Analisis de Vomer Basilli

7/25/2019 Analisis de Vomer Basilli

1/14

J. Stomat. Occ. Med. (2009) 2: 191204

DOI 10.1007/s12548-009-0032-x

Printed in Austria

Springer-Verlag 2009

Three-dimensional CT analysis of vomer bonein the architecture of craniofacial structures in caucasichuman skulls

Cristian Basili1;2, Takero Otsuka3, Mitsuyoshi Kubota4, Rudolf Slavicek5, Sadao Sato6

1Postgraduate Research Fellow, Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics,

Kanagawa Dental College, Yokosuka, Japan2

Department of Pediatric and Preventive Dentistry, Universidad de Valparaiso, Valparaiso, Chile3Post-Doctoral Researcher, Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics,

Kanagawa Dental College, Yokosuka, Japan4Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics, Kanagawa Dental College,

Yokosuka, Japan5Course Director of Dental Science, Danube-University, Krems, Austria6Department of Craniofacial Growth and Development Dentistry, Research Institute of Occlusion Medicine,

Research Center of Brain and Oral Science Division of Orthodontics, Kanagawa Dental College, Yokosuka, Japan

Received July 7, 2009; Accepted September 28, 2009

Introduction:The craniofacial architecture is the result of avery complex interrelation. The nasal septum and speciallyvomer bone, because of its strategic spatial location between

the cranial base and the mid-face, inuence the growth of thisarea of the facial skeleton, thus playing a major role in the

organization of the craniofacial architecture. The purpose wasto analyze the inuence of vomer bone on the morphology ofthe craniofacial architecture, evaluate its correlation withdifferent structures, and compare the spatial position anddimensions between dentoskeletal frames.

Method: 3D cephalometric measurements were ana-lyzed and correlated in 302 digitally reconstructed skulls by3D CBCT of a caucasic European adult population.

Results:Changes inthe inclinationand thedimensions ofvomer bone were strongly correlated with other craniofacial

structures. There were signicant variations in vomer bonebetween the different dentoskeletal frames.

Conclusions:Vomer bone seems to play an important

role in the interrelation of the craniofacial architecture.

Keywords: Vomer, cranial base, maxilla, occlusal plane,posterior occlusal plane, skull, 3D CBCT

Introduction

The craniofacial architecture is the result of a very complexinterrelation between different structures, which variesamong individuals. Some theories have been developed to

represent these dynamic relations emphasizing on the articu-lar mobility of the cranium and the interaction between thedifferent craniofacial structures. Among these theories, Dr.

Sadao Sato emphasizes the importance of synchondrosesbetween the bones, which allows them to be situated withina exible or moving structure when pressure or tension isexerted on craniofacial structures. These synchondroses per-mit slight relative movements called articular mobility of thecranium [30]. This mobility between the structures is impor-

tant during growthand development of the mid-face, becauseof the varying relation between different bone structures,muscles, and functional inuences that modulate the expres-sion of the morphological skeletal patterns. In this interrela-tion, the nasal septum especially vomer bone, because of itsspatial location between the cranial base and the mid-face,shape and the anatomical relation to important structures,serves as an important structure that inuences the growth ofthis areaof the facial skeleton. Therefore, it could playa major

role in the organization of the craniofacial architecture.Some researchers have partially described the role of

vomer bone in the development of the maxillary complex as apossible inuencing factorin theloweringof thehardpalateorin the distribution of masticatory forces to the cranial base. Atthe same time, some approaches for the development of theanterior portion of the maxilla [3, 7, 11, 14, 21], and someinuence on the evolution of patients with cleft palate havebeen described [8, 10, 17]. However, its inuence on themorphology of the craniofacial architecture still remainsunclear.

Most of the information from previous studies aboutcraniofacial interrelations was obtained from 2D cephalomet-ric images, with limitation in the identication of this struc-ture. Nowadays, the development of the Cone beam

Correspondence: Cristian Basili, Department of Craniofacial Growthand Development Dentistry, Division of Orthodontics, Kanagawa DentalCollege, 82 Inaoka-cho, Yokosuka 238-8580, Japan.E-mail: [email protected]

original article

J. Stomat. Occ. Med. Springer-Verlag Three-dimensional CT analysis of vomer bone 4/2009 191


2/14

Tab. 1: Denition of anatomic landmarks for 3-dimensional computed tomography

Landmark Abbreviation Denition on CT image

Nasion N Nasofrontal structure in the midline

Sella S Center of the pituitary fossa

Basion Ba Anterior-inferior margin of the foramen magnum

Upper vomer UV The most anterior point of the vomer bone base

Lower vomer LV The midpoint in the posterior surface of the vomer bone base

Anterior nasal spine ANS Central point of the anterior nasal spine

Posterior nasal spine PNS The most posterior point of the palate in the medial plane

A point A The deepest point of the midline maxillar frontal surface

Right tuberosity TubR The midpoint of the junction between right sphenoid pterigoid processus

and maxilla tuberosity

Left tuberosity TubL The midpoint of the junction between left sphenoid pterigoid processus

and maxilla tuberosity

Tuberosity medial TubMed Computerized 3D middle point between tuberosity left and right la ndmarks

Right canine 3R Tip of the cusp of the right canine

Left canine 3L Tip of the cusp of the left canine

Right 2nd premolar 5R Tip of the bucal cusp of the second right premolar

Left 2nd premolar 5L Tip of the bucal cusp of the second left premolar

2nd premolar mean Premed Computerized 3D mean point between right and left second premolars

Right 1st molar 6R Bucal area of the contact point between right rst molar and right second premolar

Left 1st molar 6L Bucal area of the contact point between left rst molar and left second premolar

Right 2nd molar 7R Tip of the disto-bucal cusp of the right second molar

Left 2nd molar 7L Tip of the disto-bucal cusp of the left second molar

B point B The deepest point of the mid mandibular frontal surface

Menton Me The lowest border of the mid mandibular suture

Tangent gonion right TGoR The lowest point in the distal right portion of the mandible

Tangent gonion left TGoL The lowest point in the distal left portion of the mandible

Upper interincisor point UII The most incisal point between the two upper central Incisors

Fig. 1: 3D Landmarks. Frontal and lateral images of the 3D virtual model of the skull with the cephalometric landmarks. 1. Nasion; 2. Sella;3. Basion; 4. Upper vomer; 5. Lower vomer; 6. Anterior nasal spine; 7. Posterior nasal spine; 8. A point; 9. Right tuberosity; 10. Left tuberosity;11. Tuberosity medial; 12. Right canine; 13. Left canine; 14. Right 2nd premolar; 15. Left 2nd premolar; 16. Right 1st molar; 17. Left 1st molar;18. Right 2nd molar; 19. Left 2nd molar; 20. B point; 21. Menton; 22. Tangent gonion right; 23. Tangent gonion left; 24. Interincisor point;25. Median second premolar

original article

192 4/2009 Three-dimensional CT analysis of vomer bone Springer-Verlag J. Stomat. Occ. Med.


3/14

computed tomography systems and its applications in cra-niofacial diagnosis provide new alternatives to evaluate themorphology of the craniofacial skeleton in a three-dimension-al way with great accuracy [1, 19, 20, 23, 24, 33].

The purpose of this study was to analyze the inuence ofvomer bone on the morphology of the craniofacial architec-ture, evaluate its correlation with different structures, andcompare the spatial position and dimensions between den-toskeletal frames in 3D digitally reconstructed skulls of acaucasic European adult population.

