A cephalometric unit for research and hospital environments.
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Cephalometry↗
Biomedical subjects
S Kreiborg
Publications and source records attributed to S Kreiborg.
Cleft lip and palate in Denmark, 1976-1981: epidemiology, variability, and early somatic development.
The present investigation describes the incidence and variability of the primary cleft condition in all Danish infants born with cleft lip, cleft palate, or both, from 1976 to 1981 and analyzes general somatic growth from birth to age 22 months. Because of excellent sampling conditions in Denmark, the study material is nearly complete. Six hundred and seventy-eight infants with facial clefts were born during the period, corresponding to 1.89 per 1,000 of all newborns. Six hundred and two patients were examined--most of them twice: at 2 months and at 22 months. Material uptake included plaster casts of the upper jaw, cephalometric films in three projections, anthropometric registrations, and information from hospital charts. A detailed grading of the clefts according to severity was carried out. Sex distribution was 61% males and 39% females, of whom 34% had isolated cleft lip, 39% combined cleft lip and palate, and 27% an isolated cleft palate. Left-sided clefts were most frequent. In the combined cleft lip and palate group, 90% exhibited subtotal or total clefts, whereas the clefts were less severe in the isolated cleft lip and isolated cleft palate patients. Birth weight and length showed values close to the average for Danish newborns, but a lag was seen in infants in whom severe palatal cleft was included. The extended method of classification was suggested to select subgroups for special care.
Body Height↗
Partial trisomy 3q syndrome inherited from familial t(3;9)(q26.1; p23).
A five-year-old girl was referred to prometaphase chromosome analysis because of mental retardation, facial dysmorphic features suggestive of Cornelia de Lange syndrome, cleft palate and additional minor congenital malformations of the cardiac system and fingers and toes. A familial balanced translocation (3;9)(q26.1; p23) was found. The karyotype of the proposita was 46,XX,der(9),t(3;9)(q26.1;p23). Thus the patient was trisomic for 3q26.1-qter and monosomic for 9p23-pter. The unbalanced chromosome constitution was not detected by standard Q-banding analysis shortly after birth. The karyotype was misdiagnosed as 46,XX,9(p+) in the proposita and her mother, and thought to be a normal variant of chromosome 9. The repeated cytogenetic study led to the diagnosis of the translocation and to the possibility of prenatal diagnosis in the translocation carriers. A survey of 22 published cases of dup(3q) showed that nearly 60% were secondary to familial balanced rearrangements with an excess of maternally derived abnormal chromosomes 3. Red blood cell galactose-1-phosphate-uridyltransferase (GALT) activity was normal in the patient, consistent with previous assignment of the gene locus for GALT to 9p13 (Shih et al. 1982).
Abnormalities, Multiple↗
Effect of separate malocclusion traits on concern for dental appearance.
Effects of separate traits of malocclusion on concern for dental appearance were isolated by means of multiple regression analysis in a 15-yr follow-up study of 30-yr-old Danes. On the basis of questionnaires (response rate 86%, n = 841), the dependent "concern-for-dental-appearance" variable was constructed from the respondents' replies about recalled perceptions and societal reactions concerning their dental appearance at the time of adolescence. In the same individuals, separate traits of malocclusion had been recorded clinically 15 yr earlier. These traits were inserted as independent dummy variables into the regression model. In both sexes the closest relationship with the dependent variable was displayed by the most conspicuous traits in the anterior region of the dentition. Some traits showed significant associations only in women, whose regression coefficients were, in general, higher than those of men. About half of the variation in the dependent variable was explained by the model.
Adult↗
Pre- and postsurgical facial growth in patients with Crouzon's and Apert's syndromes.
Our report deals with 8 patients with Crouzon's and Apert's syndromes followed longitudinally with roentgencephalometric examinations during the growth period. The purpose of the study was to analyze: presurgical facial growth, the displacement of the maxillary complex in connection with Le Fort III advancement, the stability of the surgical result, and postsurgical facial growth. Presurgical facial growth was characterized by lack of maxillary sutural growth and abnormal remodeling of the maxilla. The surgical displacement of the maxilla consisted of an average advancement of about 10 mm and a backward rotation. The maxilla remained stable following surgery. However, onlay bone grafts tended to resorb over the long term. Postsurgical facial growth revealed lack of maxillary displacement with development of exophthalmos, relative mandibular prognathism, and malocclusion. However, it was concluded that the positive effects of early craniofacial surgery in patients with severe forms of Crouzon's and Apert's syndromes outweigh these disadvantages.
Acrocephalosyndactylia↗
Psychosocial implications of malocclusion: a 15-year follow-up study in 30-year-old Danes.
