Post-natal size and morphology of the sella turcica. Longitudinal cephalometric standards for Norwegians between 6 and 21 years of age

The purpose of this study was to establish normative longitudinal cephalometric standards of size and to describe the morphology of the sella turcica in Norwegian males and females between 6 and 21 years of age using standardized lateral radiographic cephalograms. The subjects comprised 35 males and 37 females from the Oslo University Craniofacial Growth Archive. All were healthy Caucasians, with an Angle Class I molar and canine relationship with no apparent facial disharmony. None had undergone orthodontic therapy.The length, depth, and diameter of the sella turcica was measured and the mean values were analysed longitudinally. Comparisons between the dimensions of the sella turcica of males and females in each age group were performed using a Student's t-test.The length of the sella turcica was almost constant throughout the observation period and the depth and diameter increased with age. No differences between males and females were detected for the depth and diameter of the sella turcica, but the length was larger in males throughout the observation period.The morphology of the sella turcica was assessed and five different morphological aberration types were identified: oblique anterior wall, sella turcica bridging, double contour of the floor, irregularity (notching) in the posterior part of the dorsum sellae, and pyramidal shape of the dorsum sellae. The female subjects had slightly more sella turcicas with aberrant morphology.These reference standards for the dimensions of the sella turcica can be used in the study of growth and development of individuals with craniofacial aberrations and syndromes.     

Sella turcica morphology in patients with genetic syndromes: A systematic review

The sella turcica is an important anatomical reference used in orthodontics for the evaluation of craniofacial growth. Studies have found variations in the sella turcica morphology in patients with syndromes affecting the craniofacial complex. This review aims to determine whether genetic syndromes involving the craniofacial complex are associated with abnormal radiographic sella turcica morphology and whether there is a pattern of malformation which is consistent within each syndrome. An electronic database search was conducted to identify relevant studies. We included primary studies describing the morphology of the sella turcica on lateral radiographs in human subjects with genetic syndromes involving the craniofacial complex. No restrictions were placed on language or timeframe. PROSPERO registration CRD42019148060. Thirty-eight studies were included in this review. A ‘J’-shaped sella was found in patients with Hutchinson-Gilford-Progeria syndrome and other syndromes. A bulbous dorsum sellae was highly prevalent Cleidocranial dysplasia, and a bulbous dorsum sellae and uneven contours of the clivus was found in Cri du chat syndrome. A steep clivus was described in patients with Axenfeld-Rieger syndrome. An oblique anterior wall was the most frequent malformation found in Down’s syndrome. Genetic syndromes affecting the craniofacial complex are associated with abnormal morphology of the radiographic sella turcica. Clinicians should be observant of abnormal sella turcica morphology which can be a sign of undiagnosed or subclinical syndromes. More high-quality studies are needed which use standardized and objective methods of determining the morphology of the sella turcica.     

中国东北地区3～24岁正畸患者的蝶鞍形态

目的观察中国东北地区3~24岁正畸患者的蝶鞍形态,分析不同年龄段的生长变化,为临床诊断及应用提供参考依据。方法选择2008—2015年就诊于中国医科大学附属口腔医院正畸科的患者1 758例,测量每位患者的头颅侧位定位片,分别得出男性和女性蝶鞍的长度、深度、最大直径,观察蝶鞍形态伴随生长发育的变化情况。使用SPSS17.0统计软件对所得数据进行统计学分析。结果在生长发育过程中,蝶鞍的长度、深度、最大直径随着年龄的增加逐渐增大,18岁以后蝶鞍形态趋于稳定。蝶鞍的长度、深度变化均匀而缓慢,蝶鞍的最大直径的变化存在高峰期,即男性12~16岁,女性10~14岁。结论蝶鞍大小随年龄增长而逐渐增大,蝶鞍的最大直径的变化存在高峰期。     

Morphology,incidence of bridging,and dimensions of sella turcica in different racial groups

Objectives

This study was performed to assess the morphological appearance, incidence of bridging, and linear dimensions of the sella turcica (ST) in Bosnian and Iraqi subjects, and to identify associations of sex, age, and racial group with the size of the ST.

