Craniofacial Anatomy Research Articles

Assessment of anterior loop of mental foramen with cone beam computed tomography-An institutional based study

Cone beam computed tomography (CBCT) is a specialized imaging technology designed to create accurate 3D images of craniofacial anatomy while using significantly less radiation than traditional CT scans. This advancement allows clinicians to closely examine dental and maxillofacial structures, forensic analysis, and modern therapeutic techniques.To evaluate several anatomical variants of the anterior loop of the mental foramen using cone-beam computed tomography (CBCT).The study involved 30 randomly selected patients aged 20-60 year from the departmental OPD, who underwent CBCT of the anterior mandibular region to assess the mental foramen. After obtaining a detailed history, a diagnosis was made and explained to the patients. Data were analyzed according to the classification by Solar et al. (1994).Type 1 mental nerve loop presence was 6.6% greater on the right side (13.3%) than on the left side (6.7%), while Type 3 mental nerve loop presence was 6.6% higher on the left side (63.3%) than on the right side (56.7%) based on a comparison of the anterior loop of the mental foramen.However, Type 2 was similar on both the right (30.0%) and the left (30.0%) sides. The anterior loop of the mental foramen is an important anatomical feature and was comparable (Type 1/Type 2/Type 3) in patients on the right and left side (p > 0.05) (χ2=0.78, p = 0.678), showing no significant difference. Understanding its anatomy and occurrence has a significant impact on therapeutic strategies.

Mechanisms Underlying Sex Differences in Temporomandibular Disorders and Their Comorbidity with Migraine.

Sexual dimorphism in temporomandibular disorders (TMDs) and their comorbidity with migraine are important phenomena observed in clinics. TMDs are the most prevalent orofacial pain conditions with jaw joint and masseter muscle dysfunction. Migraine is the predominant headache commonly associated with TMDs. Women much more often suffer from this orofacial pain than men. However, currently, there is no gender-specific therapy for such pain conditions. Understanding the pathophysiological mechanisms behind sex differences in TMDs as well as their comorbidity with migraines is essential for developing novel approaches for gender-specific treatment of TMDs and related orofacial pain comorbidity. In this review, we summarize recent research progress regarding sex differences in TMDs, focusing on the underlying mechanisms including craniofacial anatomy, hormonal regulation, and roles of opioids, transient receptor potential channels, and endocannabinoid systems. We also discuss the mechanisms of comorbid TMDs and migraine. The information covered in this review will provide mechanistic insights into sex differences in TMDs and their comorbidity with migraine, which could aid in developing effective treatment strategies for the overlapping orofacial pain condition.

Prevalence, Severity, and Treatment of Obstructive Sleep Apnea in Children with Down Syndrome in Qatar.

Patients with Down syndrome (DS) are at risk for sleep disorder breathing (SDB) due to their abnormal craniofacial anatomy, hypotonia, and propensity for obesity. The prevalence and severity of SDB in this population vary between different cohorts due to the multifactorial nature of these patients and the different diagnostic criteria used. We aim to report the prevalence and severity of SDB in the DS population in Qatar. This study is a retrospective review of all patients with genetically confirmed DS who completed a diagnostic polysomnography (PSG) study at Sidra Medicine in Doha, Qatar, which is the only pediatric sleep center in the country, between September 2019 and July 2022. Clinical and PSG data were collected from the patients' electronic medical records. Central and obstructive events were scored according to the American Academy of Sleep Medicine (AASM) criteria. Obstructive sleep apnea (OSA) diagnosis was made based on apnea-hypopnea index (AHI) and defined as AHI>1.5 events/hour.OSA was considered mild if AHI was ≥ 1.5 but < 5, moderate if AHI was ≥ 5 but < 10, and severe if AHI was ≥ 10 events/hour. Diagnosis with central apnea was considered if the central apnea index was > 5 events/hour. Hypoventilation was considered present if end-tidal/transcutaneous carbon dioxide gas was more than 50 mmHg for more than 25% of total sleep time.Multiple regression analysis was performed to evaluate predictors of high AHI and rapid eye movement (REM)-AHI. A total of 80 patients (49 males and 31 females) were included. Median (range) age was 7.3 years (0.9, 21). The mean (range) BMI z-score was 1.7 (-1.3, 4.3). Sixty-five patients were diagnosed with OSA, with a prevalence rate of 81%. OSA was mild in 25 (38.5%) patients, moderate in 15 (23.1%) patients, and severe in 25 (38.5%) patients. Only one patient was diagnosed with central apnea and five patients (6.9%) with alveolar hypoventilation. Multiple regression analysis showed BMI (P = 0.007) and snoring/apnea symptoms (P=0.023) to be predictive of high AHI. No correlation was found between the same variables and REM-AHI. Treatments used for OSA included anti-inflammatory medications in 37 (46%) patients, tonsillectomy/adenoidectomy in 13 (16.5%) patients, and positive airway pressure support in 10 (15%) patients. Our patient population with DS had a high prevalence of OSA comparable to other reported cohorts. High BMI and symptoms of snoring are predictive of OSA.

