Development and Validation of a Nomogram for Predicting Obstructive Sleep Apnea Severity in Children

Purpose

The clinical presentation of Obstructive Sleep Apnea (OSA) in children is insidious and harmful. Early identification of children with OSA, particularly those at a higher risk for severe symptoms, is essential for making informed clinical decisions and improving long-term outcomes. Therefore, we developed and validated a risk prediction model for severity in Chinese children with OSA to effectively identify children with moderate-to-severe OSA in a clinical setting.

Patients and Methods

From June 2023 to September 2023, we retrospectively analyzed the medical records of 367 Children diagnosed with OSA through portable bedside polysomnography (PSG). Predictor variables were screened using the least absolute shrinkage and selection operator (LASSO) and logistic regression techniques to construct nomogram to predict the severity of OSA. Receiver operating characteristic curve (ROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) were used to determine the discrimination, calibration, and clinical usefulness of the nomogram.

Results

A total of 367 children with a median age of 84 months were included in this study. Neck circumference, ANB, gender, learning problem, and level of obstruction were identified as independent risk factors for moderate-severe OSA. The consistency indices of the nomogram in the training and validation cohorts were 0.841 and 0.75, respectively. The nomogram demonstrated a strong concordance between the predicted probabilities and the observed probabilities for children diagnosed with moderate-severe OSA. With threshold probabilities ranging from 0.1 to 1.0, the predictive model demonstrated strong predictive efficacy and yielded improved net benefit for clinical decision-making. ROC analysis was employed to classify the children into high and low-risk groups, utilizing the Optimal Cutoff value of 0.39.

Conclusion

A predictive model using LASSO regression was developed and validated for children with varying levels of OSA. This model identifies children at risk of developing OSA at an early stage.

Lower Incisor-Pg: A New Cephalometric Parameter to Evaluate the Anterior Limit of Dentition

Background: This present retrospective study aimed to introduce Lower Incisor-Pg and to assess how this new parameter varies with the skeletal sagittal and vertical relationships. Methods: A total of 1256 cephalometric analyses were performed using lateral cephalometric radiographs of a sample of subjects divided according to SN^Go-Gn, ANPg^, and IMPA measurements. The differences in Lower Incisor-Pg between the groups were assessed through ANOVA tests and posthoc analyses, while Pearson's correlation analysis was used to assess the correlations between the measurements. Results: The mesofacial growth pattern (61.0%) was more common than dolichofacial (30.0%) and brachyfacial (8.6%) ones in the sampled population. Regarding skeletal sagittal relationships, Class I was more frequent (70.9%) than Class II (19.3%) and Class III (9.8%). The mean value of the Lower Incisor-Pg was 3.2 ± 4.0 mm. Linear regression showed that the β coefficient was 0.45 and 0.36 for ANPg^ and SnGoGn^, respectively. Conclusions: Lower Incisor-Pg is a linear cephalometric measurement to evaluate the lower incisor sagittal position. For each degree of increase in ANPg^ and SNGoGn^, the Lower Incisor-Pg increased 0.45 mm and 0.36 mm, respectively.

Sagittal and Vertical Changes of the Maxilla after Surgically Assisted Rapid Palatal Expansion: A Systematic Review and Meta-Analysis