Methods

The digital standardised lateral cephalograms of 360 Bosnian and Iraqi patients (116 female, 64 male; age range 8–28 years) were retrospectively analysed. The following ST-related parameters were analysed on the lateral cephalograms: sella morphology, sella bridging, and sella size. The data were correlated with sex, age, and race.

Results

The ST exhibited a normal morphology in most subjects of both races (86.7%). The frequency of partial bridging was found in 38.9 and 37.2% of Bosnian and Iraqi subjects, respectively. A significant correlation was detected between the length of the ST and sex in both the Bosnian and Iraqi subjects (p?< 0.05). A direct correlation was present between patient age and the size of the ST in both races at the 0.01 and 0.001 levels for depth, length, and diameter. When race was compared with sella size, a significant difference was found in the length and depth of the ST (p < ?0.001).

Conclusions

Similarities were found between Bosnian and Iraqi subjects in the morphology, incidence of bridging, and linear dimensions of the ST. Length was the only parameter significantly associated with sex, age, and racial group. These findings could be used as reference standards for studying the ST in both races.

     

腭侧埋伏阻生尖牙与鞍桥的相关性研究

目的:比较腭侧埋伏阻尖牙生和尖牙正常萌出患者的蝶鞍大小,检测鞍桥和腭侧埋伏阻生尖牙之间是否存在关联。方法:选择腭侧埋伏阻生尖牙患者的头颅侧位片作为实验组,共103例,尖牙正常萌出者作为对照组,共103例。测量蝶鞍的长度、深度、直径,依据蝶鞍的钙化程度将其分为Ⅰ、Ⅱ、Ⅲ型。结果:除蝶鞍深度外,蝶鞍长度、直径两组间比较差异均有统计学意义。实验组男性的蝶鞍深度大于女性,蝶鞍长度及蝶鞍直径男女无统计学差异。而对照组男性与女性间蝶鞍的大小比较均无统计学差异。实验组鞍桥部分和完全钙化的发生率分别为41.75％和15.53％,但性别间比较差异无统计学意义;对照组鞍桥部分和完全钙化的发生率分别为8.73%和4.85％ 。实验组鞍桥发生率是对照组的8.52倍。结论:腭侧埋伏阻生尖牙患者的蝶鞍长度、直径均较对照组大,其鞍桥的发生率显著增加,但无性别差异。     

The human spheno-occipital synchondrosis II. A histological and microradiographic study of its growth

The spheno-occipital synchondrosis, dorsum sellae and clivus were studied post mortem in tissue samples from 53 males and 25 females, aged 2 days to 24 years 11 months. The investigation aimed at ascertaining the growth and remodelling changes in these structures during the growth period. Light microscopic and microradiographic techniques were used. In the early ages the organization of the synchondrosis was similar to that of an epiphyseal disc, except that the morphology of the synchondrosial cartilage was bipolar. With increasing age the hyaline cartilage in the upper part of the synchondrosis was replaced by fibro-cartilage, while the central zone in the lower part underwent asbestos transformation. The synchondrosis was completely ossified by 16—17 years of age in girls, and about two years later in boys. Appositional growth and endochondral ossification continued up to 3 years of age in cartilage covering the superior and clival aspects of the dorsum sellae. The cartilage on the superior aspect of dorsum sellae persisted until after puberty and occasionally longer. Minor areas of resorption were seen i the posterior wall of the sella turcica. This resorption, together with the growth of the cartilage covering the dorsum sellae, may cause a shift of the cephalometric reference point sella in an upward direction during the growth period. The intracranial surface of the occipital bone showed resorption. On the extracranial surface there was simultaneous bone apposition.     

