The shape and size of the sella turcica in skeletal Class I, Class II, and Class III Saudi subjects

Cephalometric Assessment of Sella Turcica Morphology and Dimensions in Patients with Non-Syndromic Cleft Lip and Palate: A Systematic Review and Meta-Analysis

ObjectiveThis review aimed to analyze the size and morphology of the Sella Turcica (ST) in 2-dimensional cephalometric radiographs of individuals with non-syndromic cleft lip and or palate (CLP/CP) compared with non-cleft individuals.MethodsA comprehensive search of multiple electronic databases was conducted without language and date restrictions until October 12, 2024. Studies were included that assessed ST dimensions in lateral cephalograms and compared the patients with non-syndromic CLP or CP and non-cleft individuals. The studies' quality assessment was assessed using the JBI case-control guidelines and the Anatomical Quality Assurance checklist. Quantitative analysis was performed using the random-effects meta-analysis model. The GRADE approach was employed to evaluate the certainty of evidence.ResultsOut of 1087 studies, 10 met the inclusion criteria, and 6 were included in the quantitative analysis. Of all, 7 studies were rated moderate, 2 low, and 1 high quality. Unilateral CLP (UCLP) cohort showed statistically significant smaller dimensions for length (MD = -1.22; 95% CI: -2.21, -0.24), depth (MD = -0.65; 95% CI: -1.41, -0.11), and area (MD = -4.75; 95% CI: -7.22, -2.28) and the odds of ST bridging were more than twice compared to non-cleft control. No significant differences were observed in ST dimensions in bilateral CLP versus non-Cleft and UCLP.ConclusionThe evidence of differences in ST dimensions between non-cleft individuals and patients with UCLP is weak, owing to a greater risk of bias resulting from inadequate reporting of design variability, participant demographics, and measurement methods. Future studies with better methodology and larger sample sizes are needed.

Craniofacial and atlas vertebra structures in patients with maxillary palatally displaced canines: A cone-beam computed tomography-based retrospective study

INTRODUCTION

This retrospective cone-beam computed tomography (CBCT) study aimed to analyze the associations between maxillary palatally displaced canine (PDC) with the craniofacial and atlas vertebra structures.

METHODS

A total of 94 patients (47 with PDC and 47 normal) were included. Then, their CBCT data were reconstructed and analyzed to measure the 3-dimensional angular positions of canines, the structures of sella turcica, atlas vertebra, and cranial base. Comparisons of continuous variables between 2 groups were performed using the independent samples t test or the Mann-Whitney U test, whereas 1-way analysis of variance or Kruskal-Wallis tests were used for comparisons among multiple groups. Categorical variables were compared using the chi-square test or Fisher exact test, as appropriate. Binary logistic regression analyses, along with Spearman or Pearson correlation analyses, were conducted to determine the associations between variables.

RESULTS

No significant differences were observed in sella turcica structures or the occurrence of ponticulus posticus between the 2 groups (P >0.05). The anterior cranial base length was significantly smaller, and the cranial base angle was significantly larger in subjects with PDC (P <0.05). Moreover, a significant negative correlation was identified between anterior cranial base length and the occurrence of PDC (P <0.05). However, the angular positions of canines showed no significant correlation with any craniofacial variables.

CONCLUSIONS

On the basis of CBCT data, the structures of sella turcica and atlas vertebra did not differ between patients with PDC and those with normally erupted canines. However, patients with PDC exhibited a significantly shorter anterior cranial base length and a greater cranial base angle, suggesting a possible developmental link between cranial base morphology and maxillary canines. The explicit relationship and clinical significance of PDC with craniofacial structures require further investigation.

Three-dimensional analysis of sella turcica morphology and dimensions in non-syndromic cleft lip and palate patients: A systematic review and meta-analysis

INTRODUCTION

The dimensions and morphology of sella turcica (ST) are often altered in individuals with craniofacial anomalies, including those with cleft lip and palate (CLP). Therefore, the review aimed to identify the current evidence on the 3D morphological characteristics of the ST in patients with CLP.

METHODS

A systematic literature search was conducted using different databases without language or publication date restrictions. Studies were included comparing non-syndromic CLP patients to non-cleft controls using 3D imaging techniques for ST assessment. Critical appraisal of included studies was evaluated using the JBI case-control checklist and Anatomical Quality Assurance (AQUA) checklist. A random-effects meta-analysis was used for quantitative synthesis.

RESULTS

Out of 1187 identified articles, six studies met the inclusion criteria. Four studies were rated moderate quality, while two were considered low quality. Most studies reported larger overall ST dimensions in non-cleft controls, with significant differences in ST depth and diameter. The meta-analysis revealed reduced ST depth (MD=-0.95; 95% CI: -1.73, -0.17; P=0.02) and diameter (MD=-1.00; 95% CI: -1.88, -0.11; P=0.03) in CLP patients, while no significant difference was observed in ST length. CLP patients exhibited more irregular ST morphologies, such as flattening and irregular posterior walls.

CONCLUSIONS

The review highlights an association between CLP and alterations in ST morphology and dimensions. However, variability in methodologies and the lack of standardized protocols across studies limit the generalizability of these findings. Future research should focus on standardized protocols and larger, more diverse samples to enhance the understanding of ST variations in CLP.

REGISTRATION

Registered with the International Prospective Register of Systematic Reviews (PROSPERO-CRD42024505594).

Morphometric Analysis of Radiological Features of Pituitary Tumors and Optic Pathway Distortion Associated with Visual Impairment in Pituitary Macroadenomas with Suprasellar Extension

OBJECTIVE

To validate the correlation between visual impairment (VI) and suprasellar extension (SSE) in pituitary macroadenomas and to identify patients at heightened risk of preoperative visual deficits by analyzing anatomical distortion of optic nerve and optic chiasm (OC) using preoperative magnetic resonance imaging.

METHODS

Ninety-seven patients with pituitary macroadenomas and SSE, treated between January 2015 and April 2022, were analyzed. Associations between VI, demographic data, SSE, and optic pathway deformation were assessed. SSE cutoff points for predicting VI were determined using receiver operating characteristic curves, with univariate and multivariate logistic regression identifying potential risk factors.

RESULTS

Of the 97 patients, 47 had confirmed VI. Independent predictors of VI included visual symptoms lasting >1 month, sagittal SSE >10.35 mm, and vertical OC width >5.6 mm. Additional risk factors were older age, nonfunctioning pituitary adenoma, coronal SSE, dumbbell-shaped tumors, large and giant adenomas, reduced optic nerve diameter, increased horizontal OC width, and thinned OC thickness.

CONCLUSIONS

Tumor morphology and optic pathway distortion predict preoperative VI in patients with pituitary macroadenomas. These findings support the development of a viable approach for assessing VI risk in clinical practice, aiding in decisions regarding optimal surgical timing.

Retrospective evaluation of ponticulus posticus prevalence, sella turcica types, and stylohyoid complex calcifications in a group of Turkish population

The aim of this retrospective analysis was to assess the incidence of ponticulus posticus and stylohyoid ligament calcification and to evaluate the morphological variations of the sella turcica within the Turkish demographic using CBCT scans. Involving a retrospective review of 460 CBCT scans and utilizing the NewTom 3G system, the study analyzed high-quality CBCT images to investigate ponticulus posticus, stylohyoid ligament calcifications, and sella turcica morphology. The ponticulus posticus was examined for complete or partial formations, while the stylohyoid ligament was classified according to its elongation and calcification patterns. The sella turcica was categorized into six distinct morphological types, enhancing the understanding of structural variations in the context of the Turkish population. The calcification patterns of the styloid processes were examined on both sides of 380 individuals, revealing the highest prevalence in the 'd' and 'e' categories on the right, and similar findings on the left among 373 individuals. Symmetric calcification patterns were more common, with 68.4% symmetry observed. For the sella turcica, category 'a' was the most frequent among 363 individuals. Analysis of ponticulus posticus absence and presence showed a majority lacking this feature on both sides, with complete and partial forms less common. The study highlights the anatomical variability and bilateral symmetry of the styloid processes, sella turcica, and ponticulus posticus, illustrating that these structures do not significantly vary with gender or age. These results hold clinical significance for the diagnosis and treatment of related conditions, prompting further investigation into their impact on patient care.

Morphometric Analysis of the Sella Turcica on Cone-Beam Computed Tomography Images

INTRODUCTION

Sella turcica is an important anatomic formation that contains the pituitary gland and is in a close neighborhood with many vital structures. It is important to know the morphometry of the sella turcica, as it is a transition point during surgical interventions such as the endoscopic endonasal transsphenoidal approach to the region. The findings obtained are thought to be useful in the examination of sella turcica and surrounding structures and will contribute to the literature by knowing the morphometry of the region for the surgical method.

METHOD

In this study, cone-beam computed tomography images of 400 individuals, 200 females and 200 males, aged between 18 and 65 years, who did not have craniofacial pathology, who applied to Gaziantep University, Faculty of Dentistry between 2015 and 2020 for any reason, were evaluated retrospectively. In the sagittal section, 8 parameters were examined, 6 of which were transverse.

RESULTS

The length () of the sella turcica in the sagittal plane is 10.19±1.77 mm, the diameter of the sella turcica is 11.6±1.69 mm, the anterior height of the sella turcica is 7.88±1.56 mm, the median height of the sella turcica 8.18±1.42 mm, posterior height of sella turcica 6.98±1.31 mm, width of sella turcica 11.10±1.6 mm. The distance between anterior clinoid processes in the transverse plane was 24.93±2.57 mm, and the distance between posterior clinoid processes was 14.92±2.46 mm.