3D Printing for the Development of Palatal Defect Prosthetics.

Three-dimensional (3D) printing has emerged as a promising new technology for the development of surgical prosthetics. Research in orthopedic surgery has demonstrated that using 3D printed customized prosthetics results in more precise implant placements and better patient outcomes. However, there has been little research on implementing customized 3D printed prosthetics in otolaryngology. The program sought to determine whether computed tomography (CT) serves as feasible templates to construct 3D printed palatal obturator prosthetics for defects in patients who have been treated for head and neck cancers. A retrospective review of patients with palatal defects was conducted and identified 1 patient with high quality CTs compatible with 3D modeling. CTs of the patient's craniofacial anatomy were used to develop a 3D model and a Formlabs 3B+ printer printed the palatal prosthetic. We successfully developed and produced an individualized prosthetic using CTs from a veteran with head and neck deformities caused by cancer treatment who was previously treated at the Veterans Affairs Palo Alto Health Care System. This project was successful in printing patient-specific implants using CT reproductions of the patient's craniofacial anatomy, particularly of the palate. The program was a proof of concept and the implant we created was not used on the patient. Customized 3D printed implants may allow otolaryngologists to enhance the performance and efficiency of surgeries and better rehabilitate and reconstruct craniofacial deformities to restore appearance and function to patients. Additional research will strive to enhance the therapeutic potential of these prosthetics to serve as low-cost, patient-specific implants.

Ontogenetic changes in jaw leverage and skull shape in tufted and untufted capuchins.

The ontogeny of feeding is characterized by shifting functional demands concurrent with changes in craniofacial anatomy; relationships between these factors will look different in primates with disparate feeding behaviors during development. This study examines the ontogeny of skull morphology and jaw leverage in tufted (Sapajus) and untufted (Cebus) capuchin monkeys. Unlike Cebus, Sapajus have a mechanically challenging diet and behavioral observations of juvenile Sapajus suggest these foods are exploited early in development. Landmarks were placed on three-dimensional surface models of an ontogenetic series of Sapajus and Cebus skulls (n = 53) and used to generate shape data and jaw-leverage estimates across the tooth row for three jaw-closing muscles (temporalis, masseter, medial pterygoid) as well as a weighted combined estimate. Using geometric morphometric methods, we found that skull shape diverges early and shape is significantly different between Sapajus and Cebus throughout ontogeny. Additionally, jaw leverage varies with age and position on the tooth rowand is greater in Sapajus compared to Cebus when calculated at the permanent dentition. We used two-block partial least squares analyses to identify covariance between skull shape and each of our jaw muscle leverage estimates. Sapajus, but not Cebus, has significant covariance between all leverage estimates at the anterior dentition. Our findings show that Sapajus and Cebus exhibit distinct craniofacial morphologies early in ontogeny and strong covariance between leverage estimates and craniofacial shape in Sapajus. These results are consistent with prior behavioral and comparative work suggesting these differences are a function of selection for exploiting mechanically challenging foods in Sapajus, and further emphasize that these differences appear quite early in ontogeny. This research builds on prior work that has highlighted the importance of understanding ontogeny for interpreting adult morphology.

