Fig. 115 Cephalometric landmarks and lines for Caucasians.

are then drawn between some of these landmarks. The angles between these can then be compared with standard values to indicate facial skeletal variations from normal. Digital photographic images may also be superimposed on the radiographic images and surgical predications carried out with the computer software. Typical Caucasian measurements are:
SNA SNB ANB

Clinical box Typical diagnosis for a dentofacial anomaly Class III skeletal relationship owing to both prognathic mandible and hypoplastic maxilla. Lower facial height increased. Competent lips and large tongue. Prominent nose and normal ears. Class III occlusal relationship with spaced lower incisors. Narrow maxillary intercanine width. All first molar teeth restored. No other restorations. Oral hygiene poor.

81 3 78 3 3 2

An ANB difference in a Negro patient of 5 is acceptable whereas in Oriental patients 3 or less is normal.

Diagnosis
For dentofacial anomalies, the diagnosis will describe the maxillary and mandibular base relationship relative to the skull together with a description of the dental occlusion and comments about general condition of the dentition and oral hygiene. The mandible and maxilla may be described as prognathic, hypoplastic or asymmetrical. The effect of these may be to produce a long face, open bite or short face. The chin may also be described using various classifications of excess (macrogenia),

hypoplasia (microgenia) and asymmetry. For craniofacial anomalies, the diagnosis will also describe the orbits, eyes, ears and other features and may suggest various syndromes in a differential diagnosis.

Treatment planning
Treatment planning usually consists of: 1. Preoperative orthodontic management to move teeth into a position for the best possible occlusion at operation. This may involve relief of crowding, flattening of the occlusal plane or other treatment.
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