Maduración de la Sutura Palatina Media En Adolescentes y Adultos Jóvenes Chilenos: Estudio Transversal / Midpalatal Sutural Maturation in Chilean Adolescents and Young Adults: Cross-sectional Study

RESUMEN: Objetivo: Evaluar la maduración de la sutura palatina media en adolescentes y adultos jóvenes chilenos, mediante valoración morfológica de imágenes de tomografía computarizada de haz cónico del maxilar. Material y método: Se analizó la sutura palatina media de 150 sujetos entre 15 y 30 años, seleccionados desde la base de datos radiológicos de un centro universitario de salud. La maduración sutural fue evaluada en el corte axial, utilizando el método de Angelieri y cols., clasificándola en cinco etapas (A, B, C, D y E). Se utilizaron las pruebas de correlación de Pearson para medir la concordancia intra e interexaminador, y T-Student para las diferencias entre sexos. Resultados: El estado de maduración más frecuente fue C (43,3%), seguido por E (33,3%) y D (22%). En hombres, la etapa C fue más frecuente (49%), mientras que en mujeres fue la etapa E (39%). Sin embargo, no se encontraron diferencias estadísticamente significativas entre ambos sexos. Conclusiones: Aunque la mayoría de la muestra presentó una etapa tardía de maduración sutural, el 45% presentó estados de maduración sutural donde sería posible la expansión de naturaleza no quirúrgica. Debido a la variabilidad observada en adolescentes y adultos jóvenes, se recomienda la evaluación individual con imagenología 3D.

ABSTRACT: Objective: To evaluate midpalatal suture maturation in Chilean adolescents and young adults through morphological assessment of cone-beam computed tomography images of the maxilla. Materials and methods: Analysis of the midpalatal suture of 150 subjects aged between 15 and 30 was performed, selected from a university clinical center radiological database. Sutural maturation was evaluated in the axial cross-section, using the method described by Angelieri et al., classifying it in five stages (A, B, C, D and E). Pearson's correlation tests were used to assess intra- and inter-examiner agreement, and T-Student for assessing differences between genders. Results: The most frequent maturation stage was C (43.3%), followed by E (33.3%) and D (22%). In men, stage C was more frequent (49%), while in women it was stage E (39%). However, no statistically significant differences were found between genders. Conclusions: Although the majority of the sample presented a late stage of sutural maturation, 45% presented states of sutural maturation where the expansion of a non-surgical nature would be possible. Due to the variability observed in adolescents and young adults, individual evaluation with 3D imaging is recommended.

Síndrome de Saethre-Chotzen: a propósito de un caso / Saethre-Chotzen syndrome: a case report

El síndrome de Saethre-Chotzen es un síndrome malformativo craneofacial caracterizado por una sinostosis de las suturas coronales y alteraciones de extremidades. Tiene una prevalencia de 1 de cada 25 000-50 000 recién nacidos vivos. Se presenta el caso de un neonato sin antecedentes de interés con alteraciones craneofaciales al nacer. Ante los rasgos fenotípicos del paciente, se realizó una tomografía axial computada craneal, que mostró la fusión parcial de la sutura coronal y evidenció la presencia de huesos wormianos en localización metópica y lambdoidea derecha. Con la sospecha clínica de síndrome malformativo craneofacial, se solicitó análisis del exoma dirigido, que confirmó que el paciente era portador heterocigoto de la variante patogénica c.415C>A, que inducía un cambio de prolina a treonina en la posición 139 del gen TWIST1, responsable del síndrome. La presencia de huesos wormianos, hallazgo no descrito hasta ahora en la literatura, amplía la variabilidad fenotípica conocida de este síndrome.

The Saethre-Chotzen syndrome is a craniofacial malformation syndrome characterized by synostosis of coronal sutures and limb anomalies. The estimated prevalence of this syndrome is 1 in 25 000-50 000 live births. We present a case report of a neonate, without relevant family history, who presented craniofacial alterations at birth. Given the phenotypic features, a cranial computed tomography scan was performed, showing partial fusion of the coronal suture, evidencing the presence of wormian bones in the metopic and right lambdoid location. With the clinical suspicion of craniofacial malformation syndrome, an analysis of the directed exome was requested confirming that the patient is a heterozygous carrier of the pathogenic variant c.415C>A, which induces a change of proline to threonine at position 139 of the TWIST1 gene, responsible for Saethre-Chotzen syndrome.The presence of wormian bones, a finding not described so far in the literature, extends the well-known phenotypic variability of this syndrome.

