OBJECTIVE: To evaluate the morphometric effect of prenatal exposure to phenytoin, phenobarbital and carbamazepine on the shape of the maxilla the posterior and overall cranial base. MATERIAL AND METHODS: Sample selection: This study is a retrospective analyses of lateral cephalograms of 67 (Phenobarbital =21, Phenytoin=21, Carbamazepine=25) children age 6 to 16 who had been exposed prenatally to one of these drugs and compared to a control group of 44 unexposed children of the same age. Cephalometric films were digitized and anatomical landmarks identified by a single investigator. Landmarks were chosen to outline the maxilla, the posterior and overall cranial base. Morphometric analysis including Procrustes superimposition was used to compare the exposed children to the control group. Principal components analysis (PCA) and MANOVA tests were performed to determine the differences between the two groups. RESULTS: The superimposed average showed a significant difference between the two groups. In the exposed group, the anterior cranial base was vertically shorter. Glabella was more inferior and anterior relative to nasion, and the nasal tip was more superior and posterior. Orbitale was more inferior and posterior, suggesting a more posterior articulation with maxilla. The posterior cranial base was vertically taller and sagittally shorter. Also in the exposed group, the maxilla was vertically shorter. CONCLUSION: These results demonstrate a shorter, retrusive maxilla that articulates more posteriorly with a shorter anterior cranial base, confirming the midface hypoplasia of traditional anticonvulsant facies.

Climate has a selective influence on nasal cavity morphology. Due to the constraints of cranial integration, naturally selected changes in one structure necessitate changes in others in order to maintain structural and functional cohesion. The relationships between climate and skull/nasal cavity morphology have been explored, but the integrative role of nasal variability within the skull as a whole has not. This thesis presents two hypotheses: 1) patterns of craniofacial integration observed in 2D can be reproduced using 3D geometric morphometric techniques; 2) the nasal cavity exhibits a higher level of covariation with the lateral cranial base than with other parts of the skull, since differences in nasal morphology and basicranial breadth have both been linked to climatic variables. The results support the former hypothesis, but not the latter; covariation observed between the nasal cavity and other cranial modules may suggest that these relationships are characterized by a unique integrative relationship. / February 2016

Un examen des relations basicrânio-faciales et leurs variations au cours de l'ontogenèse est réalisé chez l'homme moderne. L'étude de la « typologie » faciale sagittale (classe squelettique) est envisagée en relation avec la configuration de la base du crâne. L'objectif est d'établir un modèle de développement basicrânio-facial conduisant aux différentes typologies faciales de l'homme actuel. - Une première étude bidimensionnelle a pour but de définir les variables de la base du crâne caractéristiques des relations faciales dans les dysmorphoses sagittales extrêmes. Ces résultats soulignent le lien entre flexion de la base du crâne, sa région postérieure et le décalage antéro- postérieur de la face. - Une seconde étude sur scanners Rx s'attache aux interactions entre la dimension transversale et sagittale. Elle confirme l'importance du positionnement antéro-postérieur des structures basicrâniennes dans la conformation faciale sagittale. Elle révèle peu de liens entre la dimension transversale de la base du crâne et les prognathismes maxillaire et mandibulaire, mais souligne l'influence de l'orientation des pyramides pétreuses, de l'écartement des processus ptérygoïdiens et de la flexion sphénoïdale. - Une troisième étude longitudinale analyse l’évolution des variables mises en évidence selon l'âge et le stade d'évolution dentaire pour chaque classe squelettique. Les paramètres basicrâniens ne sont pas prédéfinis à la naissance, ceux décrivant la flexion et la région postérieure de la base du crâne deviennent caractéristiques plus tardivement. Les stades occlusion de la denture temporaire et évolution de la première molaire permanente sont des évènements clés dans le lien entre la base du crâne et le type facial. Un modèle de développement basicrânio-facial est proposé à partir des trois conformations crânio-faciales dégagées (dysmorphoses squelettiques). Des perspectives en anthropologie des populations anciennes et actuelles sont proposées. / Basicranio-facial relationships and their variations during ontogenesis are studied on the modern human. The study of the sagittal facial typology (skeletal class) has been realized in relation with the cranial base shape. The aim was to establish a model of the basicranio-facial development leading to the different facial typologies of modern human. - A first two-dimensional study aims to define the variables of the cranial base caracteristical of the facial relations in the extreme sagittal dysmorphoses. The results show the link between the flexion of the cranial base, its posterior region and the facial antero-posterior discrepancy. - A second study on X-ray scanners looks into the interactions between the transverse and sagittal dimension. The results suggest the importance of the antero-posterior positioning of the cranial structures in sagittal facial shape. This study reveals few relationships between the basicranial transverse dimension and maxillary, mandibular prognathism, but shows the influence of the petrous pyramids orientation, the distance between pterygoid processes and the cranial base angle flexion. - A third longitudinal study analyzes the evolution of the variables observed in relation with the age and the stage of dental evolution for each skeletal class. The basicranial parameters are not predetermined at birth, those describing flexion and the posterior region of the cranial base become characteristic later on. The stages of the deciduous occlusion denture and of the first permanent molar evolution are key events for the link between cranial base and facial type. Based on the three craniofacial shapes described (skeletal dysmorphoses) a basicranio-facial development model is proposed. Perspectives in ancient and modern population anthropology are suggested.

