The functional matrix hypothesis revisited. 4. The epigenetic antithesis and the resolving synthesis

Mandibular Lengthening by Distraction for Airway Obstruction in Treacher-Collins Syndrome: The 30-Year Results

Treacher-Collins syndrome is a rare facial clefting disorder, the management of which remains among the most challenging for craniofacial teams. Herein, we report the long-term outcome of early mandibular lengthening by distraction osteogenesis for established airway obstruction in Treacher-Collins syndrome. This case, which was the first literature report in this clinical scenario1, has subsequently been reviewed at skeletal maturity2 and can now be addressed more than 30 years later.

Tooth wear and tertiary crowding: a 13-year cohort study in Amazon Indigenous populations

BACKGROUND

Tooth wear is an important mechanism for reducing dental dimensions and, consequently, dental crowding. The objective of this cohort study was to examine the relation of tooth wear, adjusted for covariates (age, tooth loss, arch perimeter and intercanine width), on tertiary crowding in Amazon Indigenous populations.

METHODS

A sample of 40 Indigenous people in permanent dentition at T0 (baseline) and after 13 years (T1) were evaluated. The sample included 16 males and 24 females belonging to two villages, Arara (n = 22, mean ages 16.6 and 29.9 years) and Assurini do Xingu (n = 18, mean ages 16.0 and 29.6 years). Clinical, intraoral photograph and dental cast evaluations were performed at both times. The anterior crowding was measured using Little's Irregularity Index (LI) and modeled through a multilevel linear regression with the predictor variables: village, tooth wear (T1-T0), age (T0), tooth loss (T1-T0), changes in intercanine width (T1-T0) and changes in arch perimeter (T1-T0).

RESULTS

A slight increase was observed (< 1 mm) in anterior dental crowding and a decrease in arch perimeter < 1.5 mm, while tooth wear increased between 0.65 and 0.99 units. The contextual variable (village) had no significant association with LI. In the upper arch, tooth loss was the only variable that showed an inverse association with LI (β=-0.41, p < 0.05). In the lower arch, the increase in dental crowding was inversely associated with tooth wear (β=-1.30, p < 0.05) and changes in arch perimeter (β=-0.31, p < 0.05). The other variables did not show significant associations.

CONCLUSION

After 13 years, dental crowding and tooth wear increased, while the arch dimensions tended to decrease. The changes in long-term dental crowding seem to have distinct etiological components for each dental arch. In the mandible, the changes in incisor alignment were associated with increased tooth wear and decreased dental arch dimensions. Whereas in the maxilla, only tooth loss caused alterations in tooth alignment. It is suggested that the effect of increased tooth wear on the etiology of tertiary crowding is of small magnitude and restricted to the lower dental arch.

Investigation of the Relationship Between ACTN3 rs1815739 Polymorphism and Openbite Cases: A Prospective Study

OBJECTIVE

The aim of this study was to examine whether ACTN3 rs1815739 polymorphism, which causes the deficiency of the alpha-actinin-3 muscle protein, is related to the formation of open bite malocclusion.

MATERIALS AND METHODS

Fifty-eight participants (18.5 ± 3.6 years old) with anterior open bite (n = 29) and normal overbite (n = 29) who presented to Marmara University, Department of Orthodontics for treatment were included in the study. Initial cephalometric radiographs were used for the diagnosis of malocclusion. The case group was divided into three subgroups according to degree of open bite. For DNA isolation, oral epithelial cells were collected with buccal swabs (Van Allen Way, Carlsbad, USA), and the real-time PCR method was used for the genotyping of all polymorphisms. The results were statistically analysed, and the threshold for statistical significance was set at p < 0.05.

RESULTS

The frequencies of RR, RX and XX genotypes of ACTN3 rs1815739 polymorphism were found as 6 (20.7%), 14 (48.3%) and 9 (31.0%) in the control group and 8 (8%), 9 (31.0%) and 12 (41.4%) in the case group, respectively. There was no statistically significant difference between the groups in terms of the presence of the examined polymorphism (p > 0.05). However, the intra-group evaluation of case group revealed a significant difference in the prevalence of XX genotype (83.3%) for the subgroup with an open bite of -5 mm or above.

CONCLUSION

Although no significant difference was observed between the case and control groups, a possible association was identified between ACTN3 rs1815739 polymorphism and an increased severity of open bite malocclusion.

Evaluation of Facial Aesthetic Changes in Growing Class II Patients Treated with Herbst or Elastodontics: A Retrospective Study

Objective: The objective of this study was to evaluate the facial profile changes of patients treated for class II skeletal malocclusions with an elastodontic appliance compared to those treated with the Herbst appliance and a control group. Methods: Forty class II patients were treated using an elastodontic appliance (Group EA) and were compared to 40 patients treated with the Herbst appliance (Group H) and to 40 untreated class II children (Group C). Aesthetic profile variables were analysed using Arnett's analysis. Cephalograms were compared pre-treatment (T0) and post-treatment (T1). The Wilcoxon signed-rank test or paired-samples t-test was used for pairwise comparison of cephalometric measurements taken at T0 and T1. One-way ANOVA and Tukey's post hoc test were performed to assess differences between the groups. Results: In the elastodontic group, the inclination of the upper incisors increased by 4.05°. In addition, the Pog-TVL and B-TVL distances decreased by 2.84 mm and 1.79 mm, respectively. In patients treated with an elastodontic appliance, the inclination of the upper incisors increased by 4.05°. In addition, the Pog-TVL and B-TVL distances decreased by 2.84 mm and 1.79 mm, respectively. In patients treated with the Herbst appliance, the inclination of the lower incisors increased by 6.11°. Furthermore, the treatment resulted in reductions in the Pog-TVL distance (2.58 mm), the B-TVL distance (2.26 mm), and the LL-TVL distance (2.31 mm). Conclusions: The profile changes achieved by both devices are favourable for correcting class II skeletal malocclusion.

Dental arch shape in twins: A morphometric study of genetic influences

INTRODUCTION

The objective of this study was to assess the relative contribution of genes to shape variation in the permanent dental arches in individuals of Western European descent.

