cephalometric analysis for orthognathic surgery
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CEPHALOMETRIC ANALYSIS FOR ORTHOGNATHIC SURGERY
Dr. Mohd Ullah KhanDept of Othodontics & Dentofacial OrthopedicsCIDS
CONTENTS
INTRODUCTION CHARACTERISTICS LANDMARKS CHARLES.J.BURSTONE ANALYSIS CONCLUSION REFERENCES
INTRODUCTION
Developed in University of connecticut
The successful t/t of orthognathic surgical pt is dependent of careful diagnosis.
This system describes H and V position of facial bones Size of bone—linear measurement Shape ----angular measurements
CHARACTERISTICS
1. The chosen landmarks and measurements can be altered by various surgical procedures.
2. The comprehensive appraisal includes all of the facial bones and a cranial base reference.
3. Measurements can be readily transferred to a study cast for mock surgery.
4. Critical facial skeletal components are examined.5. For variations in age and sex standards are available.6. Computerized systematic approach to measurement can be
used.
LANDMARKS
Sella (S)
CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978
Nasion (N) –
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9Articulare (Ar)
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10 Pterygomaxillary fissure (PTM)
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11
Subspinale (A) –
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12 Pogonion (Pog)
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13Supramentale (B)-
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14 Anterior nasal spine (ANS) –
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15Menton (Me) –
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16
Gnathion (Gn)
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17 Posterior Nasal Spine (PNS)
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18 Mandibular plane (MP) –
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19 Nasal Floor (NF)
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20 Gonion (Go)
7HP
Horizontal plane
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Hard tissue analysis Cranial base Horizontal profile Vertical height - dental & skeletal Maxilla & mandible Dental
Cranial base
1. Ar-N (||HP)
2. Ar-Ptm (||
HP)
Ar-PTM
Ar-N
Ar-N(||HP)(in mm) (F) 50 +3(M) 52.8 + 4.1
Ar-Ptm(||HP)(in mm) (F) 32.8 +1.9(M) 37.1 + 2.8
Ar-PTM is measured to determine horizontal distance b/w post aspect of maxilla and mand.. Greater the distance bt Ar-ptm mandible placed post to maxilla
HORIZONTAL PROFILE
1.N-A-Pog(Angle)2. N-A(|| HP)3. N-B(|| HP)4. N-Pog(|| HP)
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N-A-Pog (F)2.6° + 5.1° (M)3.9° + 6.4°
N
A
Pog
• Degree of skeletal convexity.
.
N-A(||HP) (in mm)(F) -2 + 3.7(M) 0 + 3.7
.
N-B(||HP) (in mm) (F) -6.9 + 4.3 (M) -5.3 + 6.7
..
N-Pog(||HP) (in mm)(F) -6.5 + 5.1(M) -4.3 + 8.5
VERTICAL HEIGHT - SKELETAL
Vertical Skeletal &
Dental
Anterior
N-ANS ANS-Gn
posterior
PNS-N MP-HP
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HP
ANS
NN-ANS ( in mm) (F) 50 + 2.4 (M) 54.7 + 3.2
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HP
Gn
ANS
ANS-Gn (in mm) (F) 61.3 + 3.3 (M) 68.6 + 3.8
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HP
PNS
N PNS-N (F) 50.6 + 2.2 (M) 53.9 + 1.7
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HP NMP-HP angle (F) 24.2° + 5° (M) 23.0° + 5.9°
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35 VERTICAL HEIGHT - DENTAL
Vertical dental
dysplasia
Ant
U1-NF L1-MP
post
U6-NF L6-MP
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HP N U1-NF (in mm) (F) 27.5 + 1.7 (M) 30.5 + 2.1
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HP N l1-MP (in mm) (F) 40.8 + 1.8 (M) 45.0 + 2.1
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HP N U6-NF (in mm) (F) 23.0 + 1.3 (M) 26.2 + 2.0
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HP N L6-MP (in mm) (F) 32.1 + 1.9 (M)35.8 + 2.6
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40 MAXILLA & MANDIBLE
PNS-ANS (||HP) Ar-Go Go-Pog B-Pog (||MP) Ar-Go-Gn (°)
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HP N PNS-ANS(in mm) (F)52.6 + 3.5 (M)57.7 + 2.5
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Ar-Go (in mm) (F) 46.8 + 2.5 (M) 52.0 + 4.2
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B-Pog (in mm) (F) 7.2 + 1.9 (M) 8.9 + 1.7
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Ar-Go-Gn (in °) (F) 122°+ 6.9° (M) 119.1° + 6.5°
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45 DENTAL
OP-HP (angle) A-B(||0P) U1-NF (angle) L1-MP (angle)
OP-HP angle
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HP NOP-HP angle (F) 7.1 + 2.5 (M) 6.2 + 5.1
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HP N A-B(||0P) (in mm) (F) -0.4 + 2.5 (M) -1.1 + 2
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HP NU1-NF angle (F) 112° + 5.3 (M) 111° + 4.7
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HP N L1-MP angle (F) 95.9° + 9.7 (M) 95.9° + 5.2
SOFT TISSUE Landmarks used for the analysis
GLABELLA
GLABELLA
COLUMELLA POINT
COLUMELLA POINT
SUBNASALE
LABRALE SUPERIUS
STOMION SUPERIUS
LABRALE INFERIUS
STOMION INFERIUS
SOFT TISSUE POGONION
SOFT TISSUE MENTON
CERVICAL POINT
SOFT TISSUE GNATHION
Horizontal analysis of the soft tissue profile
Facial Form Angle of convexity G to Sn and Sn to Pog Mean Value is 12 degree with a
standard deviation of 4 degree
So to define the anterior posterior position of the jaws two soft tissue measures are taken.
Sn point to G perp : 6 +/- 3 mm
Pog’ point to G perp : 0 +/- 4 mmm
Lower cervicofacial angle Formed by the
intersection of Sn – Gn’ and Gn’ – C lines.
Mean Value is 100 degree with a SD of 7 degree.
.
1. Height of the mid third of the face/ height of the lower third ( A / B)
Height of the lower third of the face increases in : a) Maxillary vertical over growth b) Class 3 patients with vertical height increase c) Skeletal open bites Height of the lower third of the face decreases in : a) Maxillary Vertical undergrowth b) Mandibular retrusion with deep bite c) Vertical undergrowth of the chin
Nasolabial Angle
Formed by the intersection of lines Cl-Sn and Sn-Ls.
Mean Value is 102 degree with a standard deviation of 8 degree.
A-P Lip PositionLine drawn from Subnasale to soft tissue Pog to Ls 3mm
Line drawn from Subnasale to soft tissue Pog to Li 2mm
Labiomental sulcus
Sulcus perp to Li-Pog
4 mm normal
MAXILLARY INCISORS EXPOSURE
2mm is desirable.
INTERLABIAL GAP
Lightly touching to approximately 2mm apart.
CONCLUSION
• A simplified and relevant ceph analysis has been developed that is applicable to planning tt for pt requiring orthognathic surgeries.
• This analysis evaluates both hard tissue and soft tissue with both vertical as well as horizontal aspects of the face.
• If a prime pbjective of orthognathic surgery is facial improvement, soft tissue analysis becomes paramount in treatment planning
REFERENCES
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