Associations between the Cervical Vertebral Column and Craniofacial Morphology

Aim. To summarize recent studies on morphological deviations of the cervical vertebral column and associations with craniofacial morphology and head posture in nonsyndromic patients and in patients with obstructive sleep apnoea (OSA). Design. In these recent studies, visual assessment of the cervical vertebral column and cephalometric analysis of the craniofacial skeleton were performed on profile radiographs of subjects with neutral occlusion, patients with severe skeletal malocclusions and patients with OSA. Material from human triploid foetuses and mouse embryos was analysed histologically. Results. Recent studies have documented associations between fusion of the cervical vertebral column and craniofacial morphology, including head posture in patients with severe skeletal malocclusions. Histological studies on prenatal material supported these findings. Conclusion. It is suggested that fusion of the cervical vertebral column is associated with development and function of the craniofacial morphology. This finding is expected to have importance for diagnostics and elucidation of aetiology and thereby for optimal treatment

Head Posture and Upper Cervical Spine Morphology in Patients with Obstructive Sleep Apnea

The main aim of this chapter is to describe the role of upper cervical spine morphology and head and neck posture in the etiology, diagnosis, and treatment in patients with obstructive sleep apnea (OSA). Previously it has been documented that the posture of the head and neck was related to the morphology of the facial profile, dysfunction of the jaws, and obstruction of the upper airway. It has been shown that head posture in relation to the upper cervical spine was extended in OSA patients. New findings have been added concerning the occurrence and pattern of deviations of the upper cervical spine morphology in OSA. Furthermore, associations between upper cervical spine morphology and the morphology of the facial profile, including the cranial base in OSA patients have been reported. In addition, the occurrence of upper cervical spine morphological deviations in OSA patients seems to affect the outcome of the treatment with a mandibular advancement devise (MAD). Accordingly, it is suggested that upper cervical spine morphology and posture of the head and neck are important factors in the etiology, diagnosis, and treatment considerations in OSA patients

Ethnic differences in craniofacial and upper spine morphology in children with skeletal Class II malocclusion

OBJECTIVES: To analyze differences in upper cervical spine and craniofacial morphology, including posterior cranial fossa and growth prediction signs, between Danish and South Korean pre-orthodontic skeletal Class II children and to analyze associations between upper cervical spine morphology and craniofacial characteristics. MATERIALS AND METHODS: One hundred forty-six skeletal Class II children—93 Danes (54 boys and 39 girls, mean age 12.2 years) and 53 Koreans (27 boys and 26 girls, mean age 10.8 years)—were included. Upper spine morphology, Atlas dimensions, and craniofacial morphology, including posterior cranial fossa and growth prediction signs, were assessed on lateral cephalograms. Differences and associations were analyzed by multiple linear and logistic regression analyses adjusted for age and gender. RESULTS: Significant differences between the ethnic groups were found in the sagittal and vertical craniofacial dimensions (P < .001), mandibular shape (P < .01), dental relationship (P < .01), posterior cranial fossa (P < .05), and growth prediction signs (P < .001). No significant differences were found in upper spine morphology and Atlas dimensions between the groups. Upper spine morphology/dimensions were significantly associated with the cranial base angle (P < .01), sagittal craniofacial dimensions (P < .001), posterior cranial fossa (P < .001), and growth prediction signs (P < .05). CONCLUSIONS: Upper spine morphology/dimensions may be valuable as predictive factors in treatment planning for growing Class II children

Risk factors for small pharyngeal airway dimensions in preorthodontic children:A three-dimensional study

Objective: To analyze which parameters, gathered from standard orthodontic diagnostic material, were most relevant for identifying small pharyngeal airway dimensions in preorthodontic children. Materials and Methods: The sample was composed of 105 cone beam computed tomography scans of healthy preorthodontic children (44 boys, 61 girls; mean age, 10.7 ± 2.4 years). Airway volume and minimal cross-sectional area were three-dimensionally assessed. Cephalometric features and skeletal maturity were assessed on generated two-dimensional cephalograms. Associations were analyzed and adjusted for age, gender, and skeletal maturity by multiple regression analyses. Results: Airway volume and minimal cross-sectional area were significantly smaller in prepubertal children (P < .001, P < .05, respectively) and positively associated with age (P < .001, P < .01, respectively). After adjustment of age, skeletal maturity and gender significant associations were found between pharyngeal airway dimensions and craniofacial morphology. Airway volume was positively associated with maxillary and mandibular width (P < .01; P < .001, respectively) and anterior face height (P < .05; P < .05, respectively). Minimal cross-sectional area was positively associated with maxillary and mandibular width (P < .01; P < .001, respectively) and negatively associated with sagittal jaw relationship (AnPg, P < .05). Mandibular width and age were the most relevant factors for airway volume (r2 = 0.36). Mandibular width and sagittal jaw relationship were the most relevant factors for minimal cross-sectional area (r2 = 0.16). Conclusion: Pharyngeal airway dimensions were significantly associated with age, skeletal maturity, and craniofacial morphology in all three planes. Children with a reduced mandibular width and increased sagittal jaw relationship are particularly at risk of having small pharyngeal airway dimensions