CONCLUSION

It was determined that there was an increase in many parameters with age, and length of the sella turcica and anterior clinoid processes were statistically significantly higher in males.

Correlation between sphenoid sinus pneumatization and sella turcica dimensions using computed tomography

OBJECTIVE

This study was performed to determine the dimensions of the sella turcica (ST) in relation to sex, age groups, and sphenoid sinus (SS) pneumatization patterns in a cohort of Iraqi individuals.

METHODS

This cross-sectional study analyzed computed tomography images of 99 individuals (53 men, 46 women) aged 24 to 59 years to measure ST dimensions, including length, width, height, depth, and surface area. SS pneumatization was classified by sex and age. We also examined the relationship between ST size and SS pneumatization patterns.

RESULTS

Women exhibited a significantly greater mean ST depth (9.37 mm) than men (8.19 mm). The ST diameter was significantly larger in the middle-aged group (13.1 mm) than in the young adult group (11.83 mm). The ST area showed a highly significant difference between sexes. The sellar pneumatization pattern was the most common, whereas the conchal pattern had the lowest prevalence. A significant correlation was observed between ST size and SS pneumatization.

CONCLUSION

The ST depth and diameter showed statistically significant differences across sex and age groups, respectively. The variability in SS pneumatization patterns underscores the importance of considering pneumatization types during surgical planning to minimize the risk of iatrogenic injury and improve treatment outcomes.

Evaluation and comparison of planum clival angle in three malocclusion groups : A CBCT study

PURPOSE

Cranial base flexure is an overlooked topic in craniofacial research. The aim of this retrospective observational study was to compare a new parameter, the planum clival angle (PCA), which represents cranial base flexure, in skeletal class I, II, and III malocclusions using cone beam computed tomographic images (CBCT) and correlate PCA with the stages of the fusion of the spheno-occipital synchondrosis (SOS).

MATERIALS AND METHODS

A total of 125 CBCTs were divided into two groups based on chronological age (19-25 years and 12-18 years). The CBCT images from 57 subjects (19-25 years old) were categorized into three groups based on their skeletal malocclusion for measuring PCA and cranial base angles (CBA). In the second group, comprising 68 CBCT data sets of individuals in the age group of 12-18 years, the PCA angle was correlated with stages of fusion of the SOS. Data were statistically analyzed using independent samples t test, one-way analysis of variance (ANOVA, intergroup), Pearson correlation, and χ2 test.

RESULTS

There was a statistically significant linear correlation (P < 0.001) between the two parameters PCA and CBA but no significant difference was found in PCAs between the three groups. One-way ANOVA to compare the PCA values in the three stages of fusion of the SOS revealed a highly significant relationship in male subjects (p < 0.001), thereby, suggesting that as fusion progresses, the planum clival angle increases. The χ2 test to compare the planum clival angle in males and females revealed that SOS fusion occurred earlier in females.

CONCLUSION

There is a constant dynamic change in the value of the parameter PCA that progresses until completion of SOS fusion. The SOS fuses earlier in females. Assessment of the stage of fusion of the SOS can be used in deciding whether growth modification of the craniofacial complex is still possible during orthodontic therapy.

How successful is the CatBoost classifier in diagnosing different dental anomalies in patients via sella turcica and vertebral morphologic alteration?

BACKGROUND

To investigate how successfully the classification of patients with and without dental anomalies was achieved through four experiments involving different dental anomalies.

METHODS

Lateral cephalometric radiographs (LCRs) from 526 individuals aged between 14 and 22 years were included. Four experiments involving different dental anomalies were created. Experiment 1 included the total dental anomaly group and control group (CG). Experiment 2 only had dental agenesis and a CG. Experiment 3 consisted of only palatally impacted canines and the CG. Experiment 4 comprised patients with various dental defects (transposition, hypodontia, agenesis-palatally affected canine, peg-shaped laterally, hyperdontia) and the CG. Twelve sella measurements and assessments of the ponticulus posticus and posterior arch deficiency were given as input. The target was to distinguish between anomalies and controls. The CatBoost algorithm was applied to classify patients with and without dental anomalies.

RESULTS

In order from lowest to highest, the predictive accuracies of the experiments were as follows: experiment 4 < experiment 2 < experiment 3 < experiment 1. The sella area (SA) (mm2) was the most important variable in experiment 1. The most significant variable in prediction model of experiment 2 was sella height posterior (SHP) (mm). Sella area (SA) (mm2) was again the most relevant variable in experiment 3. The most important variable in experiment 4 was sella height median (SHM) (mm).

CONCLUSIONS

Every prediction model from the four experiments prioritized different variables. These findings may suggest that related research should focus on specific traits from a diagnostic perspective.

Morphology of the Sella Turcica in Individuals With Different Skeletal Malocclusions in Upper Egypt Assessed Using Lateral Cephalometric Radiographs

OBJECTIVE

To evaluate the morphology of sella turcica (ST) in individuals with different skeletal malocclusions in upper Egypt.

MATERIALS AND METHODS

300 lateral cephalometric radiographs of adult patients of both sexes, varying ages from 18 to 30 years, were selected and divided into three equal groups, group (1): skeletal class I (control group), group (2): skeletal class II, and group (3): skeletal class III. Pre-treatment lateral cephalograms were taken from the archives of the Department of Orthodontics, Faculty of Dentistry, Minia University. The tuberculum and dorsum sella, the floor of ST, and posterior and anterior clinoid processes (ACPs) were drawn. The direct measurements such as diameter (APD), depth (D), and length(L) of sella were measured using Silverman and Kisling methods.

RESULTS

A significant difference was found in depth (D) between class I and class II, with class II having a greater depth. Also, the largest diameter (APD) was found in the class III group. A significant difference was found in diameter (APD) between the two age groups (from 18 to 24 years and from 25 to 30 years) Conclusion: The larger diameter values were seen in the skeletal class III subjects, while the larger depth values were observed in the class II subjects. The older age group (25-30 years) has a greater diameter than the younger one. Highly significant differences were found in length and depth between the sexes.

Calcification patterns and morphology of Sella turcica are related to anteroposterior skeletal malocclusions: A cross-sectional study

BACKGROUND

The sphenoid bone is an irregular, unpaired, symmetrical bone located in the middle of the anterior skull and is involved in craniofacial growth and development. Since the morphology of Sella turcica (ST) is associated with different craniofacial patterns, this study aimed to investigate if there is a correlation between ST morphology on the one hand and sagittal craniofacial patterns on the other hand.

METHODS

This study was conducted with a convenience sample that included Brazilian individuals undergoing orthodontic treatment. Lateral cephalograms were used to evaluate the calcification pattern and morphology of ST, as well as skeletal class by analyzing the ANB angle. Pearson's chi-square test with Bonferroni post-hoc test was performed to evaluate the association between ST calcification pattern and morphology, and anteroposterior skeletal malocclusion. The established significance level was 0.05.

RESULTS

The study collective was comprised of 305 orthodontic patients (178 (58.4 %) female, 127 (41.6 %) male), who had a mean age of 23.2 (±10.6) years. 131 participants (42.9 %) presented skeletal class I, 142 (46.6%) skeletal Class II, and 32 (10.5%) had a skeletal class III. The degree of prognathism of the mandible showed a homogenous distribution within the study collective (91 (29.9 %) orthognathic, 100 (32.9 %) retrognathic, 113 (37.2 %) prognathic mandible). Concerning the maxilla, 92 (30.2%) individuals presented an orthognathic upper jaw, whereas 60 (19.7%) showed maxillary retrognathism and 153 (50.2%) maxillary prognathism. Compared to patients with skeletal class I, skeletal class III individuals presented significantly more hypertrophic posterior clinoid process (p<0.007) and pyramidal shape of the dorsum of the ST (p<0.038).

CONCLUSIONS

Our results suggest that the hypertrophic posterior clinoid process and pyramidal shape of the ST dorsum are more prevalent in individuals with skeletal class III malocclusion.

Potential role of the sella turcica X-ray imaging aspects for sex estimation in the field of forensic anthropology: a systematic review and meta-analysis

Several studies have evaluated the parameters of normality of the sella turcica (ST), which is important to face different craniofacial syndromes that may affect this structure. Therefore, this research summarized the scientific evidence on the role of ST in the sex estimation of non-syndromic individuals. The research protocol was registered (Prospective International Registry of Systematic Reviews # CRD42021256469), followed by an electronic search in six databases (PubMed, LILACS, Web of Science, Scopus, EMBASE, and LIVIVO) and gray literature (Google Scholar and OpenGrey). Meta-analysis of linear (width, length, height, and diameter) and volumetric measurements, in addition to an assessment of risk of bias (RoB) and certainty of evidence, were performed. After the screening of 986 articles, 13 were evaluated by meta-analysis (1 307 males and 1 231 females). In subgroup analysis, females had lower values for width (lateral radiograph; -0.67 mm; P = 0.040), length (computed tomography; -0.23 mm; P = 0.020), and diameter (computed tomography; -0.27 mm; P < 0.001) compared to males. There was no statistically significant difference regarding height (P = 0.95), area (P = 0.72), and volume (P = 0.21). Most studies exhibited moderate RoB, and the certainty of evidence of the outcomes was very low. In this review, significant differences were observed between the sexes for the length and diameter of the ST; however, the heterogeneity of the studies must be considered.

