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Craniofacial Asymmetry in Adults With Neglected Congenital Muscular Torticollis.

Jeong KY, Min KJ, Woo J, Yim SY - Ann Rehabil Med (2015)

Bottom Line: The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06±0.03 and 1.07±0.03, respectively, which was increased significantly with age in the linear regression analysis (r(2)=0.176, p=0.019 and r(2)=0.188, p=0.015, respectively).The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05).This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.

View Article: PubMed Central - PubMed

Affiliation: The Clinic for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Objective: To evaluate the craniofacial asymmetry in adults with neglected congenital muscular torticollis (CMT) by quantitative assessment based on craniofacial three-dimensional computed tomography (3D-CT).

Methods: Preoperative craniofacial asymmetry was measured by 3D-CT for 31 CMT subjects ≥18 years of age who visited a tertiary medical center and underwent 3D-CT between January 2009 and December 2013. The relationship between the age and the severity of craniofacial asymmetry was analyzed in reference to anteroposterior length asymmetry of the frontal bone and zygomatic arch, vertical and lateral displacements of the facial landmarks, and mandibular axis rotation.

Results: The age at CT was 27.71±7.02 years (range, 18-44 years). All intra-class correlation coefficients were higher than 0.7, suggesting good inter-rater reliability (p<0.05) of all the measurements. The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06±0.03 and 1.07±0.03, respectively, which was increased significantly with age in the linear regression analysis (r(2)=0.176, p=0.019 and r(2)=0.188, p=0.015, respectively). The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05).

Conclusion: Craniofacial asymmetry of neglected CMT became more severe with age in terms of anteroposterior length asymmetry of the ipsilateral frontal bone and zygomatic arch on the axial plane even after growth cessation. This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.

No MeSH data available.


Related in: MedlinePlus

Measurement of the anteroposterior length asymmetry on the axial plane. (A) The FLR, b/a, which represents the anteroposterior length asymmetry of the OS on the CMT side in comparison with that on the non-CMT side on the superior cranial view. The z1-axis was defined as the coronal line perpendicular to the sagittal plane, which crosses the intersection of the 2 diagonals from the OS. (B) The ZLR, d/c, which represents the anteroposterior length asymmetry of the ZM on the CMT side in comparison with that on the non-CMT side on the inferior cranial view. The z2-axis was defined as the line connecting the bilateral MA. (C) Linear regression analysis between FLR and the subjects' ages. (D) Linear regression analysis between ZLR and the subjects' ages. The scatter plots of FLR and ZLR show statistically significant linear correlation (*p<0.05) with age. OS, orbitale superius; CMT, congenital muscular torticollis; ZM, zygomaxillare; MA, mastoid processes.
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Figure 1: Measurement of the anteroposterior length asymmetry on the axial plane. (A) The FLR, b/a, which represents the anteroposterior length asymmetry of the OS on the CMT side in comparison with that on the non-CMT side on the superior cranial view. The z1-axis was defined as the coronal line perpendicular to the sagittal plane, which crosses the intersection of the 2 diagonals from the OS. (B) The ZLR, d/c, which represents the anteroposterior length asymmetry of the ZM on the CMT side in comparison with that on the non-CMT side on the inferior cranial view. The z2-axis was defined as the line connecting the bilateral MA. (C) Linear regression analysis between FLR and the subjects' ages. (D) Linear regression analysis between ZLR and the subjects' ages. The scatter plots of FLR and ZLR show statistically significant linear correlation (*p<0.05) with age. OS, orbitale superius; CMT, congenital muscular torticollis; ZM, zygomaxillare; MA, mastoid processes.

Mentions: The cranial vault asymmetry index (CVAI) was used to measure the severity of plagiocephaly [1314]. The diagonal diameters were obtained from the orbitale superius (OS) directly above the most superior point of the superior orbital rim to the occipital landmark, which is defined by a parallel line directed posteriorly from the OS on the opposite side (Fig. 1A). CVAI (%) was calculated as [(longer diagonal shorter diagonal) / shorter cranial diagonal] × 100. Cranial asymmetry was considered significant if CVAI >3.5%, and was classified as mild (3.5%-7%), moderate (7%-12%), or severe (>12%).


Craniofacial Asymmetry in Adults With Neglected Congenital Muscular Torticollis.