Made available in DSpace on 2014-06-11T19:29:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-28Bitstream added on 2014-06-13T19:58:58Z : No. of bitstreams: 1 arrais_ldf_me_sjc.pdf: 947347 bytes, checksum: cddf2e979701126cb70be679fceed984 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Este trabalho se propôs a avaliar o complexo crânio-facial dos indivíduos portadores de SD com o objetivo de comparar os valores obtidos das mensurações com o valor padrão para indivíduos sem síndrome. Para isso, foram utilizadas 55 radiografias cefalométricas, em norma lateral, de indivíduos portadores de SD (28 do sexo masculino e 27 do sexo feminino), compreendidos entre as faixas etárias de seis a dezoito anos. As grandezas foram medidas duas vezes em cada indivíduo – com um intervalo de 15 dias - para se detectar possíveis erros no método, tanto aleatórios como sistemáticos. Para verificar a confiabilidade das medições foi utilizado o teste T-Student Pareado com nível de significância de 5%. Em seguida foi feita a comparação entre o grupo experimental e os valores padrões para cada sexo/faixa etária separadamente. Para isso foi utilizado o teste Z. As variáveis A-Nperp e Pog-Nperp apresentaram valores aumentados nos indivíduos com SD quando comparados aos valores padrões para essas medidas, obtidos em indivíduos sem síndrome, do mesmo sexo e faixa etária, indicando a protrusão da maxila e da mandíbula em relação à base de crânio. As medidas (Co-A), (Co-Gn) e AFAI, por sua vez, apresentaram valores menores nos indivíduos com SD. O ângulo do plano mandibular encontrou-se diminuído e o ângulo do eixo facial apresentou-se aumentado nos indivíduos com SD quando comparado ao valor padrão. Esses conhecimentos são fundamentais, pois visam estimar a perspectiva de crescimento craniofacial de modo que sejam fornecidos dados ao profissional para que este escolha adequadamente a melhor mecanoterapia aplicável ao caso dos indivíduos portadores de SD / This paper presents the evaluation of the craniofacial complex in Down’s syndrome individuals, based on McNamara cephalometric radiographic analysis, using as reference standard values from measurements in individuals without DS. The sample comprised 55 cephalometric radiographies, in lateral norm, of DS individuals (28 males and 27 females), in a group ranging from age six to eighteen. Computerized cephalometric analysis was performed on all subjects twice in fifteen days interval – to detect possible errors in the analysis method, being random or systematic. In order to check the measurement’s reliability, the data was submitted to a paired Student´s t test, with significant level of 5%. Next, a comparison between the experimental group and the standard values was done for each sex and age group separately, using the Z-test. The distance from point A and pogonion to the nasion perpendicular presented high values in DS individuals when compared to the standard values for those measurements (obtained from individuals without DS, within the same sex and age group), thus indicating the protrusion of the maxilla and the mandible related to the cranial base. The measurement (Co-A) and (Co-Gn), presented low values in DS individuals. The lower anterior facial height also presented diminished in DS individuals. The mandibular plane angle was found diminished and the facial axis angle was statistically high in DS individuals when compared to the standard value, for both sexes and in all age groups analyzed, indicating horizontal growth trend and braquifacial pattern. The importance of this knowledge is the possibility of predicting the craniofacial growth, helping the professionals choosing the best treatment alternative for DS individuals