Material and methods

This Research Protocol was approved by the Natural HistoryMuseum Vienna, Donau University and Kanagawa Dental

College Research Committee. The samples included 322caucasic European adult dry skulls, randomly selected fromthe Weissbach Collection of the Natural History MuseumVienna. Augustine Weissbach was a physician in charge of amilitary hospital in Constantinople and he foresaw the ben-ets of preserving the skulls of soldiers in the Imperial Army,who were killed or died circa 1870. There were about 850skulls in the original collection donated in 1885 to theanthropology division of the Natural History Museum ofVienna. Although no complete documentation about demo-graphic information is available, the skulls are mainly ofmales, and the age at the time of death, ranges from 19 to 50years.

The sample was selected on the basis of the followingcriteria: 1. no evident cranial deformity 2. complete skull bone

structure, and 3. the presence of a stable and reproduciblemandible position. A group of orthodontists checked theocclusion to conrm the stability and reproducibility. A sili-cone plaster was placed in the joint space to ll the areabetween glenoid fossa and the condylar head, with the man-dible in maximun intercuspation, to improve the stability ofthelower jaw. A customplastic headholder wasconstructedtosupport the skulls during imaging and was placed with a lasermarker. Cone Beam Computerized Tomography (CBCT)scans were acquired with the Galileo Compact (Sirona DentalSystemGmbH,Germany)at 220V, frequency of 50/60 Hz witha total ltration of X-ray tube assembly >2.5 Al. The Cone-beam angle is collimated to approximately 24 and has an

orbital angle of 204. Thescanning time was approximately 14seconds and 200 single exposures were performed for each

skull with a eld of view of 15 cm diameter15 cm height.Since the samples did not have a soft-tissue component,exposure parameters were controlled by automatic exposurecontrol. The CBCT data were exported from the SIDEXIS XGsoftware (Sirona Dental System GmbH, Germany) in DICOMmultile format andimportedinto MAXILIM software version2.2.0 (MEDICIM, Mechelen, Belgium).

The models were obtained and reevaluated by a single-calibrated operator (CB). These 3D reconstructed skulls mod-els were re-analyzed on the basis of the following criteria 1.Available Nasion Landmark, 2. Available Sella Landmark, and3. Presence of Skeletal basic structures. 20 skulls were elimi-nated from the sample, because of the unavailable well-dened Nasion (19 skulls) or Sella (1 skull) landmarks. 3Dmeasurements were undertaken in stages. The 3D cephalo-

metric analysis was designed with 25 different landmarks(Table 1, Fig. 1) on the skulls. Computerized generation ofeight 3D Planes was dened (Table 2, Fig. 2) and established.The cephalometric landmarks were located and marked on

Tab. 2: Denition of 3D planes used in the

analysis

Plane Abbreviation Denition

Horizontal

plane

HP Automatically computed plane

6 below SN along the hori-

zontal direction of the

natural head position

Vertical plane VP Plane through sella and

perpendicular to the horizontal

plane and sagital planeSagital plane SP Plane through sella and nasion

and perpendicular to the

horizontal plane

Sella nasion

plane

SN Plane through S-N line,

perpendicular to sagital plane

Palatal plane PP Plane through ANS-PNS line,

perpendicular to sagital plane

Anterior

occlusal plane

AOP Plane dened by 3 landmarks:

upper Interincisor point, right

and left second premolar

Posterior

occlusal plane

POP Plane dened by 3 landmarks:

medial second premolar, left

and right second molar

Mandibular

plane

MP Plane dened by 3 landmarks:

menton, right and left tangent

gonion

Fig. 2: Graphicrepresentation of the 3D planes. Constructed3D planesare shown in red. Reference planes are represented in blue. 1. Sellanasion plane (SN); 2. Horizontal plane (HP); 3. Palatal plane (PP);4. Anterior occlusal plane (AOP); 5. Posterior occlusal plane (POP);6. Mandibular plane (MP); 7. Vertical plane (VP); 8. Sagital plane (SP)

original article



4/14

the skulls using an optical mouse in a 69 cm (27 inch) LCD

Display Monitor (Dell, USA). Finally, 24 angular (Table 3) and37 linear 3D cephalometric measurements (Table 4, Figs. 3and 4) previously designed were obtained in the MaxilimSoftware. All the cephalometric images of the 302 skulls, weredeveloped by a single-calibrated operator.

The Maxilim Software can export the measurement datato Excel les, therefore all the angular and linear 3D cephalo-metric measurement data were exported with the originalskull identication number. After this stage, Excel les wereexported to SPSS software version 15 for the statistic analysis.

The samples were classied according to the dentoske-letal frame groups, into Class I, Class II, and Class III based inthe antero-posterior dysplasia indicator (APDI)[16], followingthis criteria: Class II< 81.37 3.79 (Class I)


5/14

(Dvo-SN, Svo-SN, and Bvo-SN) showed a signicant positivecorrelation (p< 0.01), which means that extension of thecranial base is correlated to a downward inclination of vomerbone. At the same time, in the analysis of the linear measure-

ments of thecranial baseand most of themeasurements of theinclination of vomer bone, we noted a negative correlation ofthe anterior and posterior cranial base dimensions with theN-Ba distance. This shows that a bigger dimension of the

Tab. 4: Denition of the 3D linear measurements in the analysis

Linear measurement Abbreviation Denition

ANS-PNS ANS-PNS Distance between landmarks ANS and PNS

N-Ba N-Ba Distance between landmarks N and Ba

S-Me S-Me Distance between landmarks S and Me

Anterior cranial base Ant Cr Base Distance between landmarks S and N

Sagital maxilla Max Dist Distance between landmarks ANS and TubMed

Lower anterior facial height Fv (L) Distance between landmarks ANS and Me

Upper anterior facial height Fv (S) Distance between landmarks N and ANS

Total facial height Fv (T) Distance between landmarks N and Me

Posterior cranial base Post Cr Base Distance between landmarks Ba and S

Vomer diagonal distance Vo Diag Distance between landmarks LV and ANS

Vomer posterior distance Vo Post Distance between landmarks LV and PNS

Vomer superior distance Vo Sup Distance between landmarks UV and ANS

Media second premolar-SN 5-SN Distance from landmark Premed to SN plane

A-VP A-VP Distance from landmark A point to vertical Plane

ANS-VP ANS-VP Distance from landmark ANS to vertical Plane

B-VP B-VP Distance from landmark B point to vertical plane

Me-VP Me-VP Distance from landmark Me to vertical plane

N-VP N-VP Distance from landmark N to vertical plane

Inter second mo la r Int 7 on PP Distance between pro jections of landmar ks 7R and 7L on the pala tal plane

Inter second premolar Int 5 on PP Distance between pro jections of landmar ks 5R and 5L on the pala tal plane

Intertuberosity Int Tub Distance between projections of landmarks TubR and TubL on the palatal plane

UV-ANS Up Vo-ANS on VP Distance between projections of landmarks UV and ANS on the vertical plane

UV-PNS Up Vo-PNS on VP Distance between projections of landmarks UV and PNS on the vertical plane

Left anterior maxilla A-6 Lt on PP Distance between pro jections of landmark s A a nd 6L on the palatal plane

Right anterior maxilla A-6 Rt on PP Distance between pro jections of landmark s A a nd 6R on the palatal plane

