A Qualitative Assessment Of Bone Mineral Density In Individuals With Hemifacial Microsomia: A CBCT Study
Rahma ElNaghy1, Rany Bous1, Afriti Chinoy1, Manish Valiathan1, Anand Kumar2.
1Case Western Reserve University, Cleveland, OH, USA, 2University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
PURPOSE: Hemifacial Microsomia (HFM) is a craniofacial condition characterized by a disturbance in the development of the structures of the first and second branchial arches. It can be manifested in different degrees of severity. Facial asymmetry of the mandible alone or in conjunction with the maxilla is the main characteristic feature of HFM. While it is understood the quantity of the bone on the affected side of the mandible is compromised, few studies have evaluated the quality of the bone among this cohort of patients. The purpose of this study is to utilize Cone-Beam Computed Tomography (CBCT) to compare the bone mineral density on the affected versus non-affected side, among individuals with HFM.
METHODS: This retrospective study included nine individual with HFM (2 females and 7 males, with mean age of 11 years and 10.8 years respectively). Pre-treatment CBCT volumes were imported into Invivo5 software, which was used to measure the bone density through Hounsfield Units (HU) in three regions of the mandible; inferior to the lower lateral incisors, inferior to the first molar and at the ramus inferior to the sigmoid notch. All measurements were done at 10mm superior to the inferior border of the mandible. Each region was measured at the buccal cortical bone, lingual cortical bone and cancellous bone., yielding nine areas of measurements on each side. The densities on the right and left sides were compared by Wilcoxon signed-rank test.
RESULTS: Overall, the bone mineral density on the affected side tended to show slightly lower values when compared to the non-affected side. Differences ranged from 14 HU at the lingual cortical plate of the first molar region to 234 HU at the buccal cortical plate of the ramus region. Differences were only statistically significant at the ramus region for the buccal (p=.002) and lingual (p=.008) cortical plates and at the lower incisor region at the buccal cortical plate (p=.016) and cancellous bone (p=.044). The differences, however, did not seem to be clinically significant.
CONCLUSION: Among patients with HFM, bone mineral density on the affected side seems to be slightly lower than that on the unaffected side. The differences are emphasized at the ramus and anterior body of the mandible. Findings from the current study show that the quality of bone on the affected side may be slightly reduced, but not to clinically significant levels.
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