A Cross-Sectional Study to Determine and Compare the Craniofacial Anthropometric Norms in a Selected Kenyan and Chinese Population

Background: Craniofacial anthropometry provides essential data for diagnosis and treatment planning, with the norms for many races having been investigated. The results reveal that facial morphometry varies greatly because of geographical, ethnic, and racial variations. This study aims to gather the normative anthropometric data and compare the differences in facial morphometry between the Kenyan population and that of the Chinese. Methods: Four vertical measurements (trichion–nasion, nasion–subnasale, subnasale–gnathion, and superaurale–subaurale) and 6 horizontal measurements (zygion–zygion, exocanthion–endocanthion, endocanthion–endocanthion, pupil-pupil, alare–alare, and chelion–chelion) were obtained manually from subjects with no craniofacial abnormality. Results: A total of 180 participants (90 Kenyans and 90 Chinese) were included. Among the Kenyans, males generally had greater dimensions in comparison to the Kenyan females with the exception of the upper third, lower third, and intercanthal, and interpupillary distances. Among the Chinese, there was a significant difference between the 2 genders with the exception of intercanthal distance. All measurements were greater in Chinese males in comparison to the females. Comparison between races shows that Kenyans had greater vertical measurements with exception of the ear length for both genders. The Chinese males had increased facial width and intercanthal distance, while the Chinese females showed increased intercanthal distance compared to Kenyans. Kenyans exhibited hyperleptoprosopic-type face, while Chinese exhibited mesoprosopic-type face, with none of the 2 groups conforming to the neoclassical canons. Conclusion: Kenyans generally have greater craniofacial measurements versus Chinese, except for the facial width and intercanthal distance for males and interorbital distance for females.

Anthropometric Study of Facial Height among Tribal (Garo) and Non-Tribal Bangladeshi Female of Greater Mymensingh District in Bangladesh

Background: Craniofacial anthropometry is an important stem of anthropometry, in which the dimensions of the head and face are measured. It provides quantitative data, identifying people having different physical characteristics, diagnosing people having craniofacial abnormality related to congenital or genetic cause and differentiating between males and females. Objective: The purpose of the present study was to establish the ethnic anthropometric data for adult tribal (Garo) and non-tribal Bangladeshi female. Methodology: This cross sectional analytical type of study was conducted in Department of Anatomy, Sir Salimullah Medical College, Dhaka, from January 2015 to December 2015.The study materials consist of two hundred (200) adult Bangladeshi female of greater Mymensingh district age ranging from 25 to 45 years. Results: Among 200 female, 100 was tribal (Garo) female and 100 non-tribal female, the mean (±SD) facial height from ‘nasion to gnathion’ was higher in non-tribal female than tribal female (p<0.001). Conclusion: Facial height from ‘nasion to gnathion is higher in non-tribal female compared to tribal female among Bangladeshi female living in Mymensingh district. Journal of Current and Advance Medical Research 2020;7(1): 36-39

Dental and Skeletal Changes after Transpalatal Distraction

Maxillary constriction is a common skeletal craniofacial abnormality, and transverse maxillary deficiency affects 30% of patients receiving orthodontic and surgical treatment. The aim of the study was to analyse craniofacial skeletal changes in adults with maxillary constriction after transpalatal distraction. The study group consisted of 36 patients (16 women) aged 17 to 42 years (M = 27.1; SD = 7.8) with a known complete skeletal crossbite and who underwent transpalatal distraction procedure. The measurements were obtained on diagnostic models, and cephalometric PA radiograms were obtained at time points, i.e., before treatment (T1) and after the completion of active distraction (T2). The analysis of diagnostic models involving the arch width measurement at different levels demonstrated a significant increase in L1, L2, L3, L4, L5, and L6 dimensions after transpalatal distraction. The largest width increase (9.5 mm) was observed for the L3 dimension (the intercanine distance). The analysis of frontal cephalograms displayed a significant increase in W1, W2, and W3 dimensions after transpalatal distraction. The largest width increase (4.9 mm) was observed for the W1 dimension at the level of the alveolar process of the maxilla. Transpalatal distraction is an effective treatment for transverse maxillary deficiency after the end of bone growth. The expansion observed on diagnostic models is close to a parallel segment shift mechanism, with a mild tendency towards a larger opening anteriorly. The maxillary segment rotation pattern analysed based on the frontal cephalograms is close to a hand fan unfolding with the rotation point at the frontonasal suture.

