Anatomic analysis of the conchal bowl cartilage.

PURPOSE: The conchal bowl is a portion of auricular cartilage commonly used as an autologous graft for various maxillofacial procedures. Few studies have attempted to describe the anatomy of this region in detail, particularly in relation to the curvature of the conchal bowl. The present study has provided detailed information about the anatomy of the auricular cartilage in the conchal bowl region that could assist in the surgical design of graft harvesting. MATERIALS AND METHODS: A total of 35 pairs of cadaver ears without gross deformity (15 male, 20 female; aged 39 to 99 years) were dissected to completely expose the cartilage skeleton. Each cartilage was stabilized, and the conchal bowl was mapped. The starting reference point was defined as the intersection of the lateral border of the antihelix and the superiormost aspect of the inferior crux. A prefabricated grid was then used to imprint a 4 × 5 matrix of pinpoint ink spots on the surface of each cartilage, with 6-mm increments between each spot. The grid's y and x axes were then aligned with the landmarks above. Next, a MicroScribe 3-dimensional digitizer (ghost3d.com) was used to capture the 3-dimensional coordinates for each point on the ear's surface and the coordinates were transferred into an Excel spreadsheet. After digitization, a Boley gauge was used to measure the thickness of the cartilage at each premarked spot. The gathered data points and measurements were examined to describe our parameters of interest (ie, depth, thickness, and curvature). RESULTS: The average maximum conchal bowl depth was 10.5 ± 3.0 mm in the female ears and 10.7 ± 2.5 mm in the male ears. In general, the conchal bowl depth at each point did not differ significantly between the males and females. The mean cartilage thickness ranged from 0.77 to 1.79 mm (mean 1.15 ± 0.26) in the females and 0.95 to 1.45 mm (mean 1.25 ± 0.23) in the males. Both genders showed an increase in the conchal bowl depth from inferiorly to superiorly and from posteriorly to anteriorly. The cartilage thickness also increased from posteriorly to anteriorly; however, the exact shape is complex. CONCLUSIONS: A detailed understanding of the facial anatomy is important in the practice of facial surgery. The results we have presented will provide surgeons with information on the overall dimensions, thickness, and curvature of the conchal bowl that could allow more advantageous donor site selection.

Mixed longitudinal evaluation of masticatory performance in children 6 to 17 years of age.

INTRODUCTION: The purposes of this study were to determine (1) how masticatory performance changes with age, (2) whether masticatory performance differs between the sexes, and (3) whether patterns of masticatory performance differ among subjects with various types of malocclusion. METHODS: A total of 450 children and adolescents (244 boys, 206 girls) were assigned to 4 age cohorts (ages 6, 9, 12, and 15 years) and followed for 3 consecutive years. The subjects were selected based on having about equal numbers of boys and girls, and about equal numbers of subjects with normal occlusion and Class I and Class II malocclusions. Masticatory performance was assessed by using the artificial food CutterSil (Heraeus Kulze, South Bend, Ind). The peer assessment rating index was used to quantify the severity of the malocclusions. RESULTS: Median particle size (MPS) decreased significantly from 6 to 17 years of age. There were no statistically significant differences in MPS between the 3 occlusal groups, but there were significant sex differences, with girls having smaller MPS than boys. Multilevel analysis showed greater decreases in MPS between 6 and 9 years, and after 12 years of age, than between 9 and 12 years of age. There were no significant correlations between MPS and the weighted peer assessment rating index. MPS showed significant intercorrelations between measures of MPS obtained at years 1, 2, and 3, with correlations tending to be highest for the oldest age cohort. CONCLUSIONS: Masticatory performance improves with age, and the changes appear to be influenced by the loss of the deciduous teeth during the late mixed dentition phase of dental development. Although there are limited sex differences in masticatory performance among subjects 6 to 17 years of age, mild forms of Class I and Class II malocclusions have little or no effect on masticatory performance.

Relative contributions of occlusion, maximum bite force, and chewing cycle kinematics to masticatory performance.