Craniofacial anomalies in schizophrenia-relevant GFAP.HMOX10-12m mice.

Subtle craniofacial dysmorphology has been reported in schizophrenia patients. This dysmorphology includes midline facial elongation, frontonasal anomalies and a sexually dimorphic deviation from normal directional asymmetry of the face, with male patients showing reduced and female patients showing enhanced facial asymmetry relative to healthy control subjects. GFAP.HMOX10-12m transgenic mice (Mus musculus) that overexpress heme oxygenase-1 in astrocytes recapitulate many schizophrenia-relevant neurochemical, neuropathological and behavioral features. As morphogenesis of the brain, skull and face are highly interrelated, we hypothesized that GFAP.HMOX10-12m mice may exhibit craniofacial anomalies similar to those reported in persons with schizophrenia. We examined craniofacial anatomy in male GFAP.HMOX10-12m mice and wild-type control mice at the early adulthood age of 6-8 months. We used computer vision techniques for the extraction and analysis of mouse head shape parameters from systematically acquired 2D digital images, and confirmed our results with landmark-based geometric morphometrics. We performed skull bone morphometry using digital calipers to take linear distance measurements between known landmarks. Relative to controls, adult male GFAP.HMOX10-12m mice manifested craniofacial dysmorphology including elongation of the nasal bones, alteration of head shape anisotropy and reduction of directional asymmetry in facial shape features. These findings demonstrate that GFAP.HMOX10-12m mice exhibit craniofacial anomalies resembling those described in schizophrenia patients, implicating heme oxygenase-1 in their development. As a preclinical mouse model, GFAP.HMOX10-12m mice provide a novel opportunity for the study of the etiopathogenesis of craniofacial and other anomalies in schizophrenia and related disorders.

Using Geometric Morphometric Analysis of Magnetic Resonance Imaging to Assess the Anatomy of the Eustachian Tube in Children with and without Otitis Media.

Otitis media (OM) is among the most common of childhood illnesses. It has long been hypothesized that children under age two are predisposed to OM due to differences in the anatomy of the Eustachian tube (ET), including the angle of the ET. OM in later childhood is less common but does occur, begging the question, are there shape differences in the ET that persist underlying later occurrences of OM? To answer this question, a novel method, which applied geometric and morphometric shape analysis to landmarks obtained from MRI data, was used. MRI scans were performed on 16 children (5 control, 3 cOME, and 8 rAOM) between 2011 and 2015. Sixteen landmarks representing the shape of the ET, cranial base, and palate were analyzed. The results of a Procrustes ANOVA indicate that the shape of the ET varies significantly (p < 0.01) between the OM and control groups. The shape differences between the OM group and the control are a medial and low attachment site of the tensor veli palatini (TVP) muscle, a posterior and high torus tubarius, and an anteriorly projected palate. These results support previous findings that a relatively horizontal ET is associated with a predisposition for OM. This study used a novel approach to examine anatomical differences in children with and without OM. First, the data set is unique in that it includes MRI scans of children with a confirmed OM diagnosis. Second, the use of MRI scans in craniofacial anatomy OM research is novel and allows for the collection of soft tissue landmarks and the visualization of soft tissue structures. Third, geometric morphometric shape analysis is a statistical method that captures shape differences, offering a more universal picture of nuanced changes within the entire set of landmarks, in contrast to more traditional linear and angular measurements used in prior OM studies examining craniofacial anatomy.

OBSTRUCTIVE SLEEP APNEA AND ITS PROSTHODONTIC MANAGEMENT: A DENTAL OUTLOOK

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. Prevalence of obstructive sleep apnea is favored in men more than woman. Risk factors include nasal obstruction, obesity, gender, craniofacial anatomy, and smoking. Polysomnography is proved to be the golden-standard method for diagnosing obstructive sleep apnea. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures. Oral appliance, namely, mandibular advancement device (MAD) is the recommended treatment appliance for the patient with mild to moderate OSA. For the dental profession in general and in prosthodontists speciality, the subject of sleep medicine continues to offer great challenges and opportunities in diagnosis, treatment planning, and treatment based on qualitative evidence. This article discusses the various aspects and prosthodontic perspectives of obstructive sleep apnea in detail.