Tomographic analysis of midpalatal suture prior to rapid maxillary expansion

ABSTRACT Introduction: In Orthodontics and Facial Orthopedics, the timing of treatment onset may be critical and individual analysis should be applied to promote a favorable treatment planning. In this study, individual analysis of midpalatal suture (MS) and palatal measurements were performed in teenagers and young adult patients treated with rapid maxillary expansion (RME). Description: Twenty-six patients submitted to RME with a tooth-supported appliance (Hyrax) were evaluated. The inclusion criteria were: minimum age of 14 years, presenting all posterior teeth, diagnosed with transverse maxillary discrepancy, and with a clinical indication for maxillary expansion. The pretreatment CBCT scans of these patients were assessed to obtain the stages of MS maturation (MSM); density ratio (MSD); and palatal length, thickness (anterior, intermediate and posterior) and sagittal area. Results: The maturation stages present were C, D or E; the density ranged from 0.6 to 1, and lower density (MSD < 0.75) and higher density (MSD ≥ 0.75) groups were determined. Individuals with higher MSD presented smaller sagittal area, compared to the lower density group. Individuals in D and E MSM stages presented smaller sagittal area and intermediate thickness, compared to stage C. Conclusions: Smaller palatal sagittal area was observed in the high MSD groups and in the stages D and E of MSM.

RESUMO Introdução: Em Ortodontia e Ortopedia Facial, o momento de início do tratamento pode ser crítico, e uma análise individual deve ser aplicada para promover um planejamento de tratamento favorável. No presente estudo, foram realizadas a avaliação individualizada da sutura palatina mediana (SPM) e medições no palato de adolescentes e adultos jovens tratados com expansão rápida da maxila (ERM). Descrição: Foram avaliados vinte e seis pacientes submetidos à ERM com aparelho dentossuportado (Hyrax). Os critérios de inclusão foram: idade mínima de 14 anos, apresentando todos os dentes posteriores, diagnosticado com discrepância transversa da maxila e com uma indicação clínica para expansão maxilar. A tomografia computadorizada de feixe cônico (TCFC) pré-tratamento desses pacientes foi avaliada para obter os estágios de maturação da SPM (MSPM), densidade da SPM (DSPM), comprimento do palato, espessura (anterior, intermediária e posterior) e área sagital. Resultados: Os estágios de maturação presentes foram C, D ou E; a densidade variou de 0,6 a 1, e foram determinados grupos de baixa (DSPM < 0,75) e alta densidade (DSPM ≥ 0,75). Indivíduos com maior DSPM apresentaram menor área sagital, em comparação com o grupo de densidade mais baixa. Indivíduos nos estágios D e E de MSPM apresentaram menor área sagital e espessura intermediária, comparados aos indivíduos no estágio C. Conclusão: Uma menor área sagital palatina foi observada nos grupos de alta DSPM e nos estágios D e E de MSPM.

Chinese morphological stages of midpalatal suture and its correlation with Demirjian dental age / 北京大学学报(医学版)

OBJECTIVE@#To investigate the correlation between morphological stages of midpalatal suture (MPS) and Demirjian dental age.@*METHODS@#In this retrospective study, 1 076 cone-beam CT (CBCT) images (female: 675, male: 401; age range: 6.0 to 21.0 years) were included. Horizontal view of each sample's CBCT images was observed, each sample's MPS stage was recorded, and dental age. MPS stage and dental age were ordered with categorical variables. Therefore, their correlation was investigated through Spearman correlation coefficient analysis and diagnostic test analysis.@*RESULTS@#(1) For left lower second premolar: 95.2% of those in dental age stage B-D were in MPS 1-2, accounting for the largest proportion. 85.3% of those in dental age stage E were in MPS 1-2, still accounting for the largest proportion. Another 14.7% were in MPS 3.45.1% of those in dental age stage F were in MPS 3, 46.1% in MPS 1-2, and another 8.8% in MPS 4s1.49.8% of those in dental age stage G were in MPS 3.24.9% in MPS 4s1, and 18.9% in MPS 1-2.80.1% of those in dental age stage H were in MPS 4-5. Another 16.3% were in MPS 3. (2) For left lower second molar: 89.7% of those in dental age stage B-D were in MPS 1-2, accounting for the largest proportion. 67.4% of those in dental age stage E were in MPS 1-2, still accounting for the largest proportion. Another 26.1% were in MPS 3.55.3% of those in dental age stage F were in MPS 3, 34.2% in MPS 1-2, and another 10.5% in MPS 4s1.50.7% of those in dental age stage G were in MPS 3, 24.3% in MPS 4s1, and 16.8% in MPS 1-2.83.8% of those in dental age stage H were in MPS 4-5, another 14.2% were in MPS 3. (3) To diagnose MPS stage with dental age, diagnostic pairs with good performance included: Dental age of left lower second molar-MPS: H-4s2, H-5, D-1; Dental age of left lower second premolar-MPS: H-4s2, H-5, G-3. Other diagnostic pairs were of ordinary diagnostic efficiency. (4) For dental age-MPS Spearman correlation analysis, dental age of left lower second molar-MPS had the highest Spearman coefficient (0.68), dental age of left lower second premolar-MPS was the second high (0.64). (5) Dental age stage H of left lower second molar or left lower second premolar indicated that the individual was later than MPS 4s2.@*CONCLUSION@#Dental age's diagnostic efficiency for MPS stage is ordinary on the whole, except for some pairs with good performance. Therefore, pre-treatment CBCT examination should be considered as assistance for evaluating maturation and fusion status of midpalatal suture.

