Tek taraflı dudak ve damak yarığı görülen bireylerde kraniyal kaide ve sella tursika morfolojisinin değerlendirilmesi

Yıl 2019, , 33 - 40, 01.05.2019

Nehir Canıgür Bavbek , Fatma Tekin Kaymaz , Çağrı Türköz

https://doi.org/10.17214/gaziaot.493495

Cited By: 3

Öz

Amaç: Bu çalışmanın amacı, tek taraflı dudak damak
yarıklı bireylerde (TDDY), kraniyal kaide ve sella tursikanın boyutlarını ve
morfolojisini, maksiller yetersizliğe bağlı Sınıf III anomali gösteren bireyler
(CL3) ve normal sınıf I kraniyofasiyal yapıya sahip bireyler (CL1) ile
karşılaştırmaktır.

Gereç ve Yöntem: Bu retrospektif çalışma,
TDDY (10 kız, 4 erkek; 12.05±1.14 yıl), CL3 (10 kız, 5 erkek; 11.73±0.89 yıl)
ve CL1 (10 kız, 5 erkek; 13.11±1.11 yıl) hasta gruplarına ait lateral
sefalometrik radyografiler üzerinde yapıldı. Sella tursika ve kraniyal kaideye
ait açısal ve doğrusal ölçümler radyografilere ait çizimler üzerinde yapıldı.
Gruplar-arası karşılaştırmalarda tek yönlü ANOVA ve Tukey testi veya Bonferroni
düzeltmesi ile Kruskal-Wallis testi kullanıldı (p<0.05); korelasyonlar için
ise Spearman korelasyon analizi kullanıldı (p<0.01).

Bulgular:
Maksillanın efektif boyutu (Co-A) TDDY (p=0.035)
ve CL3 (p=0.001) gruplarında
CL1’e göre azalmış bulundu. Toplam kraniyal uzunluk (Ba-N), TDDY grubunda CL3’e
(p=0.012) ve CL1’e (p=0.016)  göre
artmış bulundu. Kraniyal kaide açısı (N-S-Ar°), CL3 grubunda TDDY (p=0.001) ve CL1’e (p=0.009)
göre daha azdı. Ba-N (p=0.003)
ve ön kafa kaidesi uzunluğu (S-N) (p=0.000)
ile Co-A arasında ve arka kafa kaidesi uzunluğu (S-Ba) ile ramus
yüksekliği (Ar-Go) (p=0.001)
arasında pozitif korelasyonlar bulundu. Sella tursikanın çapının CL1 grubunda
CL3’e göre daha fazla olduğu görüldü (p=0.025).
Sella tursikaya ait morfolojik varyasyonlar TDDY grubunda kontrol gruplarına
göre daha yüksek orandaydı (%71.4).

Sonuç: TDDY grubunda maksiller yetersizliğe bağlı bir sınıf
III maloklüzyon eğilimi olsa da, Sınıf III bireylerde görülen karakteristik
kraniyal kaidedenin artmış fleksiyonu, TDDY grubunda görülmedi. Sella
tursikanın boyutları TDDY ve CL3 varlığında önemli bir değişim göstermezken
morfolojik varyasyonların TDDY grubunda daha fazla olduğu izlendi.

Anahtar Kelimeler

Angle sınıf 3, kafa tabanı, sella tursika, yarık damak, yarık dudak, maloklüzyon

Evaluation of the cranial base and sella turcica morphology in patients with unilateral cleft lip and palate

Öz

Objective: The aim of this study was to investigate the size and morphology of the sella turcica and cranial base in individuals with unilateral cleft lip and palate (UCLP), and to compare it with individuals showing Class III discrepancy due to maxillary deficiency (CL3) and with individuals having normal (CL1) craniofacial development.

Materials and Method: This retrospective study was carried out on the lateral cephalogram tracings of UCLP (10 females, 4 males; 12.05±1.14 years), CL3 (10 females, 5 males; 11.73±0.89 years) and CL1 (10 females, 5 males; 13.11±1.11 years) patients. Linear and angular measurements related to sella turcica and cranial base were performed. Intergroup comparisons were either made with one-way ANOVA followed by Tukey’s test or with Kruskal-Wallis test with Bonferroni adjustment (p<0.05). Spearman correlation coefficient was used for correlations (p<0.01).

