Temporomandibular disorders in relation to craniofacial dimensions, head posture and bite force in children selected for orthodontic treatment.

The present study examined the associations between craniofacial dimensions, head posture, bite force, and symptoms and signs of temporomandibular disorders (TMD). The sample comprised 96 children (51F, 45M) aged 7-13 years, sequentially admitted for orthodontic treatment of malocclusions entailing health risks. Symptoms and signs of TMD were assessed by 37 variables describing the occurrence of headache and facial pain, clicking, jaw mobility, tenderness of muscles and joints, and the Helkimo Anamnestic and Dysfunction indices. Craniofacial dimensions (33 variables), and head and cervical posture (nine variables) were recorded from lateral cephalometric radiographs taken with the subject standing with the head in a standardized posture (mirror position). Dental arch widths were measured on plaster casts and bite force was measured at the first molars on each side by means of a pressure transducer. Associations were assessed by Spearman correlations and multiple stepwise logistic regression analyses. The magnitudes of the significant associations were generally low to moderate. On average, temporomandibular joint (TMJ) dysfunction was seen in connection with a marked forward inclination of the upper cervical spine and an increased craniocervical angulation, but no firm conclusion could be made regarding any particular craniofacial morphology in children with symptoms and signs of TMJ dysfunction. Muscle tenderness was associated with a 'long face' type of craniofacial morphology and a lower bite force. Headache was associated with a larger maxillary length and increased maxillary prognathism. A high score on Helkimo's Clinical Dysfunction Index was associated with smaller values of a number of vertical, horizontal, and transversal linear craniofacial dimensions and a lower bite force.

Molecular properties of Streptococcus thermophilus plasmid pER35 encoding a restriction modification system.

Bacteriophage attack on lactic fermentation bacteria (LFB) is costly to the dairy industry because it results in product loss. One mechanism used by LFB to protect themselves from bacteriophage attack is restriction of foreign DNA. Three plasmids, pER16, pER35, and pER36, from three different strains of the thermotolerant dairy fermentation bacterium Streptococcus thermophilus were sequenced. One of these plasmids, pER35, isolated from S. thermophilus ST135, encoded a type IC restriction-modification (R-M) system very similar to those encoded on plasmids pIL2614 in Lactococcus lactis subsp. lactis and pND861 in Lactococcus lactis biovar diacetylactis. The high degree of identity between the R-M systems encoded on pER35, pIL2614, and pND861 indicated the potential for horizontal transfer of these genes between different species of lactic fermentation bacteria. Similar to the functional R-M system encoded on pIL2614 that protects the mesophilic L. lactis subsp. lactis against phage attack, the R-M system on pER35 most likely functions in the same role in S. thermophilus ST135. The plasmid pER16 was found to encode the specificity subunit of the R-M system, but not the R or M subunits. In addition, all three plasmids encoded proteins that are present on other S. thermophilus plasmids, including a protein for rolling-circle replication (RepA) and a low-molecular-weight stress protein (Hsp). The presence of a complete R-M system encoded on a plasmid in S. thermophilus, a species that often lacks plasmids, is novel and may be beneficial for protecting S. thermophilus from bacteriophage attack under dairy fermentation conditions.

Bite force in pre-orthodontic children with unilateral crossbite.

In the present study bite force was examined in pre-orthodontic children with unilateral posterior crossbite and compared with an age- and sex-matched control group. The sample comprised 52 children aged 7-13 years, 26 pre-orthodontic children with unilateral posterior crossbite (crossbite group), and 26 children with neutral occlusion (control group). Unilateral bite force was measured at the first molar by means of a pressure transducer. Furthermore, symptoms and signs of temporomandibular disorders (TMD) and number of teeth in contact in the intercuspal position (ICP) were recorded. In both groups, the maximum bite force increased significantly with age and with increasing stages of dental eruption, but the bite force in both sexes did not differ significantly. There were no significant differences in bite force between sides, but this was significantly smaller in the crossbite group than in the controls (P < 0.001). Regression analysis showed that stage of dental eruption (P < 0.001), number of teeth in occlusal contact (P < 0.01), and unilateral crossbite (P < 0.001) were the only variables significantly correlated with bite force. The number of teeth in contact was significantly smaller in the crossbite group than in the controls (P < 0.05) and the frequency of muscle tenderness was significantly higher in the crossbite group than in the controls (P < 0.05). These results suggest that differences in the muscle function associated with unilateral crossbite lead to a significantly smaller bite force in the crossbite group compared with controls and this difference did not diminish with age and development. These findings indicate that early treatment of unilateral posterior crossbite is advisable to optimize conditions for function.

