Association between craniofacial skeletal patterns and the morphology and dimensions of the sella turcica: a cone-beam computed tomography study.

OBJECTIVES: This study aimed to classify sella turcica morphologies using lateral cephalograms, analyze craniofacial skeletal pattern differences among distinct morphologies, and investigate their associations. METHODS: This retrospective study included 240 adults (120 males and 120 females; mean age, 20.0 ± 1.6 years) selected through stratified random sampling from 729 eligible records obtained between 2023 and 2024. Sella turcica morphology was classified on lateral cephalograms into four groups: normal sella turcica, anterior wall/floor abnormality, posterior wall abnormality, and sella turcica bridging. Associations between morphology groups and skeletal pattern distributions were evaluated using chi-square or Fisher-Freeman-Halton exact tests. Group differences in continuous variables were analyzed using one-way analysis of variance or Kruskal-Wallis tests with appropriate post hoc comparisons. Correlations were assessed using Pearson or Spearman coefficients. Statistical significance was set at α = 0.05. RESULTS: Sagittal skeletal pattern distribution differed significantly among the four morphology groups (p < 0.001). The bridging group showed the highest proportion of skeletal Class III subjects (36.7%), whereas the anterior wall/floor abnormality and posterior wall abnormality groups were predominantly skeletal Class I and Class II, respectively. Vertical skeletal pattern distribution also differed (p = 0.030), with a higher proportion of low-angle cases in the anterior wall/floor abnormality group and normodivergent cases in the posterior wall abnormality group. Several cephalometric variables differed among groups, including FH-NPo, SNB, APDI, FH-MP, Y-axis angle, ODI, and U1-NPo. Correlations between three-dimensional sella turcica parameters and cephalometric variables were statistically significant but generally weak, with the most consistent associations involving clinoid region distances and angles. CONCLUSIONS: Sella turcica bridging was more frequently associated with a skeletal Class III-associated profile and dentoalveolar compensation. Three-dimensional clinoid region parameters showed weak but significant associations with cephalometric variables, suggesting their potential value as adjunctive imaging markers in adult orthodontic assessment rather than as standalone diagnostic criteria.