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Use of the Kirschner wire for mandibular reconstruction.

An adaptation of the Kirschner wire, using tie wires for fixation of the Kirschner wire in primary mandibular reconstruction following ablative surgery, is described. Eighteen patients with a Kirschner wire serving as a prosthesis following mandibular resection were followed up. Except for three patients, who had extensive resection of the tongue, all patients were judged as having satisfactory mastication and deglutition. Only two patients required another operation for wire-related complications. The Kirschner wire, when modified as presented, proved a dependable and stable prosthesis for mandibular reconstruction.

Adult↗

Sexual dimorphism and interspecific cranial form in two capuchin species: Cebus albifrons and C. apella.

Ontogenetic patterns of sexual dimorphism and cranial form in two capuchin monkeys, Cebus albifrons and C. apella, are investigated by means of univariate, bivariate, and multivariate statistics. The analyses are based on 23 linear variables. Univariate analyses indicate that similar ontogenetic patterns of cranial sexual dimorphism are present; however, interspecific differences exist in timing. Ontogenetic scaling is present in both species' crania; however, it is more prevalent in C. albifrons. Several departures are present in cranial regions associated with orbital shape, the dental arcade, and the muscles of mastication. The latter two indicate that sexual differences in diet and/or foraging strategies may exist. Sexual selection is suggested as being the primary selective regime underlying the observed patterns of cranial sexual dimorphism in each species. Interspecific comparisons confirm that C. apella possesses a more dimorphic cranium than C. albifrons and that sexual dimorphism in C. apella begins earlier in development. Although interspecific ontogenetic scaling is present in some cranial variables, C. apella is not just a scaled-up version of C. albifrons. These sympatric congeners seem to be differentiated by variables related to the orbital region and the masticatory apparatus, as indicated by both departures from ontogenetic scaling and results of the discriminant function analysis. Ecological selection, rather than varying degrees of sexual selection, is likely to be responsible for this finding given that C. apella is known to consume hard-object foods. This is consistent with the predicted outcome of the competitive exclusion principle.

Animals↗

Jaws and teeth of Australopithecus afarensis from Maka, Middle Awash, Ethiopia.

The Maka locality in Ethiopia's Middle Awash area has yielded new craniodental remains dated to 3.4 million years (myr) in age. These remains are described and assessed functionally and systematically. The fossils are assigned to Australopithecus afarensis. Maka thus joins Hadar and Laetoli as the third major locality yielding this species. As with previous site samples, the Maka collection displays a wide range of size variation. The nearly complete and undistorted MAK-VP-1/12 adult mandible from Maka is an excellent match for Hadar and Laetoli counterparts, confirming the geographic and temporal distribution of A. afarensis. This specimen shows that this taxon is functionally and developmentally hominid in its incisor/canine/premolar complex. A postulated evolutionary trajectory through A. anamensis to A. afarensis would have involved postcanine megadontia and other adaptations to a more heavily masticated diet relative to the earlier Ardipithecus ramidus.

Adult↗

Prognostic value of paranasopharyngeal extension of nasopharyngeal carcinoma. A significant factor in local control and distant metastasis.

