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

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.

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).

Sella turcica and facial bones: Morphological integration in the human fetal cranium

OBJECTIVES

The cranial base plays a significant role in facial growth, and closer analyses of the morphological relationship between these two regions are needed to understand the morphogenesis of the face. Here, we aimed to study morphological integration between the sella turcica (ST) and facial bones during the fetal period using geometric morphometrics.

MATERIALS AND METHODS

Magnetic resonance images of 47 human fetuses in the Kyoto Collection, with crown-rump lengths of 29.8-225 mm, were included in this study. Anatomical homologous landmarks and semilandmarks were registered on the facial bones and the midsagittal contour of the ST, respectively. The shape variations in the craniofacial skeleton and the ST were statistically investigated by reducing dimensionality using principal component analysis (PCA). Subsequently, the morphological integration between the facial bones and ST was investigated using two-block partial least squares (2B-PLS) analysis.

RESULTS

PCA showed that small specimens represented the concave facial profile, including the mandibular protrusion and maxillary retrusion. The 2B-PLS showed a strong integration (RV coefficient = 0.523, r = .79, p < .01) between the facial bones and ST. The curvature of the anterior wall of the ST was highly associated with immature facial morphology characterized by a concave profile.

CONCLUSION

The strong integration between the two regions suggested that the anterior ST may be associated with facial morphology. This result quantitatively confirms previous studies reporting ST deformities in facial anomalies and induces further research using postnatal subjects.

The Relationship Between Orthodontic Malocclusion and Morphological Features of Sella Turcica Bridging and Ponticulus Posticus

Background and Objectives: Recent years have been marked by a search for new relationships between malocclusions and the morphological features of the cranial base and upper cervical spine. The aim of this study was to evaluate the relationship between skeletal orthodontic malocclusions and the morphological features of sella turcica bridging (STB) and ponticulus posticus (PP). Materials and Methods: The study sample consisted of 300 randomly selected pre-orthodontic treatment patients aged 7-40 years. Cephalometric analysis was performed twice by two researchers. The patients were divided into three groups according to the type of skeletal malocclusion. Statistical analysis was performed using SPSS 29.0 software. Results: The prevalence of incomplete PP was 40%, and the prevalence of complete PP was 11.33% and was significantly more common in males (56.7%). STB had a prevalence of 52.67% (15.67% complete, 37.0% partial), with a significantly higher prevalence in females (60.1%, p < 0.001). PP and STB were more common in Class II patients, followed by Class I and Class III. However, only PP showed a statistically significant difference (p = 0.042). According to logistic regression, men were twice as likely to have an open groove of PP (p = 0.015), while females had higher odds of partial and complete STB (p < 0.05). Class II malocclusion increases the odds of type 2 and type 4 PP as well as partial STB. However, it was not statistically significant (p > 0.05). Conclusions: The morphological features of sella turcica bridging and ponticulus posticus were related to sex and the orthodontic skeletal pattern. Ponticulus posticus was more prevalent in males, while sella turcica bridging was more prevalent in females; both conditions were more common in patients with a Class II skeletal pattern. Males were more likely to have an open groove of ponticulus posticus, whereas females were twice as likely to have both forms of sella turcica bridging.

The relationship between sphenoidal sinus and sella turcica morphometry in the Turkish population: a retrospective study

PURPOSE

The anatomical position of the sphenoidal sinus (SS) is very important for neurosurgeons because of the transsphenoidal approach to the pituitary gland. Therefore, the aim of this study was to determine the volume and shape of the SS and its relationship with the morphometry of the sella turcica.

METHODS

This study included CT images of 282 males and 258 females with a mean age of 50.52 years (range 18-75) who underwent head CT. The morphometric values of the sella turcica and the volume of the SS were measured on the included radiologic images. Measurements were made on the sagittal slice closest to the midline in T1 sequence. Morphometric measurements were made with Micro Dicom Viewers software program and volume measurements were made with ITK SNAP software program.

