original article

J. Stomat. Occ. Med. (2009) 2: 191204

DOI 10.1007/s12548-009-0032-x
Printed in Austria
Springer-Verlag 2009

Three-dimensional CT analysis of vomer bone

in the architecture of craniofacial structures in caucasic
human skulls
Cristian Basili1;2 , Takero Otsuka3 , Mitsuyoshi Kubota4 , Rudolf Slavicek5 , Sadao Sato6
1

Postgraduate Research Fellow, Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics,
Kanagawa Dental College, Yokosuka, Japan
2
Department of Pediatric and Preventive Dentistry, Universidad de Valparaiso, Valparaiso, Chile
3
Post-Doctoral Researcher, Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics,
Kanagawa Dental College, Yokosuka, Japan
4
Department of Craniofacial Growth and Development Dentistry, Division of Orthodontics, Kanagawa Dental College,
Yokosuka, Japan
5
Course Director of Dental Science, Danube-University, Krems, Austria
6
Department of Craniofacial Growth and Development Dentistry, Research Institute of Occlusion Medicine,
Research Center of Brain and Oral Science Division of Orthodontics, Kanagawa Dental College, Yokosuka, Japan
Received July 7, 2009; Accepted September 28, 2009

Introduction: The craniofacial architecture is the result of a

very complex interrelation. The nasal septum and specially
vomer bone, because of its strategic spatial location between
the cranial base and the mid-face, inuence the growth of this
area of the facial skeleton, thus playing a major role in the
organization of the craniofacial architecture. The purpose was
to analyze the inuence of vomer bone on the morphology of
the craniofacial architecture, evaluate its correlation with
different structures, and compare the spatial position and
dimensions between dentoskeletal frames.
Method: 3D cephalometric measurements were analyzed and correlated in 302 digitally reconstructed skulls by
3D CBCT of a caucasic European adult population.
Results: Changes in the inclination and the dimensions of
vomer bone were strongly correlated with other craniofacial
structures. There were signicant variations in vomer bone
between the different dentoskeletal frames.
Conclusions: Vomer bone seems to play an important
role in the interrelation of the craniofacial architecture.
Keywords: Vomer, cranial base, maxilla, occlusal plane,
posterior occlusal plane, skull, 3D CBCT

Introduction
The craniofacial architecture is the result of a very complex
interrelation between different structures, which varies
among individuals. Some theories have been developed to
Correspondence: Cristian Basili, Department of Craniofacial Growth
and Development Dentistry, Division of Orthodontics, Kanagawa Dental
College, 82 Inaoka-cho, Yokosuka 238-8580, Japan.
E-mail: cristianbasili@gmail.com

J. Stomat. Occ. Med.
Springer-Verlag

represent these dynamic relations emphasizing on the articular mobility of the cranium and the interaction between the
different craniofacial structures. Among these theories, Dr.
Sadao Sato emphasizes the importance of synchondroses
between the bones, which allows them to be situated within
a exible or moving structure when pressure or tension is
exerted on craniofacial structures. These synchondroses permit slight relative movements called articular mobility of the
cranium [30]. This mobility between the structures is important during growth and development of the mid-face, because
of the varying relation between different bone structures,
muscles, and functional inuences that modulate the expression of the morphological skeletal patterns. In this interrelation, the nasal septum especially vomer bone, because of its
spatial location between the cranial base and the mid-face,
shape and the anatomical relation to important structures,
serves as an important structure that inuences the growth of
this area of the facial skeleton. Therefore, it could play a major
role in the organization of the craniofacial architecture.
Some researchers have partially described the role of
vomer bone in the development of the maxillary complex as a
possible inuencing factor in the lowering of the hard palate or
in the distribution of masticatory forces to the cranial base. At
the same time, some approaches for the development of the
anterior portion of the maxilla [3, 7, 11, 14, 21], and some
inuence on the evolution of patients with cleft palate have
been described [8, 10, 17]. However, its inuence on the
morphology of the craniofacial architecture still remains
unclear.
Most of the information from previous studies about
craniofacial interrelations was obtained from 2D cephalometric images, with limitation in the identication of this structure. Nowadays, the development of the Cone beam
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Tab. 1: Denition of anatomic landmarks for 3-dimensional computed tomography

Landmark

Abbreviation

Denition on CT image

Nasion

Nasofrontal structure in the midline

Sella

Center of the pituitary fossa

Basion

Ba

Anterior-inferior margin of the foramen magnum

Upper vomer

UV

The most anterior point of the vomer bone base

Lower vomer

LV

The midpoint in the posterior surface of the vomer bone base

Anterior nasal spine

ANS

Central point of the anterior nasal spine

Posterior nasal spine

PNS

The most posterior point of the palate in the medial plane

A point

The deepest point of the midline maxillar frontal surface

Right tuberosity

TubR

The midpoint of the junction between right sphenoid pterigoid processus

and maxilla tuberosity

Left tuberosity

TubL

The midpoint of the junction between left sphenoid pterigoid processus

and maxilla tuberosity

Tuberosity medial

TubMed

Computerized 3D middle point between tuberosity left and right landmarks

Right canine

3R

Tip of the cusp of the right canine

Left canine

3L

Tip of the cusp of the left canine

Right 2nd premolar

5R

Tip of the bucal cusp of the second right premolar

Left 2nd premolar

5L

Tip of the bucal cusp of the second left premolar

2nd premolar mean

Premed

Computerized 3D mean point between right and left second premolars

Right 1st molar

6R

Bucal area of the contact point between right rst molar and right second premolar

Left 1st molar

6L

Bucal area of the contact point between left rst molar and left second premolar

Right 2nd molar

7R

Tip of the disto-bucal cusp of the right second molar

Left 2nd molar

7L

Tip of the disto-bucal cusp of the left second molar

B point

The deepest point of the mid mandibular frontal surface

Menton

Me

The lowest border of the mid mandibular suture

Tangent gonion right

TGoR

The lowest point in the distal right portion of the mandible

Tangent gonion left

TGoL

The lowest point in the distal left portion of the mandible

Upper interincisor point

UII

The most incisal point between the two upper central Incisors

Fig. 1: 3D Landmarks. Frontal and lateral images of the 3D virtual model of the skull with the cephalometric landmarks. 1. Nasion; 2. Sella;
3. Basion; 4. Upper vomer; 5. Lower vomer; 6. Anterior nasal spine; 7. Posterior nasal spine; 8. A point; 9. Right tuberosity; 10. Left tuberosity;
11. Tuberosity medial; 12. Right canine; 13. Left canine; 14. Right 2nd premolar; 15. Left 2nd premolar; 16. Right 1st molar; 17. Left 1st molar;
18. Right 2nd molar; 19. Left 2nd molar; 20. B point; 21. Menton; 22. Tangent gonion right; 23. Tangent gonion left; 24. Interincisor point;
25. Median second premolar

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original article

computed tomography systems and its applications in craniofacial diagnosis provide new alternatives to evaluate the
morphology of the craniofacial skeleton in a three-dimensional way with great accuracy [1, 19, 20, 23, 24, 33].
The purpose of this study was to analyze the inuence of
vomer bone on the morphology of the craniofacial architecture, evaluate its correlation with different structures, and
compare the spatial position and dimensions between dentoskeletal frames in 3D digitally reconstructed skulls of a
caucasic European adult population.

