Filipovićisar./SELATURCIKAKODRAZLIČITIHMALOKLUZIJA

1035

RADIOLOŠKA VELIČINA SELE TURCIKE KOD RAZLIČITIH MALOKLUZIJA

RADIOLOGICAL MEASURING OF SELLA TURCICA’S SIZE IN DIFFERENT MALOCCLUSIONS

Gordana Filipović,1 Mirjana Burić,2 Mirjana Janošević,1 Maja Stošić1

MEDICINSKI FAKULTET U NIšU, 2 KLINIKA ZA STOMATOLOGIJU,ODELJENJE ZA ORTODONCIJU, NIŠ, SRbIJA

MEDICAL FACULTy, NIš2 CLINIC OF STOMATOLOGy, DEPARTMENT OF ORTHODONTICS, NIS, SERBIA

ActaStomatologicaNaissi Jun/June2011,vol.27,br./num.63str./p1035-1042

Kratak sadržaj.

Uvod. Sella turcica je deo kranijalne baze u kome je smeštena hipofiza. Smatra se da postoji korelacija izmedju veličine kranijalne baze a sa-mim tim i sella turcice kao njenog sastavnog dela i malokluzija.Cilj ovog ispitivanja bio je da radiološkom analizom profilnih snimaka glave osoba sa različitim malokluzijama odrede linearne dimenzije ST, postojanje polnog dimorfizma i povezanost veličine ST sa odredjenom malokluzijom. Materijal. Ispitivanjem je obuhvaćeno ukupno 90 osoba koje su na osnovu vrednosti ugla ANB podeljene u tri grupe ( po 30 osoba sa malokluzijom I klase, II klase i III klase po Angle-u). Merene su lin-earne dimenzije (dužina, širina i dijametar) ST . Rezultati. Ispitivanje je pokazalo da osobe sa malokluzijom II klase imaju najmanje a osobe sa malokluzijom III klase najveće vrednosti lin-earnih dimenzija sela turcice.Ni u jednoj ispitivanoj grupi nije utvrdjen polni dimorfizam ispitivanih parametara.Zaključak. Na osnovu dobijenih rezultata može se zaključiti da postoji korelacija izmedju veličine sella turcice i odredjenih malokluzija.

Ključne reči: sella turcica, malokluzija.

UvodKranijalnabazapredstavljaosnovunakojoj

se razvija humano lice i brojna istraživanjapokazujudadimenzije srednjekranijalne foseutiču na odnose izmedju nazomaksilarnogkompleksaimalokluzija.1,2

U kranijalnoj bazi, u centru sella turcika(ST)nalazisejednaodnajčešćekorišćenihkra-nijalnihtačakaukefalometriji,podistoimenimnazivom - sella turcica. U anatomskom delusellaturcicesmeštenajehipofiza.

Kefalometrijskaispitivanjaosobasapatolo-gijomhipofizemogu,unekimslučajevima,po-

Abstract

Introduction. Sella turcica is a part of cranial base where the pituitary is located. It is believed that there is a correlation between the size of the cranial base and thus sella turcica as its integral part and the malocclusions.The goal of this study was to determine the linear dimensions of ST by radiological analysis of different malocclusions, to determine the exis-tence of sexual dimorphism and to determine the connection between the size of ST with certain malocclusions.Material. This study is completed upon 90 persons, who were divided into three groups according to the values of ANB angle (30 persons in each group with malocclusion class I, class II and class III according to Angle). The linear dimensions were measured (length, width, diam-eter) ST. Results. The study has proven that the persons with the malocclusion of the II class have the lowest and persons with malocclusion class III the highest values of the linear dimensions of sella turcica. In none of the studied groups was sexual dimorphism of the examined parameters present. Conclusion. According to the results, we may conclude that there is a correlation between the size of sella turcica and certain malocclusions.

Key words: sella turcica, malocclusion.

Introduction

Cranialbasisrepresentsthebaseonwhichahumanfaceisdevelopedandthereisanumberof studieswhich show that thedimensionsofthemiddlecranialfossainfluencetherelationsbetweentheNasal-Maxillary complexandthemalocclusions. 1,2

Inthecranialbasisinthecentreofsellatur-cica (ST) there is one of themost frequentlyused cranial spots in cephalometry, with theverysamename–sellaturcica.Intheanatomicpartofsellaturcica,pituitaryislocated.

