The short face syndrome

H. Opdebeeck, D.D.S.,** and W. H. Bell, D.D.S.**

Louvain, Belgium, and Dallas, Texas

Currently, great emphasis is placed on the vertical dimensions of facial

morphology. Vertical dysplasias, however, are difficult to discribe within the framework
of traditional anteroposterior classifications. In addition, such dysplasias are in many
cases associated with, and may indeed be at the origin of, anteroposterior dysplasias.’
Consequently, new terms have been introduced to describe extreme vertical facial types,
according to what is considered to be the most important clinical manifestation or possible
etiologic factor. Faces with reduced lower facial height have been designated either
“low-angle type”2 to express the positive correlation between the SN : MP angle? and the
reduced lower facial height or “skeletal deep-bite type”3 to indicate that the lower face
height is reduced and associated with deep overbites.
Other names take possible etiologic factors into account. “Vertical maxillary de-
ficiency”4 and ‘ ‘idiopathic short face”5 attribute the reduced lower face height to a
reduced maxillary dentoalveolar height which allows the mandible to rotate in a coun-
terclockwise manner. Hence, the use of another term, “extreme counterclockwise rotation
type,” has evolved. Because it became clear that in a given facial type similar esthetic,
cephalometric, and occlusal features are grouped together, the term “syndrome”6 has
been introduced to describe the face in vertical dimensions. This general term allows a
more complete description of the facial, dental, and skeletal characteristics of a given
facial type and its variants. It is in contrast to the above-mentioned, more exclusive
designations which, in the description of a given facial type, emphasize a single parame-
ter, such as the SN : MP angle, the degree of overbite, or the posterior maxillary height.
It has been our clinical experience that a reduced lower facial height is not always
associated with a decreased SN : MP angle. The opposite finding of a normal lower facial
height combined with a reduced SN:MP value is not uncommon either. That, indeed, a
single parameter is not sufficient to accurately identify a given facial type has also been
suggested by Bishara and Augspurger.7
Hence, the purpose of this study was to identify other parameters which, in combina-
tion with the SN:MP angle, would enable us more accurately to identify the “short face
syndrome.” A similar study characterizing the long face syndrome has recently been
published.6
*In private practice of orthodontics, Louvain, Belgium; formerly Oral Surgery Research Fellow,
University of Texas Health Science Center, Department of Surgery, Division of Oral Surgery.
**Associate Professor, University of Texas Health Science Center, Department of Surgery, Division
of Oral Surgery, Center for Correction of Dentofacial Deformities, Dallas, Texas.
tSN:MP angle: Angle between the cranial base (SN) and the mandibular plane (MP), the latter
expressed as Go-Me.

0002-9416/78/0573-0499$01.30/O 0 The C. V. Mosby Co. 499

500 Opdebeeck and Bell

!
d anotomlc points
- derived points

Fig. 1. A 22Gpoint crartiofacial modal, modified after Walker and Kowalski?

Yatmialr and methods

Selection ofputients. The subjects described in this study were selected on the basis of
a clinical impression of short face. This impression was brought about either by an
obvious reduction in lower facial height in a face of normal width or by a normal (or even
increased lower facial height) in a broad face. Only those patients both authors indepen-
dently considered as belonging to the short face group were included. The clinical picture
(Fig. 3) was characterized by a normal height of the middle and upper thirds of the face.
The nose was often rather broad with enlarged nasal apertures. The nasolabial angle,
which was most frequently increased, added to the impression of a “jutted-out” nose. A
projected nose, an increased nasolabial angle, and a well-developed pogonion resulted in a
“concave” lower profile, with the upper and lower lips far posterior to the Rick&s
esthetic plane.
Examination of the lower third of the face in frontal view revealed thin, curled lips.
The height of the lip curvature was decreased, while the corners of the mouth were at a
greater than normal distance from each other. A deep labiomental fold was usually
present. In repose, no teeth were exposed; many times, the upper lip covered the full
length of the anterior teeth and, when smiling, the patients had difficulty in showing their
teeth and, as a result, had an “edentulous look.” Deep bite was a common finding. A
broad, shallow palate with torus palatinus and a reduced distance between the root apices
and the nasal floor were striking characteristics. As a rule, a clinically reduced SN:MP
angle was found. The individual expression of these general features, however, was quite
variable. The short face group under study consisted of untreated adult Caucasians,
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Short face syndrome 501