Change in the width of the mandibular body from 6 to 23 years of age: an implant study.

After the ossification of the mandibular symphysis, shortly after birth, changes in mandibular width would be expected to occur only by surface apposition or resorption on the buccal surfaces of the left and right mandibular halves. However, evidence for an opening hinge movement of the two mandibular halves around a vertical axis located in the region of the mandibular symphysis was recently found in longitudinal studies of 29 subjects with unilateral implant markers in the mandible. These subjects were followed from 8.5 to 15.5 years of age (Korn and Baumrind, 1990; Baumrind and Korn, 1992). The aim of the present investigation was to examine whether the presence of such an age-related increase in mandibular body width could be confirmed in a sample with bilateral implant markers in the mandible. The sample comprised 10 subjects (3F, 7M) from the files of another longitudinal study with implant markers (Björk, 1968). A total of 122 pairs of annual lateral and postero-anterior (p-a) cephalometric records were available, covering longitudinal observation periods ranging from 8 to 16 years within an age interval of between 6 and 23 years. The width between a right and left side mandibular implant marker was measured with digital callipers on all p-a radiographs. Each measurement was corrected mathematically for various sources of radiographic enlargement. A small, but statistically significant increase in the distance between the right and left implant markers, i.e. in the bilateral width of the mandibular body, was observed in all subjects. The total increase in width in each subject ranged from 0.7 to 1.7 mm for the various periods of observation (P < or = 0.01). For the 12-year period from 6 to 18 years, the average total increase was 1.6 mm (P < or = 0.001, SD = 0.42), i.e. 0.13 mm/year. After this age there was no systematic trend. The mechanism for this increase in width is unknown. It is suggested that during postnatal growth, an increasing load from the masticatory occlusal forces might influence endosteal bone remodelling in the mandibular body, thus producing or allowing a gradual permanent outward bending of the right and left mandibular halves.

Comparison of low-molecular-weight heat stress proteins encoded on plasmids in different strains of Streptococcus thermophilus.

Streptococcus thermophilus is used extensively for industrial fermentation of dairy products. Some strains of S. thermophilus are known to carry plasmids, and many of these plasmids are suspected of encoding low-molecular-weight heat stress proteins (Hsps) that may aid in survival under stressful conditions. In order to confirm the presence and examine the similarity of these low-molecular-weight Hsps, genes were identified and sequenced encoding Hsps on plasmids pER16 (4.5 kb), pER35 (10 kb), and pER36 (3.7 kb) from three different strains of S. thermophilus. The plasmid replication proteins were also sequenced to examine their relatedness. Amino acid sequence comparisons of the Hsps and of the replication proteins revealed a high degree of identity suggesting a common origin. Heat stress proteins enhance the viability of bacteria in extreme environments, and the presence of an Hsp encoded on a plasmid may enhance survival of S. thermophilus under harsh production conditions.

The impact of automatic prescriptions on reducing low-density lipoprotein cholesterol levels.

CONTEXT: Compliance with the National Cholesterol Education Program (NCEP) guidelines for secondary prevention of atherosclerotic disease has been poor. OBJECTIVE: To determine whether an automatic prescription would improve compliance with NCEP guidelines on low-density lipoprotein (LDL) cholesterol for secondary prevention of atherosclerotic disease. DESIGN: Observational study in which physicians chose whether to use an automatic prescription system. PATIENTS: 126 patients with established coronary or cerebrovascular disease whose LDL cholesterol level was greater than 100 mg/dL. INTERVENTION: By signing the automatic prescription, physicians allowed the study team (medical director and pharmacist) to change lipid-lowering medications. One member of the team then contacted the patient, advising him or her of any changes to medications and treatment. The patient was told that his or her doctor was recommending this change on the basis of recent laboratory tests. OUTCOME MEASURES: The proportion of patients reaching the LDL cholesterol goal of 100 mg/dL or less. RESULTS: Physicians used the automatic prescription for 25 patients. Eighteen of the 25 patients in the intervention group (72.0%) achieved the LDL cholesterol goal compared with only 43 of the 101 controls (42.6%) (P = 0.004). After adjustment for differences in age, sex, triglyceride levels, total cholesterol levels, high-density lipoprotein cholesterol levels, and preintervention LDL cholesterol levels, the likelihood of achieving the LDL cholesterol goal was 1.74 times higher in the automatic prescription group than in the control group (P = 0.025). CONCLUSION: An automatic prescription can help physicians comply with the NCEP guidelines.