Cephalometric examinations of personswithpathologyofpituitarymayinsomecases

NAUČNI RADSCIENTIFIC ARTICLE

ActaStomatologicaNaissi,jun/June2011,vol.27,broj/number63

1036

kazatinenormalniizgledpredelasellaturciceamoguća je i obrnuta situacija pri čemu osobesa abnormalnom sela turcicommogu u stvariimati neotkrivene bolesti 3-5. Promene oblikaiveličineturskogsedlamogusejavitikodra-scepausneinepca6,urodjenihkraniofacijalnihanomalija7,8,akromegalije9,poremećajaradaštitnežlezde10.

Korelacijaveličinekranijalnebazeimalo-kluzijajediskutovanaodbrojnihautora.11-14

Morfološki izgledsella turcicaustanovljenjeuuranomembrionomstadijumu.15-18

Morfologijasellaturcicasenemenjasigni-fikantnoposle12godine19,20 ismatrasedajeposleovogperiodaveličinaselaturcicekodosoba muškog i osoba ženskog pola gotovoista.21,22

Iako postoji veći broj radova u kojima suanalizirane dimenzije ST, različitim metoda-ma,jošuveknematačnoodredjenihstandardapokojimasemože odreditiveličinaST.Pre-meravanjasemoguvršitinakadaverima23,24, uglavnomsuopisaniradovinatelerendgenskimsnimcima,madasemogukoristitiutesvrheianteroposteriornisnimci.10,25,26

Cilj rada

Obziromnapomenutučinjenicuda jeselaturcika deo kranijalne baze cilj ovoga rada jebioda se radiološkomanalizomprofilnih sni-maka glave odredi veličina sela turcike kodosobasarazličitimsagitalnimodnosomvilica.

Materijal i metod

Ispitivanjejeobavljenona90profilnihsni-makaglaveosobaobapola, starosti od18-22godine, sa teritorijeNiša i okoline, pacijenataKlinikezastomatologijuuNišu,odeljenjezaortopediju vilica. Premavrednosti uglaANB(ugao razlike maksilarnog i mandibularnogprognatizma), svi ispitanici supodeljeni u trigrupe:

1. 30osobasaprvomklasompoAngle-u,(vrednostuglaANBod20-40)

2. 30osobasadrugomklasompoAngle-u,(vrednostiuglaANBvećeod40)

3. 30osobasatrećomklasompoAngle-u,(vrednostiuglaANBmanjeod20)

showtheabnormallookofthesellaturcicare-gion.However,exactlytheoppositemayhap-pen–thatpersonswithabnormallookofsellaturcica may in fact have some undiscovereddiseases3-5.Thechangesintheshapeandsizeofsellaturcicamayappearwhenthereiscleftlip andpalate6 , inborn cranial anomalies 7,8, acromegaly9,dysfunctionofthyroid10.

The correlation of the size of the cranialbase and malocclusion is discussed by manyauthors.11-14

Themorphological lookof sella turcica isestablishedintheearlyembryostadium.15-18

Themorphologyofsellaturcicaisnotsig-nificantlychangedafter12years19,20anditisbelievedthatafter thisperiodthesizeofsellaturcicaisalmostthesameinbothmalesandfe-males.21,22

Althoughthereisagreatnumberofstudiesinwhich thedimensionsof sella turcicahavebeen analyzed, using differentmethods, therearestillnospecificstandardsbywhichthesizeofSTisdetermined.Themeasurementscanbedoneoncadavers23,24.Mostlytheworkswithtele-X-ray have been described, though therearealsoanteroposteriorrecords.10,25,26

The aimSincethementionedfact,thatsellaturcicais

apartofthecranialbase,theaimofourresearchwastodefinethesizeofsellaturcicabyradio-logicalanalysisofprofilecephalogramsatper-sonswithdifferentsagittalrelationofthejaws.