Fig. 2. Points, planes, and measurements as used in this study. Al, Most anterior point on the anterior
outline of the first vertebra. AZ, Most posterior point on the posterior outline of the first vertebra. AS,
Point resulting from the cross section on the cranial base and the anterior outline of the first vertebra.
A.t, Inferior and anterior point on the anterior outline of the second vertebra. AS, Superior and anterior
point on the anterior outline of the third vertebra. As, Inferior and anterior point on the anterior outline of
the fifth vertebra. HI, Most anterior and superior point on the superior outline of the greater horn of the
hyoid bone. HZ, Most posterior and superior point on the superior outline of the greater horn of the hyoid
bone. CA, Canalis insicivus or incisive canal. C.S., Condyle summit. Most anterior and superior point
on the outline of the condyle. (For more information, see Material and methods.)

fourteen females and thirteen males, varying in age from 17 to 55 years.

Cephalometric positioning. A modified “natural head position” as described by
Bench’ was used in this study. The patient was placed in front of a mirror and was asked to
look into the reflection of his or her own eyes with the teeth in centric occlusion and the
lips in a relaxed position. The cephalometer was then moved until the ear rods fit into both
ear canals. Neither orbital registration nor nasion rest was employed.
Tracing of the cephalograms. The cephalograms were traced according to the com-
puterized craniofacial model of Walker and Kowalskig as adapted by Schendel and asso-
ciates.‘O This model was further modified by adding the hyoid bone, the inner cortex
outline of the occipital bone, and the spine. This created a model of 220 points (Fig. 1)
which was fed into a DEC system 10 computer according to the method described by
Schendel and colleagues. lo In case of double image, the midline between both structures
was chosen. Landmarks were identified by conventional definitions unless otherwise
stated. All cephalometric drawings were superimposed on SN with SN horizontal regis-
tered at S. The results were expressed as means + S.D. unless otherwise stated.
Significance between means was established by Student’s t test.
502 Opdeheeck and Bell

Cephalometric measurements (Fig. 2). The following measurements were used:

Linear meusurements
I. ATFH (anterior total facial height or N-ME. Nasion (N) to menton (Me) measured
along a perpendicular to SN.
2. AUFH (anterior upper facial height) or N-ANS. Nasion to anterior nasal spine (ANS)
measured along a perpendicular to SN.
3. ALFH (anterior lower facial height) or ANS-Me. Anterior nasal spine to menton
measured along a perpendicular to SN.
4. RH (ramus height). Linear distance between condyle summit (most superior and
anterior point on condyle) and gonion (Go).
5. ART-GO. Linear distance between articulare and gonion measured perpendicular to
SN.
6. CL (corpus length). Actual linear distance between gonion and menton.
7. Sella d Hor. Horizontal linear distance from the mesiobuccal cusp tip of the maxil-
lary first molar from sella along SN.”
8. S-PNS Hor. Horizontal distance between S and perpendicular projection of PNS on
SN.
9. OP-PP (posterior maxillary dento-alveolar height). Actual distance between mesio-
buccal cusp of first molar and lower border of the palatal plane (PP) along the
longaxis of 6.
IO. OP-MP (posterior mandibular dentoalveolar height). Vertical distance between me-
siobuccal cusp of first lower molar and mandibular plane (MP) along a perpendicular
on MP.‘l
11. AUDH (anterior upper dentoalveolar height). Vertical distance from ANS to the
incisal edge of the maxillary incisor measured perpendicular to SN.
12. ALDH (anterior lower dentoalveolar height). Ventrical distance from the in&al edge
of the mandibular incisor to MP, measured perpendicular to MP.
13. PTFH (posterior total facial height) or S-Go Vert. Vertical distance between sella (S)
and gonion (Go) measured perpendicular to SN.
14. PUFH (posterior upper facial height) or S-PNS Vert. Sella to PNS measured perpen-
dicular to SN.
15. PLFH (posterior lower facial height). Linear distance between PNS and MP measured
perpendicular to MP.
16. Overbite. Linear distance between the incisal edge of the maxillary and mandibular
central incisors along a perpendicular to the occlusal plane.
17. Overjet. Horizontal distance along the occlusal plane between the incisal edge of the
maxillary and mandibular central incisors.
18. SN. Horizontal distance between sella (S) and nasion (N).
19. N-Ba. Nasion to basion.
20. S-Ba. Sella to basion.
2 I x. Horizontal distance between S and perpendicular through condyle summit on SN.
y. Vertical distance between S and condyle summit, measured perpendicular to SN.
22.* H, on A:rA,. Vertical distance between most anterosuperior point of the superior
outline of the greater horn of the hyoid bone (H,) and the long axis of the two first
cervical vertebrae.
23.* H-Me. Distance between HI (see measurement 22) and Me projected on SN.
24.* HI-S (horizontal) or X,,. Horizontal distance between S and perpendicular through
H, on SN.