metric analysis was designed with 25 different landmarks

(Table 1, Fig. 1) on the skulls. Computerized generation of
eight 3D Planes was dened (Table 2, Fig. 2) and established.
The cephalometric landmarks were located and marked on

Tab. 2: Denition of 3D planes used in the

analysis
Plane

Abbreviation

Denition

Horizontal
plane

HP

Automatically computed plane

6 below SN along the horizontal direction of the
natural head position

Vertical plane

VP

Plane through sella and

perpendicular to the horizontal
plane and sagital plane

Sagital plane

SP

Plane through sella and nasion

and perpendicular to the
horizontal plane

Sella nasion
plane

SN

Plane through S-N line,

perpendicular to sagital plane

Palatal plane

PP

Plane through ANS-PNS line,

perpendicular to sagital plane

Anterior
occlusal plane

AOP

Plane dened by 3 landmarks:

upper Interincisor point, right
and left second premolar

Posterior
occlusal plane

POP

Plane dened by 3 landmarks:

medial second premolar, left
and right second molar

Mandibular
plane

MP

Plane dened by 3 landmarks:

menton, right and left tangent
gonion

Material and methods

This Research Protocol was approved by the Natural History
Museum Vienna, Donau University and Kanagawa Dental
College Research Committee. The samples included 322
caucasic European adult dry skulls, randomly selected from
the Weissbach Collection of the Natural History Museum
Vienna. Augustine Weissbach was a physician in charge of a
military hospital in Constantinople and he foresaw the benets of preserving the skulls of soldiers in the Imperial Army,
who were killed or died circa 1870. There were about 850
skulls in the original collection donated in 1885 to the
anthropology division of the Natural History Museum of
Vienna. Although no complete documentation about demographic information is available, the skulls are mainly of
males, and the age at the time of death, ranges from 19 to 50
years.
The sample was selected on the basis of the following
criteria: 1. no evident cranial deformity 2. complete skull bone
structure, and 3. the presence of a stable and reproducible
mandible position. A group of orthodontists checked the
occlusion to conrm the stability and reproducibility. A silicone plaster was placed in the joint space to ll the area
between glenoid fossa and the condylar head, with the mandible in maximun intercuspation, to improve the stability of
the lower jaw. A custom plastic head holder was constructed to
support the skulls during imaging and was placed with a laser
marker. Cone Beam Computerized Tomography (CBCT)
scans were acquired with the Galileo Compact (Sirona Dental
System GmbH, Germany) at 220 V, frequency of 50/60 Hz with
a total ltration of X-ray tube assembly >2.5 Al. The Conebeam angle is collimated to approximately 24 and has an
orbital angle of 204 . The scanning time was approximately 14
seconds and 200 single exposures were performed for each
skull with a eld of view of 15 cm diameter15 cm height.
Since the samples did not have a soft-tissue component,
exposure parameters were controlled by automatic exposure
control. The CBCT data were exported from the SIDEXIS XG
software (Sirona Dental System GmbH, Germany) in DICOM
multile format and imported into MAXILIM software version
2.2.0 (MEDICIM, Mechelen, Belgium).
The models were obtained and reevaluated by a singlecalibrated operator (CB). These 3D reconstructed skulls models were re-analyzed on the basis of the following criteria 1.
Available Nasion Landmark, 2. Available Sella Landmark, and
3. Presence of Skeletal basic structures. 20 skulls were eliminated from the sample, because of the unavailable welldened Nasion (19 skulls) or Sella (1 skull) landmarks. 3D
measurements were undertaken in stages. The 3D cephaloJ. Stomat. Occ. Med.
Springer-Verlag

Fig. 2: Graphic representation of the 3D planes. Constructed 3D planes

are shown in red. Reference planes are represented in blue. 1. Sella
nasion plane (SN); 2. Horizontal plane (HP); 3. Palatal plane (PP);
4. Anterior occlusal plane (AOP); 5. Posterior occlusal plane (POP);
6. Mandibular plane (MP); 7. Vertical plane (VP); 8. Sagital plane (SP)

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Tab. 3: Denition of the 3D angular measurements in the analysis

Angular measurement

Abbreviation

Denition

Cranial base

Cr Base

Angle between landmarks N-S-Ba

AOP-POP

AOP-POP

3D angle between AOP and POP

AOP-SN

AOP-SN

3D angle between AOP and SN plane

POP-SN

POP-SN

3D angle between SN plane and POP

Vomer diagonal-SN

Dvo-SN

Angle between the line LV-ANS and the SN plane

SN-PP

SN-PP

Angle between the line S-N and the palatal plane

MP-AB

MP-AB

Angle between the line A-B and the mandibular plane

PP-AB

PP-AB

Angle between the line A-B and the palatal plane

S-Me-SP

S-Me-SP

Angle between the line S-Me and the sagital plane

SN-MP

SN-MP

Angle between the line S-N and the mandibular plane

Vomer Base-SN

Bvo-SN

Angle between the line UV-LV and the SN plane

Vomer Post-SN

Pvo-SN

Angle between the line LV-PNS and the SN plane

Vomer Sup-SN

Svo-SN

Angle between the line UV-ANS and the SN plane

ANB

ANB

Angle between three landmarks: A, B, N

ANS-S-Me

ANS-SMe

Angle between three landmarks: ANS, S, Me

N-S-Me

NSMe

Angle between three landmarks: N, S, Me

SNA

SNA

Angle between three landmarks: S, N, A

SNB

SNB

Angle between three landmarks: S, N, B

the skulls using an optical mouse in a 69 cm (27 inch) LCD

Display Monitor (Dell, USA). Finally, 24 angular (Table 3) and
37 linear 3D cephalometric measurements (Table 4, Figs. 3
and 4) previously designed were obtained in the Maxilim
Software. All the cephalometric images of the 302 skulls, were
developed by a single-calibrated operator.
The Maxilim Software can export the measurement data
to Excel les, therefore all the angular and linear 3D cephalometric measurement data were exported with the original
skull identication number. After this stage, Excel les were
exported to SPSS software version 15 for the statistic analysis.
The samples were classied according to the dentoskeletal frame groups, into Class I, Class II, and Class III based in
the antero-posterior dysplasia indicator (APDI) [16], following
this criteria: Class II < 81.37  3.79 (Class I) < Class III.
The abbreviations used in this study are listed in
Tables 1, 2, 3, and 4.
Statistical analysis
Statistical analysis was performed with a standard statistical
software package SPSS version 15 for Windows (SPSS Inc.,
Chicago, USA). In addition to standard descriptive statistic
calculations (means and standard deviations), the Pearson
product moment correlation coefcients were calculated to
estimate the relationship between vomer bone and the skeletal parameters. The statistically signicant levels were predetermined at P < 0.05 and P < 0.01. Additionally, regarding
the inuence of vomer bone on the morphology of the
craniofacial architecture, ANOVA test was used to evaluate
differences among the skeletal frames. When ANOVA yielded

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Three-dimensional CT analysis of vomer bone

signicant results indicating that at least one group was

signicantly different from the others, post-hoc analyses (Tukey, Bonferroni tests) were performed for multiple group
comparison to determine which group signicantly differed.
To determine intra-observer reliability and assess cephalometric method error, duplicate 3D tracing and measurements of 25 randomly selected skulls were performed by the
same investigator (CB) after 1 month. Random and standard
errors were calculated by correlation, which showed values
between 0.80 and 0.99, and paired samples t-test between rst
and second angular and linear measurements. No systematic
errors were detected.

