An Atlas on Cephalometric Landmarks

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  • CephalometriC landmarks

    an atlas on

  • CephalometriClandmarks

    JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD

    New Delhi London Philadelphia Panama

    Basavaraj Subhashchandra PhulariBDS MDS (Ortho-TSMA-Russia) FAGE FRSH

    FormerlyFaculty, Department of Orthodontics and

    Dentofacial OrthopedicsMauras College of Dentistry, Hospital and

    Oral Research InstituteRepublic of Mauritius

    an atlas on

  • Jaypee Brothers Medical Publishers (P) Ltd

    Overseas OfficesJ.P. Medical Ltd Jaypee-Highlights Medical Publishers Inc. Jaypee Brothers Medical Publishers, Ltd83 Victoria Street, London City of Knowledge, Bld. 237, Clayton The BourseSW1H 0HW (UK) Panama City, Panama 111 South Independence Mall EastPhone: +44-2031708910 Phone: + 507-301-0496 Suite 835, Philadelphia, PA 19106, USAFax: +02-03-0086180 Fax: + 507-301-0499 Phone: + 267-519-9789Email: info@jpmedpub.com Email: cservice@jphmedical.com Email: joe.rusko@jaypeebrothers.com

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    2013, Jaypee Brothers Medical Publishers

    All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher.

    Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

    This book has been published in good faith that the contents provided by the author contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the author specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the author. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.

    An Atlas on Cephalometric Landmarks

    First Edition: 2013ISBN: 978-93-5090-324-7

    Printed at

    HeadquartersJaypee Brothers Medical Publishers (P) Ltd4838/24, Ansari Road, DaryaganjNew Delhi 110 002, IndiaPhone: +91-11-43574357Fax: +91-11-43574314Email: jaypee@jaypeebrothers.com

  • ToMy dear parents Subhashchandra and Shivalingamma Phulari

    brothers Sangamesh, Jagadish and Manjunathmy beloved wife Dr Rashmi GS

    and my dear sons Yashas and Vrishank

  • Preface

    Cephalometrics has been used in orthodontics for diagnosis, treatment planning, to evaluate the dentofacial changes during treatment and to assess the dentofacial growth and development. Cephalometrics makes use of certain landmarks on the skull. The first important step in cephalometric analysis is accurate location and tracing of cephalometric landmarks on the cephalogram. Any error in tracing the landmarks may result in incorrect cephalometric analysis. This book focuses on understanding the various cephalometric landmarks. Each cephalometric landmark is explained in detail including its abbreviation, definition by various researchers, origin and radiographic anatomy of the landmarks. There are 20 chapters divided into 11 sections. Chapter two lists the different ways of classifying cephalometric landmarks given in the literature. In addition, a new working classification has been given that lists the numerous cephalometric landmarks logically which makes remembering easier. This working classification is used as a blueprint to systemically explain the cephalometric landmarks from chapter 3 through chapter 19. Chapter 20 explains application of all types of cephalometric landmarks in various cephalometric analyses. In addition to the landmarks on lateral cephalogram, the landmarks on the posteroanterior (P-A) cephalogram and submentovertex (S-V) radiographic projection are also dealt in this book. I regret any deficiencies and shortcomings that might have crept in despite my best efforts. I would also welcome comments and suggestions from both students and teachers for further improvement of the book.

    Basavaraj Subhashchandra Phulari basavarajsp@gmail.com

  • Acknowledgments

    I express my heartfelt gratitude to Dr Rajendrasinh Rathore MDS, Chairman of Manubhai Patel Dental College and Hospital, Vadodara, Gujarat for his inspirational support during this endeavor and throughout my career. I also thank Dr Yashraj Rathore, Trustee, Manubhai Patel Dental College and Hospital, Vadodara, Gujarat, India for encouraging me during this project. I am indebted to my dear parents for all their love and sacrifices that have made me what I am. My special thanks are due to my beloved wife for her valuable comments and suggestions, and my dear sons for being the constant source of inspiration to set and reach new goals in life. I would like to thank Anatomage Inc. for providing images in chapter 17 and for the cover. Most of all I thank the Almighty for all His kindness and blessings showered upon me.

