Sagittal Cephalometric Characteristics in Females With Turner Syndrome in Comparison to Nonsyndromic Females: A Meta-Analysis

Abstract

The present study aimed to assess the sagittal cephalometric characteristics in females with Turner syndrome (TS) as compared with nonsyndromic females. A literature search was carried out using six electronic databases to identify studies that compared the sagittal lateral cephalometric measurements in females with TS, with the last search performed in February 2024. Studies were selected according to the following inclusion criteria: an experimental group of individuals with TS compared to a control group of females without TS; with sagittal cephalometric characteristics evaluated on lateral cephalometric radiographs. Sagittal cephalometric variables measured in three or more studies were put to meta-analysis, using the random-effects model. Subgroup meta-analyses were also carried out based on karyotype. A modified version of the AXIS tool was used to assess the risk of bias in the included studies. From the initial 199 records identified, 17 studies and 11 sagittal cephalometric variablesere analysed. Four hundred and seventeen unique patients with TS, coming from 10 different European countries, were included. All of the sagittal linear variables compared, namely S-N, N-Ba, Go-Gn, Go-Pg and ANS-PNS, were significantly reduced in those with TS. Concerning the six angular variables compared, the A-N-B angle showed no difference between the groups, whereas the S-N-A, S-N-B and S-N-Pg angles were significantly reduced, and the N-S-Ba and the N-S-Ar angles significantly increased in those with TS. The subgroup meta-analyses for karyotype consistently revealed mean differences much greater than the norm for the 45,X karyotype group than those of the mosaic and isochromosome karyotypes. The sagittal lateral cephalometric characteristics of females with TS differ significantly from those of nonsyndromic females, with the greatest deviation from the norm displayed in the 45,X karyotype. Bimaxillary retrognathia and reduced anterior cranial base and maxillary and mandibular lengths were observed, without this resulting, however, in any difference with regard to the sagittal intermaxillary relationships for the females with TS. While informative, the results of this meta-analysis should be considered in conjunction with the respective risk of bias of each study, as most studies rated towards the moderate to high end of the spectrum.

Trial Registration: This study was registered in PROSPERO on September 22, 2022, with the ID CRD42022356773