Results
3D data obtained from the analysis of correlations between
vomer bone and different structures and measurements of
the skulls are presented. Figure 5 shows the lateral representation of a constructed vomer bone. Table 5 presents
descriptive data of angular and linear measurements. Table 6
shows the correlations between angular measurements and
different parameters of the skull. Table 7 presents the correlations of linear measurements of vomer bone. For the
analysis, correlations were determined by their relation to
different structures.
Vomer bone and cranial base
In the sample group, the relation between the cranial base and
the inclination of vomer bone in the angular measurements

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original article

Tab. 4: Denition of the 3D linear measurements in the analysis

Linear measurement

Abbreviation

Denition

ANS-PNS

ANS-PNS

Distance between landmarks ANS and PNS

N-Ba

N-Ba

Distance between landmarks N and Ba

S-Me

S-Me

Distance between landmarks S and Me

Anterior cranial base

Ant Cr Base

Distance between landmarks S and N

Sagital maxilla

Max Dist

Distance between landmarks ANS and TubMed

Lower anterior facial height

Fv (L)

Distance between landmarks ANS and Me

Upper anterior facial height

Fv (S)

Distance between landmarks N and ANS

Total facial height

Fv (T)

Distance between landmarks N and Me

Posterior cranial base

Post Cr Base

Distance between landmarks Ba and S

Vomer diagonal distance

Vo Diag

Distance between landmarks LV and ANS

Vomer posterior distance

Vo Post

Distance between landmarks LV and PNS

Vomer superior distance

Vo Sup

Distance between landmarks UV and ANS

Media second premolar-SN

5-SN

Distance from landmark Premed to SN plane

A-VP

A-VP

Distance from landmark A point to vertical Plane

ANS-VP

ANS-VP

Distance from landmark ANS to vertical Plane

B-VP

B-VP

Distance from landmark B point to vertical plane

Me-VP

Me-VP

Distance from landmark Me to vertical plane

N-VP

N-VP

Distance from landmark N to vertical plane

Inter second molar

Int 7 on PP

Distance between projections of landmarks 7R and 7L on the palatal plane

Inter second premolar

Int 5 on PP

Distance between projections of landmarks 5R and 5L on the palatal plane

Intertuberosity

Int Tub

Distance between projections of landmarks TubR and TubL on the palatal plane

UV-ANS

Up Vo-ANS on VP

Distance between projections of landmarks UV and ANS on the vertical plane

UV-PNS

Up Vo-PNS on VP

Distance between projections of landmarks UV and PNS on the vertical plane

Left anterior maxilla

A-6 Lt on PP

Distance between projections of landmarks A and 6L on the palatal plane

Right anterior maxilla

A-6 Rt on PP

Distance between projections of landmarks A and 6R on the palatal plane

Inter rst molar

Int 6 on PP

Distance between projections of landmarks 6R and 6L on the palatal plane

Intercanine

Int 3 on PP

Distance between projections of landmarks 3R and 3L on the palatal plane

Left posterior maxilla

Max Post Lt on PP

Distance between projections of landmarks 6L and TubL on the palatal plane

Right posterior maxilla

Max Post Rt on PP

Distance between projections of landmarks 6R and TubR on the palatal plane

Left tuberosity-A on PP

Tub Lt-A on PP

Distance between projections of landmarks A and TubL on the palatal plane

Right tuberosity-A on PP

Tub Rt-A on PP

Distance between projections of landmarks A and TubR on the palatal plane

Posterior lower height of vomer bone

Vo Post Lo on VP

Distance between projections of landmarks LV and PNS on the vertical plane

Postero-superior vomer bone

Vo Post Up on HP

Distance between projections of landmarks LV and UV on the horizontal plane

Posterior upper height of vomer bone

Vo Post Up on VP

Distance between projections of landmarks UV and LV on the vertical plane

Antero-superior vomer bone

Vo Ant Up on HP

Distance between projections of landmarks UV and ANS on the horizontal plane

Average anterior maxilla

Aver A-6 on PP

Average between A-6Lt on PP and A-6Rt on PP

Average posterior maxilla

Aver Max Post on PP

Average between Max Post Lt on PP and Max. Post Rt on PP

Average tuberosity-A on PP

Aver Tub-A on PP

Average between TubLt-A on PP and TubRt-A on PP

(Dvo-SN, Svo-SN, and Bvo-SN) showed a signicant positive

correlation (p < 0.01), which means that extension of the
cranial base is correlated to a downward inclination of vomer
bone. At the same time, in the analysis of the linear measureJ. Stomat. Occ. Med.
Springer-Verlag

ments of the cranial base and most of the measurements of the

inclination of vomer bone, we noted a negative correlation of
the anterior and posterior cranial base dimensions with the
N-Ba distance. This shows that a bigger dimension of the
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Fig. 3: Lateral image of virtual skull representing 3D linear sagital and

vertical measurements, calculating the distance from the different landmarks to the Vertical (VP), Horizontal (HP) or SN Planes. 1. ANS-PNS; 2.
N-Ba; 3. S-Me; 4. Ant Cr Base; 5. Max Dist; 6. Fv(L); 7. Fv(S); 8. Fv(T); 9.
Post Cr Base; 10. Vo diag; 11. Vo post; 12. Vo sup; 13. 5-SN; 14. A-VP; 15.
ANS-VP; 16. B-VP; 17. Me-VP; 18. N-VP; 19. Up Vo-ANS on VP; 20. Up
Vo-PNS on VP; 21. Vo Post Lo on VP; 22. Vo Post Up on VP; 23. Vo Post
Up on HP; 24. Vo Ant Up on HP

Fig. 5: Lateral representation of the constructed vomer bone. The

difference in the anterior extension with the anatomical vomer bone has
to be considered in the analysis of the results, as a portion of the maxilla
is included. 1. Lower vomer landmark (LV); 2. Upper vomer landmark
(UV); 3. Anterior nasal spine (ANS); 4. Posterior nasal spine (PNS);
5. Posterior vomer (Pvo); 6. Vomer base (Bvo); 7. Superior vomer (Svo);
8. Palatal plane (PP); 9. Diagonal vomer (Dvo)

Vomer bone and maxilla

Fig. 4: Image of the 3D linear transversal measurements between landmarks, projected on the Palatal Plane (red color) to avoid vertical
variations. 1. Inter canine (Int 3 on PP); 2. Inter second premolars (Int
5 on PP); 3. Inter rst molars (Int 6 on PP); 4. Inter second molars (Int 7 on
PP); 5. Inter tuberosity (Int Tub); 6. Anterior right maxilla (A-6 Rt on PP); 7.
Anterior left maxilla (A-6 Lt on PP); 8. Posterior right maxilla (Max post Rt
on PP); 9. Posterior left maxilla (Max post Lt on PP); 10. Right tuberosityA point (Tub Rt-A on PP); 11. Left tuberosity-A point (Tub Lt-A on PP)

anterior or posterior cranial base length is correlated with less

inclination of vomer bone. Only the base of the vomer (BvoSN) showed different results having only signicant negative
correlation with the posterior cranial base length. On the other
hand, in vomer bone dimensions, there was no correlation
with the diagonal length (Vo Diag) and the cranial base angle,
and the posterior dimension of vomer bone (Vo Post) showed
negative correlation. At the same time, the projected measurements of the height of vomer bone in the vertical plane,
anterior and posterior lines, UV-ANS on VP show a positive
correlation and UV-PNS on VP a negative correlation with
cranial base.