METHODS

The dental casts from 64 monozygotic and 38 dizygotic twins, housed in the Adelaide Dental School's twin record collection, Australia, were assessed. The subjects were of Western European descent, with a mean age of 19.4 ± 5.4 years. Dental casts were scanned using a 3-dimensional scanner (3Shape E4, 3Shape, Copenhagen, Denmark), and landmarks were placed on incisal edges and cusp tips of canines, premolars, and molars. Procrustes superimposition and principal components analysis were applied to examine shape variation. Two-block partial least-squares analysis was used to assess shape covariation between arches. Structural equation modeling was utilized to decompose observed shape variation into genetic and environmental components using the normal assumptions of the twin model.

RESULTS

The first 3 principal components (PCs) of the maxillary and mandibular arch were meaningful, accounting for 53% and 50% of the variation in shape space, respectively. The PCs represented shape variability as follows: PC1 - arch depth-width ratio, PC2 - arch taper, canine position (and first premolar rotation for the mandibular arch), and PC3 - incisor displacement and rotation. Genetic modeling indicated that a model incorporating additive genetic and unique environmental factors optimally explained the observed variation for all meaningful PCs. Within shape space, most of the variation in maxillary and mandibular arches exhibited moderate to high heritability (h2 = 0.61-0.74). Maxillary and mandibular dental arches had strong and significant shape covariation, with high heritability in their reciprocal influences on shape (h2 = 0.72-0.74; rpls coefficient = 0.87; P <0.05).

CONCLUSIONS

In this cohort, dental arch shape variation was predominantly influenced by genetic factors. High covariation and heritability were observed between the maxillary and mandibular dental arches. This information may help inform decisions around orthodontic intervention.

Management of Pediatric Mandibular Condyle Fractures: A Literature Review

This narrative review evaluates the literature on the management of mandibular condyle fractures in growing patients. It aims to illustrate some fundamental biological principles and to offer a series of considerations applicable to clinical practice. The discussion is based on 116 papers published in PubMed and two relevant textbooks. Condylar fractures may be overlooked, especially in pre-scholar children, where compliance is usually reduced. However, these injuries can have disabling sequelae such as ankyloses, facial deformities, malocclusion, and chronic pain in some patients if not diagnosed and managed correctly. Due to their significance, mandibular condyle fractures in children are a subject of considerable clinical interest. As of today, there is consensus about their treatment. Four management options are available: expectative (analgesia, soft food and follow-up), functional protocols (guiding elastics, orthodontic appliances and exercises), maxillomandibular fixation (MMF), and open reduction and internal fixation (ORIF). Nondisplaced and minimally displaced fractures should be treated expectantly; severely displaced non-comminuted fractures can be safely operated on if the expertise is available, even in patients with deciduous dentition. Moderately displaced fractures can be managed with functional protocols or operatively, depending on the background and know-how of the specialist. Functional protocols can achieve good outcomes, especially in patients with deciduous dentition. MMF should be foregone in children due to its many drawbacks.

Correlation between oral muscle pressure and malocclusion in mixed dentition: a cross-sectional study

OBJECTIVE

To investigate the relationship between oral muscle pressure and malocclusion in the mixed dentition.

MATERIALS AND METHODS

Maximum tongue, lip and cheek pressure was measured using the Iowa Oral Performance Instrument (IOPI) in 3 patient cohorts: patients with (1) posterior crossbite, (2) class II relationship and (3) a control group of patients without malocclusion. Linear models were used to compare the mean differences in muscle pressure between groups, with correction for age and gender. The imbalance between lips and tongue and between lips and cheeks was calculated by the Delta z-scores of each group.

RESULTS

A total of 146 participants were included, 46 (mean age 8.71±0.85), 41 (mean age 11.74±1.17) and 35 (mean age 10.71±1.92) in groups 1, 2 and 3 respectively. Patients with malocclusion showed significantly higher lip and lower cheek pressure and imbalance favouring the lips over the tongue compared to controls. Class II,1 patients showed significantly higher tongue pressure than Class II,2. No differences were found in muscle pressure or imbalance between crossbite and Class II nor between crossbite types.

CONCLUSION AND CLINICAL RELEVANCE

These findings suggest that oral muscle pressure may be associated with malocclusion. This highlights the importance of functional diagnosis and its implications on the prevention and treatment of malocclusion, as well as on orthodontic stability.

Sagittal suture strain in capuchin monkeys (Sapajus and Cebus) during feeding

OBJECTIVES

Morphological variation in cranial sutures is used to infer aspects of primate feeding behavior, including diet, but strain regimes across sutures are not well documented. Our aim is to test hypotheses about sagittal suture morphology, strain regime, feeding behavior, and muscle activity relationships in robust Sapajus and gracile Cebus capuchin primates.

MATERIALS AND METHODS

Morphometrics of sinuosity in three regions of the sagittal suture were compared among museum specimens of Sapajus and Cebus, as well as in robust and gracile lab specimens. In vivo strains and bilateral electromyographic (EMG) activity were recorded from these regions in the temporalis muscles of capuchin primates while they fed on mechanically-varying foods.

RESULTS

Sapajus and the anterior suture region exhibited greater sinuosity than Cebus and posterior regions. In vivo data reveal minor differences in strain regime between robust and gracile phenotypes but show higher strain magnitudes in the middle suture region and higher tensile strains anteriorly. After gage location, feeding behavior has the most consistent and strongest impact on strain regime in the sagittal suture. Strain in the anterior suture has a high tension to compression ratio compared to the posterior region, especially during forceful biting in the robust Sapajus-like individual.

DISCUSSION

Sagittal suture complexity in robust capuchins likely reflects feeding behaviors associated with mechanically challenging foods. Sutural strain regimes in other anthropoid primates may also be affected by activity in feeding muscles.