Translation of obstructive sleep apnea pathophysiology and phenotypes to personalized treatment: a narrative review.

Obstructive Sleep Apnea (OSA) arises due to periodic blockage of the upper airway (UA) during sleep, as negative pressure generated during inspiration overcomes the force exerted by the UA dilator muscles to maintain patency. This imbalance is primarily seen in individuals with a narrowed UA, attributable to factors such as inherent craniofacial anatomy, neck fat accumulation, and rostral fluid shifts in the supine posture. Sleep-induced attenuation of UA dilating muscle responsiveness, respiratory instability, and high loop gain further exacerbate UA obstruction. The widespread comorbidity profile of OSA, encompassing cardiovascular, metabolic, and neuropsychiatric domains, suggests complex bidirectional relationships with conditions like heart failure, stroke, and metabolic syndrome. Recent advances have delineated distinct OSA phenotypes beyond mere obstruction frequency, showing links with specific symptomatic manifestations. It is vital to bridge the gap between measurable patient characteristics, phenotypes, and underlying pathophysiological traits to enhance our understanding of OSA and its interplay with related outcomes. This knowledge could stimulate the development of tailored therapies targeting specific phenotypic and pathophysiological endotypes. This review aims to elucidate the multifaceted pathophysiology of OSA, focusing on the relationships between UA anatomy, functional traits, clinical manifestations, and comorbidities. The ultimate objective is to pave the way for a more personalized treatment paradigm in OSA, offering alternatives to continuous positive airway pressure therapy for selected patients and thereby optimizing treatment efficacy and adherence. There is an urgent need for personalized treatment strategies in the ever-evolving field of sleep medicine, as we progress from a 'one-size-fits-all' to a 'tailored-therapy' approach.

Craniofacial risk factors for obstructive sleep apnea-systematic review and meta-analysis.

Obstructive sleep apnea (OSA) is caused by temporary partial or complete constriction of the upper airway during sleep which leads to reduced blood oxygen and cardiovascular risks. Main symptoms vary between adults and children leading to misdiagnosis or delayed patient identification. To improve early diagnosis, lateral cephalograms can provide craniofacial measurements associated with a higher risk of OSA. In order to identify the most relevant craniofacial measurements, a systematic literature review with meta-analysis was conducted combining the terms 'orthodontic*', 'craniofacial', 'cephalometr*', 'cephalogram', 'OSA*', 'UARS', 'SDB', 'sleep disordered breathing', 'sleep apnea' and 'sleep apnoea'. Of 3016 publications, 19 were included in the systematic review and meta-analysis, 15 with adult patients and four with children. A total of 16 measurements (six angles, 10 distances) were compared, nine showed a possible influence in patients with OSA compared to controls: NSBa angle (-0.28°), ANB angle (+0.33°), ML-NSL angle (+0.34°), Me-Go-Ar angle (+0.33°), SN distance (-0.70 mm), N-ANS distance (-0.36 mm), MP-H distance (+1.18 mm), uvula length (+1.07 mm) and thickness (+0.96 mm). Posterior airway measurements were not sufficiently described or comparably measured to be statistically analysed. There is some evidence for altered craniofacial anatomy in patients with OSA compared to controls. Lateral cephalograms should be screened for these aspects routinely to improve early diagnosis of OSA and craniofacial orthopaedics should complement the interdisciplinary treatment plan for young patients with OSA.

Using Machine-Learning to Predict Sleep-Disordered Breathing Diagnosis From Medical Comorbidities and Craniofacial Features.