Surgically assisted rapid palatal expansion (SARPE) is often performed to correct the transverse deficiency in the maxilla for skeletally mature patients. However, there is little consensus on the sagittal and vertical displacement of the maxilla after SARPE. This systematic review aims to analyze the position changes of the maxilla in the sagittal and vertical dimensions after the completion of SARPE. Registered with PROSPERO (registration number: CRD42022312103), this study complied with the 2020 PRISMA guideline and was conducted on 21 January 2023. Original studies were screened from MEDLINE (PubMed), Elsevier (SCOPUS), and Cochrane, and supplemented by hand-searching. Cephalometric changes of skeletal vertical and sagittal measurements were the focus. A fixed-effects model was applied in R for meta-analysis. After applying inclusion and exclusion criteria, seven articles were included in the final review. Four studies had a high risk of bias, and the other three had a medium risk of bias. Meta-analysis revealed that the SNA angle increased by 0.50° ± 0.08° (95% confidence interval, 0.33° to 0.66°), and the SN-PP angle increased by 0.60° ± 0.09° (95% confidence interval, 0.41° to 0.79°) after SARPE. In summary, the maxilla displayed statistically significant forward and clockwise downward movement after SARPE. However, the amounts were small and might not be clinically significant. Due to the high risk of bias of included studies, our results must be taken cautiously. Future studies are needed to discern the effects of direction and angulation of the osteotomies of SARPE on the displacement of the maxilla.

Association of Body Mass Index (BMI) with Lip Morphology Characteristics: A Cross-Sectional Study Based on Chinese Population

BACKGROUND

Lip morphology is essential in diagnosis and treatment of orthodontics and orthognathic surgery to ensure facial aesthetics. Body mass index (BMI) has proved to have influence on facial soft tissue thickness, but its relationship with lip morphology is unclear. This study aimed to evaluate the association between BMI and lip morphology characteristics (LMCs) and thus provide information for personalized treatment.

METHODS

A cross-sectional study consisted of 1185 patients from 1 January 2010 to 31 December 2020 was conducted. Confounders of demography, dental features, skeletal parameters and LMCs were adjusted by multivariable linear regression to identify the association between BMI and LMCs. Group differences were evaluated with two-samples t-test and one-way ANOVA test. Mediation analysis was used for indirect effects assessment.

RESULTS

After adjusting for confounders, BMI is independently associated with upper lip length (0.039, [0.002-0.075]), soft pogonion thickness (0.120, [0.073-0.168]), inferior sulcus depth (0.040, [0.018-0.063]), lower lip length (0.208, [0.139-0.276]), and curve fitting revealed non-linearity to BMI in obese patients. Mediation analysis found BMI was associated with superior sulcus depth and basic upper lip thickness through upper lip length.

CONCLUSIONS

BMI is positively associated with LMCs, except for nasolabial angle as negatively, while obese patients reverse or weaken these associations.

Esthetic preferences of orthodontists, dentists, and plastic surgeons for balanced facial profiles

PURPOSE

The aim of this investigation was to determine whether the facial esthetics of subjects rated as "attractive" can be related to specific cephalometric soft tissue parameters.

METHODS

The profile silhouettes of 100 subjects (45 males and 55 females) were rated by 60 esthetics specialists (20 orthodontists, 20 dentists, and 20 plastic surgeons) using a Likert scale, and 30 of the subjects were selected as being "attractive". The cephalometric measurements of the attractive group were then compared with norms for the general Caucasian population.

RESULTS

The effects of specific measured parameters on profile beauty grades were assessed using the median test, and the following variables were found to show significant correlations between the Caucasian norms and the attractive profile group: the ratio of the upper to lower face height (P = 0.011), the ratio of the subnasale - labrale inferius (Sn-Li) and labrale inferius - menton (Li-Me`) lines (P = 0.011), the distance between the chin and the subnasale perpendicular (P = 0.002), upper lip thickness (P = 0.021), soft tissue chin thickness (P = 0.021), vertical height ratio (P = 0.021), and nasolabial angle (P = 0.021).

CONCLUSION

A straight profile with a fuller and more protruded upper lip, a higher nasal tip, and a smaller lower facial third are considered to be the most attractive facial features, and may be useful for improvement of facial esthetics.

Excessive Daytime Sleepiness as a Risk Factor for Obstructive Sleep Apnoea among Public Transport Drivers: A Cross-Sectional Study

Context

Excessive daytime sleepiness (EDS) due to obstructive sleep apnoea (OSA) is reported to be a major contributor to many road traffic accidents. Lack of awareness and diagnosis of OSA among public transport workers remains a threat to the society.