Results: The length of the maxilla (Co-A) was shorter in UCLP (p=0.035) and CL3 (p=0.001) than in CL1. Total cranial length (Ba-N) was greater in UCLP than in CL3 (p=0.012) and CL1 (p=0.016). Cranial base angle (N-S-Ar°) was less in CL3 than in UCLP (p=0.001) and CL1 (p=0.009). Ba-N (p=0.003) and anterior cranial length (S-N) (p=0.000) were positively correlated with Co-A. Posterior cranial length (S-Ba) was positively correlated with ramus height (Ar-Go) (p=0.001). The diameter of sella was bigger in CL1 than in CL3 (p=0.025). The prevalence of morphologic variations of sella turcica in UCLP was higher (71.4%) than in control groups.

Conclusion: Although there was a Class III tendency in UCLP due to maxillary deficiency, cranial base flexure characteristic to CL3 anomalies was not seen in this group. The existence of UCLP or CL3 did not alter dimensions of sella turcica, but morphologic variations were more common in UCLP.

Anahtar Kelimeler

Angle Class III, cleft lip, cleft palate, cranial base, sella turcica, malocclusion

Kaynakça

• Enlow DH, McNamara JA Jr. The neurocranial basis for facial form and pattern. Angle Orthod 1973;43:256-70.
• Proff P, Will F, Bokan I, Fanghanel J, Gedrange T. Cranial base features in skeletal Class III patients. Angle Orthod 2008;78:433-9.
• Singh GD, McNamara JA Jr, Lozanoff S. Morphometry of the cranial base in subjects with Class III malocclusion. J Dent Res 1997;76:694-703.
• Kjaer I. Orthodontics and foetal pathology: a personal view on craniofacial patterning. Eur J Orthod 2010;32:140-7.
• Kjaer I, Hansen BF, Keeling JW. Axial skeleton and pituitary gland in human fetuses with spina bifida and cranial encephalocele. Pediatr Pathol Lab Med 1996;16:909-26.
• Molsted K, Boers M, Kjaer I. The morphology of the sella turcica in velocardiofacial syndrome suggests involvement of a neural crest developmental field. Am J Med Genet A 2010;152A:1450-7.
• Axelsson S, Storhaug K, Kjaer I. Post-natal size and morphology of the sella turcica in Williams syndrome. Eur J Orthod 2004;26:613-21.
• Russell BG, Kjaer I. Postnatal structure of the sella turcica in Down syndrome. Am J Med Genet 1999;87:183-8.
• Molsted K, Kjaer I, Dahl E. Spheno-occipital synchondrosis in three-month-old children with clefts of the lip and palate: a radiographic study. Cleft Palate Craniofac J 1993;30:569-73.
• Kjaer I, Reintoft I, Poulsen H, Nolting D, Prause JU, Jensen OA, et al. A new craniofacial disorder involving hypertelorism and malformations of external nose, palate and pituitary gland. J Craniofac Genet Dev Biol 1997;17:23-34.
• Nielsen BW, Molsted K, Kjaer I. Maxillary and sella turcica morphology in newborns with cleft lip and palate. Cleft Palate Craniofac J 2005;42:610-7.
• Nielsen BW, Molsted K, Skovgaard LT, Kjaer I. Cross-sectional study of the length of the nasal bone in cleft lip and palate subjects. Cleft Palate Craniofac J 2005;42:417-22.
• Alkofide EA. The shape and size of the sella turcica in skeletal Class I, Class II, and Class III Saudi subjects. Eur J Orthod 2007;29:457-63.
• Hagberg C, Larson O, Milerad J. Incidence of cleft lip and palate and risks of additional malformations. Cleft Palate Craniofac J 1998;35:40-5.
• Milerad J, Larson O, Hagberg C, Ideberg M. Associated malformations in infants with cleft lip and palate: a prospective, population-based study. Pediatrics 1997;100:180-6.
• Tanaka SA, Mahabir RC, Jupiter DC, Menezes JM. Updating the epidemiology of cleft lip with or without cleft palate. Plast Reconstr Surg 2012;129:511e-8e.