Jeong KY, Min KJ, Woo J, Yim SY - Ann Rehabil Med (2015)

Measurement of the anteroposterior length asymmetry on the axial plane. (A) The FLR, b/a, which represents the anteroposterior length asymmetry of the OS on the CMT side in comparison with that on the non-CMT side on the superior cranial view. The z1-axis was defined as the coronal line perpendicular to the sagittal plane, which crosses the intersection of the 2 diagonals from the OS. (B) The ZLR, d/c, which represents the anteroposterior length asymmetry of the ZM on the CMT side in comparison with that on the non-CMT side on the inferior cranial view. The z2-axis was defined as the line connecting the bilateral MA. (C) Linear regression analysis between FLR and the subjects' ages. (D) Linear regression analysis between ZLR and the subjects' ages. The scatter plots of FLR and ZLR show statistically significant linear correlation (*p<0.05) with age. OS, orbitale superius; CMT, congenital muscular torticollis; ZM, zygomaxillare; MA, mastoid processes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496516&req=5

Figure 1: Measurement of the anteroposterior length asymmetry on the axial plane. (A) The FLR, b/a, which represents the anteroposterior length asymmetry of the OS on the CMT side in comparison with that on the non-CMT side on the superior cranial view. The z1-axis was defined as the coronal line perpendicular to the sagittal plane, which crosses the intersection of the 2 diagonals from the OS. (B) The ZLR, d/c, which represents the anteroposterior length asymmetry of the ZM on the CMT side in comparison with that on the non-CMT side on the inferior cranial view. The z2-axis was defined as the line connecting the bilateral MA. (C) Linear regression analysis between FLR and the subjects' ages. (D) Linear regression analysis between ZLR and the subjects' ages. The scatter plots of FLR and ZLR show statistically significant linear correlation (*p<0.05) with age. OS, orbitale superius; CMT, congenital muscular torticollis; ZM, zygomaxillare; MA, mastoid processes.
Mentions: The cranial vault asymmetry index (CVAI) was used to measure the severity of plagiocephaly [1314]. The diagonal diameters were obtained from the orbitale superius (OS) directly above the most superior point of the superior orbital rim to the occipital landmark, which is defined by a parallel line directed posteriorly from the OS on the opposite side (Fig. 1A). CVAI (%) was calculated as [(longer diagonal shorter diagonal) / shorter cranial diagonal] × 100. Cranial asymmetry was considered significant if CVAI >3.5%, and was classified as mild (3.5%-7%), moderate (7%-12%), or severe (>12%).

Bottom Line: The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06±0.03 and 1.07±0.03, respectively, which was increased significantly with age in the linear regression analysis (r(2)=0.176, p=0.019 and r(2)=0.188, p=0.015, respectively).The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05).This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.

View Article: PubMed Central - PubMed

Affiliation: The Clinic for Torticollis, Department of Physical Medicine and Rehabilitation, Ajou University School of Medicine, Suwon, Korea.

ABSTRACT

Objective: To evaluate the craniofacial asymmetry in adults with neglected congenital muscular torticollis (CMT) by quantitative assessment based on craniofacial three-dimensional computed tomography (3D-CT).

Methods: Preoperative craniofacial asymmetry was measured by 3D-CT for 31 CMT subjects ≥18 years of age who visited a tertiary medical center and underwent 3D-CT between January 2009 and December 2013. The relationship between the age and the severity of craniofacial asymmetry was analyzed in reference to anteroposterior length asymmetry of the frontal bone and zygomatic arch, vertical and lateral displacements of the facial landmarks, and mandibular axis rotation.

Results: The age at CT was 27.71±7.02 years (range, 18-44 years). All intra-class correlation coefficients were higher than 0.7, suggesting good inter-rater reliability (p<0.05) of all the measurements. The frontal and the zygomatic length ratio (i.e., the anteroposterior length asymmetry on the axial plane) was 1.06±0.03 and 1.07±0.03, respectively, which was increased significantly with age in the linear regression analysis (r(2)=0.176, p=0.019 and r(2)=0.188, p=0.015, respectively). The vertical or lateral displacement of the facial landmarks and rotation of the mandibular axis did not significantly correlate with age (p>0.05).

Conclusion: Craniofacial asymmetry of neglected CMT became more severe with age in terms of anteroposterior length asymmetry of the ipsilateral frontal bone and zygomatic arch on the axial plane even after growth cessation. This finding may enhance the understanding of therapeutic strategies for craniofacial asymmetry in adults with neglected CMT.

No MeSH data available.


Related in: MedlinePlus