Lack Of Teeth Research Articles

Tooth transplantation in cherubism and incontinentia pigmenti: report of two unusual cases

In children, autotransplantation has been an accepted treatment alternative in the Scandinavian countries for decades in cases of agenesis or trauma. When working with children with rare syndromes, lack of teeth is often so pronounced that there are no teeth available for transplantation. Even so, sometimes there are retained teeth that can be transplanted! Here we present two patients with rare syndromes in which a retained tooth was transplanted. In both cases, neither the donor tooth nor the recipient site was ideal for transplantation. The first case is a girl with incontinentia pigmenti, 15 years old at the time of transplantation, and the second case is a boy with severe cherubism, aged 9.5 years at the time of transplantation. In the first case, a second molar with multiple roots retained at a mesial angle to the first molar in the upper jaw was transplanted to an infected site. In the second case, a retained first premolar in the upper jaw was transplanted to a cystic lesion. In both patients, the profit in the event of a successful transplantation was so great, that an attempt was made in spite of the negative circumstances. Both teeth were successfully transplanted and have been followed for more than 2 years with no ankylosis or pulp necrosis developing. We conclude that in a child with multiple missing teeth, the conventional rules of transplantation may be stretched.

Interleukin-34: An enigmatic cytokine

Macrophage colony-stimulating factor (M-CSF) is required for the differentiation, proliferation and survival of cells of the monocyte lineage. M-CSF deficiency in mice (op/op mice) leads to a specific phenotype including skeletal deformities, a lack of teeth, and a marked osteopetrosis explained by an absence of osteoclasts. Recently, a novel cytokine, interleukin-34 (IL-34), has been discovered and shares a common receptor with M-CSF, resulting in functional overlaps in bone (similar effect on osteoclastogenesis) and in inflammatory systems (monocyte proliferation, and upmodulation of chemokine production). This Perspective focuses on the biology of IL-34 as suggested by recent published data and discusses IL-34's potential role in bone pathophysiology.

Diversification of Prey Capture Techniques Among the Piscivores in Lake Tana's (Ethiopia)LabeobarbusSpecies Flock (Cyprinidae)

Lake Tana harbours the only known intact species flock of large cyprinid fishes (15 Labeobarbus spp.). One of the most curious aspects of this species flock is the large number (8) of piscivorous species. Cyprinids are not well designed for piscivory (i.e. small slit-shaped pharyngeal cavity, lack of teeth in the oral jaws, lack of a stomach), which raises the question how well adapted these labeobarbs actually are to function as piscivores? In this study we analyse the kinematics of prey capture (by varied combinations of suction, swimming and jaw protrusion) among Lake Tana's piscivorous labeobarbs. Suction feeding kinematics were similar to values reported for other piscivorous fish species. A detailed analysis of several Labeobarbus species displayed distinct types of techniques (overswimming, velocity/volume suction with jaw protrusion) suited to capture elusive prey in different macro-habitats, Lake Tana's Labeobarbus species evolved a wide range of piscivorous predation techniques, a unique scenario for cyprinid fishes.

Diversification of prey capture techniques among the piscivores in Lake Tana’s (Ethiopia) Labeobarbus species flock (Cyprinidae)

Lake Tana harbours the only known intact species flock of large cyprinid fishes (15 Labeobarbus spp.). One of the most curious aspects of this species flock is the large number (8) of piscivorous species. Cyprinids are not well designed for piscivory (i.e. small slit-shaped pharyngeal cavity, lack of teeth in the oral jaws, lack of a stomach), which raises the question how well adapted these labeobarbs actually are to function as piscivores? In this study we analyse the kinematics of prey capture (by varied combinations of suction, swimming and jaw protrusion) among Lake Tana’s piscivorous labeobarbs. Suction feeding kinematics were similar to values reported for other piscivorous fish species. A detailed analysis of several Labeobarbus species displayed distinct types of techniques (overswimming, velocity/volume suction with jaw protrusion) suited to capture elusive prey in different macro-habitats. Lake Tana’s Labeobarbus species evolved a wide range of piscivorous predation techniques, a unique scenario for cyprinid fishes.