*Measurements 22 to 25 are used in the accompanying paper

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Short face syndrome
Number 5

25.* H,-S (vertical) or Y,,. Vertical distance between H, and S along a perpendicular on
SN”.
Angular measurements
26. ArGoMe or gonial angle. Angle between articulare, gonion, and menton.
27. kto SN. Long axis of upper incisor to SN angle.
28. ( I to MP. Long axis of lower incisor to MP angle.
29. SN . MP. Angle between the cranial base (SN) and the mandibular plane (Go-Me).
30. SN.OP. Angle between the cranial base (SN) and the occlusal plane (OP).
3 I. SN . PP. Angle between the cranial base (SN) and the palatal plane (ANS-PNS).
32. SN.HP. Angle between the cranial base (SN) and the hyoid plane (HP).
33. SN. Ba or cranial base angle. Angle between anterior cranial base (SN) and posterior
cranial base (SBa).
34. MP. HP. Angle between mandibular plane (Go-Me) and hyoid plane (HP).
35.* PP.HP. Angle between palatal plane (ANS-PNS) and hyoid plane (HP).
36.” I.V. angle or intervertebral angle. Angle between the long axis of the two first
cervical vertebrae and the long axis of vertebrae 3, 4 and 5.
37.* A,Az. A,A,. Angle between the horizontal axis of the first vertebra (A,A,) and the
long axis of the two first vertebrae. (A,A,)
38.* SN. AsA,. Angle between the cranial base and the long axis of the two first verte-
brae *
39-43. SNA, SNB, ANB, SN-ANS are measured by conventional methods.

Results
Mean values and standard deviation of the linear measurements obtained in the short
face group are given in Table I. Table II shows the angular measurements. These data are
compared with the Bolton standards** of the normal face, 18 years old, females and males
pooled (Tables I and II, column 2).
Anterior and posterior vertical dimensions. The ATFH was reduced in the SFS group.
As expected, the reduced ATFH was the expression of a reduction in anterior lower facial
height. The AUFH as within normal limits. The differences in ALFH were accompanied
by a significant reduction in the mandibular plane cant, the occlusal plane cant, and also
the hyoid plane cant (SN :MP, SN:OP, and SN:HP, Table II) in the SFS group. Other
important differences in craniofacial relations were expressed in the posterior vertical
dimensions. The PTFH was larger in the SFS group as compared to the Bolton standards.
This is explained by the longer ramus found in this group and a larger vertical distance
between the condyle summit and the cranial base (Y, Table I). This value (19.08) was
close to the value published by Droel and Isaacson l3 for the low-angle group (19.35). The
PTFH was further determined by the SN:MP angle and the gonial angle as expressed by
the significant negative correlations between PTFH and SN:MP and between PTFH and
gonial angle (ArGoMe) (Table III). The upper posterior facial height as expressed by
S-PNS vert. was not different from the Bolton standards. It seems therefore, that the
palatal plane does not follow the same cant as does the mandibular plane and the hyoid
plane, if SN is kept horizontal. The posterior dentoalveolar maxillary height (OP-PP) was
decreased. Correlation coefficients were computed between OP-PP and SN : MP, ramus
height and ArGoMe (Table IV). There was a significant positive correlation between
OP-PP and ramus height. The other correlations did not reach the level of significance.

*Measurements 35 to 38 are used in the accompanying paper.

 Ant. J. Orrhtd.
504 Opdebeeck and Bell ‘WMaV197x

Table I. Means and standard deviations of linear measurements in the SFS and the “normal
face” as published in the “Bolton Standards of Dentofacial Developmental Growth“ (male
and female pooled, 18 years old)

Short face syndrome Normu1.i

Linear measurements * Mean S.D. Mean S.D.

