Cephalometric analysis method

Holdaway analysis online — lateral cephalogram analysis

Robert M. Holdaway · 1983

Soft tissue profile

Holdaway analysis translates nose, lip, and chin profile into H-angle, esthetic E-line, and distances E-Ls and E-Li on the lateral cephalogram. Robert M. Holdaway linked soft tissue to skeletal context SNA, SNB, and ANB. CephCalc calculates the block after PogSoft and lip tracing. Before extractions and orthognathic work this preset is often required. H-angle and E-line support profile discussion before extractions.

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About the method

Holdaway soft-tissue cephalometric analysis turns nose, lip, and chin profile into measurable angles and distances. Robert M. Holdaway described H-angle as soft-tissue harmony and the esthetic line Pn–PogSoft as a lip protrusion reference. Distances E-Ls and E-Li show how upper and lower lips relate to the esthetic line. Skeletal context SNA, SNB, and ANB stays in the table to link profile to bases. CephCalc calculates the block after soft-tissue landmark tracing. Check image quality on serial cephalograms. Include E-Ls and E-Li in extraction planning beside Ii and ANB.

What the analysis focuses on

H-angle, esthetic E-line, lip distances to E-line, skeletal context SNA, SNB, ANB.

When to use it clinically

Useful for profile-driven planning, extraction decisions, and lip balance in Class II and III. Before orthognathic preparation Holdaway is often combined with Steiner for skeleton and Merrifield for cross-checking lips. Accuracy depends on correct PogSoft on the chin contour. Holdaway does not replace airway screening or growth type without Jarabak. On case review, match the CephCalc table with profile photos, models, and TMJ exam: numbers without context are easy to misread.

What CephCalc calculates

9 landmarks
6 measurements
H-angle: ∠ H-angle (Holdaway) — angle at N between lines N–PogSoft and N–Pn
E-Ls: E-Ls (mm) — distance from Ls to the esthetic line Pn–PogSoft (+ lip anterior to line)
E-Li: E-Li (mm) — distance from Li to the esthetic line Pn–PogSoft (+ lip anterior to line)
SNA: ∠ SNA — angle between lines S–N and A–N (maxillary position relative to the cranial base)
SNB: ∠ SNB — angle between lines S–N and B–N (mandibular position)
ANB: ∠ ANB — difference in jaw positions: angle between B–N and A–N

H-angle and E-line: measurements for training

H-angle describes harmony of nose, lips, and chin soft tissue. E-line links Pn and PogSoft. E-Ls and E-Li quantify lips. Students should compare Holdaway with clinical profile photos.

H-angle — soft-tissue balance
E-Ls, E-Li — lips to E-line
Pn, PogSoft — E-line ends
SNA, ANB — skeletal background

PogSoft and lips: tracing errors

PogSoft sits on soft-tissue chin contour, not skeletal B. Film contrast affects lips. On repeat cephs use the same rules. PogSoft error shifts E-line.

PogSoft ≠ skeletal Pog
Ls, Li on lip outline
Pn on nasal tip
Match photo protocol

Combinations and limitations

Holdaway does not describe growth type or airway. Jarabak and McNamara airways extend the plan. CephCalc switches to Wits or McNamara after Holdaway when needed.

Merrifield — Z-angle, S-line
Steiner / Wits — skeleton
Jarabak — vertical
McNamara airways — pharynx

Try it in practice — free

Try it in practice

Upload a lateral cephalogram to CephCalc, place the landmarks, and run the Holdaway analysis online — no software to install. Try it in practice free.

Ready-made method preset on your radiograph
Table of angular and linear measurements with race-specific reference norms (Caucasoid, East Asian, African)
Save to the patient chart and export to PDF
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Frequently asked questions

How do I run Holdaway analysis online?

In CephCalc select Holdaway and mark soft-tissue and skeletal landmarks. H-angle, E-line, and lip distances appear with PDF export.

When use Holdaway clinically?

Use Holdaway for profile-driven planning, extraction decisions, lip balance in Class II/III, and esthetic discussion. Pair with Steiner for skeleton.

How should a resident read E-Ls and E-Li?

E-Ls and E-Li show lip protrusion or retrusion relative to E-line. Read them with H-angle, not alone. Record both distances in the chart.

How does Holdaway differ from Merrifield?

Holdaway uses E-line Pn–PogSoft. Merrifield uses Z-angle and S-line. On one film use both to cross-check lips.

Is Steiner needed with Holdaway?

Yes. Steiner gives SNA, SNB, and ANB; Holdaway gives profile. CephCalc keeps both presets on one tracing without re-upload.