Inter rst molar Int 6 on PP Distance between projections of landmarks 6R and 6L on the palatal plane

Intercanine Int 3 on PP Distance between projections of landmarks 3R and 3L on the palatal plane

Lef t p oster ior maxil la Max Post Lt on PP Distan ce between project ions of lan dmarks 6 L and Tu bL on the palatal plan e

Right posterior maxil la Max Post Rt on PP Distance between projections of landmarks 6R and TubR on the palatal plane

Lef t tub erosi ty-A on PP Tub Lt-A on PP Distan ce between project ions of lan dmarks A and TubL on the palatal plan e

Righ t tuberosi ty-A on P P Tub Rt-A on PP Distan ce between project ions of lan dmarks A and TubR on the palatal plane

Posterior lower height of vomer bone Vo Post Lo on VP Distance between projections of landmarks LV and PNS on the vertical plane

Postero-superior vomer bone Vo Post Up on HP Distance between projections of landmarks LV and UV on the horizontal plane

Posterior upper height of vomer bone Vo Post Up on VP Distance between projections of landmarks UV and LV on the vertical plane

Antero-superior vomer bone Vo Ant Up on HP Distance between projections of landmarks UV and ANS on the horizontal plane

Average a nterior maxilla Aver A-6 on PP Average between A-6Lt on PP and A-6Rt on PP

Average posterior maxilla Aver Max Post on PP Average between Max Post Lt on PP and Max. Post Rt on PP

Average tuberosity-A on PP Aver Tub-A on PP Average between TubLt-A on PP and TubRt-A on PP

original article



6/14

anterior or posterior cranial base length is correlated with lessinclination of vomer bone. Only the base of the vomer (Bvo-SN) showed different results having only signicant negativecorrelation with theposterior cranialbase length. Onthe otherhand, in vomer bone dimensions, there was no correlationwith the diagonal length (Vo Diag) and the cranial base angle,and the posterior dimension of vomer bone (Vo Post) showednegative correlation. At the same time, the projected mea-surements of the height of vomer bone in the vertical plane,anterior and posterior lines, UV-ANS on VP show a positivecorrelation and UV-PNS on VP a negative correlation withcranial base.

Vomer bone and maxilla

The inclination of vomer bone (Dvo-SN) is directly related to asimilar rotation of the maxilla, as the Palatal Plane presents a

positive correlation. At the same time, a negative correlationwith SNA and SNB was shown, which means that a higherinclination of vomer bone is correlated with posteriorpositionof the jaws, or a retrusive position tendency.

Theinclinationof vomer bone measured by Dvo-SN, Svo-SN,andBvo-SN,hadasignicant negative correlationwith thesagittal measurement of the maxilla (Max Dist). The angle ofthe posterior vomer (Pvo-SN) showed a positive correlationwith the sagittal maxilla dimension (ANS-PNS) that indicateschanges in the shape of the posterior part of the bone inrelation to the maxilla changes. At the same time, analyzingthe proportions in the maxilla and the inclination of vomerbone (Dvo-SN), we observed a negative correlation with theanterior dimension of the maxilla (Aver A-6 on PP), and nocorrelation with theposterior(AverMax Post on PP), although

there is a negative tendency.On the other hand, a signicant negative correlation was

found between some transversal dimensions of the maxilla(Int 7 on PP, Int 6 on PP) and the inclination of vomer bone(Dvo-SN). However a negative tendency in all the othertransversal measurements is appreciated (Int 5 on PP, Int 3on PP, Int Tub).

The diagonal length of the vomer showed a negativecorrelation with the angular inclinations, this could be relatedto thecorrelationwiththe sagitalsize of themaxilla. There wasa positive relation with ANB. If there is a class II tendency,vomer bone is bigger, and the same happens with the dimen-sion of the maxilla. The posterior vomer dimension (Vo Post)showeda negative correlation with thepalatal plane;when itismore inclined the posterior dimension is smaller. At the same

Fig. 3: Lateral image of virtual skull representing 3D linear sagital andvertical measurements, calculating the distance from the different land-marks to the Vertical (VP), Horizontal (HP) or SN Planes. 1. ANS-PNS; 2.N-Ba; 3. S-Me; 4. Ant Cr Base; 5. Max Dist; 6. Fv(L); 7. Fv(S); 8. Fv(T); 9.Post CrBase; 10.Vodiag; 11.Vopost; 12.Vosup;13.5-SN; 14.A-VP;15.

ANS-VP; 16. B-VP; 17. Me-VP; 18. N-VP; 19. Up Vo-ANS on VP; 20. UpVo-PNS on VP; 21. Vo Post Lo on VP; 22. Vo Post Up on VP; 23. Vo PostUp on HP; 24. Vo Ant Up on HP

Fig. 4: Image of the 3D linear transversal measurements between land-marks, projected on the Palatal Plane (red color) to avoid verticalvariations. 1. Inter canine (Int 3 on PP); 2. Inter second premolars (Int5 onPP); 3.Interrstmolars (Int 6 onPP);4. Intersecond molars(Int7 onPP); 5.Intertuberosity(Int Tub); 6. Anteriorrightmaxilla (A-6 Rton PP); 7.

Anterior left maxilla (A-6 Lt on PP); 8. Posterior right maxilla (Max post Rt

onPP);9. Posteriorleftmaxilla (Max post Lt onPP); 10.Right tuberosity-A point (Tub Rt-A on PP); 11. Left tuberosity-A point (Tub Lt-A on PP)

Fig. 5: Lateral representation of the constructed vomer bone. Thedifference in the anterior extension with the anatomical vomer bone hasto be considered in theanalysisof theresults,as a portion of themaxillais included. 1. Lower vomer landmark (LV); 2. Upper vomer landmark(UV); 3. Anterior nasal spine (ANS); 4. Posterior nasal spine (PNS);5. Posterior vomer (Pvo); 6. Vomer base (Bvo); 7. Superior vomer (Svo);8. Palatal plane (PP); 9. Diagonal vomer (Dvo)

original article



7/14

Tab. 5: Descriptive statistic of the different parameters

Measurements N Mean S.D. Min. Max.

Angular measurements

CrBase 302 131.0 5.4 115 147.4

AOP-POP 101 7.9 4.0 1.2 18.4

AOP-SN 113 12.7 4.6 3.1 25

POP-SN 138 19.9 4.2 6.6 29.9

Dvo-SN 302 23.0 3.0 14.5 32.1

MP-AB 302 75.9 5.7 55.7 89.8

PP-AB 302 82.6 5.5 70.2 107.5

SN-MP 302 27.5 5.7 11.7 43.1

Bvo-SN 302 158.3 5.7 140.5 173.6

Pvo-SN 302 57.0 6.5 40.5 77.8

Svo-SN 302 38.3 3.6 25.3 47.9

ANB 302 3.0 2.8 6.1 9.1

ANS-S-Me 302 30.5 3.0 20.8 39.5

NSMe 302 68.2 3.5 58.3 78

SNA 302 83.1 4.1 72.2 92.7

SNB 302 80.1 3.6 70.8 92.2

SN-PP 302 7.1 3.5 4.6 15.7

Linear measurements

ANS-PNS 302 51.1 3.2 41.3 60.9

N-Ba 302 101.5 4.4 89.1 112.9

S-Me 302 121.6 5.9 103 134.7

Ant Cr Base 302 67.9 3.6 57.2 77.9

Max Dist 302 52.5 2.9 45.2 63

Fv(L) 302 66.0 5.8 46.9 79.7

Fv(S) 302 50.0 2.7 38.9 55.9

Fv(T) 302 115.1 6.1 90.5 126.4

Post Cr Base 302 43.2 2.8 30.9 51

Vo Diag 302 70.0 3.7 59.5 79.5

Vo Post 302 25.4 3.0 17.8 35.9

Vo Sup 302 56.9 3.4 47.6 65.7

5-SN 137 72.5 3.1 57.5 78.8

A-VP 302 66.6 4.7 52.6 79

ANS-VP 302 69.2 4.4 55.1 81.6

B-VP 302 61.1 6.5 42.5 80.2

Me-VP 302 56.7 7.5 34.8 77.9

N-VP 302 67.6 3.5 56.9 77.4

Int 7 on PP 239 62.2 4.4 50.4 79.1

Int 5 on PP 136 51.3 3.1 40.8 60.8

Int Tub 302 43.2 3.0 34.6 49.7

(Continued)