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The inclination of vomer bone (Dvo-SN) is directly related to a

similar rotation of the maxilla, as the Palatal Plane presents a
positive correlation. At the same time, a negative correlation
with SNA and SNB was shown, which means that a higher
inclination of vomer bone is correlated with posterior position
of the jaws, or a retrusive position tendency.
The inclination of vomer bone measured by Dvo-SN, SvoSN, and Bvo-SN, had a signicant negative correlation with the
sagittal measurement of the maxilla (Max Dist). The angle of
the posterior vomer (Pvo-SN) showed a positive correlation
with the sagittal maxilla dimension (ANS-PNS) that indicates
changes in the shape of the posterior part of the bone in
relation to the maxilla changes. At the same time, analyzing
the proportions in the maxilla and the inclination of vomer
bone (Dvo-SN), we observed a negative correlation with the
anterior dimension of the maxilla (Aver A-6 on PP), and no
correlation with the posterior (Aver Max Post on PP), although
there is a negative tendency.
On the other hand, a signicant negative correlation was
found between some transversal dimensions of the maxilla
(Int 7 on PP, Int 6 on PP) and the inclination of vomer bone
(Dvo-SN). However a negative tendency in all the other
transversal measurements is appreciated (Int 5 on PP, Int 3
on PP, Int Tub).
The diagonal length of the vomer showed a negative
correlation with the angular inclinations, this could be related
to the correlation with the sagital size of the maxilla. There was
a positive relation with ANB. If there is a class II tendency,
vomer bone is bigger, and the same happens with the dimension of the maxilla. The posterior vomer dimension (Vo Post)
showed a negative correlation with the palatal plane; when it is
more inclined the posterior dimension is smaller. At the same

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Tab. 5: Descriptive statistic of the different parameters

Measurements

Mean

S.D.

Min.

Max.

302

131.0

5.4

115

147.4

Angular measurements
CrBase
AOP-POP

101

7.9

4.0

1.2

18.4

AOP-SN

113

12.7

4.6

3.1

25

POP-SN

138

19.9

4.2

6.6

29.9

Dvo-SN

302

23.0

3.0

14.5

32.1

MP-AB

302

75.9

5.7

55.7

89.8

PP-AB

302

82.6

5.5

70.2

107.5

SN-MP

302

27.5

5.7

11.7

43.1

Bvo-SN

302

158.3

5.7

140.5

173.6

Pvo-SN

302

57.0

6.5

40.5

77.8

Svo-SN

302

38.3

3.6

25.3

47.9

ANB

302

3.0

2.8

6.1

9.1

ANS-S-Me

302

30.5

3.0

20.8

39.5

NSMe

302

68.2

3.5

58.3

78

SNA

302

83.1

4.1

72.2

92.7

SNB

302

80.1

3.6

70.8

92.2

SN-PP

302

7.1

3.5

4.6

15.7

ANS-PNS

302

51.1

3.2

41.3

60.9

N-Ba

302

101.5

4.4

89.1

112.9

S-Me

302

121.6

5.9

Ant Cr Base

302

67.9

3.6

57.2

77.9

Max Dist

302

52.5

2.9

45.2

63

Fv(L)

302

66.0

5.8

46.9

79.7

Fv(S)

302

50.0

2.7

38.9

55.9

Fv(T)

302

115.1

6.1

90.5

126.4

Post Cr Base

302

43.2

2.8

30.9

51

Vo Diag

302

70.0

3.7

59.5

79.5

Vo Post

302

25.4

3.0

17.8

35.9

Linear measurements

103

134.7

Vo Sup

302

56.9

3.4

47.6

65.7

5-SN

137

72.5

3.1

57.5

78.8

A-VP

302

66.6

4.7

52.6

79

ANS-VP

302

69.2

4.4

55.1

81.6

B-VP

302

61.1

6.5

42.5

80.2

Me-VP

302

56.7

7.5

34.8

77.9

N-VP

302

67.6

3.5

56.9

77.4

Int 7 on PP

239

62.2

4.4

50.4

79.1

Int 5 on PP

136

51.3

3.1

40.8

60.8

Int Tub

302

43.2

3.0

34.6

49.7
(Continued)

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Tab. 5: Continued
Measurements

Mean

S.D.

Min.

Max.

Up Vo-ANS on VP

302

30.4

3.1

19.4

40.3

Up Vo-PNS on VP

302

29.6

2.9

20.1

37.7

Int 6 on PP

245

53.3

3.9

38.8

63.6

Int 3 on PP

152

36.1

2.8

25.7

42

Vo Post Lo on VP

302

19.6

2.8

11.6

27.8

Vo Post Up on HP

302

19.0

2.6

11.9

27.3

Vo Post Up on VP

302

10.1

2.2

5.2

17.8

Vo Ant Up on HP

302

48.0

3.8

35.5

60.6

Aver A-6 on PP

288

34.0

2.2

27.65

41.9

Aver Max Post on PP

288

29.2

3.3

17.5

52.55

Aver Tub-A on PP

302

54.2

2.8

47.3

62.8

Tab. 6: Correlation of craniofacial morphology between vomer angular measurements and the different
parameters
Measurement

Dvo-SN

Bvo-SN

Cor. Co.

Signif.

Pvo-SN

Cor. Co.

Signif.

Svo-SN

Cor. Co.

Signif.

Cor. Co.

Signif.

CrBase

302

0.326



0.000

0.279



0.000

0.078

NS

0.177

0.316



0.000

AOP-POP

110

0.153

NS

0.127

0.051

NS

0.611

0.164

NS

0.102

0.127

NS

0.207

AOP-SN

122

0.440



0.000

0.037

NS

0.696

0.328



0.000

0.413



0.000

POP-SN

168

0.365



0.000

0.072

NS

0.402

0.205



0.016

0.360



0.000

Dvo-SN

302

0.345



0.000

0.504



0.000

0.778



0.000

MP-AB

302

0.037

NS

0.527

0.017

NS

0.466

0.082

NS

0.155

0.004

NS

0.944

PP-AB

302

0.182



0.001

0.010

NS

0.820

0.143



0.013

0.167



0.004

SN-MP

302

0.235



0.000

0.143

0.050

0.184

0.001

0.166



0.004

Bvo-SN

302

0.345



0.000

0.026

NS

0.654

0.033

NS

0.572

Pvo-SN

302

0.504



0.000

0.026

NS

0.654

0.427



0.000

Svo-SN

302

0.778



0.000

0.033

NS

0.572

0.427

ANB

302

0.115

0.045

0.051

NS

0.381

0.137

ANS-Sme

302

0.200



0.000

0.029

NS

0.614

0.051

NSMe

302

0.376



0.000

0.201



0.000

0.325

SNA

302

0.431



0.000

0.171

0.003

SNB

302

0.391



0.000

0.218



0.000

SN-PP

302

0.607



0.000

0.260



ANSPNS

302

0.272



0.000

0.052

NS

N-Ba

302

0.199



0.001

0.011

NS

S-Me

302

0.239



0.000

0.145

Ant Cr Base

302

0.211



0.000

Max Dist

302

0.275



0.000

Fv(L)

