Craniocervical posture in patients with skeletal malocclusion and its correlation with craniofacial morphology during different growth periods.

The association between craniocervical posture and craniofacial structures in the various sagittal skeletal malocclusion during different growth stages has been the focus of intense interest in fields of orthodontics, but it has not been conclusively demonstrated. Thus, this study aimed to investigate the association between craniofacial morphology and craniocervical posture in patients with sagittal skeletal malocclusion during different growth periods. A total of 150 from a large pool of cephalograms qualified for the inclusion and exclusion were evaluated and classified into three groups according to the Cervical Vertebral Maturation (CVM) by examining the morphological modifications of the second through fourth cervical vertebrae, each group consisted of 50 cephalograms. In each growth period, for the comparison of head and cervical posture differences among various skeletal classes, the radiographs were further subdivided into skeletal Class I (0° < ANB < 5°, n = 16), skeletal Class II (ANB ≥ 5°, n = 18), and skeletal Class III (0° ≤ ANB, n = 16) on the basis of their ANB angle. There was no significant difference in gender (P > 0.05). Some variables were found to be significant during pubertal growth and later in patients with sagittal skeletal malocclusion (P < 0.05). Most indicators describing craniocervical posture were largest in skeletal Class II and smallest in skeletal Class III during the peak growth periods and later. Cervical inclination variables were greater in skeletal Class III than in skeletal Class II. Variables of craniofacial morphology and craniocervical posture are more correlated during the pubertal growth period and later in patients with sagittal skeletal malocclusion. A tendency is an indication of the close interrelationship that a more extended head was in skeletal Class II while a flexed head was in skeletal Class III. Nevertheless, with the considerations of some limitations involved in this study, further longitudinal studies with large samples are required to elucidate the relationship clearly.

Lateral Cephalometric Analytical Uses for Temporomandibular Joint Disorders: The Importance of Cervical Posture and Hyoid Position.

The temporomandibular joint disorder (TMD) is a syndrome that affects the masticatory muscles and temporomandibular joint (TMJ). Its pathophysiology is not yet fully known. Cephalometric analysis is used for routine evaluation regarding orthodontic treatment and other purposes. The aim of this study was to assess if using cephalometric analysis and TMJ conservative therapy to evaluate the hyoid bone position and the cervical posture reduced symptoms in adults with TMDs compared to no intervention. The authors conducted a systematic review of the literature (PubMed, Cochrane, Web of Science, Scopus, and Embase) for clinical studies of TMDs with conservative treatment and lateral cephalometric analysis of the hyoid and cervical posture. To assess the risk of bias for non-randomized clinical trials ROBINS-I tool was used. Out of 137 studies found, 6 remained to be included. Most of them found a link between TMD and lateral cephalometric analysis, but there was a high risk of bias. This review found a possible link between TMDs, the neck and cervical posture. There is a benefit reported regarding the use of the lateral cephalometry as a treatment, but more extensive prospective randomized clinical trials are necessary to be able to draw definitive conclusions.

Relationship of temporomandibular joint disorders with cervical posture and hyoid bone position.

Objective: To evaluate craniocervical posture and hyoid bone position in patients with and without temporomandibular joint disorder (TMD).Methods: A total of 113 people were included in the study, including 55 TMD patients and 58 healthy controls. Using lateral cephalograms, the craniofacial, craniocervical, and hyoid bone positions of the participants were evaluated in terms of 27 variables.Results: There was no significant difference in craniocervical angles between participants with or without TMD. While the Hy-B, Hy-NSL, Hy-NL measurements and FMA (°), AFH (mm) measurements of participants with TMD were lower than the control group, the hyoid angle was greater than the control group.Conclusion: These study findings provide evidence that TMD is not related to craniocervical posture but to the position of the hyoid bone and craniofacial morphology.