Objectives This paper attempts to use machine-learning (ML) algorithms to predict the presence of sleep-disordered breathing (SDB) in a patient based on their body habitus, craniofacial anatomy, and social history. Materials and methods Data from a group of 69 adult patients who attended a dental clinic for oral surgeries and dental procedures in the last 10 years was used to train machine-learning models to predict whether a subject is likely to have SDB based on input information such as age, gender, smoking history, body mass index (BMI), oropharyngeal airway (Mallampati assessment), forward head posture (FHP), facial skeletal pattern, and sleep quality. Logistic Regression (LR), K-nearest Neighbours (kNN), Support Vector Machine (SVM) and Naïve Bayes (NB) were selected as these are the most frequently used supervised machine-learning models for classification of outcomes. The data was split into two sets for machine training (80% of total records) and the remaining was used for testing (validation). Results Initial analysis of collected data showed overweight BMI (at 25 or above), periorbital hyperchromia (dark circle eyes), nasal deviation, micrognathia, convex facial skeletal pattern (class 2) and Mallampati class 2 or above have positive correlations with SDB. Logistic Regression was found to be the best performer amongst the four models used with an accuracy of 86%, F1 score of 88% and area under the ROC curve (AUC) of 93%. LR also had 100% specificity and 77.8% sensitivity. Support Vector Machine was the second-best performer with an accuracy of 79%, F1 score of 82% and AUC of 93%. k-Nearest Neighbours and Naïve Bayes performed reasonably well with F1 scores of 71% and 67%, respectively. Conclusions This study demonstrated the feasibility of using simple machine-learning models as a credible predictor of sleep-disordered breathing in patients with structural risk factors for sleep apnoea such as craniofacial anomalies, neck posture and soft tissue airway obstruction. By utilising higher-level machine-learning algorithms, it is possible to incorporate a broader range of risk factors, including non-structural features like respiratory diseases, asthma, medication use, and more, into the prediction model.

0444 Racial Differences in Positive Airway Pressure Requirements Amongst Obstructive Sleep Apnea Patients (The RACE-PAP Study)

Abstract Introduction Prior studies of patients with obstructive sleep apnea (OSA) show racial differences in clinical presentation. When compared with White patients, Black patients present with more severe OSA and greater sleepiness. Racial differences in upper airway collapsibility could explain these differences. Here, we investigated whether mean positive airway pressure (PAP) levels, a clinically accessible measure of upper airway collapsibility, differed by race in a cohort of patients adherent to PAP. Methods We conducted a retrospective analysis of White and Black adults with OSA who were prescribed auto-adjusting PAP (aPAP) therapy at a single academic center between January 2018 and January 2020. The analysis included adherent patients (usage on &amp;gt;70% of nights for ≥4 hours per night) with well-controlled OSA (defined as ≥50% reduction in apnea-hypopnea index [AHI] on aPAP and residual AHI&amp;lt; 10). Mean PAP level was compared between White and Black patients using linear regression controlled for age, gender, body mass index (BMI), AHI, O2 nadir, and mask type (full face, nasal, or unknown). Results Overall, 148 Black (56% women) and 230 White (36% women) patients were included. On average, Black patients were younger (50.7±14.6 vs. 53.8±12.7 years; p=0.037) with higher BMI (40.4±9.5 vs. 34.9±7.6 kg/m2; p&amp;lt; 0.0001). Black patients had less severe OSA on average, but this difference was not statistically significant (AHI of 33.9±25.5 vs 38.6±24.9 events/hour; p=0.077). After adjusting for covariates, Black patients had a 0.62 cm H2O (95% CI: 0.21 to 1.03) higher mean PAP level than White patients (p=0.003). There was a larger racial difference in mean PAP level among men (0.76 [0.16, 1.35] cm H2O; p=0.013) compared to a non-significant difference among women (0.34 [-0.23, 0.91] cm H2O; p=0.242). While statistically significant, differences were &amp;lt; 1 cm H2O and, thus, not clinically meaningful. Conclusion Black patients with OSA had a statistically significant but clinically insignificant difference in mean PAP level when compared with White patients. There was evidence of stronger differences in men than women. Further studies are needed to explore other potential mechanisms, including craniofacial anatomy, which may underlie racial differences in OSA presentation and outcomes. Support (if any) National Institutes of Health R01 1R01HL144859 (PIs: Schwartz, Dedhia)

In-House 3D Printing and Model Processing Technique for Creating High-Fidelity Transparent Craniofacial Models.