Age Estimation in Han Adults by Thin-Layer CT Scan of Cranial Sutures / 法医学杂志

Objective To explore the value of degree of cranial suture closure in forensic adult age estimation by thin-layer CT scan and establish an adult age estimation model of the Han nationality. Methods Thin-layer CT scan samples of the heads of 220 healthy Sichuan Han adults （110 males, 110 females） aged 20 to 70 were collected, of which 20 samples （10 males, 10 females） were randomly selected as test samples. The sagittal suture, coronal suture （both left and right） and lambdoid suture （both left and right） were respectively and equally divided into 2 segments, and every segment was equally divided into 10 layers and the corresponding multiplanar reformation （MPR） images were selected. The closure of cranial sutures on MPR images was classified into the grades 1-7. The correlations between cranial sutures and age were analyzed to build regression equation for age estimation. Results The degree of closure of sagittal suture, coronal suture （both left and right） and lambdoid suture （both left and right） was positively correlated with age. The coefficient of determination （R2） of regression equation was 0.419 in males, 0.589 in females, and 0.522 in all samples. The results of the verification test showed that the mean absolute error （MAE） was 6.39 years in males, 6.16 years in females, and 6.29 years in all samples. Conclusion There was a higher accuracy in adult age estimation by thin-layer CT scan of cranial sutures. The age of Han nationality adults can be estimated by the degree of cranial sutures closure.

Premaxilla: an independent bone that can base therapeutics for middle third growth!

ABSTRACT Premaxilla, in its early descriptions, had the participation of Goethe. In our face, in a certain period of growth and development processes, premaxilla is an independent and, then, a semi-independent bone to finally be totally integrated to the maxilla. Formation of the premaxilla acts as a stabilization element inside the facial skeleton comparable to the cornerstone of a Roman arch and is closely related to the development of human face and its abnormal growth with characteristic malformations. Until when the premaxillary-maxillary suture remains open and offers opportunities to orthopedically influence facial growth to exert influence over facial esthetics and function? Contact with preliminary results in 1183 skulls from anatomic museums at USP, Unicamp and Unifesp led us to question therapeutic perspectives and its clinical applicability.

RESUMO A descrição inicial da pré-maxila teve a participação de Goethe. Na face, em determinado período do crescimento e desenvolvimento, têm-se a pré-maxila como um osso independente e, depois, semi-independente para, finalmente, se integrar totalmente à maxila. A formação da pré-maxila atua como um elemento estabilizador dentro do esqueleto facial, comparável com a pedra angular de um arco romano, e está intimamente relacionada com o desenvolvimento da face humana e seu crescimento anormal, com malformações características. Até quando a sutura pré-maxilar-maxilar continua aberta e oferece oportunidades para se influenciar ortopedicamente o crescimento facial e modificar a estética e função da face? O contato com estudos preliminares em 1.183 crânios de museus anatômicos da USP, Unicamp e Unifesp nos induziu a questionar sobre as perspectivas terapêuticas e aplicabilidades clínicas.

Prediction of rapid maxillary expansion by assessing the maturation of the midpalatal suture on cone beam CT

ABSTRACT Rapid maxillary expansion (RME) primarily involves the mechanical opening of the midpalatal suture of the maxillary and palatine bones. The fusion of the midpalatal suture determines the failure of RME, a common event in late adolescents and young adults. Recently, the assessment of the maturation of midpalatal suture as viewed using cone beam computed tomography (CBCT) has been introduced. Five maturational stages of the midpalatal suture have been presented: Stage A = straight high-density sutural line, with no or little interdigitation; Stage B = scalloped appearance of the high-density sutural line; Stage C = two parallel, scalloped, high-density lines that lie close to each other, separated in some areas by small low-density spaces; Stage D = fusion of the palatine bone where no evidence of a suture is present; and Stage E = complete fusion that extends also anteriorly in the maxilla. At Stage C, less skeletal response would be expected than at Stages A and B, as there are many bony bridges along the suture. For patients at Stages D and E, surgically assisted RME would be necessary, as the fusion of the midpalatal suture already has occurred either partially or totally. This diagnostic method can be used to estimate the prognosis of the RME, mainly for late adolescents and young adults for whom this procedure is unpredictable clinically.

