Assessment of sella turcica area and skeletal maturation patterns of children with unilateral cleft lip and palate.

OBJECTIVES: The aim of this case-control study was to assess sella turcica area and skeletal maturity in children with unilateral cleft lip and palate (UCLP) and compare with those of non-cleft children. SETTING AND SAMPLE POPULATION: A total of 85 UCLP patients aged 7.5-17.08 years (Group 1: age 7-11 years, Group 2: age 11-14 years and Group 3: age 14-18 years) were compared with 85 control subjects without clefts who were divided into similar age groups. MATERIALS AND METHODS: Hand-wrist radiographs and cervical vertebra maturation stages (CVMS) were used to evaluate growth. Lateral cephalograms were traced, and reference points of sella were determined. Sella turcica area was measured using a digital planimeter. RESULTS: Comparison of overall growth on hand-wrist radiographs revealed no significant difference between cleft and non-cleft subjects. However, according to the chronological age groups, Group 1-UCLP showed statistically significant delay in skeletal maturation when compared with the age-matched control subjects (P = .05). This difference was due to the delay among male subjects (P = .05). As for CVMS, more significant maturation delay was observed in Group 1-UCLP (P = .001) and was attributable to both male and female subjects (P = .05). Comparison of sella turcica area showed no significant difference between UCLP patients and controls. CONCLUSION: Although children with CLP showed significant delay in growth when they are younger compared with the non-cleft children, sella turcica area measurements were similar for individuals in both groups.

Ontogenesis of the Sella Turcica among Egyptians: Forensic and Radiological Study.

The sella turcica has gained importance as a stable bony landmark in cephalometric studies. This study explored the changes that accompany postnatal ontogeny of the sella turcica until full development and verified its contribution in age estimation and sexual assignment among Egyptians. Six selected measurements of the sella turcica of 215 Egyptian patients were assessed using multidetector computed tomography. The patients represented different ages and were referred to the Diagnostic and Interventional Radiological Department, Faculty of Medicine, Alexandria University. The gathered data were then subjected to statistical analysis, including correlation and regression analysis. The measurements of the sella showed a strong correlation with age. Three selected measurements demonstrated significant sexual dimorphism: sella width and anterior and median height in subjects 20-25 years old. Six regression equations were derived. The accuracy achieved by the combined parameters in the younger group (<25 years old) was higher than that in the older individuals. This study provides useful tools in the determination of age and sex in both forensic and bioarcheological disciplines. However, further studies concerning the shape are strongly suggested.

The normal dimensions of the sella turcica in Jordanians: a study on lateral cephalograms.

BACKGROUND: The sella turcica is an important anatomic and radiologic entity. The dimensions of the sella turcica vary greatly in normal individuals and are influenced by genetic and local factors. The main objective of this study is to build up a normative database of the dimensions of the sella turcica in the Jordanian population. MATERIALS AND METHODS: For this purpose 509 computed cephalograms of 252 male and 257 female healthy Jordanians aged 10-40 years were collected and divided into two adolescent and adult age-groups for both genders. Viewbox 3 software was used to determine linear dimensions and area of the sella turcica. RESULTS: Our results showed that the overall values for width, length, height, area, and aperture (interclinoid distance) were 8.72, 7.68, 6.25, 40.80, 3.92, and 8.67, 7.42, 6.38, 41.26, 3.68 mm (mm2) for males and females, respectively. Significant differences were found between adult male group on one hand and adolescent female group and adult female group on the other hand. Between age categories and within male and female groups, sella parameters were significantly different between adolescent and adult age-groups. CONCLUSIONS: Our data clearly confirm the classical notion of general trend of increase in parameters with age, irrespective of gender, with the area scoring the highest increase, and the height in females and length in males contributing most obviously to this trend. The aperture appears to decrease in females while it increases in males as adulthood is reached. This seems to reflect differential growth of the pituitary gland under neurohormonal effects.

Postnatal sellar spine growth: A case report and literature review.