Aims

The primary aim of this study was to assess the risk of OSA among transport drivers of south Kerala using modified Berlin questionnaire. The secondary objective included craniofacial assessment of the high-risk patients identified through the questionnaire using lateral cephalogram.

Settings and Design

A cross-sectional study was conducted among 180 transport drivers of south Kerala.

Methods and Material

Modified Berlin questionnaire and limited physical examination [body mass index (kg/m2), neck circumference (cm), waist circumference (cm), hip circumference and waist to hip ratio, blood pressure (mm Hg)] were recorded. The screened subjects were categorized as high-risk snorers and low-risk snorers based on modified Berlin questionnaire. Craniofacial morphological variations of high-risk group were assessed by lateral cephalograms.

Statistical Analysis Used

The descriptive statistics were represented as mean and standard deviation and percentage. Inter-group comparison was performed with independent sample t test.

Results

The study demonstrated 64.4% of subjects were non-snorers and 35.6% were snorers. Furthermore, among the snorers, 46.9% were identified as high-risk snorers, whereas the remaining 53.1% represented low-risk snorers.

Conclusions

The study revealed the concealed risk of OSA among transport drivers could be screened through the questionnaires and demographics assessment. The application of the proposed screening protocol would triage and enhance safety of OSA affected transport drivers.

Correlation of cephalometric variables with obstructive sleep apnea severity among children: a hierarchical regression analysis

OBJECTIVE

To evaluate the correlation between cephalometric parameters and apnea-hypopnea index (AHI) after controlling gender, body mass index (BMI), and adenoid size in children with obstructive sleep apnea (OSA).

METHODS

Sixty-four children with OSA (40 males, 24 females, 8.72 ± 0.899 years) were chosen by simple random sampling for a cross-sectional study from January 2018 to March 2022. They were diagnosed with OSA, assessed by Obstructive Sleep Apnea-18 questionnaire and home polysomnography and underwent lateral cephalograms.

RESULTS

Hierarchical regression analysis indicated that cephalometric parameters (except adenoid size) were associated with OSA severity, explaining 18.1% of the AHI variance. Among cephalometric measurements, AHI was positively associated with H-RGn and N-Go-Me angle (p < 0.05) and negatively associated with NP (p < 0.05).

CONCLUSION

The sagittal diameter of the oropharynx, lower gonial angle, and hyoid position are significant AHI predictors in children with OSA, independent of demographic characteristics and adenoid size.

Skeleto-dental features among a sample of Saudi female children compared to British standards: A cephalometric study

Aim

This cross-sectional observational retrospective study aimed at assessing the cephalometric skeleto-dental features of class I, II, and III skeletal relationship of Saudi female school children sample and comparing the results to the established British Caucasian cephalometric standards.

Materials and Methods

The sample consisted of 205 retrospective lateral cephalometric radiographs of female school children. The age range of the subjects were between 10 and 13 years old with a mean age of 11 ± 1 years. Several cephalometric and constructed points were identified. Angular, linear, and proportional measurements were obtained and analyzed. The skeleto-dental features of class II and class III were compared to class I of this sample and then compared with the established British Caucasian population. Different angular, linear, and proportional variables were investigated. Descriptive statistics and Student's t-test were used for data analysis.

Results

The distribution of the skeletal relationship revealed that 68.3% of the sample showed class I relationship, 16.1% class II, and 15.6% class III. The result indicates significant differences among the different classes. A greater tendency towards class II facial pattern and more convex profile among Saudis were detected in the present study compared to Caucasians. Furthermore, The dento-alveolar relationship results showed more bi-maxillary protrusion among Saudi females compared to the British Caucasians.

Conclusion

The results of the study can serve as a base-line for future investigations in Saudi Arabia. Furthermore, the results obtained can also be of great value in distinguishing the various skeleto-dental features in the different skeletal classes among the Saudi females, and in the clinical diagnosis and treatment planning.