INTRODUCTION: The purpose of this study was to explore the contributions of occlusion, maximum bite force, and chewing cycle kinematics to masticatory performance. METHODS: A prospective cross-sectional study was performed on 30 subjects with Class I occlusion. Masticatory performance was measured with the test food Cuttersil (Heraeus Kulzer, South Bend, Ind) and the fractional-sieve technique. Blu-Mousse (Parkell Biomaterials, Farmingdale, NY) bite registrations were used to measure occlusal contact areas. The American Board of Orthodontics occlusal discrepancies were measured on the subjects' dental models. Maximum bite forces were recorded with a custom transducer, and 3-dimensional chewing cycle kinematics were tracked with an opto-electric computer system and Optotrak software (Northern Digital, Waterloo, Ontario, Canada). RESULTS: Masticatory performance was most closely correlated with occlusal contact area, indicating larger contact areas in subjects with better performance. Occlusal contact area and occlusal discrepancies were also related to bite force and chewing cycle kinematics. Maximum bite force was positively related with masticatory performance. CONCLUSIONS: Although masticatory performance is related, both directly and indirectly, to a number of morphologic and functional factors, it is most closely related to occlusal factors.

The anatomic basis of lingual nerve trauma associated with inferior alveolar block injections.

PURPOSE: This study describes the anatomic variability in the position of the lingual nerve in the pterygomandibular space, the location of the inferior alveolar nerve block injection. MATERIALS AND METHODS: Simulated standard landmark-based inferior alveolar nerve blocks were administered to 44 fixed sagitally bisected cadaver heads. Measurements were made of the diameter of the nerves and distances between the needle and selected anatomic landmarks and the nerves. RESULTS: Of 44 simulated injections, 42 (95.5%) passed lateral to the lingual nerve, 7 (16%) passed within 0.1 mm of the nerve, and 2 (4.5%) penetrated the nerve. The position of the lingual nerve relative to bony landmarks within the interpterygoid fascia was highly variable. CONCLUSION: Variation in the position of the lingual nerve is an important contributor to lingual nerve trauma during inferior alveolar block injections. This factor should be an important part of preoperative informed consent.

Design and construction of a transducer for bite force registration.

This study describes the development of a system for quantification of human biting forces by (1) determining the mechanical properties of an epoxy resin reinforced with carbon fiber, (2) establishing the transducer's optimal dimensions to accommodate teeth of various widths while minimizing transducer thickness, and (3) determining the optimal location of strain gages using a series of mechanical resistance and finite element (FE) analyses. The optimal strain gage location was defined as the position that produced the least difference in strain pattern when the load was applied by teeth with two different surface areas. The result is a 7.3-mm-thick transducer with a maximum load capacity beyond any expected maximum bite force (1500N). This system includes a graphic interface that easily allows acquisition and registration of bite force by any health-sciences or engineering professional.

Effects of bolus size and hardness on within-subject variability of chewing cycle kinematics.

This study analysed how bolus hardness and size affect within-subject variability of chewing cycle kinematics. Two independent prospective studies were performed; both tracked chin movements using an optoelectronic recording system. Computer programs identified each subject's ten most representative cycles, and multilevel modelling procedures were used to estimate variances. One study evaluated 38 subjects who chewed 1, 2, 4 or 8 g of gum presented in random order. The second study evaluated 26 subjects who chewed approximately 2.5 g of harder (670 g) or softer (440 g) gum, also presented in random order. In terms of bolus size, the 2g and 1g boluses produced the least and greatest relative within-subject variability, respectively; the largest differences were found for cycle duration and excursions. Within-subject variability when chewing the harder gum was consistently greater than when chewing the softer gum, except for lateral movement towards the balancing side. Because bolus hardness and bolus size influence within-subject variability differently, they must be taken into consideration when designing experiments to study masticatory kinematics. We conclude that a 2g bolus of soft gum should be used in studies of chewing cycle kinematics in order to reduce within-subject variability and increase statistical power.

Chewing cycle kinematics of subjects with deepbite malocclusion.

