Restricted accessResearch articleFirst published online 2025
Cephalometric Assessment of Sella Turcica Morphology and Dimensions in Patients with Non-Syndromic Cleft Lip and Palate: A Systematic Review and Meta-Analysis
This review aimed to analyze the size and morphology of the Sella Turcica (ST) in 2-dimensional cephalometric radiographs of individuals with non-syndromic cleft lip and or palate (CLP/CP) compared with non-cleft individuals.
Methods
A comprehensive search of multiple electronic databases was conducted without language and date restrictions until October 12, 2024. Studies were included that assessed ST dimensions in lateral cephalograms and compared the patients with non-syndromic CLP or CP and non-cleft individuals. The studies’ quality assessment was assessed using the JBI case-control guidelines and the Anatomical Quality Assurance checklist. Quantitative analysis was performed using the random-effects meta-analysis model. The GRADE approach was employed to evaluate the certainty of evidence.
Results
Out of 1087 studies, 10 met the inclusion criteria, and 6 were included in the quantitative analysis. Of all, 7 studies were rated moderate, 2 low, and 1 high quality. Unilateral CLP (UCLP) cohort showed statistically significant smaller dimensions for length (MD = −1.22; 95% CI: −2.21, −0.24), depth (MD = −0.65; 95% CI: −1.41, −0.11), and area (MD = −4.75; 95% CI: −7.22, −2.28) and the odds of ST bridging were more than twice compared to non-cleft control. No significant differences were observed in ST dimensions in bilateral CLP versus non-Cleft and UCLP.
Conclusion
The evidence of differences in ST dimensions between non-cleft individuals and patients with UCLP is weak, owing to a greater risk of bias resulting from inadequate reporting of design variability, participant demographics, and measurement methods. Future studies with better methodology and larger sample sizes are needed.
JacobsonAJacobsonRL. Radiographic Cephalometry: From Basics to 3-D Imaging. Quintessence Pub.; 2006.
2.
AlkofideEA. The shape and size of the Sella Turcica in skeletal class I, class II, and class III Saudi subjects. Eur J Orthod. 2007;29(5):457–463. doi:https://doi.org/10.1093/ejo/cjm049
3.
KjærI. Sella Turcica morphology and the pituitary gland-a new contribution to craniofacial diagnostics based on histology and neuroradiology. Eur J Orthod. 2015;37(1):28–36. doi:https://doi.org/10.1093/ejo/cjs091
TrotmanCACollettARMcNamaraJACohenSR. Analyses of craniofacial and dental morphology in monozygotic twins discordant for cleft lip and unilateral cleft lip and palate. Angle Orthod. 1993;63(2):135–139. doi:https://doi.org/10.1043/0003-3219(1993)063 < 0135:AOCADM>2.0.CO;2
6.
KimNYBaekSH. Cleft sidedness and congenitally missing or malformed permanent maxillary lateral incisors in Korean patients with unilateral cleft lip and alveolus or unilateral cleft lip and palate. Am J Orthod Dentofacial Orthop. 2006;130(6):752–758. doi:https://doi.org/10.1016/j.ajodo.2005.02.029
7.
KyrkanidesSBellohusenRSubtelnyJD. Skeletal asymmetries of the nasomaxillary complex in noncleft and postsurgical unilateral cleft lip and palate individuals. Cleft Palate Craniofac J. 1995;32(5):428–433. doi:https://doi.org/10.1597/1545-1569_1995_032_0428_saotnc_2.3.co_2
8.
MossML. The functional matrix hypothesis revisited. 1. The role of mechanotransduction. Am J Orthod Dentofacial Orthop. 1997;112(1):8–11. doi:https://doi.org/10.1016/s0889-5406(97)70267-1
9.
FriedlandBMeazziniMC. Incidental finding of an enlarged Sella Turcica on a lateral cephalogram. Am J Orthod Dentofacial Orthop. 1996;110(5):508–512. doi:https://doi.org/10.1016/s0889-5406(96)70057-4
LipinskiRJSongCSulikKK, Everson JL, Gipp JJ, Yan D, Bushwan W, Rowland IJ.Cleft lip and palate results from hedgehog signaling antagonism in the mouse: phenotypic characterization and clinical implications. Birth Defects Res A Clin Mol Teratol. 2010;88(4):232–240. doi:https://doi.org/10.1002/bdra.20656
12.