  • Section 2: Classification of Cephalometric Landmarks

    Contents

    Section 1: Introduction and History

    1. Cephalometry in Orthodontics ...................................................................................................... 3Technical Aspects 4Cephalometric X-ray Tracing Techniques 4

    2. Classification of Cephalometric Landmarks ................................................................................ 7Classification of Cephalometric Landmarks (Points) 7

    Section 3: Cephalometric Landmarks Related to Cranial Bones

    3. Cephalometric Landmarks Related to Frontal Bone ................................................................. 15Parts of Frontal Bone 15Articulation of Frontal Bone 15Cephalometric Landmarks (Points) on Frontal Bone 15Radiographic Anatomy of Frontal Bone 15

    Nasion 16Supra-Orbitale 17Roof of the Orbital Cavity 17Frontonasal/Fronto maxillary Nasal Suture 18

    4. Cephalometric Landmarks Related to ethmoid bone .............................................................. 21Parts of Ethmoid Bone 21Articulation of Ethmoid Bone 21Cephalometric Landmarks (Points) on Ethmoid Bone 21Temporale 21

    Neck of Crista Galli 23Medio-orbitale 23Sphenoethmoidal Point 24Ethmoidale 24

    5. Cephalometric Landmarks Related to Nasal bone ................................................................... 26Articulation of Frontal Bone 26Radiographic Anatomy of nasal Bone 26Nasion 26

    Frontonasal/Fronto maxillary Nasal Suture 28Rhinion 29

    6. Cephalometric Landmarks Related to Temporal bone ............................................................ 31Articulation of Temporal Bone 31Radiographic Anatomy of Temporal Bone 31Cephalometric Landmarks (Points) on Temporal Bone 31

    Porion 32Zygomatic Arch 32Mastiodale 33

    7. Cephalometric Landmarks Related to Sphenoid bone ............................................................ 35Cephalometric Landmarks (Points) on Sphenoid Bone 35Dorsum of Sella 36Floor of Sella 37Clinoidale 38Spheno-Occipital Synchondrosis 39

    Pterygoid Point 40Sella 41Sella Entrance 41Sphenoethmoidal point 42Pterygomaxillary Fissure 44

  • An Atlas on Ce

    phalometric La

    ndmarks

    xii

    Radiographic Anatomy of Zygomatic Bone 52Cephalometric Landmarks (Points) on Zygomatic Bone 52

    Orbitale 52Temporale 54

    8. Cephalometric Landmarks Related to Occipital bone ............................................................. 46

    9. Cephalometric Landmarks Related to Zygomatic bone ............................................................ 52

    Section 4: Cephalometric Landmarks Related to Facial Bones and Dentition

    Section 5: Cephalometric Landmarks Related to Cervical Bones

    13. Cephalometric Landmarks Related to Hyoid bone ................................................................ 101

    14. Cephalometric Landmarks Related to Vertebrae ........................................................................ 103

    Cephalometric Landmarks (Points) on occipital Bone 46Radiographic Anatomy of Occipital Bone 46basion 46

    Opisthion 48boltons Point 48Spheno-Occipital Synchondrosis 50

    10. Cephalometric Landmarks Related to Maxilla ........................................................................... 59Cephalometric Landmarks (Points) on Maxilla 59Anterior Nasal Spine 59Point A 61Prosthion 62

    Posterior Nasal Spine 64Pterygomaxillary Fissure 65Key Ridge 66Orbitale 67

    11. Cephalometric Landmarks Related to Dentition ........................................................................... 70Incision Superius Incisalis 71Incision Superius Apicalis 73Incision Inferius Incisalis 74Incision Inferius Apicalis 75Anterior Point of Occlusion 76Posterior Point of Occlusion 77

    Maxillary Central Incisor 79Maxillary First Molar 79Mandibular Central Incisor 80Mandibular First Molar 81mi 82ms 83

    12. Cephalometric Landmarks Related to Mandible ........................................................................... 85Cephalometric Landmarks (Points) on Mandible 85Parts of Mandible 85nerve Supply to Mandible 85Articulations 86Infradentale 86Point B 87Pogonion 88

    Gnathion 89dd 91Menton 92Gonion 93Articulare 93kk 94Condylion 95

    Parts of the Hyoid Bone 101Radiographic Anatomy of Hyoid Bone 101

    Cephalometric Landmarks (Points) on Hyoid Bone 101Hyoid 101

    Radiographic Anatomy of Cervical vertebrae 103Cephalometric Landmarks on Cervical vertebra 103Cephalometric Landmarks (Points) Related to Cervical vertebra 103

    cv2ip 104cv2ap 104cv2ia