Cephalometry

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Craniometry Skull, 1902 Craniometry skull 1902.jpg
Craniometry Skull, 1902

Cephalometry is the study and measurement of the head, usually the human head, especially by medical imaging such as radiography. Craniometry, the measurement of the cranium (skull), is a large subset of cephalometry. Cephalometry also has a history in phrenology, which is the study of personality and character as well as physiognomy, which is the study of facial features. Cephalometry as applied in a comparative anatomy context informs biological anthropology. In clinical contexts such as dentistry and oral and maxillofacial surgery, cephalometric analysis helps in treatment and research; cephalometric landmarks guide surgeons in planning and operating.

Contents

History

The history of cephalometry ( cephalo- + -metry , "head measurement") can be traced through art, science, and anthropology. The origins of the important method of measuring has its origins in the Renaissance. Leonardo da Vinci is perhaps the most well known scientist and artist studying facial proportions during the Renaissance. Da Vinci along with others utilized grids to study the proportions of the face and make generalizations about them. Da Vinci looked for divine proportions in his quest to understand facial proportions. The divine proportion has since been found to exist in 20th centuries of facial proportions as they relate to esthetics. Beginning with Petrus Camper in the 18th century angles began to be employed in the measurement of facial form. Camper also began the practice of ethnographic grouping based on facial form. [1] Anders Retzius defined the cephalic index and classified different shapes of the head. Brachycephalic refers to a small, rounded head. Dolichocephalic refers to a long head. Mesocephalic refers to a medium-sized head, typically between the brachycephalic and dolichocephalic sizes.

Timeline

Machine Dimensions

To carry out cephalometry, the X-ray source is placed a steady five feet away from the mid sagittal plane, with film situated just 15 cm from there. This allows for accurate measurements to be taken and recorded. [2] Distance has a direct impact on cephalometric image magnification. With an object-to-film interval of 15 cm and a source-to-object span of 5 feet, magnification of anatomical landmarks will be reduced in all three dimensions.When attempting to analyze a patient's anatomy through lateral and frontal cephalograms, the challenge arises due to these images being two-dimensional projections of three-dimensional structures. Magnification and distortion as an outcome of traditional radiography further complicates the process by blurring important details. [3]

Applications

Dentistry

Cephalometric analysis is used in dentistry, and especially in orthodontics, to gauge the size and spatial relationships of the teeth, jaws, and cranium. This analysis informs treatment planning, quantifies changes during treatment, and provides data for clinical research. Cephalometry focuses on linear and angular dimensions established by bone, teeth, and facial measurements. It has also been used for measurements of hard and soft tissues of the craniofacial complex.

Obstetrics

Ultrasound cephalometry is useful for determining baby growth in utero. Cephalometry can also determine if an unborn child will pass through the birth canal. Certain 3D imaging applications are now used in obstetric cephalometry. In 1961, Donald and Brown employed ultrasound technique for measurement of the fetal head. Other scientists tried the method and found that the ultrasound technique was 3mm different than the post-natal measurement with calipers. This method requires that the transponder be placed on the maternal abdomen over the area of the fetal head. The transponder is moved until a pair of echos are strong and equal. This indicates that the parietals are perpendicular to the transmitting beam. The distance of the reflections equal the biparietal diameter. From this, the size of the head and the fetal weight can be determined with incredible accuracy. The use of ultrasound cephalometry is meant to be used in addition to other radiographic techniques. Thus far, no ill effects have been reported to the fetus or the mother using the ultrasound fetal cephalometry. [4]

Forensics

Cephalometry can be used to assist in forensic investigations. Researchers work to compile databases of population-level craniometric data. Due to variations in cranial measurements by population these types of databases can help assist investigators working in a known region.

