atlas and the axis were larger in HR patients than in controls (P ≤ 0.001), and fusions (FUS) occurred more often in HR patients (39%) than in controls (6%; P ≤ 0.001). In HR patients, the length of the atlas correlated positively (P = 0.008) and the height of the dens correlated negatively (P = 0.043) with the severity of skeletal impact. The height of the posterior arch of the atlas and the length of the axis correlated negatively with the cranial base angle (P ≤ 0.017), and the vertical dimensions of the atlas correlated positively with the thickness of the occipital skull (P ≤ 0.015). The length of the atlas correlated positively with mandibular prognathism (P = 0.042). FUS correlated positively with the frontal and parietal thickness (P = 0.034 and P = 0.003, respectively).

CONCLUSIONS

The dimension of the atlas and the axis and the prevalence of the FUS were increased in HR patients compared with controls. Upper spine dimensions were associated with craniofacial dimensions, primarily in relation to the posterior cranial fossa.

Cervical vertebral column morphology in patients with obstructive sleep apnoea assessed using lateral cephalograms and cone beam CT. A comparative study

OBJECTIVES

Few studies have described morphological deviations in obstructive sleep apnoea (OSA) patients on two-dimensional (2D) lateral cephalograms, and the reliability of 2D radiographs has been discussed. The objective is to describe the morphology of the cervical vertebral column on cone beam CT (CBCT) in adult patients with OSA and to compare 2D lateral cephalograms with three-dimensional (3D) CBCT images.

METHODS

For all 57 OSA patients, the cervical vertebral column morphology was evaluated on lateral cephalograms and CBCT images and compared according to fusion anomalies and posterior arch deficiency.

RESULTS

The CBCT assessment showed that 21.1% had fusion anomalies of the cervical column, i.e. fusion between two cervical vertebrae (10.5%), block fusions (8.8%) or occipitalization (1.8%). Posterior arch deficiency occurred in 14% as partial cleft of C1 and in 3.5% in combination with block fusions. The agreement between the occurrence of morphological deviations in the cervical vertebral column between lateral cephalograms and CBCT images showed good agreement (κ = 0.64).

CONCLUSIONS

Prevalence and pattern in the cervical column morphology have now been confirmed on CBCT. The occurrence of morphological deviations in the cervical vertebral column showed good agreement between lateral cephalograms and CBCT images. This indicates that 2D lateral cephalograms (already available after indication in connection with, e.g. treatment planning) are sufficient for identifying morphological deviations in the cervical vertebral column. For a more accurate diagnosis and location of the deviations, CBCT is required. New 3D methods will suggest a need for new detailed characterization and division of deviations in cervical vertebral column morphology.