Key points

Studies from different geographic regions evaluated the morphology of ST according to sex and showed this anatomical structure as an important indicator of dimorphism.Meta-analysis showed shorter ST length and diameter in women.Subgroup analysis found lower ST width in women based on lateral skull radiographs.Subgroup analysis found smaller lengths and diameters in women based on CT scans.

Is hand-wrist radiography still necessary in orthodontic treatment planning?

OBJECTIVES

The aim of our study is to compare the relationship between hand-wrist and cervical vertebra maturation stages with chronological age and to investigate the effect of malocclusion type on the relationship between these methods.

MATERIALS AND METHODS

Hand-wrist and cephalometric radiographs of 1000 patients (526 females, 474 males) with a mean age of 13.41 ± 1.83 were analyzed. The methods of Bacetti et al. were used for the cervical vertebra maturation stage, and Björk, Grave and Brown's methods were used for the hand-wrist maturation stage. One-way ANOVA test was applied to compare skeletal classes between them. Tukey post hoc test was used to determine the differences. The relationship between the malocclusion type, cervical vertebra and hand-wrist maturation stages was evaluated with the Spearman correlation test.

RESULTS

Spearman's correlation coefficient was 0.831, 0.831 and 0.760 in Class I, II and III females, respectively. In males, it was calculated as 0.844, 0.889 and 0.906, respectively. When sex and malocclusion were not differentiated, the correlation was found to be 0.887. All were statistically significant (P < 0.001). The highest correlation was observed in class III males, while the lowest was found in class III females.

CONCLUSION

Cervical vertebrae can be used safely to assess pubertal spurt without hand-wrist radiography. Diagnosing growth and development stages from cephalometric images is important in reducing additional workload and preventing radiation risk.

Morphometric Analysis of Sella Turcica and a Proposed Novel Sella Turcica Index - A Digital Lateral Cephalometric Study

Background: The sella turcica is a structure readily seen on lateral cephalograms and sella point is routinely traced for various cephalometric analyses. The aim of the present study was to evaluate the morphometric variation in size and shape of sella turcica via lateral cephalogram. The objectives were to introduce a novel sella turcica index (STI) and assess its reliability that could be helpful in gender determination. Materials and Methods: A total of 80 lateral cephalograms of the patients of age group 10-30 years were included for the study. The morphological variations of the sella turcica was done based on the classification given by Axelsson et al. (2004). The length, depth and perimeter of the sella turcica was measured and STI derived and calculated. The data was further subjected to discriminant analysis to validate the gender outcome. Reliability of the novel index was determined by calculating the sensitivity and specificity. Results: The overall most common morphological type of sella turcica was Type A (56.25%) followed by Type B (18.75%) and Type E (13.75%). The mean perimeter and depth of sella turcica was higher in females whereas the mean length of sella turcica was higher in males. The mean STI was higher in males and statistically highly significant. The sensitivity and specificity of this index was 72.5% and 90% respectively. Conclusion: A significant relationship was observed between the morphometric measurements of sella turcica and gender. STI could be of great help as a reliable tool for personal identification in forensic sciences.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-04082-9.

Associations across 22 dental and craniovertebral anomalies or variations, sagittal skeletal relationships, and vertical growth patterns: a comprehensive epidemiological study of 43 dentoskeletal traits

INTRODUCTION

Despite researchers' recent interest in identifying links between some dental and craniovertebral abnormalities, there are many important, unassessed gaps in our knowledge of this matter. In addition, previous samples were small. This large study aimed to examine, for the first time, the occurrence/severity of numerous dental and skeletal anomalies or variations and their correlations with each other and with growth patterns.

METHODS

This epidemiological study was conducted on pretreatment radiographs of 1194 patients from 3 cities (815 females). Skeletal sagittal skeletal relationships and vertical growth patterns were determined. The occurrence/severity were assessed for: cervical vertebral fusion (CVF), atlas posterior arch deficiency (APAD), ponticulus posticus (PP), sella turcica bridging (STB), hypodontia, oligodontia, hyperdontia, missing of maxillary laterals, microdontia, macrodontia, root dilaceration, odontoma, taurodontism, dental fusion, dental gemination, enamel pearl, permanent molar ankylosis, primary molar ankylosis, dens in dente, dens invaginatus, dental impaction, ectopic eruption, and dental transposition. Incidental findings were recorded as well. Concurrent anomalies, sex dimorphism, and correlations across variables were examined statistically, adjusting for the false discovery rate (α = 0.05).

RESULTS

Prevalence was calculated for 43 dentoskeletal traits/anomalies (22 abnormalities/variations [plus their severities/types] as well as 21 incidentally found traits/anomalies). Dental impaction may be more common in hyperdivergent and severer cases of sella bridging; also, primary molar ankylosis was associated with missing teeth. Dental impaction was associated only with STB and not with PP, APAD, or vertebral fusion. The only association observed among the four skeletal anomalies was seen between APAD and CVF. Merely the variables 'sagittal skeletal relationships, vertical growth patterns, PP, and APAD' showed sexual dimorphism; of these, only vertical growth pattern and APAD remained sexually dimorphic after adjusting for the FDR; still, the other two remained marginally significant and worth further evaluations. Sex dimorphism did not exist in concurrent abnormalities. The skeletal Class III was associated with the concurrent occurrence of craniovertebral, dental, and dentoskeletal abnormalities. Skeletal Class I was associated with fewer occurrences of concurrent dental anomalies. Vertical growth patterns were not associated with concurrent dental or dentoskeletal anomalies. However, the hyperdivergent pattern was associated with fewer cases of concurrent craniovertebral abnormalities.

CONCLUSIONS

STB and hyperdivergent pattern were associated with dental impaction. However, APAD, CVF, or PP were not associated with dental impaction. APAD was associated with CVF. Sexual dimorphism existed conclusively in the case of vertical growth patterns and APAD. Concurrent abnormalities (dental, skeletal, and dentoskeletal) were associated with skeletal Class III.

A Cephalometric Study of Sella Turcica: Correlation of Its Size with Different Skeletal Malocclusions

Introduction

The present study was done to determine the size of the sella turcica in different skeletal type subjects and to evaluate if any significant difference exists between them, which could be the basis for early diagnosis.

Materials and methods

A total of 60 lateral cephalograms of patients above 15 years of age were selected and distributed according to skeletal malocclusion into class I (n = 20), class II (n = 20), and 20 class III (n = 20). Syndromic patients (physically/mentally/both) or patients with major illnesses were not included. Two linear measurements of the sella turcica, that is, length and depth in mid-sagittal plane, were obtained in accordance with Silverman and Kisling method. Unpaired t-test and one-way analysis of variance (ANOVA) were performed.

Results

The mean length of sella turcica in class I, class II, and class III subjects was 3.81, 3.37, and 3.9, respectively. Similarly, the mean depth of sella turcica in class I, class II, and class III subjects was 7.6, 6.83, and 9.075, respectively.

Conclusion

No significant difference in length of the sella turcica could be found between different skeletal types. Maximum depth of sella turcica was found to be in subjects with class III and minimum with class II skeletal types.

Clinical significance

The linear dimensions of sella turcica can be used to approximate the pituitary gland size. The pedodontist should be familiar with different morphologies of the sella turcica to differentiate normal from abnormal appearance so that treatment can be diagnosed and treated early.

How to cite this article

Grover N, Khan DUZ, Bhagchandani J, et al. A Cephalometric Study of Sella Turcica: Correlation of Its Size with Different Skeletal Malocclusions. Int J Clin Pediatr Dent 2023;16(S-3):S229-S232.

Geometric analysis of tooth size among different malocclusion groups in a Hispanic population

INTRODUCTION

Tooth size ratio is important for optimal dentofacial esthetics, occlusal interdigitation, and postorthodontic treatment stability. Tooth geometry influences tooth size ratio; therefore, tooth size normative data may not be practical across diverse ethnic groups. This study aimed to determine whether there are significant differences in 3-dimensional tooth size among patients in the Hispanic population with Angle Class I, II, and III malocclusions.

METHODS

The data were collected using intraoral scanned orthodontic study models representing Hispanic orthodontic patients with Angle Class I, II, and III malocclusions. The scanned models were digitized and transferred to a geometric morphometric system. Tooth sizes were determined, quantified, and visualized using contemporary geometric morphometric computational tools.

RESULTS

Tooth size was determined for all teeth and showed a significant difference in 4 out of 28 teeth: Maxillary right first molar, mandibular left second molar, mandibular right first molar and mandibular right second molar. This significant difference was noted among females and affected different malocclusion groups.

CONCLUSIONS

Tooth size discrepancy in the Hispanic population varies among malocclusion groups, and the variation is determined by the participant's gender.

Association between sella turcica bridging and the impaction severity of palatally displaced canines: A retrospective study

INTRODUCTION

This retrospective study aimed to investigate the association between the extent of the bridging and dimensions of sella turcica and the impaction severity of palatally displaced canines. Secondarily, any possible association between skeletal age and gender was evaluated.

METHODS

Panoramic and cephalometric radiographs of 94 patients (63 female, 31 male; 19 pre-peak, 75 post-peak) with palatally displaced canines were evaluated. Sector classification and α angle were used to determine the impaction severity of palatally displaced canines on panoramic radiographs. The distance from the cusp tip of the palatally displaced canines to the occlusal plane (d) and the extent of the bridging and dimensions of the sella turcica were evaluated on cephalometric radiographs.