Material and methodThe study was conducted upon 90 profile

cephalogramsofpersonsofbothsex,agesbe-tween18-22,fromtheterritoryofNisandthesurroundings,allpatientsof theClinicofsto-matology,Nis,DepartmentofJawOrthopedics.AccordingtothevaluesoftheANBangle(theangleofthedifferenceofthemaxillarandman-dibularprognathism),all thepatientsweredi-videdintothreegroups:

1. 30 persons with the first class accordingtotheAngle(thevaluesofANBanglearefrom2°-4°)

2. 30 persons with the second class accord-ingtotheAngle(thevaluesofANBanglehigherthan4°)

3. 30 persons with the third class accordingtotheAngle(thevaluesofANBanglelessthan2°)

Filipovićetal./SELLATURCICAINDIFFERENTMALOCCLUSIONS

1037

Zasvepacijenteurađenisu,podistimuslovi-ma,profilnitelerendgenskisnimcipomoćuapa-ratamarke»Simens«,snage90KWiekspozici-jomod1sekunde.Glavapacijenta jefiksiranapomoćukefalostatatakodajeFrankfurtskaho-rizontalabilaparalelnasapodom,asrednjasagi-talnaravanjebilaparalelnasakasetomifilmom.

Svitelerendgenskisnimcisuanaliziraninaistinačinodstranejednogispitivačaklasičnimnačinomanalizekojipodrazumevaiscrtavanjekonturakoštanihstrukturanaacetatnompapiruapotomimerenjeodređenihlinearnihparame-tara.Iscrtanajekonfiguracijaselaturcicakojasesastojiiztuberculumsella,podselaturcike,dorsumselleianteriorniiposteriorniclinoidniprocessus.(slika1)

LinearnedimenzijeSTsumerenepometodiSilverman27iKisling.28Svereferentnelinijeuovojstudijisu lociraneusrednjojsagitalnojravni.Dužinaselaturcikejemerenakaorazda-ljinaodtuberculumseledovrhadorsumasele.Dubina sela turcike je normala od najdubljetačkenapodusella turcicena linijukojaspa-jatangiranajvišutačkutuberculumaidorsumaselle.Anteroposteriornidijametarjemerenkaorastojanjeodtuberculumaseledonajdistalnijetačkenaposteriornomzidufosse.

Greškapremeravanjaodređenajeponovlje-nim merenjem deset telerendenskih snimakaodabranihmetodomslučajnoguzorkaimerenihdesetdanaposleprvogmerenja.Wilcoxstati-stičkaanalizanijepokazalastatističkiznačajnerazlikeizmeđudvapremeravanja.

Razlikeispitivanihparametaraizmedjupo-lovairazličitihmalokluzijatestiranesu

Dobijeni rezultati obrađeni su statističkii izračunati su sledećiparametri:X,SD,Cv imin-max. Razlike ispitivanih parametara iz-medjupolova i različitihmalokluzija testiranesuStudentovimt-testom.

Forallthepatientsprofiletele-X-raysnap-shotsweremadewithadevicetype“Siemens”90kWpowerandexplosionof1sec.Theheadof the patientwasfixatedwith cephalostat sothattheFrankfurthorizontalwasparalleltothefloorandthemiddlesagittalplainwasparalleltothecassetteandthefilm.

All tele-X-ray snapshots were analyzedin the same way by one examiner by classi-calmethodofanalysiswhich includescontourdrawingofthebonestructureontheacetylpa-perandafterthatmeasurementofcertainlinearparameters. The configuration of sella turcicawhichwasdrawnconsistsof tuberculumsella,thebottomofsellaturcica,dorsumsellaandan-teriorandposteriorclinoidalprocessus(pic.1).

LineardimensionsofSTweremeasuredac-cordingtoSilverman27andKisling28method.Allreferentlinesinthisstudyarelocatedinthemediansagittalplain.Thelengthofsellaturcicaismeasuredasthedistancefromthetuberculumsellatothetipofselladorsum.Thedepthofsellaturcicaisnormalfromthedeepestpointonthebottomof sella turcicaon the linewhichcon-nectsthehighestpointtuberculumanddorsumsella. Anteroposterior diameter was measuredasthedistancefromthetuberculumsellatothemostdistalpointoftheposteriorwalloffosse.