INTRODUCTION: The notion that chewing cycle shape and cycle dynamics differ between subjects with and without malocclusion is largely based on qualitative studies that combined various types of malocclusion. The purpose of this prospective study was to determine whether chewing cycle kinematics of untreated young adults with deepbite malocclusion differ from those with normal occlusion. METHODS: Twenty-three deepbite subjects (>50% overbite) and 24 controls with normal occlusion chewed gum (right side only) while their jaw movements were recorded at 100 Hz by using an optoelectric jaw tracking system. RESULTS: Differences in cycle duration between deepbite and control subjects were small and not significant (P >.05). The deepbite subjects showed significantly (P <.05) less maximum inferior excursion (7.7 vs 9.0 mm) and significantly greater maximum posterior excursion (5.1 vs 4.0 mm) than subjects with normal occlusion. In addition, the deepbite subjects had significantly smaller maximum vertical velocities than subjects with normal occlusion (49.2 vs 60.8 mm per second). Deepbite subjects also showed significantly (P <.05) less cycle-to-cycle variability in maximum velocities and excursions to the balancing side but significantly (P <.05) greater variability in cycle duration and maximum posterior excursions. CONCLUSIONS: A deepbite malocclusion alters the shape of chewing cycles and the consistency of chewing cycle kinematics.

Anatomical variation of the nasal septum: analysis of 57 cadaver specimens.

OBJECTIVES: The purpose of this study was to examine the anatomical variation of the osseous and cartilaginous components of the nasal septum. STUDY DESIGN: Fifty-seven cadaver specimens were digitally scanned and analyzed utilizing Bersoft Image software. Anatomical data were statistically analyzed utilizing SPSS 13.0. Evaluation of the area of the osseous/cartilaginous nasal septum as well as an estimation of the available cartilage for grafting was performed. RESULTS: Septal specimens revealed males had greater variation in cartilaginous area compared to female specimens. The intranasal/extranasal cartilage contributes about 45%/55% of the total cartilage, respectively. The data indicate that the mean area of cartilage available for grafting is around 420 mm(2). CONCLUSIONS: Significant variability in the cartilaginous elements of the nose is the rule rather than the exception. Key differences exist in the anatomic location of the graft material between males and females. This has important surgical implications given the critical attention required during graft harvesting in order to maintain support of the nose.

Comparability of radiographic and 3D-ultrasound measurements of facial midline tissue depths.

As a second step in our three-dimensional (3D) ultrasound research on facial tissues, orthodontic patients with available lateral cephalographs (radiographs) allowing measurements of tissues along the midline of the face were recruited for ultrasound scanning. Comparison of three points on the upper lip (A-point), chin (B-point), and nose (nasion) produced differences of varying magnitude between radiographic and ultrasound measurements, with the B-point measurement being clearly affected by head orientation. Concordance was better for A-point and best for nasion. Although extension of two-dimensional (2D) ultrasound scanning of facial tissues to 3D scanning for forensic and surgical reconstructive purposes remains a worthy goal, it must be recognized that because of the differences in technique, measurements obtained from the different visualization modalities at present vary in their comparability.

Effect of an auditory cue on chewing cycle kinematics.

OBJECTIVES: This study analysed the systematic and random effects of a rhythmic auditory cue on chewing cycle kinematics. METHODS: The chin movements of 25 subjects (19-35 years of age) with normal class I occlusion were recorded at 100Hz (Optotrak) Northern Digital) during two natural gum chewing (2.5 g) sequences to determine the chewing rate of each subject. Another sequence was recorded with the subjects chewing at their natural rate following an audible cue. Multilevel modeling procedures were used to evaluate differences between natural chewing with and without an audible cue. RESULTS: Differences were found between experimental conditions for excursions, velocities and cycle shape. When chewing with the audible cue velocities were slower and there was less excursion of the chin marker, with the exception of initial lateral movements toward the balancing side. No differences in between-subject variability were found when chewing with or without an audible cue. Within-subject variability was 44% smaller for total cycle duration and 53% smaller for total 3D excursion when chewing with the auditory cue. CONCLUSIONS: Chewing at one's normal rate while following an auditory cue produces more consistency in chewing cycle kinematics. This method may be applicable, with some limitations, to reduce within-subject variability in chewing cycle kinematics.

Treatment of mandibular condylar process fractures: biological considerations.

