An evaluation of head position and craniofacial reference line variation

Natural head position (NHP) is the usual, balanced position of the head which is adopted for viewing the horizon or an object at eye level. Determination of NHP is useful when reconstructing facial form in art, forensics, orthodontic diagnosis and treatment planning for surgical management of craniofacial dysmorphic conditions. When NHP is uncertain, correction such as orientation to Frankfurt horizontal (FH) has been advocated. However, FH angulation varies between individuals and is subject to landmark identification error. Previous studies have measured FH and other craniofacial planes in relation to the true horizontal (HOR) with subjects in NHP and have found similar variation to that found with FH. This study measured craniofacial planes in 40 Aboriginal Australians (20 male, 20 female, aged 17 years or greater) from lateral cephalographs and compared its results with classical previous studies. Four planes, the neutral horizontal axis (NHA), FH, Krogman–Walker line (KW line), and palatal plane (P plane) demonstrated near parallelism and averaged between −1° and −2° from HOR. The combined use of NHA, FH, KW line, and P plane enables more effective corrected head position (CHP).