Differential modulation of the tyrosine phosphorylation state of the insulin receptor by IRS (insulin receptor subunit) proteins.

In response to insulin, tyrosine kinase activity of the insulin receptor is stimulated, leading to autophosphorylation and tyrosine phosphorylation of proteins including insulin receptor subunit (IRS)-1, IRS-2, and Shc. Phosphorylation of these proteins leads to activation of downstream events that mediate insulin action. Insulin receptor kinase activity is requisite for the biological effects of insulin, and understanding regulation of insulin receptor phosphorylation and kinase activity is essential to understanding insulin action. Receptor tyrosine kinase activity may be altered by direct changes in tyrosine kinase activity, itself, or by dephosphorylation of the insulin receptor by protein-tyrosine phosphatases. After 1 min of insulin stimulation, the insulin receptor was tyrosine phosphorylated 8-fold more and Shc was phosphorylated 50% less in 32D cells containing both IRS-1 and insulin receptors (32D/IR+IRS-1) than in 32D cells containing only insulin receptors (32D/IR), insulin receptors and IRS-2 (32D/IR+IRS-2), or insulin receptors and a form of IRS-1 that cannot be phosphorylated on tyrosine residues (32D/IR+IRS-1F18). Therefore, IRS-1 and IRS-2 appeared to have different effects on insulin receptor phosphorylation and downstream signaling. Preincubation of cells with pervanadate greatly decreased protein-tyrosine phosphatase activity in all four cell lines. After pervanadate treatment, tyrosine phosphorylation of insulin receptors in insulin-treated 32D/IR, 32D/ IR+IRS-2, and 32D/IR+IRS-1F18 cells was markedly increased, but pervanadate had no effect on insulin receptor phosphorylation in 32D/IR+IRS-1 cells. The presence of tyrosine-phosphorylated IRS-1 appears to increase insulin receptor tyrosine phosphorylation and potentially tyrosine kinase activity via inhibition of protein-tyrosine phosphatase(s). This effect of IRS-1 on insulin receptor phosphorylation is unique to IRS-1, as IRS-2 had no effect on insulin receptor tyrosine phosphorylation. Therefore, IRS-1 and IRS-2 appear to function differently in their effects on signaling downstream of the insulin receptor. IRS-1 may play a major role in regulating insulin receptor phosphorylation and enhancing downstream signaling after insulin stimulation.

Angiotensin II inhibits insulin-induced egr-1 expression in mesangial cells.

The gene early growth response gene-1 (egr-1) encodes a zinc transcription factor involved in cell proliferation. Increased expression of egr-1 has been linked to heart and kidney disease. In mouse mesangial cells, insulin stimulated egr-1 expression more than angiotensin II, suggesting that insulin may play an important role in stimulating cell proliferation, leading to glomerulonephritis and diabetic nephropathy. Angiotensin II inhibited insulin-induced egr-1 expression but not c-fos expression, and the decrease in egr-1 expression was concurrent with a decrease in insulin receptor substrate-1 (IRS-1) tyrosine phosphorylation. These results suggest that insulin-induced egr-1 expression in mouse mesangial cells is downstream of tyrosine phosphorylation of IRS-1 and activation of the MAP kinase pathway and that crosstalk between angiotensin II and insulin signaling pathways led to an inhibition of IRS-1 tyrosine phosphorylation and egr-1 expression.

The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study.

Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing splint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs. Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm). These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible.

Malocclusion traits and symptoms and signs of temporomandibular disorders in children with severe malocclusion.