BACKGROUND: This study was conducted to evaluate the prognostic value of paranasopharyngeal extension in local control and distant metastasis in patients with nasopharyngeal carcinoma. METHODS: Three hundred and sixty-four patients with newly diagnosed nasopharyngeal carcinoma without distant metastasis were reviewed. Patients were staged according to Ho's staging system. Using a semiquantitative method, tumor extension into the paranasopharyngeal space was graded as: 0: no extension; 1: extension to the retrostyloid space; 2: extension to the prestyloid space; and 3: extension to the anterior part of the masticator space. All patients received radiotherapy as primary treatment. Median follow-up time was 45 months (range, 4.7 to 76.5 months). Relapse free, local relapse free, and distant metastasis free survival were estimated using the Kaplan-Meier method. Cox regression was also performed to adjust for prognostic factors. RESULTS: The incidence of paranasopharyngeal extension was high (72.5%). Of these patients, 65.5% had Grade 2 or 3 extension. The 5-year relapse free survival rates for Grade 0, 1, 2, and 3 extension were 76%, 70%, 46%, and 43%, respectively. The main difference was between Grade 0/1 and Grade 2/3 extension, the latter having a lower 5-year local control rate (86% in Grade 0/1 vs. 72% in Grade 2/3; P < 0.0001) and distant metastasis free survival rate (87% in Grade 0/1 vs. 68% in Grade 2/3; P = 0.0002). Multivariate analysis showed that Grade 2/3 paranasopharyngeal extension was an independent factor in predicting overall relapse, local relapse, and distant metastasis. Advanced T classification (T3) was another independent factor in predicting overall and local relapse, whereas advanced N classification (N3) was another independent factor in predicting overall relapse and distant metastasis. CONCLUSIONS: Extensive paranasopharyngeal extension (Grade 2/3) was an independent prognostic factor associated with poorer treatment outcome, both in local control and distant metastasis. Ho's T2 disease should be further subclassified into T2a and T2b, which include Grade 0/1 and Grade 2/3 paranasopharyngeal disease, respectively.

Adult↗

Postnatal development of protein gene product 9.5- and calcitonin gene-related peptide-like immunoreactive nerve fibers in the rat temporomandibular joint.

BACKGROUND: The aim of this study was to investigate the little-known postnatal development of innervation in the temporomandibular joint (TMJ). METHODS: We therefore investigated the protein gene product 9.5-like immunoreactive (PGP-LI) and calcitonin gene-related peptide-like immunoreactive (CGRP-LI) nerves in the rat TMJ from days 0-24 in wholemount preparations and frozen sections by immunohistochemistry using the avidin-biotin-peroxidase complex method. RESULTS: At birth, PGP-LI and CGRP-LI nerves were observed only in the disk attachment but not in the peripheral portion of the disk. From days 3-6, the peptidergic nerves associated with the development of synovial cells were first found in the anterior (3rd day) or posterior (6th day) peripheral portion of the disk in which synovial cells later appear. From days 7-10, incisal occlusion started and simultaneously the distinct networks of the nerves were formed in four peripheral portions of the disk. On the 14th day, the PGP-LI nerves were first more numerous than the CGRP-LI nerves only in the anterior disk attachment. From days 18-24, the occlusion between the first molars started. Simultaneously, the distribution and number of the nerves were comparable to those of adult rats. However, from days 0-24, the central portion of the disk (actual disk) did not contain any nerves. CONCLUSIONS: These findings suggest that functional stimuli such as sucking and mastication might be associated with the development of nerves in the TMJ during the early and late postnatal days, whereas the actual disk except for both disk attachment and peripheral portion of the disk is not innervated and does not contribute to the afferent sensory information from the TMJ. The presence of peptidergic nerves prior to the appearance of synovial lining cells furthermore suggests that the neuropeptide released from these nerves may affect on the differenciation and maturation of synovial cells.

Age Factors↗

Animating functional anatomy for the web.

The instructor sometimes has a complex task in explaining the concepts of functional anatomy and embryology to health professional students. However, animations can easily illustrate functional anatomy, clinical procedures, or the developing embryo. Web animation increases the accessibility of this information and makes it much more useful for independent student learning. A modified version of the animation can also be used for patient education. This article defines animation, provides a brief history of animation, discusses the principles of animation, illustrates and evaluates some of the video-editing or movie-making computer software programs, and shows examples of two of the author's animations. These two animations are the inferior alveolar nerve block from the mandibular nerve anesthetics unit and normal temporomandibular joint (TMJ) function from the muscles of the mastication and the TMJ function unit. The software discussed are the industry leaders and have made the job of producing computer-based animations much easier. The programs are Adobe Premiere, Adobe After Effects, Apple QuickTime and Macromedia Flash .

Anatomy↗

Application of medical thermography to the diagnosis of Frey's syndrome.