Difficult Mask Ventilation

Mask ventilation is the most fundamental skill in airway management. In this review, we summarize the current knowledge about difficult mask ventilation (DMV) situations. Various definitions for DMV have been used in the literature. The lack of a precise standard definition creates a problem for studies on DMV and causes confusion in data communication and comparisons. DMV develops because of multiple factors that are technique related and/or airway related. Frequently, the pathogenesis involves a combination of these factors interacting to cause the final clinical picture. The reported incidence of DMV varies widely (from 0.08% to 15%) depending on the criteria used for its definition. Obesity, age older than 55 yr, history of snoring, lack of teeth, the presence of a beard, Mallampati Class III or IV, and abnormal mandibular protrusion test are all independent predictors of DMV. These signs should, therefore, be recognized and documented during the preoperative evaluation. DMV can be even more challenging in infants and children, because they develop hypoxemia much faster than adults. Finally, difficult tracheal intubation is more frequent in patients who experience DMV, and thus, clinicians should be familiar with the corrective measures and management options when faced with a challenging, difficult, or impossible mask ventilation situation.

Obesity, obstructive sleep apnoea, and diabetes mellitus: anaesthetic implications

Obesity is an epidemic in much of the Western World. The extent of this problem, combined with the increasing preference for ambulatory surgical procedures, has produced a difficult situation for many anaesthesiologists. Even the simplest anaesthetic procedures can become very complicated and potentially difficult in this population. Although there are numerous complications associated with obesity, perhaps obstructive sleep apnoea (OSA) and diabetes mellitus are among the more significant. Patients with OSA are often not ideal candidates for certain day-case procedures, but many outpatient procedures can be performed on patients with OSA as long as attention is paid to anaesthetic technique. Diabetic patients are prone to numerous complications in the perioperative period, including cardiac problems, but with careful management, they are able to undergo day-case surgical procedures safely.

Biocultural Anthropology

Previous articleNext article FreeCurrent ApplicationsBiocultural AnthropologyR. SchachtR. Schacht Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreA Gap in Sudanese Refugee ResettlementThe civil war in Sudan has left hundreds of thousands dead and uprooted more than 2.5 million people. Most of the displaced people find their way into refugee camps in nearby countries to await resettlement. The United States is home to more than 20,000 of these resettled refugees, who represent more than ten southern Sudanese ethnic groups. Of these, approximately 50% live in Nebraska, largely because of the state’s low cost of living, low unemployment levels, and low crime rates.The state of Nebraska’s Minority Health Office sought help in incorporating this growing refugee population into the public health system. To do this, they contacted a local anthropologist, Mary Willis, from the University of Nebraska–Lincoln (UNL), who had conducted fieldwork with refugees in Africa. Willis began by convening focus groups aimed at identifying refugee health issues. One concern of Nebraskans and Sudanese alike was the refugees' teeth or, rather, their lack thereof. A majority of Nebraska’s Sudanese refugees are Nuer or Dinka, and as do many other Nilotic populations, they practice dental extraction. Among the Dinka, this involves the removal of the lower front teeth, while the Nuer remove those teeth as well as the upper canines, eight teeth in all. This dental practice is part of a coming‐of‐age ceremony for both boys and girls and a crucial component of tribal identity, adulthood, and beauty.However, according to Willis, for the many Dinka and Nuer who have relocated to the United States, the lack of teeth is problematic. Typical U.S. foods require the front teeth for processing; the inability to bite into food could mean a less healthy diet. Also, many U.S. foods are harder than traditional Sudanese foods such as porridges, milk, and stews. Perhaps more importantly, dental gaps have social implications in the United States. Individuals with missing teeth face negative stereotypes related to intelligence, attractiveness, and health, just to name a few, and the Sudanese refugees are suffering the consequences of these stereotypical judgments.A patient inspects his new dental work.View Large ImageDownload PowerPointBecause Willis realized the importance of the anterior teeth for physical and mental health in the United States and because of the growing number of requests she received from refugees to have their teeth replaced, she arranged complete dental restorations for five refugees at UNL’s College of Dentistry in 2003. Word of mouth created such an overwhelming demand for implant restoration that Willis sought support and was awarded $230,000 from the Langeloth Foundation to assist 23 more refugees. A new grant is in the works to fit more than 100 hopeful refugees with a tool that is highly valued in the United States—a smile full of straight, white teeth with no gaps or spaces. Previous articleNext article DetailsFiguresReferencesCited by Current Anthropology Volume 49, Number 4August 2008 Sponsored by the Wenner-Gren Foundation for Anthropological Research Article DOIhttps://doi.org/10.1086/588527 Views: 187Total views on this site © 2008 by The Wenner‐Gren Foundation for Anthropological Research. All rights reserved.PDF download Crossref reports no articles citing this article.