original article



8/14

Tab. 6: Correlation of craniofacial morphology between vomer angular measurements and the different

parameters

Measurement N Dvo-SN Bvo-SN Pvo-SN Svo-SN

Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif.

CrBase 302 0.326 0.000 0.279 0.000 0.078 NS 0.177 0.316 0.000

AOP-POP 110 0.153 NS 0.127 0.051 NS 0.611 0.164 NS 0.102 0.127 NS 0.207

AOP-SN 122 0.440 0.000 0.037 NS 0.696 0.328 0.000 0.413 0.000

POP-SN 168 0.365 0.000 0.072 NS 0.402 0.205 0.016 0.360 0.000

Dvo-SN 302 0.345 0.000 0.504 0.000 0.778 0.000

MP-AB 302 0.037 NS 0.527 0.017 NS 0.466 0.082 NS 0.155 0.004 NS 0.944

PP-AB 302 0.182 0.001 0.010 NS 0.820 0.143 0.013 0.167 0.004

SN-MP 302 0.235 0.000 0.143 0.050 0.184 0.001 0.166 0.004

Bvo-SN 302 0.345 0.000 0.026 NS 0.654 0.033 NS 0.572

Pvo-SN 302 0.504 0.000 0.026 NS 0.654 0.427 0.000

Svo-SN 302 0.778 0.000 0.033 NS 0.572 0.427 0.000

ANB 302 0.115 0.045 0.051 NS 0.381 0.137 0.017 0.202 0.000

ANS-Sme 302 0.200 0.000 0.029 NS 0.614 0.051 NS 0.379 0.191 0.001

NSMe 302 0.376

0.000 0.201

0.000 0.325

0.000 0.333

0.000SNA 302 0.431 0.000 0.171 0.003 0.327 0.000 0.514 0.000

SNB 302 0.391 0.000 0.218 0.000 0.262 0.000 0.423 0.000

SN-PP 302 0.607 0.000 0.260 0.000 0.095 NS 0.099 0.545 0.000

ANSPNS 302 0.272 0.000 0.052 NS 0.366 0.114 0.047 0.260 0.000

N-Ba 302 0.199 0.001 0.011 NS 0.844 0.251 0.000 0.145 0.012

S-Me 302 0.239 0.000 0.145 0.012 0.098 NS 0.090 0.309 0.000

Ant Cr Base 302 0.211 0.000 0.038 NS 0.513 0.239 0.000 0.191 0.001

Max Dist 302 0.275 0.000 0.006 NS 0.921 0.153 0.008 0.351 0.000

Fv(L) 302 0.269 0.000 0.063 NS 0.276 0.023 NS 0.692 0.296 0.000

(Continued)

Tab. 5: Continued

Measurements N Mean S.D. Min. Max.

Up Vo-ANS on VP 302 30.4 3.1 19.4 40.3

Up Vo-PNS on VP 302 29.6 2.9 20.1 37.7

Int 6 on PP 245 53.3 3.9 38.8 63.6

Int 3 on PP 152 36.1 2.8 25.7 42

Vo Post Lo on VP 302 19.6 2.8 11.6 27.8

Vo Post Up o n HP 302 19.0 2.6 11.9 27.3

Vo Post Up o n VP 302 10.1 2.2 5.2 17.8

Vo Ant Up on HP 302 48.0 3.8 35.5 60.6

Aver A-6 on PP 288 34.0 2.2 27.65 41.9

Aver Max Post on PP 288 29.2 3.3 17.5 52.55

Aver Tub-A on PP 302 54.2 2.8 47.3 62.8

original article



9/14

time, the posterior height (UV-PNS on VP) showed a signi-cant negative correlation, but the anterior height (UV-ANS onVP) showed a positive one, in relation to the spatial andstructural variation.

Vomer bone and face height

In relation to facial height dimension and the inclination ofvomer bone (Dvo-SN), there was a negative correlation withthe lower dimension (Fv(L) and a positive with the upperheight (Fv(S)) in the 4 measurements (Dvo-SN, Pvo-SN, Svo-SN, and Bvo-SN), this means that if we have a higher inclina-tion of vomer bone, it is associated specially with an increasein the upper height of the face. At the same time, it showed adecrease in the lower dimension. Despite these inuences,there was no correlation between vomer inclination and thetotal face height.

The angle ANS-S-Me had a negative correlation withDvo-SN and Svo-SN, and no correlation with the base orposterior vomer. As vomer bone rotates downward, this isrelated to the rotation of the maxilla, which makes the ANSpoint to also rotate downwards. This inuence seems to behigher in the maxilla than in the lower structures. All facialsagital dimensions had negative correlation with the inclina-tion of vomer bone (Dvo-SN), this representsthat a downwardinclination,showssmaller dimensions of A, ANS, B, N, andMeto the vertical plane.

Vomer bone and occlusal planes

The downward inclination of vomer bone (Dvo-SN) isrelated to a similar inclination of the Posterior and AnteriorOcclusal Plane (POP-SN and AOP-SN), which can beunderstood as the inclination of the complete maxillary

Tab. 6: Continued

Measurement N Dvo-SN Bvo-SN Pvo-SN Svo-SN

Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif.