A New Old Way to Look at Airway Assessment

Imagine performing an oral endotracheal intubation with the tongue totally absent from your line of sight of the laryngeal anatomy, including the glottis. The addition of the Angle's Classification of Malocclusion, a tool some may call archaic, should be added alongside airway assessment tools that dental surgeons and nurse anesthesiologists commonly use, such as the Mallampati Classification (or Mallampati Score), Thyromental Distance (TMD), Neck Range of Motion, Size of the Tongue, and Interincisor Distance, also called Intermaxillary Distance.

Two-dimensional upper airway normative values in children aged 7 to 17 years

Objective: To develop two-dimensional (2D) upper airway normative values in pediatric patients and correlate upper airway measurements with age.Methods: Cone beam computed tomography scans of 3738 patients were examined, and a sample of 61 patients, divided into two age groups (7-11 and 12-17 years), w used to reconstruct lateral cephalograms.Results: The mean adenoid-nasopharynx (A/N) ratio was 0.45 and 0.44 for age groups 1 and 2, respectively. The mean PNS-ad1 and PNS-ad2 were 24 and 18.7 mm, respectively, for age group 1, and 26.7 and 21.2 mm, respectively, for age group 2. Additional normative values for the hyoid bone, airway space, uvula, and tongue are presented. The highest correlation with age was the upper airway length (r = 0.557, p < 0.001).Conclusion: Although cephalometric radiographs remain 2D reconstructions of three-dimensional structures, they have significant value and can aid clinicians in the screening process for pediatric sleep apnea.

Skeleto-dental features among a sample of Saudi female children compared to North American standards: A cephalometric study

Objectives

This cross-sectional observational retrospective study aimed at assessing the cephalometric skeleto-dental features of class I, II, and III skeletal relationships of Saudi female school children samples and comparing the results to the established North American Caucasian cephalometric standards.

Methods

The sample consisted of 205 retrospective lateral cephalometric radiographs of female school children. The age range of the subjects was between 10 and 13 years with a mean age of 11 ± 1 years. Several cephalometric and constructed points were identified. Angular, linear, and proportional measurements were obtained and analyzed. The skeleto-dental features of class II and class III were compared to class I of this sample then compared with the established North American Caucasian population. Different angular, linear, and proportional variables were investigated. Descriptive statistics and student t-test were used for data analysis.

Results

The distribution of the skeletal relationship revealed that 68.3% of the sample showed class I relationship, 16.1% class II, and 15.6% class III. The result indicates significant differences between the different classes. A greater tendency towards class II facial pattern and more convex profile among Saudis were detected in the present study compared to Caucasians. Furthermore, The dentoalveolar relationship results showed more Bi-maxillary protrusion among Saudi females compared to the North American Caucasians.

Conclusion

The results obtained can be of great value in distinguishing the various skeleto-dental features in the different skeletal classes among the Saudi females and in the clinical diagnosis and treatment planning. Furthermore, the results of the study can also serve as a base-line for future investigations in Saudi Arabia.

Cephalometric and Functional Mandibular Reconstructive Outcomes Using a Horizontal Scapular Tip Free Flap

Scapula tip free flaps (STFFs) have become an increasingly popular option for head and neck reconstruction. The aim of this study is to demonstrate the feasibility of using the STFF in a horizontal orientation to take advantage of the anatomy of the scapular tip bone to re-create a mandibular symphysis. Eight patients underwent oromandibular reconstruction with a horizontally oriented STFF between October 2016 and June 2020. Virtual surgical planning was used to design the bony reconstruction in 6 cases. Primary outcomes, including flap survival, complications, and return to oral diet, were collected. Cephalometric measurements were obtained to compare preoperative and postoperative mandibular projection and width. All flaps survived without compromise, and no fistulas developed postoperatively. Seven patients returned to taking an oral diet. Cephalometric analysis revealed comparable measurements between preoperative and postoperative mandibles and reconstructed mandibles, respectively. STFFs may be oriented horizontally to reconstruct large anterior mandibular defects with satisfactory results.