302

0.269



0.000



0.000



0.017

0.202



0.000

NS

0.379

0.191



0.001



0.000

0.333



0.000

0.327



0.000

0.514



0.000

0.262



0.000

0.423



0.000

0.000

0.095

NS

0.099

0.545



0.000

0.366

0.114



0.047

0.260



0.000

0.844

0.251



0.000

0.145

0.012

0.012

0.098

NS

0.090

0.309



0.000

0.038

NS

0.513

0.239



0.000

0.191



0.001

0.006

NS

0.921

0.153



0.008

0.351



0.000

0.063

NS

0.276

0.023

NS

0.692

0.296



0.000
(Continued)

198 4/2009

Three-dimensional CT analysis of vomer bone

Springer-Verlag J. Stomat. Occ. Med.

original article

Tab. 6: Continued
Measurement

Dvo-SN

Bvo-SN

Cor. Co.

Signif.

Pvo-SN

Cor. Co.

Signif.

Svo-SN

Cor. Co.

Signif.

Cor. Co.

Signif.

302

0.631



0.000

0.175



0.002

0.191



0.001

0.474



0.000

Fv(T)

302

0.036

NS

0.432

0.019

NS

0.737

0.110

0.056

0.050

NS

0.386

Post Cr Base

302

0.347



0.000

0.166

0.004

0.191



0.001

0.261



0.000

Vo Diag

302

0.210



0.000

0.185



0.001

0.441



0.000

0.345



0.000

Vo Post

302

0.127

0.027

0.224



0.000

0.118

0.041

0.119



0.039

Vo Sup

302

0.045

NS

0.225

0.271



0.000

0.201

0.000

0.262



0.000

5-SN

154

0.039

NS

0.368

0.003

NS

0.975

0.018

NS

0.836

0.038

NS

0.656

A-VP

302

0.515



0.000

0.174



0.002

0.447



0.000

0.567



0.000

ANS-VP

302

0.516



0.000

0.204



0.000

0.368



0.000

0.561



0.000

B-VP

302

0.471



0.000

0.221



0.000

0.368



0.000

0.487



0.000

Me-VP

302

0.417



0.000

0.230



0.000

0.319



0.000

0.407



0.000

N-VP

302

0.210



0.002

0.037

NS

0.517

0.237



0.002

0.191



0.002

Int 7 on PP

240

0.129

0.046

0.061

NS

0.347

0.123

NS

0.057

0.158

0.014

Int 5 on PP

154

0.118

NS

0.172

0.009

NS

0.917

0.258



0.002

0.111

NS

0.200

Fv(S)

Int Tub

302

0.086

NS

0.136

0.038

NS

0.507

0.121

0.035

0.095

NS

0.099

Up Vo-ANS on VP

302

0.728



0.000

0.109

NS

0.059

0.287



0.000

0.812



0.000

Up Vo-PNS on VP

302

0.085

NS

0.142

0.423



0.000

0.395



0.000

0.239



0.000

Aver A-6 on PP

288

0.236



0.000

0.035

NS

0.553

0.078

NS

0.188

0.206



0.000

Int 6 on PP

252

0.220



0.001

0.001

NS

0.990

0.255



0.000

0.215



0.001

Int 3 on PP

161

0.105

NS

0.200

0.112

NS

0.168

0.106

NS

0.193

0.193

0.017

Aver Max Post on PP

288

0.083

NS

0.158

0.160

NS

0.073

0.354



0.000

0.199



0.001

Aver Tub -A on PP

302

0.261



0.000

0.064

NS

0.267

0.312



0.000

0.362



0.000

Vo Post Lo on VP

302

0.436



0.000

0.179



0.002

0.547



0.000

0.177

0.002

Vo Post Up on HP

302

0.087

NS

0.446

0.470



0.000

0.286



0.000

0.219



0.000

Vo Post Up on VP

302

0.426



0.000

0.742



0.000

0.164

0.004

0.084

NS

0.147

Vo Ant Up on HP

302

0.420



0.000

0.217



0.000

0.360



0.000

0.694



0.000

Cor. Co Correlation Coefcient. NS not signicant.  Statistical signicance at level 0.05.  Statistical signicance at level 0.01

time, the posterior height (UV-PNS on VP) showed a signicant negative correlation, but the anterior height (UV-ANS on
VP) showed a positive one, in relation to the spatial and
structural variation.

Vomer bone and face height

In relation to facial height dimension and the inclination of
vomer bone (Dvo-SN), there was a negative correlation with
the lower dimension (Fv(L) and a positive with the upper
height (Fv(S)) in the 4 measurements (Dvo-SN, Pvo-SN, SvoSN, and Bvo-SN), this means that if we have a higher inclination of vomer bone, it is associated specially with an increase
in the upper height of the face. At the same time, it showed a
decrease in the lower dimension. Despite these inuences,
there was no correlation between vomer inclination and the
total face height.
J. Stomat. Occ. Med.
Springer-Verlag

The angle ANS-S-Me had a negative correlation with

Dvo-SN and Svo-SN, and no correlation with the base or
posterior vomer. As vomer bone rotates downward, this is
related to the rotation of the maxilla, which makes the ANS
point to also rotate downwards. This inuence seems to be
higher in the maxilla than in the lower structures. All facial
sagital dimensions had negative correlation with the inclination of vomer bone (Dvo-SN), this represents that a downward
inclination, shows smaller dimensions of A, ANS, B, N, and Me
to the vertical plane.

Vomer bone and occlusal planes

The downward inclination of vomer bone (Dvo-SN) is
related to a similar inclination of the Posterior and Anterior
Occlusal Plane (POP-SN and AOP-SN), which can be
understood as the inclination of the complete maxillary
Three-dimensional CT analysis of vomer bone

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original article

Tab. 7: Correlation of craniofacial morphology between vomer Linear Measures and the different
parameters
Measurement

Vo Diag

Vo Post

Vo Sup

Cor. Co.

Signif. Cor. Co.

Signif. Cor. Co.

UV-ANS on VP
Signif.

Cor. Co.

UV-PNS on VP

Signif. Cor. Co.

Signif.