Fv(S) 302 0.631 0.000 0.175 0.002 0.191 0.001 0.474 0.000

Fv(T) 302 0.036 NS 0.432 0.019 NS 0.737 0.110 0.056 0.050 NS 0.386

Post Cr Base 302 0.347 0.000 0.166 0.004 0.191 0.001 0.261 0.000

Vo Diag 302 0.210 0.000 0.185 0.001 0.441 0.000 0.345 0.000

Vo Post 302 0.127 0.027 0.224 0.000 0.118 0.041 0.119 0.039

Vo Sup 302 0.045 NS 0.225 0.271 0.000 0.201 0.000 0.262 0.000

5-SN 154 0.039 NS 0.368 0.003 NS 0.975 0.018 NS 0.836 0.038 NS 0.656

A-VP 302 0.515 0.000 0.174 0.002 0.447 0.000 0.567 0.000

ANS-VP 302 0.516 0.000 0.204 0.000 0.368 0.000 0.561 0.000

B-VP 302 0.471 0.000 0.221 0.000 0.368 0.000 0.487 0.000

Me-VP 302 0.417 0.000 0.230 0.000 0.319 0.000 0.407 0.000

N-VP 302 0.210 0.002 0.037 NS 0.517 0.237 0.002 0.191 0.002

Int 7 on PP 240 0.129 0.046 0.061 NS 0.347 0.123 NS 0.057 0.158 0.014

Int 5 on PP 154 0.118 NS 0.172 0.009 NS 0.917 0.258 0.002 0.111 NS 0.200

Int Tub 302 0.086 NS 0.136 0.038 NS 0.507 0.121 0.035 0.095 NS 0.099

Up Vo-ANS on VP 302 0.728 0.000 0.109 NS 0.059 0.287 0.000 0.812 0.000

Up Vo-PNS on VP 302 0.085 NS 0.142 0.423 0.000 0.395 0.000 0.239 0.000

Aver A-6 on PP 288 0.236 0.000 0.035 NS 0.553 0.078 NS 0.188 0.206 0.000

Int 6 on PP 252 0.220 0.001 0.001 NS 0.990 0.255 0.000 0.215 0.001

Int 3 on PP 161 0.105 NS 0.200 0.112 NS 0.168 0.106 NS 0.193 0.193 0.017

Aver Max Post on PP 288 0.083 NS 0.158 0.160 NS 0.073 0.354 0.000 0.199 0.001

Aver Tub -A on PP 302 0.261 0.000 0.064 NS 0.267 0.312 0.000 0.362 0.000

Vo Post Lo on VP 302 0.436 0.000 0.179 0.002 0.547 0.000 0.177 0.002

Vo Post Up on HP 302 0.087 NS 0.446 0.470 0.000 0.286 0.000 0.219 0.000

Vo Post Up on VP 302 0.426 0.000 0.742 0.000 0.164 0.004 0.084 NS 0.147

Vo Ant Up on HP 302 0.420 0.000 0.217 0.000 0.360 0.000 0.694 0.000

Cor. CoCorrelation Coefcient.NSnot signicant. Statistical signicance at level 0.05. Statistical signicance at level 0.01

original article



10/14

Tab. 7: Correlation of craniofacial morphology between vomer Linear Measures and the different

parametersMeasurement N Vo Diag Vo Post Vo Sup UV-ANS on VP UV-PNS on VP

Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif.

Cr Base 302 0.010 NS 0.886 0.116 0.043 0.097 NS 0.091 0.265 0.000 0.157 0.006

AOP-POP 110 0.089 NS 0.376 0.008 NS 0.939 0.023 NS 0.817 0.130 NS 0.194 0.103 NS 0.306

AOP-SN 122 0.220 0.019 0.193 0.041 0.086 NS 0.365 0.329 0.000 0.037 NS 0.699

POP-SN 168 0.218 0.010 0.142 NS 0.096 0.169 0.048 0.240 0.005 0.072 NS 0.404

DVoSN 302 0.210 0.000 0.127 0.027 0.045 NS 0.433 0.728 0.000 0.085 NS 0.142

MP-AB 302 0.126 0.029 0.139 0.016 0.060 NS 0.295 0.028 NS 0.623 0.129 0.025

PP-AB 302 0.027 NS 0.642 0.053 NS 0.360 0.032 NS 0.584 0.190 0.001 0.131 0.023

SN-MP 302 0.101 NS 0.079 0.014 NS 0.803 0.094 NS 0.104 0.099 NS 0.085 0.041 NS 0.480

Bvo-SN 302 0.185 0.001 0.224 0.000 0.271 0.000 0.109 NS 0.059 0.423 0.000

Pvo-SN 302 0.441 0.000 0.118 0.041 0.201 0.000 0.287 0.000 0.395 0.000

Svo-SN 302 0.345 0.000 0.119 0.039 0.262 0.000 0.812 0.000 0.239 0.000

ANB 302 0.242 0.000 0. 037 NS 0. 517 0.191 0.001 0.097 NS 0.094 0.169 0.003

ANS-Sme 302 0.006 NS 0.914 0.092 NS 0.112 0.081 NS 0.163 0.247 0.000 0.074 NS 0.198

NSMe 302 0.220 0.000 0.135 0.019 0.225 0.000 0.178 0.002 0.086 NS 0.137

SNA 302 0.338 0.000 0.193 0.001 0.363 0.000 0.299 0.000 0.021 NS 0.714

SNB 302 0.192 0.001 0.239 0.000 0.253 0.000 0.262 0.000 0.145 0.012

SN-PP 302 0.037 NS 0.520 0.353 0.000 0.035 NS 0.549 0.554 0.000 0.482 0.000

ANSPNS 302 0.612 0.000 0.237 0.001 0.489 0.000 0.032 NS 0.582 0.028 NS 0.062

N-Ba 302 0.513 0.000 0.040 NS 0.487 0.362 0.000 0.087 NS 0.130 0.021 NS 0.711

S-Me 302 0.421 0.000 0.369 0.000 0.454 0.000 0.051 NS 0.380 0.322 0.000

Ant Cr Base 302 0.514 0.000 0.162 0.005 0.410 0.000 0.064 NS 0.266 0.123 0.033

Max Dist 302 0.759 0.000 0.153 0.008 0.642 0.000 0.037 NS 0.520 0.122 0.034

Fv(L) 302 0.149 0.009 0.159 0.006 0.117 0.042 0.242 0.000 0.152 0.008

Fv(S) 302 0.331 0.000 0.161 0.05 0.416 0.000 0.703 0.000 0.135 0.019

Fv(T) 302 0.252 0.000 0.224 0.000 0.260 0.000 0.083 NS 0.150 0.210 0.000

Post Cr Base 302 0.210 0.000 0. 056 NS 0.333 0.168 0.003 0.154 0.007 0.004 NS 0.939

Vo Diag 302 0.438 0.000 0.775 0.000 0.122 0.034 0.093 NS 0.107

Vo Post 302 0.438 0.000 0.414 0.000 0.127 0.028 0.539 0.000

Vo Sup 302 0.775 0.000 0.414 0.000 0.330 0.000 0.329 0.000

5-SN 154 0.301 0.000 0.294 0.000 0.317 0.000 0.120 NS 0.163 0.233 0.006

A-VP 302 0.664 0.000 0.279 0.000 0.608 0.000 0.197 0.001 0.112 NS 0.052

ANS-VP 302 0.732 0.000 0.252 0.000 0.683 0.000 0.145 0.011 0.169 0.003

B-VP 302 0.447 0.000 0.300 0.000 0.447 0.000 0.206 0.000 0.194 0.001

Me-VP 302 0.355 0.000 0.259 0.000 0.372 0.000 0.172 0.003 0.198 0.001

N-VP 302 0.515 0.000 0.163 0.004 0.411 0.000 0.065 NS 0.262 0.124 0.031

Int 7 on PP 240 0.201 0.002 0.055 NS 0.401 0.126 NS 0.052 0.075 NS 0.247 0.028 NS 0.664

Int 5 on PP 154 0.263 0.001 0.078 NS 0.367 0.296 0.000 0.072 NS 0.403 0.011 NS 0.901

Int Tub 302 0.248 0.000 0.130 0.024 0.180 0.002 0.020 NS 0.733 0.071 NS 0.216

U V-ANS on VP 302 0.122 0.034 0.127 0.028 0.330 0.000 0.433 0.000

(Continued)

original article



11/14

bone. But this inclination of vomer bone was not correlatedwith the angle between the two occlusal planes (AOP-POP). On the other hand, there was no signicant correla-tion between the height of the occlusal plane to SN plane,and the inclination of vomer bone.