RESULTS

Sella turcica bridging and dimensions did not vary regarding the impaction severity of palatally displaced canines, but a significant association was found between sella turcica bridging and skeletal age (P = 0.038). Class II (33.3%) and Class III (12.0%) bridging was higher in postpubertal patients. No differences between females and males were detected for the extent of bridging and dimensions of the sella turcica.

CONCLUSIONS

These findings indicate no association between sella turcica bridging and dimensions and the impaction severity of palatally displaced canines. Sella turcica bridging is more frequent in the postpubertal period, whereas gender does not influence sella turcica bridging. More studies are needed to evaluate if the extent of sella turcica bridging may be indicative of severely impacted palatal canines, which in turn would allow for careful monitoring of patients from an early age and for the clinician to take preventive measures.

Investigating the Relationship between the Dimensions and Morphology of Sella Turcica with the Long-Face Growth Pattern and the Vertical Growth Pattern

Introduction

The sella turcica is one of the important landmarks of lateral cephalometry, which is used in orthodontics for the diagnosis, treatment plan, and evaluation of skeletal development and maturity. The purpose of the present study is to investigate the relationship between the dimensions and morphology of sella turcica with the long-face growth pattern and people with an open bite. This study also examines the relationship between sella turcica bridging (STB) and the vertical growth pattern.

Methods

As many as 153 radiographs were analyzed using the Romexis software, considering the basal, gonial, and FMA angles to determine the vertical growth pattern of the face. The basal angle was also used to check for an open bite. Of these patients, 80 had a long vertical face growth pattern, and 73 had a normal face growth pattern. The four landmarks of tuberculum sellae, dorsum sellae, sellae floor, and posterior clinoid were determined on the cephalograms to measure the length, depth, and anteroposterior diameter of the sella turcica.

Results

In this study, it was found that the chance of developing a long face in people with partial and complete bridging is 8.37 and 1.92, respectively. An increase in the length of the sella turcica for one unit decreases the chance of a long face, and as the depth of the sella turcica increases, the chance of a long face increases.

Conclusions

STB is frequently seen in people with long faces. However, this finding should be considered in relation to other diagnostic parameters. The shorter the length and higher the depth of sella turcica, the higher the chance of developing a long face.

Morphology of the Sella Turcica: A Meta-Analysis Based on the Results of 18,364 Patients

BACKGROUND

This meta-analysis aimed to present data on the sella turcica (ST) morphology and variations. Furthermore, a detailed morphometric analysis of the ST was conducted.

METHODS

Major online databases such as PubMed, Scopus, Embase, Web of Science, and the Cochrane Library were searched through. The overall search process was conducted in three stages.

RESULTS

This meta-analysis was based on the results of 18,364 patients and demonstrates the most up-to-date and relevant data regarding the morphology of the ST in the available literature. Four classification methods of the ST shape can be distinguished, in which the most commonly occurring variants are the normal ST (55.56%), the U-shaped ST (73.58%), the circular type of ST (42.29%), and non-bridging ST (55.64%). The overall midpoint height of the ST was 6.59 mm (SE = 0.13). The overall length of the ST was 9.06 mm (SE = 0.15). The overall volume of the ST was 845.80 mm3 (SE = 288.92). Four main classification methods of ST morphology can be distinguished in the available literature. Various morphometric characteristics of the ST may be applied in clinical practice to evaluate its shape, dimensions, and normal or pathological variants.

Morphometric and morphological evaluation of the optic canal in three different parts in MDCT images

PURPOSE

This study aimed to classify the morphometry and variations of optic canal by examining its changes according to gender and body side, and developments according to age.

METHODS

We retrospectively evaluated the orbit and paranasal sinus computerized tomography images of 200 individuals (age range 3 months-90 years;106 female, 94 male). In this study, three different parts of optic canal in evaluated morphometric and morphological.

RESULTS

The intracranial aperture was found to be statistically significantly wide in males than females on both sides (p ˂ 0.05). When optic canal types were evaluated, the most common type among healthy individuals was conical type (right: 68%, left:67.5%), and the least common type was irregular type (right and left:1.5%). According to the type of optic waist, the most common was triangle type.

CONCLUSION

Considering the possible effect of optic canal size on pathologies, it is important to establish a basis for the parameters of this structure in healthy individuals. In this study, both the morphology and morphometry of the canal as well as variations were examined and it was determined that the structure was affected by gender, body side and age group. Knowledge of anatomic morphometry, variations and complexities arising from these are important for clinical diagnosis and management.

Morphological Variations and Anomalies of the Sella Turcica on Lateral Cephalograms of Cleft-Palate-Only (CPO) Patients

Sella turcica abnormalities were reported in malocclusions and clefts. No studies were found on sella turcica abnormalities in CPO patients. This study aimed to compare the prevalence of sella turcica abnormalities on cephalometric radiographs in CPO versus non-cleft orthodontic patients. Cephalograms of CPO patients (n = 89) and controls (n = 89) were analyzed for normal sella turcicae and sella turcica abnormalities. Then, cephalometric analysis was performed using specialized software. Statistical analysis was performed using the Rv.4.1.1 package. No variation in or anomaly of the sella turcica was more frequent in CPO compared to non-cleft individuals. Patients with hypertrophic posterior clinoid process had higher interincisal and 1+:Nasion-A angles. Subjects with hypertrophic posterior clinoid process and double contour of the floor had higher Sella-Nasion-A, Sella-Nasion-B and Sella-Nasion-Pogonion and lower ANB. A pyramidal shape of the dorsum sellae was more prevalent in males, as was double contour of the floor in females. Subjects with an oblique anterior wall had lower SNB, GntgoAr and NLA. Subjects with a normal sella had higher SNPg, ML-NSL and 1+:NAmm. A normal sella was more prevalent in younger patients. CPO is not associated with sella turcica abnormalities compared to non-cleft orthodontic patients.

Radiographic Analysis of Morphological Variations of Sella Turcica in Different Skeletal Patterns Among Saudi Subpopulations

Background

Size and shape of the sella turcica is considered vital for many radiographic analyses.

Objectives

To assess and compare the linear dimensions and shape of sella turcica on digital lateral cephalograms in Saudi subpopulation with different skeletal patterns, age groups and genders.

Methodology

A total of 300 digital lateral cephalograms were retrieved from the hospital archive. The selected cephalograms were grouped based on the age, gender, and skeletal types. The linear dimensions and shape of sella turcica were measured on each radiograph. Data were analyzed using an independent t-test and a one-way ANOVA. To test the inter-relationship of age, gender, and skeletal type with the dimensions of sella turcica, regression analyses were used. Statistical significance was set at P ≤ 0.01.

Results

Significant differences in linear dimensions between the age groups (P < 0.001) and genders (P < 0.001) were noted. On comparing sella size with different skeletal types, a significant difference was found for all sella dimensions (P < 0.001). The mean length, depth and diameter among skeletal class III were significantly higher than that among classes I and II. On comparing age, gender, and skeletal type with size of sella, age and skeletal type were significantly related to the change of length, depth and diameter (P < 0.001), whereas gender was found to be significantly related only to a change in length of the sella (P < 0.01). For the sella shape, normal morphology was noted in 44.3% of patients.

Conclusion

According to the findings of this study, the measurements of sella can be used as reference standards for future studies in Saudi subpopulation.

Sella turcica variations in patients with transverse skeletal discrepancies versus patients with normal transverse relationships. a cross- sectional study

BACKGROUND

The sella turcica (ST) is a crucial landmark in orthodontics. It is utilized as a reliable predictor of future growth of the skeletal pattern, assisting in early diagnosis and promoting better treatment planning options. The goal of this research was to compare the morphology and bridging of the sella turcica in transverse maxillary deficient malocclusions and malocclusions with normal transverse relationships.

METHODS

A total of 52 cone beam computed tomographic (CBCT) images were selected with an age range of 18-30 years. Group I comprised 26 patients previously diagnosed with transverse maxillary deficiency, while group II comprised 26 patients with normal transverse skeletal relationships. The length, depth and diameter of the ST were measured by two observers, the shape was evaluated as round, oval or flat and sellar bridging was calculated in each case. An Independent t-test was used to compare between the sellar dimensions in both groups. For assessment of bridging percentage Chi square test was used.

RESULTS

The mean values of the length, depth and diameter of the sella in group I was 11.09 mm, 8.56 and 12.81 mm respectively and 10.34 mm, 8.24 and 12.38 mm in group II respectively (P ≤ 0.05). No significant differences were found between both groups in any of the sellar dimensions. The rounded ST shape was the most prevalent among both groups (59.6%). Partial ST bridging was found in only 7.7% of group I (p < 0.0001*). Complete ST bridging wasn't detected in either of the groups.

CONCLUSIONS

There was no correlation found between transverse maxillary deficiency and the morphology and bridging of the sella turcica.

Automated methods for sella turcica segmentation on cephalometric radiographic data using deep learning (CNN) techniques

OBJECTIVE

The objective of this work is to present a novel technique using convolutional neural network (CNN) architectures for automatic segmentation of sella turcica (ST) on cephalometric radiographic image dataset. The proposed work suggests possible deep learning approaches to distinguish ST on complex cephalometric radiographs using deep learning techniques.

