Cephalometric Analysis for Orthognathic Surgery

CEPHALOMETRIC
ANALYSIS FOR
ORTHOGNATHIC
SURGERY
Dr. Mohd Ullah Khan
Dept of Othodontics & Dentofacial Orthopedics
CIDS

CONTENTS
 INTRODUCTION
 CHARACTERISTICS
 LANDMARKS
 CHARLES.J.BURSTONE ANALYSIS
 CONCLUSION
 REFERENCES

INTRODUCTION
 Developed in University of connecticut
 The successful t/t of orthognathic surgical pt is dependent of careful diagnosis.
 This system describes H and V position of facial bones
 Size of bone—linear measurement
 Shape ----angular measurements

CHARACTERISTICS
1. The chosen landmarks and measurements can be altered by various
surgical procedures.
2. The comprehensive appraisal includes all of the facial bones and a cranial
base reference.
3. Measurements can be readily transferred to a study cast for mock surgery.
4. Critical facial skeletal components are examined.
5. For variations in age and sex standards are available.
6. Computerized systematic approach to measurement can be used.

Sella (S)
CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL
1978

Nasion (N) –
CHARLES J BURSTONE,J ORAL SURGERY...VOL
36,APRIL 1978

Articulare (Ar)
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CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978

Pterygomaxillary fissure (PTM)
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10

Subspinale (A) –
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Pogonion (Pog)
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12

Supramentale (B)-
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13

Anterior nasal spine (ANS) –
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14

Menton (Me) –
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15

Gnathion (Gn)
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Posterior Nasal Spine (PNS)
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Mandibular plane (MP) –
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18

Nasal Floor (NF)
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19

Gonion (Go)
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20

7
HP
Horizontal plane
36,APRIL 1978

Hard tissue analysis
 Cranial base
 Horizontal profile
 Vertical height - dental & skeletal
 Maxilla & mandible
 Dental

Cranial base
1. Ar-N (||HP) 2. Ar-Ptm (||HP)

Ar-PTM
Ar-N
Ar-N(||HP)
(in mm)
(F) 50 +3
(M) 52.8 + 4.1
Ar-Ptm(||HP)
(in mm)
(F) 32.8 +1.9
(M) 37.1 + 2.8
Ar-PTM is measured to determine horizontal distance b/w post aspect of maxilla
and mand.. Greater the distance bt Ar-ptm mandible placed post to maxilla

HORIZONTAL PROFILE
1.N-A-Pog(Angle)
2. N-A(|| HP)
3. N-B(|| HP)
4. N-Pog(|| HP)
36,APRIL 1978

N-A-Pog
(F)
2.6° + 5.1°
(M)
3.9° + 6.4°
N
A
Pog
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• Degree of skeletal convexity.

.
N-A(||HP)
(in mm)
(F) -2 + 3.7
(M) 0 + 3.7

.
N-B(||HP)
(in mm)
(F) -6.9 + 4.3
(M) -5.3 + 6.7

.
.
N-Pog(||HP)
(in mm)
(F) -6.5 + 5.1
(M) -4.3 + 8.5

VERTICAL HEIGHT - SKELETAL
Vertical Skeletal
& Dental
Anterior
N-ANS ANS-Gn
posterior
PNS-N MP-HP

HP
ANS
N
N-ANS
( in mm)
(F)
50 + 2.4
(M)
54.7 + 3.2
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HP
Gn
ANS
ANS-Gn
(in mm)
(F)
61.3 + 3.3
(M)
68.6 + 3.8
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HP
PNS
N
PNS-N
(F)
50.6 + 2.2
(M)
53.9 + 1.7
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HP
N
MP-HP angle
(F)
24.2° + 5°
(M)
23.0° + 5.9°
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VERTICAL HEIGHT - DENTAL
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Vertical dental
dysplasia
Ant
U1-NF L1-MP
post
U6-NF L6-MP