Vomer bone and mandibular plane

Three of the angular measurements (Dvo, Svo, and Bvo) were

positively correlated with the mandibular plane inclination.On the other hand, there is no correlation between the MP-ABand the inclination of vomer bone.

Vomer bone

All the angles of vomer bone had a positive correlationbetween them, which reects a bodily rotation; only the baseof the vomer had a slightly different or less correlation. Theinclination of vomerbone (Dvo-SN) had a negative correlationwith the diagonal length of itself (Vo Diag).

There is a positive correlation with the vertical dimen-sion of the vomer height to ANS (UV-ANS on VP) as theinclination of the vomer is increasing and positive or nocorrelation with the height to PNS (UV-PNS on VP) with the

different variables.The spatial measurement of vomer bone in relation to

horizontal and vertical plane was correlated with a bodilyrotation of the bone itself. In the vertical plane, the inclinationof vomer bone (Dvo-SN) showed a positive correlation withthe projected lower height (Vo Post Lo on Vp) and a decreasein the upper one (Vo Post Up on VP). In the horizontal plane,this is clearer with the negative correlation of the anteriordimension of vomer bone (Vo Ant Up on HP) and the inclina-tion of the bone (Dvo-SN) (Fig. 6).

Interjaw relation

There was a positive correlation of APDI (PP-AB) and theinclination of the diagonal (Dvo-SN) and the superior lines

(Svo-SN) of the vomer. The Base (Bvo-SN) showed nocorrelation and the posterior vomer showed negative cor-relation. On the other hand, the ANB angle showed acorresponding negative correlation with the same threemeasures.

There was a positive correlation between PP-AB and theanterior height of the vomer (UV-ANS on VP) and negativecorrelation with the posterior height, both statistically sig-nicant. ANB angle showed positive correlation with thelength of the diagonal (Vo Diag) and superior dimension ofvomer bone (Vo Sup), and also with the length of the anteriorportion of vomer bone in the projection to the horizontalplane.

Tab. 7: Continued

Measurement N Vo Diag Vo Post Vo Sup UV-ANS on VP UV-PNS on VP

Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif. Cor. Co. Signif.

UV-PNS on VP 302 0.093 NS 0.107 0.539 0.000 0.329 0.000 0.433 0.000

Aver A-6 on PP 288 0.336 0.000 0.115 0.050 0.250 0.000 0.048 NS 0.417 0.154 0.009

Int 6 on PP 252 0.327 0.000 0.068 NS 0.286 0.241 0.000 0.055 NS 0.392 0.012 NS 0.851

Int 3 on PP 161 0.377 0.000 0.038 NS 0.645 0.277 0.000 0.021 NS 0.793 0.066 NS 0.420

Aver Max Post on PP 288 0.499 0.000 0.137 0.020 0.414 0.000 0.053 NS 0.372 0.131 0.026

Aver Tub-A on PP 302 0.732 0.000 0.231 0.000 0.595 0.000 0.001 NS 0.984 0.043 NS 0.459

Vo Post Lo on VP 302 0.086 NS 0.137 0.757 0.000 0.218 0.000 0.294 0.000 0.712 0.000

Vo Post Up on HP 302 0.349 0.000 0. 000 NS 0.998 0.225 0.000 0.117 0.043 0.078 NS 0.177

Vo Post Up on VP 302 0.025 NS 0.663 0.220 0.000 0.165 0.004 0.218 0.000 0.444 0.000

Vo Ant Up on HP 302 0.751 0.000 0.367 0.000 0.876 0.000 0.160 0.005 0.124 0.031

Cor. CoCorrelation coefcient.NSnot signicant. Statistical signicance at level 0.05. Statistical signicance at level 0.01

Fig. 6: Representation of the projection of vomer bone in the referenceplanes. In the horizontalplane (HP),landmarks areprojectedto measureanterior and posterior dimensions. In the vertical plane (VP), landmarksareprojected to measure upperand lowerdimensions of vomerbone.1.Horizontal plane;2. Verticalplane; 3. VoPostLo onVP; 4. VoPostUp on

Vp; 5. Vo Post Up on HP; 6. Vo Ant Up on HP

original article



12/14

Comparison between dentoskeletal frames

In Table 8, a comparison between vomer bone and the

different skeletal frames is presented. There was a differ-ence in the inclination of the diagonal vomer line betweenthe groups, showing a tendency for the angle to increasefrom Class II to Class III, with a statistically signicantdifference between these two groups (p < 0.05). No differ-ence was observed in the vomer base inclination betweenthe groups, and the posterior vomer line tendency in-creased from Class III to class II, reecting some vertica-lization tendency of the posterior area. The superior vomerangle (Svo) also showed that the smaller value is found inthe Class II group being signicantly different with theother two groups. Even though these angular differencesexisted, no statistical signicance was found between thegroups in the linear measurements of vomer bone in thesuperior, diagonal, and posterior dimensions.

The distance from the upper vomer to anterior or poste-rior nasal spine (UV-ANS onVP, UV-PNSon VP)showed someinteresting differences between the groups. The distance tothe posterior nasal spine, was not signicant, although therewas a slight tendency to decrease towards Class III. On theother hand, the distance to the anterior nasal spine shows thesmallest value in the Class II, which was signicantly differentfrom the other two groups. Especially with the Class III, whichshowed a higher value, this could be interpreted as a verticalgrowth tendency in this group.

There was a signicant difference between the twogroups with lower vertical projection of vomer bone in thevertical plane (Vo Post Lo on VP) (Fig. 6). Class II showed thehighest value and class III the smallest. On the other hand, nodifference was seen in the projected upper portion of vomer

bone. This result seems to be related to the inclination of themaxilla, as the values also reect the inclination of the palatalplane. The projection of vomer bone on the horizontal plane

(Vo Post Up on HP, Vo Ant Up on HP) (Fig. 6) showed nosignicant difference with the skeletal frames, although themeasurement of theanterior portion of vomer bone tended tobe reduced towards Class III.

Discussion

The results of this study show that vomer bone has veryinterestinginterrelationswithin craniofacial architecture. Thisbone usually remains hidden from our cephalometric analy-sis, because of the difculties in identifying it in a two-dimen-sional X-ray. The application of the three-dimensionalComputerized Tomography, and the possibility of creating3D volumetric digital skull reconstruction provided us the

opportunity to analyze theskull, with great accuracy [1, 20, 24,33] andreproducibility [23], by applying a different computer-based software, like the one used in this study. The analysis ofthe structures was developed by dening landmarks andplanes. These were extracted initially from the traditional2D cephalometric analysis, allowing us to compare the datawith other study results; and some of them redened to athree-dimensional environment, in order to be able to corre-late anatomical structures.

The denition of the constructed vomer bone slightlydiffers from that of a real vomer bone. The reason for this wasto obtain clear landmarks and excellent reproducibility inpositioning them. In this way, the constructed vomer bonewas extended forward to the ANS point. This must be consid-ered in the interpretation of the results.

Tab. 8: Comparison of vomer bone between different skeletal frames

Class II Class I Class III Signif.