The mistake of the measurement was de-fined by another measuring of ten tele-X-raysnapshots chosen by the method of randomsample, which were measured ten days afterthefirstmeasurement.Wilcoxstatisticanalysisdidnotshowsignificantstatisticdifferencesbe-tweenthetwomeasurements.

The acquired results were statistically de-finedandcalculatedaccordingtothefollowingparameters:X,SD,Cvandmin-max.Thedif-ferences of the examined parameters betweensexes anddifferentmalocclusionswere testedbyStudent’st-test.

Slika 1. TS-tuberculum selle, DS-dorsum selle, BPF- baza pituitarne fose, tačkasta linija-dubina selle, isprekidana linija-

dijametar selle

Figure 1. Normal sella turcica morphology and reference lines used for measuring sella size: TS, tuberculum sella; DS,

dorsum sella; BPF, base of the pituitary fossa; black line, length of sella; dashed line, diameter of sella; dotted line,

depth of sella.

ActaStomatologicaNaissi,jun/June2011,vol.27,broj/number63

1038

RezultatiLinearnedimenzijeSTsuprikazanenata-

beli1.Uporedjenesuprosečnadužina,širinaidijametarSTkodosobasarazličitimmaloklu-zijama.Sobziromdanepostojepolnerazlikeniujednojispitivanojgrupi,grupesudaljeana-liziranekaocelina.

Prosečna vrednost širine ST kod osoba samalokluzijom I klase iznosila je 9,18 mm ± 1,74akodosobasamalokluzijomIIklase8,59mm ± 1,50 .OsobesamalokluzijomIIIklaseimajustatističkoznačajnovećuvrednostširineSTuodnosunaprethodnedvegrupeispitanikakojaiznosi10,11mm±1,70.

Osobe sa malokluzijom III klase odlikujuseznačajnovećomprosečnomvrednošćuširineSTuodnosunaosobesamalokluzijomIklase(p<0,05)iIIklase(p<0,001).

Dubina ST pokazuje sličnu tendenciju.Prosečne vrednosti dubine ST kod ispitanikasa I, II i III klasom iznose 8,48 mm ±1,28;7,48mm± 1,16i9,20mm±1,26Takodjejeznačajno veća kod osoba samalokluzijom IIIklaseuodnosunaosobesaIklasom(p<0,05)iIIklasom(p<0,001).

Prosečne vrednosti dijagonale ST kodosoba samalokluzijom I, II i III klase iznose10,95mm± 1,04;10,45mm± 1,70 i 11,28 mm ± 1,29.DijagonalajetakođenajvišakodklaseIII,statističkijevećanokodispitanikaIIklase(p<0,05).

The resultsThe linear dimensions ofST are shown in

thetable1.Theaveragelength,widthanddiam-eterofSTwerecomparedatpersonswithdif-ferentmalocclusions.Baringinmindthattherearenosexualdifferencesinanyoftheexaminedgroups,thegroupswereanalyzedasawhole.

TheaveragevalueofthewidthofSTofper-sonswithmalocclusionofclassIwas9.18mm±1.74, andofpersonswithmalocclusionclassIIwas 8.59mm± 1.50.Personswithmalocclu-sionsofthethirdclass,havestatisticallysignifi-cantlyhighervalueofthewidthofSTcompar-ingtotheprevioustwogroups,whichis10.11mm ±1.70.

ThepersonswithmalocclusionofthethirdclasshavesignificantlyhigheraveragevalueofthewidthofSTcomparedtothepersonswiththe first classmalocclusions (p<0.05) and thesecondclass(p<0,001).

The depth of ST shows similar tendency.TheaveragevaluesofthedepthofSTofthepa-tientswithI,IIandIIIclassare8.48mm±1.28;7.48mm± 1.16and9.20mm±1,26.Also,thedepthissignificantlyhigherwithpersonswiththemalocclusionof the III class compared totheIclass(p<0,05)andIIclass(p<0,001).

TheaveragevaluesofthediagonalofSTofpersonswithmalocclusionofI,IIandIIIclassare10.95mm± 1.04;10.45mm± 1.70 and 11.28mm± 1.29. Thediagonalisalsothehigh-est with the III class, statistically it is higherthanthatofthepatientsoftheIIclass (p<0.05).