Long-term psychosocial effects of malocclusion should be studied longitudinally from childhood to adulthood in orthodontically untreated populations. In 1965-66, the occurrence of morphologic traits of malocclusion was recorded in 977 Danish adolescents who had no access to organized orthodontic care. In a follow-up study 15 years later, a questionnaire was mailed to the subjects; this contained general questions about body image and specific inquiries concerning self-perception and social implications of dental appearance. The response rate was 86%. Ten percent had received orthodontic treatment. In the remaining individuals, only one entry among thirteen items of body image--the teeth--was rated significantly less satisfactory by subjects with malocclusion at adolescence than by subjects without malocclusion at adolescence. The lowest ratings were observed in subjects with extreme maxillary overjet, extreme deep bite, and crowding. Highly significant differences were found between the two groups (subjects with and without malocclusion) in recalling adolescent awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavorable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred seven times more often in the presence of malocclusion. Differences were less marked in the perceptions of the same individuals in adulthood. However, in both adolescence and adulthood unfavorable perceptions of the teeth were expressed significantly more often by subjects with extreme maxillary overjet, extreme deep bite, and crowding. No association was found between malocclusion and present occupational status. It was concluded that certain malocclusions, especially conspicuous occlusal and space anomalies, may adversely affect body image and self-concept, not only at adolescence but also in adulthood.
Adolescent↗
Skeletal and functional craniofacial adaptations in plagiocephaly.
The present report aims to contribute to our understanding of craniofacial development in plagiocephaly. A previously unreported dry skull with plagiocephaly and two clinical cases with unoperated plagiocephaly are presented. The clinical cases were followed longitudinally with roentgencephalometry in lateral, frontal, and axial projections. In addition, in one of the cases, electromyographic analysis of the temporal, masseter, sternomastoid, and trapezius muscles was carried out. The dry skull revealed premature closure of the sphenofrontal suture in addition to the coronal suture. Furthermore, severe asymmetry of the cranial base and mandible was observed. The clinical cases revealed a similar marked asymmetry of the cranial base. Mandibular asymmetry was observed to develop in early infancy secondary and compensatory to the primary asymmetry of the cranial base. The electromyographic examination revealed that the muscles of mastication were less developed on the affected side. Furthermore, the analysis of the muscles of the neck would seem to indicate that the patient compensated for her cranial base asymmetry and lateral deviation of the orbital axis on the affected side by rotating the head to the opposite side to secure binocular vision. Based on these findings, it would seem pertinent to consider early surgical release of the sutures of the calvaria and cranial base in plagiocephaly to prevent asymmetric facial development.
Bone Development↗
The application of roentgencephalometry to the study of craniofacial anomalies.
Objective quantitative methods for standardized reproducible descriptions of the findings of an examination are prerequisite for the optimal care of patients with congenital or acquired craniofacial anomalies. The present report gives a brief review of the development of roentgencephalometry with special emphasis on the infant roentgencephalometric techniques pioneered by Dr. Samuel Pruzansky. In addition, some of the significant findings that have emerged from the application of these techniques to patients with craniofacial anomalies are presented, again, with emphasis on the contributions made by Dr. Pruzansky and co-workers. Finally, perspectives for future clinical and research work within the field are outlined. These perspectives include improvement of cephalometric units for studies of patients with craniofacial anomalies; inclusion of additional cephalometric projections, especially in patients with craniofacial asymmetry; increased utilization of infant cephalometry; utilization of metallic implants in selected cases; greater utilization of computerized cephalometrics and multivariate statistics; and combined use of longitudinal cephalometric studies and various longitudinal physiological examinations, eg, electromyography, kinesiography, and air flow studies, in the individual patient.
Cephalometry↗
Malocclusion at adolescence related to self-reported tooth loss and functional disorders in adulthood.
It has been argued that malocclusion may predispose to tooth loss and functional disorders of the masticatory system. It was the purpose of this study to examine relationships between untreated malocclusion, recorded at adolescence, and self-reported tooth loss and functional disorders in adulthood. In 1965-66, the occurrence of morphologic traits of malocclusion was recorded in 977 Danish adolescents who did not have access to organized orthodontic care. Fifteen years later, 841 (86%) of these subjects responded to a questionnaire screening for tooth loss, symptoms involving the temporomandibular joints and muscles, and some other symptoms of dysfunction. The occurrence of malocclusion was related to the symptoms of the temporomandibular joints and muscles and other functional symptoms. Only a few significant coefficients of correlation were observed. Extreme maxillary overjet (greater than 9 mm) and frontal open bite showed significant correlations with unsatisfactory biting ability. Crossbite was correlated positively with speech defects but negatively with tenderness or fatigue of the cheeks; unilateral crossbite was associated with locking of the mandible. It was concluded that the untreated morphologic traits of malocclusion did not seem to predispose to tooth loss or functional disorders of the masticatory system as reported at the age of 30 years.
Adolescent↗
[Long term results in malocclusion. A 15-year follow-up study of 30-year-old adults with tooth loss and implications of functional and psychosocial problems].
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Adult↗
A 15-year follow-up study of 30-year-old Danes with regard to orthodontic treatment experience and perceived need for treatment in a region without organized orthodontic care.
It was the aim to study orthodontic treatment experience and past and present perceived need for treatment in 30-year-old Danes who, at adolescence, had no access to organized orthodontic care. In order to identify the malocclusion traits which elicited treatment or need for treatment, the findings were related to the occurrence of various traits which had been registered in the same individuals 15 years earlier. From questionnaires (response rate 86%, n = 841) it appeared that 10% had received treatment and 20% perceived need for treatment either in childhood or at present. At adolescence, the subjects who had subsequently received treatment, displayed relatively high frequencies of ectopic eruption, anterior cross-bite, extreme maxillary overjet, deep bite, and crowding; among those who perceived need for treatment, extreme maxillary overjet, mandibular overjet and crowding were relatively prevalent.