MATERIALS AND METHODS

The dataset of 525 lateral cephalometric images was employed and randomly split into different training and testing subset ratios. The ground truth (annotated images) represents pixel-wise annotation of the ST using an online annotation platform by dental specialists. This study compared convolutional neural network architectures based on fine-tuned versions of the VGG19, ResNet34, InceptionV3, and ResNext50 architectures to select an appropriate model for autonomous segmentation of the nonlinear structure of ST.

RESULTS

The study compared training and prediction results of the selected models: VGG19, ResNet34, InceptionV3, and ResNext50. The mean IoU scores for VGG19, ResNet34, InceptionV3 and ResNext50 are 0.7651, 0.7241, 0.4717, 0.4287, dice coefficients are 0.7794, 0.7487, 0.4714, 0.4363 and loss scores are 0.0973, 0.1299, 0.2049 and 0.2251, respectively.

CONCLUSION

The obtained findings suggest that the VGG19 and Resnet34 architectures (mean IoU and dice coefficient > 75%) comparatively outperformed the InceptionV3 and ResNext50 architectures (mean IoU and dice coefficients is around 45%) for considered cephalometric radiographic dataset. The study findings can be used as a reference model for future investigation of non-linear ST morphological characteristics and related biological anomalies.

Deep learning-based automatic sella turcica segmentation and morphology measurement in X-ray images

BACKGROUND

Although the morphological changes of sella turcica have been drawing increasing attention, the acquirement of linear parameters of sella turcica relies on manual measurement. Manual measurement is laborious, time-consuming, and may introduce subjective bias. This paper aims to develop and evaluate a deep learning-based model for automatic segmentation and measurement of sella turcica in cephalometric radiographs.

METHODS

1129 images were used to develop a deep learning-based segmentation network for automatic sella turcica segmentation. Besides, 50 images were used to test the generalization ability of the model. The performance of the segmented network was evaluated by the dice coefficient. Images in the test datasets were segmented by the trained segmentation network, and the segmentation results were saved in binary images. Then the extremum points and corner points were detected by calling the function in the OpenCV library to obtain the coordinates of the four landmarks of the sella turcica. Finally, the length, diameter, and depth of the sella turcica can be obtained by calculating the distance between the two points and the distance from the point to the straight line. Meanwhile, images were measured manually using Digimizer. Intraclass correlation coefficients (ICCs) and Bland-Altman plots were used to analyze the consistency between automatic and manual measurements to evaluate the reliability of the proposed methodology.

RESULTS

The dice coefficient of the segmentation network is 92.84%. For the measurement of sella turcica, there is excellent agreement between the automatic measurement and the manual measurement. In Test1, the ICCs of length, diameter and depth are 0.954, 0.953, and 0.912, respectively. In Test2, ICCs of length, diameter and depth are 0.906, 0.921, and 0.915, respectively. In addition, Bland-Altman plots showed the excellent reliability of the automated measurement method, with the majority measurements differences falling within ± 1.96 SDs intervals around the mean difference and no bias was apparent.

CONCLUSIONS

Our experimental results indicated that the proposed methodology could complete the automatic segmentation of the sella turcica efficiently, and reliably predict the length, diameter, and depth of the sella turcica. Moreover, the proposed method has generalization ability according to its excellent performance on Test2.

Morphometric evaluation and classification of the superior orbital fissure on 3D MDCT images

The anatomy of the superior orbital fissure is very important because of the spaces it connects, the regions it is adjacent to, and the structures it contains. We aimed to study the width, length and types of the structure, their change according to gender, body sides, and age. The fissure shape has many variations that are not easy to systematize. Therefore, it was aimed to classify them with various reference points determined for the first time, identify their types and determine their incidence. An objective and comprehensive classification was used on 3-dimensional images using multidetector computed tomography. We retrospectively evaluated the orbit and paranasal sinus computerized tomography images of 200 individuals (age range: 3 months-90 years;106 female, 94 male). The shape of fissure were identified and classified, it is length and width were measured. There was no statistical difference in the length of the fissure according to gender on both sides, and in width only on the left (p˃0.05). On the right side, it was statistically significantly wider in female (p˂0.05). While the fissure types were grouped based on observation in the literature, they were defined more comprehensively according to different shape features by giving a certain reference lines by us for the first time and evaluated over seven types. The most common shape for both sides was racket-shaped type (right: 24.5%, left: 26%), while the least common was narrow type (right: 1%, left: 2%). Thus, the shape variations of structure have gained a systematic typing criterion for the first time with the definitions in our study.

A CBCT Investigation of the Sella Turcica Dimension and Sella Turcica Bridging in Different Vertical Growth Patterns

This study aimed to compare the sella turcica dimensions and sella turcica bridging (STB) via cone-beam computed tomography in different vertical patterns and then analyze the link between the sella turcica and vertical growth patterns. The CBCT images of 120 skeletal Class I subjects (an equal proportion of females and males; mean age of 21.46 years) were divided into three vertical growth skeletal groups. Student's t tests and Mann-Whitney U tests were used to assess the possible diversity in genders. The link between sella turcica dimensions and different vertical patterns was explored by one-way analysis of variance, as well as Pearson and Spearman correlation tests. The prevalence of STB was compared using the chi-square test. Sella turcica shapes were not linked to gender, but statistical differences were observed among different vertical patterns. In the low-angle group, a larger posterior clinoid distance and smaller posterior clinoid height, tuberculum sellae height, and dorsum sellae height were determined, and the incidence of STB was higher (p < 0.01). Sella turcica shapes were linked to vertical growth patterns, mainly involving the posterior clinoid process and STB, which could be used as an index to assess vertical growth trends.

Radio-Morphometric Analysis of Sella Turcica in Relation to Age and Gender in Sri Ganganagar Population: A Prospective Cephalometric Study

Background Sella turcica (ST) is a crucial structure that is morphologically situated in the median position and is well-utilised in cephalometrics. This saddle-shaped sella constitutes a significant radiographic landmark for various related analyses. Therefore, studying its varying dimensions in different populations is of utmost importance. This paper evaluates and compares the linear dimensions and morphological variations of ST in different facial skeletal classes in relation to age and gender using lateral cephalograms in the Sri Ganganagar population. Methodology The study population was selected through simple random sampling from the accessible population of the Sri Ganganagar district. A total of 180 participants of both genders were selected from patients who visited the outpatient clinic of the Department of Oral Medicine and Radiology of Surendra Dental College and Research Institute in Sri Ganganagar. These samples were equally divided into three age groups. Apart from typical morphology, five possible variations of ST were determined. The area of ST on the lateral cephalogram was also evaluated. The extent of ST was calculated from the tubercle portion to the top of the dorsal side. The relative deepness of the sella was assessed by making a tangent across the innermost point of the sella. SPSS software was utilised for statistical analysis and related inferences. Results In the study sample (n = 180), 50% were men and 50% were women. The sample was divided into three equal groups based on age: Group I (n = 60; 33.33%) consisted of participants aged 15-20; Group II (n = 60; 33.33%) consisted of participants aged 21-25; and Group III (n = 60; 33.33%) consisted of participants aged 26-30. Conclusions The anteroposterior diameter of the sella structure is strongly related to age progression with no significant gender correlation. The most common shape of ST other than the normal one was oblique. Additionally, skeletal relationships showed a significant relationship with the shape of ST in the study population.

Sella turcica dimensions and maxillary growth in patients with unilateral cleft lip and palate

OBJECTIVES

We aimed to investigate associations between sella turcica dimensions and maxillary growth in children with unilateral cleft lip and palate (UCLP).

METHODS

Forty-nine patients with non-syndromic UCLP, prior to secondary alveolar bone-grafting, were included. The outcomes measured were sella turcica and maxillary cephalometric measurements, and scores representing dental arch relationships derived from dental casts. On lateral cephalograms, sella width, height, and area were measured, as well as maxillary length, height, protrusion, and inclination. Dental arch relationships were measured using the modified Huddart/Bodenham (MHB) scoring system, and translated GOSLON yardstick score. Multiple linear regression was used to assess associations between sella turcica measurements and either cephalometric parameters or MHB/GOSLON scores, including age and sex as covariables.

RESULTS

No significant associations were found between sella turcica dimensions and dental arch relationships. For cephalometric measurements, sella height and area were associated with basal maxillary length, alveolar maxillary length, and anterior maxillary height.

CONCLUSIONS

Sella height and area seem to be predictors for both maxillary length and height as assessed cephalometrically, in a sample of patients with non-syndromic UCLP.

Relationship between palatally impacted canines and dimensions and morphology of sella turcica: A cone-beam computed tomography study

INTRODUCTION

This study aimed to analyze the association of unilateral and bilateral palatal canine impaction with the dimensions and morphology of sella turcica from 3-dimensional cone-beam computed tomography (CBCT) images.

METHODS

CBCT images of patients with bilateral (BPI) (n = 12; 9 female 3 male; 20.75 ± 5.88 years) and unilateral (UPI) (n = 35; 22 female 13 male; 19.28 ± 5.57 years) palatally impacted canines were compared with a control group (n = 56; 34 female 22 male; 20.82 ± 4.88 years). Linear measurements regarding sella turcica were made, and its morphologic variations were categorized. Two group comparisons were made with the Student t test or Mann-Whitney U-test, whereas one-way analysis of variance or Kruskal-Wallis tests were used for multiple group comparisons. Categorical variables were compared using the chi-square or Fisher exact test as appropriate. The binary logistic regression analyses and correlations using Spearman or Pearson correlation analyses were used to determine associations between variables (P <0.05).