Tab.1 Linearne dimenzije sella turcica kod osoba sa različitim malokluzijama

Table 1. Linear dimensions of sella turcica of persons with different malocclusions

I kl I class

IIkl IIclass

IIIkl IIIclass

parametar parameter X±SD X±SD X±SD

Širina width 9,18±1,74 8,59±1,50 10,11 ±1,70b*c***

dubina depth 8,48±1,28a** 7,48±1,16 9,20±1,26b*c***

Dijagonala diagonal 10,95±1,04 10,45±1,70 11,28 ±1,29c*

aIvsII,bIvsIII,cIIvsIII*-p<0,05**-p<0,01***-p<0,001

Filipovićisar./SELATURCIKAKODRAZLIČITIHMALOKLUZIJA

1039

Diskusija

Rezultatiovogispitivanjaiduuprilogpre-thodnimistraživanjimakojatvrdedaosobesarazličitim skeletnim odnosom vilica pokazujurazlikeuveličiniselaturcika.

ŠirinaSTmerenajepometodiSilvermana27 iKisling28kaorastojanjeodtuberculumselledo dorzuma selle. Silverman27 nije objaviovrednostiovogparametraalijepokazaoposto-janjekorelacijeizmedjugodinaispitanika,polaidimenzijaST.

Izmedju rezultata našeg ispitivanja i re-zultata prethodnih ispitivača mogu se uočitiodredjene razlike. Quakinine i Hardy24 radili supremeravanjadimenzijaSTnakadaverimarazličiteuzrastnedobi.Njihovirezultatipoka-zujuješirinaST12mm,anteroposteriornidi-jametar8mmadubina6mm,štosuznačajnomanjevrednostiodnaših.Sličnerezultateobja-vilisuAxelssonisar29.naispitivanomuzorkuuNorveškoj.

Našimispitivanjemnisudobijenepolnera-zlikeniu jednoj ispitivanojgrupi,štosepok-lapa sa nalazima Israel i sar.21, Alkofide30, Andredaki31, PhilippMeyer-Marcotty i sar.32

anepoklapasanalazimaAxelssonisar29kojisuutvrdilipostojanjerazlikauširinisella tur-cice izmedju polova. Jones i sar.8 su meriliširinu ST kod osoba kod kojih je planiranaortodontsko-hirurškaterapijaikodosobakojesu tretirane samoortodontski.Ovi autori nisunašli statističke razlike za vrednosti širine STizmedjuovedveispitivanegrupe.

Rezultati našeg ispitivanja pokazali su dadubinaST ima najmanje vrednosti kod osobasa malokluzijom II klase a najveće vrednostikodosobasamalokluzijomIIIklase.DeChi-ro25 iNelson6objavili suda je srednjavred-nostdubineSTkododraslihosoba8mmštojepribližnorezultatimanašegispitivanjazaosobesamalokluzijomIklase.NeštoniževrednostidobilisuAxelssonisar.29(vrednostdubineSTkodosobamuškogpolabila je7,4mmakodosobaženskogpola7,1mm.)

Ispitivanja Jones i sar.8 pokazuju da jeprosečnavrednostdubineST8,6mminepoka-zujeznačajnurazlikuizmedjuispitivanihgru-pa(osobesaortodontsko-hirurškimtretmanomiosobesasamoortodontskomterapijom).

Discussion

Theresultsofthisresearchverifytheformerresearcheswhichstatethatpersonswithdiffer-entskeletalrelationofjawshavesignificantdif-ferencesinthesizeofsellaturcica.

ThewidthofST ismeasuredaccording toSilverman27 andKisling28method as the dis-tance from the tuberculum sella to dorsumsella.Although,Silverman27hasnotpublishedthevaluesofthisparameter,hehasshowntheexistenceofthecorrelationbetweentheageofthepatient,theirsexandthedimensionsofST.

There are certain differences between theresults of our study and the previous studies.QuakinineiHardy24havemeasuredthedimen-sionsofSToncadaversofdifferentages.Theirresultsshowthat thewidthofST12mm,an-teroposterior diameter 8mm and the depth 6mm,whicharesignificantlysmallervaluesthanours.SimilarresultswerepublishedbyAxels-sonatal29ontheexaminedsampleinNorway.

