학위논문
Craniofacial aysmmetries and dysmorphosis.
2005-09-13 00:00:00
조회 1900
"Craniofacial asymmetries and dysmorphosis. Craniofacial
architectural analysis of La Queue-en-Brie (Val-de-Marne, Ile-de-
France) medieval populations."
In Val-de-Marne, hundreds of anthropological remains from
many necropolis have been uncovered. Our topic is about the
ones of La Queue-en-Brie’s Saint Nicolas church. The age of this
area is set between 890 and 1638 (respectively – 1114 and – 366
B.P.) by Carbon 14 analysis.
A large number of the 251 skeletons exhumed in La Queue-en-
Brie show cranio-facial disharmonies with various types of
asymmetries. The several causes of these asymmetries are :
craniostenosis, pseudo-plagiocephaly, torsion, lateral bending
rotation … The effects of craniostenosis develop also some
asymmetries that may lead to malocclusions. Why are we
observing such phenomena ? From the fetal stage and for the
whole growth, children crania will evolve according to the strains
they are submitted to, what may result in cranio-facial architectural
changes and also in dental malocclusions. With the presence of a
malocclusion one can infer that possibly craniofacial
morphogenesis went abnormally.
Medical studies tend to link observed abnormalities and its
origins. Mechanics laws may be applied to bone parts that make
up cranium. A strain applied on one of those parts will drive
determined effect on the others. All these lacks of balance and
strains set hallmarks on the cranium that biodynamics may study.
These phenomena of craniofacial disharmonies are well known in
other fields of medicine such as Orthodontics, Dentofacial
Orthopedics and Osteopathy. Their approach consists in
understanding how cranium and face of children and adults
affected have evolved.
Traditional ways of analysis are not enough to understand
observed abnormalities. One has to use new tools, such as
teleXrays, following Orthodontists.
Main axis of our study is structured around craniofacial set
architectural biodynamics thinking and its connections with
occlusion. It brings together comprehensive anthropological study
and sex and age related parameters determination.
Craniofacial biodynamics analysis consists in analysing crania
parts according to pre-established forms procedures. All crania
followed clinical analysis concepts continuously tested in
Dentofacial Orthopedics. First this one deals with eventual dental
or dentoskeletal perturbation knock-on effect on cranium base.
Secondly it makes it possible to analyse opposite phenomena, to
say craniofacial perturbations that have an impact on occlusion
during the growth.
Architectural analysis is based exclusively on teleXrays
snapshots taking. This method consists in drawing a number of
lines and angles on the snapshot that give values about cranium
and face structure and about its modifications during the growth,
under the influence of some abnormalities.
Anthropological study :
We first notice that this population is mainly made up of females.
When we consider the graph of the mortality, we see that children
mortality is not very high but higher anyway than the one of
adolescents. Female mortality among young adults is considerable
and could be possibly related to environmental conditions.
Maximum male mortality is reached among adults, female one is
reached among elderly adults.
The crania of this population have a very large width with regard
to its length giving a short antero-posterior shape. Following, the
horizontal cranium index shows that the people of this population
are mainly brachycephals. Index study indicates that
brachycephals are logically associated to on the one hand
orthocephal and hypsicephal on the other hand tapinocephal.
Often cranium height with regard to its length is high but low with
regard to its width. Mainly foreheads are domed, large occipital
curvature prevails among males while among females large and
light curvature is equally present. Foreheads are divergents and
wides, often foramen magnum is wide.
Architectural analysis :
The use of teleradiography allowed us to detect maxillo-
mandibular imbalances. Architectural analysis shows that class III
(flexion) prevails, for almost half of individuals, over class II
(extension). Disharmonies are present at all ages. Class III
(flexion) prevails among adults whatever the age, as well as it
prevails among males and among females. Class II (extension)
rate is about the same among males and among females.
Those primitive disharmonies may be ordered in 4 categories,
according to spheno-occipital kinetics :
Category 1 : sphenoid in anterior rotation, occipital with forward
basion
Category 2 : sphenoid in anterior rotation, occipital with backward
basion
Category 3 : sphenoid in posterior rotation, occipital with forward
basion
Category 4 : sphenoid in posterior rotation, occipital with
backward basion
Usual kinetics of class II and class III put it respectively in
category 4 and 1. Spheno-occipital kinetics following those usual
kinetics are said concordant while otherwise they are said
discordant. Category 2 prevails strongly among this population.
