Cephalometric Findings in a Normal Nigerian. Population Sample and Adult Nigerians with Unrepaired Clefts

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1 Cephalometric Findings in a Normal Nigerian Population Sample and Adult Nigerians with Unrepaired Clefts MICHAEL C. ISIEKWE, B.D.S., D. ORTH. GABRIEL O. A. SOWEMIMO, M.B., F.R.C.S. Lagos, Nigeria Cephalometric values have been established for twenty adult Nigerians, three adults with unrepaired unilateral cleft lip and alveolus (UCLA) and two adults with unrepaired unilateral cleft lip and palate (UCLP). Normal values for SNA and SNB were and respectively, and the mean ANB values were The cephalometric data for unilateral cleft lip and alveolus (UCLA) subjects whose clefts were not repaired until adulthood did not differ significantly from normal controls. However, in two adults with unrepaired unilateral cleft lip and palate (UCLP), the SNA values were less than normal controls and the ANB values were reduced to negative levels. Bimaxillary protrusion of the incisors appears to be a normal feature in Nigerians. There appears to be inhibition of maxillary growth in UCLP patients but not in UCLA cases. Cephalometric data are available in the literature for American Negroes (Drummond, R. A. (1968); Fonseca, R. I. and Klein, W. C. (1978); Hitchcock, H. P. (1970) Taylor, W. H. and Hitchcock, H. P. (1966)) but not for Africans. The aims of this study were to establish some normal cephalometric values for healthy adult Nigerian Africans, and to obtain cephalometric data on adult Nigerians whose clefts were not repaired until adulthood. Sample Twenty volunteer Nigerian Dental students were used for the study, 15 males and 5 females, ranging in age from 18 to 25 years with a mean of 21.8 yrs. Each student had an ideal occlusion i.e. a normal class I occlusion with good anterior posterior relationship of the teeth (Figure 1). The facial profile for each was good. None had ever worn an orthodontic appliance. The appearances of all the volunteers conformed to the average Nigerian African look. Beauty or the lack of it was not a criterion for selection. Five male adults with unoperated cleft lip were used for comparative study. (Figure 2). Three had unilateral cleft lip and alveolus (UCLA) and two had unilateral cleft lip and palate (UCLP). The authors are affiliated with the College of Medicine, University of Lagos, Nigeria. Address editorial correspondence to: Dr. Michael C. Isiekwe, Department of Child Dental Health, College of Medicine, University of Lagos, P.M.B , Lagos, Nigeria. Paper presented at 4th International Conference on Cleft Palate and Related Craniofacial Anomalies, Acapulco, Mexico, May 3-8, Procedure Cephalometric radiographs of the twenty volunteers were taken and of the five adults with clefts. The cephalometric films were traced and a Downs analysis used. The landmarks used in this investigation were SNA, SNB, ANB, 1 to Frankfort Plane, 1

2 FIGURE 1. Normal occlusion and facial form of a Normal Nigerian. 324

Isiekwe and Sowemimo, CEPHALOMETRIC FINDINGS IN ADULT NIGERIANS 325 FIGURE 2. An adult Nigerian with unoperated UCLA. to Mandibular Plane and F.M.A. (Figure 3).

3 Isiekwe and Sowemimo, CEPHALOMETRIC FINDINGS IN ADULT NIGERIANS 325 FIGURE 2. An adult Nigerian with unoperated UCLA. to Mandibular Plane and F.M.A. (Figure 3). The linear measurements of anterior facial height (AFH), upper facial height (UFH), lower facial height (LFH), ramal height and mandibular length were also UFH _... taken and the Trg "24 determined. (Fig. 4). A detailed definition of these landmarks has been presented elsewhere. (Bishara 1975, Bjork 1947, Krogman 1957, Meredith 1959). Results The Clinical findings showed that the three patients with unilateral cleft lip and alveolus (UCLA) had near normal molar relationships judging by the first permanent molars. There was no buccal crossbite, although there was a decrease in overbite anteriorly. _ The two Unilateral Cleft Lip and Palate (UCLP) showed marked buccal crossbite and a class III molar relationship. The incisors were in cross bite with mesiolingual rotation of the central incisor in the region of the cleft. The cephalometric data for the twenty normal adult Nigerians are shown in Table 1. The subjects were all young adults and their ages ranged from 18 to 25 years, (mean ). Table 2 presents the cephalometric data of three adults with unrepaired UCLA and two adults with UCLP. Whereas the normals and the UCLA show positive mean ANB values the UCLP have a negative mean ANB value. Discussion Normal Nigerians show higher SNA, SNB, 1 to Frankfort Plane and 1 to Mandibular Plane values than Caucasians. The

4 SNA = 86 snb = 82 ANB = 4 N rma = 20 TO MAND PLANE 103 I L To FRANK PLANE 123 FIGURE 3. Cephalometric tracing and landmarks of the Normal Nigerian shown in Figure 1. CcONDYLE (p= " 6 rare MANDIBULAR PLANE: J } CEPHALOMETRIC TRACING OF NIGERIAN ADULT g FIGURE 4. Cephalometric tracing and linear measurements of the Normal Nigerian shown in Figure 1.

