Burstone analysis
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Burstone cephalometric analysis norms facial analysis
Burstone analysis, often called the Burstone and Legan analysis or COGS (Cephalometric Analysis for Orthognathic Surgery), is a lateral cephalometric analysis used mainly for diagnosis and surgical planning in dentofacial deformities.
It assesses the face in three dimensions conceptually, although it is commonly performed on a 2D lateral cephalogram:
- Cranial base and skeletal pattern
- Vertical facial proportions
- Maxillary and mandibular position and length
- Dental position relative to the jaws
- Soft-tissue facial profile
Main purpose
Unlike analyses aimed chiefly at orthodontic tooth movement, Burstone analysis helps decide:
- whether the maxilla or mandible is deficient, excessive, retruded, or protruded
- whether a vertical discrepancy is present, such as long-face or short-face pattern
- the likely skeletal movements needed in orthognathic surgery
- whether soft-tissue balance will be improved by the planned movement
Common measurements assessed
| Area | Examples of measurements / assessment |
|---|---|
| Cranial base | Anterior and posterior cranial-base dimensions |
| Maxilla | Maxillary length, maxillary projection, vertical position |
| Mandible | Ramus height, body length, mandibular projection, chin position |
| Vertical proportions | Upper anterior facial height, lower anterior facial height, posterior facial height |
| Interjaw relation | Sagittal and vertical maxillo-mandibular discrepancy |
| Dentition | Upper and lower incisor position and inclination |
| Soft tissue | Facial convexity, nasolabial angle, upper/lower lip protrusion, lower-face throat angle |
Key features
- Uses a horizontal reference plane based on the Frankfort horizontal plane, with a constructed horizontal reference plane often used in the original method.
- Separates skeletal, dental, and soft-tissue components.
- Particularly useful in Class II, Class III, vertical maxillary excess, open bite, facial asymmetry, and combined jaw deformities.
- Norms should be interpreted cautiously because facial proportions vary with ethnicity, sex, age, and individual facial type. Population-specific Burstone norms have been reported, including Japanese, Chinese, South Indian, and Taiwanese populations.
Clinical interpretation examples
- Reduced maxillary projection suggests maxillary retrusion and may support maxillary advancement.
- Reduced mandibular projection with a short mandibular body supports mandibular deficiency.
- Increased lower anterior facial height with excessive maxillary incisor display can suggest vertical maxillary excess.
- Protrusive lips despite acceptable skeletal values may indicate dental protrusion or soft-tissue considerations that change the surgical plan.
Important limitation
Burstone analysis is not a diagnosis by itself. It must be correlated with:
- facial examination at rest and on smile
- occlusion and dental compensations
- TMJ and airway assessment where relevant
- photographs and, increasingly, 3D imaging/virtual surgical planning
Recent reviews indicate that AI-assisted cephalometric tracing can be accurate, but landmark and measurement errors remain relevant, so clinical verification is still needed, as noted in a 2024 systematic review.
The Burstone framework is also referenced among established chin and lower-facial-structure analyses in Cummings Otolaryngology Head and Neck Surgery (p. 2070-2116).
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