BACKGROUND: In Frey's syndrome, the secretory parasympathetic fibers of the parotid gland are thought to communicate with the sympathetic nerve fibers of sweat glands and blood vessels of the skin following parotidectomy. Miscommunication results in subjective gustatory sweating and facial flushing, which appear early with postoperative mastication. In this study, we compared the efficacy of medical thermography to the Minor's starch-iodine test to determine the presence of gustatory sweating in Frey's syndrome. METHODS: Patients were considered to have Frey's syndrome if signs of gustatory sweating and localized skin flushing of the parotid region were present. In four patients who had undergone unilateral parotidectomy, gustatory sweating and facial flushing were present after gustatory stimulation, and the presence of Frey's syndrome was confirmed with Minor's starch test in all patients. Infrared thermography was then performed, and the same area measured. The contralateral side served as an internal control for each patient. RESULTS: Before gustatory stimulation, the isothermal pattern of the diseased side and the nonoperative side was similar. Stress thermography using a sialogogue (lemon, 3 mL) showed a cold spot at the operative site in all four patients with Frey's syndrome. The contralateral nonoperative side showed normal skin temperature distribution in all patients. Minor's test was positive in all patients. CONCLUSIONS: Thermography is a noninvasive, facile test that provides a qualitative visual analysis of the cutaneous capillary response in Frey's syndrome following parotid surgery.

Adenocarcinoma↗

Osseointegrated implants in the head and neck cancer patient.

BACKGROUND: Osseointegrated implants allow patients with oromandibular defects to obtain complete or partial dentition via implant-assisted or implant-borne prostheses. Implants restore masticatory and occlusal function, improving oral intake and articulation. However, use of implants in head and neck cancer patients has been discouraged due to lack of data supporting their utility in these patients. This study attempts to establish the validity of using osseointegrated implants for dental restoration in head and neck cancer patients. METHODS: Six patients who underwent resection/reconstruction for head and neck cancer received osseointegrated implants. Integration was assessed clinically, radiographically, and mechanically at 4-8 months; oral intake, mastication, and articulation were evaluated 6-12 months after receiving the dental prosthesis. RESULTS: Osseointegration occurred in 92% (24/26) of the implants: 100% (14/14) in neomandibles and 83% (10/12) in native mandibles. One patient had implants (2/5) that failed to integrate. The remaining patients' implants were immobile, free of infection, with no osteoradionecrosis. These patients tolerated a regular diet and experienced weight gain and improved articulation. CONCLUSIONS: The advent of osseointegrated implants and their compatibility with native and neomandible allows the restoration of functional dentition in patients undergoing ablative surgery for head and neck cancer.

Carcinoma, Squamous Cell↗

Sensate osteocutaneous fibula flap: anatomic study of the innervation pattern of the skin flap.

BACKGROUND: For oromandibular reconstructions, an osteocutaneous fibula flap provides sufficient bone and pliable skin. Sensory reinnervation could possibly prevent problems in mastication and deglutition. METHODS: In this anatomic study, 33 cadaver limbs were microsurgical dissected. We investigated the lateral sural cutaneous nerve (LSCN), which supplies sensation to the skin of the lateral lower leg, in relation to the fibula skin flap. The fibula is vascularized by the peroneal vessels via the posterior intermuscular septum. Therefore, the posterior septum determines the center line of the flap design. RESULTS: The LSCN runs in 74% of the dissections posterior to the posterior septum, whereas an anterior branch was seen in 26%. In 54% of the dissections, the distance to the posterior septum was within 3 cm from the septum, whereas in 86%, the distance was found to be within 4 cm. CONCLUSION: The skin flap should be designed more posteriorly to achieve maximal reinnervation.

Cadaver↗

Effect of external stresses on calcium phosphate glass investigated by IR spectroscopy.