Testing the accuracy of Bedek et al's new models based on 1-to-7 mandibular teeth for age estimation in 7-15 year old south Indian children

Age estimation significantly contributes to forensic medicine and law enforcement in Indonesia. However, lateral cephalometric radiographs of cervical vertebrae have not been used to estimate age in the Indonesian population. This study developed a formula to estimate the skeletal age of cervical vertebrae using multiple linear regression analyses, estimating the dental age and evaluating the agreement between cervical vertebrae skeletal-chronological, dental-chronological, and cervical vertebrae skeletal-dental ages. Several anatomical parameters were measured to obtain cervical vertebrae ratios from 100 lateral cephalometric radiographs, and followed by the calculation of  dental tooth crown index data from 100 panoramic radiographs of subjects 9-18 years old. The Bland-Altman plot of cervical vertebrae skeletal and dental ages showed a mean difference of -0.094 ± 1.52 years, with upper and lower limits of 2.882 and -3.070 years, respectively. The means of the cervical vertebrae skeletal, dental, and chronological ages were 13.97 (2.67), 14.06 (2.45), and 13.97 (2.97), respectively. The mean differences between cervical vertebrae skeletal-chronological and dental-chronological ages were 0.566 (2.26) and 4.005 (2.07), respectively. Furthermore, a validation trial (group 2, n = 10, three males and seven females) was conducted to test the accuracy of the cervical vertebrae skeletal age estimation formula using consecutive sampling. The age range was 9-11 years. Cervical vertebrae skeletal age showed a better agreement with chronological age than did dental age.

Radiologic Evaluation of the Influence of Cleft Treatment on Nasal Dorsum Growth

OBJECTIVE

The study addresses whether the growth of the nasal dorsum is disturbed by cleft treatments, for cleft lip only (CL) and cleft lip with cleft palate (CLP).

DESIGN

A total of 576 patients with cleft (278 CL, 298 CLP) and 333 individuals without orofacial clefts were retrospectively enrolled. Cleft lip only group was treated with a modified Millard technique combined with Tajima incision for rhinoplasty at 3 to 6 months. The CLP group underwent the same lip repair technique and then underwent a Sommerlad palatoplasty at 9 to 12 months. Lateral cephalometric radiographs of all individuals were taken to evaluate the nasal length and nasal dorsum height. Dunn test was used to analyze the difference (P < .001).

RESULTS

Compared with control, in CL, nasal bone angle and nasal dorsum angle increase by age similarly (5-18 years, P > .05); the total dorsum is significantly shorter (5-18 years, P < .001), while the upper nasal dorsum length is similar (except in 5-6 years), and the lower nasal dorsum is shorter (5-18 years, P < .001). In CLP, nasal bone angle develops insufficiently as children grow (8-18 years, P < .001); the nasal dorsum angle is notably smaller (5-18 years, P < .001); nasal bone length is not significantly different except 11 to 13 years (P < .05); nasal dorsal length is similar at skeletal maturity (17-18 years, P > .05), although it is shorter during 8 to 16 years (P < .05); the upper nasal dorsum is overdeveloped (14-18 years, P < .05), whereas the lower nasal dorsum is underdeveloped (5-18 years, P < .001).

CONCLUSION

Treatments in both CL and CLP could be the important factors in disturbing the growth of cartilaginous portion of the nasal dorsum (including nasal tip) and the nasal dorsum height.

Web-based Fully Automated Cephalometric Analysis: Comparisons between App-aided, Computerized, and Manual Tracings

Objective

To compare the accuracy of cephalometric analyses made with fully automated tracings, computerized tracing, and app-aided tracings with equivalent hand-traced measurements, and to evaluate the tracing time for each cephalometric analysis method.