Restored vertical dimension for the removable partial denture.

Partial dental prosthesis is a very important field of dental rehabilitation process that usually is not well understood, mainly because it involves the repercussion on more than 10 of the 32 functions performed by the stomatognatic system. In order to fit several very important considerations about partial removable dental prosthesis design, some discernment about the need to consider factors that could affect the temporomandibular joint (TMJ) are presented, particularly when the lack of teeth is unilateral or bilateral. It is necessary to take on account that stomatognatic system performs the mastication, the oral carbohydrate digestion, the vocalization and other functions that could change drastically when there are no sufficient posterior teeth. But this lack also affects two general functions: the dynamic balance and the listening capability. All of those factors are very important to formulate and to produce high quality removable dental prosthesis; therefore, this kind of work couldn’t be performed by a simple dentist or by a dental prosthetic technician without a professional guidance. Since this is a very important and complex assignment, this paper is the first of a four assay being oriented to improve the rehabilitation treatment of the masticatory system as a part of the stomatognatic system.

Biocultural Anthropology. A Gap in Sudanese Refugee Resettlement

Previous articleNext article FreeCurrent ApplicationsBiocultural AnthropologyR. SchachtR. Schacht Search for more articles by this author PDFPDF PLUSFull Text Add to favoritesDownload CitationTrack CitationsPermissionsReprints Share onFacebookTwitterLinked InRedditEmailQR Code SectionsMoreA Gap in Sudanese Refugee ResettlementThe civil war in Sudan has left hundreds of thousands dead and uprooted more than 2.5 million people. Most of the displaced people find their way into refugee camps in nearby countries to await resettlement. The United States is home to more than 20,000 of these resettled refugees, who represent more than ten southern Sudanese ethnic groups. Of these, approximately 50% live in Nebraska, largely because of the state’s low cost of living, low unemployment levels, and low crime rates.The state of Nebraska’s Minority Health Office sought help in incorporating this growing refugee population into the public health system. To do this, they contacted a local anthropologist, Mary Willis, from the University of Nebraska–Lincoln (UNL), who had conducted fieldwork with refugees in Africa. Willis began by convening focus groups aimed at identifying refugee health issues. One concern of Nebraskans and Sudanese alike was the refugees' teeth or, rather, their lack thereof. A majority of Nebraska’s Sudanese refugees are Nuer or Dinka, and as do many other Nilotic populations, they practice dental extraction. Among the Dinka, this involves the removal of the lower front teeth, while the Nuer remove those teeth as well as the upper canines, eight teeth in all. This dental practice is part of a coming‐of‐age ceremony for both boys and girls and a crucial component of tribal identity, adulthood, and beauty.However, according to Willis, for the many Dinka and Nuer who have relocated to the United States, the lack of teeth is problematic. Typical U.S. foods require the front teeth for processing; the inability to bite into food could mean a less healthy diet. Also, many U.S. foods are harder than traditional Sudanese foods such as porridges, milk, and stews. Perhaps more importantly, dental gaps have social implications in the United States. Individuals with missing teeth face negative stereotypes related to intelligence, attractiveness, and health, just to name a few, and the Sudanese refugees are suffering the consequences of these stereotypical judgments.A patient inspects his new dental work.View Large ImageDownload PowerPointBecause Willis realized the importance of the anterior teeth for physical and mental health in the United States and because of the growing number of requests she received from refugees to have their teeth replaced, she arranged complete dental restorations for five refugees at UNL’s College of Dentistry in 2003. Word of mouth created such an overwhelming demand for implant restoration that Willis sought support and was awarded $230,000 from the Langeloth Foundation to assist 23 more refugees. A new grant is in the works to fit more than 100 hopeful refugees with a tool that is highly valued in the United States—a smile full of straight, white teeth with no gaps or spaces. Previous articleNext article DetailsFiguresReferencesCited by Current Anthropology Volume 49, Number 4August 2008 Sponsored by the Wenner-Gren Foundation for Anthropological Research Article DOIhttps://doi.org/10.1086/588527 Views: 80 © 2008 by The Wenner‐Gren Foundation for Anthropological Research. All rights reserved.PDF download Crossref reports no articles citing this article.

