PDF herunterladen
Informationen aus Orthodontie & Kieferorthopädie 2014; 46(03): 165-170
DOI: 10.1055/s-0034-1384607
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Volumentomografische Untersuchung von Anomalien der Halswirbelsäule bei Individuen mit kraniofazialen Störungen und bei Kontrollpersonen

CBCT Analysis of Upper Cervical Vertebrae Anomalies in Individuals with Craniofacial Anomalies and in Controls
B. Maxfield
1   Orthodontic resident, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
,
S. Douglas
2   Dentist, Rocklin, CA, USA
,
S. Oberoi
3   Professor of Clinical Orofacial Sciences, Department of Orofacial Sciences, School of Dentistry, University of California at San Francisco, San Francisco, CA, USA
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
07. Oktober 2014 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

Zielsetzung: Entwicklung einer systematischen Methode zur Identifizierung von Anomalien der oberen Halswirbel mithilfe der digitalen Volumentomografie (DVT) CBCT – cone beam computed tomography), Anwendung dieser Methode bei Patienten mit Lippen-Kiefer-Gaumenspalte ohne Syndromcharakter und mit otomandibulärer Dysostose sowie Vergleich der Ergebnisse mit denen einer Kontrollgruppe.

Material und Methoden: Retrospektive Querschnittsstudie mit einer Stichprobe aus 47 volumentomografischen Scans von 38 Patienten mit Lippen-Kiefer-Gaumenspalte und 9 Patienten mit Dysostosis otomandibularis aus dem UCSF Center for Craniofacial Anomalies und 45 volumentomografischen Scans von Kontrollpersonen aus der Abteilung für Kieferorthopädie der UCSF. Die Scans wurden mithilfe des Softwarepakets Anatomage (Invivo 3.0, San Jose, California) von 2 gleichzeitig arbeitenden Untersuchern interpretiert.

Das Volumenrendering ermöglichte die isolierte Darstellung der Wirbel und erlaubte die Betrachtung der 3-dimensionalen Oberflächen von allen Seiten. Die Scans wurden zusätzlich noch schichtweise in sagittaler, koronaler und axialer Richtung untersucht. Daten wurden für 3 Befunde erhoben: Anomalien im Bereich des dorsalen Wirbelbogens, Wirbelfusion und die Kombina­tion aus beiden Befunden.

Ergebnisse: Die Methode erwies sich als zuverlässig. In der Gruppe mit Lippen-Kiefer-Gaumenspalte fanden sich bei 14,29% der Patienten auch Anomalien der Halswirbel, in der Gruppe mit otomandibulärer Dysplasie 11,11%. In der Kon­trollgruppe hatten 9,76% der Individuen Anomalien der Halswirbelsäule. Dieser Unterschied war statistisch nicht signifikant (p-Wert: 0,604).

Schlussfolgerungen: Die entwickelte Methode, mithilfe des Softwarepakets Anatomage volumentomografische Scans zur Diagnostik von Ano­malien der Halswirbel einzusetzen, führte bei den beiden Untersuchern zu denselben Ergebnissen. Anomalien der Halswirbel treten bei Patienten mit kraniofazialen Anomalien, wie z. B. Lippen-Kiefer-Gaumenspalten, zwar häufig auf, sind allerdings auch in einer normalen Kontrollgruppe relativ häufig nachweisbar.

Abstract

Objective: To develop a systematic method to identify upper cervical vertebrae anomalies (CVA) using CBCT, to apply the method in individuals with non-syndromic cleft lip and palate (CLP) and hemifacial microsomia (HFM), and to compare the findings with those in control individuals.

Materials and Methods: Retrospective cross-sectional study on a sample of 47 cone beam computed tomography (CBCT) scans of 38 individuals with CLP and 9 with HFM from the UCSF Center for Craniofacial Anomalies and 45 CBCT scans of control subjects from the UCSF Divi­sion of Orthodontics. CBCT scans were interpreted using Anatomage software (In Vivo 3.0, San Jose, California, USA) by 2 concurrently viewing examiners. The scans were analyzed using the vol­ume rendering tool allowing the examiners to isolate the vertebrae and visualize all captured vertebrae in 3-dimensions from all directions. Scans were also interpreted in a step-wise manner through the slices in the sagittal, coronal, and axial view. The data were recorded in 3 categories; posterior arch deficiencies, fusion, and the association of both.

Results: The method was found to be reliable. In the cleft group, 14.29% had CVA and 11.11% in the HFM group. In the control sample, 9.76% showed anomalies of the cervical spine. This difference was not statistically significant (p-value: 0.604).

Conclusions: The method developed using the Anatomage software tool to interpret CBCT scans for diagnosing CVA yielded the same results be­tween the 2 examiners. Although CVA are common in individuals with craniofacial anomalies, even in cleft lip and palate, there is a relatively high prevalence in normal controls as well.