AlkofideEA. Sella Turcica morphology and dimensions in cleft subjects. Cleft Palate Craniofac J. 2008;45(6):647–653. doi:https://doi.org/10.1597/07-058.1
13.
MosavatFSarmadiSAminiAAsgariM. Evaluation of dimension and bridging of Sella Turcica and presence of Ponticulus posticus in individuals with and without cleft: a comparative study. Cleft Palate Craniofac J. 2023;60(6):695–700. doi:https://doi.org/10.1177/10556656221075935
14.
PageMJMcKenzieJEBossuytPM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol. 2021;134:178–189. doi:https://doi.org/10.1016/j.jclinepi.2021.03.001
TomaszewskiKAHenryBMKumar RamakrishnanP, Joyeeta R, Vikse J, Loukas M, Tubss RS, Walocha JA. Development of the anatomical quality assurance (AQUA) checklist: guidelines for reporting original anatomical studies. Clin Anat. 2017;30(1):14–20. doi:https://doi.org/10.1002/ca.22800
17.
MoolaSMunnZTufunaruC,Aromataris E, Sears K, Sfetcu R, Currie M, Lisy K, Qureshi R, Mattis P, et al. Systematic reviews of etiology and risk (2020). In: AromatarisELockwoodCPorrittKPillaBJordanZ, editors. JBI Manual for Evidence Synthesis. JBI; 2024. doi:10.46658/JBIMES-24-06. Available from: https://synthesismanual.jbi.global.
AntonarakisGSGhislanzoniLHFisherDM. Sella Turcica bridging and tooth agenesis in children with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2021;58(11):1382–1388. doi:https://doi.org/10.1177/1055665620984649
20.
NielsenBWMølstedKKjaerI. Maxillary and Sella Turcica morphology in newborns with cleft lip and palate. Cleft Palate Craniofac J. 2005;42(6):610–617. doi:https://doi.org/10.1597/04-104r.1
AkayGErenIKaradagOGungorK. Three-dimensional assessment of the Sella Turcica: comparison between cleft lip and palate patients and skeletal malocclusion classes. Surg Radiol Anat. 2020;42(9):977–983. doi:https://doi.org/10.1007/s00276-020-02481-z
23.
PaknahadMShahidiSKhaleghiI. A cone beam computed tomographic evaluation of the size of the Sella Turcica in patients with cleft lip and palate. J Orthod. 2017;44(3):164–168. doi:https://doi.org/10.1080/14653125.2017.1343221
24.
EltabakhAEl GemeayWEl RawdyARamadanA. Shape and dimensions of Sella Turcica in cleft and non-cleft palate subjects: a radiographic study. Dental Science Updates. 2023;4(1):115–122. doi:https://doi.org/10.21608/dsu.2023.142037.1127
25.
YasaYOcakABayrakdarISDumanSBGumussoyI. Morphometric analysis of Sella Turcica using cone beam computed tomography. J Craniofac Surg. 2017;28(1):e70–e74. doi:https://doi.org/10.1097/SCS.0000000000003223
26.
YasaYBayrakdarISOcakADumanSBDedeogluN. Evaluation of Sella Turcica shape and dimensions in cleft subjects using cone-beam computed tomography. Med Princ Pract. 2017;26(3):280–285. doi:https://doi.org/10.1159/000453526
27.
AntonarakisGSGhislanzoniHFisherLMD. Sella Turcica dimensions and maxillary growth in patients with unilateral cleft lip and palate. J Stomatol Oral Maxillofac Surg. 2022;123(6):e916–e921. doi:https://doi.org/10.1016/j.jormas.2022.06.008
28.
TziavarasNMihailidisSRajionZYusofAAndersonPJTownsendG. A three-dimensional computed tomography analysis of craniofacial asymmetry in Malaysian infants with cleft lip and palate. Malays J Med Sci. 2010;17(4):25–35.
29.
HolstAIHolstSNkenkeEFennerMHirschfelderU. Vertical and sagittal growth in patients with unilateral and bilateral cleft lip and palate-a retrospective cephalometric evaluation. Cleft Palate Craniofac J. 2009;46(5):512–520. doi:https://doi.org/10.1597/08-041.1
30.
FudalejPOblojBMiller-DrabikowskaDSamarcew-KrawczakADudkiewiczZ. Midfacial growth in a consecutive series of preadolescent children with complete unilateral cleft lip and palate following a one-stage simultaneous repair. Cleft Palate Craniofac J. 2008;45(6):667–673. doi:https://doi.org/10.1597/07-174.1
31.
