Are third molars associated with orofacial pain? Findings from the SHIP study

OBJECTIVES

To examine the association between third molars and orofacial pain. We hypothesized that impacted third molars are a cause of orofacial pain.

METHODS

Magnetic resonance images of 1808 participants from two population-based cohorts from Northeastern Germany were analysed to define the status of third molars according to the Pell and Gregory classification. A self-reported questionnaire and a clinical dental examination were used to detect chronic and acute complaints of orofacial pain, masticatory muscle pain, migraine and other types of headache. Logistic regression models were used to analyse the associations between third molar status and orofacial pain.

RESULTS

Individuals with impacted third molars in the maxilla had a higher chance of chronic orofacial pain than those with erupted third molars (odds ratio 2.19; 95% CI 1.19-4.02). No such association was detected for third molars in the lower jaw. Third molars were not associated with masticatory muscle pain, migraine or other types of headache.

CONCLUSIONS

Impacted maxillary third molars might be a cause of chronic orofacial pain. Thus, physicians should consider the eruption/impaction status of third molars in their decision-making process when treating patients who complain of orofacial pain.

Does craniofacial morphology affect third molars impaction? Results from a population-based study in northeastern Germany

Objectives

It is still not clear why impaction of third molars occurs. Craniofacial morphology and facial parameters have been discussed to be strong predictors for third molar impaction. Thus, this study aimed to investigate the effect of craniofacial morphology on erupted or impacted third molars in a German population sample.

Materials and methods

Erupted and impacted third molars in 2,484 participants from the Study of Health in Pomerania were assessed by whole-body magnetic resonance imaging. Markers of facial morphology were determined in 619 individuals of those participants in whose 421 participants (16.7%) had at least one impacted third molar. Craniofacial morphology was estimated as linear measurements and was associated in a cross-sectional study design with impacted and erupted third molars by multinomial logistic regression models. Erupted third molars were used as reference outcome category and regression models were adjusted for age and sex.

Results

Maximum Cranial Width (Eurion-Eurion distance) was significantly associated with impacted third molars (RR: 1.079; 95% confidence interval 1.028–1.132). This association was even more pronounced in the mandible. Individuals with a lower total anterior facial height (Nasion-Menton distance) and a lower facial index also have an increased risk for impacted third molars in the mandible (RR 0.953; 95% confidence interval 0.913–0.996 and RR: 0.943; 95% confidence interval 0.894–0.995). No significant associations of third molar status with facial width (Zygion-Zygion distance), and sagittal cranial dimension (Nasion-Sella distance; Sella-Basion distance) were observed.

Conclusion

Individuals with an increased maximal cranial width have a higher risk for impaction of third molars in the mandible and in the maxilla. Individuals with a lower anterior total anterior facial height and lower facial index also have an increased risk for third molars impaction in the mandible. These findings could help orthodontic dentists, oral surgeons and oral and maxillofacial surgeons in decision-making for third molars removal in their treatment. These findings highlight the necessity of an additional analysis of the maximal cranial width by the Eurion- Eurion distance.

Association of anthropometric markers with globe position: A population-based MRI study

Purpose

Exophthalmometry is a common examination in ophthalmology. For example it is relevant for diagnosis or follow-up of thyroid eye disease. However, exophthalmometry is affected by several factors such as ethnicity, sex and age. The purpose of this study was to determine the globe position by magnetic resonance imaging (MRI) and to investigate its correlates among the general Northeast German adult population.

Methods

A total of 3030 subjects aged between 20 and 89 from the population-based Study of Health in Pomerania (SHIP) underwent a standardised whole-body MRI. Axial length and globe position were determined in axial T1-weighted images of the orbit. The image had to include the corneal apex as well as the optic nerve head. Study participants were excluded from imaging analysis if there was no plane available that included both structures. Further exclusion criterion was a lateral deviation of the subject’s viewing direction. Images with inadequate quality due to motion artefacts or other technical reasons were excluded as well. Globe position was defined as the perpendicular distance between the interzygomatic line and the posterior surface of the cornea (exophthalmometric value). The distance between the posterior surface of the cornea and the posterior pole of the eyeball, at the boundary with orbital fat, was defined as axial length. We used posterior surface of the cornea for our measurements, because it seemed to be less vulnerable for motion artefacts than the anterior one. Moreover body measurements including body mass index (BMI), waist and hip circumferences were determined. Associations between anthropometric measurements with exophthalmometric outcomes were analysed by linear regressions adjusted for age and stratified by sex. P-values <0.05 were considered as statistically significant. To assess intra-reader variability intra-class correlation coefficients (ICC) were computed for repeated measurements of the MRI scans of 25 subjects.