RESULTS

Sella diameter was significantly smaller in the BPI group compared to UPI and control groups. There was a significant association between sella diameter and BPI when compared with the control group (χ2[1] = 9.150; P = 0.008). There were no significant differences between groups in the distribution of sella turcica morphology.

CONCLUSIONS

Despite the similar genetic origin of the sella turcica region and teeth, the association of palatal canine impaction with dimensions and morphology of sella turcica was weak. Both local and genetic factors might contribute to the ectopic position of the canine.

Oral manifestations of eleven individuals with Noonan syndrome. A case series

AIMS

Noonan syndrome (NS) is a clinically and genetically heterogeneous condition characterized by distinctive facial features, short stature, and congenital heart defects. The oral manifestations have not been sufficiently described. In an attempt to enrich our understanding regarding the oral manifestations, the aim of the current study was to present the clinical, radiographic, and microbiological findings of eleven subjects with NS syndrome.

METHODS AND RESULTS

A complete intraoral clinical evaluation, a radiographic analysis using panoramic and cephalometric x-rays, and a supra- and sub-gingival microbiological profiling of 20 periodontal and cariogenic microbiota using the checkerboard DNA-DNA hybridization technique were performed in a series of 11 NS individuals. Compared to previous reports very few dental findings were present. Gingivitis and carious lesions were present in all subjects and could be related to poor oral hygiene. High-arched palate and malocclusions such as crossbite, open-bite, and deep-bite were very common findings but without a specific pattern. Two findings that have not been reported before included the different shapes of the condyles and the irregular shape of the sella turcica.

CONCLUSION

Due to the elevated prevalence of gingivitis, caries, and malocclusion, a multidisciplinary approach including dental follow-ups should be the standard care in NS patients.

Convolutional Neural Network Performance for Sella Turcica Segmentation and Classification Using CBCT Images

The present study aims to validate the diagnostic performance and evaluate the reliability of an artificial intelligence system based on the convolutional neural network method for the morphological classification of sella turcica in CBCT (cone-beam computed tomography) images. In this retrospective study, sella segmentation and classification models (CranioCatch, Eskisehir, Türkiye) were applied to sagittal slices of CBCT images, using PyTorch supported by U-Net and TensorFlow 1, and we implemented the GoogleNet Inception V3 algorithm. The AI models achieved successful results for sella turcica segmentation of CBCT images based on the deep learning models. The sensitivity, precision, and F-measure values were 1.0, 1.0, and 1.0, respectively, for segmentation of sella turcica in sagittal slices of CBCT images. The sensitivity, precision, accuracy, and F1-score were 1.0, 0.95, 0.98, and 0.84, respectively, for sella-turcica-flattened classification; 0.95, 0.83, 0.92, and 0.88, respectively, for sella-turcica-oval classification; 0.75, 0.94, 0.90, and 0.83, respectively, for sella-turcica-round classification. It is predicted that detecting anatomical landmarks with orthodontic importance, such as the sella point, with artificial intelligence algorithms will save time for orthodontists and facilitate diagnosis.

Relationship between Craniovertebral Abnormalities and Maxillary Lateral Incisors Agenesis: A Case-Control Study

Objectives

This study aimed to investigate whether the sella turcica bridging (STB) and ponticulus posticous (PP) are associated with the congenital missing maxillary lateral incisor (CMMLI), based on lateral cephalograms of patients who needed orthodontic treatment.

Materials and Methods

This case-control study examined 160 panoramic images and lateral cephalograms of 2000 patients seeking orthodontic treatment. The case group included 80 patients with CMMLI (40 with unilateral and 40 with bilateral CMMLI) and the control group included 80 patients without CMMLI. Panoramic images were used to diagnose CMMLI and lateral cephalograms showed STB and PP extension. The researchers used statistical analyses to examine the relationship among STB, PP, and CMMLI (P < 0.05).

Results

The prevalence of STB type I, II, and III was 47.5%, 35%, and 17.5% in the case group and 72.5%, 22.5%, and 5% in the control group, respectively, determining a positive relationship between CMMLI and STB and a significant relationship between bilateral CMMLI and STB (P < 0.05 for both). The prevalence of normal, incomplete, and complete PP extension was 80%, 5%, and 15% in the case group and 82.5%, 5%, and 12.5% in the control group, respectively. There was no significant relationship between CMMLI and PP extension (P > 0.05) and between the STB and the PP extension (P > 0.05).

Conclusion

CMMLI was significantly related to STB but not to PP extension. Investigating the relationship between unilateral/bilateral CMMLI, STB, and PP has shown only a significant relationship between bilateral CMMLI and STB. There was no significant relationship between STB and PP extension.

Soft-Tissue Analysis of Different Sagittal Skeletal Patterns Using the Geometric Morphometric Method

OBJECTIVES

 This study aimed to investigate the size and shape variations of soft-tissue patterns in different sagittal skeletal patterns using the geometric morphometrics method (GMM) obtained from lateral cephalograms.

MATERIALS AND METHODS

 This is a retrospective study, where the sample comprised of 188 Malaysian Malay subjects aged between 18 and 40 years and with different sagittal skeletal patterns. Overall, 71 males and 117 females were gathered for all size and shape analyses. This study incorporated 11 soft-tissue landmarks, which underwent landmark application using tpsDig2 software version 2.31, while the shape analysis was done using MorphoJ software version 1.07a.

STATISTICAL ANALYSIS

 Statistical analyses were performed using IBM SPSS Statistics 26. The result of the analysis of variance (ANOVA) test showed significant differences in some of the parameters between the landmarks. Length D, Length E, Length F, Length H, and Length I showed significant differences (p < 0.05), while other parameters showed no difference (p > 0.05).

RESULTS

 The shape variation of soft-tissue landmarks in different skeletal patterns existed in 18 different dimensions which showed by 18 principal components (PCs). Procrustes ANOVA and canonical variate analysis showed the size and shape differences of soft-tissue patterns between Class II and III and gender groups (p < 0.0001). In discriminant function analysis for Class II subjects, the classification accuracy was 98.4%, whereas subsequent to cross-validation, the classification accuracy was 90.6%. For Class III subjects, the classification accuracy was 96.6%, while after cross-validation, the classification accuracy was 90%.

CONCLUSION

 Different sagittal skeletal patterns demonstrated different soft-tissue shape variations. Class III showed the most protrusive upper and lower lips, while Class II demonstrated the most retrusive lower lip.

Craniofacial measurements in children with sella turcica shape’s anomalies

Objectives:

The objective of the study is to evaluate the cephalometric measurements of Tunisian children who presented sella turcica’s (ST) shape anomalies.

Materials and Methods:

This cross-sectional study was conducted between January and June 2019 in the Department of Pediatric Dentistry of Monastir and Faculty of Dentistry of Tunisia. Radiographs were gathered from patients aged between 7 and 12 years old (n = 104) who had consulted for a malocclusion. The inclusion criteria were considered as follows: Good visibility of anatomic structures and absence of congenital craniofacial deformities. We excluded bad radiographs with errors and discrepancies: Double limits, deformities as well as children having hereditary craniofacial anomalies and underlying diseases. The cephalometric analysis was conducted according to Segner and Hassund’s method. ST’s shape was identified according to Axelsson’s classification modified by Becktor. The sample size was divided into groups: Group 1 with normal ST’s shape and Group 2 with sella’s anomaly. Statistics were performed using IBM SPSS STATISTICS 22. Data normality has been tested using Shapiro–Wilk test. The normality of variance was investigated too with Levene’s test, and comparison of means between groups was performed with t-test.

Results:

The prevalence of aberrations of ST’s form in Tunisian children is about 59.6%. The inclination of upper incisors to the maxilla differed in children with ST’s anomaly compared to normal kids. Children with sella aberration are characterized by retroclination of upper incisors to the maxilla. The variables which showed a statistically significant relationship between abnormalities of ST and cephalometric measurements were 1+NA with P = 0.03 and NL-NSL with P = 0.04.

Conclusion:

The prevalence of ST’s shape anomalies in Tunisian children is about two-thirds. It seems that the anomaly of ST influences the position of the maxilla to the cranial base and the position of upper incisors to the maxilla.

A geometric morphometric evaluation of facial hard tissue patterns

OBJECTIVE:

The purpose of this study was to investigate the size and shape variations of hard tissue patterns in different skeletal relations in Malaysian Malay subjects using the two-dimensional geometric morphometrics method.

MATERIALS AND METHODS:

A total of 188 lateral cephalograms of adult Malay subjects (aged between 18 and 40 years) with Class I, II, and III skeletal relations were collected. Ten two-dimensional hard tissue landmarks were applied on lateral cephalograms which underwent landmark application and shape analyses as Procrustes ANOVA analysis, principal component analysis, canonical variate analysis, and discriminant function analysis. Statistical analyses were performed to find the mean and variance of each landmark using one-way ANOVA. The raw data from shape analysis were used to calculate the link between landmarks.