A new species of Aethionema (Brassicaceae) from the Bulgarian flora

Aethionema rhodopaeum D. Pavlova is described as a new species from the eastern Rhodope Mountains. The plant was found growing only on serpentines, in two localities, at an altitude of approximately 400 m. The localities are typical open habitats with sparsely colonized debris. The plant communities, composed mainly of xerophytes with a mosaic distribution, contain a large number of rare and endemic species for the Bulgarian flora. The new species belongs to the Aethionema saxatile group and is quite close to the species A. saxatile (L.) R. Br., in particular to ssp. creticum and ssp. graecum. The following diagnostic features are given for the new species: inner filament length always greater than half the petal length, lack of teeth of the filaments, longer [2‐3(3.5) mm] style than that of A. saxatile subspecies, and dark purple petals. All leaves are broadly elliptical to suborbicular, obtuse, and fleshy. The chromosome number of the new species is 2n = 24. The differences between the new species and related taxa are also discussed. © 2007 The Linnean Society of London, Botanical Journal of the Linnean Society, 2007, 155, 533‐540. ADDITIONAL KEYWORDS: Rhodope Mountains ‐ serpentine ‐ systematics ‐ taxonomy.

Caenotropus schizodon, a new chilodontid fish from the Rio Tapajós drainage, Brazil (Ostariophysi: Characiformes: Chilodontidae)

Caenotropus schizodon, n. sp., is described from the Rio Tapajós, Rio Amazonas drainage. The new species is readily distinguished from C. labyrinthicus and C. mestomorgmatos by its bifid premaxillary teeth. Caenotropus schizodon differs from C. maculosus by its lack of teeth on the lower jaw, the dusky distal portions of the anterior dorsal-fin rays but without a distinct patch of dark pigmentation, and the possession of 28-30 lateral-line scales vs. 27 rarely 28. The hypothesis of a sister-species relationship of C. schizodon with C. labyrinthicus is supported by three synapomorphies.