Uso de teléfonos móviles, postura cervical anormal y su repercusión en el sistema estomatognático / Use of mobile phones, abnormal cervical posture and its impact on the stomatognathic system

Desde la introducción de los teléfonos móviles en los años 80, el crecimiento de su uso ha sido continuo y con una tasa de crecimiento cada vez mayor. Este crecimiento ha generado preocupación a nivel mundial respecto de los efectos que sobre la salud provocan. Uno de ellos tiene que ver con los cambios adaptativos que surgen a nivel de la columna cervical, por la acción de inclinar la cabeza hacia adelante repetidas veces, con el objeto de visualizar la pantalla. Se ha descrito una estrecha relación entre la columna cervical y el completo cráneomandibular, por lo que se espera que los componentes de ambos sistemas tengan la capacidad potencial de influirse de manera recíproca. Se ha demostrado que distintas actitudes posturales derivan en características diversas de oclusión, por lo que una modificación de la posición craneocervical afectaría tanto a la oclusión dentaria de manera particular, como de forma general a la biomecánica mandibular. El propósito de este trabajo es informar sobre los efectos que las posturas inadecuadas que adopta la columna cervical al utilizar teléfonos móviles, pueden provocar a nivel del sistema estomatognático (AU)

Altered cervical posture kinematics imposed by heavy school backpack loading: A literature synopsis (2009-2019).

BACKGROUND: Habitual school backpack carriage causes neuro-musculoskeletal vertebral, shoulder and hand pain; deviated posture compromised cardiopulmonary function and proprioception. OBJECTIVE: Present a novel literature summary of the influence of backpack carriage associated with deviated cervical posture and compromised pulmonary function. METHOD: An electronic literature appraisal adopting the Preferred Reporting Items for Systematic Reviews, using Google Scholar, Science Direct, EMBASE, AMED, OVID, PubMed and Sabinet search engines, was instituted during 2009-2019. Key search words: schoolbag, backpack, carriage, cervical posture and children. The quality of the studies was assessed using the Downs and Black Appraisal Scale. RESULTS: 583 records were initially identified which was reduced to 14 experimental and observational studies. A total of 1061 participants were included across the 14 studies, with an average age of 11.5 ± 1.3 years, body mass of 37.8 ± 6.6 kilograms (kg), height of 1.41 ± 0.05 meters (m), backpack mass of 5.2 ± 0.9 kg and percentage backpack mass to child's body mass of 13.75%. The studies mean rating according to the Downs and Black Appraisal Scale was 76.3%. The average craniovertebral angle (CVA) was 53.9° ± 14.6° whilst standing without carrying a backpack was reduced to 50.4° ± 16.4° when loaded (p < 0.05). Backpack loads carried varied from 5% - 30% of the participant's body mass that produced a mean CVA decline of 3.5°. CONCLUSION: Backpack carriage alters cervical posture, resulting in smaller CVA and compromised pulmonary function. There is no consensus of the precise backpack mass that initiates postural changes. Girls' posture begin changes when carrying lighter backpacks as compared to boys of the same age strata.

Influence of the Craniocervical Posture on Tongue Strength and Endurance.

Tongue strength has an important role in the swallowing process, and previous research has suggested that tongue position, concerning the craniomandibular region, could affect the oral function. This study aimed to evaluate the strength and endurance of three areas of the tongue in three experimentally induced craniocervical postures. A cross-sectional study with a nonprobabilistic sample of 37 participants (mean age: 3.85 ± 3.64 years; 20 men, 17 women) was performed. Tongue strength and endurance were assessed using a pressure device entitled Iowa Oral Performance Instrument (IOPI), in three different craniocervical positions: neutral head position (NHP), anterior head translation-or forward head position (FHP), and posterior head translation-or retracted head position (RHP). Measurements taken using the IOPI system showed significant differences in tongue strength for the anterior (p = 0.015) and middle areas of the tongue (p = 0.01). Significant differences were observed in analysis of variance (ANOVA) in the FHP (p = 0.02) and NHP (p = 0.009). The results of tongue endurance measurements showed statistically significant differences for FHP (p = 0.001), NHP (p = 0.00), and RHP (p = 0.007). The craniocervical position influences tongue strength, especially in the anterior and middle tongue areas, concerning the posterior, and, in the anterior and neutral head posture, regarding the retracted position. No differences were found in tongue resistance between the various craniocervical positions, but differences were found in resistance between the different tongue areas.

Effects of carrying school bags on cervical and shoulder posture in static and dynamic conditions in adolescent students.