恒牙先天缺失患者蝶鞍和颅底的头影测量研究

目的 探究不同程度恒牙先天缺失患者蝶鞍与颅底的大小及形态差异。 方法 选取2020—2021年就诊于四川大学华西口腔医院正畸科的322例患者为研究对象,依据先天缺牙数目将患者分为3组：对照组（无恒牙先天缺失,112例）;试验Ⅰ组（先天缺失1~2颗恒牙,104例）;试验Ⅱ组（先天缺失3颗及以上恒牙,106例）。使用Uceph头影测量软件对每位患者头颅侧位片的蝶鞍的长度、深度和直径以及颅底相关线性和角度参数进行测量。对每位患者的蝶鞍形态进行判定。采用SPSS 21.0软件对数据进行统计学分析。 结果 3组的蝶鞍长度、深度、直径以及颅底相关的线性和角度参数差异均无统计学意义（P>0.05）。3组的鞍桥发生率的差异有统计学意义（P=0.013）,试验组高于对照组（P<0.05）,试验Ⅰ组和试验Ⅱ组差异无统计学意义（P>0.05）。 结论 虽然蝶鞍的线性大小及颅底特征在正常人和先天缺牙患者中未见明显差异,但在先天缺牙患者中鞍桥发生率更高,提示该人群的蝶鞍解剖学形态可能异常。     

Bridging and dimensions of sella turcica in subjects treated by surgical-orthodontic means or orthodontics only

The aim of the study was to compare the incidence of sella turcica bridging and sella turcica dimensions in 150 Caucasian subjects who had combined surgical-orthodontic correction of their malocclusion with a randomly selected group of 150 Caucasian subjects who were treated contemporaneously by orthodontic means only. Pretreatment lateral cephalometric radiographs were scanned and analyzed. A sella turcica bridge was identified as a continuous band of bony tissue extending from the anterior cranial fossa to the posterior cranial fossa. The dimensions of the sella turcica were measured. In the group treated by combined surgical-orthodontic means, the incidence of bridging was 16.7%, whereas it was 7.3% in the orthodontics-only group (P = .012). Significant increases in the mean surface area (P = .02) and mean perimeter of the sella turcica (P = .01) were found for the combined surgical-orthodontic group compared with the orthodontics-only group. The mean interclinoid distance was significantly smaller in the surgical-orthodontic group (P = .02). These findings appear to indicate the greater likelihood of sella turcica bridging and abnormal sella turcica dimensions in subjects treated by combined surgical-orthodontic means rather than by orthodontics only.     

The shape and size of the sella turcica in skeletal Class I, Class II, and Class III Saudi subjects

The purpose of this study was to describe the shape and measure the size of the sella turcica in Saudi subjects with different skeletal types. Lateral cephalometric radiographs of 180 individuals (90 males and 90 females) with an age range of 11-26 years were taken and distributed according to skeletal classification; 60 Class I, 60 Class II, and 60 Class III. The sella turcica on each radiograph was analysed and measured to determine the shape of the sella, in addition to the linear dimensions of length, depth, and diameter. A Student's t-test was used to calculate differences in linear dimensions, while a one-way analysis of variance was performed to study the relationship between skeletal type and sella size. The results show that the sella turcica presented with a normal morphology in the majority of subjects (67 per cent). No significant differences in linear dimensions between genders could be found. When age was evaluated, significant differences were found between the older (15 years or more) and the younger (11-14 years) age groups at the 0.01 and 0.001 levels for length, depth, and diameter. Sella size of the older age group was larger than in the younger age group. When skeletal type was compared with sella size, a significant difference was found in the diameter of sella between the Class II and Class III subjects (P < 0.01). Larger diameter values were present in the skeletal Class III subjects, while smaller diameter sizes were apparent in Class II subjects (multiple comparison tests). When gender, age, and skeletal type were all compared with the size of the sella (regression analyses), age was significantly related to a change of length (P < 0.01) and diameter (P < 0.001). Sella shape and dimensions reported in the current study can be used as reference standards for further investigations involving the sella turcica area in Saudi subjects.     