The topic of condylar injury in adults has generated more discussion and controversy than any other in the field of maxillofacial trauma. It is an important subject because such injuries are common and complications of trauma to the temporomandibular joint (TMJ) are far-reaching in their effects. Why are there so many different methods to treat this injury? How can seemingly disparate treatment options all produce satisfactory outcomes in the majority of patients? The reason lies with the biological adaptations that occur within the masticatory system that are poorly understood, not readily quantifiable, and variable from one person to the next. This discussion presents our current understanding of the adaptations that must occur to provide the patient with a satisfactory outcome. The adaptations for patients treated open are different than for those treated closed. However, it is when these adaptations fail to occur that unsatisfactory outcomes occur, regardless of how they were treated.

A new technique for three-dimensional ultrasound scanning of facial tissues.

We report the development of an ultrasonic facial scanning technique that allows for the visualization of continuous contours without deforming surface tissues. Adhesive markers are placed on the face to enable measurement of facial tissue thicknesses at specific landmarks. The subject immerses the face in a clear plastic box filled with water for about 20 seconds while the researcher moves the transducer along the bottom of the box, guiding transducer movement by watching the facial image in a mirror placed below. 3D Echotech software (1) builds the images from sequentially acquired 2D frames. Reliability of repeat measurements at landmarks is good, and individual tissues (skin, subcutaneous, muscle) can be distinguished. The method is simple, reliable, less expensive and less time consuming than alternatives such as magnetic resonance imaging (MRI). It is applicable in both research and clinical contexts.

Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process.

PURPOSE: We sought to compare mandibular motion during mastication in patients treated in either an open or a closed fashion for unilateral fractures of the mandibular condylar process. PATIENTS AND METHODS: Eighty-one male patients with unilateral condylar process fractures were treated either with (n = 37) or without (n = 44) surgical reduction and rigid fixation of their condylar process fractures. At 6 weeks, 6 months, 1 year, and 2 years after treatment, the subjects' chewing cycles were recorded using a magnetic sensor array (Sirognathograph; Siemens Corp, Bensheim, Germany) while chewing Gummi-Bears (HARIBO, Bonn, Germany) unilaterally on the same side as the fracture and on the opposite side. The chewing cycles were analyzed using a custom computer program, and the duration, excursive ranges, and 3-dimensional cycle shape were compared between the 2 treatment groups at each time interval using multilevel linear modeling statistics. RESULTS: The 2 treatment groups did not differ significantly for any measure of cycle duration or any excursive range (except lateral excursions at 1 year post-treatment) at any of the time intervals. However, the 3-dimensional cycle shapes of the 2 groups did differ significantly at all time intervals. CONCLUSION: Surgical correction of unilateral condylar process fractures has relatively little effect on the more standard measures (duration and excursive ranges) of masticatory function. However, surgical correction better normalizes opening incisor pathways during mastication on the side opposite the fracture.

Jaw kinematics during mastication after unilateral fractures of the mandibular condylar process.

This study compared the mandibular kinematics during mastication of patients treated for unilateral fractures of the mandibular condylar process with those of control subjects. We used a Sirognathograph (Siemens, Bensheim, Germany) to record the chewing cycles of 81 male patients with unilateral condylar process fractures while they chewed a constant bolus unilaterally on the same side as the fracture and on the opposite side. Recordings were made at 6 weeks, 6 months, 1 year, and 2 years after treatment. Similar chewing cycles were recorded for 15 male controls (Class I dental and Class I skeletal occlusion) without fractures of the condylar process. The chewing cycles of both groups were analyzed with a custom computer program, and the duration, excursive ranges, and 3-dimensional cycle shape were compared at each time interval with multilevel linear modeling statistics. Fracture patients had significantly slower chewing cycles, with significantly less maximum excursion toward the working side during the closing phase and significantly greater excursion toward the balancing side during the opening phase than the controls. The opening pathway of the incisors showed greater differences between patients and controls than the closing pathways. Differences in chewing cycle shape persisted for up to 2 years, especially when chewing was on the side opposite the fracture. Unilateral condylar process fractures produce long-lasting changes in chewing cycle duration and chewing cycle shape of adults.

Maximum bite force, muscle efficiency and mechanical advantage in children with vertical growth patterns.