Endocranial anatomy of the Guercy 1 early Neanderthal from Baume Moula-Guercy (Soyons, Ardèche, France)

We provide the first comparative description of the endocranium of the Guercy 1 Early Neanderthal and examine its affinities to Preneanderthals, Neanderthals, and Homo sapiens. The Guercy 1 cranium derives from deposits chronostratigraphically and biostratigraphically dated to the Eemian Interglacial (MIS 5e). For comparative purposes, we compiled a sample of European and Southwest Asian subadult and adult Middle-to-Late Pleistocene hominins (≈MIS 12-MIS 1; N = 65). We sampled both a Preneanderthal-Neanderthal group and a Homo sapiens group. The Preneanderthal-Neanderthal group was further divided into three time-successive subgroups defined by associated MIS stages. Metric and morphological observations were made on original fossils and physical and virtual endocranial reconstructions. Guercy 1 and other Early Neanderthals, differ from Preneanderthals by increased development of the prefrontal cortex, precentral and postcentral gyri, inferior parietal lobule, and frontoparietal operculum. Early Neanderthal differ, in general, from Late Neanderthals by exhibiting less development in most of the latter brain structures. The late group additionally differentiates itself from the early group by a greater development of the rostral superior parietal lobule, angular gyrus, superior and middle temporal gyri, and caudal branches of the superior temporal gyrus. Endocranial morphology assessed along the Preneanderthal-Neanderthal sequence show that brain structures prominent in Preneanderthals are accentuated in Early-to-Late Neanderthals. However, both the Early and Late groups differentiate themselves by also showing regionally specific changes in brain development. This pattern of morphological change is consistent with a mosaic pattern of neural evolution in these Middle-to-Late Pleistocene hominins.

Uniformity of palatal volume and surface area in various malocclusions

AIMS

To assess palatal volume, surface area and linear dimensions across sagittal and vertical components of malocclusion.

METHODS

Pre-treatment cephalographs and dental casts of 178 non-growing patients (88 males, 90 females, age 25.81 ± 8.23 years) were used for classification in sagittal malocclusion groups: Class I (n = 48), Class II division 1 (n = 42), Class II division 2 (n = 40) and Class III (n = 48); and in vertical divergence groups based on the MP/SN angle: hypodivergent (n = 35), normodivergent (n = 95) and hyperdivergent (n = 48). Dental casts were scanned and palatal measurements recorded: palatal width, depth and interdental distances; palatal surface area (PSA, mm² ) and volume (PV, mm³ ). A 3-way ANOVA was used to compare palatal dimensions across groups. Pearson product-moment correlations were employed to assess associations among variables.

RESULTS

PSA and PV (in both sex groups) were not statistically significantly different across sagittal malocclusions and vertical patterns. Significant differences were depicted more among the vertical divergence groups than sagittal groups. Correlations between PSA and PV and palatal dimensions were low to moderate. Predictability of PSA and PV ranged between 15 and 18%.

CONCLUSION

The finding of similar palatal volume and surface area, on average, across malocclusions possibly underscores the limitations of environmental influences within the inherited orofacial phenotype. The vertical facial pattern seems to be more interactive with palatal dimensions than sagittal relations. Studies of palatal changes following orthodontic and orthognathic treatments are warranted.

Novel genes linked to Class II Division 1 malocclusion with mandibular micrognathism

INTRODUCTION

Mandibular micrognathism (MM) is an underdeveloped mandible resulting from complex interactions between genetic and environmental factors. Prior research focused mainly on the genetic determinants of mandibular retrognathism, not necessarily reflecting micrognathism, thus supporting the need to study MM. This study aimed to explore the inheritance pattern and identify the candidate genes involved in the development and familial transmission of MM.

METHODS

Diagnosing probands with MM was based on clinical and lateral cephalometric data. The pedigrees were drawn for 11 identified families, 5 of whom accepted to undergo detailed data and biospecimen collection. These families included 15 MM and 13 non-MM subjects over 2-3 generations. The procedure involved the withdrawal of 5 mL of blood. Genomic DNA was isolated from blood cells to investigate protein-coding regions via whole exome sequencing. Standardized filtering steps were employed, and candidate genes were identified.

RESULTS

Most of the pedigrees suggested a Mendelian inheritance pattern and segregated in an autosomal-dominant manner. One of the families, which also underwent biospecimen, displayed an X-linked inheritance pattern of the trait. Genetic screening disclosed 8 potentially novel genes (GLUD2, ADGRG4, ARSH, TGIF1, FGFR3, ZNF181, INTS7, and WNT6). None of the recognized exonic regions were previously reported.

CONCLUSIONS

Eight novel genes were identified in association with MM in the largest number of families reported to date. The genes were X-linked in 1 family, a finding previously not observed in mandibular genetics.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up

BACKGROUND

The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients.

METHODS

Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed.

RESULTS

Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location.

CONCLUSIONS

A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Cranial-Vertebral-Maxillary Morphological Integration in Down Syndrome

Background: Morphological integration refers to the tendency of anatomical structures to show correlated variations because they develop in response to shared developmental processes or function in concert with other structures. The objective of this study was to determine the relationships between the dimensions of different cranial-cervical-facial structures in patients with Down syndrome (DS). Methodology: The study group consisted of 41 individuals with DS who had undergone cone-beam computed tomography (CBCT) at the Dental Radiology Unit of the University of Santiago de Compostela (Spain). In the historical archive of this same unit, 41 CBCTs belonging to individuals with no known systemic disorders or severe malformations of the maxillofacial region were selected, forming an age and sex-matched control group. Twenty-nine measurements were performed on each participant’s CBCT images, which were grouped into three blocks: atlantoaxial dimensions, craniovertebral dimensions and cephalometric dimensions. To determine whether there were significant differences between the dimensions obtained in the DS and control groups, we applied multiple analysis of variance and linear discriminant analysis tests. The analysis of the association between blocks (in pairs) was performed with the canonical correlation analysis test. Results: The dimensions evaluated in the three blocks of variables of individuals with DS differ significantly from those of nonsyndromic controls (p < 0.001). The highest discriminative capacity to identify controls and patients with DS was obtained with the cephalometric dimensions (87.5%). With regard to the association between blocks (two-by-two measurements), we found no significant relationship in the DS group. However, we confirmed a statistically significant correlation between all pairs of blocks of variables in the controls, especially between the atlantoaxial and cephalometric dimensions (p < 0.001) and between the craniovertebral and cephalometric dimensions (p < 0.001). Conclusions: Our results confirm a very poor morphological integration of the cranial-cervical-maxillary complex in individuals with DS. This finding reinforces the proposal that gene overload enhances the channeling process.

Anatomic development of the upper airway during the first five years of life: A three-dimensional imaging study

PURPOSE

Normative data on the growth and development of the upper airway across the sexes is needed for the diagnosis and treatment of congenital and acquired respiratory anomalies and to gain insight on developmental changes in speech acoustics and disorders with craniofacial anomalies.