The present study reports the prevalence of the various traits of malocclusion, as well as the occurrence of associations between malocclusion, and symptoms and signs of temporomandibular disorders (TMD) in children selected for orthodontic treatment by the new Danish procedure for screening the child population for severe malocclusions entailing health risks. The sample comprised 104 children (56 F, 48 M) aged 7-13. Malocclusion traits were recorded at the time of selection, symptoms and signs of TMD were recorded at recall. The most prevalent malocclusion traits were distal molar occlusion (Angle Class II; 72 per cent), crowding (57 per cent), extreme maxillary overjet (37 per cent) and deep bite (31 per cent). Agenesis or peg-shaped lateral teeth were observed in 14 per cent of the children. The most prevalent symptom of TMD was weekly headache (27 per cent); the most prevalent signs of TMD were tenderness in the anterior temporal, occipital, trapezius, and superficial and profound masseter muscles (39-34 per cent). Seven per cent of the children were referred for TMD treatment. The Danish TMD screening procedure was positive in 26 per cent, while 20 per cent had severe symptoms (Aill), and 30 per cent had moderate signs (Dill) according to Helkimo (1974). Symptoms and signs of TMD were significantly associated with distal molar occlusion, extreme maxillary overjet, open bite, unilateral crossbite, midline displacement, and errors of tooth formation. The analysis suggests that there is a higher risk of children with severe malocclusions developing TMD. Errors of tooth formation in the form of agenesis or peg-shaped lateral teeth showed the largest number of associations with symptoms and signs of TMD; these associations have not previously been reported in the literature.

Archael phosphoproteins. Identification of a hexosephosphate mutase and the alpha-subunit of succinyl-CoA synthetase in the extreme acidothermophile Sulfolobus solfataricus.

When soluble extracts from the extreme acidophilic archaeon Sulfolobus solfataricus were incubated with [gamma-32P]ATP, several radiolabeled polypeptides were observed following SDS-PAGE. The most prominent of these migrated with apparent molecular masses of 14, 18, 35, 42, 46, 50, and 79 kDa. Phosphoamino acid analysis revealed that all of the proteins contained phosphoserine, with the exception of the 35-kDa one, whose protein-phosphate linkage proved labile to strong acid. The observed pattern of phosphorylation was influenced by the identity of the divalent metal ion cofactor used, Mg2+ versus Mn2+, and the choice of incubation temperature. The 35- and 50-kDa phosphoproteins were purified and their amino-terminal sequences determined. The former polypeptide's amino-terminal sequence closely matched a conserved portion of the alpha-subunit of succinyl-CoA synthetase, which forms an acid-labile phosphohistidyl enzyme intermediate during its catalytic cycle. This identification was confirmed by the ability of succinate or ADP to specifically remove the radiolabel. The 50-kDa polypeptide's sequence contained a heptapeptide motif, Phe/Pro-Gly-Thr-Asp/Ser-Gly-Val/Leu-Arg, found in a similar position in several hexosephosphate mutases. The catalytic mechanism of these mutases involves formation of a phosphoseryl enzyme intermediate. The identity of p50 as a hexosephosphate mutase was confirmed by (1) the ability of sugars and sugar phosphates to induce removal of the labeled phosphoryl group from the protein, and (2) the ability of [32P]glucose 6-phosphate to donate its phosphoryl group to the protein.

Head posture and malocclusions.

The present study aimed to examine whether any pattern of associations could be found between the posture of the head and neck, and the occurrence of malocclusions. The sample comprised 96 children (45 M, 51 F) aged 7-13 years, sequentially admitted for orthodontic treatment of severe malocclusions. Malocclusions were diagnosed clinically and classified into occlusal, spacing, and dentitional anomalies and their subdivisions. Craniovertical, craniocervical, and cervicohorizontal postural variables were recorded from lateral cephalometric radiographs taken with the subject standing with the head in the natural head position (mirror position). A clear pattern of associations between crowding and craniocervical posture was found. Subjects with anterior crowding, i.e. more than 2 mm lack of space in the upper or lower anterior segments of the dental arch, had craniocervical angles that were on average 3-5 degrees larger than subjects without crowding (P < 0.05, P < 0.01). The findings were in agreement with the soft tissue stretching hypothesis, according to which the sagittal development of the dentoalveolar arches is impeded by the increased dorsally-directed soft tissue pressure in subjects with extended craniocervical posture.