BACKGROUND: A sellar spine is a bony spur protruding anteriorly from the central portion of the dorsum sellae. Its etiology is an ossified notochordal remnant of the cephalic end of the notochord. It is presumed to be a congenital malformation based on magnetic resonance imaging (MRI) findings of sellar spine in a 4-year-old boy. A sellar spine should therefore be detectable at birth with or without ossification, and the posterior pituitary lobe should be displaced. METHODS AND RESULTS: Here we review the literature and report the first case of typical sellar spine in an 8-year-old girl who presented with precocious puberty, but her MRI taken at age 4 months for a febrile convulsion did not show a sellar spine or posterior pituitary lobe deformation. T1-weighted sagittal images at 8 years old showed a bony structure protruding anteriorly from the central portion of the dorsum sellae. The length of this lesion was 3.8 mm on computed tomography (CT) scanning at 9 years old, and it elongated to 4.7 mm on CT at 12 years old. CONCLUSIONS: Based on the present case, we speculate that the sellar spine would be too small to detect early in development and would grow in size after birth. In this case, a sellar spine and precocious puberty were potentially associated due to deformation of the growing pituitary gland.

Bony Regeneration of the Sella after Transsphenoidal Pituitary Surgery.

OBJECTIVE: The purpose of this study is to demonstrate the possible bony regrowth of the sella after transsphenoidal surgery without any intraoperative sellar reconstruction. METHODS: Radiologic findings of the sella were reviewed in patients with pituitary tumors treated by transsphenoidal surgery. In 17 patients who had postoperative cranial computed tomography scans, bony regeneration of the sellar floor was evaluated by comparing immediate and late postoperative scans. The bony opening reduction was measured in transverse and sagittal planes. RESULTS: The median bony opening diameter in the transverse plane was 8.8 mm (interquartile range [IQR] 5.7-11.4) on the first scan and 4.2 mm (IQR 0.8-6.8) on the second scan. In the sagittal plane, it was 4.8 mm (IQR 1.8-6.8) on the first scan and 2.9 mm (IQR 1.6-3.9) on the second scan. These changes occurred in a median time of 36 months (IQR 22-42). There was a statistically significant decrease of the bony opening diameters in both the transverse and sagittal planes (P < 0.0001 and P = 0.0004, respectively). Bone regeneration was observed in 16 of the 17 patients (approximately 94%). CONCLUSION: There is a natural bony regeneration of the sella after transsphenoidal pituitary surgery.

Comparison of craniofacial growth of untreated Class I and Class II girls from ages 9 to 18 years: a longitudinal study.

INTRODUCTION: The purposes of this study were to examine and compare the craniofacial growth in girls with Class I or Class II occlusion from the ages of 9 to 18. METHODS: Twenty-five Class I (ANB, 1°-4°) and 21 Class II (ANB, >4°) untreated Caucasian girls were selected from the Burlington Growth Centre in Toronto, Ontario, Canada. Cephalograms of each subject at ages 9, 14, and 18 years were traced, and 29 parameters were measured. The growth changes in each parameter from ages 9 to 14, 14 to 18, and 9 to 18 were calculated, and comparisons of each parameter were made between the 2 groups. RESULTS: From ages 9 to 14, the Class I and Class II groups had similar skeletal growth patterns (increases of SNA and SNB angles, decreases of ANB, MP-SN, and gonial angles). Dentally, the Class II group showed less maxillary incisal proclination and more overbite than did the Class I group. From ages 14 to 18, the 2 groups also showed similar growth patterns, with little sagittal but continued vertical growth, and the MP-SN angle continued to decrease. From ages 9 to 18 (combined periods of 9-14 and 14-18), the 2 groups showed similar skeletal growth, with the exception of a slightly higher ANS-ME/N-Me in the Class I group. Dental changes were similar in the 2 groups, except that overbite increased slightly more in the Class II group. CONCLUSIONS: Overall, the craniofacial growth patterns of Class I and Class II girls were similar. With growth, the face became more flattened with a decrease of the ANB angle, and the mandible demonstrated forward rotation with decreases of the MP-SN and gonial angles, and an increase of PFH:AFH.

Late adult skeletofacial growth after adolescent Herbst therapy: a 32-year longitudinal follow-up study.