Our research does not show sexual differ-ences in any of the age groups, which is thesame with the results of Israel and team.21, Alkofide30,Andredaki31, PhilippMeyer-Mar-cottyatal.32.However,itisnotthesamewiththe resultsofAxelssonat al 29 ,whoclaimedthattherewasadifferenceinthewidthofsellaturcicawithdifferentsexes.Jonesatal.8havemeasuredthewidthofSTofpersonswhohavehadorthodonticsurgeryplannedandofpersonswho have been orthodontically treated.Theseauthorshavenot found statisticdifferences inthevaluesofthewidthofSTbetweenthesetwoexaminedgroups.

TheresultsofourstudyshowthatpersonswithmalocclusionIIclasshaslowervaluesofthedepthofST,andpersonswithmalocclusionIIIclasshavethehighestvalues.DeChiro25 and Nelson6havepublishedthattheaveragevalueofthedepthofSTofadultsis8mm,whichisclosetotheresultsofourresearchforpersonswithmalocclusionofIclass.Somewhatlowervalueswere publishedby Axelsson at al. 29 (the value of the depth of STwithmalewas7.4mmandfemale7.1mm).TheresearchbyJonesandal8showsthattheaveragevalueofthedepthofSTis8.6mmandthereisnosignif-icantdifferencebetween theexaminedgroups(personswithorthodonticsurgeryandpersonswithorthodontictherapy).

ActaStomatologicaNaissi,jun/June2011,vol.27,broj/number63

1040

ZaključakOsobesamalokluzijomIIklaseimajunaj-

manjevrednosti aosobesamalokluzijomIIIklase najveće vrednosti linearnih dimenzijasela turcike što ukazuje na postojanje korel-acijeizmedjuveličineselleturcikeiodredjenihmalokluzija.

ConclusionPersonswithmalocclusionofIIclasshave

lower values and persons with the malocclu-sionofIIIclasshavethehighestvaluesofthelineardimensionsofsellaturcica,whichpointsouttheexistenceofthecorrelationbetweenthesizeofsellaturcicaandcertainmalocclusions.

Filipovićetal./SELLATURCICAINDIFFERENTMALOCCLUSIONS

1041

LITERATURA / REFERENCES

1.EnlowD,KurodaT,LewisA.BThemorphologicalandmorphogeneticbasisforcraniofacialformandpattern.AngleOrthod1971;41:161-188

2.EnlowD,McNamaraJ.A Theneurocranialbasisforfacialformandpattern.AngleOrthod1973;43:256-270

3.WeisbergLA,ZimmermanEA,FrantzAG.Diagnosisandevaluationofpatientswithanenlargedsellaturcica.AmJMed1976;61:590-596

4.FriedlandB,MeazziniMC.Incidentalfindingofanenlargedsella turcicaona lateralcephalogram.AmJ Or-thodDentofacialOrth1996;110:508–512

5.AlkofideE.Pituitaryadenoma:acephalometricfind-ing.AmJOrthodDentofacialOrthod2001;120:559–562

6.NielsenBW,MolstedK,KjaerI.Maxillaryandsellaturcicamorphology in newbornswith cleft lip andpalate.CleftPalateCraniofacJ2005;42:610-617

7.Bector JP,EinersenS,Kjaer I.Asella turcicabridgeinsubjectswithseverecraniofacialdeviations.EurJOrthod2000;22:69-74

8.JonesRM,FaqirA,MillettDT,MoosKF,McHughS.Bridginganddimensionsofsellaturcicainsubjectstreatedby surgical-orthodontic means or orthodontic only.AngleOrthod2005;75:714-718.

9.DostalovaS,SonkaK,SmahelZ,WeissV,MarekJ.Cephalometricassessmentofcranialabnormalities inpati-entswithacromegaly.JCraniomaxillofacSurg2003;31:80-87

10.YamadaT,TsukuiT, IkejiriK,YukimuraY,KotaniM.Volumeofsellaturcicainnormalsubjectsandinpatientswith primary hypothyroidism and hyperthyroidism. JClinEndocrinolMetab1976;42:817-822

11.RenfroeEW.Astudyofthefacialpatternsassoci-atedwithclassI,classIIdivision1,classIIdivision2mal-occlusions. AngleOrthod1948;18:12–15.

