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NASAL INTEGUMENT - AN
INDICATOR OF MAXILLARY
SKELETAL PATTERN

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
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




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INTRODUCTION

FACIAL SKELETON

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FACIAL INTEGUMENT


Importance of integument



Will integument follow underlying
skeleton pattern?

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ANATOMY OF MAXILLA

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RIGHT AND LEFT MAXILLA
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

NASAL ANATOMY

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EXTERNAL MORPHOLOGY

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COLUMELLA

ALAE
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INTERNAL
MORPHOLOGY[SKELETAL]

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 NASAL PARAMETERS

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NASAL LENGTH
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NASAL PROJECTION
NASOLABIAL ANGLE

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GROWTH & DEVELOPMENT

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

NASAL INTEGUMENT AS AN
INDICATOR OF MAXILLARY
SKELETAL PATTERN

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AIMS AND OBJECTIVES



Evaluate nasal morphology in sagittal and
vertical maxillary excess.



Evaluate nasal morphology in sagittal and
vertical maxillary deficiency.



To correlate the nasal morphology to class II
skeletal and class III skeletal patterns.

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MATERIALS AND METHODS


DATA PRESENTATION



Pretreatment lateral cephalometric radiographs
of 40 patients / 4 sub groups



10 Patients Sagittal Maxillary Deficiency



10 Patients Sagittal Maxillary Excess



10 Patients Vertical Maxillary Deficiency



10 Patients Vertical Maxillary Excess

5Male and 5Female in each subgroup
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SOURCE OF SAMPLE



Pretreatment lateral cephalometric radiographs of
Sample selected from the patients who are
visiting department of orthodontics at Narayana
dental college.

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

INCLUSION CRITERIA
1. AGE > 18 Years for both Male and Female samples



EXCLUSION CRITERIA
1. Prior history of Orthodontic treatment
2. History of Trauma or Surgery to Facial region

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.
.
Vertical facial skeletal parameters assessed on lateral cephalogram
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Soft tissue reference planes and variables used to assess nose on
.
.
lateral cephalogram
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NORMATIVE VALUES FOR ADULT NASAL PARAMETERS

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

RESULTS

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

SIGNIFICANT CORRELATION WERE SEEN BETWEEN THE
FOLLOWING SKELETAL AND SOFT TISSUE NASAL
VARIABLES

1.ANTERIOR FACIAL HEIGHT AND NASAL LENGTH
AFH

NASAL LENGTH

2.ANGLE OF INCLINATION AND NASAL LENGTH
- AOI

NLTH

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3.UPPER ANTERIOR FACIAL HEIGHT AND NASAL
DEPTH
- AFH

ND

4.AOI AND NASAL DEPTH
AOI

ND

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5.NASOLABIAL ANGLE AND ANTERIOR FACIAL LENGTH
AFH

NASOLABIAL ANGLE

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

CONVEX NASAL PROFILE IS SEEN IN CLASS II CASES



CONCAVE NASAL PROFILE IS SEEN IN CLASS III CASES



NASAL DEPTH IS INCREASED INCREASED MAXILLARY
SAGITTAL DIMENSIONS



NASAL LENGTH INCREASED IN CLASS III SKELETAL
PATTERNS
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

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DISCUSSION


Subtelny [AJO 1959;45:481-507],
- first demonstrated downward and forward growth of
mandible during maturity.
-nose grows more vertically when compared to its
growth in sagittal dimension.



Meng etal [AJO1988 ],

-Supported the subtelny conclusions

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

Scott [Br.Dent J 1953;95:37-43],
- Nasal septum is determinant of midfacial growth



Lathum [J Anat 1970;107:47-78],
-nasal septum acted as a starter mechanism ,pulling
the premaxillae and maxillae forward via the so
called septo-premaxillary ligaments

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

Grymer et al [Rhinology 1997;35: Abstract],

- Deficient nasal septum growth along with decreased
anteroposterior growth of the maxilla leads to an
upward displacement of the anterior part of the
maxilla indicating a strong relationship between nasal
growth and inclination of the maxillary plane.

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

Robinson et al [AJO 1986;89:499-506],

-Their cephalometric study on the
relationship between skeletal facial pattern and soft
tissue nasal form concluded that nasal shape followed
the underlying skeletal pattern very closely in the
sagittal dimension.

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

Peter H. Buschang [JCO 1992;26:111-118],

-Horizontal growth at pr and sn is closely associated
with horizontal growth at ANS and A POINT

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CONCLUSION

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-Nasal length was seen to be significantly correlated to
upper anterior facial height and inclination of palatal
plane.

-An upturned nose in an adult individual was
significantly correlated with anti-clockwise rotation
of maxilla.

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-SIgnificant correlation is present between nasal
projection and nasal length with sagittal
maxillary dimensions.

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

Growth and development of any structure will
occur in three dimensions of space simultaneously
and the overlying integument adapts in three
dimensions.so,its wise to understand the concept
in three dimensions of space than analyzing in one
or two dimensions.

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Thank you
For more details please visit
www.indiandentalacademy.com

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Editor's Notes

  1. Integument is derived from the Latin word "integumentum", which literally means "a covering". As a general term in biology the word "integument" refers most commonly to the natural covering of an organism or an organ, such as its skin, husk, shell, or rind and then onwards determines HOMEOSTASIS and the MORPHOLOGICAL GROWTH of underlying structures.YES it follows the underlying skeleton pattern, but initially it determines the underlying skeleton pattern growth and developmentand laterit adopts itself in camouflaging according to the DETERINANTS of the same (growth and development)
  2. Integument is derived from the Latin word "integumentum", which literally means "a covering". As a general term in biology the word "integument" refers most commonly to the natural covering of an organism or an organ, such as its skin, husk, shell, or rind and then onwards determines HOMEOSTASIS and the MORPHOLOGICAL GROWTH of underlying structures.YES it follows the underlying skeleton pattern, but initially it determines the underlying skeleton pattern growth and developmentand laterit adopts itself in camouflaging according to the DETERINANTS of the same (growth and development)
  3. As There exists a strong relationship between nasal morphology and maxillary skeletal pattern. It is essential to have a knowledge about this relationship for proper orthodontic diagnosis and treatment planning. Therefore the primary purpose of this study was to