The use of high-fidelity stereolithographic models that accurately reflect patient-specific pathology has become commonplace in craniofacial surgery. Multiple studies have reported the use of commercially available three-dimensional (3D) printers that allow medical centers with limited resources to reconstruct 3D models comparable to industry-made counterparts. However, most models are printed using only a single filament, which portrays the surface craniofacial anatomy, but fails to highlight relevant intraosseous structures. This presents a significant limitation when used for preoperative planning and intraoperative guidance in surgical procedures requiring osteotomies, where knowledge of the precise location of critical structures is paramount to avoid injury. The authors report a novel technique for creating transparent 3D models of relevant intraosseous craniofacial anatomy at a cost that mitigates the financial burden of industrial 3D model or industrial 3D printer acquisition. Cases are presented to demonstrate the diverse applications of this technique, with accurate display of the tooth roots, the inferior alveolar nerve, and the optic nerve, to aid in preoperative planning of osteotomies. This technique enables production of low-cost, high-fidelity transparent 3D models with applications in preoperative planning for craniofacial surgery.

Craniofacial Soft-Tissue Anthropomorphic Database with Magnetic Resonance Imaging and Unbiased Diffeomorphic Registration.

Objective assessment of craniofacial surgery outcomes in a pediatric population is challenging because of the complexity of patient presentations, diversity of procedures performed, and rapid craniofacial growth. There is a paucity of robust methods to quantify anatomical measurements by age and objectively compare craniofacial dysmorphology and postoperative outcomes. Here, the authors present data in developing a racially and ethnically sensitive anthropomorphic database, providing plastic and craniofacial surgeons with "normal" three-dimensional anatomical parameters with which to appraise and optimize aesthetic and reconstructive outcomes. Patients with normal craniofacial anatomy undergoing head magnetic resonance imaging (MRI) scans from 2008 to 2021 were included in this retrospective study. Images were used to construct composite (template) images with diffeomorphic image registration method using the Advanced Normalization Tools package. Composites were thresholded to generate binary three-dimensional segmentations used for anatomical measurements in Materalise Mimics. High-resolution MRI scans from 130 patients generated 12 composites from an average of 10 MRI sequences each: four 3-year-olds, four 4-year-olds, and four 5-year-olds (two male, two female, two Black, and two White). The average head circumference of 3-, 4-, and 5-year-old composites was 50.3, 51.5, and 51.7 cm, respectively, comparable to normative data published by the World Health Organization. Application of diffeomorphic registration-based image template algorithm to MRI is effective in creating composite templates to represent "normal" three-dimensional craniofacial and soft-tissue anatomy. Future research will focus on development of automated computational tools to characterize anatomical normality, generation of indices to grade preoperative severity, and quantification of postoperative results to reduce subjectivity bias.

Complications and treatment errors in peri-implant hard tissue management.

Bone augmentation procedures aim to regenerate the deficient alveolar ridge to properly place dental implants that are completely surrounded by bone. However, these are invasive and technically demanding surgeries that are not free of either complications or treatment errors. Careful patient selection and preparation is a mandatory process to reduce the rate of complications in bone regeneration procedures, irrespective of the technique used. It is important to assess the cost benefit of the intervention and to evaluate the potential impact on the patient's quality of life, especially in the elderly and medically compromised patients. Most common postoperative complications are wound dehiscences, which may be reduced, at least partially, by proper knowledge of the surgical technique and the craniofacial anatomy. Other complications that may appear are postoperative infections or nerve injuries. The aim of this narrative review is to summarize the best available scientific evidence on the incidence of complications, as well as the ideal strategies for their prevention and management. Depending on the severity of the complication, treatment approaches may vary and can include drug prescription or even surgical re-entries to remove exposed barrier membranes or contaminated bone grafts. Adequate prevention and proper management of complications associated with bone augmentation interventions are a requirement for clinicians carrying out these demanding procedures. A series of cases illustrating proper management of complications in different clinical scenarios is presented.

Oral Processing of Three Guenon Species in Taï National Park, Côte d'Ivoire.

