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ABSTRACT
AIM : To determine the correlation between the area of frontal sinus and maxillary sinus
with other craniofacial patterns
MATERIALS AND METHODS: The total of 96 subjects were collected from the patients
who came to the Department of Orthodontics and Dentofacial Orthopaedics for treatment of
their malocclusion. Of all the patients those who were subjected to prescription of lateral
cephalogram and those who satisfy the inclusion criteria were taken as subjects.Among those
chosen subjects who already had their own radiograph were not exposed twice; rather the
existing radiograph were used. The subjects lateral cephalograms were traced and divided
into three groups based on their ANB angle and certains craniofacial patterns were assessed
followed by evaluation of FSA and MSA by graphical method. Obtained craniofacial patterns
were correlated with evaluated FSA and MSA values.
RESULTS: The results showed significant correlation of frontal sinus area with SNB of
Class II which has the ‗p‘ value of 0.037 and weak Pearson‘s correlation coefficient of 0.127.
The correlation with Pearson‘s correlation coefficient showed significant correlation of
maxillary sinus area with CO-A of class II skeletal malocclusion which has the ‗p‘ value of
0.044 and Pearson‘s correlation coefficient of 0.571.
CONCLUSION: It was concluded that certain parameters in Class II malocclusion seems to
have a significant positive correlation with both frontal and maxillary sinus area which aids in
assessment of Class II skeletal malocclusion whereas Class I and Class III doesn‘t show any
significant correlation.
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LIST OF ABBREVIATION
SL.NO ABBREVIATIONS MEANING
1. MP3 MIDDLE PHALYNX OF THIRD FINGER
2. GI FOREHEAD
3. NaS ANTERIOR CRANIALBASE
4. CT COMPUTED TOMOGRAPHY
5. FUNC FUNCTIONAL APPLIANCE
6. RME RAPID MAXILLARY
7. MSL MAXILLARY SINUS LENGTH
8. MSH MAXILLARY SINUS HEIGHT
9. CBCT CONE BEAM COMPUTED TOMOGRAPHY
10. NHP NATURAL HEAD POSTION
11. N NASION
12. S SELLA
13. A POINT A OR SUBSPINALE
14. B POINT B OR SUPRAMENTALE
15. Gn GNATHION
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SL.NO ABBREVIATIONS MEANING
16. Go GONION
17. Me MENTON
18. Ar ARTICULARE
19. Cd CONDYLION
20. Or ORBITALE
21. ANS ANTERIOR NASAL SPINE
22. Ba BASION
23. Ptm PTERYGOMAXILLARY FISSURE
24. Pog POGONION
25. Po PORION
26. N‘ SOFT TISSUE NASION
27. FAA FACIAL AXIS ANGLE
27. CO-A EFFECTIVE MIDFACIAL LENGTH
28. CO-Gn EFFECTICE LENGTH OF MANDIBULAR
BODY
29. FSA FRONTAL SINUS AREA
30. MSA MAXILLARY SINUS AREA
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LIST OF FIGURES
SL.NO FIGURE PAGE NUMBER
1. Radiographic apparatus with OPG machine and Cephalostat. 31
2. Shows the kV and exposure time 31
3. Armamentarium used in tracing 32
4. Lateral cephalogram with tracing 32
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SL.NO LIST OF TABLES PAGE NO.
1. Mean values of the Parameters in various study groups. 37
2. Correlation between the frontal sinus area and skeletal
parameters in various study groups.
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3. Correlation between the maxillary sinus area and skeletal
parameters in various study groups.
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SL.NO LIST OF GRAPHS PAGE NO.
1. Mean values angular parameters 40
2. Mean value of linear measurements 40
3. Mean value area of MSA and FSA 41
4. Correlation between the frontal sinus area and skeletal
parameters in various study groups.
41
5. Correlation between the maxillary sinus area and skeletal
parameters in various study groups.