Results

After considering the exclusion criteria 1926 evaluable subjects remained. There was no significant difference between means of right and left eyes. The mean exophthalmometric value was significantly higher in men (16.5 +/- 2.2 mm) than in women (15.3 +/- 2.1 mm). The mean MRI-axial length was 23.4 +/- 0.8 mm for men and 22.8 +/- 0.9 mm for women. BMI, waist and hip circumferences were positively correlated with exophthalmometric value (p<0.001). Difference of mean MRI-based exophthalmometric value for obese subjects (BMI ≥30 kg/m²) and non-overweight (BMI <25 kg/m²) was 2.1 mm for men and 1.6 mm for women. ICC between 0.97 and 0.99 indicate excellent repeatability of our method.

Conclusion

We conclude that MRI-based exophthalmometric values are positively correlated with BMI, waist- and hip-circumference among the general Northeast German adult population. This association is independent from age and axial length. Consequently bodyweight of patients should be regarded to interpret exophthalmometric values correctly. MRI-exophthalmometry seems to be a suitable method to determine globe position. Considering the large number of study participants, exophthalmometric values of our study could be used as comparative values for exophthalmometry of people of Western European descent in future.

Third molars and periodontal damage of second molars in the general population

AIM

The aim of this study was to clarify the association between impacted or erupted third molars and periodontal pathology, assessed by probing depth (PD) and clinical attachment levels (CAL), in adjacent second molars.

MATERIALS AND METHODS

Data from the population-based Study of Health in Pomerania (SHIP) was used. This is the first project with whole-body magnetic resonance imaging (WB-MRI) application in a general population setting with dental issues. Calibrated and licensed dentists measured PD and CAL with a periodontal probe.

RESULTS

In the mandible, individuals with erupted third molars had a 1.45-fold higher odds ratio (CI:1.03; 2.05; p = 0.031) and individuals with impacted third molars had a 2.37-fold higher odds ratio (CI:1.45; 3.85; p < 0.001) to have higher PD values in the adjacent distal site of second molar than individuals with missing third molars in the total population. These significant associations were even more pronounced in the population free of periodontitis disease. In participants with periodontitis in the maxilla, there was an association of erupted third molars with an increased PD of adjacent molars.

CONCLUSION

In particular, in the mandible, those findings could guide dental practitioners more in the direction to remove the third molars after having evaluated the periodontium of the adjacent teeth.

Daris R. Swindler (1925-2007)

N/A

Sinuses and flotation: does the aquatic ape theory hold water?

The idea that people went through an aquatic phase at some time in their evolutionary past is currently undergoing a popular resurgence (see Foley & Lahr). This idea has even started to gain some traction in more learned circles; the late paleoanthropologist Phillip Tobias wrote in support of aspects of it in an edited e-book and a conference on the topic held recently in London was endorsed by celebrities such as the television presenter Sir David Attenborough. Despite (or perhaps because of) the lack of interest within the academic community, advocates of the concept continue to fill the media (and blogosphere) with challenges to the "savannah hypothesis" of the origins of people and to bemoan the fact that their views are not taken seriously by mainstream academia.

Three-dimensional micro-imaging (μCT) based physical anatomic teaching models: implementation of a new learning aid for routine use in anatomy lectures

The aim of our project is the development and implementation of μCT based plastic anatomical models to make them commercially available as an anatomy learning tool for students at all levels. High resolution μCT of human ossicles and trabecular bone was performed. After image processing, application of rapid prototyping and rapid manufacturing technologies, enlarged physical teaching models, magnified by a factor of 20, were built and provided an accurate representation of the human anatomy.

Functional anatomy of the nose

The human nose is a very complex entity with a great amount of variation among and within different human populations. Even though the morphology of the nasal pyramid and its soft tissue coverage is principally known, a standardized nomenclature does not yet exist. The past two decades have witnessed a considerable increase of new studies on the functional morphology of the external nasal anatomy. Detailed anatomic and clinical knowledge about the external nose is a prerequisite for successful rhinosurgery, thus this report deals with the basic structures necessary for functional and aesthetic rhinoplasty.

Factors affecting the variation in the adult temporomandibular joint of archaeological human populations

To elucidate factors that may affect the variation in the bony components of temporomandibular joint (TMJ), a preliminary study was conducted on the temporal articular surface of the TMJ of 30 skulls from Iron Age and medieval populations from Lithuania and a mixed Neolithic and Bronze Age population from the Central Elbe-Saale region (CESR). Using three-dimensional (3D) photos of the skulls, length and width measurements of the TMJ were obtained and compared with external skull measurements. Distinct, random variation between the TMJ values from opposite sides of the cranium were identified as fluctuating asymmetry. ANOVA results suggest significant differences in the length of the TMJ between the population of the CESR and the two Lithuanian populations, but not between the two Lithuanian populations. Environmental factors, including geography, may be responsible for the variation in the TMJ form.

