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. 2025 May 29;25(1):195.
doi: 10.1186/s12880-025-01744-8.

Assessment of the association between C2 vertebral morphology and facial asymmetry using CBCT and panoramic radiography

Çağan Erkman Şaylan  1 , Mehmet Birol Özel  2 , Alican Kuran  3 , Enver Alper Sinanoğlu  3
Affiliations

Assessment of the association between C2 vertebral morphology and facial asymmetry using CBCT and panoramic radiography

Çağan Erkman Şaylan et al. BMC Med Imaging. .

Abstract

Purpose: To investigate the relationship between the morphology of the Axis (C2 vertebra) and facial asymmetry using cone-beam computed tomography (CBCT) and panoramic radiographs.

Materials and methods: A retrospective evaluation was performed on CBCT and panoramic radiographs of 50 patients (aged 18-45 years) selected from university archives. Axis vertebral morphology was assessed on CBCT using angular and perpendicular measurements of the dens and transverse processes. Facial asymmetry was evaluated on panoramic radiographs by measuring bilateral distances and angles from the condylion to the midsagittal plane. Pearson's correlation and Chi-square tests were used to analyze associations. Sample size was calculated based on a priori power analysis.

Results: Moderate but statistically significant correlations were identified between specific vertebral and facial asymmetry parameters. A negative correlation was observed between the right Axis angle and the right Co-ANSMe perpendicular distance (r = - 0.31, p = 0.026), while the left Axis perpendicular distance showed a positive correlation with both right (r = 0.36, p = 0.009) and left (r = 0.33, p = 0.018) Co-ANSMe perpendicular distances. Additionally, combined measurements of Axis and Co-ANSMe distances demonstrated a moderate positive correlation (r = 0.31, p = 0.028). No other statistically significant correlations were found.

Conclusions: Morphological differences in the Axis vertebra appear moderately associated with transverse facial asymmetry. These findings may offer additional reference points for radiographic assessment. Further studies with larger samples are recommended to confirm these observations.

Keywords: Anterior nasal spine; Cervical vertebra; Cone-beam computed tomography; Facial asymmetry; Panoramic radiograph.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Kocaeli University Non-Interventional Clinical Research Ethics Committee (Protocol code: GOKAEK-2024/05.15). Written informed consent was obtained from all participants whose data were included in this retrospective analysis. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Sample from panoramic measurements and selected landmarks. (a) Condylion-ANS-Menton angle on patient’s right side; (b) perpendicular distance from the Condylion point to the midsagittal plane on patient’s right side; (c) perpendicular distance from the Condylion point to the midsagittal plane on patient’s left side
Fig. 2
Fig. 2
Sample from CBCT Axis measurements and selected landmarks. (a) Right axis angle; (b) Left axis angle; (c) Right Axis Perpendicular Distance; (d) Left Axis Perpendicular Distance; DAS: Dens Axis Superior; DAVL: Dens Axis Vertical Line; TPA: Transverse Processes Axis
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