RESULTS

In this study, 4 types of SS shapes were obtained in the whole population: amorphous, pentagonal, triangular and quadrilateral. The mean SS volume was 7055.88 mm3 in males and 5694.48 mm3 in females and a statistically significant difference was observed (p < 0.001). In addition, a statistically significant difference was found between the sexes in the width and surface area parameters of the sella turcica (p < 0.05).

CONCLUSION

In this study, the morphometric relationship between the shape of the sinus sphenoidale and sella turcica was demonstrated between men and women. In particular, the shape of the sinus sphenoidale was found to be anthropometrically different between men and women in the Turkish population. It is hypothesised that the data obtained in our study will guide surgeons performing transsphenoidal approach.

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.

Exploring the association between PITX2, third molars agenesis and sella turcica morphology : PITX2, third molars agenesis and sella turcica morphology

OBJECTIVES

PITX2 is required for mammalian development and single nucleotide polymorphisms (SNPs) in this gene could be involved in dental agenesis and sella turcica patterns. Thus, the present study evaluated the association between SNPs in PITX2, third molars agenesis and sella turcica phenotypes.

MATERIALS AND METHODS

The sample consisted of healthy orthodontic German patients with lateral cephalometric radiographs with clearly visualization of the sella turcica, and dental orthopantomograms. The morphological variations of the sella turcica were evaluated using the lateral cephalograms, while third molar agenesis was evaluated using orthopantomograms. DNA isolated from buccal cells was used for genotyping three SNPs in PITX2 (rs3796902, rs1947187, and rs2595110). The analyzes were performed using a significance of 5%. There was no association between third molar agenesis and sella turcica phenotypes (p > 0.05). SNPs in PITX2 were also not associated with third molars agenesis (p > 0.05).

RESULTS

SNPs in PITX2 were associated with sella turcica phenotypes. The rs3796902 was associated with hypertrophic posterior clinoid process (p = 0.013). The rs1947187 and rs2595110 were associated with sella turcica bridge type A (p = 0.013 and p = 0.011, respectively for genotype distribution). Patients that carry the genotypes GG-CC-AG (rs3796902- rs1947187- rs2595110) had 7.2 higher chance to present sella turcica bridge type A (p = 0.002; Odds ratio = 7.2, Confidence interval 95% 2.04-27.04).

CONCLUSIONS

Third molar agenesis was not associated with SNPs in PITX2 and sella turcica phenotypes. SNPs in PITX2 may have an important role in sella turcica pattern.

Relationship of the Morphology and Size of Sella Turcica with Dental Anomalies and Skeletal Malocclusions

This study aimed to assess the relationship of the morphology and size of the sella turcica (ST) with dental anomalies and skeletal malocclusions. This cross-sectional study was conducted on records of fixed orthodontic patients treated between 2013 and 2022. Cephalometric analysis was performed to determine the anteroposterior and vertical skeletal patterns. Preoperative panoramic radiographs and lateral cephalograms, intraoral photographs, and primary dental casts of patients were used to detect dental anomalies. Gender, sagittal and vertical skeletal patterns, dental anomalies, and dimensions (length, depth, and diameter), and morphology of the ST were all recorded according to the lateral cephalograms of patients. Data were analyzed using independent t-test, one-way and two-way ANOVA, Chi-square test, and log rank test (alpha = 0.05). The depth and diameter of the ST had no significant correlation with gender (p > 0.05); however, the length of the ST was significantly longer in males than females (p < 0.05). The morphology of the ST had a significant correlation with gender (p < 0.05). The ST morphology had a significant correlation with the anteroposterior skeletal pattern, microdontia, and tooth impaction as well (p < 0.05). The present results revealed a significant correlation of the ST morphology with the anteroposterior skeletal pattern, microdontia, and tooth impaction.

Anatomical features of sella turcica with comprehensive literature review

OBJECTIVE

This study aimed to explore the relationship between skeletal patterns and the frequency of sella turcica bridging in a sample of young Turkish adults in order to provide a better understanding of the relationship between craniofacial morphology and sella turcica abnormalities.