Adult↗
Longitudinal study of body height, radius length and skeletal maturity in Danish boys with cleft lip and palate.
Body height, radius length and skeletal maturity were registered longitudinally in 48 boys with combined cleft lip and palate (CLP) and compared with measurements in a non-cleft control group. Age range was from 6 to 20 yr. Skeletal maturity was evaluated according to the TW2 method. Distance and velocity curves for radius length and body height were determined by means of a computer program which for each month calculated the median and percentiles of the distribution. Compared to the control group the CLP boys were slightly shorter from 6 to 18 yr of age. The velocity curves revealed that pubertal growth maximum occurred on an average 6 months later in the CLP boys and that the pubertal growth spurt was less marked. However, the total growth period was prolonged thus enabling the CLP group to catch up with the control group. Skeletal maturity was retarded during the whole period when compared to normal children. It is suggested that the early feeding problems and recurrent infections of the upper airways combined with the surgical procedures account for an essential part of the delay in the present CLP group.
Adolescent↗
Description of a dry skull with Crouzon syndrome.
A dry skull from a young adult subject showing the stigmata of Crouzon syndrome was described. All calvarial sutures were prematurely fused. The calvaria was high and pointed in the region of the anterior fontanelle. The cranial base revealed premature fusion of all sutures and of the spheno-petrosal and petro-occipital synchondroses. Furthermore, the internal cranial base showed a number of abnormal morphological traits, especially in the region of the sella turcica. The optic foramina were compressed vertically. Most sutures in the bony orbit were prematurely fused. The orbital cavities were short and their axes deviated laterally. The interorbital distance was increased. Nearly all maxillary sutures were fused and the maxilla was short and narrow, whereas the mandible showed no marked deviations. The molar occlusion was mesial and there was mandibular overjet and bilateral crossbite. The findings were discussed and it was suggested that the involvement of fibrous cartilage may be one of the factors distinguishing the complex forms of craniosynostosis from the simple.
Adolescent↗
Comparison of craniofacial morphology in infants with incomplete cleft lip and infants with isolated cleft palate.
The craniofacial morphology was compared in 30 infants with incomplete left-sided cleft lip and 30 infants with isolated cleft palate. Cephalometric radiographs were obtained prior to any surgical management at 2-3 months of age in the lateral, anteroposterior and axial projections. Compared to the cleft lip group, the infants with isolated cleft palate showed the following characteristics: short anterior cranial base, short maxilla, reduced posterior maxillary height, reduced dimensions of the mandible--especially mandibular length--, narrow naso- and oropharyngeal airway. The cleft lip group had larger interorbital width and symmetry deviations in the anterior art of the maxilla. It was concluded that already at two months of age and prior to any surgical interference significant differences in craniofacial morphology distinguished the group with clefts of the secondary palate from the group with clefts of the primary palate.
Cephalometry↗
Abnormalities of the cranial base in cleidocranial dysostosis.
The purpose of the present investigation was to describe the size, shape, and morphologic characteristics of the cranial base in adult patients with cleidocranial dysostosis in an attempt to contribute to an improved understanding of the syndrome. The sample comprised seventeen patients with cleidocranial dysostosis, eight males and nine females aged 16 to 46 years. The morphology was evaluated from lateral cephalometric radiographs and midsagittal tomograms of the cranial base. The size of the anterior and posterior cranial base and the cranial base angle were compared to normative data. In addition, a qualitative screening for abnormal morphologic traits in the cranial base was carried out. The anterior and posterior cranial base was significantly shorter and the cranial base angle smaller in the syndrome groups than in the control groups. Patients with cleidocranial dysostosis exhibited high frequencies of anomalous traits in the cranial base, the most striking being a distortion of the clivus. In 82 percent the clivus was flexed, with the convexity toward the endocranium. All patients exhibited bulbous dorsum sellae, and 47 percent had small pituitary fossae. It is suggested that bone remodeling showed less resorption than normal in the craniofacial region of patients with cleidocranial dysostosis.
Adolescent↗
Craniofacial asymmetry of a dry skull with plagiocephaly.
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Adult↗
Craniofacial growth in premature craniofacial synostosis.
Serial cephalometric radiographs of 55 patients with different types of premature craniofacial synostoses were analysed. The aim of the study was to answer the following four questions in an effort to provide a better rational for classification, treatment, and possibly add insight into the mechanisms controlling craniofacial growth. (1) Is the shape of the skull syndrome specific. (2) How does the craniofacial complex grow. (3) What is the effect of craniectomy on the growth of the cranium. (4) Can roentgencephalometry provide a rational basis for planning reconstructive surgery. The results were presented as answers to each of the questions restated under each type of craniosynostosis. i.e. oxycephaly, scaphocephaly, plagiocephaly, trigonocephaly, Crouzon syndrome, and Apert syndrome.
Adult↗