INTRODUCTION: The aim of this longitudinal 32-year follow-up investigation was to analyze the very long-term effects of Herbst treatment on the dentoskeletal structures. We followed 14 patients from a sample of 22 with Class II Division 1 malocclusions who were consecutively treated with the banded Herbst appliance at ages 12 to 14 years. The subjects were reexamined after therapy at the ages of 20 years (when the radius epiphysis/diaphysis plate was closed) and 46 years. METHODS: Lateral head films were analyzed from before (T1) and after (T2) treatment, and at 6 years (T3) and 32 years (T4) after treatment. RESULTS: (1) In the standard analysis (angular measurements) during the T2 to T3 period of 6 years, significant skeletal changes were the following: increase of the SNB (1.0°; P <0.01), decrease of the ANB (0.9°; P <0.01), and decrease of the ML/NSL (2.5°; P <0.001). During the T3 to T4 period of 24 years, no further significant angular changes occurred. (2) In the analysis of the sagittal changes in the occlusion (linear measurements) during the T2 to T3 period of 6 years, the mandible (6.1 mm; P <0.001) and the maxilla (3.0 mm; P <0.01) grew forward. During the T3 to T4 period of 24 years, the mandible (2.8 mm; P <0.01) and the maxilla (3.1 mm; P <0.01) continued to grow forward. Thus, during the total posttreatment (T2-T4) period of 32 years, there was continuous forward growth of the mandible (8.9 mm; P <0.001) and the maxilla (6.1 mm; P <0.001). (3) The analysis of superimposed lateral head films showed in all 14 subjects large amounts of sagittal and vertical skeletofacial growth during T3 to T4. CONCLUSIONS: In all 14 subjects, large amounts of sagittal and vertical skeletofacial growth occurred after the age of 20 years. However, the question of when, during the period from 20 to 46 years, growth had come to an end remains open. Closure of the radius epiphysis/diaphysis plate is not useful as an indicator for completed skeletofacial growth. Our findings indicate the importance of considering late adult skeletofacial growth in dentofacial orthopedics, orthognathic surgery, and tooth implantology with respect to treatment timing, posttreatment retention, and relapse.

The inadequacy of the Y-axis of growth (SNGn) for the vertical pattern assessment in patients with sagittal discrepancies.

AIM: The aim of this cephalometric study was to evaluate the influence of the sagittal skeletal pattern on the 'Y-axis of growth' measurement in patients with different malocclusions. MATERIALS AND METHODS: Lateral head films from 59 patients (mean age 16y 7m, ranging from 11 to 25 years) were selected after a subjective analysis of 1630 cases. Sample was grouped as follows: Group 1 - class I facial pattern; group 2 - class II facial pattern; and Group 3 - class III facial pattern. Two angular measurements, SNGoGn and SNGn, were taken in order to determine skeletal vertical facial pattern. A logistic regression with errors distributed according to a binomial distribution was used to test the influence of the sagittal relationship (Class I, II, III facial patterns) on vertical diagnostic measurement congruence (SNGoGn and SNGn). RESULTS: RESULTS show that the probability of congruence between the patterns SNGn and SNGoGn was relatively high (70%) for group 1, but for groups II (46%) and III (37%) this congruence was relatively low. CONCLUSION: The use of SNGn appears to be inappropriate to determine the vertical facial skeletal pattern of patients, due to Gn point shifting throughout sagittal discrepancies. Clinical Significance: Facial pattern determined by SNGn must be considered carefully, especially when severe sagittal discrepancies are present.

Anterior cranial-base time-related changes: A systematic review.

INTRODUCTION: The anterior cranial base has long been considered a stable reference structure for superimposing radiographs. However, some studies have questioned its stability. Therefore, the purposes of this systematic review were to give an overview of the studies evaluating growth and development of the anterior cranial base, assess their methodologic quality, and evaluate their validity and accuracy. METHODS: Medline, Embase, and Google Scholar were searched without limitations up to June 2013. Additionally, the bibliographies of the finally selected articles were hand searched to identify any relevant publications that were not identified before. The lowest levels of evidence accepted for inclusion were cohort and cross-sectional studies. RESULTS: A total of 11 articles met all inclusion criteria. They were published between 1955 and 2009. The sample sizes of these studies ranged from 28 to 464 subjects. Their methodologic quality ranged from moderate to low. CONCLUSIONS: Sella turcica remodels backward and downward, and nasion moves forward because of the increase in size of the frontal sinus. These events lead to a continuous increase in the length of the cranial base until adulthood. The presphenoid and cribriform plate regions can be considered stable after age 7, making them the best cranial-base superimposition areas.