Maxillary sinus pneumatization of an adult skull with an untreated bilateral cleft palate

INTRODUCTION

Patients with clefts of lip, alveolus and palate show a high incidence of maxillary sinusitis. In order to evaluate sinus size as a factor in sinusitis, this study investigates maxillary sinus morphology in an adult skull with an untreated bilateral cleft.

MATERIAL AND METHODS

The maxillary sinus volume (MSV) of a mixed-sex sample of 140 adult skulls from three different populations was assessed and compared with the MSV of a skull of a 25 year old man showing an untreated complete bilateral cleft. A least squares regression analysis was used to investigate the relationship between MSV and different external cranial dimensions.

RESULTS

The cleft skull shows a well-developed set of paranasal sinuses. There are close, significant relationships between MSV and the cranial measurements. The cleft skull had a MSV that does not deviate substantially from that predicted from the size of its facial skeleton.

CONCLUSION

This study indicates a close link between the size of the facial skeleton and the MSV in humans, even in case of an untreated bilateral cleft. This, in conjunction with the existing literature, makes it extremely unlikely that the sizes of the paranasal sinuses are a factor for sinusitis in patients with cleft lip, alveolus and palate.

Cartilaginous septum deviation in children with cleft lip, alveolus and palate--an MRI analysis

INTRODUCTION

This study aimed to investigate by MRI examination the degree of deviation of the cartilaginous septum in relation to cleft size in patients with cleft lip, alveolus and palate.

MATERIAL AND METHODS

Six children with cleft lip, alveolus and palate at age 5-20 days were examined with a 1.0 Tesla scanner using a head coil. The following parameters were evaluated: maximal cleft size (millimeter) and degree of the nasal septum deviation from the median-sagittal plane (degrees).

RESULTS

Two children with bilateral clefts had no deviation; 3 children with unilateral (left-sided) cleft had a deviation to the right and 1 patient with a unilateral right-sided cleft a deviation to the left side. In all 4 patients, the degree of the nasal septum deviation increased with cleft size.

CONCLUSION

Cartilaginous nasal septum deviation was noticed only in patients with unilateral cleft lip and palate toward the non-cleft side and was greater with increasing cleft sizes.

Morphofunctional changes of orofacial muscles in patients with unilateral or bilateral cleft lip, alveolus and palate

The facial musculature is part of a biocybernetic feedback system within the stomatognathic system, the continuity of which is disturbed by clefts of the lip, jaw, and palate (cheilognathopalatoschisis). This results in topographic, fine-structural and functional alterations of the facial musculature. In two heads with unilateral clefts and two heads with bilateral clefts, the facial musculature was dissected and the M. orbicularis oris macroscopically and topographically examined. We found changes in the attachment of the M. orbicularis oris. The modiolus, which is coresponsible for the proper topographic relation of the M. obicularis oris to the other facial muscles, was unchanged. Further, we examined the vascular system of the muscle, which likewise adapts to the altered situation. Lip/jaw/palatal clefts result in anatomically functional and fine-structural alterations of the M. orbicularis oris, while the rest of the facial musculature remains unchanged.

Maxillary sinus atelectasis in a wild born gibbon (Hylobates moloch)

In a mixed sex sample of ten adult gibbon (Hylobates moloch) skulls, one cranium of a male with maxillary sinus atelectasis of the left side was identified. While external inspection revealed a slight drop of the left orbital floor, serial coronal computer tomography (CT) scans show characteristic changes of the left maxillary sinus and its surrounding structures. In addition to the sunken orbital floor, radiological features of the specimen include an inward bowing of the medial sinus wall, sinus opacification, and a reduction in maxillary sinus size to a slit-like cavity, which suggest a diagnosis of silent sinus syndrome. This report is the first, to our knowledge, of maxillary sinus atelectasis in a non-human primate. This finding is valuable for the understanding of the pathogenesis and etiology of maxillary sinus atelectasis. At the same time, however, paleoanthropologists and primatologists may refer to this information when dealing with the interpretation of maxillary sinus pneumatization of partially broken archaeological and fossil skulls.