GümrükçüZBilgirEBayrakSBayrakdarİŞ. Evaluation of sphenoid sinus variations by using cone beam computed tomography in patients with cleft lip/palate. Oral Radiol. 2020;36(3):248–253. doi:https://doi.org/10.1007/s11282-019-00401-5
32.
PérezIEChávezAK. Frequency of Ponticulus posticus, Sella Turcica bridge and clinoid enlargement in cleft lip and palate Peruvian patients: a comparative study with non-cleft patients. Int J Morphol. 2015;33(3):895–901. doi:https://doi.org/10.4067/S0717-95022015000300015
33.
BartzelaTKatsarosCRønningE, Rizell S, Semb G, Bronkhorst E, Halazonetis D, Kuijpers-Jagtman AM.A longitudinal three-center study of craniofacial morphology at 6 and 12 years of age in patients with complete bilateral cleft lip and palate. Clin Oral Investig. 2012;16(4):1313–1324. doi:https://doi.org/10.1007/s00784-011-0615-y
34.
GoyencYBGurelHGMemiliB. Craniofacial morphology in children with operated complete unilateral cleft lip and palate. J Craniofac Surg. 2008;19(5):1396–1401. doi:https://doi.org/10.1097/SCS.0b013e318184333d
35.
SundareswaranSNipunCA. Bridging the gap: Sella Turcica in unilateral cleft lip and palate patients. Cleft Palate Craniofac J. 2015;52(5):597–604. doi:https://doi.org/10.1597/13-258
36.
CesurEAltugATToygar-MemikogluUGumru-CelikelDTagrikuluBErbayE. Assessment of Sella Turcica area and skeletal maturation patterns of children with unilateral cleft lip and palate. Orthod Craniofac Res. 2018;21(2):78–83. doi:https://doi.org/10.1111/ocr.12219
AlamMKAlfawzanAA. Evaluation of Sella Turcica bridging and morphology in different types of cleft patients. Front Cell Dev Biol. 2020;8:656. doi:https://doi.org/10.3389/fcell.2020.00656
39.
NerurkarSKambleRShrivastavS, Sanchla A, Kaiser J, Mathew J, Toshniwal N.The comparative evaluation of the morphology and dimensions of the Sella Turcica in skeletal class III patients and patients with unilateral cleft lip and palate in post-pubertal age group. Cureus. 2022;14(9):e29730. doi:https://doi.org/10.7759/cureus.29730
40.
AntonarakisGSHuanca GhislanzoniLLa ScalaGCFisherDM. Sella Turcica morphometrics in children with unilateral cleft lip and palate. Orthod Craniofac Res. 2020;23(4):398–403. doi:https://doi.org/10.1111/ocr.12380
41.
ZawiślakAJankowskaAGrocholewiczKJaniszewska-OlszowskaJ. Morphological variations and anomalies of the Sella Turcica on lateral cephalograms of cleft-palate-only (CPO) patients. Diagnostics (Basel). 2023;13(15):2510. doi:https://doi.org/10.3390/diagnostics13152510
42.
CicchettiDV. Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychol Assess.1994;6(4):284–290. doi:https://doi.org/10.1037/1040-3590.6.4.284
43.
SilvermanFN. Roentgen standards fo-size of the pituitary fossa from infancy through adolescence. Am J Roentgenol Radium Ther Nucl Med. 1957;78(3):451–460.
44.
ZimmermanTSWhiteMGDaughadayWHGoetzFC. Hypopituitarism with normal or increased height. report of two cases, with measurement of plasma growth hormone levels. Am J Med. 1967;42(1):146–150. doi:https://doi.org/10.1016/0002-9343(67)90012-5
45.
LaronZTaubeEKaplanI. Pituitary growth hormone insufficiency associated with cleft lip and palate. an embryonal developmental defect. Helv Paediatr Acta. 1969;24(6):576–581.
46.
RudmanDDavisTPriestJH, Patterson JH, Kutner MH, Heymsfield SB, Bethel RA.Prevalence of growth hormone deficiency in children with cleft lip or palate. J Pediatr. 1978;93(3):378–382. doi:https://doi.org/10.1016/s0022-3476(78)81141-x
LangJ. Structure and postnatal organization of heretofore uninvestigated and infrequent ossifications of the Sella Turcica region. Acta Anat (Basel). 1977;99(2):121–139. doi:https://doi.org/10.1159/000144840
49.