ATFH 112.55 7.44 119.8 7.00

AUFH 54.44 4.10 54.3 3.48
ALFH 58.10 4.74 65.4 4.96
RH 62.78 6.92 56.30 3.Y2
An-Go 51.19 5.44 49.9 3.63
CL 74.63 6.23 77.5 -
X 16.67 3.21 15.52
Y 19.88 3.48 15.22$ -
RamusDept. 30.94 3.06 -
ANS-PNS 54.49 3.87 56.X 2.88y;
Sella 6 Hor. 37.73 6.05 37.0 -
S-PNS 16.98 4.24 15.0 -
ANS-N 3.41 7.34 1.0 -
OP-PP 19.24 2.35 21.0 -
OP-MP 29.19 3.53 32.0 -
AUDH 25.88 2.65 28.5 -
ALDH 39.09 4.03 30.0 -
PTFH 81.59 7.69 7Y.O
PUFH 47.17 4.14 46.0 -
PLFH 43.99 5.74 43.0 -
Overbite 7.68 2.79 2.0 -
Overjet 5.33 4.21 2.0 -
SN 74.88 4.57 73.5 -
N-Ba 112.85 4.66 106.0 -

*In miliimeters,unlessotherwisestated.
tFrom Broadbent, Broadbent, and Golden.”
$FromDroeland Isaacson.”
§From Bishara and Augspurger.’

The posterior mandibular dentoalveolar height (OP-MP) was shorter in the SFS group
(29.19) than in the Bolton standards (32.0). The upper and lower anterior dentoalveolar
heights were also reduced.
Mandible. Summarizing the data concerning the mandible, the ramus height (ex-
pressed by the actual distance between Go and condyle summit) was increased in the SFS
group. The ramus height was also increased when compared with the value published by
Isaacson and co-authors” for their “average MP group” (62.78 in the SFS group in the
present study, 56.30 in Isaacson’s “average MP group”). Isaacson’s data apply to a
population of children selected on the value of the SN:MP angle, which is a different
selection criterion than used in this study. The gonial angle was smaller-in the SFS group
than in the Bolton standards. No major differences were found in the corpus length as
expressed by the absolute distance between gonion and menton. To assessthe position of
the condyle, the horizontal sella-condyle summit (X) and the vertical sella-condyle sum-
mit distances (Y) according to Droel and Isaacson13 were used. However, instead of using
Volume73
Number S Short face syndrome 505

Table II. Means and standard deviations of angular measurements in the SFS group and the
normal face as published in the “Bolton Standards of Dentofacial Developmental Growth”
(male and female pooled, 18 years old)
Short face syndrome Normal *

Angular measurements Mean S.D. Mean S.D.

SNA 81.0 4.3 83.9 2.43

SNB 78.9 4.6 81.2 2.63
ANB 2.1 3.9 2.7 1.39
SN:ANS 85.9 3.9 87.9 3.7
N: can. inst. 70.8 4.2 72.0
ArGoMe 123.28 6.5 - -
AlGcGN 120.4 6.4 126 -
&toSN 100.8 14.4 100.2 5.68
iltoMP 90.9 10 95.9 6.9-F
Interincisal angle 142.4 18.5 140.6 8.2
SN:MP 24.5 5.1 39.7 4.2t
SN:OP 8.3 5.8 - -
SN:PP 7.7 3.3 - -
SN:HP 34.9 11.1 -
MP:HP 10.2 11.4 - -
PP:HP 27.2 10.7 - -

*From Broadbent, Broadbent, and Golden. I2 If no S.D. is given, the cephalometric angular value was directly
measured on the “average” transparency for male and female pooled, 18 years old.
tFrom Bishara, and Augspurger.’

the fossa summit, the most superior and anterior point on the outline of the condyle was
used. A lower and slightly more posterior position of the condyle was found as compared
to the values published by Droel and Isaacson13 in their study on low-angle and skeletal
Class II subjects.
SNB, commonly used as a parameter to relate the position of the mandible to the
cranial base, was larger in the short face syndrome. This more protruded position of the
mandible was probably related to the reduced SN: MP angle.14
Muxilfu. The maxillary length (ANS-PNS) was within normal limits for the SFS
group. In order to evaluate the position of the maxilla relative to the cranial base, the
values of the angles SNA, SN:ANS, and SN:IC were computed. A slightly reduced
SNA, SN: ANS, and SN: IC were found. In evaluating the position of the maxilla relative
to the cranial base in linear values, a slightly increased S-PNS distance was noted.
Dental characteristics. The degree of overbite was larger in the SFS group. The
overjet was more pronounced in the SFS group (5.33 in the SFS group) as compared to
normal values (2.0).
The horizontal linear distance from the mesiobuccal cusp of the upper first molar from
sella along SN was used to assess the horizontal position of the maxillary molars.” No
obvious difference was present as compared to the Bolton standards.
The inclination of the upper incisor to SN was similar in the SFS group and in the
Bolton standards. The lower incisor, on the other hand, seemed to be in a more upright
position in the SFS group. No obvious difference was found in the interincisal angles.
506 Opdebeeck and Bell