Three guenon species in Taï National Park frequently form and maintain stable polyspecific associations despite significant feeding competition. This dietary overlap provides an opportunity to examine how closely related and anatomically similar taxa process the same foods. Our research examines whether the oral-processing behaviors of these guenons differ when they consume the same foods. Methods: Data on oral-processing behavior were collected on one habituated group each of Cercopithecus campbelli, C. diana, and C. petaurista in Taï National Park, Côte d'Ivoire from January 2016 to December 2018. We recorded the frequency with which foods were introduced to the mouth (ingestive action) and the frequency with which foods were processed using incisors, canines, and postcanine teeth. Oral-processing profiles for species-specific plant foods, fungi, and invertebrates were compared using Monte Carlo resampling. We quantified oral-processing behavior during a total of 2316 five-minute focal periods. Diana monkeys use their incisors significantly more per ingestive action than Campbell's monkeys or Lesser spot-nosed guenons. Lesser spot-nosed guenons use their incisors more than Campbell's monkeys. Diana monkeys also use significantly more post-canine chews per ingestive action than Campbell's monkeys and Lesser spot-nosed guenons. Lesser spot-nosed guenons generally use fewer post-canine chews than Diana monkeys but more than Campbell's monkeys. Canine use during feeding was rare in all three taxa. The three study species use different oral-processing profiles when consuming the same foods. These results are intriguing given the overall similarity in dental and cranial anatomy in these taxa. The oral-processing profiles we report do not encompass the full dietary breadth of all species; however, the behavioral diversity demonstrated during consumption of the same foods suggests that insight into feeding behavior is more likely obtained by examining oral processing of individual foods rather than broad food categories. Furthermore, these results underscore that important variation in feeding behavior is not necessarily associated with morphological differences in dental or craniofacial anatomy.

Epidemiology of Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia.

To investigate the prevalence of diagnosed Eustachian tube dysfunction and related otologic diagnoses among children with achondroplasia as compared to a control population. The TriNetX Analytics Network, a federated health research network that aggregates the de-identified electronic health record data of over 78 million patients across the United States, was queried for patients 18 years old or younger with achondroplasia. Patients in this group with any occurrence of diagnosed Eustachian tube dysfunction or specified otologic diagnoses were recorded and reported. Out of 2,195 patients 18 years old or younger with diagnosed achondroplasia, 379 (17.27%, 95% CI: 15.71-18.91) had a diagnosis of Eustachian tube dysfunction with an 8.65 (95% CI: 7.89-9.48) times higher risk than children without achondroplasia (n=12,818,655). Children with achondroplasia also had higher risks for diagnosed otitis media (RR: 2.21), tympanic membrane retraction (RR: 7.29), middle ear cholesteatoma (RR: 6.35), cleft palate (RR: 12.24), conductive hearing loss (RR: 12.15), and tympanostomy tube placement (RR: 9.71). Each increased risk was maintained when cleft palate patients were removed from the achondroplasia group. Children with achondroplasia are at a significantly higher risk for diagnosed Eustachian tube dysfunction and related middle ear diagnoses. Atypical craniofacial anatomy among children with achondroplasia may play a role in the dysfunction of the Eustachian tube and thus the observed epidemiology of otologic conditions. Children with achondroplasia should be monitored closely for middle ear conditions and the constellation of symptoms related to a dysfunctional Eustachian tube.

Substrate type induces plastic responses in the craniofacial morphology of a winnowing cichlid

Understanding how local populations respond to specific changes in the environment can help us better predict how populations respond to such change. With this topic in mind, we followed up on a previous study by exploring the capabilities of a Geophagini cichlid, known for its unique feeding strategy, to mount a plastic response. We exposed Satanoperca daemon, a winnowing cichlid, to three different substrate types, two of which encouraged winnowing behaviors and a third that prevented winnowing entirely. Using geometric morphometrics, we quantified aspects of craniofacial anatomy to test for morphological differences between the treatments and to test for the integration of different traits across the head. We found significant differences across our experimental populations in both shape and disparity. We report evidence in support of wide-spread integration across craniofacial traits. A notable exception to this pattern was the epibranchial lobe, a structure unique to the Geophagini, which exhibited more modular variation. Since anthropogenic alterations such as the damming of rivers can impact substrate type, these data offer insights into how Geophagini cichlids may respond to environmental change. In addition, this work further illuminates the functional morphology of winnowing foraging behaviors.

Craniofacial Malformations as Fundamental Diagnostic Tools in Syndromic Entities.