METHODS

The growth of the upper airway in children ages birth to 5 years, as compared to adults, was quantified using an imaging database with computed tomography studies from typically developing individuals. Methodological criteria for scan inclusion and airway measurements included: head position, histogram-based airway segmentation, anatomic landmark placement, and development of a semi-automatic centerline for data extraction. A comprehensive set of 2D and 3D supra- and sub-glottal measurements from the choanae to tracheal opening were obtained including: naso-oro-laryngo-pharynx subregion volume and length, each subregion's superior and inferior cross-sectional-area, and antero-posterior and transverse/width distances.

RESULTS

Growth of the upper airway during the first 5 years of life was more pronounced in the vertical and transverse/lateral dimensions than in the antero-posterior dimension. By age 5 years, females have larger pharyngeal measurement than males. Prepubertal sex-differences were identified in the subglottal region.

CONCLUSIONS

Our findings demonstrate the importance of studying the growth of the upper airway in 3D. As the lumen length increases, its shape changes, becoming increasingly elliptical during the first 5 years of life. This study also emphasizes the importance of methodological considerations for both image acquisition and data extraction, as well as the use of consistent anatomic structures in defining pharyngeal regions.

The role of the nasal region in craniofacial growth: An investigation using path analysis

This study focuses on the role of the nasal region and its interactions with adjacent facial elements during early ontogeny. A series of linear measurements, areas and volumes were extracted from a collection of 227 medical CT-scans of children from 0 to 6 years of age. These measurements describe aspects of the form of the orbit, maxilla, peri-alveolar (subnasal) region, nasal area, eye, oral region, masseter, and temporal muscles. Hypothesized interactions were then examined using path analysis. Two paths were designed: the first to investigate potential interactions in, and relative contributions of the nasal derivatives and adjacent regions to overall facial growth and development; the second path sees the addition of facial soft tissue measurements and aims to assess their effects on skeletal components, and on overall facial growth and development. The results of the first path indicate a large contribution of the nasal and subnasal regions to facial development. This indicates that the nasal septum and the developing dentition provide an important but variable contribution to facial ontogeny during early years. This result is confirmed in the second path, where the soft tissue elements were added to the diagram. Results of the second path indicate that the soft tissues contribute only locally to the development of some skeletal elements of the face. This indicates that the contribution of skeletal components has a more direct effect on facial height than soft tissue matrices, however there are complex interactions between soft tissues and skeletal elements throughout ontogeny.

Combating Constraints of the Functional Matrix: The Importance of Overcorrection in Pediatric Craniofacial Surgery

Background:

To effectively manipulate the bone, particularly in the growing patient, the craniofacial surgeon must understand the principles related to bone-based reconstruction. A theory of craniofacial growth that is both biologically accurate and clinically relevant is thus needed.

Methods:

A historical review of major findings across various disciplines (including orthopedic surgery, anatomy, embryology, orthodontics, and cell biology) will be covered, as it pertains to the concept of the functional matrix of the craniofacial skeleton.

Results:

The functional matrix dictates the interplay between the soft tissue envelope and bone grafts, thus guiding donor site choice and inset methods. The soft tissue may also warrant the use of bony hypercorrection especially in cranial vault remodeling. Control of both bone and boundaries of the soft tissue functional matrix can be achieved via distraction osteogenesis.

Conclusion:

The soft tissue functional matrix must be accounted for during craniofacial bone grafting, mobilizing osteotomies, and distraction osteogenesis if optimal aesthetic results are to be obtained using the least amount of procedures.

Management of Pediatric Orbital Fractures

INTRODUCTION

Although uncommon in children, orbital fractures can be devastating to both vision and appearance. Due to the scarce information in the literature, the authors here present our experience and management with all pediatric orbital fracture patients.

MATERIAL AND METHODS

A 6-years retrospective study was conducted on pediatric patients presented with orbital wall fracture (OFx). All patients (n = 43) were grouped for comparison based on the treatment method. The cohorts were analyzed for demographics data, location of fracture, type of material used for reconstruction, complication rate and follow up length. Data was analyzed utilizing SPSS for χ2 test.

RESULTS

The majority of patients were male (86%) and the mean age of patients was 12.09 ± 4 years. Mean follow-up time was 237 ± 72 days. Most of Patients 31 (72%) underwent surgical intervention. A higher rate of complications was observed in the surgically treated group (32%) compared to the conservative group (8%) regardless to the defect size. Subgroup analysis of the surgery treated group revealed that large size defect had inferior outcome compared to small size defect.

CONCLUSION

The consequences of treatment on long-term growth and development must be a cornerstone when choosing the optimal therapeutic method. Conservative management should be considered first in the absence of significant clinical pathologies. In addition, when surgery is indicated the least invasive procedure should be applied. The use of autogenous bone graft is preferable over alloplastic materials, however, when there is insufficient bone quantity the use of alloplastic materials is not contraindicated for reconstruction.

Growth and sexual dimorphism of the hyoid bone and its relationship to the mandible from birth to 19 years: A three-dimensional computed tomography study

The hyoid bone and the hyomandibular complex subserve the functions of respiration, deglutition, and speech. This study quantified the growth of the hyoid bone and the hyomandibular relationships in males and females from birth to 19 years. Using 97 computed tomography (CT) scans, from a previous study (Kelly et al., 2017) on mandibular growth from 49 individuals (16 with longitudinal scans), landmarks were placed on 3D CT models and used to calculate four distance, and three angular measurements. A general increase in growth trend was observed in hyoid bone linear measurements-length, width, and depth-as well as relational mandible-to-hyoid distance, throughout the developmental ages examined in both males and females, with most variables having larger measurements for females up to age 10 years. A general decrease in all three angular measurements was observed in both males and females up to approximately age 12 years, at which time male angular measurements gradually increased with significant sexual dimorphism emerging after age 15 years. As expected, postpubertal males had greater hyoid angle than females; they also had greater hyoid angle of inclination than mandible body inclination (with inclination relative to the anterior-posterior nasal plane), likely related to hyo-laryngeal descent. This study contributes to normative data on hyoid bone and hyomandibular relational growth in typically developing individuals and provides a baseline against which structural and functional influences on anatomic growth may be examined by clinical disciplines that address the aerodigestive and speech functions, as well as the fields of anatomy, forensics, and anthropology.