Cr Base

302

0.010

NS 0.886

0.116

0.043

0.097

NS 0.091

0.265

 0.000

0.157

 0.006

AOP-POP

110

0.089

NS 0.376

0.008

NS 0.939

0.023

NS 0.817

0.130

NS 0.194

0.103

NS 0.306

AOP-SN

122

0.220

0.019

0.193

0.041

0.086

NS 0.365

0.329

 0.000

0.037

NS 0.699

POP-SN

168

0.218

0.010

0.142

NS 0.096

0.169

0.048

0.240

 0.005

0.072

NS 0.404

DVoSN

302

0.210

 0.000

0.127

0.027

0.045

NS 0.433

0.728

 0.000

0.085

NS 0.142

MP-AB

302

0.126

0.029

0.139

0.016

0.060

NS 0.295

0.028

NS 0.623

0.129

 0.025

PP-AB

302

0.027

NS 0.642

0.053

NS 0.360

0.032

NS 0.584

0.190

 0.001

0.131

 0.023

SN-MP

302

0.101

NS 0.079

0.014

NS 0.803

0.094

NS 0.104

0.099

NS 0.085

0.041

NS 0.480

Bvo-SN

302

0.185

 0.001

0.224

 0.000

0.271

 0.000

0.109

NS 0.059

0.423

 0.000

Pvo-SN

302

0.441

 0.000

0.118

0.041

0.201

 0.000

0.287

 0.000

0.395

 0.000

Svo-SN

302

0.345

 0.000

0.119

0.039

0.262

 0.000

0.812

 0.000

0.239

 0.000

ANB

302

0.242

 0.000

0.037

NS 0.517

0.191

 0.001

0.097

NS 0.094

0.169

 0.003

ANS-Sme

302

0.006

NS 0.914

0.092

NS 0.112

0.081

NS 0.163

0.247

 0.000

0.074

NS 0.198

NSMe

302

0.220

 0.000

0.135

0.019

0.225

 0.000

0.178

 0.002

0.086

NS 0.137

SNA

302

0.338

 0.000

0.193

 0.001

0.363

 0.000

0.299

 0.000

0.021

NS 0.714

SNB

302

0.192

 0.001

0.239

 0.000

0.253

 0.000

0.262

 0.000

0.145

SN-PP

302

0.037

NS 0.520

0.353

 0.000

0.035

NS 0.549

0.554

 0.000

0.482

 0.000

ANSPNS

302

0.612

 0.000

0.237

 0.001

0.489

 0.000

0.032

NS 0.582

0.028

NS 0.062

N-Ba

302

0.513

 0.000

0.040

NS 0.487

0.362

 0.000

0.087

NS 0.130

0.021

NS 0.711

S-Me

302

0.421

 0.000

0.369

 0.000

0.454

 0.000

0.051

NS 0.380

0.322

 0.000

Ant Cr Base

302

0.514

 0.000

0.162

 0.005

0.410

 0.000

0.064

NS 0.266

0.123

 0.033

Max Dist

302

0.759

 0.000

0.153

 0.008

0.642

 0.000

0.037

NS 0.520

0.122

 0.034

Fv(L)

302

0.149

 0.009

0.159

 0.006

0.117

 0.042

0.242

 0.000

0.152

 0.008

Fv(S)

302

0.331

 0.000

0.161

0.416

 0.000

0.703

 0.000

0.135

Fv(T)

302

0.252

 0.000

0.224

 0.000

0.260

 0.000

0.083

NS 0.150

0.210

 0.000

Post Cr Base

302

0.210

 0.000

0.056

NS 0.333

0.168

 0.003

0.154

0.007

0.004

NS 0.939

Vo Diag

302

0.438

 0.000

0.775

 0.000

0.122

0.034

0.093

NS 0.107

Vo Post

302

0.438

 0.000

0.414

 0.000

0.127

0.028

0.539

 0.000

Vo Sup

302

0.775

 0.000

0.414

 0.000

0.330

 0.000

0.329

 0.000

5-SN

154

0.301

 0.000

0.294

 0.000

0.317

 0.000

0.120

NS 0.163

0.233

 0.006

A-VP

302

0.664

 0.000

0.279

 0.000

0.608

 0.000

0.197

 0.001

0.112

NS 0.052

ANS-VP

302

0.732

 0.000

0.252

 0.000

0.683

 0.000

0.145

0.011

0.169

 0.003

B-VP

302

0.447

 0.000

0.300

 0.000

0.447

 0.000

0.206

 0.000

0.194

 0.001

Me-VP

302

0.355

 0.000

0.259

 0.000

0.372

 0.000

0.172

 0.003

0.198

 0.001

N-VP

302

0.515

 0.000

0.163

 0.004

0.411

 0.000

0.065

NS 0.262

0.124

Int 7 on PP

240

0.201

0.002

0.055

NS 0.401

0.126

NS 0.052

0.075

NS 0.247

0.028

NS 0.664

Int 5 on PP

154

0.263

 0.001

0.078

NS 0.367

0.296

 0.000

0.072

NS 0.403

0.011

NS 0.901

Int Tub

302

0.248

 0.000

0.130

 0.024

0.180

 0.002

0.020

NS 0.733

0.071

NS 0.216

UV-ANS on VP

302

0.122

0.127

0.330

 0.000

0.433

 0.000

0.034

0.05

0.028

0.012

0.019

0.031

(Continued)

200 4/2009

Three-dimensional CT analysis of vomer bone

Springer-Verlag J. Stomat. Occ. Med.

original article

Tab. 7: Continued
Measurement

Vo Diag

Vo Post

Vo Sup

Cor. Co.

Signif. Cor. Co.

Signif. Cor. Co.

UV-ANS on VP
Signif.

Cor. Co.

UV-PNS on VP

Signif. Cor. Co.

Signif.

UV-PNS on VP

302

0.093

NS 0.107

0.539

 0.000

0.329

 0.000

0.433

 0.000

Aver A-6 on PP

288

0.336

 0.000

0.115

0.050

0.250

 0.000

0.048

NS 0.417

0.154

 0.009

Int 6 on PP

252

0.327

 0.000

0.068

NS 0.286

0.241

 0.000

0.055

NS 0.392

0.012

NS 0.851

Int 3 on PP

161

0.377

 0.000

0.038

NS 0.645

0.277

 0.000

0.021

NS 0.793

0.066

NS 0.420

Aver Max Post on PP 288

0.499

 0.000

0.137

0.414

 0.000

0.053

NS 0.372

0.131

Aver Tub-A on PP

302

0.732

 0.000

0.231

 0.000

0.595

 0.000

0.001

NS 0.984

0.043

NS 0.459

Vo Post Lo on VP

302

0.086

NS 0.137

0.757

 0.000

0.218

 0.000

0.294

 0.000

0.712

 0.000

Vo Post Up on HP

302

0.349

 0.000

0.000

NS 0.998

0.225

 0.000

0.117

0.043

0.078

NS 0.177

Vo Post Up on VP

302

0.025

NS 0.663

0.220

 0.000

0.165

 0.004

0.218

 0.000

0.444

 0.000

Vo Ant Up on HP

302

0.751

 0.000

0.367

 0.000

0.876

 0.000

0.160

 0.005

0.124

0.020

0.026

0.031

Cor. Co Correlation coefcient. NS not signicant.  Statistical signicance at level 0.05.  Statistical signicance at level 0.01

