Craniofacial Asymmetry in Congenital Muscular Torticollis Patients - A Study using Cephalometry -

Dong Yeon Lee; Byung Wook Song; Tae-Joon Cho; In Ho Choi; Chin Youb Chung; Won Joon Yoo

doi:10.4055/jkoa.2007.42.1.24

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Lee, Song, Cho, Choi, Chung, and Yoo: Craniofacial Asymmetry in Congenital Muscular Torticollis Patients - A Study using Cephalometry -

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2007; 42(1): 24-31.

Published online: 28 February 2007

DOI: https://doi.org/10.4055/jkoa.2007.42.1.24

Craniofacial Asymmetry in Congenital Muscular Torticollis Patients - A Study using Cephalometry -

Dong Yeon Lee, M.D., Byung Wook Song, M.D., Tae-Joon Cho, M.D., In Ho Choi, M.D., Chin Youb Chung, M.D., Won Joon Yoo, M.D.

Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul, Korea.

Address reprint requests to Tae-Joon Cho, M.D. Department of Orthopedic Surgery, Seoul National University Children's Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea. Tel: +82.2-2072-2878, Fax: +82.2-745-3367, tjcho@snu.ac.kr

Abstract

Purpose

To propose an objective method for evaluating the craniofacial asymmetry in congenital muscular torticollis patients, and to determine the correlation between the craniofacial asymmetry and clinical parameters such as age and the limitation of neck motion.

Materials and Methods

Forty eight patients with congenital muscular torticollis, who underwent cephalometry for an evaluation, were enrolled in this study. The craniofacial curvature on the coronal plane, calvarial asymmetry, and mastoid process length were analyzed on the radiograph of the cephalometry. These radiographic measurements were analyzed to determine the correlation between the craniofacial asymmetry and clinical parameters.

Results

The craniofacial axis was tilted to the affected side by 5.2°±2.8°. The skullbase axis was tilted to the affected side by 2.6°±2.6°, and the mandible axis was tilted to the affected side by 1.0°±2.3°. The difference in the mastoid process length from the skullbase was 7.0%±8.5%. The calvarial width from the vertical midline was 15.4%±11.6% larger in the affected side. In patients older than 5 years, the mandibular tilting angle (p=0.017) and the length of the mastoid process (p=0.007) were greater than those of the younger patients.

Conclusion

We proposed a new objective method for quantifying the craniofacial asymmetry in congenital muscular torticollis patients. This method confirmed the patients to have an angular deformity and asymmetry in the craniofacial bone.

Keywords: Congenital muscular torticollis, Cephalometry, Craniofacial asymmetry

Figures and Tables

Fig. 1

The cephalometry was taken in the posteroanterior projection with the skull stabilized with a device that had references of the external auditory meatus for standardization.

Fig. 2

Parameters evaluating the craniofacial asymmetry using cephalometry. (A) The angle between the horizontal meatus line (line connecting bilateral external auditory meatus) and the horizontal petrous line (line connecting the bilateral upper margin of the petrous part of the temporal bone) was defined as the skullbase tilting angle (arrow) and the angle between the horizontal meatus line and the horizontal mandibular line (line connecting bilateral mandibualr angle) was defined as the mandibular tilting angle (arrow head). (B) The angle between the vertical cranial line(line connecting the sagittal suture and the nasal septum) and the vertical facial line(line connecting the nasal septum and the midline of two incisors of the mandible) was defined as the craniofacial tilting angle (arrow). (C) The length of the mastoid process was measured from the upper margin of the petrous part of the temporal bone to the mastoid process tip. The mastoid length difference ratio was calculated; the mastoid length of the normal side was subtracted from that of the involved side and then divided by the length of the normal side. The result is expressed as a percentage parameter. (D) The horizontal length of the skull was measured from a line passing the nasal septum, which is tangential to the horizontal meatus line to the margin of the parietal bone. The difference in the cranial asymmetry length was calculated by subtracting the length of the normal side from that of the involved side and divided by the length of the normal side. The result is expressed as a percentage parameter. (E) The horizontal lengths of the skullbase and mandibular angle were measured from the vertical facial line to the margin of the petrous part of the temporal bone and to the mandibular angle respectively. The skullbase asymmetry and the mandibular asymmetry were calculated by subtracting the length of the involved side from that of normal the side and then divided it by the length of the normal side. The result are expressed as percentage parameters. PB, petrous part of the parietal bone; EAM, External auditory meatus; MA, Mandibular angle; NS, Nasal septum; MI, midline of two central incisor; MP, Mastoid process.

Fig. 3

Difference in the length of the mastoid process length between the 4 groups. The results were analyzed by dividing the patients into four groups according to age and the difference in neck motion.

Table 1

Patients' Data

Table 2

Case Analysis according to Age

^*average±SD.

Table 3

Case Analysis according to Difference in Neck Motion

^*average±SD.

Table 4

Analytic Results between the 4 Groups using ANOVA

The results were analyzed by dividing the patients into four groups according to age and the difference in neck ROM. The mean values between 4 groups were compared.

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