Mean S.D. Mean S.D. Mean S.D. I vs. II I vs. III II vs. III

Dvo-SN 22.26 2.85 23.13 2.99 23.78 2.71 NS NS

Bvo-SN 158.98 6.28 158.41 5.9 158.72 4.82 NS NS NS

Pvo-SN 58.34 6.78 57.01 6.86 55.11 5.69 NS NS

Svo-SN 37.18 3.1 38.69 3.82 39.3 3.66 NS

ANB 5.8 1.87 3.52 2.43 1.13 2.38

Vo Diag 69.9 3.7 69.84 3.86 69.44 3.39 NS NS NS

Vo Post 25.78 2.87 25.28 3.05 25.19 2.96 NS NS NS

Vo Sup 56.43 3.46 56.64 3.37 56.55 3.61 NS NS NS

UV-ANS on VP 29.26 2.51 30.52 3 31.09 3.36 NS

UV-PNS on VP 29.97 2.63 29.47 2.87 28.84 3.18 NS NS NS

Vo Post Lo on VP 20.27 2.79 19.49 2.76 18.95 2.59 NS NS

Vo Post Up o n HP 19.02 2.55 19.14 2.65 19.07 2.55 NS NS NS

Vo Post Up o n VP 9.91 2.29 10.08 2.19 10.06 2.3 NS NS NS

Vo Ant Up on HP 48.25 3.85 47.61 4.06 47.18 3.79 NS NS NS

ANOVA.NSnot signicant. Statistical signicance at level 0.05

original article



13/14

Some authors have mentionedthe potentialroleof vomerbone on thedevelopment of malocclusions. Accordingto Satoand Slavicek [30], there is a functional complex involving theoccipital, sphenoid, maxilla, and vomer. This complex isconnected through sutures, which allow some degree ofdynamic interrelation known as articular mobility of thecranium. Transmission of forcesfrom the occlusion,or motionin any of the structures can inuence the entire complex andthe related structures [5, 6, 26, 30]. The role of vomer bone inthe transmission of the masticatory forces was also describedby Hilloowala [11], who reported a comparison of the humanskull and a gothic cathedral. Jerolimov [14] also indicatedtransmission of the masticatory forces through the vomer tothe sphenoid bone.

In histological analysis of the postnatal developmentof the nasal septum, it was described that some cartilagi-

nous structure could increase the ability of the septum totransfer forces from the incisor region to the sphenoidbone [22]. In this study, a description of the increase in thedimension of vomer bone was established. Apposition inthe anterior surface was found during the rst 12 years,and apposition in the posterior margins and in the superiorsurface (base of the vomer) was reported as a continuousprocess until 17 years in men and 15 years in woman, theperiod when most of the facial development takes place.Although the author did notnd a reason to believe in theimportance of the septal cartilage in the growth of themaxillary complex, the results were consistent with thecorrelation found in this study.

Other authors have described the importance of vomerbone in the growth of the maxilla. Growth retardation was

reported in theupperjaw indogs with articialcleftpalateandextirpation of thevomer[21]. Squier[31]indicatedthat traumato thevomer mayimpair anteriorposteriorgrowth of thepre-maxilla and maxilla. Friede [7] reported that alteration in thevomero-maxillary suture is likely to be an important factor inthe etiology of the midfacial retrusion that is sometimes seenin patients with unilateral cleft lip and palate. According toKimes [17], unrestricted growth of the nasal septum wasrelated to abnormal midfacial osseous changes. Friede H [8]reported that the maxillary complex was displaced forward-downwards in relation to the vomer.

From the results of this study, variation in the incli-nation of vomer bone (Dvo-SN) seemed to be correlatedwith differen ces in the cranial base angle. This is a veryinteresting nding as previous studies had focused mainly

on the inuence of the cranial base and the interrelationbetween the jaws, which have shown contradictory results[2, 4, 13, 15, 18, 25, 34], and not the relation of thisanatomically related structure. In this study, extension ofthe cranial base seems to be associated to a higher incli-nation of the vomer bone, while exion is related to lessinclination of it. This interrelation is presented in theangular measurements of the lines of the constructedvomer bone to SN Plane (Dvo-SN, Bvo-SN, and Svo-SN),which are also coinciden t with the projection in the Verti-cal Plane of the anterior and posterior height measure-ments of the vomer bone. Both correlations, positive withUV-ANS on VP and negative with UV-PNS on VP, could bealso expressing the rotation of the vomer bone. Interest-ingly the analysis of this last correlation (UV-PNS on VP),

and the negative correlation of the posterior length (VoPost) with the cranial base angle, make us suppose thatdifferences in the shape of the bone could also bepresented.

Another remarkable nding was that variations in theposition and rotation of vomer bone appear to be correlatedwith the spatial position and dimension of the maxilla, whichbecame more retruded andsmaller in thesagital dimensionasthe inclination increased. The inclination of vomer bonemeasured by Dvo-SN, Svo-SN, and Bvo-SN, shows a signi-cant negative correlation with the sagital measurement of themaxilla. This could be interpreted as if the vomer is rotateddownwards, the sagital dimension of the maxilla shows asmaller dimension, as is evident from ANS-PNS, Max Dist,and TUB-A measurements.

In the analysis of the internal proportions in the maxilla

and the inclination of vomer bone (Dvo-SN), a negativecorrelation with the anterior dimension of the maxilla (AverA-6 on PP), and no correlation with the posterior (Aver MaxPost on PP), was observed. This could be interpreted as alarger inuence of vomer bone inclination on the anteriorportion of themaxilla. On theotherhand,in theanalysis of thetransversal dimensionof themaxilla,a negative tendency inallthetransversal measurementsis appreciated (Int 7 on PP,Int 6on PP, Int 5 on PP, Int 3 on PP, Int Tub). These results showthat in this sample, there could be a relation not only on theposition but also in the transversal and sagital dimensions ofthe maxilla; as we can see from the corresponding positivecorrelation between the size of the diagonal vomer and theSNA and SNB angles.

Another nding was the correlation between vomer

bone and the occlusal planes; the inclination of vomerbone (Dvo-SN) and the related rotation of the maxillacould inuence the inclination of the anterior or posteriorocclusal planes (AOP-SN, POP-SN). At the same time, theangle between the two occlusal planes (AOP-POP) was notcorrelated, which can be interpreted as a bodily rotation ofthe maxilla, instead of some different inclination betweenone or another occlusal plane. This inclination of theocclusal planes could be one important factor determiningthe relation between vomer bone and the mandibularplane, as it has been described previously that verticaldimension of dentoalveolar structures and variation in thecant of the posterior oclusal planes inuence the positionof the mandible [9, 12, 2729, 32].

All facial sagital dimensions had negative correlation with

the inclination of vomer bone (Dvo-SN), this can be inter-pretedthat a downward inclinationshows smallerdimensionsof A, ANS, B, N, and Me to the vertical plane. This couldrepresenta more vertical or retruded distributionof theface ina higher inclination of vomer bone.

The vomer showed signicant differences between thedifferent skeletal frames. These differences were expressed onthe inclinations of the complete bone, and also in the changesof shape and consequent variation in the relation with theother structures. This makes usassumethatvomerbonecouldbe an important connecting structure between the cranialbase and maxilla. More longitudinal evaluation studies ingrowing patients should be conducted in order to comple-ment the understanding of its role in the craniofacialarchitecture.

original article



14/14

Conclusions

1. Vomer bone seems to play an important role in the inter-relation of the craniofacial architecture.

2 Changes in the inclination and the dimensions of vomerbone are strongly correlated with other craniofacialstructures.

3 There are signicant variations of vomer bone between thedifferent dentoskeletal frames.

Take-home message

The potential inuence of vomer bone in the craniofacialarchitecture has been described in a dynamic functionalcomplex involving occipital, sphenoid, vomer, and maxillabones. Vomer bone seems to play an important role

modulating the interrelation between cranial base andmaxilla, showing signicant variations between dentoske-letal frames.