bone. But this inclination of vomer bone was not correlated

with the angle between the two occlusal planes (AOPPOP). On the other hand, there was no signicant correlation between the height of the occlusal plane to SN plane,
and the inclination of vomer bone.
Vomer bone and mandibular plane
Three of the angular measurements (Dvo, Svo, and Bvo) were
positively correlated with the mandibular plane inclination.
On the other hand, there is no correlation between the MP-AB
and the inclination of vomer bone.
Vomer bone
All the angles of vomer bone had a positive correlation
between them, which reects a bodily rotation; only the base
of the vomer had a slightly different or less correlation. The
inclination of vomer bone (Dvo-SN) had a negative correlation
with the diagonal length of itself (Vo Diag).
There is a positive correlation with the vertical dimension of the vomer height to ANS (UV-ANS on VP) as the
inclination of the vomer is increasing and positive or no
correlation with the height to PNS (UV-PNS on VP) with the
different variables.
The spatial measurement of vomer bone in relation to
horizontal and vertical plane was correlated with a bodily
rotation of the bone itself. In the vertical plane, the inclination
of vomer bone (Dvo-SN) showed a positive correlation with
the projected lower height (Vo Post Lo on Vp) and a decrease
in the upper one (Vo Post Up on VP). In the horizontal plane,
this is clearer with the negative correlation of the anterior
dimension of vomer bone (Vo Ant Up on HP) and the inclination of the bone (Dvo-SN) (Fig. 6).
Interjaw relation
There was a positive correlation of APDI (PP-AB) and the
inclination of the diagonal (Dvo-SN) and the superior lines
J. Stomat. Occ. Med.
Springer-Verlag

Fig. 6: Representation of the projection of vomer bone in the reference

planes. In the horizontal plane (HP), landmarks are projected to measure
anterior and posterior dimensions. In the vertical plane (VP), landmarks
are projected to measure upper and lower dimensions of vomer bone. 1.
Horizontal plane; 2. Vertical plane; 3. Vo Post Lo on VP; 4. Vo Post Up on
Vp; 5. Vo Post Up on HP; 6. Vo Ant Up on HP

(Svo-SN) of the vomer. The Base (Bvo-SN) showed no

correlation and the posterior vomer showed negative correlation. On the other hand, the ANB angle showed a
corresponding negative correlation with the same three
measures.
There was a positive correlation between PP-AB and the
anterior height of the vomer (UV-ANS on VP) and negative
correlation with the posterior height, both statistically signicant. ANB angle showed positive correlation with the
length of the diagonal (Vo Diag) and superior dimension of
vomer bone (Vo Sup), and also with the length of the anterior
portion of vomer bone in the projection to the horizontal
plane.
Three-dimensional CT analysis of vomer bone

4/2009

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original article

Tab. 8: Comparison of vomer bone between different skeletal frames

Class II

Class I

Class III

Signif.

Mean

S.D.

Mean

S.D.

Mean

S.D.

I vs. II

I vs. III

II vs. III

Dvo-SN

22.26

2.85

23.13

2.99

23.78

2.71

NS

NS

Bvo-SN

158.98

6.28

158.41

5.9

158.72

4.82

NS

NS

NS

Pvo-SN

58.34

6.78

57.01

6.86

55.11

5.69

NS

NS

Svo-SN

37.18

3.1

38.69

3.82

39.3

3.66

NS

5.8

1.87

3.52

2.43

1.13

2.38

Vo Diag

69.9

3.7

69.84

3.86

69.44

3.39

NS

NS

NS

Vo Post

25.78

2.87

25.28

3.05

25.19

2.96

NS

NS

NS

ANB

Vo Sup

56.43

3.46

56.64

3.37

56.55

3.61

NS

NS

NS

UV-ANS on VP

29.26

2.51

30.52

31.09

3.36

NS

UV-PNS on VP

29.97

2.63

29.47

2.87

28.84

3.18

NS

NS

NS

Vo Post Lo on VP

20.27

2.79

19.49

2.76

18.95

2.59

NS

NS

Vo Post Up on HP

19.02

2.55

19.14

2.65

19.07

2.55

NS

NS

NS

Vo Post Up on VP

9.91

2.29

10.08

2.19

10.06

2.3

NS

NS

NS

Vo Ant Up on HP

48.25

3.85

47.61

4.06

47.18

3.79

NS

NS

NS

ANOVA. NS not signicant.  Statistical signicance at level 0.05

Comparison between dentoskeletal frames

In Table 8, a comparison between vomer bone and the
different skeletal frames is presented. There was a difference in the inclination of the diagonal vomer line between
the groups, showing a tendency for the angle to increase
from Class II to Class III, with a statistically signicant
difference between these two groups (p < 0.05). No difference was observed in the vomer base inclination between
the groups, and the posterior vomer line tendency increased from Class III to class II, reecting some verticalization tendency of the posterior area. The superior vomer
angle (Svo) also showed that the smaller value is found in
the Class II group being signicantly different with the
other two groups. Even though these angular differences
existed, no statistical signicance was found between the
groups in the linear measurements of vomer bone in the
superior, diagonal, and posterior dimensions.
The distance from the upper vomer to anterior or posterior nasal spine (UV-ANS on VP, UV-PNS on VP) showed some
interesting differences between the groups. The distance to
the posterior nasal spine, was not signicant, although there
was a slight tendency to decrease towards Class III. On the
other hand, the distance to the anterior nasal spine shows the
smallest value in the Class II, which was signicantly different
from the other two groups. Especially with the Class III, which
showed a higher value, this could be interpreted as a vertical
growth tendency in this group.
There was a signicant difference between the two
groups with lower vertical projection of vomer bone in the
vertical plane (Vo Post Lo on VP) (Fig. 6). Class II showed the
highest value and class III the smallest. On the other hand, no
difference was seen in the projected upper portion of vomer

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bone. This result seems to be related to the inclination of the

maxilla, as the values also reect the inclination of the palatal
plane. The projection of vomer bone on the horizontal plane
(Vo Post Up on HP, Vo Ant Up on HP) (Fig. 6) showed no
signicant difference with the skeletal frames, although the
measurement of the anterior portion of vomer bone tended to
be reduced towards Class III.

Discussion
The results of this study show that vomer bone has very
interesting interrelations within craniofacial architecture. This
bone usually remains hidden from our cephalometric analysis, because of the difculties in identifying it in a two-dimensional X-ray. The application of the three-dimensional
Computerized Tomography, and the possibility of creating
3D volumetric digital skull reconstruction provided us the
opportunity to analyze the skull, with great accuracy [1, 20, 24,
33] and reproducibility [23], by applying a different computerbased software, like the one used in this study. The analysis of
the structures was developed by dening landmarks and
planes. These were extracted initially from the traditional
2D cephalometric analysis, allowing us to compare the data
with other study results; and some of them redened to a
three-dimensional environment, in order to be able to correlate anatomical structures.
The denition of the constructed vomer bone slightly
differs from that of a real vomer bone. The reason for this was
to obtain clear landmarks and excellent reproducibility in
positioning them. In this way, the constructed vomer bone
was extended forward to the ANS point. This must be considered in the interpretation of the results.