METHODS

A total of 90 individuals aged between 18 and 25 years were examined in this study. The individuals were classified according to their skeletal pattern, specifically Class I, Class II, and Class III. Each group consisted of 15 males and 15 females. The length, depth, and anteroposterior diameter of sella turcica were calculated. The shape and bridging of sella turcica were estimated using lateral cephalometric images. All data were correlated and statistically analyzed according to skeletal patterns, genders, and age.

RESULTS

The mean length, depth, and anteroposterior diameter of sella turcica were 7.02±2.13, 7.56±1.38, and 10.54±1.3 mm in Classes I-III, respectively. There was no significant difference between the dimensions of sella turcica according to gender and age (p˃0.05). The length of sella turcica was larger in Class III, and the depth of sella turcica was larger in Class II individuals (p<0.05). A total of 44.4% of the individuals had normal sella turcica, while the remaining 56.6% had other types of sella turcica. It was determined that 31.1% of the individuals have no calcification, 62.2% had partial calcification, and 6.7% had total calcification.

CONCLUSION

The normal dimensions, shape, and bridging of the sella turcica can be used by the orthodontist for diagnosis, treatment planning, and evaluation of various pathological conditions associated with the sella turcica.

Assessing the relationship between single nucleotide polymorphisms in Wingless signaling pathway genes and sella turcica morphology

Sella turcica development involves molecular factors and genes responsible for ossification. It is possible that single nucleotide polymorphisms (SNPs) in key genes are involved in morphological variation of sella turcica. Genes belonging to the WNT signaling pathway are involved in the ossification process and are candidates of sella turcica morphology. This study aimed to evaluate if SNPs in WNT6 (rs6754599) and WNT10A (rs10177996 and rs3806557) genes are associated with the calcification and patterns of the sella turcica. Nonsyndromic individuals were included in the research. Cephalometric radiographs were examined and the sella calcification was evaluated and classified according to the calcification of the interclinoid ligament (no calcification, partial calcification, and incomplete calcification) and sella turcica pattern (normal sella turcica, bridge type A-ribbon-like fusion, bridge type B-extension of the clinoid processes, incomplete bridge, hypertrophic posterior clinoid process, hypotrophic posterior clinoid process, irregularity in the posterior part, pyramidal shape of the dorsum, double contour of the floor, oblique anterior wall, and oblique contour of the floor). DNA samples were used to evaluate SNPs in the WNT genes (rs6754599, rs10177996, and rs3806557) using real-time PCR. Chi-square test or Fisher's exact test were used to compare the allele and genotype distributions according to sella turcica phenotypes. The alpha was set as 5% for all comparisons. A total of 169 individuals were included, 133 (78.7%) present sella turcica partially or completely calcified. Sella turcica anomalies were found in 131 individuals (77.5%). Sella turcica bridge type A (27.8%), posterior hypertrophic clinoid process (17.1%), and sella turcica bridge type B (11.2%) were the most prevalent morphological patterns observed. Individuals carrying the TT genotype in rs10177996 (TT vs. CT + CC) had higher chance to present a partially calcified sella turcica (p = 0.047; Odds ratio = 2.27, Confidence Interval 95% 1.01-5.13). In conclusion, the SNP in WNT10A is associated with the calcification phenotype of the sella turcica, the pleiotropic effect of this gene should be taken into consideration in future studies.

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.

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.

The Skull's Girder: A Brief Review of the Cranial Base

The cranial base is a multifunctional bony platform within the core of the cranium, spanning rostral to caudal ends. This structure provides support for the brain and skull vault above, serves as a link between the head and the vertebral column below, and seamlessly integrates with the facial skeleton at its rostral end. Unique from the majority of the cranial skeleton, the cranial base develops from a cartilage intermediate-the chondrocranium-through the process of endochondral ossification. Owing to the intimate association of the cranial base with nearly all aspects of the head, congenital birth defects impacting these structures often coincide with anomalies of the cranial base. Despite this critical importance, studies investigating the genetic control of cranial base development and associated disorders lags in comparison to other craniofacial structures. Here, we highlight and review developmental and genetic aspects of the cranial base, including its transition from cartilage to bone, dual embryological origins, and vignettes of transcription factors controlling its formation.