BACKGROUND: Neck and Back Pain in Students is closely related to the school bags that they carry. There is a dearth of literature in terms of postural changes due to school bags in adolescents, especially those discussing postural changes in static and dynamic loading conditions. OBJECTIVE: To assess the effects of weight, position, and time of school bag carriage in static and dynamic conditions on cervical and shoulder posture in adolescent students. SUBJECTS: Seventy adolescents (35 Females, 35 Males) between 10 and 15 years of age. Methods: Craniohorizontal Angle, Craniovertebral Angle, Sagittal Shoulder Posture, Anterior Head Alignment were assessed in 7 different conditions using Photographic Method and MB Ruler. RESULTS AND CONCLUSION: Significant changes in Sagittal Shoulder Posture and Craniohorizontal Angle were found with unilateral school bag carriage as compared to minimal significant postural changes with bilateral carriage. Maximal significant postural changes, in terms of all outcome measures were noted during loaded dynamic activity. Craniovertebral Angle kept significantly reducing with time. Immediate assessments taken with a school bag weighing 13.5% of the body weight showed a significant decrement in the Craniohorizontal Angle. Even a bag weighing less than 10% of the body weight proved to bring about biomechanical changes, when assessments were taken during the activities that a child has to perform with a school bag (Post Standing, Post Walking, and During Walking).

Potential orofacial hazards of resistance training: A controlled comparative study.

OBJECTIVE: To evaluate the effect of resistance training (RT) regarding potential hazard for dental wear, tooth abfractions, temporomandibular joint disc displacement, limitation in mouth opening, and existence of cervical spine disorders. The initial study hypothesis was that extensive resistance trainees (ExRT) would suffer from the above-mentioned symptoms more often than recreational trainees (RcT). METHODS: A controlled comparative study among male gym members via questionnaires and a clinical examination. RESULTS: ExRT had a higher prevalence of teeth indentations on the tongue (26% vs. 2% p < 0.001) and a higher prevalence of tooth abfractions than RcT (28% vs. 4% p < 0.005). ExRT exhibited a higher prevalence of cervical movement limitations (p < 0.05) and inadequate posture (p < 0.001). CONCLUSION: RT by itself may not be a risk factor for disc displacement. Nevertheless, it may act as a potential risk factor for irreversible hard tooth tissue damage and contribute to neck postural and mobility impairments.

Effect of unifocal versus multifocal lenses on cervical spine posture in patients with presbyopia.

Significance. There are many environmental considerations which may or may not lead to the development of faulty cervical mechanics. The design of near-vision lenses could contribute to the development of such cervical dysfunction and consequently neck pain. Decision-making regarding the proper type of lens prescription seems important for presbyopic individuals. Purpose. To investigate the effect of unifocal and multifocal lenses on cervical posture. Methods. Thirty subjects (18 females and 12 males) participated in the study with an age range from 40 to 64 years. Each subject wore consequently both unifocal and multifocal lenses randomly while reading. Lateral cervical spine X-ray films were taken for each subject during each lens wearing. X-ray films were analyzed with digital software (AutoCAD 2D version 22) to measure segmental angles of the cervical vertebrae (occiput/C1, C1/C2, C2/C3, C3/C4, C4/C5, C5/C6, C6/C7, C3/C7, C0/C3, and occiput/C7). Results. Higher significant extension angles were observed in the segments C0/C7, C1/C2, C5/C6, C6/C7 and C3/C7 (p < 0.05) during multifocal lens wearing, in contrast to higher flexion angles between C3/C4 and C4/C5 (p < 0.05) when wearing unifocal lenses. Conclusion. Multifocal lens spectacles produce increased extension in the cervical vertebrae angles when compared with the use of unifocal lenses.

Does improvement towards a normal cervical sagittal configuration aid in the management of cervical myofascial pain syndrome: a 1- year randomized controlled trial.