Morphometric Variation at Different Spatial Scales: Coordination and Compensation in the Emergence of Organismal Form

It is a classic aim of quantitative and evolutionary biology to infer genetic architecture and potential evolutionary responses to selection from the variance–covariance structure of measured traits. But a meaningful genetic or developmental interpretation of raw covariances is difficult, and classic concepts of morphological integration do not directly apply to modern morphometric data. Here, we present a new morphometric strategy based on the comparison of morphological variation across different spatial scales. If anatomical elements vary completely independently, then their variance accumulates at larger scales or for structures composed of multiple elements: morphological variance would be a power function of spatial scale. Deviations from this pattern of “variational self-similarity” (serving as a null model of completely uncoordinated growth) indicate genetic or developmental coregulation of anatomical components. We present biometric strategies and R scripts for identifying patterns of coordination and compensation in the size and shape of composite anatomical structures. In an application to human cranial variation, we found that coordinated variation and positive correlations are prevalent for the size of cranial components, whereas their shape was dominated by compensatory variation, leading to strong canalization of cranial shape at larger scales. We propose that mechanically induced bone formation and remodeling are key mechanisms underlying compensatory variation in cranial shape. Such epigenetic coordination and compensation of growth are indispensable for stable, canalized development and may also foster the evolvability of complex anatomical structures by preserving spatial and functional integrity during genetic responses to selection.[Cranial shape; developmental canalization; evolvability; morphological integration; morphometrics; phenotypic variation; self-similarity.]

The Jaw Epidemic: Recognition, Origins, Cures, and Prevention

Contemporary humans are living very different lives from those of their ancestors, and some of the changes have had serious consequences for health. Multiple chronic "diseases of civilization," such as cardiovascular problems, cancers, ADHD, and dementias are prevalent, increasing morbidity rates. Stress, including the disruption of traditional sleep patterns by modern lifestyles, plays a prominent role in the etiology of these diseases, including obstructive sleep apnea. Surprisingly, jaw shrinkage since the agricultural revolution, leading to an epidemic of crooked teeth, a lack of adequate space for the last molars (wisdom teeth), and constricted airways, is a major cause of sleep-related stress. Despite claims that the cause of this jaw epidemic is somehow genetic, the speed with which human jaws have changed, especially in the last few centuries, is much too fast to be evolutionary. Correlation in time and space strongly suggests the symptoms are phenotypic responses to a vast natural experiment-rapid and dramatic modifications of human physical and cultural environments. The agricultural and industrial revolutions have produced smaller jaws and less-toned muscles of the face and oropharynx, which contribute to the serious health problems mentioned above. The mechanism of change, research and clinical trials suggest, lies in orofacial posture, the way people now hold their jaws when not voluntarily moving them in speaking or eating and especially when sleeping. The critical resting oral posture has been disrupted in societies no longer hunting and gathering. Virtually all aspects of how modern people function and rest are radically different from those of our ancestors. We also briefly discuss treatment of jaw symptoms and possible clinical cures for individuals, as well as changes in society that might lead to better care and, ultimately, prevention.

Nose approximation among South African groups from cone-beam computed tomography (CBCT) using a new computer-assisted method based on automatic landmarking

Considering the high demand for the identification of unknown remains in South Africa, a need exists to establish reliable facial approximation techniques that will take into account sex and age and, most importantly, be useful within the South African context. This study aimed to provide accurate statistical models for predicting nasal soft-tissue shape from information about the underlying skull subtract among a South African sample. The database containing 200 cone-beam computer tomography (CBCT) scans (100 black South Africans and 100 white South Africans). The acquisition and extraction of the 3D relevant anatomical structures (hard- and soft-tissue) were performed by an automated three-dimensional (3D) method based on an automatic dense landmarking procedure using MeVisLab © v. 2.7.1 software. An evaluation of shape differences attributed to known factors (ancestry, sex, size, and age) was performed using geometric morphometric and statistical models of prediction were created using a Projection onto Latent Structures Regression (PLSR) algorithm. The accuracy of the estimated soft-tissue nose was evaluated in terms of metric deviations on training and un-trained datasets. Our findings demonstrated the influence of factors (sex, aging, and allometry) on the variability of the hard- and soft-tissue among two South African population groups. This research provides accurate statistical models optimized by including additional information such as ancestry, sex, and age. When using the landmark-to landmark distances, the prediction errors ranged between 1.769mm and 2.164mm for black South Africans at the tip of the nose and the alae, while they ranged from 2.068mm to 2.175mm for the white subsample. The prediction errors on un-trained data were slightly larger, ranging between 2.139mm and 2.833mm for the black South African sample at the tip of the nose and the alae and ranging from 2.575mm to 2.859mm for the white South African sample. This research demonstrates the utilization of an automated 3Dmethod based on an automatic landmarking method as a convenient prerequisite for providing a valid and reliable nose prediction model that meets population-specific standards for South Africans.

Correlations between dental wear and oral cavity characteristics: Mandibular torus, palatine torus, and oral exostoses

OBJECTIVE

This study evaluates the correlations amongst mandibular torus, palatine torus, oral exostoses to dental wear/loss and temporomandibular damage.

METHODS

The sample consists of 504 skulls from the Hamann-Todd Osteological Collection; 223 African American and 281 European Americans aged between 30 and 80 years. The sample was analyzed using Pearson's Chi-square for significance of sex, age, ancestry, and wear as well as the interactions between the demographic variables and the presence of mandibular torus, palatine torus and oral exostoses.

RESULTS

Wear was statistically significant by age and sex but not ancestry. The maxillary exostoses varied significantly by age, ancestry and wear but not sex. Mandibular torus frequencies varied significantly by wear, sex and ancestry. The palatine torus varied significantly across wear groups, sex and ancestry.

DISCUSSION

The etiology of nonmetric oral cavity characteristics, mandibular torus, palatine torus and oral exostosis, is complex. The degree to which traits' presence and expression is the result of genetic and environmental interactions is not fully understood. More than age, sex or ancestry, the degree of dental wear and tooth loss influences the presence and expression of the oral cavity traits. The sample can be characterized as the presence of exostoses in higher frequencies in young African American males with little tooth loss. Males of both ancestral groups with heavy wear have higher frequencies of mandibular tori than females. The palatine torus is more common in edentulous European American females.