RESULTS:

Skeletal relations showed 16 Principal Components which indicated that variances existed in 16 different dimensions. In Procrustes ANOVA, the Centroid size was significantly different in genders and skeletal relations (P < 0.01). Canonical variate analysis showed the highest Mahalanobis distances and Procrustes distances between Class II and III among skeletal relations and between gender groups (P < 0.0001). Discriminant function analysis showed the classification was mostly accurate, especially for Class II and Class III with success rates of 90.6% and 83.3%, respectively, after cross-validation. The statistical analysis showed significant differences (P < 0.05) in hard tissue landmarks.

CONCLUSION:

There were different ANB angles in different skeletal relations. The GMM could be used as an alternative tool for diagnosis and treatment planning for craniofacial shape evaluations for future orthodontists and maxillofacial surgeons.

Sella Turcica Abnormalities, Dental Age and Dental Abnormalities in Polish Children

The frequency of some sella turcica abnormalities on cephalometric radiographs is age related. Chronological age might not overlap with growth; however, no studies could be found on the association between sellar morphology and dental age. Although an association exists between sella turcica bridging and dental abnormalities, no studies have been found correlating sellar abnormalities other than bridging with dental abnormalities. The aim of this study was to find any correlations between sella turcica abnormalities and dental age or dental abnormalities. Methods: Lateral cephalograms and panoramic radiographs of 206 children aged 6–15 years were analyzed for sela turcica abnormalities, Demirijan dental age, and dental abnormalities. Results: The prevalence of dental abnormalities in patients with sela turcica abnormalities was 16.98%, while in those with normal sella, it was 3%. The differences between dental and chronological age were higher in patients with sella turcica abnormalities (p = 0.002). Dental abnormalities were more prevalent (p = 0.001) in patients with sellar abnormalities other than sellar bridging than in those with sellar bridging or normal sella. Conclusions: Sella turcica abnormalities are correlated with delayed dental age. Dental abnormalities are more frequent in patients with sellar abnormalities. Dental abnormalities are less frequent in subjects with sellar bridges compared to those with other sellar abnormalities.

Is there a relationship between transverse maxillary deficiency and sella turcica: A cephalometric analysis study?

Objectives:

The aim of this study was to investigate the dimensions and morphological variations of sella turcica and to test whether a relationship exists between sella turcica and transverse maxillary deficiency.

Materials and Methods:

The cephalometric radiographs of patients older than 17.99 years, which have been taken before the orthodontic treatment, and patient records were analyzed to investigate sella turcica dimensional and morphological analysis. Linear measurements of sella are as follows sella length, sella width, sellar area, sella height anterior, posterior, and median. The sella turcica morphological shape analysis was performed into six groups (normal sella turcica, oblique anterior wall, sella turcica bridge, double contour of floor, irregularities of the posterior part of the dorsum sella, and pyramidal shape of the dorsum sella). The width of the maxillary arch is measured by the digital caliper. Male participants with a maxillary width of less than 30.8 mm and a maxillary width of less than 31.1 mm in female patients in the first molar region were determined as a transverse maxillary deficiency. The mean dimensions of sella turcica and the relationship between cases with transverse maxillary deficiency and non-skeletal anomaly were compared using independent samples t-tests. The transverse maxillary deficiency and the sellar morphology relationship were compared using Chi-square test. Post hoc multiple comparisons and analyzes were performed at 95% confidence interval by Bonferroni correction.

Results:

The sella length measurements yielded higher values among the patients with transverse maxillary deficiency (P < 0.05). The normal sella morphology had quantitative superiority in patients without skeletal anomaly in comparison with transverse maxillary deficiency cases (P < 0.05). It was observed that the sella turcica bridge had a statistically superiority in patients with transverse maxillary deficiency (P < 0.05).

Conclusion:

The increased sellar measurement and sella turcica bridging, may provide knowledge about possible transverse maxillary deficiency.

The Shapes and Normal Dimensions of the Sella Turcica

OBJECTIVE

The aim of this study was to evaluate the normal dimensions and shape of the sella turcica (ST) in the Turkish population using multidetector computed tomography.

METHODS

This single-center, retrospective study included 188 patients who met the study criteria and had paranasal multidetector computed tomography taken between January 2019 and December 2019. The patients included in the study comprised 77 females and 111 males. The whole patient group was separated into 3 age groups of 18 to 25 years (group 1), 25 to 40 years (group 2), and 40 years and over (group 3). They were also separated according to gender.

RESULTS

The mean length of the ST was determined as 8.52 ± 1.42 mm (min-max 4.61-12.73 mm), mean height as 7.00 ± 1.31 mm (min-max 3.00-10.51 mm), mean aperture as 6.50 ± 2.00 mm (min-max 2.24-12.51 mm), and mean width as 11.01 ± 1.50 mm (min-max 7.78-14.94 mm). No statistically significant difference was determined between the length, height, width, and aperture size values of the ST according to gender and age groups.

CONCLUSION

The results of this study demonstrated no significant difference in ST dimensions according to gender or age groups. It can be considered that the shape and dimensions of the ST can be more accurately evaluated with computed tomography and classification can be more robustly applied.

The bridging and normal dimensions of sella turcica in Yemeni individuals

Objective

This study aimed to evaluate and compare sizes, shapes and bridging of the sella turcica (ST) in Yemeni individuals with different skeletal patterns, genders, and ages, and to assess the association between the linear dimension of ST and gender, age, or skeletal patterns. The standard anatomical structure of ST among Yemeni subjects is still unknown and this study can be considered as the first reference regarding ST of Yemeni individuals.

Materials and methods

Cephalogram images for 234 subjects (167 females and 67 males) were traced and classified for groups by gender, age, and dentofacial skeletal patterns. Size, shape, and bridging of ST were assessed. Multivariate ANOVA (MANOVA) analysis was used to detect the interaction between gender, age, and skeletal patterns on ST dimensions.

Results

The mean values for length, anteroposterior diameter, and depth of ST were 8.02 ± 1.67, 11.37 ± 1.60, and 8.56 ± 1.26 mm, respectively. A significant difference in length of ST between gender and age stages (p < 0.05) was detected while older subjects revealed a greater anteroposterior diameter than younger subjects (p < 0.05). The morphological variations of ST were observed in 55.6% of samples. No significant association between the shape of ST and skeletal patterns (p > 0.05) was found.

Conclusions

ST bridging was highly prevalent in Yemeni subjects (35.9%). Samples showed a higher rate of complete ST bridging in the three skeletal patterns, Class I (17.1%), Class II (18.9%), and Class III (20%). ST dimensions and shape findings in this study can be used as reference standards for further investigation, including the ST area in the Yemeni population.

Diagnostic accuracy of lateral cephalograms and cone-beam computed tomography for the assessment of sella turcica bridging

INTRODUCTION

The purpose of this research was to assess the diagnostic accuracy of sella turcica bridging on lateral cephalograms when compared with true sella turcica bridging determined via cone-beam computed tomography (CBCT).

METHODS

A cross-sectional study was conducted using CBCT images from which lateral cephalograms were generated. The study included 185 subjects (118 females and 67 males; age range, 10-30 years; mean age, 16.63 ± 4.20 years). Sella turcica landmarks and related measurements were calculated for both diagnostic modalities and analyzed by 1 examiner. Subjects were classified into 1 of 3 outcome groups: no bridging, partial bridging, and complete bridging. Diagnostic accuracy was evaluated using sensitivity, specificity, positive and negative predictive values, and receiver operator characteristic curves.

RESULTS

Ten patients were diagnosed as complete bridging on CBCT, whereas 31 patients were diagnosed as complete bridging on lateral cephalogram. Although the lateral cephalogram detected all subjects with complete bridging, it incorrectly classified 12% of subjects. The percent agreement between both diagnostic methods was 55.68%, with a kappa statistic of 0.22 on the right sella turcica and 0.20 on the left sella turcica, indicating fair but statistically significant agreement. The overall accuracy of lateral cephalograms as a diagnostic modality in discriminating between no bridging and partial bridging was good as determined with the area under the curve values of 0.86 and 0.85 for right and left sides, respectively.

CONCLUSIONS

Although lateral cephalograms overestimate patients with complete bridging compared to CBCTs, they are a suitable screening modality for accurately suggesting complete sella turcica bridging and differentiating between patients with no bridging and partial bridging.

Sella turcica bridging and ponticulus posticus calcification in subjects with different dental anomalies

INTRODUCTION

This study aimed to evaluate and compare the bridging and dimensions of the sella turcica and calcification of the ponticulus posticus in subjects with different dental anomalies.

METHODS

Pretreatment records of orthodontic patients with palatally impacted canines (n = 95), mandibular second premolar agenesis (n = 45), maxillary lateral incisor agenesis (n = 75), tooth transpositions (TT, n = 25), peg-shaped maxillary lateral incisors (n = 30), and third molar agenesis (TMA, n = 145) were analyzed and compared with the control group (CG) consisting of 145 subjects with skeletal Class I malocclusion and no dental anomalies. The length, diameter, and depth of the sella turcica were calculated for each patient. The degree of sella turcica bridging was scored as type I, II, and III, whereas the extent of ponticulus posticus was classified as Class I, II, and III.

RESULTS

Only decreases in the length and diameter of the sella turcica in subjects with TT were found to be statistically significant. Although type II bridging frequency was found to be significantly lower in subjects with mandibular second premolar agenesis, maxillary lateral incisor agenesis, TT, and TMA, type III bridging frequency was found to be significantly higher only in subjects with TMA. The decrease in Class I calcification frequencies and the increase in Class II calcification frequencies were found to be significant in subjects with palatally impacted canines, TT, and TMA compared with the CG. In addition, the presence of Class III calcification was found to be significantly more frequent in subjects with TMA than in the CG.

