1. AJEESHA NAIR

2. INTRODUCTION

Dr JAMES A McNAMARA

1984

3.  A method of cephalometric analysis that is sensitive
not only to the position of the teeth within a given
bone but also to the relationship of the jaw elements
and cranial base structures one to another.
 In short, the method of analysis described here
represents an effort to relate teeth to teeth, teeth to
jaws, each jaw to the other, and the jaws to the cranial
base.

4. Skeletal and dental components of the
face in normal occlusion

5. Maxillary skeletal protrusion

6. Maxillary dentoalveolar protrusion

7. 
The method of analysis described here
represents an effort to relate

teeth to teeth,

teeth to jaws,

each jaw to the other, and

the jaws to the cranial base.

8. THE COMPOSITE NORMATIVE STANDARDS DERIVED FROM 3
SAMPLES
1
2
3
• Lateral cephalograms of the children
comprising the Bolton standards
• Selected values from a group of
untreated children from the Burlington
Research Centre
• A sample of 111young adults from
Ann Arbor, having good to excellent
facial and dental configurations and
good skeletal balance with an
orthognathic facial profile

10. Soft tissue
evaluation
NASOLABIAL
ANGLE
CANT OF UPPER
LIP
Hard tissue
evaluation

11. DRAWING A LINE TANGENT TO THE BASE OF THE NOSE
AND A LINE TANGENT TO THE UPPER LIP FORMS THE
NASOLABIAL ANGLE

12. CANT OF UPPER LIP

13. Hard tissue evaluation
NP
FH
.A
Relationship of point A to nasion perpendicular

14. 0 mm in mixed dentition
1 mm in adult male& female

17. 
In well – balanced faces,this measurement is:
0 mm in mixed dentition
1 mm in adult females and males.

18. Exceptions

19. MAXILLA TO
MANDIBLE

20. Maxilla To Mandible
Anteroposterior relationship
Midfacial length
Effective mandibular length
Maxillomandibular differential
Any effective midfacial length corresponds
to an effective mandibular length .

21. MID-FACIAL LENGTH

measuring a line from Condylion to point A.
Condylion- most posterosuperior point
on the outline of mandibular condyle
MANDIBULAR LENGTH

-measuring a line from Condylion to
anatomic Gnathion
Gnathion – most anteroinferior aspect of the
mandibular symphysis.

22. Condylion
Point A
Gnathion

23.  The effective lengths of max & mand are related to
the size of the component parts .
Thus termed:
small for mixed dentition
medium for adult female
large for adult male
The Maxillomandibular Difference :
In small individuals: 20-24 mm,
In medium sized individuals: 25-28 mm
In large individual : 29-33 mm

24. •A
Gn

27. VERTICAL RELATIONSHIP
LOWER ANTERIOR
FACIAL HEIGHT
MANDIBULAR
PLANE ANGLE
FACIAL AXIS
ANGLE

28. measured from).
anterior nasal
spine(ANS) to
Menton(Me
Increases with
age.
If LAFH
retrognathic
mandible.
Correlated to the
effective length
of the midface.
If LAFH
prognathic
mandible

33. 

It is the angle between anatomic FH and the
line drawn along the lower border of the
mandible through constructed Gonion(Go)
and Menton(Me).
Average is 22 ± 4 degrees.

- Excessive lower facial height

- Deficiency in lower facial height.

35. 


It is formed by a line constructed from the
posterosuperior aspect of the pterygomaxillary
fissure (PTM) to gnathion(Gn) and a line
perpendicular to cranial base (ie a line from
basion(Ba) to nasion(N).
An ideal relationship is when PTM-Gn lies on
the perpendicular(0 degrees).
If PTM-Gn lies anterior to the perpendicular,
the angle is positive, suggesting deficient
vertical development of face and vice versa.

38. MANDIBLE TO
CRANIAL BASE

39. 
Is determined by measuring distance from
pogonion to nasion perpendicular.

In mixed dentition 6-8 mm (behind N per)

In adult female
0-4 mm (behind N per)

In adult male
2 mm(behind to 5 mm
fwd of N per)

41. DENTITI0N
Helps in determining the antero-posterior
position of both upper and lower incisors

42. Ideal distance measured horizontally from point A
to the facial surface of maxillary incisors is 4 to 6
mm

43. 
Anteroposterior position:
Measurement of the
facial surface of the lower
incisor to the A-Pogonion
line.
Normal = 1 - 3 mm

44. In vertical position mandibular incisors are
related to functional occlusal plane.
 If curve of Spee is excessive
incisors intruded or molars
Extruded
LAFH is the determining factor


45. AIRWAY
ANALYSIS

46. 
Two measurements are used to
examine the possibility of airway
impairment.
Upper pharynx
Lower pharynx

47. It is measured from a point on the posterior
outline of the soft palate to the closest point
on the posterior pharyngeal wall.

Normal(adults) - 17.4 mm

Increases with age

48. It is measured from the intersection of the
posterior border of the tongue and the inferior
border of the mandible to the closest point on
the posterior pharyngeal wall.

Normal – 10 – 12mm

Does not change with age

49. SIGNIFICANCE

Adenoid obstruction of upper airway –
upper pharyngeal width decreases.

Lower pharyngeal width –greater than
15 mm
-anterior positioning of tongue –
habitual or
enlargement of tonsils .

51. McNamara Analysis
1. Maxilla to cranial base
Normal
Patient
Inference
Nasolabial Angle
102±8˚
110˚
Normal upper lip
Cant of upper lip
14±8˚
8˚
Normal upper lip
Point A to Nperpendicular
0-1mm
-9mm
retrusive maxilla

52. 2.Maxilla to mandible
Normal
Patient
value
Inference
Maxillary Length
100.9
103mm
Maxillary length normal
Mandibular
Length
131mm
127mm
decreased mandibular length
(136-139)
Anteroposterior
Maxillomandibula 30mm
r differential
24mm
decreased
Vertical
LAFH(ANS-Me)
71.6mm
67mm
Reduced
Mandibular Plane
Angle(FH-Go-Me)
22± 4˚
34˚
VGP
Facial Axis Angle
0±3.5˚
-7˚
VGP

53. Normal
Patient
Value
Inference
0-4mm
-13mm
Backwardly placed chin
Maxillary incisor
to point A
4-6mm
7mm
Protrusive upper incisor
Mandibular
incisor to A-p0g
1-3mm
5mm
Protrusive lower incisor
3.Mandible to
cranial base
Pog to Nperpendicular
4.Dentition
5.Airway
Upper pharynx
15-20mm 17mm
Normal upper pharyngeal width
L0wer pharynx
11-14mm
Normal lower pharyngeal width
12mm

54. References
 Radiographic Cephalometry-Jacobson 2nd edition
 AJO-DO 1984 Dec (449-469)-McNamara