Do Exostoses Correlate with Contact Disfunctions? A Case Study of a Maxillary Exostosis

A maxillary exostosis is a benign overgrowth of bone that occurs on the outer or facial surface of the maxilla and is usually located near the premolar or molar teeth. This paper investigates the correlation between the presence and growth of jaw exostoses and the oral mechanics of contact. For this purpose, a case study of an upper jawbone exostosis of a female patient was considered. 3D models of the patient’s cranial bones were extracted from 2D computerized tomography (CT) data and were analyzed by proper software. A contact congruence evaluation based on the Winkler contact model was performed, and results were presented in terms of indentation maps and load distributions. Results were correlated with the theory of bone remodelling by Wolff.

Dietary material properties shape cranial suture morphology in the mouse calvarium

Cranial sutures are fibrous connective tissue articulations found between intramembranous bones of the vertebrate cranium. Growth and remodeling of these tissues is partially regulated by biomechanical loading patterns that include stresses related to chewing. Advances in oral processing structure and function of the cranium that enabled mammalian-style chewing is commonly tied to the origins and evolution of this group. To what degree masticatory overuse or underuse shapes the complexity and ossification around these articulations can be predicted based on prior experimental and comparative work. Here, we report on a mouse model system that has been used to experimentally manipulate dietary material properties in order to investigate cranial suture morphology. Experimental groups were fed diets of contrasting material properties. A masticatory overuse group was fed pelleted rodent chow, nuts with shells, and given access to cotton bedding squares. An underuse group was deprived of cotton bedding as well as diverse textured food, and instead received gelatinized food continuously. Animals were raised from weaning to adulthood on these diets, and sagittal, coronal and lambdoid suture morphology was compared between groups. Predicted intergroup variation was observed in mandibular corpus size and calvarial suture morphology, suggesting that masticatory overuse is associated with jaw and suture growth. The anterior region of the sagittal suture where it intersects with the coronal suture (bregma) showed no effect from the experiment. The posterior sagittal suture where it intersects with the lambdoid sutures (lambda) was more complex in the overuse group. In other words, the posterior calvarium was responsive to dietary material property demands while the anterior calvarium was not. This probably resulted from the different strain magnitudes and/or strain frequencies that occurred during overuse diets with diverse material properties as compared with underuse diets deprived of such enrichment. This work highlights the contrasting pattern of the sutural response to loading differences within the calvarium as a result of diet.

[The nose, an orthodontic-surgical marker]

INTRODUCTION

Inthe quest for a universal marker to describe the physiological function of facialmechanics, the author has found nasal ventilation at rest to be a major factor to beborne in mind.

MATERIALS AND METHODS

Factors related to embryology, anatomyand respiratory physiology, along with analysis of the literature in the relevantareas, now enable us to view the nose in a different light.

CONCLUSION

The authorconcludes that nasal ventilation at rest constitutes a mandatory objective in theperformance of all types of therapy.

Skeletal dimensions as predictors for the shape of the nose in a South African sample: A cone-beam computed tomography (CBCT) study

The profile of the nose is an important feature for facial approximations. Although several manual and semi-automated prediction guidelines exist for estimating the shape of the nose, the reliability and applicability of these methods to South Africans groups are unknown. The aim of this study was to predict the displacements of capulometric landmarks from hard-tissue planes to facilitate nasal soft-tissue reconstruction in a South African sample. Cone beam computed tomography (CBCT) scans of 120 adult South Africans were selected from the Oral and Dental Hospital, University of Pretoria, South Africa. Measurements involving craniometric and capulometric landmarks of the nose were obtained as plane-to-plane distances. Correlation coefficients between hard- and soft-tissue measurements were determined, and regression equations computed to assist in the prediction of the most probable shape and size of the nose. All hard- and soft-tissue measurements appeared significantly different between groups, except for the distance between the pronasale and nasion in the transverse plane and for the distance between the alare and the nasion in the coronal plane. The nasal height, nasal bone length and the nasal bone projection were significant predictors of the pronasale, subnasale and alare positions. More precisely, the nasal height and the nasal bone length were significant predictors of the pronasale position in both groups. Nasal bone projection was only useful for predicting shape in white South Africans. The variation in the skeletal predictors of the external shape of the nose noted between black and white South Africans and the results of the cross-validation testing emphasize the need for population specific guidelines.

Management of Craniofacial Development in the Parry-Romberg Syndrome: Report of Two Patients

Objective

The aim of this article is to describe the orthodontic therapy for Parry-Romberg syndrome. The therapeutic goal is to minimize the wasting effects of progressive atrophy on facial development of a part of the face.

Design

To correct problems affecting craniofacial development of these patients, occurring during puberty, an orthodontic appliance was employed, which helps maintain parallelism of the facial planes, in particular the mandibular plane.

Setting

Orthodontic care was carried out in the Dental Clinic of the Catholic University of the Sacred Heart of Rome.

Intervention

Two patients underwent orthodontic therapy for 6 years. Appliances were checked every month and modified periodically so as to adapt to facial bone growth.

Results

At the end of craniofacial growth, the mandible was almost symmetric and the problem relating to atrophy remained confined to the initial area. Cephalometric analyses demonstrated that the occlusal plane and the mandibular plane maintained a straight orientation in relation to the bizygomatic plane. The ratio between the left and right side of the ramus and condyle, in the mandible, improved.

Conclusions

The use of orthodontic therapy allows patients affected by hemifacial progressive atrophy to present a more harmonic face at the end of puberty when final reconstruction can be planned. These results provide for a limitation of surgical intervention to the sclerodermic area alone.

Soft Tissue Facial Angles in Individuals with Ectodermal Dysplasia: A Three-Dimensional Noninvasive Study

Objective

To supply quantitative information about the facial soft tissues of patients with hypohidrotic ectodermal dysplasia.

Design

Prospective assessment.

Setting

National meetings of hypohidrotic ectodermal dysplasia patients and families.

Patients and Main Outcome Measures

Facial and mandibular corpus convexities in the horizontal plane; facial convexity in the sagittal plane; interlabial, naso-labial, nasal convexity, and left and right soft tissue gonial angles were calculated from the three-dimensional coordinates of 11 soft tissue facial landmarks obtained in 18 male and 17 female hypohidrotic ectodermal dysplasia patients aged 3 to 41 years and in 504 reference healthy individuals. In addition, z-scores were computed and the patients were grouped by cluster analysis.