The morphology of sella turcica in cleft and non-cleft individuals

Aims and ObjectivesThe aim of the study was to analyze the morphology and expedient the linear dimensions of Sella Turcica among cleft and non-cleft Indian individuals, and then to determine whether differences exist between different study groups.Materials and methodsThe lateral cephalogram of 300 patients (150 cleft and 150 non-cleft), aged 18 to 30 years who reported for various treatments of malocclusions were studied.ResultThe normal morphology of the sella turcica were seen in 85 of the 150 non-cleft individuals which was highest (56.66%) in the non-cleft group, however in the cleft group it was seen in only 16 of the 150 individuals (10.6%). Sella turcica bridge were seen in 10% of the non-cleft subjects, whereas in the cleft group it was seen in 38% of the individuals. A significant difference was seen in the linear measurements of the sella turcica of cleft and no-cleft individuals.ConclusionThe normal morphology of the sella turcica was seen in the majority of the non-cleft individuals. The cleft individuals showed an increased incidence of sella turcica bridging with reduced linear measurements of the sella as compared to the non-cleft individuals.     

A sella turcica bridge in subjects with dental anomalies

Calcification of the interclinoid ligament (ICL) of the sella turcica, or sella turcica bridging, has been associated with severe craniofacial deviations. Despite no comprehensive study on the sella turcica bridge, a relationship with tooth and eruption disturbances has been reported. In order to investigate whether congenital absence of the second mandibular premolar, or the presence of a palatally displaced canine (PDC), is associated with sella bridging, a retrospective study was performed. Lateral cephalometric radiographs from 20 males and 14 females, aged between 8 and 16 years, with a PDC and second mandibular premolar aplasia were reviewed and compared with a control group. A standardized scoring scale was established to quantify the extent of a sella turcica bridge from each radiograph (no calcification, partially calcified, and completely calcified). The prevalence of complete calcification of the ICL in adolescents with dental anomalies was equal to 17.6 per cent, while an incidence 9.9 per cent was found in the control group. A partially calcified sella turcica was observed in 58.8 per cent of adolescents with dental anomalies compared with 33.7 per cent in the control group. The association between the degree of calcification of the ICL and the presence of dental anomalies in the studied adolescents was statistically significant according to chi-square statistics (P = 0.004). This was confirmed by Fisher's exact test (P = 0.003). According to these findings, the prevalence of a sella turcica bridge in adolescents with dental anomalies is increased, while age and gender do not greatly influence ossification of the ICL. The very early appearance during development of a sella turcica bridge should alert clinicians to possible tooth anomalies in life later.     

An association between sella turcica bridging and dental transposition

The aim of the present study was to determine any association between tooth transposition and bridging of the sella turcica, given the evidence of common embryonic origins associated with these structures and a genetic basis underlying these two conditions. Clinical records of subjects demonstrating dental transposition and normal controls were collected from several hospital orthodontic departments and specialist orthodontic practices. All cases and controls were documented with good quality lateral cephalometric radiographs and dental panoramic tomograms (DPTs). The study sample consisted of 21 Caucasian subjects (7 males and 14 females; mean age 14.5 years; SD 2.2 years), demonstrating either maxillary or mandibular dental transposition. The control group, matched for age and gender to the study sample, comprised 70 Caucasians (31 males and 39 females; mean age 13.8 years; SD 1.8 years) without dental anomalies randomly selected from subjects referred for orthodontic treatment within the same departments. The extent of sella turcica bridging was quantified from each profile radiograph using comparative measurement of length and diameter. Sella turcica bridging was found more frequently in subjects diagnosed with dental transposition than in the controls, with the difference being statistically significant [chi-square=7.4; degrees of freedom (df)=2; P=0.025; Fisher's exact test; P=0.042]. The increased frequency of complete and partial bridging of the sella turcica in subjects with dental transposition provides further evidence of a genetic basis to this condition. As calcification and bridging of this region can present during early childhood, it may act as a useful diagnostic predictor of susceptibility to local dental problems.     