The effect of external stress on calcium phosphate glasses was investigated because they experience high stress in practical uses such as mastication. In order to understand the structural change of calcium phosphate glasses caused by an applied stress, the IR reflection peak shift of the phosphate structural band of the calcium phosphate glass fiber due to a bending stress was measured. The peak shift represents the change of the P-O-P bond angle. The IR reflection peak of the phosphate structural bands near approximately 1300 and approximately 910 cm(-1) shifted to a higher wavenumber under tensile stress and to a lower wavenumber under compressive stress when calcium phosphate fiber with a uniform structure was employed. This indicates that the P-O-P bond angle increases under tensile stress and decreases under compressive stress. The extents of both peak shifts were larger with a lower [corrected] Ca/P ratio than with a higher [corrected] Ca/P ratio. Therefore, phosphate glass with a higher Ca/P ratio is expected to withstand loads under external stress.

Biocompatible Materials↗

Seed dispersal by neotropical seed predators.

From a plant's perspective, the difference between a seed predator and a seed disperser should be straightforward: attract animals that will disperse seeds and defend seeds from potential predators. Unlike pulp-eating frugivores, seed predators regularly encounter diverse plant protective mechanisms. The purpose of this paper is to examine feeding constraints, morphological adaptations, and the mechanical process of seed predation. While there is evidence that some seed predators cause severe losses to seed crops, there is also evidence that seed predators enhance seed dispersal and germination. We also examine four methods by which neotropical seed predators may contribute to dispersal. 1) Seed predators examined here ingested fruit when seeds were full-sized, but not yet mature (i.e., seeds of mature fruit may be avoided by seed predators and available for dispersal by other frugivores). 2) Sympatric seed predators may ingest seeds from different plants thus reducing overall predator load on any individual plant. 3) Seed predators that manipulate seeds (e.g., remove pericarp and seed coat) may enhance germination if the prepared seeds are dropped, discarded, or buried and not ingested. 4) Small seeds may miss mastication and swallowed intact with a food bolus. The last mechanism is the most likely to contribute to seed dispersal by the widest array of vertebrate seed predators, but primate seed predators may facilitate seed dispersal using all four mechanisms. Therefore, the traditional dichotomy of seed predator vs. seed disperser oversimplifies the interactions between seed predators and plants.

Animals↗

Evolutionary and ecological implications of primate seed dispersal.

In this paper, we evaluate patterns of fruit eating and seed dispersal in monkeys and apes and draw an important distinction between 1) the ecological consequences of primates as seed dispersers and 2) the evolutionary implications of primates on the seed and fruit traits of the plant species they exploit. In many forest communities, primates act as both seed predators and seed dispersers and are likely to have an important ecological impact on patterns of forest regeneration and tree species diversity. Evidence from Kibale National Park, Uganda, and Manu National Park, Peru, as well as several other South American sites indicates that monkeys and apes display a wide range of fruit-processing behaviors, including spitting seeds, dropping seeds, masticating seeds, and swallowing seeds. Differences in consumer body size, diet, ranging patterns, and oral and digestive morphology result in different patterns in the distance and distribution of seeds from the parent plant. In the case of South American monkeys, for example, despite their relatively small body size, platyrrhines were found to exploit larger fruits and swallow larger seeds on average than did Old World monkeys and apes of the Kibale forest. We found little evidence to support the existence of a coevolutionary relationship between a single or set of primate dispersers and the particular plant species they disperse. This is due to variability in the manner in which monkeys and apes select fruits and treat seeds, the fact that many species of primates and nonprimates exploit and disperse the same fruit species, and the fact that extremely high levels of postdispersal seed, seedling, and sapling mortality serve to dilute the influence that any primate species may have on the recruitment of the next generation of adult trees. It is apparent that many primate lineages exhibit dental, digestive, and/or sensory adaptations that aid in the exploitation of particular food types and that many lineages of flowering plants have evolved characteristics of fruits and seeds that facilitate seed dispersal. However, in light of currently available data, we argue that these represent evolutionary rather than more strictly defined coevolutionary relationships.

Animals↗

Effect of saliva dilution on the release of diacetyl and 2-heptanone from cream style dressings.