Orientador: Luiz Cesar de Moraes / Banca: Edmundo Medici Filho / Banca: Evelise Ono / Resumo: Este trabalho se propôs a avaliar o complexo crânio-facial dos indivíduos portadores de SD com o objetivo de comparar os valores obtidos das mensurações com o valor padrão para indivíduos sem síndrome. Para isso, foram utilizadas 55 radiografias cefalométricas, em norma lateral, de indivíduos portadores de SD (28 do sexo masculino e 27 do sexo feminino), compreendidos entre as faixas etárias de seis a dezoito anos. As grandezas foram medidas duas vezes em cada indivíduo - com um intervalo de 15 dias - para se detectar possíveis erros no método, tanto aleatórios como sistemáticos. Para verificar a confiabilidade das medições foi utilizado o teste T-Student Pareado com nível de significância de 5%. Em seguida foi feita a comparação entre o grupo experimental e os valores padrões para cada sexo/faixa etária separadamente. Para isso foi utilizado o teste Z. As variáveis A-Nperp e Pog-Nperp apresentaram valores aumentados nos indivíduos com SD quando comparados aos valores padrões para essas medidas, obtidos em indivíduos sem síndrome, do mesmo sexo e faixa etária, indicando a protrusão da maxila e da mandíbula em relação à base de crânio. As medidas (Co-A), (Co-Gn) e AFAI, por sua vez, apresentaram valores menores nos indivíduos com SD. O ângulo do plano mandibular encontrou-se diminuído e o ângulo do eixo facial apresentou-se aumentado nos indivíduos com SD quando comparado ao valor padrão. Esses conhecimentos são fundamentais, pois visam estimar a perspectiva de crescimento craniofacial de modo que sejam fornecidos dados ao profissional para que este escolha adequadamente a melhor mecanoterapia aplicável ao caso dos indivíduos portadores de SD / Abstract: This paper presents the evaluation of the craniofacial complex in Down's syndrome individuals, based on McNamara cephalometric radiographic analysis, using as reference standard values from measurements in individuals without DS. The sample comprised 55 cephalometric radiographies, in lateral norm, of DS individuals (28 males and 27 females), in a group ranging from age six to eighteen. Computerized cephalometric analysis was performed on all subjects twice in fifteen days interval - to detect possible errors in the analysis method, being random or systematic. In order to check the measurement's reliability, the data was submitted to a paired Student's t test, with significant level of 5%. Next, a comparison between the experimental group and the standard values was done for each sex and age group separately, using the Z-test. The distance from point A and pogonion to the nasion perpendicular presented high values in DS individuals when compared to the standard values for those measurements (obtained from individuals without DS, within the same sex and age group), thus indicating the protrusion of the maxilla and the mandible related to the cranial base. The measurement (Co-A) and (Co-Gn), presented low values in DS individuals. The lower anterior facial height also presented diminished in DS individuals. The mandibular plane angle was found diminished and the facial axis angle was statistically high in DS individuals when compared to the standard value, for both sexes and in all age groups analyzed, indicating horizontal growth trend and braquifacial pattern. The importance of this knowledge is the possibility of predicting the craniofacial growth, helping the professionals choosing the best treatment alternative for DS individuals / Mestre

Objective. To assess the accuracy and precision in measurement of pairwise implant displacement across three methods of cranial base superimposition. Background. Cephalometric superimposition is the principal radiographic method used to evaluate changes within the craniofacial skeleton. Many studies have examined the accuracy of software intended to produce cephalometric superimposition. Such studies have utilized anatomic landmarks, selected by the respective software manufacturers, as registration points for constructing superimpositions and their analysis. As a result, these studies are only as accurate as the stability and validity of anatomic registration landmarks used. To our knowledge, no other study has utilized metallic implants to critically assess digital vs. analog cephalometric cranial base superimposition. Methods. Serial cephalograms from twenty-two patients across three time points containing metallic implants were obtained from the Mathews Acquisition Group. Each of the sixty-six cephalograms was traced by hand and digitally. Cranial base superimpositions were completed according to the analog structural method proposed by Björk and Skieller, and Johnston, and then by Dolphin version 11.5 and Quick Ceph Studio V3.2.8 digital software according to manufactures instructions. Total displacement measurements of selected implants across paired time points were recorded for both digital methods and analog method of superimposition with analog serving as the reference. Results: There were no statistically significant contrasts of mean total displacement of implants by superimposition method (p = 0.999). No significant differences are reported in mean implant displacement when comparing digital to analog superimposition methods for contrasts by time, structure, or implant location. Conclusions: The results show that there are no significant differences in accuracy and precision of digital and analog cranial base superimposition. The results of this study suggest that cranial base superimpositions on S-Na that are registered on S may be a good approximation of the structural method of cranial base superimposition. There are many methodological differences between digital and analog cranial base superimposition and future research examining such differences is recommended.