Dental Health and Cognitive Impairment in an English National Survey Population

To investigate the association between dental health and cognitive impairment and to examine the extent to which dental status accounts for the association between cognitive impairment and low body mass index (BMI) in a national survey sample. A secondary analysis of data from the Health Survey for England 2000. A nationally representative cross-sectional population survey. Two thousand four hundred sixty-three adults aged 65 and older living in private households and 1,569 adults aged 65 and older living in care homes. Data collected by interview (self-reported or by proxy) included age, sex, level of education, disability, BMI, dental status, and cognitive function (Abbreviated Mental Test Score). Less than half of the community sample (40.4%) and 67.9% of the care home sample were edentulous; lack of teeth was significantly associated with cognitive impairment (odds ratio=3.59, 95% confidence interval=2.36-5.47). This association remained strong after adjustment for other covariates only in the community sample. Cognitive impairment was associated with lower BMI in both samples, but dental status did not explain this. Poor dentition is associated with cognitive impairment. Nutritional status in people with cognitive impairment is recognized to be at risk. Although dental health did not account for the association between cognitive impairment and low BMI in this sample, other possible nutritional consequences require further evaluation.

TWO NEW SPECIES OF THE GENUS XENYLLA TULLBERG, 1869 FROM CHINA (COLLEMBOLA: HYPOGASTRURIDAE)

Abstract Two new species of Xenylla from Jilin Province, Northeast China are described and illustrated. Xenylla changlingensis, new species clearly differs from the closely related species X. piceeta Stebaeva & Potapov, 1994 in the presence of dorsal la2 of thoracic segments II and III, the absence of ventral seta p2 on abdominal segment II, 1 median ventral seta above the retinaculum on abdominal segment III, and lack of teeth on the mucro. Xenylla changchunensis, new species is similar to the species X. osetica Stebaeva & Potapov, 1994. However, it is separable from the latter by the presence of a furca, a tenaculum, and the ventral chaetotaxy on abdominal segment III.

Prosthodontic and psychological factors in treating patients with congenital and craniofacial defects

This article addresses treatment of patients with various types of congenital defects, including partial and total anodontia, hypohydrotic ectodermal dysplasia, dentinogenesis imperfecta, and cleft lip and palate. The psychosocial aspects of these patients and rehabilitation with removable, fixed, and implant-supported prostheses are discussed. The factors to be considered are altered anatomy, lack of teeth or malformed teeth, teeth in abnormal positions, lack of facial growth, and altered arch development. The short- and long-term treatment of patients in these categories is discussed.

A new species of Periclimenes Costa, 1844 (Crustacea: Decapoda: Palaemonidae) from the Caribbean coast of Quintana Roo, Mexico, and a key for the “iridescens” complex

A new species of pontoniine shrimp, Periclimenes siankaanensis, is described from the Mexican Caribbean coast. The new species shares morphological features with P. patae Heard & Spotte,1991, P. antipathophilus Spotte, Heard & Bubucis, 1994, and P. mclellandi Heard & Spotte, 1997, all species belonging to the “iridescens” complex, and with P. platalea Holthuis, 1951, of the tropical east Atlantic. Periclimenes siankaanensis differs from P. patae and P. mclellandi by its large size, pereopods 3–5 with 2 or 3 spines on propodal inner margin and the presence of bifid dactyl, and is distinguished from P. antipathophilus by its smaller size, entire endite on the second maxilla, pereopods 2 of same shape, and by the lack of tooth on the movable finger. In addition, P. siankaanensis can be separated immediately from P. platalea by having the second pereopods equal in shape and length, and bifid dactyl present on pereopods 3–5. Periclimenes siankaanensis inhabits shallow water Thalassia testudinum seagrass meadows and sandy bottoms, while the other species here compared are associated with gorgonians in deeper zones.