Springer-Verlag J. Stomat. Occ. Med.

original article

Some authors have mentioned the potential role of vomer

bone on the development of malocclusions. According to Sato
and Slavicek [30], there is a functional complex involving the
occipital, sphenoid, maxilla, and vomer. This complex is
connected through sutures, which allow some degree of
dynamic interrelation known as articular mobility of the
cranium. Transmission of forces from the occlusion, or motion
in any of the structures can inuence the entire complex and
the related structures [5, 6, 26, 30]. The role of vomer bone in
the transmission of the masticatory forces was also described
by Hilloowala [11], who reported a comparison of the human
skull and a gothic cathedral. Jerolimov [14] also indicated
transmission of the masticatory forces through the vomer to
the sphenoid bone.
In histological analysis of the postnatal development
of the nasal septum, it was described that some cartilaginous structure could increase the ability of the septum to
transfer forces from the incisor region to the sphenoid
bone [22]. In this study, a description of the increase in the
dimension of vomer bone was established. Apposition in
the anterior surface was found during the rst 12 years,
and apposition in the posterior margins and in the superior
surface (base of the vomer) was reported as a continuous
process until 17 years in men and 15 years in woman, the
period when most of the facial development takes place.
Although the author did not nd a reason to believe in the
importance of the septal cartilage in the growth of the
maxillary complex, the results were consistent with the
correlation found in this study.
Other authors have described the importance of vomer
bone in the growth of the maxilla. Growth retardation was
reported in the upper jaw in dogs with articial cleft palate and
extirpation of the vomer [21]. Squier [31] indicated that trauma
to the vomer may impair anteriorposterior growth of the premaxilla and maxilla. Friede [7] reported that alteration in the
vomero-maxillary suture is likely to be an important factor in
the etiology of the midfacial retrusion that is sometimes seen
in patients with unilateral cleft lip and palate. According to
Kimes [17], unrestricted growth of the nasal septum was
related to abnormal midfacial osseous changes. Friede H [8]
reported that the maxillary complex was displaced forwarddownwards in relation to the vomer.
From the results of this study, variation in the inclination of vomer bone (Dvo-SN) seemed to be correlated
with differences in the cranial base angle. This is a very
interesting nding as previous studies had focused mainly
on the inuence of the cranial base and the interrelation
between the jaws, which have shown contradictory results
[2, 4, 13, 15, 18, 25, 34], and not the relation of this
anatomically related structure. In this study, extension of
the cranial base seems to be associated to a higher inclination of the vomer bone, while exion is related to less
inclination of it. This interrelation is presented in the
angular measurements of the lines of the constructed
vomer bone to SN Plane (Dvo-SN, Bvo-SN, and Svo-SN),
which are also coincident with the projection in the Vertical Plane of the anterior and posterior height measurements of the vomer bone. Both correlations, positive with
UV-ANS on VP and negative with UV-PNS on VP, could be
also expressing the rotation of the vomer bone. Interestingly the analysis of this last correlation (UV-PNS on VP),
J. Stomat. Occ. Med.
Springer-Verlag

and the negative correlation of the posterior length (Vo

Post) with the cranial base angle, make us suppose that
differences in the shape of the bone could also be
presented.
Another remarkable nding was that variations in the
position and rotation of vomer bone appear to be correlated
with the spatial position and dimension of the maxilla, which
became more retruded and smaller in the sagital dimension as
the inclination increased. The inclination of vomer bone
measured by Dvo-SN, Svo-SN, and Bvo-SN, shows a signicant negative correlation with the sagital measurement of the
maxilla. This could be interpreted as if the vomer is rotated
downwards, the sagital dimension of the maxilla shows a
smaller dimension, as is evident from ANS-PNS, Max Dist,
and TUB-A measurements.
In the analysis of the internal proportions in the maxilla
and the inclination of vomer bone (Dvo-SN), a negative
correlation with the anterior dimension of the maxilla (Aver
A-6 on PP), and no correlation with the posterior (Aver Max
Post on PP), was observed. This could be interpreted as a
larger inuence of vomer bone inclination on the anterior
portion of the maxilla. On the other hand, in the analysis of the
transversal dimension of the maxilla, a negative tendency in all
the transversal measurements is appreciated (Int 7 on PP, Int 6
on PP, Int 5 on PP, Int 3 on PP, Int Tub). These results show
that in this sample, there could be a relation not only on the
position but also in the transversal and sagital dimensions of
the maxilla; as we can see from the corresponding positive
correlation between the size of the diagonal vomer and the
SNA and SNB angles.
Another nding was the correlation between vomer
bone and the occlusal planes; the inclination of vomer
bone (Dvo-SN) and the related rotation of the maxilla
could inuence the inclination of the anterior or posterior
occlusal planes (AOP-SN, POP-SN). At the same time, the
angle between the two occlusal planes (AOP-POP) was not
correlated, which can be interpreted as a bodily rotation of
the maxilla, instead of some different inclination between
one or another occlusal plane. This inclination of the
occlusal planes could be one important factor determining
the relation between vomer bone and the mandibular
plane, as it has been described previously that vertical
dimension of dentoalveolar structures and variation in the
cant of the posterior oclusal planes inuence the position
of the mandible [9, 12, 2729, 32].
All facial sagital dimensions had negative correlation with
the inclination of vomer bone (Dvo-SN), this can be interpreted that a downward inclination shows smaller dimensions
of A, ANS, B, N, and Me to the vertical plane. This could
represent a more vertical or retruded distribution of the face in
a higher inclination of vomer bone.
The vomer showed signicant differences between the
different skeletal frames. These differences were expressed on
the inclinations of the complete bone, and also in the changes
of shape and consequent variation in the relation with the
other structures. This makes us assume that vomer bone could
be an important connecting structure between the cranial
base and maxilla. More longitudinal evaluation studies in
growing patients should be conducted in order to complement the understanding of its role in the craniofacial
architecture.
Three-dimensional CT analysis of vomer bone

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203

original article

Conclusions
1. Vomer bone seems to play an important role in the interrelation of the craniofacial architecture.
2 Changes in the inclination and the dimensions of vomer
bone are strongly correlated with other craniofacial
structures.
3 There are signicant variations of vomer bone between the
different dentoskeletal frames.

Take-home message
The potential inuence of vomer bone in the craniofacial
architecture has been described in a dynamic functional
complex involving occipital, sphenoid, vomer, and maxilla
bones. Vomer bone seems to play an important role
modulating the interrelation between cranial base and
maxilla, showing signicant variations between dentoskeletal frames.

Conict of interest
The authors declare that there is no conict of interest.

Acknowledgments
This work was performed in the Research Institute of Occlusion Medicine and Research Center of Brain and Oral Science,
Kanagawa Dental College and supported by grant-in-aid for
Open Research from the Japanese Ministry of Education,
Culture, Sports, Science and Technology. The authors would
like to express their gratitude to the research project postgraduate students (Skull Project) involved in the data collection
process, especially Drs. Tanaka EM, Fujii M, Taguchi C,
Koizumi S, Sugimoto K, Sato C, Kodama T, Shinomiya M,
Okada S, Horisawa A, Yamashita R, Takahashi T, Kim Y,
Shirazu M, Park H, Sato S, Kawai Y, Onodera K, Tajima K,
Onodera Y, Tajima K.
The results of this research were partially presented at
Summer School 2009 in Tokyo, Japan.

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