This study correlated maximum bite force and masticatory muscle electromyography (EMG) activity with craniofacial morphology and mechanical advantage of children with vertical growth patterns. From lateral cephalograms of 30 females and 17 males (9.3 +/- 3.6 years of age), 13 morphological and eight biomechanical measurements were recorded. Two maximum bite forces and 12 submaximal bite forces along with their associated EMG muscle activity were recorded at the right mandibular first molar. Muscle efficiency was evaluated using the relationship between bite forces and EMG activity levels. There were no significant sex differences (P > 0.05) for any of the morphological, functional or biomechanical variables. Factor analyses reduced: (1) the 13 morphological variables to four factors explaining 82.8 per cent of the morphological variance; (2) six functional variables to two factors explaining 68.8 per cent of the functional variance; and (3) 11 biomechanical variables to three factors explaining 90.9 per cent of the biomechanical variance. The vertical size factor was negatively correlated with the muscle efficiency factor (r = -0.39; P = 0.006) and positively correlated with the moment arm factor (r = 0.67; P < 0.001). The morphological divergence factor was negatively correlated with the bite force factor (r = -0.34; P = 0.019) and the mechanical advantage factor (r = -0.32; P = 0.028). The muscle efficiency factor (functional) was negatively correlated with the moment arm factor (r = -0.33; P = 0.023). It is concluded that: (1) independent of chronological age, children with larger faces have larger moment arms and require less muscle activity to attain any given force, and (2) greater hyperdivergence is related to poorer mechanical advantage and lower maximum bite force. These data support the relationships between bite force, muscle strength and morphology in children, similar to those reported for adults.

Masticatory performance and areas of occlusal contact and near contact in subjects with normal occlusion and malocclusion.

This preliminary study evaluated relationships between masticatory performance and areas of interocclusal distance contact (<50 microm) and near contact (50-350 microm) of the buccal segments during maximum intercuspation. The sample included subjects with normal occlusion (n = 18) and Class I (n = 14), Class II (n = 13), and Class III (n = 6) malocclusions. Chewing performance was evaluated on the basis of the breakdown of CutterSil (Heraeus Kulze, South Bend, Ind); chewing ability was assessed by the number of chews necessary to swallow jerky and almonds. Impressions of the buccal segments, taken with Blu Mousse (Parkell Bio-Materials, Farmingdale, NY) impression material, were scanned and enlarged, and each subject's first molars and premolars were manually traced bilaterally to estimate the platform area. The areas of contact and near contact (ACNC) that measured between 0 and 350 microm thick were estimated optically on the basis of the amount of light transmitted through the impression. The results showed no significant differences in platform area between the right and left sides or between the malocclusion groups. ACNC were negatively related to median particle size and broadness of particle distribution. There were no correlations between ACNC and the number of chews necessary to swallow jerky or almonds. Subjects with normal occlusion had significantly larger ACNC than those with Class I, Class II, and Class III malocclusions, in descending order. Subjects with Class III malocclusions had the smallest areas of near contact (<350 microm). We concluded that ACNC are similar on the right and left sides; that subjects with larger ACNC are better able to break down foods; and that subjects with malocclusions have smaller ACNC than those with normal occlusions.

The mechanism of frill erection in the bearded dragon Amphibolurus barbatus with comments on the jacky lizard A. muricatus (Agamidae).

Amphibolurus barbatus has a threat display which includes the erection of the gular regions as a frill and may also include wide opening of the mouth to display a yellow mouth lining. Frill erection involves protraction, depression, and lateral expansion of the hyoid apparatus. Electrical stimulation of the hyoid muscles and dissection of the hyoid apparatus were used to examine specializations for producing frill erection. Specializations of the hyoid skeleton include the absence of a ceratobranchial II, presence of a synovial joint between the ceratohyal and body of the hyoid, and combined shortening of the entoglossal process and lengthening of the posterior arches. The only apparent specialization of the hyoid musculature is the anterior displacement of the origin of m. hyomandibularis. All of the hyoid muscles are involved in some way in frill erection and the actions of each muscle is described. The characteristic frill erection in the threat display of Amphibolurus barbatus is possible because of the 1:2 ratio of the anterior and posterior parts of the apparatus and the absence of the ceratobrnchial II.