The incidence and risk factors of difficult mask ventilation

The ability to ventilate and oxygenate a patient using a bag-mask breathing system may be lifesaving in the case of failure of the initial intubation attempt. In this study, we aimed to determine the incidence of difficult mask ventilation (DMV) and to find preoperative risk factors for this procedure. Based on methods used for overcoming some difficulties with bag-mask ventilation (MV), classification has been made into four categories: easy MV, awkward MV, difficult MV, and impossible MV. A univariate analysis was performed to identify potential risk factors predicting DMV, followed by a stepwise forward binary logistic regression, and the odds ratio and 95% confidence interval were calculated. A total of 576 patients were studied. Incidence of easy MV, awkward MV, and difficult MV were found to be 75.5% (n = 435), 16.7% (n = 96), and 7.8% (n = 45), respectively. Height, weight, age, male gender, increased Mallampati class, history of snoring, lack of teeth, and beard were found to be DMV risk factors (P < 0.05). Using a multivariate analysis, Mallampati class 4, male, history of snoring, age, and weight were found to be significantly associated with DMV. Although the incidence of DMV in general was 7.8% (n = 45), the incidence of DMV among patients with difficult intubation (n = 123) was found to be 15.5% (n = 19). Mallampati class 4, male patients, history of snoring, increasing age, and increasing weight were found to be risk factors for DMV in our study.

Periodontal parameters around implants anchoring orthodontic appliances: a series of case reports.

Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved. A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment. In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment. No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment.

Periodontal Parameters Around Implants Anchoring Orthodontic Appliances: A Series of Case Reports.

Implants replacing missing teeth provide advantages over clinical orthodontic treatment as compensation for reaction forces is no longer necessary and the lack of teeth is immediately resolved. A total of 38 two-stage implants were inserted (16 in maxilla, 22 in mandible) in 10 partially edentulous patients with orthodontic problems. Osseointegration and marginal bone levels were assessed via intra-oral radiographs taken at the abutment stage and at the completion of the orthodontic treatment and also via probing depth, measurement of recession toward the implant/abutment (I/A) interface, and sulcus bleeding index, recorded after completion of orthodontic treatment. In the maxilla, the cumulative survival rate was 87.1% after 2 years; for the mandible, it remained 100%. Mean amount of bone loss was 1.6 mm for maxilla and 0.8 mm for mandible. No correlation could be found between directions of orthodontic forces and marginal bone loss. Mean percentage of bleeding sites was 38.5% and 25%, respectively, for implants in the maxilla and mandible. Attachment level was 1.2 mm (SD: 1.2) below I/A interface after completion of the orthodonic treatment. No significant marginal bone loss was present. Using implants during orthodontics can result in an easier and more predictable treatment. J Periodontol 2004;75:176-181.

Rescue of cleft palate in Msx1-deficient mice by transgenic Bmp4 reveals a network of BMP and Shh signaling in the regulation of mammalian palatogenesis.

Cleft palate, the most frequent congenital craniofacial birth defects in humans, arises from genetic or environmental perturbations in the multi-step process of palate development. Mutations in the MSX1 homeobox gene are associated with non-syndromic cleft palate and tooth agenesis in humans. We have used Msx1-deficient mice as a model system that exhibits severe craniofacial abnormalities, including cleft secondary palate and lack of teeth, to study the genetic regulation of mammalian palatogenesis. We found that Msx1 expression was restricted to the anterior of the first upper molar site in the palatal mesenchyme and that Msx1 was required for the expression of Bmp4 and Bmp2 in the mesenchyme and Shh in the medial edge epithelium (MEE) in the same region of developing palate. In vivo and in vitro analyses indicated that the cleft palate seen in Msx1 mutants resulted from a defect in cell proliferation in the anterior palatal mesenchyme rather than a failure in palatal fusion. Transgenic expression of human Bmp4 driven by the mouse Msx1 promoter in the Msx1(-/-) palatal mesenchyme rescued the cleft palate phenotype and neonatal lethality. Associated with the rescue of the cleft palate was a restoration of Shh and Bmp2 expression, as well as a return of cell proliferation to the normal levels. Ectopic Bmp4 appears to bypass the requirement for Msx1 and functions upstream of Shh and Bmp2 to support palatal development. Further in vitro assays indicated that Shh (normally expressed in the MEE) activates Bmp2 expression in the palatal mesenchyme which in turn acts as a mitogen to stimulate cell division. Msx1 thus controls a genetic hierarchy involving BMP and Shh signals that regulates the growth of the anterior region of palate during mammalian palatogenesis. Our findings provide insights into the cellular and molecular etiology of the non-syndromic clefting associated with Msx1 mutations.