Craniofacial growth in Sotos syndrome

Sotos syndrome is a congenital genetic disorder characterized by overgrowth starting before birth, specific facial manifestations, advanced bone age, and developmental impairment. The characteristics of craniofacial development in Sotos syndrome have yet to be clarified. Eight patients with Sotos syndrome were studied and two types of mutations and a submicroscopic deletion within the NSD1 gene were verified using genetic analysis. Regarding craniofacial growth, the length between the nasion and the sella was longer than the norm as shown by multi-detector row computed tomography cephalometric analysis. The areas of the cranium and maxilla of patients with Sotos syndrome were larger than those of the control group, as measured on cephalometric images. The area of the sella turcica in patients with Sotos syndrome was also larger than that in the controls without significant difference and the morphology of the sella turcica was similar to that of the control. The morphology of the chin in patients with Sotos syndrome showed more protrusion than that in the controls. Early formation of teeth was found in the upper and lower first molars of patients with Sotos syndrome. Eight patients with Sotos syndrome, 6–13 years of age, had craniofacial characteristics of cranium and maxilla overgrowth, but no significant difference was observed in the mandible size between patients with Sotos syndrome and control subjects. No sella turcica bridging or early root formation of the first molars was seen in patients with Sotos syndrome.     

上颌侧切牙先天性缺失与蝶鞍相关性研究

目的 比较上颌侧切牙先天性缺失患者和牙列完整患者的蝶鞍大小,评估鞍桥和上颌侧切牙先天性缺失之间是否存在联系.方法 以上颌侧切牙先天性缺失患者作为试验组,牙列完整者作为对照组,每组各80例.利用Dolphin软件测量蝶鞍的大小,记录蝶鞍鞍桥的钙化程度.结果 两组间的蝶鞍大小除长度以外差异均无统计学意义.试验组与对照组在鞍...     

A cone beam computed tomographic evaluation of the size of the sella turcica in patients with cleft lip and palate

Objective: Changes in the size of the sella turcica are frequently related to pathologies and syndromes. The aim of this was to compare the sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate and non-cleft subjects.

Methods: Cone beam computed tomography (CBCT) images of three groups consisted of 20 patients with unilateral cleft lip and palate; 20 patients with bilateral cleft lip and palate and a control group consisting of 20 non-cleft subjects were the research population in this pilot study. The sella turcica linear dimensions in terms of length, depth and diameter were measured for all subjects. One-way ANOVA test was used to determine any significant differences among the three groups for the measured parameters.

Results: The length, depth and diameter of sella turcica were found to be significantly smaller in the unilateral and bilateral groups compared with the normal age and gender matched group. No significant differences were found in the measured variables between the unilateral and bilateral cleft patients.

Conclusion: CBCT images showed a greater likelihood of abnormal sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate. Therefore, the sella turcica dimensions may have an intrinsic relationship to the cleft condition.     

不同类型骨性错畸形患者蝶鞍特征研究

目的探讨不同类型骨性错畸形患者的蝶鞍大小、形态和鞍桥发生率。方法选取2016年7月至2019年9月于中国医科大学附属口腔医院第一门诊及正畸二科就诊的骨性Ⅰ类错畸形患者100例(Ⅰ组)、骨性Ⅱ类错畸形患者100例(Ⅱ组)、骨性Ⅲ类错畸形患者100例(Ⅲ组)。收集各组患者头颅侧位片,使用Winceph8.0软件定位相关标记点,并测量蝶鞍的长度、深度和直径,同时记录蝶鞍的形态(扁平形、椭圆形、圆形)以及鞍桥的类型(无鞍桥、部分鞍桥、完全鞍桥),计算各组患者鞍桥发生率。应用SPSS 25.0软件对数据进行统计学分析。结果各组患者蝶鞍大小、形态比较,差异均无统计学意义(均P> 0.05);但其鞍桥发生率比较,差异有统计学意义(P <0.001),其中Ⅲ组患者鞍桥发生率(66.0%)明显高于Ⅰ组(17.0%)和Ⅱ组(34.0%)。不同性别患者蝶鞍大小、形态及鞍桥发生率比较,差异均无统计学意义(均P> 0.05)。结论骨性Ⅲ类错畸形患者的鞍桥发生率显著增加,提示鞍桥的发生可能与颅颌面发育异常相关。     