Table III. Correlation coefficient (r) and level of significance (P) between the posterior total
facial height (PTFH) and ramus height (RH), SN: MP angle, genial angle (ArGoMe) and
condyle head positioning (Y)

r P

PTFHlRH 0.78 <O.Ol

ITFH/SN : MP -0.66 <O.Ol
PTFHiArGoMe -0.52 <I).01
PTFHiY 0.44 co.05

Table IV. Correlation coefficient (r) and level of significance (P) between OP: PP and SN : MP,
Ramus height (RH), and ArGoMe in the SFS and LFS groups

Short face syndrome Long face sydrome

r P r P

SN : MPIOP-PP -0.1 I N.S. -0.05 N.S.

RH/OP-PP 0.44 co.05 0.69 co.05
AtGoMelOP-PP -0.19 N.S. -0.12 N.S.

Table V. Correlation coefficient (r) and level of significance (P) between SN : MP, Ramus
height (RH), corpus length (CL), and ALFH in the short face syndrome
r P

SN : MPiRH -0.68 co.01

SN : MP/ ALFH -0.08 N.S.
SN: MP/ AffioMe 0.39 <0.0.5
SN : MP/FPI -0.79 N.S.
RH/ArGoMe -0.44 co.05
RHlCL 0.40 co.05
RH/FPI 0.31 N.S.
RH/ALFH 0.68 ‘co.01
FPIlAffioMe -0.03 N.S.
FPIKL -0.04 N.S.
IWALFH 0.60 co.05

Correlations in the short face syndrome. In Table V, correlation coefficients were

computed between SN:MP, ramus height, ArGoMe, corpus length, and FPI* in the SFS
group. As expected, a significant positive correlation was found between the anterior
lower facial height (ALFH) and the FPI. The ALFH was also positively correlated with
the ramus height, indicating that the longer the ramus, the “less short” the short face will
be. An important observation was the negative correlation found between ramus height
and SN :MP angle (-0.68)(Fig. 3).
Since the gonial angle was positively correlated with the SN: MP angle, it was not
*F’PI (facial proportion index). Anterior lower facial height (expressed as percentage of the total facial height)
minus anterior upper facial height (expressed as percentage of total facial height). FPI = 10 is considered as
normal, FP: < 10 expresses a short face tendency; FPI > 10 expresses a long face tendency (see discussion).
Volume 73
Number 5
Short face syndrome 507

Fig. 3. Variable clinical manifestations of the short face syndrome (SFS).

surprising to find that the gonial angle, like SN:MP, showed a negative correlation with
the ramus height.
A significant positive correlation was found between ramus height and corpus length.
This correlation probably expresses the concerted over-all mandibular growth. Surpris-
ingly, no significant correlation was found between SN:MP and ALFH.

Discussion
Since case selection on the basis of a reduced SN: MP angle would not include cases
with a reduced lower facial height but with a normal SN : MP angle, case material was
selected on the basis of a clinical impression of reduced lower facial height.
A short face was not necessarily associated with a reduced SN:MP.’ Some persons
within the clinical short face group manifested a normal SN: MP angle, combined, how-
ever, with a short ramus. This implies that the cephalometric measurement of the SN:MP
angle cannot be the sole criterion in the selection and diagnosis of “short face.”
Since the term “short face” is based primarily on a clinical esthetic impression
brought about by a disharmony in facial proportions, rather than by absolute dimensions,
we suggest that the “facial proportions index” (FPI) is a more useful parameter in
evaluating the cephalographic picture of either a short or a long face.
According to Strang and Thompson, I5 the upper facial height (N-ANS) should be 45
per cent of the total facial height (N-Me), while the lower facial height should be 55 per
cent, in a normal harmonious face. These values are close to the values stressed by
508 Opdebeeck and Bell

R.H 74mm
OP-PP: 22.5 mm
SNMP : 22”
FPr 12

0A

Rti 55mm
OP-PP 15mm
SNMP 22’
FPI 08

Fig. 4.A, Tracing representing SFS Subgroup I characterized by an FPI close to 10, a long ramus,
normal posterior maxillary dentoalveolar height, and reduced SN:NIP. B, Tracing representing SFS
Subgroup II characterized by an FPI close to zero, a short ramus, VMD, and reduced SN:MP.