Aroma release from a cream style dressing, consisting of a thickening agent dispersed in the water phase of an oil in water (o/w) emulsion, has been studied by a purge-and-trap (PT) and a dynamic headspace mastication (DHM) model using two representative volatile compounds, viz. diacetyl and 2-heptanone. These isolations have been carried out from three systems: the dressing, the thickening agent dispersion and the o/w type of emulsion after adding different volumes of artificial saliva. Dilution of the samples with artificial saliva influences the amounts released for diacetyl and 2-heptanone differently: diacetyl decreases upon dilution of the thickening agent dispersion, emulsion and dressing. However, the amount of released 2-heptanone decreased only in the case of the thickening agent dispersion. These differences are caused by the distribution of diacetyl and 2-heptanone between the water and the oil phases. The distribution is not so important, when the DHM model is used for the release from dressings. The viscosity of the mixture of dressing and artificial saliva then plays an essential role. In general, the viscosity is considered to suppress the release of flavour. However, it has been found that the amount of volatile compounds released from the more viscous dressing was greater than from the emulsion. Most probably, the DHM model creates a large surface area by adhesion of the dressing on the wall of the sampling flask and the plunger head. This result suggests that the DHM equipment, which mimics the mouth movement, might be used to predict the real release of flavour in the mouth more precisely than other mouth models.

Diacetyl↗

Mammalian feeding and primate evolution: An overview

Most of the papers included in this volume are derived from presentations in a symposium on Mammalian Feeding at the 65th Annual Meetings of the American Association of Physical Anthropologists in North Carolina in 1996. The aims of this symposium were to gather together the preeminent researchers on mammalian mastication and document the state of research in that field. The symposium emphasized in vivo studies of mammalian feeding because of a paucity of recent reviews of this field, but included morphometric and modeling papers as well. Subsequently the papers were revised, and were submitted in spring 1998 for publication, pending the outcome of peer review. Copyright 2000 Wiley-Liss, Inc.

Journal Article↗

Electromyography of the anterior temporalis and masseter muscles of owl monkeys (Aotus trivirgatus) and the function of the postorbital septum.

Anthropoids and tarsiers are distinguished from all other vertebrates by the possession of a postorbital septum, which is formed by the frontal, alisphenoid, and zygomatic bones. Cartmill [(1980) In: Evolutionary Biology of the New World Monkeys and Continental Drift. New York: Plenum, p 243-274] suggested that the postorbital septum evolved in the stem lineage of tarsiers and anthropoids to insulate the eye from movements arising in the temporal fossa. Ross [(1996) Am J Phys Anthropol 91:305-324] suggested that the septum insulates the orbital contents from incursions by the line of action of the anterior temporal muscles caused by the unique combination of high degrees of orbital frontation and convergence. Both of these hypotheses must explain why insulation of the orbital contents could not be achieved by decreasing the size of the anterior temporal musculature with a corresponding increase in size of the remaining jaw adductors, rather than evolving a postorbital septum. One possibility is that the anterior temporalis is an important contributor to vertically directed bite forces during all biting and chewing activities. Another possibility is that reduction in anterior temporal musculature would compromise the ability to produce powerful bite forces, either at the incisors or along the postcanine toothrow. To evaluate these hypotheses, electromyographic (EMG) recordings were made from the masseter muscle and the anterior and posterior portions of the temporalis muscles of two owl monkeys, Aotus trivirgatus. The EMG data indicate that anterior temporalis activity relative to that of the superficial masseter is lower during incision than mastication. In addition, activity of the anterior temporalis is not consistently higher than the posterior temporalis during incision. The data indicate relatively greater activity of anterior temporalis compared to other muscles during isometric biting on the postcanine toothrow. This may be due to decreased activity in superficial masseter and posterior temporalis, rather than elevated anterior temporalis activity. The anterior temporalis is not consistently less variable in activity than the superficial masseter and posterior temporalis. The EMG data gathered here indicate no reason for suggesting that the anterior temporal muscles in anthropoids are utilized especially for incisal preparation of hard fruits. Maintenance of relatively high EMG activity in anterior temporalis across a wide range of biting behaviors is to be expected in a vertically oriented and rostrally positioned muscle such as this because, compared to the posterior temporalis, superficial masseter and medial pterygoid, it can contribute relatively larger vertical components of force to bites along the postcanine toothrow. The in vivo data do not support this hypothesis, possibly because of effects of bite point and bite force orientation.