A cephalometric morphometric study of the sella turcica

The purpose of this study was to use quantitative methods to measure the size and shape of the sella turcica and thus establish normative reference standards that could assist in a more objective evaluation and detection of pathological conditions. Standardized lateral cephalograms of 184 healthy Greeks (91 males and 93 females) were used. The age range was between 6 and 17 years. Conventional measurements included three different heights of the sella turcica (anterior, posterior, median), its length, and width, measured in relation to the Frankfort reference line. In addition, the area of sella turcica was calculated. Morphometric methods were used to assess shape. The tracings were superimposed using the Procrustes method, and the average shape was computed. Principal component analysis (PCA) was used to assess shape variability. The data were correlated with centroid size, age, and gender. Unpaired t-tests were used to determine gender differences. Sella height anteriorly was the only variable found to be significantly different between the genders, being larger in females by 0.5 mm. Linear and area measurements were found to be significantly correlated with age, but all correlations were low (r(2) below 8 per cent). Sella turcica shape, as described by PCA, was different between males and females, mainly at the posterior aspect of the sella outline. However, although there was an extensive overlap between the genders, and differences were minimal. Age was not found to be correlated with the shape coefficients, although, in the female group, the first principal component of shape was marginally not significant. Allometry was observed in both genders, the sella showing a tendency towards a flatter and wider shape with increase in size. The results of this study constitute quantitative reference data that could be used for objective evaluation of sella shape.     

Morphology of the sella turcica in Axenfeld–Rieger syndrome with PITX2 mutation

Background:  Axenfeld–Rieger syndrome (ARS) is a rare autosomal dominant disorder with an incidence of 1:200 000. Genotype and phenotype are heterogeneous and clinical morphology impresses with variable expressivity. Additionally to the typical craniofacial and dental aberrations anomalies in the morphology of sella turcica are discussed.
Method:  In a multidisciplinary genetic and clinical study four patients of a family with ARS were screened by direct DNA sequencing. Radiographic analysis of the patients was performed for evaluating cranial and dental structures. Additionally, a specific analysis of the morphology of the sella turcica was made on the radiographs.
Results:  Screening for PITX2 and FOXC1 mutations revealed a P64L missense mutation in PITX2 in all four patients. The cephalometric analysis showed a midface hypoplasia associated with a skeletal Class III. All patients showed a sella turcica bridge combined with a prominent posterior clinoid process followed by a steep clivus and an elongated sella turcica.
Conclusion:  The incidence of a sella turcica bridge in combination with a PITX2 mutation would suspect that sella turcica anomalies are typical symptoms of the syndrome. Sella turcica anomalies in association with craniofacial and dental aberrations, such as maxillary retrognathia, skeletal Class III relationship and hypoplasia of teeth, might be important indicators for ARS caused by PITX2 mutation.     

Maxillary and sella turcica morphology in newborns with cleft lip and palate.

OBJECTIVE: The first aim was to examine maxillary developmental fields by analyzing bone size parameters within the maxillary bone complex in newborns with unilateral cleft lip (UCL) and unilateral cleft lip and palate (UCLP). The second aim was to evaluate sella turcica morphology in unilateral cleft lip and unilateral cleft lip and palate. SUBJECTS AND METHODS: Axial and profile radiographs from 40 newborns (boy-girl, 1:1) in each group (20 unilateral cleft lip and 20 unilateral cleft lip and palate) were randomly selected among radiographs taken for optimizing treatment planning. Analysis of maxillary bone size was performed on axial radiographs and size parameters were measured. Furthermore, analysis of sella turcica morphology was performed on profile radiographs. The results were divided into groups with normal morphology and severe deviations in the morphology. RESULTS: The maxillary areas were significantly shorter and broader in unilateral cleft lip and palate than in unilateral cleft lip. A profound asymmetry in the maxillary areas was seen in unilateral cleft lip and palate, but not in unilateral cleft lip. In both cleft types, approximately half of the individuals had deviations in sella turcica morphology. The most severe deviations occurred in newborns with unilateral cleft lip and palate. CONCLUSIONS: In newborns with unilateral cleft lip and palate, the maxillary areas are significantly shorter, broader, and more asymmetric than in newborns with unilateral cleft lip. The present study showed that bone structures are a suitable parameter for characterizing the craniofacial developmental fields. Additionally, a high incidence of deviations in sella turcica morphology might indicate that this area is affected in individuals with clefts.