Mandibular growth comparisons of Class I and Class II division 1 skeletofacial patterns.

OBJECTIVE: To determine class and sex differences in mandibular growth and modeling. MATERIALS AND METHODS: A mixed-longitudinal sample of 130 untreated French-Canadian adolescents, 77 (45 boys and 32 girls) with Class I (normal or abnormal) occlusion and 53 (26 boys and 27 girls) with Class II division 1 malocclusion, was used. Based on eight landmarks, eight traditional measurements were used to compare the anteroposterior position of the maxilla and mandible, relationship between the jaws, and mandibular size. Mandibular superimpositions were used to compare the horizontal and vertical changes of condylion, gonion, and menton. RESULTS: While there were no differences in maxillary position based on the SNA angle, Class IIs had more retrognathic mandibles than did Class Is. Total mandibular length was greater in Class Is than in Class IIs at 15 years of age. Superior and total growth and modeling changes at condylion and gonion, respectively, were greater for Class Is than Class IIs. Boys were more prognathic than girls; they had larger mandibles and exhibited greater size increases and growth changes than girls did. CONCLUSIONS: There are both class and sex differences in mandibular growth and modeling.

Dimensions and morphologic variations of sella turcica in type 1 diabetic patients.

INTRODUCTION: Some chronic diseases are associated with changes in the morphology of sella turcica, and type 1 diabetes is the most common chronic disease in children and adolescents. Therefore, the aim of this study was to evaluate the size and morphology of sella turcica in patients with type 1 diabetes compared with a healthy control group. METHODS: The study included 76 type 1 diabetic patients (38 boys, 38 girls; ages, 14.16 ± 2.46 years) and 76 controls (38 boys, 38 girls; ages, 14 ± 2.08 years). The groups were categorized as pubertal and postpubertal according to bone age. The length, height, and diameter of sella turcica were measured. Then the morphology of sella turcica was analyzed and categorized as normal, oblique anterior wall, bridging, double contour of the floor, irregularity in the posterior part of dorsum sellae, or pyramidal shape of the dorsum sellae. All measurements were made on tracings of cephalometric radiographs. Differences between the groups were tested with the Mann-Whitney U test. Categorical data were evaluated with the Fisher exact test, and the Bonferroni correction was made. The significance level was assigned as P <0.05. RESULTS: There was no statistically significant difference in the dimensions of sella between the diabetic patients (diameter, 12.20 ± 1.49 mm; length, 10.49 ± 1.55 mm; height, 8.07 ± 1.25 mm) and the controls (diameter, 12.45 ± 1.43 mm; length, 10.90 ± 1.73 mm; height, 8.29 ± 1.66 mm). However, diameter and length increased with age in the overall assessment. Length was greater in the postpubertal controls (11.39 ± 1.69 mm) compared with the pubertal controls (10.41 ± 1.64 mm). Diameter was greater in the postpubertal diabetic patients (1.283 ± 1.55 mm) than in the pubertal diabetic patients (11.56 ± 1.12 mm) and was specifically higher in postpubertal boys. Normal sella morphology was less common in general in the diabetic patients, particularly in the diabetic boys and diabetic pubertal boys (P <0.05). CONCLUSIONS: The measurements concerning sella were similar in the type 1 diabetic and control subjects, but dysmorphologic types were more common in diabetic patients.

Constancy of the angle between the Frankfort horizontal plane and the sella-nasion line: a nine-year longitudinal study.

OBJECTIVE: To investigate the constancy of the angle between the Frankfort horizontal plane (FH) and the sella-nasion line (SN) using longitudinal data. MATERIALS AND METHODS: Longitudinal lateral cephalometric data of 223 children (116 girls and 107 boys) from 6 to 14 years of age were used. The angle between FH and SN (SNFH), the distance from FH to the nasion (NFH), the distance from FH to the sella (SFH), and the differences between the NFH and SFH (Δ) were also measured. All data were analyzed statistically using independent t-tests and mixed-effect regression model analysis. RESULTS: The mean SNFH values showed some minor fluctuations, ranging from 9.26° to 9.74° in girls and 8.45° to 8.95° in boys. The mean NFH and SFH values gradually increased according to age irrespective of sex. There were statistically significant differences by sex for all measurements at several ages. The annual change in SFH and Δ showed sexual dimorphism. CONCLUSIONS: There are variations among individuals in the angle between the FH and SN. However, within an individual, the angle does not vary significantly over time during the observation period.