Animals↗

Why fuse the mandibular symphysis? A comparative analysis.

Fused symphyses, which evolved independently in several mammalian taxa, including anthropoids, are stiffer and stronger than unfused symphyses. This paper tests the hypothesis that orientations of tooth movements during occlusion are the primary basis for variations in symphyseal fusion. Mammals whose teeth have primarily dorsally oriented occlusal trajectories and/or rotate their mandibles during occlusion will not benefit from symphyseal fusion because it prevents independent mandibular movements and because unfused symphyses transfer dorsally oriented forces with equal efficiency; mammals with predominantly transverse power strokes are predicted to benefit from symphyseal fusion or greatly restricted mediolateral movement at the symphysis in order to increase force transfer efficiency across the symphysis in the transverse plane. These hypotheses are tested with comparative data on symphyseal and occlusal morphology in several mammals, and with kinematic and EMG analyses of mastication in opossums (Didelphis virginiana) and goats (Capra hircus) that are compared with published data on chewing in primates. Among mammals, symphyseal fusion or a morphology that greatly restricts movement correlates significantly with occlusal orientation: species with more transversely oriented occlusal planes tend to have fused symphyses. The ratio of working- to balancing-side adductor muscle force in goats and opossums is close to 1:1, as in macaques, but goats and opossums have mandibles that rotate independently during occlusion, and have predominantly vertically oriented tooth movements during the power stroke. Symphyseal fusion is therefore most likely an adaptation for increasing the efficiency of transfer of transversely oriented occlusal forces in mammals whose mandibles do not rotate independently during the power stroke.

Adaptation, Physiological↗

Proliferative myositis of the masseter muscle. A case report and a review of the literature.

A case of proliferative myositis of the masseter muscle in a 62-year-old woman is presented and pertinent literature is reviewed. This benign pseudosarcomatous proliferative lesion has not been previously reported in any of the muscles of mastication. Clinically the patient presented with pain and difficulty in opening of the mouth. On initial examination, a malignant salivary gland tumor was suspected. The proliferative myositis exhibits a disturbing microscopic appearance characterized by the presence of numerous hyperchromatic fibroblasts and oval or spindle-shaped giant cells which resemble malignant rhabdomyoblasts. These lesions have been often misdiagnosed as rhabdomyosarcoma and other types of sarcomas. Awareness of the microscopic characteristics of proliferative myositis and the possibility of its occurrence in the perioral soft tissues is important in avoiding misdiagnosis of this benign condition.

Cell Division↗

The morphogenetic relationship of the temporal muscle to the coronoid process in human embryos and fetuses.

The purpose of this investigation was: (a) to study the developmental relationships of the temporal muscle and the coronoid process during the critical initial stages of morphogenesis and (b) to correlate the developmental stages of the muscle and the bone with data describing the functioning of the muscles of mastication in utero. The heads of 41 human embryos and fetuses, 6 to 11 weeks, estimated fertilization age, were sectioned and examined under light microscopy. The findings are described in terms of six successive stages, each characterized by a major developmental change occurring during that stage. The data indicate that the temporal and masseter muscle anlagen begin to develop prior to the skeleton to which they ultimately become attached. The coronoid process differentiates subsequently as a discrete entity within the mass of the temporal muscle anlage at an estimated fertilization age of 7 to 7.5 weeks (23-24 mm CRL). At approximately eight weeks of age, the coronoid process unites with the main portion of the mandibular ramus. The findings here presented do not support the conclusion that the coronoid process is self-differentiating as Washburn ('47) contended. Instead, the development of this feature of the human mandible represents a response that follows the differentiation of the temporal muscle. This conclusion is consistent with the observations drawn from a number of investigations concerning structural and functional development of the face.

Fetus↗