Large Hypopharyngeal Tongue: A Shared Anatomic Abnormality for Difficult Mask Ventilation, Difficult Intubation, and Obstructive Sleep Apnea?

Groupe Hospitalier Pitié-Salpêtrière, Paris, France. olivier.langeron@psl.ap-hop-paris.frIn Reply:—We greatly appreciate the interest expressed by Drs. Chou and Wu regarding our article. 1As reported previously, 2some subjects in whom the trachea is difficult to intubate are at increased risk of obstructive sleep apnea (OSA). Moreover, patients who have difficult intubation (DI) and OSA may share upper airway anatomical abnormalities with a difficult mask ventilation (DMV) situation. In our study, we identified five independent factors (age &gt; 55 yr, body mass index &gt; 26 kg/m2, beard, lack of teeth, and history of snoring) associated significantly with DMV. Some of these risk factors for DMV (age &gt; 55 yr, body mass index &gt; 26 kg/m2, and history of snoring) are related to malproportion of overall body size or malproportion between the oropharyngeal free space and internal structures of the oropharynx, as in OSA. Our first comment in response to Drs. Chou and Wu is that the purpose of our study was to identify factors predicting DMV and not to correlate DMV to OSA. Second, Drs. Chou and Wu reported that a longer mandible and hyoid distance (MHD) indicated an increased tongue mass in the hypopharynx, compromising the posterior airway space. 3Unfortunately, measurement of MHD may be difficult because of its wide variation among the adult population and the need for experience as mentioned in their letter. Moreover in their previous study, 3MHD was obtained from lateral cervical spine radiograph measurements and not from clinical findings. Last, in a more recent study, 2MHD was not significantly different in DI and non-DI patients and was not related to OSA. Nevertheless, we are convinced that MHD could be valuable information in predicting an OSA–DMV–DI situation if it could be validated in a clinical setting without performing measurements from radiographs. Therefore, further studies are required to determine if MHD could be a reliable clinical predictor of OSA–DMV–DI cases.We thank Dr. Takenaka et al. for the interest in our work and their valuable comments. We fully agree that the jaw-thrust maneuver can reopen the obstructed airway by lifting up the base of the tongue and the epiglottis in anesthetized patients. Moreover, Calder et al. 4reported that impaired mandibular protrusion was associated with a more difficult laryngoscopy in patients with cervical spine disease. Indeed, in patients with an occipito-atlanto-axial disease as in the study of Calder et al. , 4a poor mandibular protrusion is recognized. Consequently, we may assume that decreased mandibular protrusion in an awake patient is a good predictor of a reduced cervical spine mobility associated with impaired laryngoscopy. In addition, this test may not assess reliably a potential decreased airway patency in the anesthetized patient without spine disease. Therefore, we cannot extrapolate information related to difficult laryngoscopy and difficult intubation to those with DMV requiring specific investigation. In our opinion, the relation between a reduced mandibular protrusion in the awake state and DMV remains to be shown.We thank Dr. Gentili for his interest in our work and the comments. The purpose of our study was to identify factors predicting DMV per se and not to determine the influence of the degree of clinical experience of the anesthesiologist in a DMV situation. Consequently, as mentioned in the article, this study involved staff anesthesiologists. Nevertheless, we agree with Dr. Gentili that the annual clinical case loads for an individual anesthesiologist may influence his or her clinical practice. However, this is true for any daily clinical activity for a physician and was not the purpose of our study. Last, incidence of DMV has been assessed rarely in previous studies related to airway management, and no specific investigation has been performed to study DMV. This point may explain largely the discrepancy for the DMV incidence in our study in comparison with other studies.