Alteration of maxillary and mandibular growth of adult patients with unoperated isolated cleft palate.

OBJECTIVE: The objective of this study was to investigate the effects of cleft palate itself on the growth of maxilla and mandible. PATIENTS AND METHODS: Fifty-two adult female patients with unoperated isolated cleft palate and 52 adult female individuals with normal occlusion were included in our study. Computer software was used for lateral cephalometry measurement. Manual measurement was performed for dental cast measurements, and sample t test analysis was applied to analyze the differences between the 2 groups using SPSS 17.0. RESULTS: The sella-nasion-subspinale point angle, subspinale-nasion-supramentale point angle, and maxillary arch length of the cleft group were significantly smaller than those of the control group (P < 0.01). Both maxillary and mandibular posterior dental arch widths of the cleft group were significantly larger compared with the control group (P < 0.01), whereas the sella-nasion-supramentale point angle, mandible arch length, palate height, and palate shelf inclination did not differ between the 2 groups. The measurements did not differ between the submucosal cleft and the overt cleft patients. CONCLUSIONS: Cleft palate itself has adverse effects on the maxilla growth with shorter maxillary arch length and wider posterior dental arch width.

Patterns of vertical facial growth in Korean adolescents analyzed with mixed-effects regression analysis.

INTRODUCTION: To understand the growth patterns of skeletal open bite and deepbite, we present observations from 9 years of pure longitudinal data based on lateral cephalometric radiographs using mixed-effects regression model analysis. METHODS: In total, 51 children (14 years old) with extreme values for the ratio of lower anterior facial height to total anterior facial height were assigned to 1 of 2 groups: a skeletal open-bite group (11 boys, 14 girls) or a skeletal deepbite group (14 boys, 12 girls). Measurements of total anterior facial height, upper anterior facial height, lower anterior facial height, total posterior facial height, ramus height, and ratio of lower anterior facial height to total anterior facial height were obtained for all subjects. All data were analyzed and interpreted using a mixed-effects regression model analysis with random effects. RESULTS: From these 4 groups at 14 years old, statistically significant differences were observed between the groups when subjects of the same sex were compared; however, statistical significance was not reached between subjects of opposite sexes in each group. Morphologic differences were clearly evident from the start and became more pronounced with age. There were statistical significances in the initial values and increases with age in all 6 variables except for increases with age in the ratio of lower anterior facial height to total anterior facial height. Statistical significance was also reached for morphologic differences between the annual increases in the ratio of lower anterior facial height to total anterior facial height and lower anterior facial height. In general, individual random variability was high in all variables when compared with the annual changes over time. CONCLUSIONS: Divergent patterns were established early and became more pronounced with age, with anterior facial height dimensions primarily contributing to these differences. Individual variations were so pronounced that caution is recommended for all clinical decisions.

The pattern of facial skeletal growth and its relationship to various common indexes of maturation.