CONCLUSIONS

Although type II and type III bridging frequencies were found to be higher than in previous studies because of the higher type II bridging frequency in the CG, type II bridging frequency was found to be insignificant. Furthermore, an increased frequency of ponticulus posticus calcification was observed in subjects with palatally impacted canines, TT, and TMA.

Sella turcica morphology in patients with genetic syndromes: A systematic review

The sella turcica is an important anatomical reference used in orthodontics for the evaluation of craniofacial growth. Studies have found variations in the sella turcica morphology in patients with syndromes affecting the craniofacial complex. This review aims to determine whether genetic syndromes involving the craniofacial complex are associated with abnormal radiographic sella turcica morphology and whether there is a pattern of malformation which is consistent within each syndrome. An electronic database search was conducted to identify relevant studies. We included primary studies describing the morphology of the sella turcica on lateral radiographs in human subjects with genetic syndromes involving the craniofacial complex. No restrictions were placed on language or timeframe. PROSPERO registration CRD42019148060. Thirty-eight studies were included in this review. A 'J'-shaped sella was found in patients with Hutchinson-Gilford-Progeria syndrome and other syndromes. A bulbous dorsum sellae was highly prevalent Cleidocranial dysplasia, and a bulbous dorsum sellae and uneven contours of the clivus was found in Cri du chat syndrome. A steep clivus was described in patients with Axenfeld-Rieger syndrome. An oblique anterior wall was the most frequent malformation found in Down's syndrome. Genetic syndromes affecting the craniofacial complex are associated with abnormal morphology of the radiographic sella turcica. Clinicians should be observant of abnormal sella turcica morphology which can be a sign of undiagnosed or subclinical syndromes. More high-quality studies are needed which use standardized and objective methods of determining the morphology of the sella turcica.

Sella Turcica Morphology on Cephalometric Radiographs and Dental Abnormalities-Is There Any Association?-Systematic Review

BACKGROUND

The sella turcica is a saddle-like structure in the middle cranial fossa on the intracranial surface of the sphenoid bone, visible on lateral cephalograms routinely conducted for orthodontic diagnosis. The development of facial structures follows similar traits to the sella turcica: glandular anomalies may be associated with functional disorders, e.g., altered hormonal levels, thus influencing dental development. The aim of this study is to find out if there is any association between the morphology of the sella turcica on cephalometric radiographs and the presence of dental abnormalities. (2) Methods: The search was conducted on 27 January 2021 in four search engines: Medline (PubMed Central), Scopus, Web of Science, Embase. The keywords used in the search strategy were as follows: "sella turcica" AND ("dental abnormalities" OR "dental anomalies" OR "malocclusion"). Since all the studies finally included were retrospective case-control studies, the Newcastle-Ottawa Quality Assessment Form for Case-Control Studies was applied. (3) Results: The search strategy identified 465 articles: 289 from PubMed, 121 from Scopus, 32 from Web of Science and 23 from Embase. Finally, 10 full-text papers were included into qualitative analysis. (4) Conclusions: Sella turcica bridging is very frequent among orthodontic patients. A clear association exists between dental abnormalities and sella turcica bridging.

Morphology of Sella Turcica and Bridging Prevalence Correlated with Sex and Craniofacial Skeletal Pattern in Eastern Asia Population: CBCT Study

Purpose

Sella turcica bridging (STB) refers to a rare anatomical variation formed by the ossification of the ligament between the anterior and posterior clinoid processes. The presence of the STB was significantly correlated with craniofacial skeleton classification and a higher prevalence rate in skeletal Class III. The current study is aimed at investigating the dimensions of sella turcica and the prevalence of STB in different sexes and on the three craniofacial skeletal patterns using cone beam computed tomography (CBCT).

Materials and Methods

A total of 159 adults (66 males and 93 females), including 3 different craniofacial skeletal patterns (skeletal Classes I, II, and III), were included in the study. The sella turcica dimensions and the prevalence of STB were calculated. An independent t-test and generalized linear model were used to compare the differences in the sella turcica dimensions and the skeletal relations. The Spearman rank correlation coefficient was used to analyze the correlations between sella turcica dimensions and skeletal relation.

Results

The sella length (SL) was 11.05 ± 1.80 mm for males and 10.77 ± 1.56 mm for females. The anterior clinoid distance (ACD) which was measured for the anterior width of sella turcica showed 25.83 ± 2.04 mm and 24.04 ± 2.28 mm for males and females, respectively (p < 0.0001). The overall percentage of complete bridging and partial bridging was 6.6% and 56.9%, respectively. Complete bridges were more common in males (males: 9.1%, females: 4.8%), and partial bridges were more frequent in females (males: 49.2%, females: 62.4%). Both sexes differed with respect to sella turcica dimensions. Moreover, males had a significantly larger ACD, posterior clinoid distance (PCD), and diameter of sella turcica (DST), on both sides, relative to females.

Conclusion

The prevalence rate of complete STB in the Taiwanese population was 6.6%. Significant differences between sexes were found in sella turcica dimensions. The prevalence rates of STB as well as the sella turcica dimensions did not significantly differ between different craniofacial skeletal patterns (skeletal Classes I, II, and III).

Transcranial Sonography in the Diagnosis of Pituitary Tumor-A Direct Comparison With MRI

BACKGROUND

Transcranial sonography (TCS) is a convenient tool for detecting certain brain diseases, such as brain tumors. Few studies have reported on the use of TCS in the area of Sella turcica. The accuracy and repeatability of Sella turcica with or without pituitary tumor is not clear.

PURPOSE

This study aimed to investigate the feasibility and accuracy of TCS to measure the size of Sella turcica according to the measurement in MRI and determine its diagnostic performance in individuals with pituitary tumor.

MATERIALS AND METHODS

In this cross-sectional comparative study, healthy volunteers and patients with pituitary tumor were enrolled for examination of TCS and MRI between October 2020 and July 2021. The transverse diameter (D1, cm) of Sella turcica and the volume of the pituitary tumor were measured by TCS and MRI, respectively, and compared by using Student's t-test or Mann-Whitney test, using the receiver operating characteristic (ROC) curve to analyze the diagnostic value of D1 in TCS for pituitary tumor.

RESULTS

A total of 75 healthy volunteers and 51 patients with pituitary tumor were evaluated. In healthy volunteers, the mean D1 was 1.30 ± 0.35 (range, 0.82-3.22) by TCS and 1.32 ± 0.29 (range, 0.94-3.02) by MRI (P = 0.054). In patients with pituitary tumor, the mean D1 was 2.0 ± 0.65 (range, 0.90-3.48) by TCS and 2.42 ± 1.0 (range, 0.80-4.70) by MRI (P = 0.000). The median measurement volume was 4.41 and 6.59 cm³ in TCS and MR, respectively (P = 0.000). The mean D1 was 1.31 ± 0.35 in healthy volunteers and 2.0 ± 0.65 cm in patients with pituitary tumor (P = 0.000). In the ROC curve analysis, the area under the curve was 0.836, and the optimal cutoff value (1.56) exhibited a sensitivity and specificity of 67.31 and 88.0%, respectively.

CONCLUSION

The consistency between the two imaging technologies performed well in D1 measurement, while the volume of the pituitary tumor was smaller as assessed by TCS than by MRI. D1 in TCS had good diagnostic performance in pituitary tumor.

Sella Turcica Morphology in Patients With Genetic Syndromes: Protocol for a Systematic Review

Background

The sella turcica is an important anatomical reference used in orthodontics and the evaluation of craniofacial growth. Studies have found an association between variations in sella turcica morphology in patients with certain syndromes affecting the craniofacial complex. It is hypothesized that each related syndrome or pathological condition is associated with a specific pattern of malformation of the sella turcica.

Objective

This study outlines the protocol for a systematic review that aims to determine if genetic syndromes involving the craniofacial complex are associated with abnormal radiographic sella turcica morphology and if there is a pattern of malformation that is consistent with each syndrome.

Methods

An electronic database search was conducted using a planned search strategy to identify relevant studies. We included primary studies evaluating the morphology of the sella turcica based on imaging from a lateral view. Specifically, only studies with postnatal human participants with genetic syndromes involving the craniofacial complex were included in this review. We placed no restrictions on the language or time frame of these studies. Based on the search findings, studies were further screened for relevance and eligibility by two independent reviewers. Data were extracted from the selected studies. We assessed the selected studies for risk of bias and quality by using risk of bias tools from the Joanna Briggs Institute. We will provide a narrative synthesis of our findings and a structured summary based on prespecified themes.

Results

The protocol is registered with PROSPERO (#CRD42019148060) and approved by the University of Western Cape Biomedical Science Research Ethics Committee (BM205/3). The literature search was conducted in September 2019 and updated in July 2020. The study was completed in August 2020, and the findings will be published in an open-access journal.

Conclusions

The results of this systematic review are expected to provide a comprehensive list of morphological variations of the sella turcica, which will aid in the identification of syndromes associated with the craniofacial complex. We also expect to identify patterns of sella turcica morphology that highlight genotype-phenotype correlations, thus adding to the body of evidence relating to genetics and craniofacial malformations.

Trial Registration

PROSPERO International Prospective Register of Systematic Reviews CRD42019148060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=148060

International Registered Report Identifier (IRRID)

RR1-10.2196/16633