Results

Male and female z-scores did not differ. In the pooled group, facial convexities in the horizontal and sagittal planes were significantly (Student's t, p < .01) increased (flatter) in hypohidrotic ectodermal dysplasia patients, compared with normal controls. The naso-labial angle was significantly reduced (more acute). Upper and lower facial convexity and mandibular corpus convexity in the horizontal plane deviated less from the norm with increasing age. Facial convexity in the horizontal and sagittal planes, soft tissue gonial angles, and naso-labial and interlabial angles deviated less from the norm with increasing number of teeth present in the mouth. Cluster analysis identified three homogeneous groups, all characterized by a peculiar facial phenotype. Modifications in facial convexity and gonial and interlabial angles differentiated each cluster.

Conclusions

Patients with hypohidrotic ectodermal dysplasia had flatter faces in the horizontal and sagittal planes than normal controls had. Cluster analysis revealed patterned differences in facial phenotype.

Longitudinal Craniofacial Growth Patterns in Patients with Orofacial Clefts: Geometric Morphometrics

Objective

To demonstrate craniofacial developmental patterns in repaired cleft lip and cleft palate (CLP).

Design

Retrospective, longitudinal.

Setting

Center for Craniofacial Disorders, San Juan, Puerto Rico.

Sample

Males aged 9 to 17 years: 13 noncleft (NC) Class I occlusion (NCC1); 13 NC Class III malocclusion (NCC3); 12 CLP Class I occlusion (CLPC1); and 15 CLP Class III malocclusion (CLPC3).

Main Outcome Measures

Form changes (ages 10, 13, and 16 years), using finite-element scaling analysis.

Results

NCC1, 10 to 13 interval: 30% size increase in upper midface (p < .05), mental region (p < .01), mandibular body (p < .05); 13 to 16 interval: 10% to 35% size increase in bimaxillary region and ramus (p < .01). NCC3, 10 to 13 interval: 10% to 40% size increase in posterior cranial base, upper midface, and mandible (p < .05); 13 to 16 interval: 10% to 30% size increase in bimaxillary region (p < .01), especially ramus. CLPC1, 10 to 13 interval: 10% to 15% size increase in posterior cranial base (p < .01), midface (p < .05), and mandibular ramus (p < .05); 13 to 16 interval: 8% to 20% size increase in upper midface (p < .01), lower midface (p < .05), and mandible (p < .05). CLPC3, 10 to 13 interval: no significant changes; 13 to 16 interval: upper midface and cranial base show nonsignificant size decreases, but ramus showed size increase.

Conclusions

Noncleft and CLP Class 1 occlusion groups show similar craniofacial growth patterns. Noncleft Class III groups show excessive cranial and mandibular growth. Class III malocclusion in CLP patients is associated with clinically deficient craniomaxillary growth. Growth guidance may be indicated in children with CLP with unfavorable craniofacial growth patterns.

Heredity, Genetics and Orthodontics - How Much Has This Research Really Helped?

Uncovering the genetic factors that correlate with a clinical deviation of previously unknown etiology helps to diminish the unknown variation influencing the phenotype. Clinical studies, particularly those that consider the effects of an appliance or treatment regimen on growth, need to be a part of these types of genetic investigations in the future. While the day-to-day utilization of "testing" for genetic factors is not ready for practice yet, genetic testing for monogenic traits such as Primary Failure of Eruption (PFE) and Class III malocclusion is showing more promise as knowledge and technology advances. Although the heterogeneous complexity of such things as facial and dental development, the physiology of tooth movement, and the occurrence of External Apical Root Resorption (EARR) make their precise prediction untenable, investigations into the genetic factors that influence different phenotypes, and how these factors may relate to or impact environmental factors (including orthodontic treatment) are becoming better understood. The most important "genetic test" the practitioner can do today is to gather the patient's individual and family history. This would greatly benefit the patient, and augment the usefulness of these families in future clinical research in which clinical findings, environmental, and genetic factors can be studied.

Characterizing mandibular growth using three-dimensional imaging techniques and anatomic landmarks

OBJECTIVE

To provide quantitative data on the multi-planar growth of the mandible, this study derived accurate linear and angular mandible measurements using landmarks on three dimensional (3D) mandible models. This novel method was used to quantify 3D mandibular growth and characterize the emergence of sexual dimorphism.

DESIGN

Cross-sectional and longitudinal imaging data were obtained from a retrospective computed tomography (CT) database for 51 typically developing individuals between the ages of one and nineteen years. The software Analyze was used to generate 104 3DCT mandible models. Eleven landmarks placed on the models defined six linear measurements (lateral condyle, gonion, and endomolare width, ramus and mental depth, and mandible length) and three angular measurements (gonion, gnathion, and lingual). A fourth degree polynomial fit quantified growth trends, its derivative quantified growth rates, and a composite growth model determined growth types (neural/cranial and somatic/skeletal). Sex differences were assessed in four age cohorts, each spanning five years, to determine the ontogenetic pattern producing sexual dimorphism of the adult mandible.

RESULTS

Mandibular growth trends and growth rates were non-uniform. In general, structures in the horizontal plane displayed predominantly neural/cranial growth types, whereas structures in the vertical plane had somatic/skeletal growth types. Significant prepubertal sex differences in the inferior aspect of the mandible dissipated when growth in males began to outpace that of females at eight to ten years of age, but sexual dimorphism re-emerged during and after puberty.

CONCLUSIONS

This 3D analysis of mandibular growth provides preliminary normative developmental data for clinical assessment and craniofacial growth studies.

Assessment of Labionasal Structures in Patients With Unilateral Cleft Lip

INTRODUCTION

Unilateral cleft lip (UCL) patients have lip and nose deformities that must be addressed during lip repair. Currently, devices to achieve lip and nose improvements have been developed. The most researched presurgical molding device is the nasoalveolar molding (NAM), which has shown favorable results. However, clinical observation shows that unilateral cleft patients, even without molding devices, achieve spontaneous improvements. The aim of this study is to compare morphological and symmetry changes in nose and lip, between patients less than 30-day old and those submitted to cheiloplasty, at 6 months of age.