RESUMO A expansão rápida da maxila (ERM) essencialmente consiste na abertura mecânica da sutura palatina mediana tanto nos ossos maxilares quanto nos ossos palatinos. A fusão da sutura palatina mediana determina o insucesso da ERM, um evento comum na adolescência tardia e fase adulta jovem. Recentemente, propôs-se a avaliação da maturação da sutura palatina mediana em tomografias computadorizadas de feixe cônico (TCFC), sendo apresentados cinco estágios maturacionais: Estágio A = linha sutural de alta densidade retilínea, sem ou com suave interdigitação; Estágio B = linha sutural de alta densidade, com aspecto tortuoso; Estágio C = duas linhas de alta densidade, paralelas e curvilíneas, que se aproximam em algumas regiões e, em outras, são separadas por espaços de baixa densidade; Estágio D = a fusão ocorreu no osso palatino, onde não há evidência de sutura; e Estágio E = fusão completa, que se estende anteriormente na maxila. No Estágio C, esperam-se menores efeitos esqueléticos da ERM, comparado aos Estágios A e B, visto que há muitas pontes ósseas ao longo da sutura. Para pacientes nos Estágios D e E, a expansão rápida da maxila assistida cirurgicamente (ERMAC) seria necessária, já que a fusão da sutura palatina mediana ocorreu parcial ou totalmente. Esse método de diagnóstico pode ser utilizado para estimar o prognóstico da ERM, principalmente na adolescência tardia e fase adulta jovem, período em que esse procedimento ainda apresenta-se imprevisível clinicamente.

Quantitative assessment of palatal bone thickness in an ethnic Indian population: A computed tomography study.

Context: Variations in palatal bone thickness (PBT) at various locations have caused considerable problems when using these sites for anchorage purposes. Aims: To find the comparative thickness of the palatal bone at different locations and to validate its morphology for anchorage purposes using mini-implants (MI). Settings and Design: This investigation was undertaken to compare the mean PBT and level of significance of differences between male and female subjects and between two different age-groups. Materials and Methods: The computed tomography (CT) data for 60 patients (30 males and 30 females) in two different age-groups (group A: 15-24 years; group B: 25-35 years) were imported into CAD-based medical software, (MIMICS® ; Materialise, Belgium) for multiplanar reconstruction. The measurements were made in two planes- transverse and sagittal-and at different positions in each of the planes. Statistical Analysis: The mean and standard deviations of the PBT at different points were calculated. The Student's t-test and Mann-Whitney U test were used for comparisons between the groups. Results: Significant variations were observed in the thickness of the palatal bone for both groups tested, with the anterior region at 4 mm behind the incisive papilla showing the maximum thickness. Conclusions: Despite the palatal bone being thickest in the mid-palatal suture (MPS) region, this is not the ideal site for anchorage purposes due to inadequate calcification and interposition of connective tissue, especially in young growing children. So, the alternate optimum position is the paramedian region, 3 mm lateral to the MPS and 4 mm from the incisive foramen (IF).

Medicolegal importance of inca bone in forensic.

Skull is usually available human bone for establishing personal identity. Presence of Inca bone in human skull is one such feature that may be identified on radiological examination and if earlier recorded help in establishing the identity of deceased. Complete division of membranous and cartilaginous part of occipital bone by a transverse suture extending between the two lambdoid sutures at the level of highest nuchal line above the external occipital protuberance, results in rare cranial variation presenting as Inca bone.During medicolegal examination of one male skull at Madhya Pradesh Medicolegal Institute Bhopal, presence of Inca bone was found. The interparietal bone is formed by a part of the squamous occipital bone bounded by two lambdoid sutures on two sides and additional longitudinal suture on both sides between lambdoid suture and external occipital protuberance forming diamond shaped Os Incae Centrale that can also be considered as intra-occipital bone. Such rare findings have significant anthropological and embryological basis. Specific anatomical feature if earlier documented in the clinico-radio-pathological reports of the deceased provides opportunity for establishing the identity.

Age assessment from radiological cranial suture closure in fourth to seventh decades (A Jaipur based study).

Reasonably a correct estimation of age in important in Legal, Medical, Social and Administrative matters i.e. regularization of temporary employee, retirement from service or superannuation, re-employment in services, settlement of pension cases, distribution of old age pension, potency certification, for relaxation in imprisonment on the grounds of old age and good behavior of a prisoner, to provide senior citizen benefits etc. In the dead person the age estimation at the time of autopsy is done to help the Investigating Officer. In India and other countries the task of scientific confirmation of disputed age issue of civil and criminal nature is the domain of Forensic Expert. This study is done to determine the age of individual in the fourth decade to seventh decades by correlating radiological finding of various views of skull along with the other physical findings. Maximum Number of cases was in the age group of 51-55 yrs (17%). Female to male ratio was 1:2.2, 66% cases were urban and 34% were rural, 72% Hindu and 73% were from Middle class.