Methods

Pre-treatment lateral cephalometric radiographs of 40 patients were randomly selected. Eight angular and 4 linear parameters were measured by 1 operator using 3 methods: computerized tracing with software Dolphin Imaging 13.01(Dolphin Imaging and Management Solutions, Chatsworth, Calif, USA), app-aided tracing using the CephNinja 3.51 app (Cyncronus LLC, WA, USA), and web-based fully automated tracing with CephX (ORCA Dental AI, Las Vegas, NV). Correction of CephX landmarks was also made. Manual tracings were performed by 3 operators. Remeasurement of 15 radiographs was carried out to determine the intra-examiner and inter-examiner (manual tracings) correlation coefficient (ICC). Inter-group comparisons were made with one-way analysis of variance. The Tukey test was used for post hoc testing.

Results

Overall, greater variability was found with CephX compared with the other methods. Differences in GoGn-SN (°), I-NA (°), I-NB (°), I-NA (mm), and I-NB (mm) were statistically (p<0.05) and clinically significant using CephX, whereas CephNinja and Dolphin were comparable to manual tracings. Correction of CephX landmarks gave similar results to CephNinja and Dolphin. All the ICCs exceeded 0.85, except for I-NA (°), I-NB (°), and I-NB (mm), which were traced with CephX. The shortest analyzing time was obtained with CephX.

Conclusion

Fully automatic analysis with CephX needs to be more reliable. However, CephX analysis with manual correction is promising for use in clinical practice because it is comparable to CephNinja and Dolphin, and the analyzing time is significantly shorter.

Heritability of Craniofacial Characteristics in Twins - Cephalometric Study

Introduction:

The growth and development of the craniofacial complex are under the influence of genetic and environmental factors, which determine its morphological and functional characteristics. Twin studies provide significant insight into how many genetic and environmental factors determine dental and craniofacial characteristics.

Aim:

The aim of the study was to determine the genetic influence on craniofacial complex using a twin study model.

Methods:

The study sample comprised 52 pairs of twins who were referred to the Orthodontic Department, School of Dental medicine, University of Sarajevo. Informed consent was obtained by the parents of the children included in the study. Twenty pairs of twins were diagnosed as monozygotic while 32 pairs were diagnosed as dizygotic. Zygosity was diagnosed by physical characteristics similarity. Nineteen variables were measured: 10 dental variables, 9 cephalometric.

Results:

Based on the findings of this study, t-test showed significant genetic effect on the length of cranial base (p = 0.03), corpus of maxilla (p = 0.02) and mandibular length (p = 0.03), and also for B-angle (p = 0.04). Environmental factors are more involved in determining dental traits (e.g., the inclination of the incisors).

Conclusion:

There is a significant genetic effect on the linear cephalometric variables: the length of the cranial base, maxillary length and mandibular length.

A Comparative Cephalometric Study of Nasoalveolar Molding- and Non-Nasoalveolar Molding-Treated Bilateral Cleft Patients at Early Mixed Dentition Period

OBJECTIVE

To evaluate and compare early maxillary growth in 2 groups of patients with repaired bilateral cleft lip and palate (BCLP) who had and had not received nasoalveolar molding (NAM) therapy in infancy.

HYPOTHESIS

Nasoalveolar molding does not have any effect on maxillomandibular growth at the early mixed dentition period.

DESIGN

Retrospective study.

PATIENTS

The study group consisted of forty-two 7-year-old patients with BCLP-20 in the NAM group and 22 in the no-NAM group. The control group consisted of nineteen 7-year-old noncleft, normal patients.

INTERVENTIONS

Nasoalveolar molding was carried out prior to surgeries in those children who were brought in within 8 weeks of birth. Children brought in later were treated without a presurgical intervention. All patients were treated with a single-stage modified Millard cheiloplasty without gingivoperiosteoplasty. Palatoplasty was done by single-stage Bardach palatoplasty with muscle repositioning.