Conict of interest

The authors declare that there is no conict of interest.

Acknowledgments

This work was performed in the Research Institute of Occlu-sion Medicine andResearch Centerof Brain andOral Science,Kanagawa Dental College and supported by grant-in-aid forOpen Research from the Japanese Ministry of Education,Culture, Sports, Science and Technology. The authors wouldlike to express their gratitude to theresearch projectpostgrad-uate students (Skull Project) involved in the data collectionprocess, especially Drs. Tanaka EM, Fujii M, Taguchi C,Koizumi S, Sugimoto K, Sato C, Kodama T, Shinomiya M,Okada S, Horisawa A, Yamashita R, Takahashi T, Kim Y,Shirazu M, Park H, Sato S, Kawai Y, Onodera K, Tajima K,Onodera Y, Tajima K.

The results of this research were partially presented atSummer School 2009 in Tokyo, Japan.

References

[1] Adam GL, Gansky SA, Miller AJ, Harrel WE Jr, Hatcher DC.

Comparison between traditional 2-dimensional cephalometry anda 3-dimensional approach on human dry skulls. Am J OrthodDentofacial Orthop 2004;126(4):397409.

[2] BaconW, EillerV, Hildwein M,Dubois G.The cranial base insubjectswith dental and skeletal Class II. Eur J Orthod 1992;14:2248.

[3] Barteczko K, Jacob M. A re-evaluation of the premaxillary bone inhumans. Anat Embryol 2004;207(6):41737.

[4] Dhopatkar A, Bathia S, Rock P. An investigation into the relationshipbetween the cranial base angle and malocclusion. Angle Orthod2002;72:45663.

[5] Dixon A, Hoyte D, Ronning O. Fundamentals of craniofacial growth.New York: CRC Press; 1997.

[6] Enlow D, Hans M. Essentials of facial growth. Philadelphia: WBSaunders Co; 1996.

[7] Friede H. The vomero-premaxillary suturea neglected growth sitein mid facial development of unilateral cleft lip and palate patients.Cleft Palate Craniofac J 1978;15(4):398404.

[8] Friede H. Growth sites and growth mechanism at risk in cleft lip andpalate. Acta Odont Scand 1998;56(6):34651.

[9] FushimaK, Kitamra Y,MitaH, Sato S,SuzukiY, KimY. Signicanceofthe cant of the posterior occlusal plane in Class II Division 1malocclusions. Eur J Orthod 1996;18:2740.

[10] Hansen L, Nolting D, Holm G, Hansen B, Kjaer I. Abnormal vomerdevelopment in human fetuses with isolated cleft palate. Cleft PalateCraniofac J 2004;41(5):4703.

[11] Hilloowala R. The transmission of masticatory forces and nasalseptum: structural comparison of the human skull and gothiccathedral. Cranio 2007;25(3):16671.

[12] HoHD, AkimotoS, Sato S. Occlusal plane andmandibular posture inthe hyperdivergent type of malocclusionin mixeddentitionsubjects.Bull Kanagawa Dent Coll 2002;30:8792.

[13] Hopkin G, Houston W, James G. The cranial base as an etiologicalfactor in malocclusion. Angle Orthod 1968;38:2505.

[14] Jerolimov V, Keros J, Bagic I, Lazic B, Komar D. Vomer as a relevantfactor in the mastication forces transmission system. Coll Antropol1999;23(1):13342.

[15] Kerr WJS, Adams CP. Cranial base and jaw relationships. Am JAnthrop 1988;77:21320.

[16] Kim YH, Vietas J. Anteroposterior dysplasia indicator: An adjunctto cephalometric differential diagnosis. Am J Orthod 1978;73:61933.

[17] KimesK, MooneyM, Siegel M,Todhunter J.Growth rate ofthe vomerinnormal andcleftlipand palatehumanfetal specimens. CleftpalateCraniofac J 1992;29(1):3842.

[18] Klocke A, Nanda RS, Kahl-Nieke B. Role of cranial base exure indeveloping sagittal jaw discrepancies. Am J Orthod DentofacialOrthop 2002;122:38691.

[19] Korbmacher H,Kahl-NiekeB, SchollchenM, Heiland M.Valueof twocone-beam computed tomography systems from an orthodonticpoint of view. J Orofac Orthod 2007;68(4):27889.

[20] Lagravere M, Carey J, Toogood R, Major PW. Three dimensionalaccuracy of measurements made with software on cone beamcomputed tomography images. Am J Orthod Dentofacial Orthop2008;134:1126.

[21] LathamR, Deaton T, Calabrese C. A question ofthe role ofthe vomerinthe growthof thepremaxillarysegment.CleftPalate 1975;12:3515.

[22] Melsen B. Histological analysis of the postnatal development of thenasal septum. Angle 1977;47(2):8396.

[23] Muramatsu A, et al. Reproducibility of maxillofacial anatomiclandmarks on 3-dimensional computed tomographic imagesdetermined with the 95% condence ellipse method. AngleOrthod 2008;78:396402.

[24] Periago D, et al. Linear accuracy and reliability of cone beam CTderived 3-dimensional images constructed using an orthodonticvolumetric rendering program. Angle Orthod 2008;78:38795.

[25] Polat OO, Kaya B. Changes in cranial base morphology in differentmalocclusions. Orthod Craniofacial Res. 2007;10:21621.

[26] Ricketts RM. Provocations and perceptions in craniofacialorthopedics: RMO; 1989.

[27] Sato S. Alteration of occlusal plane due to posterior discrepancyrelated to development of malocclusion-introduction to dentureframe analysis. Bull Kanagawa Dent Coll 1987;15:11523.

[28] Sato S, Takamoto K, Fushima K, Akimoto S, Suzuki Y. A neworthodontic approach to mandibular lateral displacementmalocclusion: Dentistry in Japan; 1989.

[29] Sato S. A Treatment Approach to malocclusion under theconsideration of craniofacial dynamics. Grace Printing Press Inc.;

2001.[30] Slavicek R. The masticatory organ. Austria: Gamma Medizinisch-

Wissenchafiche Fortbildungs-AG; 2002.[31] Squier C, Wada T, Ghoneim S, Kremenak C. A histological and

ultrastructural study of wound healing after vomer resection inthe beagle dog. Arch Oral Biol 1985;30(1112):83341.

[32] Tanaka E, Sato S. Longitudinal alteration of the occlusal planeand development of different dentoskeletal frames duringgrowth. Am L Orthod Dentofacial Orthop 2008;134(5):602.e1602.e11. (Online)

[33] Van Vlijmen OJ, Berge SJ, Swennen GR. Comparison of cephalometric radiographs obtained from cone-beam computedtomography scans and conventional radiographs. J Oral MaxillofacSurg 2009;67(1):927.

[34] Wilhelm BM, Beck MF, Lidral AC, Vig KWL. A comparison of cranialbase growth in Class I and Class II skeletal patterns. Am J OrthodDentofacial Orthop 2001;119:4015

original article


Documents

Analisis de Vomer Basilli