Background: A long list of syndromic entities can be diagnosed immediately through scrutinizing the clinical phenotype of the craniofacial features. The latter should be assisted via proper radiological interpretations. Patients and Methods: Different children aged from 1 month to 12 years were referred to our departments seeking orthopedic advice. Primarily, all received variable false diagnoses in other institutes. Two unrelated boys of one month and 12 months were falsely diagnosed as having positional plagiocephaly associated with contractures of idiopathic origin. Two unrelated boys of 14 months and 2 years were diagnosed with pseudo-hydrocephalus and non-specific syndrome, and were referred to explore their skeletal development. Two unrelated girls of 4 years old and 12 years old presented with multiple contractures were referred because of progressive scoliosis. A 4-year-old girl was referred with a false provisional diagnosis of facial diplegia. All children underwent detailed clinical, radiological and tomographic phenotypic characterizations and genetic testing, respectively. Results: Idaho syndrome (craniosynostosis associated with multiple dislocations) was the final diagnosis in the two unrelated boys with plagiocephaly and multiple contractures. Two children falsely diagnosed with pseudo-hydrocephalus and non-specific syndrome, were diagnosed with Silver–Russell syndrome (RSS). Contractural arachnodactyly Beals (CAB) was confirmed as the definitive diagnosis in the two unrelated girls with progressive scoliosis and multiple contractures. Parry–Romberg syndrome (PRS) associated with congenital lumbar kyphosis was the final diagnosis of the girl with the diagnosis of facial diplegia. Hypomethylation of ICR1 was confirmed in the RSS patients. Whole exome sequencing (WES) revealed a heterozygous mutation in the PRS patients. WES and array-CGH showed that no relevant variants or copy number variations (CNV) were identified in the CAB patients. Conclusions: On the one hand, newborn children can manifest diverse forms of abnormal craniofacial features, which are usually associated with either major or minor dysmorphic stigmata. A cleft lip/ palate is a major craniofacial malformation, and frontal bossing or a disproportionate craniofacial contour can be falsely considered as a transient plagiocephaly, which is spontaneously resolved by time. On the other hand, many physicians fall into the problem of deeming a countless number of diseases, such as contractures, as an idiopathic or non-specific syndrome. The latter stems from limited clinical experience. Therefore, failing to establish between the onset of the deformity and other inexplicit abnormal features that the patient or their immediate families or relatives carry is the final outcome. In this study, we used, for the first time, a reconstruction CT scan to further delineate the congenital disruption of the craniofacial anatomy and the other skeletal malformation complex.

Three-dimensional analysis of upper airways in Class II malocclusion children with obstructive sleep apnea

Morphometric evaluation of upper airways helps in identifying potential craniofacial anatomy that may predispose to pediatric obstructive sleep apnea (OSA). This study evaluated upper airway parameters three-dimensionally in children with OSA, with Class II malocclusion and a retrognathic mandible, to identify cutoff values for cone-beam computed tomography measurements that may predict the presence and severity of pediatric OSA. The study comprised 47 growing children with OSA with Class II malocclusion and 47 low-risk OSA-matched controls. Upper airway was segmented into nasopharynx, oropharynx, and hypopharynx using cone-beam computed tomography and MIMICS16.0 software. Parameters included volume, minimum cross-sectional area (CSAmin), anterioposterior and lateral distances of CSAmin, and upper airway length. The volume, cross-sectional area (CSAmin), and anteroposterior and lateral distances of CSAmin were significantly decreased at the level of the oropharynx in patients with OSA. At the level of the hypopharynx, CSAmin was significantly narrower and upper airway length was significantly increased in patients with OSA. OSA predictive cutoff values were proposed as 41.36 mm2 CSAmin at the level of oropharynx, 52.45 mm2 CSAmin at the level of hypopharynx, and 55.47 mm upper airway length. Only CSAmin at the level of the oropharynx had an independent association with OSA severity (P=0.021). Significant differences were found in the upper airway parameters of children with OSA compared with corresponding controls. CSAmin may represent part of the issues that play a role in the pathogenesis of OSA and may serve as a predictive of disease severity.