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420 Craniocervical posture: cephalometric and biophotogrammetric analysis
craniomandibular pain with the presence of postural changes
in the craniocervical segment3,14,21. During radiographic and
biophotogrammetric analysis, all volunteers were instructed
to maintain their habitual posture. Thus, it was important to
adopt natural head position in this study for faithfully
representing the position of the craniocervical structures.
There are different biophotogrammetric measures capable
of measuring the forward head as well as the cervical spine
curvature and the head flexion/ extension. In a similar study,
Silva et al.22 (2010) considered the use of the C7-tragus
horizontal angle to characterize the forward head and the
tragus-horizontal-eye angle to characterize the extension of
the head.
Regarding the angular measurements used to assess the
forward head posture through the biophotogrammetry (A1 and
A2), a moderate and negative correlation between A1 and the
angle of cranial flexion-extension (FE) was found. Thus, the
forward head position required a head extension, possibly in
order to maintain the horizontality of the optical plane23.
A moderate and a negative correlation between A1 and
the cervical distance was found, that is, the more forward
head posture (lowest angle), the greater the cervical distance. adequate to evaluate the head position. However, for analysis
Neiva et al.24 (2009) reported that the forward head is
characterized by the lower cervical flexion associated with
the upper cervical extension, what in part, is in agreement
with the photogrammetric findings of this study. The angles
A1 and A2 showed to be consistent, but with a weak
correlation.
In the analysis of cephalometric measurements, there
were positive and moderate correlations between CVA and
CPL. This finding strengthens the association between the
forward head and the head extension. No significant
correlation regarding the variable that measured the cervical
curvature was observed (CVT/EVT).
Comparing the two different methods of assessment, the
negative and moderate correlation between FE
(biophotogrammetry) and CVA (cephalometry) reinforces the
ability of the FE angle to evaluate head flexion/extension
position. Furthermore, it was observed a positive and
moderate correlation between A1 (biophotogrammetry) and
CPL (cephalometry), confirming the ability of the A1 angle
to evaluate the presence of a forward head. A positive and
significant correlation between these variables was also
demonstrated by Visscher et al.8 (2002), who also advocated
the adoption of the natural head position during radiographic
and photographic recordings. Similar craniocervical angular
measurements were used by Van Niekerk et al.25 (2008) in
the correlation between the photography and radiography,
but in the sitting position. The authors considered the
photogrammetric measurements valid and reliable for postural
assessment.
Gadotti et al.5 (2010) considered another angle formed
between chin, external auditory meatus and sternal notch
(in this paper named A2) for testing the sensitivity of
photogrammetry in evaluating the head posture in the sagittal
plane. In the present study, this same photogrammetric measure
compared with equivalent purposes used in cephalometry
Braz J Oral Sci. 11(3):416-421
did not present significant correlation.
Rocabado13 (1983) reported that the head position on
the neck related to the cervical spine curvature can be assessed
by a distance (in cm) of a horizontal line, which has as
reference the tangent to the apex of the thoracic spine, and
the deepest point of the cervical spine. However, in this study,
the DC (biophotogrammetry) showed no correlation with the
cephalometric variable CVT/EVT expressing the cervical
lordosis. Thus, it is assumed that this photogrammetric
measure is best used for assessment of the forward head
posture and not for the cervical curvature.
It is possible to study the craniocervical posture with
reliable methods and without the exposure to radiation26.
Based on the association found between the two methods
regarding the analysis of the measures that characterized the
forward head and the head flexion/extension, it can be
suggested the use of the biophotogrammetric method to assess
the craniocervical posture.
Based on the correlations obtained between the postural
assessment methods, it can be concluded that computerized
biophotogrammetry, apart from being reliable, seemed to be
of the cervical curvature, it is suggested the radiographic
method as a more objective view of the bone structures which
are not influenced by the soft tissues.
References
1. Armijo-Olivo S, Jara X, Castillo N, Alfonso L, Schilling A, Valenzuela E, et
al.Acomparison of the head and cervical posture between the self-balanced
position and the Frankfurt method. J Oral Rehabil. 2006; 33: 194-201.
2. Kendall F P, McCreary EK, Provance PG. Muscles: testing and function,
with posture and pain. São Paulo: Manole; 1995.
3. Iunes DH, Bevilaqua-Grossi D, Oliveira AS, Castro FA; Salgado HS.
Comparative analysis between visual and computerized photogrammetry
postural assessment. Rev Bras Fisioter. 2009; 13: 308-15.
4. Iunes DH, Castro FA, Salgado HS, Moura IC, Oliveira AS, Bevilaqua-
Grossi D. Intra and inter-examiner reliability and method repeatability of
postural evaluation via photogrammetry. Rev Bras Fisioter. 2005; 9: 327-34.
5. Gadotti IC, Biasotto-Gonzalez DA. Sensitivity of clinical assessments of
sagittal posture. J Eval Clin Pract. 2010; 16: 141-4.
6. Bryden L, Fitzgerald D. The influence of posture and alteration of function
upon the craniocervical and craniofacial region. Craniofacial Dysfunction
and Pain. In: Craniofacial dysfunction and pain: manual therapy,
assessment, and management. London: Butterworth-Heinemann; 2001.
p.164-71.
7. Solow B, Sandham A. Cranio-cervical posture: a factor in the development
and function of the dentofacial structures. Eur J Orthod. 2002; 24: 447-56.
8. Visscher CM, de Boer W, Lobbezoo F, Habets LLMH, Naeije M. Is there
arelationship between head posture and craniomandibular pain? J Oral
Rehabil. 2002; 29 : 1030-6.
9. Ciancaglini R, Colombo-Bolla, G, Gherlone EF, Radaelli G. Orientation of
craniofacial planes and temporomandibular disorder in Young adults with
normal occlusion. J Oral Rehabil. 2003; 30: 878-86.
10. Rosa LP, Moraes LC. Comparative study of the influence of the conventional
method and natural head posture for cephalometric lateral x-rays obtainment
using the craniocervical analysis . Cienc Odontol Bras. 2009; 12: 56-62.
11. Lee WI, Okeson JP, Lindroth J. The relationship between forward head
posture and temporomandibular disorders. J Orofac Pain. 1995; 9: 161-7.