BACKGROUND: There is a growing interest concerning the understanding of and rehabilitation of the sagittal configuration of the cervical spine as a clinical outcome. However, the literature on the topic specific to conservative treatment outcomes of patients with chronic myofascial cervical pain syndrome (CMCPS) has not adequately addressed the relationship between cervical sagittal alignment and improved pain, disability and range of motion. METHODS: A randomized controlled study with a 1-year follow-up. Here, 120 (76 males) patients with chronic CMCPS and defined cervical sagittal posture abnormalities were randomly assigned to the control or an intervention group. Both groups received the Integrated neuromuscular inhibition technique (INIT); additionally, the intervention group received the denneroll cervical traction device. Alignment outcomes included two measures of sagittal posture: cervical angle (CV), and shoulder angle (SH). Patient relevant outcome measures included: neck pain intensity (NRS), neck disability (NDI), pressure pain thresholds (PPT), cervical range of motion using the CROM. Measures were assessed at three intervals: baseline, 10 weeks, and 1 year after the 10 week follow up. RESULTS: After 10 weeks of treatment, between group statistical analysis, showed equal improvements for both the intervention and control groups in NRS (p = 0.36) and NDI (p = 0.09). However, at 10 weeks, there were significant differences between groups favoring the intervention group for PPT (p<0.001) and all measures of CROM (p<0.001). Additionally, at 10 weeks the sagittal alignment variables showed significant differences favoring the intervention group for CV p<0.001 and SH (p<0.001) indicating improved CSA. Importantly, at the 1-year follow-up, between group analysis identified a regression back to baseline values for the control group for the non-significant group differences (NRS and NDI) at the 10-week mark. Thus, all variables were significantly different between groups favoring the intervention group at 1-year follow up: NRS (p<0.001), NDI (p<0.001), PPT p<0.001), CROM (p<0.001), CV (p<0.001), SH (p<0.001). CONCLUSION: The addition of the denneroll cervical orthotic to a multimodal program positively affected CMCPS outcomes at long term follow up. We speculate the improved sagittal cervical posture alignment outcomes contributed to our findings. TRIAL REGISTRATION: Pan African Clinical Trial Registry Clinical Trial Registry: PACTR201801002968301 , registered 11 January 2018 (retrospectively registered).

Evaluation of cervical posture improvement of children with cerebral palsy after physical therapy based on head movements and serious games.

BACKGROUND: This paper presents the preliminary results of a novel rehabilitation therapy for cervical and trunk control of children with cerebral palsy (CP) based on serious videogames and physical exercise. MATERIALS: The therapy is based on the use of the ENLAZA Interface, a head mouse based on inertial technology that will be used to control a set of serious videogames with movements of the head. METHODS: Ten users with CP participated in the study. Whereas the control group (n = 5) followed traditional therapies, the experimental group (n = 5) complemented these therapies with a series of ten sessions of gaming with ENLAZA to exercise cervical flexion-extensions, rotations and inclinations in a controlled, engaging environment. RESULTS: The ten work sessions yielded improvements in head and trunk control that were higher in the experimental group for Visual Analogue Scale, Goal Attainment Scaling and Trunk Control Measurement Scale (TCMS). Significant differences (27% vs. 2% of percentage improvement) were found between the experimental and control groups for TCMS (p < 0.05). The kinematic assessment shows that there were some improvements in the active and the passive range of motion. However, no significant differences were found pre- and post-intervention. CONCLUSIONS: Physical therapy that combines serious games with traditional rehabilitation could allow children with CP to achieve larger function improvements in the trunk and cervical regions. However, given the limited scope of this trial (n = 10) additional studies are needed to corroborate this hypothesis.

CERVICAL CONTRIBUTION TO FUNCTIONAL SHOULDER IMPINGEMENT: TWO CASE REPORTS.

BACKGROUND: Subacromial impingement is a common condition among overhead athletes. The cause of subacromial impingement can be multifactorial and often involves impaired rotator cuff function. CASE DESCRIPTION: The following cases outline the presentation, examination and intervention of two overhead athletes, a high school football quarterback and a collegiate swimmer, each presenting with signs and symptoms of subacromial impingement. The unique feature in each case was the manifestation of the cervical spine as the apparent source of rotator cuff weakness, which contributed to functional subacromial impingement although other overt signs of cervical or associated nerve root involvement were absent. OUTCOME: Subsequent to this finding, the athletes demonstrated a rapid recovery of rotator cuff strength and resolution of impingement symptoms in response to cervical retraction and retraction with extension range of motion exercises along with posture correction. They both returned to unrestricted sporting activities within a week, with maintenance of strength and without reoccurrence of symptoms. DISCUSSION: The signs of functional subacromial impingement often include weakness of the supraspinatus and infraspinatus. The cause of the weakness in the two cases appeared to be the result of stresses associated with forward head posture contributing to a possible intermittent C5 nerve root compression. The findings in the two cases would suggest the cervical spine should be considered as a potential cause of rotator cuff weakness in individuals presenting with subacromial impingement. Future research should examine the influence of cervical postures and shoulder muscle strength. LEVEL OF EVIDENCE: 4.

Effect of backpack shoulder straps length on cervical posture and upper trapezius pressure pain threshold.