Wylielg (ANS-Me, 56.6 per cent), Goldsman” (ANS-Go, 54.6 per cent), Weinberg and
Kronman’* (AN,%GO, 54.8 per cent), and Schudylg (ANS-Me, 56.5 per cent). The main
source of difference in these figures is the difference in expressing lower facial height
(ANS-Me versus ANS-Go). Consequently, a difference of about 10 between upper and
lower facial height, both expressed as percentages of the ATFH, will be found in a normal
face; values below 10 per cent express a short face tendency, while values above 10 per
cent express a tendency toward a long face.
Considering the various correlations calculated for the SFS (Table V), some interest-
Volume73
Number5 Short face syndrome 509

Table VI. The two subtypes of the short face syndrome

Long ramus Short ramlcs

SFS, SFSII

FPI <IO 410

RH 77 L
SN:MP 11 L or normal
OP-PP 7 or normal L 1 (VMD)*

* VMD = Vertical maxillary deficiency.

ing points need further explanation. At first glance, it seems quite surprising that, within
the short face group, the lower facial height is correlated with the ramus height rather than
with the SN: MP angle, despite the fact that, in comparison with the normal face, the short
face group shows a low SN:MP angle and even an increased ramus height. However, this
apparent contradiction may be explained by the highly significant negative correlation
between ramus height and SN:MP angle, implying that, within the clinical group of the
short face syndrome, the anterior lower facial height is modulated by the ramus height as
well as by SN:MP.
Indeed, the negative correlation between SN : MP and ramus height merely states that
the clinical short face group consists of two extremes which gradually blend into one
another. On the one hand, there are those persons characterized by a short ramus height
and a slightly reduced or even normal SN:MP, on the other hand, there are persons
characterized by a long ramus height and an extremely low SN : MP.
The positive correlation between ramus height and anterior lower facial height indi-
cates that persons characterized by a longer ramus will have a tendency to have a longer
“short face.” Hence, FPI values will be closer to 10. However, persons within the short
face group show very low SN-MP values, resulting in a complete loss of a direct correla-
tion between SN: MP and ALFH.
The positive correlation between the posterior maxillary dentoalveolar height (OP-PP)
and the ramus height suggests that reduced posterior maxillary height (vertical maxillary
deficiency) will be associated with a short ramus (Fig. 4, B). However, the posterior
dentoalveolar maxillary height will be close to normal in the SFS characterized by a long
ramus (Fig. 4, A).
Two subgroups can be considered, on the basis of FPI ramus height, and SN:MP
(Table VI). In SFS Subgroup 1, characterized by an FPI close to 10, a long ramus, and a
slightly reduced SN : MP, the posterior maxillary height will be normal, if not increased.
In contrast, Subgroup 2 is characterized by a low FPI (close to zero, and even negative in
extreme cases), a short ramus, and an SN:MP that is only slightly reduced, if not normal.
The posterior maxillary height is reduced in the typical case and can be called VMD
(vertical maxillary deficiency).
The number of cases in this study was too small to permit a more detailed study of the
differences between the above-mentioned extremes.
The upper lip length in this study was found to be within normal limits in the SFS.
However, great individual variability was present. The decreased amount of tooth expo-
sure associated with Type 2, therefore, was not due to an increased upper lip length. In all
but two cases, a deep-bite Type A according to RuhlandzO was found. Thus, it appears that
510 Op&beeck and Bell

factors other than ramus length and SN : MP, which were not considered in this study. play
a role in the origin of degree and type of overbite. Such factors include the position of the
maxilla against the cranial base, other sagittal relationships, upper lip length. strength of
the oral musculature, oral habits, ect. Labial flaring of the incisors was commonly found
in Type II, while uprighting of anterior teeth was more characteristic of Type I.