Background: Historically, many reference lines and planes of the human skull have been used in an attempt to depict the head in a natural head position (NHP) which is a relaxed/balanced position when looking ahead at their eye level. Head position correction has been attempted in fields such as anatomy, art, anthropology, orthodontics, oral and maxillofacial surgery, plastic surgery, and forensics. In orthodontics, oral and maxillofacial surgery, and plastic surgery, corrected head position (CHP) is particularly important for diagnosis of the normality/protrusion/retrusion of the patient’s facial skeleton. Usually a single plane, such as Frankfurt horizontal, is used to correct head position, but its angulation is variable between individuals, because each individual’s anatomy is unique. It has been found previously that the Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism, and these planes averaged -1 to -2 degrees from the true horizontal (HOR, which is a horizontal plane determined as being perpendicular to the earth’s gravitational force) with subjects in NHP. Methods: Craniofacial planes were measured in an Aboriginal Australian sample and in two contemporary samples obtained from Australian orthodontic practices, and the findings were compared with previous studies. Each sample consisted of 40 individuals (20 males and 20 females) with subjects in NHP. The Aboriginal Australian sample was longitudinal (T1, mean age 10 years; T2, mean age 14 years, and T3, mean age 18 years) enabling NHP to be assessed over approximately 8 years. A soft tissue Ear - nose plane (EN plane) was also investigated. Results: NHP reproducibility over 8 years demonstrated a mean of absolute difference of 2.9 degrees, with a range of differences from -7.9 to 8.2 degrees and a standard deviation of differences equal to 3.6 degrees. The Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism with each other, and averaged between 0 and -3 degrees from HOR. On average, EN plane was horizontal but was variable. Conclusions: NHP is not consistently reproducible at the individual level. For hard tissue images, the combined use of NHA, FH, KW plane, and P plane enables prediction of CHP. Additionally, the rectangular shape of the lower orbit - nasal airway region appears to be useful for correcting head position. In facial soft tissue images, EN plane in combination with other visual factors helps to correct head position. Simple geometry enables this head position correction to be performed from any view of the head where relevant landmarks are seen. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346599 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2008

Background: Historically, many reference lines and planes of the human skull have been used in an attempt to depict the head in a natural head position (NHP) which is a relaxed/balanced position when looking ahead at their eye level. Head position correction has been attempted in fields such as anatomy, art, anthropology, orthodontics, oral and maxillofacial surgery, plastic surgery, and forensics. In orthodontics, oral and maxillofacial surgery, and plastic surgery, corrected head position (CHP) is particularly important for diagnosis of the normality/protrusion/retrusion of the patient’s facial skeleton. Usually a single plane, such as Frankfurt horizontal, is used to correct head position, but its angulation is variable between individuals, because each individual’s anatomy is unique. It has been found previously that the Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism, and these planes averaged -1 to -2 degrees from the true horizontal (HOR, which is a horizontal plane determined as being perpendicular to the earth’s gravitational force) with subjects in NHP. Methods: Craniofacial planes were measured in an Aboriginal Australian sample and in two contemporary samples obtained from Australian orthodontic practices, and the findings were compared with previous studies. Each sample consisted of 40 individuals (20 males and 20 females) with subjects in NHP. The Aboriginal Australian sample was longitudinal (T1, mean age 10 years; T2, mean age 14 years, and T3, mean age 18 years) enabling NHP to be assessed over approximately 8 years. A soft tissue Ear - nose plane (EN plane) was also investigated. Results: NHP reproducibility over 8 years demonstrated a mean of absolute difference of 2.9 degrees, with a range of differences from -7.9 to 8.2 degrees and a standard deviation of differences equal to 3.6 degrees. The Neutral Horizontal Axis (NHA), Frankfurt horizontal (FH), Krogman-Walker plane (KW plane), and Palatal plane (P plane) demonstrated near parallelism with each other, and averaged between 0 and -3 degrees from HOR. On average, EN plane was horizontal but was variable. Conclusions: NHP is not consistently reproducible at the individual level. For hard tissue images, the combined use of NHA, FH, KW plane, and P plane enables prediction of CHP. Additionally, the rectangular shape of the lower orbit - nasal airway region appears to be useful for correcting head position. In facial soft tissue images, EN plane in combination with other visual factors helps to correct head position. Simple geometry enables this head position correction to be performed from any view of the head where relevant landmarks are seen. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1346599 / Thesis (D.Clin.Dent.) - University of Adelaide, School of Dentistry, 2008