One such database was utilized to test whether craniometric measurements can be utilized to measure stature when only fragmentary remains are available. Researchers created a database cranial measurements utilizing cephalograms of Garo women living in Bangladesh. Head circumference, head length, facial height from 'nasion' to 'gnathion', bizygomatic breadth and stature were all measured and documented. The measurements of the women were placed into a database and then a normative value was given for each measurement within that population. Results indicated that only head circumference was positively statistically correlated with stature. [5]

One way in which cephalograms can be utilized is for accurate age estimation but not for sex estimation. One study confirmed that the mandibular ramus length is strongly related to chronological age and can be utilized to predict whether an individual is older than 18 years or older with a highly significant degree of accuracy (95% confidence interval). If the ramus length is 7.0 cm or more, then the individual has an 81.25% probability of being 18 years or older. Further, the study confirmed that there is not a strong degree of sexual dimorphism between mandibular ramus length until an individual reaches 16 years of age. The accuracy of predicting sex with mandibular ramus length is only 54% making it an unreliable indicator of sex in forensic contexts. The study also has impacts for providing age estimation of living people. This could be applicable in immigration, criminal and civil investigations, adoption of children, or old-age pension requests. The study utilized scanned cephalometric radiographs to conduct the study. [6] Cephalometry remains to be the most popular and useful method for investigating the craniofacial skeletal morphology. Skull measurements are also important for facial reconstruction in cases of disputed identity. In the Punjab study, the mesocephalic was the most common craniotype followed by dolicocephalic in the tropical regions. The brachycephalic was more common in the temperate regions. Genetic and environmental factors have been suggested for the presence of variations in cephalic indices among population groups. Dietary habits have also been shown to modulate the craniofacial form of people. The data this study gathered is only valid for the adult population and may be useful in future forensic contexts. [7]

Sleep apnea

An Asian study was performed on children ages 3–13 who had obstructive sleep apnea. The study concluded that four cephalometric anthropomorphic parameters were related to the apnea-hypopnea index. Three of which indicated the importance of hyoid position in pediatric sleep apnea. Future studies are needed in this area. [8] A Scottish study used cephalometric radiographs in order to find cause of sleep apnea. This was performed on adult men and women and found that location of the hyoid also correlates with the obstructive sleep apnea/hypopnea syndrome (OSAHS). The longer the distance of the hyoid to the mandibular plane along with a shorter mandibular corpus showed significantly associated with OSAHS. Compared with a control group, those with OSAHS had the hyoid bone lower in relation to the mandibular plane. [9] By using a cephalometric analysis program, a study was able to conclude that people with a reduced midface length and an inferiorly placed hyoid tend to have smaller airways which can lead to obstructive sleep apnea. Lateral cephalography is useful in analyzing skeletal and soft tissue characteristics. They recorded 22 measurements from the lateral cephalograms and craniometric landmarks were digitized. In other studies, differences in characteristics were noted in the sagittal and vertical planes of apnea sufferers versus the controls. This study did not find these differences between their groups. They did find that using cephalometry there is a difference in craniofacial morphology of persons with obstructive sleep apnea versus the healthy population. [10] On recent open public competitions, machine learning and shape analysis algorithms demonstrated the mean error of 1.92 mm for automated landmarking and up to 93.2% of agreement between automated and manual cephalometry [11] [12]

Technology

Advances in technology have allowed scientists and anthropologists to utilize statistical programs in order to estimate ancestry of a skull by taking measurements of various craniometric points. CRANID is a statistical program that is used when the source of a cranium is of unknown origin. Cranial measurements are taken and entered into a worldwide craniometric database that is compared to other known cranial metrics. This information allows the user to be able to estimate ancestry in archaeological, forensic, and repatriation context. It has highest accuracy when sex is able to be determined. [13] Dolphin Imaging Cephalometric and Tracing Software is a cephalometric analysis that can measure airway dimensions and dentofacial parameters. It has been used for studies in obstructive sleep apnea. As cephalometry become more digitized by using different programs and scanners, caution should be taken when interpreting data. Objects measured by computer assisted methods may not be an exact match of the original. Scanning and surface reconstruction can produce some data measurement uncertainty. There have been known cases of different software producing different data even when the same skull is used under the same conditions. Software packages, AMIRA and TIVMI, were used for surface reconstructions. The mean difference between measurements was lower for TIVMI. AMIRA can produce up to 4% error in known measurements and 5% in dry skull measurements. Error rates should be taken into consideration when using digitized software for this purpose. [14]

Other applications of cephalometry

See also

Bibliography

Related Research Articles

<span class="mw-page-title-main">Sleep apnea</span> Disorder involving pauses in breathing during sleep

Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times a night. In the most common form, this follows loud snoring. A choking or snorting sound may occur as breathing resumes. Because the disorder disrupts normal sleep, those affected may experience sleepiness or feel tired during the day. In children, it may cause hyperactivity or problems in school.