Schlüsselwörter

Halswirbel - kraniofaziale Anomalien - Lippen-Kiefer-Gaumenspalte - Dysostosis otomandibularis - digitale Volumentomografie (DVT)

Key words

cervical vertebrae - craniofacial anomalies - cleft lip and palate - hemifacial microsomia - cone-beam computed tomography (CBCT)
 

  • Literatur

  • 1 Yochum TR, Rowe LJ. Yochum and Rowe’s Essentials of Skeletal Radiology. 3rd ed. Lippincott Williams & Wilkins; Philadelphia, PA: 2005
    Google Scholar
  • 2 Bebnowski D, Hänggi MP, Markic G et al. Cervical vertebrae anomalies in subjects with Class II malocclusion assessed by lateral cephalogram and cone beam computed tomography. Eur J Orthod 2012; 34: 226-231
    CrossrefPubMedGoogle Scholar
  • 3 Koletsis DD, Halazonetis DJ. Cervical vertebrae anomalies in orthodontic patients: a growth-based superimpositional approach. Eur J Orthod 2010; 32: 36-42
    CrossrefPubMedGoogle Scholar
  • 4 Massengill AD, Huynh SL, Harris Jr JH. C2-3 facet joint “pseudofusion”: anatomic basis of a normal variant. Skeletal Radiol 1997; 26: 27-30
    CrossrefPubMedGoogle Scholar
  • 5 Shprintzen RJ, Siegel-Sadewitz VL, Amato J et al. Anomalies associated with cleft lip, cleft palate, or both. Am J Med Genet 1985; 20: 585-595
    CrossrefPubMedGoogle Scholar
  • 6 Osborne GS, Pruzansky S, Koepp-Baker H. Upper cervical spine anomalies and osseous nasopharyngeal depth. J Speech Hear Res 1971; 14: 14-22
    CrossrefPubMedGoogle Scholar
  • 7 Minaba T. Studies on growth and development of facial skeleton and abnormality of cervical vertebra in cleft lip and palate patients. Shikwa Gakuho 1972; 72: 1-50
    PubMedGoogle Scholar
  • 8 Farman AG, Nortjé CJ, Joubert JJ. Radiographic profile of the first cervical vertebra. J Anat 1979; 128 (Pt 3) 595-600
    PubMedGoogle Scholar
  • 9 Sandham A. Cervical vertebral anomalies in cleft lip and palate. Cleft Palate J 1986; 23: 206-214
    PubMedGoogle Scholar
  • 10 Lima MC, Franco EJ, Janson G et al. Prevalence of upper cervical vertebrae anomalies in patients with cleft lip and/or palate and noncleft patients. Cleft Palate Craniofac J 2009; 46: 481-486
    CrossrefPubMedGoogle Scholar
  • 11 Oberoi S, Gill P, Chigurupati R et al. Three-dimensional assessment of the eruption path of the canine in individuals with bone-grafted alveolar clefts using cone beam computed tomography. Cleft Palate Craniofac J 2010; 47: 507-512
    CrossrefPubMedGoogle Scholar
  • 12 Oberoi S, Chigurupati R, Gill P et al. Volumetric assessment of secondary alveolar bone grafting using cone beam computed tomography. Cleft Palate Craniofac J 2009; 46: 503-511
    CrossrefPubMedGoogle Scholar
  • 13 Popat H, Drage N, Durning P. Mid-line clefts of the cervical vertebrae – an incidental finding arising from cone beam computed tomography of the dental patient. Br Dent J 2008; 204: 303-306
    CrossrefPubMedGoogle Scholar
  • 14 Klimo Jr P, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. Neurosurg Clin N Am 2007; 18: 463-478
    CrossrefPubMedGoogle Scholar
  • 15 Ross RB, Lindsay WK. The cervical vertebrae as a factor in etiology of cleft palate. Cleft Palate J 1965; 36: 273-281
    PubMedGoogle Scholar
  • 16 Farman AG, Escobar V. Radiographic appearance of the cervical vertebrae in normal and abnormal development. Br J Oral Surg 1982; 20: 264-274
    CrossrefPubMedGoogle Scholar
  • 17 Uğar DA, Semb G. The prevalence of anomalies of the upper cervical vertebrae in subjects with cleft lip, cleft palate, or both. Cleft Palate Craniofac J 2001; 38: 498-503
    CrossrefPubMedGoogle Scholar
  • 18 Hoenig JF, Schoener WF. Radiological survey of the cervical spine in cleft lip and palate. Dentomaxillofac Radiol 1992; 21: 36-39
    CrossrefPubMedGoogle Scholar
  • 19 Smahĕl Z, Skvarilová B. Length of the cervical spine as a factor in the etiology of cleft palate. Cleft Palate Craniofac J 1993; 30: 274-278
    CrossrefPubMedGoogle Scholar
  • 20 Horswell BB. The incidence and relationship of cervical spine anomalies in patients with cleft lip and/or palate. J Oral Maxillofac Surg 1991; 49: 693-697
    CrossrefPubMedGoogle Scholar
  • 21 Osborne G. The Prevalence of Anomalies of the Upper Cervical Vertebrae in Patients with Craniofacial Malformations and their Effect on Osseous Nasopharyngeal Depth. Southern Illinois University, Department of Speech Pathology and Audiology; Carbondale IL: 1968
    Google Scholar
  • 22 Patcas R, Tausch D, Pandis N et al. Illusions of fusions: assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs. Am J Orthod Dentofacial Orthop 2013; 143: 213-220
    CrossrefPubMedGoogle Scholar
  • 23 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.e7-427.e12
    PubMedGoogle Scholar
  • 24 Sonnesen L, Jensen KE, Petersson AR et al Cervical vertebral column morphology in patients with obstructive sleep apnoea assessed using lateral cephalograms and cone beam CT. A comparative study. Dentomaxillofac Radiol 2013; 42 20130060 -
    PubMedGoogle Scholar
  • 25 Kreiborg S, Barr Jr M, Cohen MM Jr. Cervical spine in the Apert syndrome. Am J Med Genet 1992; 43: 704-708
    CrossrefPubMedGoogle Scholar