Few category 3 and 4 are observed. Then mainly the people of
this population show anterior sphenoid’s kinetics with weak
craniofacial contraction. These results emphasize that for most of
the people studied here, sphenoid and occipital are no more
following the usual dynamics. People with spheno-occipital
discordance prevails very strongly. It is important to notice that
class II is almost exclusively present in discordance. Other kinds
of discordance are observed, not only spheno-occipital but also
temporal and occipito-temporal. We noticed multiple discordances
too.
There is also another noticeable fact, which is the frequent
conflict between the occipital bone and the basion part of the basi-
occipital. As the basi-occipital goes up, the occipital bone goes
down forward insufficiently. This takes place more frequently for
class II. The distribution of cranium’s shapes (from horizontal
cranium index) as well in class III than in class II, does not show
any relation between class and cranium’s shape in this
population. Proportions of cranium’s shapes in both classes are
similar. Then brachycephal individuals of the population from La
Queue-en-Brie end up as well in class II than in class III.
Biodynamics analysis :
From biodynamics analysis, we must emphasize the important
frequency of craniofacial disharmonies in the population of La
Queue-en-Brie. Observed craniofacial disharmonies are
remarkable not only on quantitative side but also on qualitative
side. We found craniostenosis cases, side bending rotation,
torsion, craniofacial scoliosis, asymmetries, and dismorphosis. Its
etiologies appear heterogeneous.
We encountered almost all types of craniostenosis :
scaphocephaly, brachycephaly, plagiocephaly and
trigonocephaly. Some craniostenosis are responsible for
architectural asymmetry of the base of the cranium and also of the
face. We noted numerous cases of pseudo-plagiocephaly, which
corresponds to a disharmony with the appearance of a
plagiocephaly but without coronal sutures perturbation. The origin
of it can be varied.
The observed asymmetries are present either at one level only
either at all levels. Most frequents are at the same time at the level
of the vault and at the level of the base. We notice that among
individuals affected by an asymmetry, most of the time, right side
moves forward more than the left side.
As for the mandible, craniofacial asymmetry when present has
caused a height’s difference between its ramus. We most often
found left side ramus shorter than the right one, in relation with the
movement of the temporal. We observed in some individuals that in
occlusal position the mandible is shifted, often to the left, and that
the mandibular condyle on the opposite side does not fit in its
temporo-mandibular joint. Such a mandibular asymmetry could
cause in some cases a temporo-mandibular joint dysfunction.
Dental joint disorders may also be induced by anomalies of the
mandible’s implantation on the cranial base.
At the vault level, a sutural deviation, sign of a perturbed growth,
is frequently noticed, most of the time on the left side sagittal
suture and in second on the right side coronal suture.
We found tooth decays the prevalence of which at the premolars
and molars appears as well on the maxillary than on the mandible.
This localization is standard as well for ancient populations than
for modern ones. Similarly the ante-mortem teeth loss concerns
males and females in comparable proportions and affects mainly
molars, on the mandible more than on the maxillary. Third molar
agenesia is relatively frequent and is often affecting both maxillary
and mandible.
Comparison with other Val-de-Marne necropolis :
The comparison with other studies about Val-de-Marne
necropolis shows that if, similarly to La Queue-en-Brie,
brachycephalization is observed for Chevilly-Larue and Créteil
sites, it is not the same for Ivry-Parmentier site that exhibits mainly
dolichocephals. Although the populations of La Queue-en-Brie
and Chevilly-Larue both show brachycephalization, their
craniofacial morphogenetic process appears to have taken place
differently as the rates obtained for class II and class III come out
reversed on both sites.
Craniofacial asymmetries are present on all the sites of the
comparison. However this is in the population of Chevilly-Larue
that we find the higher rate, with predominance of the asymmetries
at the vault’s level over the ones at the face’s or base’s level with
a ratio about 2/3 of the last compared to the first, while the rates
between those asymmetries are close for the other sites, in
particular La Queue-en-Brie. As for the rates level of observed
asymmetries, La Queue-en-Brie comes into second position after
Chevilly-Larue, showing by this one of the important features of
our site.
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