FrancisCC. Growth of the human pituitary fossa. Hum Biol. 1948;20(1):1–20.
50.
ChidiacJJShoferFSAl-KutoubALasterLLGhafariJ. Comparison of CT scanograms and cephalometric radiographs in craniofacial imaging. Orthod Craniofac Res. 2002;5(2):104–113. doi:https://doi.org/10.1034/j.1600-0544.2002.01170.x
51.
LeonardiRBarbatoEVichiMCaltabianoM. Skeletal anomalies and normal variants in patients with palatally displaced canines. Angle Orthod. 2009;79(4):727–732. doi:https://doi.org/10.2319/082408-448.1
52.
ShresthaGKPokharelPRGyawaliRBhattaraiBGiriJ. The morphology and bridging of the Sella Turcica in adult orthodontic patients. BMC Oral Health. 2018;18(1):45. doi:https://doi.org/10.1186/s12903-018-0499-1
53.
AxelssonSStorhaugKKjaerI. Post-natal size and morphology of the Sella Turcica. Longitudinal cephalometric standards for Norwegians between 6 and 21 years of age. Eur J Orthod. 2004;26(6):597–604. doi:https://doi.org/10.1093/ejo/26.6.597
54.
MuhammedFKAbdullahAOLiuY. Morphology, incidence of bridging, dimensions of Sella Turcica, and cephalometric standards in three different racial groups. J Craniofac Surg. 2019;30(7):2076–2081. doi:https://doi.org/10.1097/SCS.0000000000005964
55.
Rino NetoJde PaivaJBQueirozGVAttizzaniMFMiasiro JuniorH.Evaluation of radiographic magnification in lateral cephalograms obtained with different X-ray devices: experimental study in human dry skull. Dental Press J Orthod. 2013;18(2):17.e1–7. doi:https://doi.org/10.1590/s2176-94512013000200005
SmahelZBrejchaM. Differences in craniofacial morphology between complete and incomplete unilateral cleft lip and palate in adults. Cleft Palate J. 1983;20(2):113–127.
58.
ChongDKSomasundaramMHoEDhoogheNSFisherDM. Comparison of presurgical anthropometric measures of right and left complete unilateral cleft lip and/or palate. Plast Reconstr Surg. 2022;149(2):248e–253e. doi:https://doi.org/10.1097/PRS.0000000000008769
59.
FellMBradleyDChadhaA, Butterworth S, Davies A, Russell C, Richard B, Wren Y, Lewis S, Chong D.Sidedness in unilateral orofacial clefts: a systematic scoping review. Cleft Palate Craniofac J. Published online December.2023;13:10556656231221027. doi:https://doi.org/10.1177/10556656231221027
60.
RoomaneyIAChettyM. Sella Turcica morphology in patients with genetic syndromes: a systematic review. Orthod Craniofac Res. 2021;24(2):194–205. doi:https://doi.org/10.1111/ocr.12426
61.
AndredakiMKoumantanouADorotheouDHalazonetisDJ. A cephalometric morphometric study of the Sella Turcica. Eur J Orthod. 2007;29(5):449–456. doi:https://doi.org/10.1093/ejo/cjm048
62.
TepedinoMLaurenzielloMGuidaL, Montaruli G, Troiano G, Chimenti C, Colonna M, Ciavarella D.Morphometric analysis of Sella Turcica in growing patients: an observational study on shape and dimensions in different sagittal craniofacial patterns. Sci Rep. 2019;9(1):19309. doi:https://doi.org/10.1038/s41598-019-55916-y
63.
Agani SabahGDinçerB. Association between Sella Turcica bridging and the impaction severity of palatally displaced canines: a retrospective study. Am J Orthod Dentofacial Orthop. 2023;164(4):567–574. doi:https://doi.org/10.1016/j.ajodo.2023.03.016
64.
SilveiraBTFernandesKSTrivinoTSantosDde FreitasLYFFC. Assessment of the relationship between size, shape and volume of the sella turcica in class II and III patients prior to orthognathic surgery. Surg Radiol Anat. 2020;42(5):577–582. doi:https://doi.org/10.1007/s00276-019-02406-5
65.
RaviMRavikalaS. Assessment of skeletal age in children with unilateral cleft lip and palate. Int J Clin Pediatr Dent. 2013;6(3):151–155. doi:https://doi.org/10.5005/jp-journals-10005-1209
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