• Parker SE, Mai CT, Canfield MA, Rickard R, Wang Y, Meyer RE, et al. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol 2010;88:1008-16.
• Lopez-Gimenez A, Silvestre-Rangil J, Silvestre FJ, Paredes-Gallardo V. Craniofacial cephalometric morphologies in different cleft types: a retrospective cross-sectional study of 212 patients. Oral Radiol 2018;34:127-35.
• Shetye PR, Evans CA. Midfacial morphology in adult unoperated complete unilateral cleft lip and palate patients. Angle Orthod 2006;76:810-6.
• Ozturk Y, Cura N. Examination of craniofacial morphology in children with unilateral cleft lip and palate. Cleft Palate Craniofac J 1996;33:32-6.
• Lin Y, Fu Z, Ma L, Li W. Cone-beam computed tomography-synthesized cephalometric study of operated unilateral cleft lip and palate and noncleft children with Class III skeletal relationship. Am J Orthod Dentofacial Orthop 2016;150:802-10.
• Harris EF. Size and form of the cranial base in isolated cleft lip and palate. Cleft Palate Craniofac J 1993;30:170-4.
• Tinano MM, Martins MA, Bendo CB, Mazzieiro E. Base of the skull morphology and Class III malocclusion in patients with unilateral cleft lip and palate. Dental Press J Orthod 2015;20:79-84.
• Alpagan Ozdemir S, Esenlik E. Three-dimensional soft-tissue evaluation in patients with cleft lip and palate. Med Sci Monit 2018;24:8608-20.
• Silverman FN. Roentgen standards fo-size of the pituitary fossa from infancy through adolescence. Am J Roentgenol Radium Ther Nucl Med 1957;78:451-60.
• Axelsson S, Storhaug K, Kjaer I. Post-natal size and morphology of the sella turcica. Longitudinal cephalometric standards for Norwegians between 6 and 21 years of age. Eur J Orthod 2004;26:597-604.
• Dhopatkar A, Bhatia S, Rock P. An investigation into the relationship between the cranial base angle and malocclusion. Angle Orthod 2002;72:456-63.
• Nie X. Cranial base in craniofacial development: developmental features, influence on facial growth, anomaly, and molecular basis. Acta Odontol Scand 2005;63:127-35.
• Sonnesen L, Kjaer I. Cervical column morphology in patients with skeletal Class III malocclusion and mandibular overjet. Am J Orthod Dentofacial Orthop 2007;132:427.e7-12.
• Singh GD. Morphologic determinants in the etiology of class III malocclusions: a review. Clin Anat 1999;12:382-405.
• Hong SX, Yi CK. A classification and characterization of skeletal class III malocclusion on etio-pathogenic basis. Int J Oral Maxillofac Surg 2001;30:264-71.
• Bui C, King T, Proffit W, Frazier-Bowers S. Phenotypic characterization of Class III patients. Angle Orthod 2006;76:564-9.
• Goyenc YB, Gurel HG, Memili B. Craniofacial morphology in children with operated complete unilateral cleft lip and palate. J Craniofac Surg 2008;19:1396-401.
• Canıgür Bavbek N. Sella tursika: Gelişimi, boyutları, morfolojisi ve patolojileri Atatürk Üniv Diş Hek Fak Derg 2016;26 Suppl 16:99-107.
• Halicioglu K, Yolcu G, Yavuz İ. Sella Tursikanin köprülenmesi ve boyutlari ile iskeletsel anomaliler arasındaki ilişki. Atatürk Üniv Diş Hek Fak Derg 2009;19:177-80.
• Preston CB. Pituitary fossa size and facial type. Am J Orthod 1979;75:259-63.
• Shah MB, Bashir U, Ilyas T. The shape and size of the sella turcica in skeletal Class I, II and III in patients presenting at Islamic International Dental Hospital, Islamabad. Pakistan Oral & Dental J 2011;31:104-10.
• Alkofide EA. Sella turcica morphology and dimensions in cleft subjects. Cleft Palate Craniofac J 2008;45:647-53.
• Sundareswaran S, Nipun CA. Bridging the gap: Sella turcica in unilateral cleft lip and palate patients. Cleft Palate Craniofac J 2015;52:597-604.