<span class="mw-page-title-main">Snoring</span> Vibratory sound made while asleep

Snoring is the vibration of respiratory structures and the resulting sound due to obstructed air movement during breathing while sleeping. The sound may be soft or loud and unpleasant. Snoring during sleep may be a sign, or first alarm, of obstructive sleep apnea (OSA). Research suggests that snoring is one of the factors of sleep deprivation.

<span class="mw-page-title-main">Hyoid bone</span> Bone situated in the neck between the chin and the thyroid cartilage

The hyoid bone is a horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage. At rest, it lies between the base of the mandible and the third cervical vertebra.

Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, orthodontics, surgery, or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.

<span class="mw-page-title-main">Craniometry</span> Measurement of the human cranium

Craniometry is measurement of the cranium, usually the human cranium. It is a subset of cephalometry, measurement of the head, which in humans is a subset of anthropometry, measurement of the human body. It is distinct from phrenology, the pseudoscience that tried to link personality and character to head shape, and physiognomy, which tried the same for facial features. However, these fields have all claimed the ability to predict traits or intelligence.

<span class="mw-page-title-main">Crouzon syndrome</span> Genetic disorder of the skull and face

Crouzon syndrome is an autosomal dominant genetic disorder known as a branchial arch syndrome. Specifically, this syndrome affects the first branchial arch, which is the precursor of the maxilla and mandible. Since the branchial arches are important developmental features in a growing embryo, disturbances in their development create lasting and widespread effects.

<span class="mw-page-title-main">Polysomnography</span> Multi-parameter study of sleep and sleep disorders

Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.

<span class="mw-page-title-main">Craniosynostosis</span> Premature fusion of bones in the skull

Craniosynostosis is a condition in which one or more of the fibrous sutures in a young infant's skull prematurely fuses by turning into bone (ossification), thereby changing the growth pattern of the skull. Because the skull cannot expand perpendicular to the fused suture, it compensates by growing more in the direction parallel to the closed sutures. Sometimes the resulting growth pattern provides the necessary space for the growing brain, but results in an abnormal head shape and abnormal facial features. In cases in which the compensation does not effectively provide enough space for the growing brain, craniosynostosis results in increased intracranial pressure leading possibly to visual impairment, sleeping impairment, eating difficulties, or an impairment of mental development combined with a significant reduction in IQ.

<span class="mw-page-title-main">Mandibular advancement splint</span>

A mandibi splint or mandibi advancement splint is a prescription custom-made medical device worn in the mouth used to treat sleep-related breathing disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders. These devices are also known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators, and sleep apnea mouth guards.

<span class="mw-page-title-main">Obstructive sleep apnea</span> Sleeping and breathing disorder

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed "apneas" with complete or near-complete cessation of breathing, or "hypopneas" when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both, may result. A high frequency of apneas or hypopneas during sleep may interfere with the quality of sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life. The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime.

<span class="mw-page-title-main">Orthognathic surgery</span> Surgery of the jaw

Orthognathic surgery, also known as corrective jaw surgery or simply jaw surgery, is surgery designed to correct conditions of the jaw and lower face related to structure, growth, airway issues including sleep apnea, TMJ disorders, malocclusion problems primarily arising from skeletal disharmonies, and other orthodontic dental bite problems that cannot be treated easily with braces, as well as the broad range of facial imbalances, disharmonies, asymmetries, and malproportions where correction may be considered to improve facial aesthetics and self-esteem.