Summary
Cephalograms of twenty-seven untreated adult Caucasians, selected on the basis of a
clinical impression of reduced lower facial height, were studied. Various linear and
angular measurements were studied and compared to the Bolton standards. The short face
syndrome SFS is a clinically recognizable facial type with reduced lower facial height as
the common denominator. On the basis of the FPI (facial proportion index), the RH
(ramus height), the OP-PP distance (or posterior maxillary height), and the SN: MP angle,
two subgroups were distinguished in the SFS group. SFS, was characterized by a long
ramus, sharply reduced SN : MP angle, an FPI close to 10, and a slightly reduced posterior
maxillary height. In contrast, SF& was characterized by a short ramus, a slightly reduced
SN: MP angle, an FPI with values around or below zero, and a sharply reduced posterior
maxillary height. The latter group was designated as vertical maxillary deficiency.
The authors are indebted to Tristan Schroeder and Nelly Bomans-Svannieuwenhoven for their
help in preparing the manuscript, to David Mishelevich and Jerome Eisenfeld for their help in
planning the study, and to Joan Reisch for her help in the statistical analysis of the data. Our special
thanks go to Dr. Isaacson and Martin Sherling for their critical review of the manuscript.
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7. Bishara, S. E., and Augspurger, E. F.. The role of the mandibular plane inclination in orthodontic diag-
nosis, Angle Orthod. 45: 273-28 I, 1975.
8. Bench, R. W.: Growth of the cervical vertebrae as related to tongue, face, and dentine behavior, AM. J.
ORTHOD. 49: 183-214, 1963.
9. Walker, G. F., and Kowalski, C. J.: A two dimensional coordinate model to the quantification, description,
analysis, prediction and simulation of craniofacial growth, Growth 35: 191-21 I, 197 I.
IO. Schendel, S. A., Eisenfeld, J. H., Bell, W. H., and Epker, B. N.: Superior repositioning of the maxilla;
stability and soft tissue osseous relations, AM. J. ORTHOD. 70: 663-674, 1976.
I I. Isaacson, J. R., Isaacson, R. J., Speidel, T. M., and Worms, F. W.: Extreme variation in vertical facial
growth and associated variation in skeletal and dental relations, Angle Orthod. 41: 219-229. 1971.
12. Broadbent, B. H.. Sr., Broadbent, B. H., Jr., and Golden, W. H.: Bolton standards of dentofacial
developmental growth St. Louis, 1976, The C. V. Mosby Company.
13. Droel, R., and Isaacson, R. J.: Some relationships between glenoid fossa position and various skeletal
discrepancies, AM. J. ORTHOD. 61: 64-78, 1972.
14. Opdebeeck, H., and Bell, W. H.: Comparative study between the SFS and LFS rotation as a possible
morphogenic mechanism (submitted for publication.)
IS. Strang, R. H. W., and Thompson, W. M.: A textbook of orthodontia, ed. 4, Philadelphia Lea and Febiger
1958
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16. Wylie, W. L.: A quantitative method of comparison of craniofacial patterns in different individuals; its
application to a study of parents and offspring, Am. J. Anat. 74: 39-60, 1944.
17. Goldsman, S.: The variation in skeletal and dental pattern in excellent adult facial types, Angle Orthod. 29:
63-92, 1959.
18. Weinberg, H., and Kronman, J. H.: Orthodontic influence upon anterior face height, Angle Orthod. 36:
80-88, 1966.
19. Schudy, F. F.: Vertical growth versus antero-posterior growth as related to function and treatment, Angle
Orthod. 34: 75-93, 1964.
20. Ruhland. A.: Tiefbiss, Bisshebung and Gesichtsschadelaufbau, Forts&r. Kieferorthop. 34: 172- 181, 1973.

5323 Harry Hines Blvd. (75235)

THE JOURNAL 60 YEARS AGO

May, 1918

Until Angle observed, thought, practiced and finally furnished a simple classification of
malocclusion of the teeth, certainly little progress had been made in making of orthodontia
either an art or a science. We know science is concisely defined as “systematized knowl-
edge.” Certainly there was not an abundance of “systematized knowledge” as applying to
our work prior to Dr. Angle’s teachings. If it is complained his work did not constitute of
orthodontia a science, in the strictest sense of the word, I reply that in the affairs of mankind
there is little that can be wholly scientific in the sense, for instance, that mathematics is a
science. There we have absolute knowledge, systematized, exact, and unvarying from a
perfect principle. (B. Frank Gray: Orthodontia in the Year Nineteen Hundred Eighteen,
International Journal of Orthodontia, predecessor of the American Journal of Orthodontics,
5: 203, 1918.)