Biosynthesis of the peptide bond in the coenzyme N-(7-mercaptoheptanoyl)-L-threonine phosphate.

The biochemical mechanism for the formation of the amide bond in N-(7-mercaptoheptanoyl)-L-threonine phosphate (HS-HTP) has been studied by measuring the incorporation of L-[3-(3)H]threonine into N-(7-mercaptoheptanoyl)-L-threonine (HS-HT) by cell extracts (CE) of Methanosarcina thermophila incubated with different precursors. Synthesis of HS-HT was observed from L-[3-(3)H]threonine and 7-mercaptoheptanoic acid (HS-H) when the incubations were conducted with either crude CE or Sephadex column-purified CE. In the presence of CE, the synthesis of HS-HT was found to be inhibited 66% by preincubation of the extract with ATPase, indicating that ATP was involved in the biosynthesis. In spite of this indication of ATP involvement in the coupling reaction, incubation of the crude CE with L-[3-(3)H]threonine, HS-H, and ATP was found to inhibit the formation of HS-HT. In contrast, the synthesis of HS-HT in the presence of Sephadex column-purified CE was found to be stimulated by the addition of ATP. Incubation of the crude CE with the CoA thioester of 7-mercaptoheptanoic acid (HS-HCoA) or the mixed disulfide formed between coenzyme M and 7-mercaptoheptanoic acid did not stimulate the biosynthesis. The biosynthesis of HS-HT was found to be strongly inhibited by an ethanol extract of the crude CE. This inhibition was found to be attributed to the HS-HTP present in the extract. Stimulation of HS-HT biosynthesis 300-fold was observed when the Sephadex column-purified CE was incubated with L-[3-(3)H]threonine and 7-mercaptoheptanoyl phosphate (HS-H-P). Data indicate that HS-HT is produced by the phosphorylation of HS-H to HS-H-P with ATP, which then reacts with L-threonine to produce HS-HT.

Gene cloning and expression and characterization of a toxin-sensitive protein phosphatase from the methanogenic archaeon Methanosarcina thermophila TM-1.

With oligonucleotides modelled after conserved regions within the protein-serine/threonine phosphatases (PPs) of the PP1/2A/2B superfamily, the gene for the archaeal protein phosphatase PP1-arch2 was identified, cloned, and sequenced from the methanogenic archaeon Methanosarcina thermophila TM-1. The DNA-derived amino acid sequence of PP1-arch2 exhibited a high degree of sequence identity, 27 to 31%, with members of the PP1/2A/2B superfamily such as PP1-arch1 from Sulfolobus solfataricus, PP1alpha from rats, PP2A from Saccharomyces cerevisiae, and PP2B from humans. The activity of the recombinant PP1-arch2 was sensitive to several naturally occurring microbial toxins known to potently inhibit eucaryal PP1 and PP2A, including microcystin-LR, okadaic acid, tautomycin, and calyculin A.

Airway dimensions and head posture in obstructive sleep apnoea.

The present cephalometric study aimed to describe the antero-posterior diameters of the pharyngeal airway in a sample of 50 male obstructive sleep apnoea (OSA) patients and a reference sample of 103 male students, and to examine the relationship between these diameters and the posture of the head and the cervical column. Subjects were recorded in the cephalometer standing with the head in its natural position (mirror position). Pharyngeal airway diameters were measured at seven levels ranging from the maxillary tuberosity to the vallecula of the epiglottis. The largest difference was observed at the level behind the soft palate where the diameter was 50 per cent narrower in the OSA sample than in the reference sample. Extension of the cranio-cervical angle and forward inclination of the cervical column were correlated with an increase in the three most caudal airway diameters in the OSA sample: at the uvula, the root of the tongue, and the epiglottis, but only to increase in the lowest diameter in the reference sample. The findings were considered to reflect a compensatory physiological postural mechanism that serves to maintain airway adequacy in OSA patients in the awake erect posture, most efficiently so at the lowest levels of the oropharyngeal airway.

