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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. 38

    3. Correlation between the maxillary sinus area and skeletal

    parameters in various study groups.

    39

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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. 1-4

    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. 5

    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. 6

    Various studies have been done to hypothesis the effect of growth and development of

    these sinuses in various skeletal malocclusions. 7

    Paranasal sinuses follows the growth pattern

    as same that of the bones. 8

    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. 9

    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 10

    .

    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

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