Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Adding Depth to Cephalometric Analysis

Comparing Two- and Three-Dimensional Angular Cephalometric Measurements

Jodeh, Diana S. MD*; Kuykendall, Lauren V. MD; Ford, Jonathan M. PhD; Ruso, Stephen DDS MS§; Decker, Summer J. PhD; Rottgers, S. Alex MD*,§

doi: 10.1097/SCS.0000000000005555
Clinical Study: PDF Only

Introduction: Lateral cephalometric radiographs (LCR) have been the standard tool used for cephalometric analysis in craniofacial surgery. Over the past decade, a three-dimensional (3D) revolution in cephalometric analysis and surgical planning has been underway. To date, research has not validated whether cephalometric measurements taken from two-dimensional (2D) and 3D data sources are equivalent and interchangeable. The authors sought to compare angular cephalometric measurements taken with 2D and 3D modalities.

Methods: Sixty-two head CT scans (36 females, 26 males) with an average age of 63 ± 20 years were studied. Twelve cephalometric angular measurements were taken from 3D reconstructed skulls using the software package Mimics 19.0 (Materialize; Leuven, Belgium). These same facial angles were measured from 2D lateral cephalograms reconstructed from the original CT scans using Dolphin 11.9. Measurements taken with both techniques were compared for agreement using a paired t test. Intra-class correlation coefficient assessment was used to determine inter-rater reliability. Statistical significance was set at P < 0.05.

Results: Five of the 12 angular measurements (SNA, SNB, MP-FH, U1-SN, and U1-L1) demonstrated statistically significant differences (P < 0.05) between the 2D and 3D analyses. All of these differences were less than the standard deviations for the respective measure.

Conclusion: The differences between angular cephalometric values obtained from 2D LCRs and 3D CT reconstructions are small. This supports the practices of using 2D and 3D cephalometric data interchangeably in most applications. Clinicians must be selective in which measures they employ to maximize accuracy and care must be taken when measuring dental inclination with lateral cephalograms.

*Division of Plastic and Reconstructive Surgery, Johns Hopkins All Children's Hospital, St. Petersburg

Department of Plastic Surgery, University of South Florida, Morsani College of Medicine, Tampa

Department of Radiology, University of South Florida, Morsani College of Medicine, Tampa

§Cleft and Craniofacial Team, Johns Hopkins All Children's Hospital, St. Petersburg, FL.

Address correspondence and reprint requests to S. Alex Rottgers, MD, Assistant Professor of Plastic Reconstructive Surgery, Johns Hopkins All Children's Hospital, Division of Plastic and Reconstructive Surgery, 601 Fifth Street South, Suite 306, St. Petersburg, FL 33701; E-mail:

Received 28 November, 2018

Accepted 12 March, 2019

The authors report no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 by Mutaz B. Habal, MD.