INTRODUCTION: Sequential stages in the development of the hand, wrist, and cervical vertebrae commonly are used to assess maturation and predict the timing of the adolescent growth spurt. This approach is predicated on the idea that forecasts based on skeletal age must, of necessity, be superior to those based on chronologic age. This study was undertaken to test this reasonable, albeit largely unproved, assumption in a large, longitudinal sample. METHODS: Serial records of 100 children (50 girls, 50 boys) were chosen from the files of the Bolton-Brush Growth Study Center in Cleveland, Ohio. The 100 series were 6 to 11 years in length, a span that was designed to encompass the onset and the peak of the adolescent facial growth spurt in each subject. Five linear cephalometric measurements (S-Na, Na-Me, PNS-A, S-Go, Go-Pog) were summed to characterize general facial size; a sixth (Co-Gn) was used to assess mandibular length. In all, 864 cephalograms were traced and analyzed. For most years, chronologic age, height, and hand-wrist films were available, thereby permitting various alternative methods of maturational assessment and prediction to be tested. The hand-wrist and the cervical vertebrae films for each time point were staged. Yearly increments of growth for stature, face, and mandible were calculated and plotted against chronologic age. For each subject, the actual age at onset and peak for stature and facial and mandibular size served as the gold standards against which key ages inferred from other methods could be compared. RESULTS: On average, the onset of the pubertal growth spurts in height, facial size, and mandibular length occurred in girls at 9.3, 9.8, and 9.5 years, respectively. The difference in timing between height and facial size growth spurts was statistically significant. In boys, the onset for height, facial size, and mandibular length occurred more or less simultaneously at 11.9, 12.0, and 11.9 years, respectively. In girls, the peak of the growth spurt in height, facial size, and mandibular length occurred at 10.9, 11.5, and 11.5 years. Height peaked significantly earlier than both facial size and mandibular length. In boys, the peak in height occurred slightly (but statistically significantly) earlier than did the peaks in the face and mandible: 14.0, 14.4, and 14.3 years. Based on rankings, the hand-wrist stages provided the best indication (lowest root mean squared error) that maturation had advanced to the peak velocity stage. Chronologic age, however, was nearly as good, whereas the vertebral stages were consistently the worst. Errors from the use of statural onset to predict the peak of the pubertal growth spurt in height, facial size, and mandibular length were uniformly lower than for predictions based on the cervical vertebrae. Chronologic age, especially in boys, was a close second. CONCLUSIONS: The common assumption that onset and peak occur at ages 12 and 14 years in boys and 10 and 12 years in girls seems correct for boys, but it is 6 months to 1 year late for girls. As an index of maturation, hand-wrist skeletal ages appear to offer the best indication that peak growth velocity has been reached. Of the methods tested here for the prediction of the timing of peak velocity, statural onset had the lowest errors. Although mean chronologic ages were nearly as good, stature can be measured repeatedly and thus might lead to improved prediction of the timing of the adolescent growth spurt.

Natural head position and growth of the facial part of the skull.

The aim of this study was to determine any correlation between natural head position and cranio-cervical growth direction and if natural head position influences facial growth direction. One hundred sixty (160) cephalometric radiographs were examined and cranio-cervical inclinations determined (angles: NS-Ver, NS-OPT, NS-CVT). On the basis of the NS-ML angle, radiographs were divided into two groups: mandibular anteriorotation and posteriorotation. On the basis of the SGo/NMe index, two groups were formed: short-faced and long-faced subjects. The angles NS-Ver, NS-OPT, and NS-CVT describe cranio-cervical inclination. Subjects with anterior mandible growth do position their heads more vertically and have a shorter face, and those with posterior mandible growth tilt their heads more backwards and have a longer face. An adaptive head position can be a factor in altering the direction of facial growth. Determination of head position and mandible growth direction can be an important indicator in patients with TMD treatment.

Growth modulation using functional appliances--cephalometric predictors of successful response.

AIM: The aim of this study was to determine any skeletal morphologic features evident on a pretreatment lateral cephalogram that may be used to predict improvement in the sagittal relationship during functional appliance therapy in Class II patients and compare changes between cases with and without a favorable response to growth modulation. METHOD: Pretreatment and postfunctional lateral cephalograms were analyzed, and the change in the ANB angle was used to determine the skeletal response to treatment with a functional appliance. Based on the change in the ANB angle, the patients were divided into two groups of 12 patients each. Comparisons were made between the mean pretreatment (T1) cephalometric parameters of group I (skeletal) and group II (nonskeletal) to assess any pretreatment parameters that were significantly different between the groups. Changes due to functional appliance therapy from the pretreatment (T1) to postfunctional (T2) stage was measured as T2-T1 in both groups. The mean changes seen in group I and group II were then compared to assess the difference between changes brought about by growth modulation using functional appliances. Comparative statistical analysis of the data was done using one-way analysis of variance F test. RESULTS AND CONCLUSION: This study showed that not all cases respond favorably to growth modulation. The pretreatment parameters that correlated to a favorable response were low mandibular plane angle, low basal plane angle, and a high Jarabak ratio. In those cases that responded favorably, the changes seen were an increase in Co-Go (ramus height), decrease in overjet, increase in SNB, and increase in the Jarabak ratio.

Eruption of the permanent maxillary canines in relation to mandibular second molar maturity.