12.BjorkA.Somebiologicalaspectsofprognatismandocclusionoftheteeth.ActaOdontolScand1950;8:1-40

13. Moss ML. Corelation of cranial base angulationwith sephalic malformations and growth disharmonies ofdentalinterest.NYstateDent1955;24:452-454

14. Ricketts RM. Facial and denture changes duringorthodontic treatment as analyzed from the temporoman-dibularjoint.AmJOrthod1955;41:407-34

15.KjaerI,WagnerA,MadsenP,BlichfeldtS,Rasmus-senK,RussellB.Thesellaturcicainchildrenwithlum-bosacralmyelomeningocele.EurJOrthod(1998)20:443–448.[

16.KjaerI,HansenN,BecktorKB,BirebaekN,BalslevT.Craniofacialmorphology, dentition, and skeletalma-turity in foursiblingswithSeckel syndrome.CleftPalate-CraniofacialJ2001;38:645–651.

17.KjaerI,HjalgrimH,RussellBG.Cranialandhandskeleton in fragile X syndrome. Am J Med Gen 2001;100:156–161.

18.KjaerI,KeelingJW,FischerHansenB,BecktorKB.Midline skeletodental morphology in holoprosencephaly.CleftPalate-CraniofacJ2002;39:357–363

19.BjörkA.Cranialbasedevelopment.AmJOrthod1955;41:198–225.

20.MelsenB.Thecranialbase: thepostnataldevelo-pmentofthecranialbasestudiedhistoricallyonhumanau-topsymaterial.ActaOdontScand1974;32:57-71

21. Israel H. Continuing growth in sella turcica withage. Am J Roentgenol Radium Ther Nucl Med 1970;108:516–527

22.PisaneschiM,KapoorG. Imagingof the sella andparasellar region.NeuroimagingClinicsofNorthAmerica2005;15:203-219

23.KarlosGA.Morphologicalobservationsonsuperiorsurfaceofbodyofsphenoidboneinhumanadults(disertati-on).Helsinki:UniversityofHelsingfors;1984

24.QuakinineGE,HardyJ.Microsurgicalanatomyofthepituitaryglandandthesellarregion:thepituitarygland.AmSurg1987;53:285–290

25. De Chiro G. The width (third dimension) of thesella turcica. Am J Roentgenol Radium Ther Nucl Med1960;84:26-37

26. McLahlan MS, Williams ED,Fortt RW,DoyleFH. Estimation of pituitary gland dimensions from radio-graphsofthesellaturcica.Apostmortemstudy.BrJRadiol1968;41:323-330

27.SilvermanFN.Roentgen standards for sizeof thepituitary fossa from infancy through adolescence. Am JRoentgen1957;78:451–460.

28. Kisling E. Cranial morphology in Down’s syn-drome.Acomparativeroentgencephalometricstudyinadultmales1966,Thesis,Munksgaard,Copenhagen.

29.AxelssonS,StorhaugK,KjærI.Post-natalsizeandmorphologyofthesellaturcica.Longitudinalcephalometricstandards forNorwegiansbetween6 and21years of age.EurJOrthod2004;26:597–604

30.AlkofideEA.TheshapeandsizeofthesellatircicainskeletalClassI,ClassII,andClassIIISaudisubjects.EurJOrthod2007;29:457-463.

31.AndredakiM,KoumantanouA,DorotheuD,Hala-zonetis D.J. A cephalometric morphometric study of thesellaturcica.EurJOrthod2007;29:449-456

32.PhilippMeyer-MarcottyPh,ReutherT,EisenhauerSA.Bridgingof thesella turcica inskeletalClass III sub-jects,EurJOrthop2009;32:148-156.

Address of correspondence:GordanaFilipović,DDS,MSD,Ph.D

ClinicofStomatologyDrZoranaDjindjića,52BLVD

18000NisSerbia

Adresa za korespondenciju:Ass.drGordanaFilipovićKlinikazastomatologiju-NišBul.drZoranaDjindjića5218000NišSrbijatel.018226216