Continued eruption of maxillary incisors and first molars in girls from 9 to 25 years, studied by the implant method.

The aim of this study was to describe the average and individual patterns of continued eruption of the maxillary incisors and first molars in a longitudinal sample of girls. The sample comprised 14 series of lateral cephalometric films of girls, obtained from the archives of the implant study of Björk (1968). All subjects had bilateral posterior maxillary implants and one or two anterior maxillary implants. Subjects with craniofacial anomalies were excluded. The sample represented various types of malocclusions, but records during periods of orthodontic treatment were excluded from the calculation of average data and average curves. The final sample comprised 147 radiographs in the age range 9-25 years. Data were debugged by comprehensive numerical and graphical procedures. The average cumulative continued eruption from 9-25 years of age was 6 mm downwards and 2.5 mm forwards for the upper incisors, and 8 mm downwards and 3 mm forwards for the upper first molars. This resulted in an average reduction of the occlusal plane inclination (OLs/IPLs) of 4.5 degrees from 9-16 years. Attention is drawn to the fact that due to the continued eruption of the natural teeth, the use of osseointegrated implants with artificial teeth should not be recommended in childhood, adolescence, and early adulthood, unless special provision is made for later revision or replacement of the artificial teeth to compensate for the lack of continued eruption of such implants.

Cloning of a potential cytochrome P450 from the archaeon Sulfolobus solfataricus.

Abstract A gene, CYP119, for a potential cytochrome P450 has been isolated and sequenced from the extreme acidothermophilic archaeon Sulfolobus solfataricus. The gene predicts a polypeptide of 368 amino acids containing the consensus heme-binding sequence Phe-Gly-Xaa-Gly-Xaa-His-Xaa-Cys-Xaa-Gly- Xaa3-Ala-Arg-Xaa-Glu. It most closely resembles the cytochrome P450s found in the bacterium Bacillus subtilis, with which it shares 129 identical amino acid residues (35%). This first sequence of a potential archaeal cytochrome P450 represents an important step in tracing the complex evolutionary history of this biologically important enzyme family.

Growth in the lateral part of the human skull during the second trimester.

The aim of the present study was to report dimensional changes in the lateral part of the prenatal human skull during the second trimester. The sample comprised 37 fetuses obtained in connection with requested autopsy. Gestational ages (GA) were available for 27 fetuses, ranging from 13 to 24 weeks. Crown-rump lengths (CRL) of 23 fetuses ranged from 78 to 228 mm. For 21 fetuses both CRL and GA were available. After excision of the midsagittal segment of the skulls by two paramedian sections from the frontal bone to the foramen magnum through the optic foramina, an incision was made through the middle of the occipital squama, bisecting the skull. The present study was based on the skull components of the resulting 74 lateral cranial tissue blocks. The tissue blocks were radiographed with a Hewlett Packard Faxitron unit. Seven reference points were digitized from each film and eight linear dimensions were calculated. Method errors ranged from 0.12 mm to 0.52 mm. The dimensions were related to crown-rump length (CRL) and lateral segment developmental stages (LSS). The increases in the linear dimensions of the anterior part of the lateral skull segments were similar to those found previously for the median skull segment. The dimensions of the anterior part of the lateral skull segments were found to increase by 150% during the second trimester, while those of the posterior part increased by 100% during the same period. Between maturity stages LSS 4 and 5 the dimensions increased by 30-50%, whereas less increase was observed between stages 5, 6, 7, and 8. This reduction was attributed to the progressive ossification of the cranial base. The almost horizontal distance from the mandibular condyle (condylion) to the anterior tympanic ring did not change significantly during the second trimester. Comparison of the bilateral skull segments showed no systematic asymmetry, but a significant individual biological variability in symmetry with standard deviations of 0.7-1.8 mm was found.

The adenoid as a key factor in upper airway infections.

The adenoids (and the nasopharynx) play a key role in the normal functioning and in various pathologies of the upper respiratory tract. In this paper the role of adenoidal pathology and the beneficial effect of adenoidectomy in some upper respiratory tract and facial anomalies and diseases are discussed; otitis media with effusion, recurrent acute otitis media, sinusitis, snoring and sleep apnea and abnormal patterns in the midface growth and development.