OBJECTIVE: To evaluate the timing of spontaneous maxillary canine eruption in relation to stages of mandibular second molar maturation. Potential confounding effects from such factors as age, growth phase, and facial features were also explored. SUBJECTS AND METHODS: A sample of 106 healthy subjects (48 females and 58 males; age range, 9.4-14.3 years) with both permanent maxillary canines during the final phase of intraoral eruption were included. Mandibular second molar maturation (stages E to H) was assessed according to the method of Demirjian. Skeletal maturity was determined using the cervical vertebral maturational (CVM) method. Facial vertical and sagittal relationships were evaluated by recording the Sella-Nasion/mandibular plane (SN/MP) angle and the ANB angle. An ordered multiple logistic regression was run to evaluate adjusted correlation of each parameter with the mandibular second molar maturational stage. RESULTS: Overall, the prevalence of the different second molar maturational stages was 36.8%, 37.8%, and 27.4% for stages E, F and G, respectively. According to the regression model, this relation was not influenced by sex, CVM stage, SN/MP angle, and ANB angle. CONCLUSIONS: Irrespective of sex, growth phase, and facial features, the maturational stage of the mandibular second molar may be a reliable indicator for the timing of spontaneous eruption of the maxillary canine.

Ontogenetic changes of craniofacial complex in Turner syndrome patients treated with growth hormone.

OBJECTIVE: The present study assessed changes of craniofacial complex in Turner syndrome (TS) patients treated with growth hormone (GH) during development. The objective was to examine the growth rate and pattern of craniofacial structures and to establish effects of GH on craniofacial development. MATERIALS AND METHODS: The study population consisted of 15 TS patients treated with GH aged 5-18.5 years (13.3 ± 4.4) and corresponding control group of 45 females aged 6.8-18.7 (11.4 ± 2.6). According to the stage of cervical vertebral maturation, subjects were categorized into pre-growth (5 TS and 15 controls) and growth (10 TS and 30 controls) subgroups. The cephalometric analysis comprised angular and linear variables, measured on lateral cephalometric radiographs. RESULTS: The mandibular corpus/anterior cranial base ratio increased significantly only in controls during development. In growth period, ramus/corpus ratio was significantly larger in TS group. SNA and SNB angles were significantly smaller in TS growth subgroup compared to corresponding controls. Among other variables, no statistically significant differences were revealed. CONCLUSIONS: In TS patients treated with GH, growth capacities of cranial base and maxilla are adequate which can be attributed to GH treatment. Shape of mandible is altered due to decreased growth of corpus and overdeveloped ramus. Both maxillary and mandibular retrognathism are becoming more expressed during development. CLINICAL RELEVANCE: Favorable influence of GH on craniofacial complex growth rate and altered growth pattern revealed in this study should be considered while planning both orthodontic treatment and retention.

Maxillary growth and maturation during infancy and early childhood.

OBJECTIVE: To describe maxillary growth and maturation during infancy and early childhood. MATERIALS AND METHODS: Serial cephalograms (N=210) of 30 subjects (15 females and 15 males) from the Bolton-Brush Growth Study were analyzed. Each subject had a series of six consecutive cephalograms taken between birth and 5 years of age, as well as one adult cephalogram. Twelve maxillary measurements (eight linear and four angular) and seven landmarks were used to characterize maxillary growth. Maturation of the linear measures was described as a percentage of adult status. RESULTS: Maxillary and anterior cranial base size increased in both sexes between 0.4 and 5 years of age. The linear anteroposterior (AP) measures (S-SE, SE-N, ANS-PNS) increased almost as much as the vertical measures (S-PNS, SE-PNS, N-A, N-ANS) over the first 5 years. After 5 years of age there was significantly more vertical than AP growth. The size and shape changes that occurred were greatest between 0.4 and 1 years; yearly velocities decelerated regularly thereafter. Overall linear growth changes that occurred between 0.5 and 5 years of age (a span of 4.5 years) were generally greater than the changes in maxillary growth that occurred between 5 and 16 years (a span of 11 years). The linear measures showed a gradient of maturation, with the AP measures being more mature than the vertical measures. Male maxillae were less mature than female maxillae at every age. CONCLUSIONS: The maxilla undergoes its greatest postnatal growth change during infancy and early childhood, when relative AP growth and maturation are emphasized.