MEAN OUTCOME MEASURES

Hard tissue and dental cephalometric values measured on lateral cephalograms, recorded at 7 years of age.

RESULTS

A comparison of the mean sagittal values showed a statistically significant maxillomandibular retrusion and incisor retroclination of both BCLP groups in comparison to the control group. None of the cephalometric parameters varied statistically between NAM and no-NAM groups. The maxillomandibular relation, lower face height ratio, mandibular plane, and mandibular axis angles did not show statistically significant difference between all 3 groups.

CONCLUSIONS

On the basis of this study, NAM does not have any effect on maxillomandibular growth at the early mixed dentition period.

Pharyngeal airway increases with LARS treatment for retrognathia

OBJECTIVE

To assess the lower pharyngeal airway sagittal width on lateral cephalograms before and after the use of a mandibular advancement device (MAD) on Class II patients and to compare the results to a control group of non-treated Class II individuals.

METHODS

All patients were Class II, ranging in age from 9 to 12 years. They were all treated with a MAD, referred to as a ligated anterior repositioning splint, which was fixed in the mouth for full-time wear. Measurements of the lower pharyngeal airway were made on before- and after-treatment cephalograms. A control group of Class II patients of similar age were selected from several growth studies, and comparisons were made.

RESULTS

A significant increase (p < .01) resulted from the treatment group; there was no change from the controls.

CONCLUSION

These findings support the effectiveness of a MAD to increase the lower pharyngeal airway in growing Class II patients.

Mean values of Arnett's soft tissue analysis in Maratha ethnic (Indian) population - A cephalometric study

AIM

The aim of this article is to evaluate the mean cephalometric values for Arnett's soft tissue analysis in the Maratha ethnic (Indian) population.

MATERIALS AND METHODS

Lateral cephalograms of 60 patients (30 males and 30 females) aged 18-26 years were obtained with the patients in the Natural Head Position (NHP), with teeth in maximum intercuspation and lips in the rest position. Moreover, hand tracings were also done. The statistical analysis was performed with the help of a statistical software, the Statistical Package for the Social Sciences version 16, and Microsoft word and Excel (Microsoft office 2007) were used to generate the analytical data.

RESULTS

Statistical significance was tested atP level (1% and 5% level of significance). Statistical analysis using student's unpaired t-test were performed. Various cephalometric values for the Maratha ethnic (Indian) population differed from Caucasian cephalometric values such as nasolabial inclination, incisor proclination, and exposure, which may affect the outcome of the orthodontic and orthognathic treatment.

CONCLUSION

Marathas have more proclined maxillary incisors, less prominent chin, less facial length, acute nasolabial angle, and all soft tissue thickness are greater in Marathas except lower lip thickness (in Maratha males and females) and upper lip angle (in Maratha males) than those of the Caucasian population. It is a fact that all different ethnic races have different facial characters. The variability of the soft tissue integument in people with different ethnic origin makes it necessary to study the soft tissue standards of a particular community and consider those norms when planning an orthodontic and orthognathic treatment for particular racial and ethnic patients.

A long-term clinical and cephalometric study of cleft lip and palate patients following intraoral maxillary quadrangular le fort I osteotomy

OBJECTIVE

To evaluate the horizontal and vertical stability of the quadrangular Le Fort I in patients with congenital cleft lip and palate.

DESIGN

Prospective longitudinal study.

PATIENTS

A total of 15 congenital cleft lip and palate patients treated with the maxillary quadrangular Le Fort I were enrolled.

INTERVENTION

Lateral cephalometric radiographic examinations were obtained preoperatively, early postoperatively, and late postoperatively for four dental and skeletal landmarks. A questionnaire regarding patients' satisfaction with treatment and functional/cosmetic outcomes (airway, speech, mastication) was administered.