[Purpose] This study was performed to investigate the effect of the length of backpack shoulder straps on upper trapezius muscle pain threshold and craniovertebral angle. [Subjects and Methods] There were 25 participants, with ages from 15 to 23 years old. Upper trapezius pain threshold and craniovertebral angle were measured for all subjects without the backpack then re-measured after walking on a treadmill for 15 min under 2 conditions: 1) wearing a backpack with short straps; and 2) wearing a backpack with long straps. [Results] there was a significant reduction in upper trapezius pain threshold and craniovertebral angle while carrying a backpack with long shoulder straps, compared to use of a backpack with short shoulder straps or no backpack. [Conclusion] A backpack with short straps is less harmful than a backpack with long straps. This result should be considered in ergonomic design of backpacks to reduce the incidence of various physiological and biomechanical disorders.

Relationships between vertical facial pattern and natural head position,cervical posture in patients with skeletal class Ⅰ relationship / 吉林大学学报(医学版)

Objective To investigate the natural head position and cervical posture in the patients with different vertical facial patterns with skeletal class Ⅰ relationship,and to clarify the relationships between vertical facial patterns and natural head position, cervical posture in the patients with skeletal class Ⅰ relationship. Methods 94 patients aged 8- 15 years old with skeletal class Ⅰ relationship were selected as the subjects.The subjects were classified into high angle group,average angle group,and low angle group according to their mandibular plane angles.The cephalometric radiographs in natural head position were taken,and the variables representing craniofacial morphology,head position,and craniocervical posture were measured.The intergroup differences in variables were compared.Results The inclinations of mandible to the true vertical and cervical column (ML/VER,ML/OPT,ML/CVT)were smallest in high angle group,and they were largest in low angle group (P 0.05). Conclusion The significant differences exist in natural head position and cervical posture among the patients with skeletal class Ⅰ relationship with different vertical facial patterns (high angle,average angle,low angle);the subjects with high angle show extended head position and cervical posture,while the subjects with low angle exhibit the opposite tendency.

Associations between cervical and scapular posture and the spatial distribution of trapezius muscle activity.

The first aim of this investigation was to quantify the distribution of trapezius muscle activity with different scapular postures while seated. The second aim of this investigation was to examine the association between changes in cervical and scapular posture when attempting to recruit different subdivisions of the trapezius muscle. Cervical posture, scapular posture, and trapezius muscle activity were recorded from 20 healthy participants during three directed shoulder postures. Planar angles formed by reflective markers placed on the acromion process, C7, and tragus were used to quantify cervical and scapular posture. Distribution of trapezius muscle activity was recorded using two high-density surface electromyography (HDsEMG) electrodes positioned over the upper, middle, and lower trapezius. Results validated the assumption that directed scapular postures preferentially activate different subdivisions of the trapezius muscle. In particular, scapular depression was associated with a more inferior location of trapezius muscle activity (r=0.53). Scapular elevation was coupled with scapular abduction (r=0.52). Scapular adduction was coupled with cervical extension (r=0.35); all other changes in cervical posture were independent of changes in scapular posture. This investigation provides empirical support for reductions in static loading of the upper trapezius and improvements in neck posture through verbal cueing of scapular posture.

Evaluation of cervical posture following rapid maxillary expansion: a review of literature.

OBJECTIVE: The aim of this article is to elucidate the state of the art about how rapid maxillary expansion (RME) produces changes in natural head position (NHP) in terms of cephalometric angles or inclinometer data during the growth period, according to the available literature. METHODS: Electronic search was done from January 2002 to June 2012 on PubMed, Cochrane and Scopus databases; in addition manual search was conducted as well. According to keywords, eleven papers were eligible for our purpose, but definitely six papers were selected in agreement with the inclusion/exclusion criteria. CONCLUSIONS: The current literature suggests that the potential relationship between RME and NHP is still unclear. In fact, although the change in the position of the head after the rapid palatal expansion is evident clinically, current orthodontic literature does not provide conclusive evidence about the nature of this relationship.

Does posture of the cervical spine influence dorsal neck muscle activity when lifting?