<span class="mw-page-title-main">Forensic facial reconstruction</span> Recreating faces from skeletal remains

Forensic facial reconstruction is the process of recreating the face of an individual from their skeletal remains through an amalgamation of artistry, anthropology, osteology, and anatomy. It is easily the most subjective—as well as one of the most controversial—techniques in the field of forensic anthropology. Despite this controversy, facial reconstruction has proved successful frequently enough that research and methodological developments continue to be advanced.

Hypopnea is overly shallow breathing or an abnormally low respiratory rate. Hypopnea is defined by some to be less severe than apnea, while other researchers have discovered hypopnea to have a "similar if not indistinguishable impact" on the negative outcomes of sleep breathing disorders. In sleep clinics, obstructive sleep apnea syndrome or obstructive sleep apnea–hypopnea syndrome is normally diagnosed based on the frequent presence of apneas and/or hypopneas rather than differentiating between the two phenomena. Hypopnea is typically defined by a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It commonly is due to partial obstruction of the upper airway.

<span class="mw-page-title-main">Pycnodysostosis</span> Genetic disease

Pycnodysostosis, is a lysosomal storage disease of the bone caused by a mutation in the gene that codes the enzyme cathepsin K. It is also known as PKND and PYCD.

Cephalometric analysis is the clinical application of cephalometry. It is analysis of the dental and skeletal relationships of a human skull. It is frequently used by dentists, orthodontists, and oral and maxillofacial surgeons as a treatment planning tool. Two of the more popular methods of analysis used in orthodontology are the Steiner analysis and the Downs analysis. There are other methods as well which are listed below.

Cecil C. Steiner was a dentist and one of Edward H. Angle's first students in 1921. He developed a form of cephalometric analysis, presented in 1953, referred to as the Steiner method of analysis.

Sleep surgery is a surgery performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes snoring, upper airway resistance syndrome, and obstructive sleep apnea. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.

Hyoid suspension, also known as hyoid myotomy and suspension or hyoid advancement, is a surgical procedure or sleep surgery in which the hyoid bone and its muscle attachments to the tongue and airway are pulled forward with the aim of increasing airway size and improving airway stability in the retrolingual and hypopharyngeal airway. The horseshoe shaped hyoid bone sits directly below the base of tongue with the arms of the bone flanking the airway. Hyoid suspension is typically performed as a treatment for obstructive sleep apnea (OSA). This procedure is frequently performed with a uvulopalatopharyngoplasty (UPPP) which targets sites of obstruction higher in the airway. Typically, a hyoid suspension is considered successful when the patient's apnea-hypopnea index is significantly reduced after surgery.

Natural head position is a reproducible position of a head when it is in an upright position, with eyes looking straight at a mark. The concept was introduced into the field of orthodontics in the late 1950s by Moorrees and Kean. A horizontal line related to the natural head position has been recommended as the most reliable plane to study cephalometric analysis.

Human jaw shrinkage is the phenomenon of continued size reduction of the human mandible and maxilla over the past 12,000 to 15,000 years. Modern human lifestyles and diets are vastly different now from what they were for most of human evolutionary history. Human jaws, as well as oral cavities, have been shrinking ever since the Neolithic agricultural revolution. This has been confirmed by bone remains dated to this time period. Researchers are able to infer the basic lifestyle practices of past cultures, enabling them to link jaw size with lifestyle practice/behaviors. Bones from burial sites of past hunter-gatherer societies are associated with larger jaws and mouths, while bones retrieved from former farming cultures have decreased jaw size. Bones from farming societies also indicate the presence of dental malocclusions, commonly known as non-straight teeth. Within recent centuries, as food has become more processed and soft in form, a rapid increase in non-straight teeth, smaller jaws, and mouths; a lack of space for wisdom teeth; and associated health conditions have been observed. Such conditions include sleep apnea, constricted airways, and decreased respiratory fitness. Medical professionals have been making similar observations and documenting them for hundreds of years. Changes in diet, lifestyle, and breathing patterns have led to maladaptive phenotypic expression in terms of morphological craniofacial development that starts in childhood but persists throughout the lifespan.

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