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.     

蝶鞍的类型和鞍桥的发生率

蝶鞍位于颅窝中部,蝶骨体内表面,中部是垂体窝。蝶鞍是脑颅和颅面复合体的X线分析的重要结构,在正畸中,蝶鞍中心点是头影测量片上最常使用的标志点之一,被用来测量上下颌相对于颅骨的位置,以及上下颌之间的相对位置,研究这些结构有助于正畸医生诊断,并且可以通过纵向的结构叠加来研究个体的生长,也用来评估正畸治疗结果。临床医生应熟悉该领域的正常解剖影像学和形态学的变化,以便识别和研究可能反映的病理情况。该文就蝶鞍的类型和鞍桥发生率作一综述。     

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.     

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.     

Retrognathic maxilla in individuals born with oral clefts is due to intrinsic factors and not only due to early surgical treatment

ObjectivesTo determine if the skeletal form of individuals born with oral clefts was associated with maxillary position.Materials and MethodsLateral cephalometric radiographs of 90 individuals 8 to 12 years old born with or without cleft lip and palate paired by age and sex were used. Skull base length, cranial base angle, cranial deflection angle, and maxillary skeletal length and position were studied. Also, mandibular skeletal length and position, lower anterior facial height, and dental position were defined. Individuals were divided into three groups: 30 individuals born with cleft lip and palate with Class III malocclusion (UCLP Class III), 30 individuals born with cleft lip and palate with Class I malocclusion (UCLP Class I), and 30 individuals born without cleft lip and palate with Class III malocclusion (non-cleft Class III).ResultsWhen comparing the UCLP Class III group with the UCLP Class I group, there were differences in maxillary position (P < .001) and mandibular position (P = .004) found. No differences were found when comparing the UCLP Class III group with the non-cleft Class III group.ConclusionsThere are intrinsic factors that affect craniofacial morphology of individuals born with cleft lip and palate.     

Post-natal size and morphology of the sella turcica in Williams syndrome

Williams syndrome (WS) is a rare congenital disorder with distinctive craniofacial features, cardiovascular abnormalities, mental retardation, and behaviour characteristics.The purpose of this study was to investigate the size and morphology of the sella turcica on profile cephalograms in a group of individuals with WS. The material consisted of radiographic cephalograms of 62 Norwegian children, adolescents, and adults with an age range of 4.7-44.4 years. The length, depth, and diameter of the sella turcica were measured and the mean values were compared with normal reference material from the Oslo University Craniofacial Growth Archive. In total, the two-dimensional size of the sella turcica in the WS group was smaller in length, depth, and diameter compared with the control group, but only occasionally reached a significance level of 5 per cent (Student's t-test).The morphology of the sella turcica was assessed and five different morphological types were identified; oblique anterior wall, extremely low sella turcica, sella turcica bridging, irregularity (notching) in the posterior part of the dorsum sellae, and pyramidal shape of the dorsum sellae. The occurrence of these morphological types was more frequent in the WS subjects compared with the reference material, except for sella turcica bridging, which was equally frequent. The females with WS had more dysmorphic sella turcicas than males.This study has demonstrated morphological aberrations in the sella turcica in Norwegian individuals with WS, which should be further elucidated in future research and combined with neurological andendocrinological investigations.     

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.     

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.

     

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.     

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.     

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。     

Factor analysis of craniofacial morphology in cleft lip and palate in man.

The lateral cephalometric X-radiographs of 39 children with repaired cleft lip and palate were compared with those of an equal number of non-cleft children matched for age (± 0.75 yr) and sex. Of 28 spatial, angular and linear measurements used to evaluate skeletal morphology, 15 showed significant differences. Using factor analysis, covariation between variables was reduced to a set of six factors: I, nasopharyngeal-maxillary complex; II, cranial base; III, mandibular; IV, lower face; V, ramus; VI, palate, The six-factor solution accounts for 92 per cent of the variance, with Factors I and IV providing the best discrimination between cleft and non-cleft individuals.     

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.     

Influences of palatoplasty by the push-back procedure on craniofacial morphology and growth

PurposeFor patients with a cleft palate, the push-back procedure which accompanies posterior shifting of palatal flap is thought to be most effective way of. achieving adequate velopharyngeal function. In this study, we aimed to evaluate the influences of the push-back procedure on the craniofacial morphology and its growth.Material and methodsUsing cephalometry we compared the craniofacial morphology and growth of three groups of Japanese children, living in the same region (Hokkaido, Japan).1) 28 children (13 girls and 15 boys) with operated submucous cleft palates at the ages of 9 and 14 respectively.2) 12 age-matched children (7 girls and 5 boys) with unoperated submucous cleft palates.3) 60 age-matched non-cleft children (30 girls and 30 boys) with normal occlusion.None of them received dentofacial orthopaedic treatment.ResultsWhile the patients who had been operated on had significant differences in posterior upper facial height and inclination of the palatal plane when compared with non-cleft children or unoperated cleft children, they showed no statistically significant difference in anteroposterior positioning of anterior part of the maxilla, compared with the unoperated.ConclusionsThe influences of palatoplasty by the push-back procedure with posterior positioning of the palatal flaps on craniofacial morphology are additional to the cleft palate, and of minor concern.     

Comparison of tooth development stage of the maxillary anterior teeth before and after secondary alveolar bone graft: Unilateral cleft lip and alveolus vs unilateral cleft lip and palate

Objective:To compare the effect of secondary alveolar bone graft (SABG) on the tooth development stage of the maxillary central incisor (MXCI) and maxillary canine (MXC) in terms of the severity of unilateral cleft.Materials and Methods:The subjects consisted of 50 boys with unilateral cleft lip and alveolus (UCLA) or unilateral cleft lip, alveolus, and palate (UCLP). The age- and sex-matched subjects were divided into group 1 (UCLA, n = 25; 9.3 ± 0.8 years old) and group 2 (UCLP, n = 25; 9.4 ± 0.6 years old). In panoramic radiographs taken 1 month before (T0) and 1 year after SABG (T1), tooth development stage was evaluated according to the Nolla developmental (ND) stage. A panoramic radiograph taken 3 years after SABG was used as a reference for the final root length of individual tooth.Results:In groups 1 and 2, the ND stage of the MXCI did not exhibit differences between the cleft and non-cleft sides at T0 and T1, respectively. However, although the ND stage of the MXC of group 2 was delayed on the cleft side compared with the non-cleft side at T0 (P < .05), the MXC on the cleft side developed faster than that on the non-cleft side after SABG (P < .01). In terms of tooth development speed, group 2 showed a higher rate of faster developed MXCs on the cleft side compared with the non-cleft side after SABG than group 1 (36.0% vs 8.0%, P < .05).Conclusion:SABG performed at approximately 9 years of age might increase tooth development speed of MXC in patients with UCLP compared with patients with UCLA.     

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.     

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.