Previous studies have shown that postural orientations of the neck, such as flexed or forward head postures, are associated with heightened activity of the dorsal neck muscles. While these studies describe the impact of variations in neck posture alone, there is scant literature regarding the effect of neck posture on muscle activity when combined with upper limb activities such as lifting. The purpose of this study was to evaluate the effect of three different neck postures on the activity of the different layers of the dorsal neck muscles during a lifting task. Ultrasound measurements of dorsal neck muscle deformation were compared over two time points (rest, during lift) during a lifting task performed in three different neck postural conditions (neutral, flexed and forward head posture) in 21 healthy subjects. Data were analysed by post-process speckle tracking analysis. Results demonstrated significantly greater muscle deformation induced by flexed and forward head postures, compared to the neutral posture, for all dorsal neck muscles at rest (p<0.05). Significant condition by time interactions associated with the lift was observed for four out of the five dorsal muscles (p<0.02). These findings demonstrate that posture of the cervical spine influenced the level of muscle deformation not only at rest, but also when lifting. The findings of the study suggest that neck posture should be considered during the evaluation or design of lifting activities as it may contribute to excessive demands on dorsal neck muscles with potential detrimental consequences.

Evaluation of cervical posture of adolescent subjects in skeletal class I, II, and III / Evaluación de la postura cervical en sujetos adolescentes con clase esqueletal I, II y III

The aim of this study was to investigate whether there are significant differences in cervical posture in adolescent subjects with a different skeletal class. Twenty-eight adolescent subjects (21 boys and 7 girls, average age of 13.6 years, SD+/-3.2) who were admitted for orthodontic treatment were included in this study. Selection criteria were as follows: no previous orthodontic, orthopaedic, or surgical treatment and absence of facial asymmetry, bruxism, nasal obstruction, orofacial pain, and temporomandibular joint dysfunction. Lateral skull radiographs were taken, and the subjects were divided into three groups based on their skeletal class according to ANB angle and Wits appraisal. The cephalometric tracings included cervical postural variables and cervical curvature. By Pearson´s correlation analysis (using the variables as continuous), we found a high linear relationship between the variables angle ANB and Wits appraisal (0.7895) and between cervical curvature and C0-C1 distance (0.6384). Statistical significance was observed between ANB angle and cervical curvature (p = 0.039) and C0-C1 distance (p = 0.045) variables, whereas Wits appraisal showed no significant association with any study variable (p > 0.05). The cervical curvature was different between the groups; however, both averages turned out to have more characteristics of rectified cervical, being female clearly the most affected, as well as an average lower than the standard posterior-inferior angle, which shows a more posterior rotation of the skull. The cervical posture seems to be strongly associated with the sagittal posture as well as the vertical structure of the face, with these data being complementary to other determinants of craniofacial growth and development.

El objetivo de este estudio fue investigar si existen diferencias significativas en la postura cervical de pacientes adolescentes con diferente clase esqueletal. Veintiocho adolescentes (21 hombres y 7 mujeres, edad promedio 13,6 años, DE+/-3,2) fueron admitidos para este estudio y el tratamiento de ortodoncia. Fueron seleccionados sujetos sin antecedentes de tratamiento ortodóncico, ortopédico o quirúrgico previo, asimetría facial, bruxismo, obstrucción nasal, dolor orofacial y disfunción de la articulación temporomandibular. Para cada caso se tomaron radiografías laterales de cráneo y los sujetos fueron divididos en tres grupos basados en su clase esqueletal según el ángulo ANB y la evaluación de Wits. Los trazados cefalométricos incluyeron las variables postural cervical y curvatura cervical. Mediante el análisis de correlación de Pearson (usando las variables como contínuas), se encontró una alta relación lineal entre las variables ángulo ANB y evaluación de Wits (0,7895) y entre curvatura cervical y la distancia C0-C1 (0,6384). Se observó significancia estadística entre el ángulo ANB y las variables curvatura cervical (p=0,039) y distancia C0-C1 (p=0,045), mientras que la evaluación de Wits no mostró una asociación con las variable de estudio (p>0,05). La curvatura cervical fue diferente entre las clases esqueletales, sin embargo, ambos promedios resultaron tener rectificación cervical, siendo las mujeres claramente más afectadas, junto con un promedio menor del ángulo postero-inferior en relación al estándar, lo que muestra una rotación más posterior del cráneo. La postura cráneocervical parece estar fuertemente asociada con la postura sagital, así como la estructura vertical de la cara, siendo estos datos complementarios a otros determinantes del crecimiento y desarrollo craneofacial.