Korean J Orthod.  2020 May;50(3):181-187. 10.4041/kjod.2020.50.3.181.

Evaluation of cephalometric characteristics and skeletal maturation of the cervical vertebrae and hand-wrist in girls with central precocious puberty

Affiliations
  • 1Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea
  • 2BK21 PLUS Project, Yonsei University College of Dentistry, Seoul, Korea
  • 3Department of Orthodontics, Gangnam Severance Dental Hospital, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, Korea

Abstract


Objective
This study aimed to evaluate the differences in cephalometric characteristics and skeletal maturation in girls with central precocious puberty (CPP) via lateral and hand-wrist radiographs. We also aimed to identify the indicators that are most effective for determining skeletal maturity in these patients.
Methods
The study included 70 Korean girls (mean age, 8.5 ± 0.5 years) diagnosed with CPP at the Department of Pediatrics, and 48 normal healthy age-matched girls who visited the Department of Orthodontics and had no history of hormone treatment or growth problems. Skeletal maturation was evaluated using lateral cephalometric and hand-wrist radiographs using cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI).
Results
The mean mandibular plane angle was smaller in the CPP group than in the control group (35.8o ± 4.9o vs. 39.0o ± 6.5o), resulting in greater posterior facial height (p = 0.003). SMI was significantly greater in the CPP group (3.5 ± 1.4 vs. 2.0 ± 1.0) than in the control group (p = 0.001) and was significantly associated with CPP (r = 0.492; p = 0.001), whereas CVMI was not.
Conclusions
In comparison with the control group, the CPP group exhibited a smaller mandibular plane angle, greater posterior facial height, and greater skeletal maturation. SMI may be more suitable than CVMI for determining skeletal maturation in CPP. Hand-wrist radiography is recommended in addition to lateral cephalogram for predicting growth in girls with CPP.

Keyword

Cephalometrics; Skeletal maturation; Central precocious puberty; Hand-wrist

Figure

  • Figure 1 Cephalometric analysis. A, Linear measurements. N-S, Anterior cranial base length; S-Ar, posterior cranial base length; ANS-PNS, maxillary length; Ar-Go, mandibular ramus height; Go-Me, mandibular corpus length; Ar-Me, total mandibular length; N-Me, anterior facial height; S-Go, posterior facial height; AO-BO, wits appraisal. B, Angular measurements. ① SNA, The relationship of the maxilla to the cranial base; ② SNB, the relationship of the mandible to the cranial base; ③ ANB, the relationship between the maxilla and the mandible; ④ SN-GoMe, mandibular plane angle; ⑤ Ar- Go-Me, gonial angle; ⑥ SN-ArGo, ramal angle; ⑦ N-S-Ar, cranial base angle. S, Sella turcica; N, nasion; Ar, articulare; ANS, anterior nasal spine; PNS, posterior nasal spine; A, point A; B, point B; AO, the point perpendicular to the occlusal plane at point A; BO, the point perpendicular to the occlusal plane at point B; Go, constructed gonion; Me, menton.

  • Figure 2 A central precocious puberty (CPP) patient exhibiting differing skeletal maturation stages on cervical vertebrae maturation indicators (CVMI) and skeletal maturity indicators (SMI). The lateral cephalogram represents CVMI 1 (A, B), and the hand-wrist radiograph represents stage SMI 6 (C, D). The CPP patient’s lateral cephalogram and hand-wrist radiograph were taken at the age of 9.4 years. They were assessed as CVMI 1, SMI 6, and a Tanner–Whitehouse 3 bone age of 11.8 years.


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