MAIN OUTCOME MEASURES

Surgical horizontal and vertical movement, late postsurgical horizontal and vertical movement, and surgical and postsurgical movement in relation to age and cleft type were evaluated using Spearman correlation coefficients, Wilcoxon signed rank tests, and Mann-Whitney tests.

RESULTS

Surgical horizontal movements of all measured points showed significant changes. Significant differences of postsurgical horizontal movement were observed in younger patients versus adult patients. Significant differences of postsurgical horizontal movement were observed in unilateral cleft patients versus bilateral cleft patients. A high percentage of patients showed significant functional improvement in nasal airflow, speech, mastication, temporomandibular joint function, and mouth versus nose breathing.

CONCLUSIONS

The quadrangular Le Fort I is a functionally stable and a surgically predictable procedure for cleft lip and palate patients who present with midface deficiency. Patients under the age of 18 at the time of the osteotomy had a higher relapse rate than patients over 18 years of age. Younger patients who need surgery should be advised regarding the increased risk of skeletal relapse. Patients' satisfaction was high in all aesthetic- and function-related items on the questionnaire.

Is there consistency in cephalometric landmark identification amongst oral and maxillofacial surgeons?

There may be significant variation amongst oral and maxillofacial surgeons (OMFS) in the identification and placement of cephalometric landmarks for orthognathic surgery, and this could impact upon the surgical plan and final treatment outcome. In an effort to assess this variability, 10 lateral cephalometric radiographs were selected for evaluation by 16 OMFS with different levels of surgical knowledge and experience, and the position of 21 commonly used cephalometric landmarks were identified on radiographs displayed on a computer screen using a computer mouse on a pen tablet. The database consisted of real position measurements (x, y) to determine the consistency of landmark identification between surgeons and within individual surgeons. Inter-examiner analysis demonstrated that most landmark points had excellent reliability (intra-class correlation coefficient >0.90). Regardless of the level of surgeon experience, certain landmarks presented consistently poor reliability, and intra-examiner reliability analysis demonstrated that some locations had a higher average difference for both x and y axes. In particular, porion, condylion, and gonion showed poor agreement and reliability between examiners. The identification of most landmarks showed some inconsistencies within different parameters of evaluation. Such variability among surgeons may be addressed by the consistent use of high-quality images, and also by periodic surgeon education of the definition of the specific landmarks.

Craniofacial parameters of Syrian children with β-thalassemia major

AIM

To investigate cephalometric craniofacial parameters (skeletal and dental) of β-thalassemic-major patients and to compare findings with a group of healthy patients in the same age group.

METHODS

Fifty-one Syrian thalassemic-major patients aged 8-12 years were recruited. Lateral cephalometric radiographs were taken. Linear and angular cephalometric measurements were recorded and compared with Syrian controls (n=50) in the same age group.

RESULTS

Thalassemic patients, when compared with controls, showed significant retrognathia in the mandible (reduced sella [mid-point of sella turcica]-nasion [most anterior point on the frontonasal suture] B-point [deepest point on the concavity of the mandibular profile between the alveolar crest and the point of the chin] angle, and decreased sella-nasion-pogonion [most anterior point on the bony chin] angle, P<0.0001), a significant decrease in ramus height (articulare-gonian=36.51 ± 3.87 mm, P<0.0001). They also exhibited a significant class II skeletal pattern (P<0.0001) and a convex facial profile as the nasion A-point (deepest point on maxillary profile between the anterior nasal spine and the alveolar crest) pogonion angle and maxillomandibular A-point-nasion P-point angle increased. They also showed a highly-significant decrease in the total posterior facial height (sella gonion [most posterior, inferior point on the angle of the mandible]=64.24 ± 5.73 mm, P<0.0001) and significant increase in the total anterior facial height (N-Me = 110.78 ± 6.66 mm, P=0.009) when compared to controls.

CONCLUSION

Thalassemic patients exhibited a skeletal class II malocclusion, retrognathia of the mandible, a short height of the ramus, an increase in anterior facial height, and a decrease in posterior facial height.