5 Isiekwe and Sowemimo, CEPHALOMETRIC. FINDINGS IN ADULT NIGERIANS U NILAT. CLEF T LIP SNA = 87 SNB = 85 ANB = 2 FMA 20 T TO MAND PLANE 105 L TO FRANK PLANE 140 E Ld FIGURE 5. Cephalometric tracing of the adult Nigerian with UCLA shown in Figure 2. TABLE 1. Values for Normal Adult Nigerians (n= 20, Mean Age 21.8 Years) Mean - S.D. Mean S.D SNA AFHt SNB UFHt ANB I to FH UFH/LFH to MP Ramal Ht FMA Mand PI TABLE 2. Cephalometric Values of 5 Nigerian Adult Males with Unoperated Clefts. Cleft Age 6 o o I to Max I to Max o Subject 7»If; mg ) SNA SNB ANB Plane * Plane FMA 1. UCLA UCLA UCLA , UCLP UCLP proclination of the upper and lower inci- and Hitchcock, H. P. 1978). This is very sors indicates that Nigerians have bimaxil- evident when viewing a normal profile lary protrusion which is similar to the find- which shows a characeristic fullness of the ings in American blacks. (Alexander T. L. middle third of the face. However, the

6 328 Cleft Palate Journal, October 1984, Vol. 21 No. 4 Frankfort Mandibular plane Angle (FMA) in Nigerians appears to be much lower than the established caucasian standards. The sample of clefts (UCLA, UCLP) is small, but some interesting observations may be noted: the 3 UCLA did not show differences from the controls and the 2 UCLP showed a tendency for a class III skeletal pattern, that is, an inhibition in growth of the maxilla. Thus, a tentative answer to whether unrepaired clefts have the same dental and skeletal growth potential as non-cleft individuals is that the cranial base and face in the unoperated UCLA individuals are not extensively malrelated when compared to non-cleft cases, whereas there is inhibition of growth in the unoperated UCLP. There appear to be distinct differences in dento-alveolar and skeletal findings in the two cleft groups. Conclusions 1. Cephalometric standards for a normal Nigerian population sample appear to be different than established caucasian standards. 2. Bimaxillary protrusion of the incisors appears to be a normal feature in Nigerians. 3. There appears to be no significant difference for the values obtained for UCLA from normal controls. 4. The UCLP showed a class III skeletal tendency. 5. More work is needed, on a much larger scale before standard cephalometric val- ues for Nigerian Africans are firmly established. Acknowledgment: We are grateful to the volunteer dental students. We also wish to thank Mr. J. A. Somoye and Mr. F. S. Okwuegbuna for taking the cephalograms and the Biomedical Communication Department for the illustrations. Secretarial assistance was provided by Mrs. R. F. Okunsanya, Mrs. Joyce Pfefferman and Mrs. J. F. Adewusi. References ALEXANDER, T. L., and HITCHCOCK, H. P., Cephalometric Standards for American Negro Children. Am. J. Orthod. 74: , BIsHARA, S. E., Cephalometric evaluation of facial growth in operated and nonoperated individuals with isolated clefts of the palate. Cleft Palate J. 3: , BJORK, A., The face in profile, Svensk-Tandlakare- Tidskrift. Vol. 40 No. 58, CHIERECI, G., HARvOLD, E., and VAGERVIK, K., Morphogenetic experiments in cleft palate. Mandibular response. Cleft Palate J. 10: 51-61, DRUMMOND, R. A., A determination of cephalometric norms for the Negro race. Am. J. Orthod. 54: , FoONSECA, R. J., and KLEIN, W. D., A cephalometric evaluation of American Negro women. Am. J. Orthod. 73: , 1978.= HrrcHcock, H. P., A cephalometric supplement Am. J. Orthod. 57: 47-54, KrROGMAN, W. M., and SAssPUNI, V. A syllabus of Roentgenographic cephalometry. Philadelphia 1957 MEREDITH, H. V., A longitudinal study of growth in face during childhood. Am. J. Phys Anthtrop. 17: , TAYLOR, W. H., and HITCHOCK, H. P., The Alabama Analysis. Am. j Orthod. 52: , 1966.

instruction. The principal investigator traced and measured all cephalograms over an illuminated view box using the standard technique described Tweed

instruction. The principal investigator traced and measured all cephalograms over an illuminated view box using the standard technique described Tweed Original Article Orthodontic Journal of Nepal Vol. 1 No. 1, November 2011 (Page 11-15) TWEED'S DIAGNOSTIC FACIAL TRIANGLE FOR NEPALESE ADULTS Dr Anjana Rajbhandari Associate Professor & Head; Department