Cephalometric analysis assesses the skeletal pattern – whether the child has a horizontal pattern (favourable – the lower jaw grows forward) or a vertical one (unfavourable – the lower jaw drops downward, the face lengthens, with a risk of open bite and breathing problems). It also reveals mandibular retrognathia, maxillary prognathism and skeletal asymmetry suggesting TMJ problems.

The CVM (Cervical Vertebral Maturation) method uses the image of the C2, C3 and C4 cervical vertebrae visible on a routine lateral cephalogram to determine the stage of skeletal maturity – six maturation stages are distinguished. This eliminates the need for an additional wrist X-ray. A cephalogram may also reveal incidental cervical spine findings in asymptomatic patients. (McNamara J.A., Franchi L., Angle Orthodontist, 2018)

The cephalometric image shows very good diagnostic accuracy in identifying adenoid enlargement and obstruction of the posterior nasopharynx. Studies have shown that over 80% of children presenting for orthodontic treatment had enlarged adenoids or palatine tonsils. Enlarged tonsils block airflow through the nose → the child breathes through the mouth → a chain of skeletal changes is set in motion. (meta-analysis, J Oral Maxillofac Surg, 2019)

The position of the hyoid bone on a cephalogram reflects the muscle tone of the floor of the mouth and the tongue. In mouth-breathing children the hyoid bone drops lower and moves back, which correlates with a lowered tongue position, further deepening of the breathing problem and disturbed growth of the lower face.