SHH signaling mediated by a prechordal and brain enhancer controls forebrain organization

Sonic hedgehog (SHH) signaling plays a pivotal role in 2 different phases during brain development. Early SHH signaling derived from the prechordal plate (PrCP) triggers secondary Shh induction in the forebrain, which overlies the PrCP, and the induced SHH signaling, in turn, directs late neuronal differentiation of the forebrain. Consequently, Shh regulation in the PrCP is crucial for initiation of forebrain development. However, no enhancer that regulates prechordal Shh expression has yet been found. Here, we identified a prechordal enhancer, named SBE7, in the vicinity of a cluster of known forebrain enhancers for Shh. This enhancer also directs Shh expression in the ventral midline of the forebrain, which receives the prechordal SHH signal. Thus, the identified enhancer acts not only for the initiation of Shh regulation in the PrCP but also for subsequent Shh induction in the forebrain. Indeed, removal of the enhancer from the mouse genome markedly down-regulated the expression of Shh in the rostral domains of the axial mesoderm and in the ventral midline of the forebrain and hypothalamus in the mouse embryo, and caused a craniofacial abnormality similar to human holoprosencephaly (HPE). These findings demonstrate that SHH signaling mediated by the newly identified enhancer is essential for development and growth of the ventral midline of the forebrain and hypothalamus. Understanding of the Shh regulation governed by this prechordal and brain enhancer provides an insight into the mechanism underlying craniofacial morphogenesis and the etiology of HPE.

Respiratory Polysomnographic Findings in Patients Treated Primarily for Unilateral Cleft Lip and Palate

Cleft lip and palate (CLP) is the most common congenital craniofacial abnormality. Obstructive sleep apnea syndrome (OSAS) is a highly prevalent but underdiagnosed disease and is frequently associated with craniofacial anomalies. There are few studies describing the sleep breathing pattern of children with CLP. This study sought to characterize the respiratory profile of 23 children with unilateral cleft lip and palate, aged 7-12 years, who had undergone cleft lip and nasal repair at age 3-4 months and palatoplasty at 12-15 months, with a particular focus on evaluating the presence of OSAS in children with CLP. Polysomnography was performed and findings were analyzed descriptively. We found a mean and median for apnea/hypopnea index (AHI) of 1.11/h (SD = 0.78) and 0.9/h, respectively. The mean obstructive apnea index (OAI) was 0.27/h (SD = 0.38) and the median, 0.1/h. Nearly 30% of patients had an AHI above 1.4 events/h. There was no significant oxyhemoglobin desaturation in the study group. In this group, the prevalence of OSAS was higher than in noncleft populations when compared to the normality values adopted. This sample of patients with unilateral cleft lip and palate exhibited an increased prevalence of OSAS during the mixed dentition stage. Although the results showed that OSAS was mild, we advise closer observation of these patients. Polysomnography is recommended for the assessment of children with airway abnormalities, to individualize the extent of treatment.

The association of cleft lip and palate with cervical vertebral anomalies- a lateral cephalographic study

Background: Cleft lip and palate is the most common major congenital craniofacial abnormality noted, which is 1 in 700 births. Although inheritance may play a role, cleft lip and palate is considered to be of multifactorial etiology, including chemical exposures, radiation, maternal hypoxia, teratogenic drugs, nutritional deficiencies, especially folic acid and cervical vertebral anomalies.Objective: To assess an association between cleft lip and palate and cervical vertebral anomalies.Methodology: The lateral cephalographs of 74 cleft lip and palate patients aged 6- 20yr were traced for cervical spine from C1- C4 on an acetate paper. Cervical vertebral anomalies were recorded and categorized into posterior arch deficiencies and fusion or both.Results: 12.16% of cleft lip and palate patients had cervical vertebral anomalies.Conclusion: The association between cleft lip and palate and cervical vertebral anomalies indicates that cervical vertebral anomalies may be implicated in the etiology of cleft lip and palate. Cervical vertebral anomalies can predispose to further disorders and identification of such anomalies mandates referral to the concerned specialist for appropriate management.

The Incidence of Palatal Fistula Postpalatoplasty in Children with Dental Caries: A Multi Centre Study

Background: Cleft lip and/or palate (CL&/P) is the most common congenital craniofacial abnormality, affecting approximately 1 in every 700 newborns. Patients with cleft lip and/or palate (CL&/P) generally display poor oral hygiene and a higher prevalence of caries. This may be due to the difficulty in achieving adequate plaque control associated with dental anomalies and defects from the lips and/or palate. Palatal fistula is a significant complication following cleft palate repair. It is the aim of this research to find correlation between palatal fistula and dental caries. Patient and Method: Patients with unilateral complete cleft palates admitted to the Cipto Mangunkusumo hospital, Adam Malik hospital within the period July 2012 till March 2013 were included in this study. All cases underwent modified two flap palatoplasty leaving lateral periosteum technique and follow-up were done in two weeks to see if there are any palatal fistula. Result: Thirty eight patients with unilateral cleft palate were enrolled in the study. Fifteen (39.5%) of them are boys and 23 (60.5%) are girls. Fifteen of the patients (41.7%) had dental caries, with six patients (40%) had palatal fistula in the follow up after palatoplasty, while there was none (0%) of the 21 (58.3%) patients that were found negative for dental caries developed a fistula. Conclusion: Dental caries is one of the important predisposing factors of palatal fistula in patients who undergo palatoplasty.