MATERIALS AND METHODS

A total of 27 UCL patients with 2 photographs were selected. The pictures were taken from frontal view and nasal base view at 2 distinct moments: before 30 days of life (t1) and at 6 months of age, during cheiloplasty surgery (T2). Images were analyzed with indirect measurement to assess lip and nose dimensions and nasal symmetry. ImageJ software was used to perform the analyses.

RESULTS

A total of 20 patients (P < 0.05) had an average cleft width reduction of 15% [standard deviation (SD) ± 11%]. A 55% average increase (SD ± 29%) was observed in nostril height of cleft side in 16 of patients (P < 0.05). There was an reduction in facial asymmetry of nostril width (P < 0.05), from 95% (SD ± 90%) (t1) to 59% (SD ± 50) (T2). Also, nasal base width asymmetry (P < 0.05) was decreased from 64% (SD ± 66%) (t1) to 40% (SD ± 29%) (T2).

CONCLUSION

Facial growth causes a natural improvement on cleft morphological changes and nasal symmetry.

Evolving concepts of heredity and genetics in orthodontics

The field of genetics emerged from the study of heredity early in the 20th century. Since that time, genetics has progressed through a series of defined eras based on a number of major conceptual and technical advances. Orthodontics also progressed through a series of conceptual stages over the past 100 years based in part on the ongoing and often circular debate about the relative importance of heredity (nature) and the local environment (nurture) in the etiology and treatment of malocclusion and dentofacial deformities. During the past 20 years, significant advancements in understanding the genomic basis of craniofacial development and the gene variants associated with dentofacial deformities have resulted in a convergence of the principles and concepts in genetics and in orthodontics that will lead to significant advancement of orthodontic treatments. Fundamental concepts from genetics and applied translational research in orthodontics provide a foundation for a new emphasis on precision orthodontics, which will establish a modern genomic basis for major improvements in the treatment of malocclusion and dentofacial deformities as well as many other areas of concern to orthodontists through the assessment of gene variants on a patient-by-patient basis.

The role of rapid maxillary expansion in the promotion of oral and general health

Rapid maxillary expansion (RME) is an effective orthopedic procedure that can be used to address problems concerned with the growth of the midface. This procedure also may produce positive side effects on the general health of the patient. The aim of the present consensus paper was to identify and evaluate studies on the changes in airway dimensions and muscular function produced by RME in growing patients. A total of 331 references were retrieved from a database search (PubMed). The widening of the nasal cavity base after midpalatal suture opening in growing patients allows the reduction in nasal airway resistance with an improvement of the respiratory pattern. The effects of RME on the upper airway, however, have been described as limited and local, and these effects become diminished farther down the airway, possibly as a result of soft-tissue adaptation. Moreover, limited information is available about the long-term stability of the airway changes produced by RME. Several studies have shown that maxillary constriction may play a role in the etiology of more severe breathing disorders such as obstructive sleep apnea (OSA) in growing subjects. Early orthodontic treatment with RME is able to reduce the symptoms of OSA and improve polysomnographic variables. Finally, early orthopedic treatment with RME also is beneficial to avoid the development of facial skeletal asymmetry resulting from functional crossbites that otherwise may lead to functional and structural disorders of the stomatognathic system later in life.

Development of the nasolacrimal apparatus in the Mongolian gerbil (Meriones unguiculatus), with notes on network topology and function

The nasolacrimal apparatus (NLA) is a multicomponent functional system comprised of multiple orbital glands (up to four larger multicellular exocrine structures), a nasal chemosensory structure (vomeronasal organ: VNO), and a connecting duct (nasolacrimal duct: NLD). Although this system has been described in all tetrapod vertebrate lineages, albeit not always with all three main components present, considerably less is known about its ontogeny. The Mongolian gerbil (Meriones unguiculatus) is a common lab rodent in which the individual components of the adult NLA have been well studied, but as yet nothing is known about the ontogeny of the NLA. In this study, serial sections of 15 fetal and three adult Mongolian gerbil heads show that the development of the NLA falls into three fetal stages: inception (origin of all features), elongation (lengthening of all features), and expansion (widening of all features). No postnatal or juvenile specimens were observed in this study, but considerable growth evidently occurs before the final adult condition is reached. The development of the orbital glands and the VNO in the Mongolian gerbil is largely consistent with those in other mammals, despite a slight nomenclatural conundrum for the anterior orbital glands. However, the Mongolian gerbil NLD follows a more circuitous route than in other tetrapods, due mainly to the convoluted arrangement of the narial cartilages, the development of a pair of enlarged incisors as well as an enlarged infraorbital foramen. The impact of these associated features on the ontogeny and phylogeny of the NLA could be examined through the approach of network science. This approach allows for the incorporation of adaptations to specific lifestyles as potential explanations for the variation observed in the NLA across different tetrapod clades.

Endocranial and masticatory muscle volumes in myostatin-deficient mice

Structural and functional trade-offs are integral to the evolution of the mammalian skull and its development. This paper examines the potential for enlargement of the masticatory musculature to limit the size of the endocranial cavity by studying a myostatin-deficient mouse model of hypermuscularity (MSTN-/-). The study tests the null prediction that the larger MSTN-/- mice have larger brains compared with wild-type (WT) mice in order to service the larger muscles. Eleven post-mortem MSTN-/- mice and 12 WT mice were imaged at high resolution using contrast enhanced micro-CT. Masticatory muscle volumes (temporalis, masseter, internal and external pterygoids) and endocranial volumes were measured on the basis of two-dimensional manual tracings and the Cavalieri principle. Volumes were compared using Kruskal-Wallis and Student's t-tests. Results showed that the masticatory muscles of the MSTN-/- mice were significantly larger than in the WT mice. Increases were in the region of 17-36% depending on the muscle. Muscles increased in proportion to each other, maintaining percentages in the region of 5, 10, 21 and 62% of total muscle volume for the external ptyergoid, internal pterygoid, temporalis and masseter, respectively. Kruskal-Wallis and t-tests demonstrated that the endocranial volume was significantly larger in the WT mice, approximately 16% larger on average than that seen in the MSTN-/- mice. This comparative reduction of MSTN-/- endocranial size could not be explained in terms of observer bias, ageing, sexual dimorphism or body size scaling. That the results showed a reduction of brain size associated with an increase of muscle size falsifies the null prediction and lends tentative support to the view that the musculature influences brain growth. It remains to be determined whether the observed effect is primarily physical, nutritional, metabolic or molecular in nature.