HP
NU1-NF
(in mm)
(F)
27.5 + 1.7
(M)
30.5 + 2.1
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HP
Nl1-MP
(in mm)
(F)
40.8 + 1.8
(M)
45.0 + 2.1
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37

HP
N
U6-NF
(in mm)
(F)
23.0 + 1.3
(M)
26.2 + 2.0
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HP
N
L6-MP
(in mm)
(F)
32.1 + 1.9
(M)
35.8 + 2.6
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MAXILLA & MANDIBLE
 PNS-ANS (||HP)
 Ar-Go
 Go-Pog
 B-Pog (||MP)
 Ar-Go-Gn (°)
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HP
N PNS-ANS
(in mm)
(F)
52.6 + 3.5
(M)
57.7 + 2.5
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Ar-Go
(in mm)
(F)
46.8 + 2.5
(M)
52.0 + 4.2
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B-Pog
(in mm)
(F)
7.2 + 1.9
(M)
8.9 + 1.7
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30 March 2016CHARLES J BURSTONE,J ORAL SURGERY...VOL 36,APRIL 1978
44
Ar-Go-Gn
(in °)
(F)
122°+ 6.9°
(M)
119.1° + 6.5°

DENTAL
 OP-HP (angle)
 A-B(||0P)
 U1-NF (angle)
 L1-MP (angle)
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HP
NOP-HP angle
(F) 7.1 + 2.5
(M) 6.2 + 5.1
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47

HP
NA-B(||0P)
(in mm)
(F)
-0.4 + 2.5
(M)
-1.1 + 2
30 March 2016
48

HP
N
U1-NF angle
(F)
112° + 5.3
(M)
111° + 4.7
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49

HP
N
L1-MP angle
(F)
95.9° + 9.7
(M)
95.9° + 5.2
30 March 2016
50

SOFT TISSUE Landmarks used
for the analysis

COLUMELLA
POINT
COLUMELLA POINT

Horizontal analysis of the soft tissue
profile

Facial Form
Angle of convexity
 G to Sn and Sn to Pog
 Mean Value is 12 degree with a
standard deviation of 4 degree

So to define the anterior posterior position
of the jaws two soft tissue measures are
taken.
Sn point to G perp
: 6 +/- 3 mm
Pog’ point to G
perp : 0 +/- 4
mmm

Lower cervicofacial angle
 Formed by the
intersection of Sn –
Gn’ and Gn’ – C lines.
 Mean Value is 100
degree with a SD of 7
degree.
 .

1. Height of the mid third of the face/
height of the lower third ( A / B)

 Height of the lower third of the face increases in :
a) Maxillary vertical over growth
b) Class 3 patients with vertical height increase
c) Skeletal open bites
 Height of the lower third of the face decreases in :
a) Maxillary Vertical undergrowth
b) Mandibular retrusion with deep bite
c) Vertical undergrowth of the chin

Nasolabial Angle
 Formed by the intersection
of lines Cl-Sn and Sn-Ls.
 Mean Value is 102 degree
with a standard deviation of
8 degree.

A-P Lip Position
Line drawn from Subnasale to soft tissue
Pog to Ls 3mm
Line drawn from Subnasale to soft tissue
Pog to Li 2mm

Labiomental sulcus
Sulcus perp to Li-Pog
4 mm normal

MAXILLARY INCISORS
EXPOSURE
2mm is desirable.

INTERLABIAL GAP
Lightly touching to approximately
2mm apart.

CONCLUSION
• A simplified and relevant ceph analysis has been developed that is
applicable to planning tt for pt requiring orthognathic surgeries.
• This analysis evaluates both hard tissue and soft tissue with both
vertical as well as horizontal aspects of the face.
• If a prime pbjective of orthognathic surgery is facial improvement,
soft tissue analysis becomes paramount in treatment planning

Cephalometric Analysis for Orthognathic Surgery

Cephalometric Analysis for Orthognathic Surgery

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