42
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LIST OF CONTENTS
SL.NO TITLE PAGE NUMBER
1. INTRODUCTION 1-2
2. AIMS AND OBJECTIVES 3
3. REVIEW OF LITERATURE 4-54
4. MATERIALS AND METHOD 25-32
5. STATISTICAL ANALYSIS 33
6. RESULTS 34-42
7. DISCUSSION 43-48
8. LIMITATION 49
9. SUMMARY AND CONCLUSION 50-51
10. RECOMMENDATION 52
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INTRODUCTION
Lateral cephalograms have become an essential diagnostic tool in assessment and
treatment planning and have become part and parcel of orthodontic treatment planning.
Various anatomical landmarks can be seen in a lateral cephalogram that can be used in
assessment of malocclusion.
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Paranasal sinuses are one of such anatomical landmarks seen
in lateral cephalogram radiograph as they can be easily assessed and does not provide
duplicate information.
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There are 4 pairs of anatomical paranasal sinuses such as Maxillary Sinus, Frontal
Sinus, Ethmoidal Sinus and Sphenoidal Sinus. Of these maxillary and frontal sinuses are seen
in lateral cephalogram in maximum number of patients.
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Various studies have been done to hypothesis the effect of growth and development of
these sinuses in various skeletal malocclusions.
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Paranasal sinuses follows the growth pattern
as same that of the bones.
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During third month of fetal development maxillary sinus starts developing from the
ethmoidal infundibulum.After birth maxillary sinus continues to extend both laterally and
inferiorly during rapid growth periods from birth to 3 years and from 7 to 12 years of age.
Maxillary sinus that lies in close proximity to the maxillary posterior teeth may differ in
different skeletal malocclusion.
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The bud of frontal sinus is present during birth and not seen projecting above thr
orbital rim radiographically until 5
th
year and rapid growth continues until 12 years and
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reaches plateau at 16 years in males and 14 in females. In relation to frontal sinus, enlarged
sinus is seen in prognathic cases and growth pattern of sinuses follows the same as the
corresponding bone.
Till date, research has been done to relate paranasal sinus with Class III malocclusions
or to predict growth through the use of dry skull panoramic radiography, cone-beam
computed tomography, magnetic resonance and lateral cephalogram but rarely discussed
aspect is which paranasal sinus of mid face better assessed the skeletal malocclusion. Hence,
the aims and objective of the study are
To evaluate the dimensions and area of the frontal and maxillary sinus in
different types of skeletal malocclusion.
To determine the correlation between the area and dimensions of frontal sinus
with other craniofacial patterns.
To determine the correlation between the area and dimensions of maxillary sinus
with other craniofacial patterns.
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AIM:
To determine the correlation between the area of frontal sinus and maxillary sinus with other
craniofacial patterns.
OBJECTIVES:
To evaluate the area of frontal sinus in various skeletal malocclusions
To evaluate the area of maxillary sinus in various skeletal malocclusions
To evaluate the correlation between two areas evaluated with other craniofacial patterns.
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REVIEW OF LITERATURE
P.E. Rossouw et al in 1991 analysed about the skeletal growth patterns of 103
subjects with Class I and III malocclusions cephalometrically to assess the abnormal
mandibular growth. The surface area (2 mm) of the frontal sinus was assessed by a
Summagraphics decoder linked to a microcomputer. Their results indicated that there was a
significant correlation between maxillary length, mandibular length, symphysis width,
condylar length, and frontal sinus size on a lateral cephalogram thus they had concluded that
the frontal sinus can possibly be used as an additional indicator when one is predicting
mandibular growth
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Atchison KA et al in 1991 conducted a study to determine the amount of diagnostic
and treatment planning information gained by orthodontists when pretreatment radiographs
are added to a set of orthodontic records. Thirty-nine orthodontists evaluated six test cases
and formulated a diagnosis and treatment plan. Information was collected about the
participants' certainty with their diagnoses and treatment plans, the impact of the radiographs,
the number and type of radiographs that were selected, and the difficulty of each case.
Results showed that orthodontists were approximately 75% confident of their diagnosis
before reviewing any radiograph. There were 741 radiogr