Extensive enlargement of the maxillary sinus in Alouatta caraya (mammalia, primates, cebidae): an allometric approach to skull pneumatization in Atelinae

In contrast to the paranasal sinuses of Old World monkeys and hominoids, little information is available about the paranasal sinuses of New World monkeys. Because this information is crucial in order to draw further conclusions about the evolution and biological role of skull pneumatization, this study investigates the morphology of the paranasal sinuses in adult black-and-gold howler monkeys (Alouatta caraya). Volumes of the paranasal sinuses were calculated using computer software (SURFdriver or Allegro) from serial coronal CT scans of 20 skulls of both sexes. Skull pneumatization in A. caraya is more complex than in other higher primates. In both sexes, the maxillary sinus (MS) is the only pneumatic cavity and enlarges regularly into neighboring bones such as the frontal bone and the basisphenoid. The resulting pansinus is often partitioned by several vertical septa. As in most external cranial dimensions, mean MS volume of A. caraya (male 4.08 cm(3); female 2.00 cm(3)) shows significant sexual dimorphism. Reduced major axis regression analysis between MS volume and different cranial dimensions for A. caraya (and for available data from other platyrrhines) suggests a distinct association for this group, with Alouatta having one of the largest pneumatic cavities. The combination of this unusual expansion of the MS of Alouatta and the occurrence of distinct septa within the sinus may be a consequence of the distinct skull architecture of Alouatta.

Metric sexual dimorphism in the deciduous teeth of old world monkeys

Metric variability of the deciduous teeth of several Old World monkey taxa were examined at the intergeneric and interspecific taxonomic levels. In general, the deciduous teeth of these taxa lack significant size sexual dimorphism with the exception of Papio cynocephalus. The data clearly demonstrate that male dimensions are not consistently larger than those of the females, in fact, female dimensions are frequently larger than those of the male. Thus, negative percentage sexual dimorphism is present in all species except Papio cynocephalus. Tooth size differences are randomly distributed among these species and do not appear to have any anatomical significance with respect to the different diets of the colobine and cercopithecine monkeys. This odontometric analysis reveals that it would be problematical to use deciduous tooth size as a basis for species identification with the possible exception of Papio cynocephalus.

The term "lateral recess" and craniofacial pneumatization in old world monkeys (Mammalia, Primates, Cercopithecoidea)

The primate superfamily Cercopithecoidea (or Old World monkeys) is characterized by a widespread lack of the maxillary sinus, a paranasal pneumatic space found in most other eutherian mammals. Previous discussions of the distribution of pneumatization in the group, however, have been ambiguous and contradictory, and have been further complicated by discussion of a poorly defined structure named the "lateral recess," linked implicitly to the maxillary sinus. Computed tomography (CT) was applied to dry crania of all cercopithecoid genera to evaluate the morphological relevance of the term "lateral recess." Results suggest that the "lateral recess" is a structural consequence of changes in skull form unrelated to pneumatization. Thus, the term should be abandoned. All Old World monkeys (except the genus Macaca) are found to lack the maxillary sinus, but a previously undescribed bulla, only separated from the nasal cavity anteriorly, was discovered in the Chinese golden monkey Rhinopithecus. If this bulla is related to the paranasal sinuses, it suggests that the initial change in cercopithecoid cranial evolution was a suppression of pneumatic development, which may have been subsequently reversed twice in the history of the group, in Macaca and Rhinopithecus.

Clinal variation of maxillary sinus volume in Japanese macaques (Macaca fuscata)

Macaques (genus Macaca) are unique among cercopithecids in that they possess a maxillary sinus, and among anthropoids in that they demonstrate a relatively weak relationship between the size of this sinus and the cranium. To test the hypothesis that extrinsic factors may contribute to maxillary sinus size variation, a sample of 46 Japanese macaque (M. fuscata) crania from known localities were subjected to computed tomography (CT) imaging, and sinus volume and nasal cavity area were analyzed relative to latitude and temperature variables. The results suggest that the environmental factors are significant determinants of nasal cavity size in Japanese macaques, but that the relationships between the environment and maxillary sinus volume (MSV) are probably a passive consequence of changes in the size of the nasal cavity. The sinus shrinks as the nasal cavity expands, due to an increased need to condition inspired air in colder climates. This in turn suggests that the sinus itself does not contribute significantly to upper respiratory function.

Ancestral loss of the maxillary sinus in Old World monkeys and independent acquisition in Macaca

Cercopithecoid monkeys are unique among primates in that all species (except macaques) lack a maxillary sinus, an unusual condition among eutherian mammals. Although this uncommon distribution of cranial pneumatization was noted previously, the phylogenetic ramifications have not been investigated fully. Recently, character state optimization analysis of computed tomography (CT) data from extant Old World monkeys suggested that the loss of the sinus may have occurred at the origin of the group, unlike previous hypotheses positing only a reduction in size of the structure. To critically evaluate the "early loss" hypothesis, a recently recovered complete cranium of Victoriapithecus macinnesi from Maboko Island, Kenya, was examined by CT to determine the extent of its cranial pneumatization. This taxon is crucial for evaluating character state evolution in Old World monkeys, due to its phylogenetic position, preceding the cercopithecine/colobine split. CT analysis reveals only cancellous bone lateral of the nasal cavity, indicating that Victoriapithecus does not possess a maxillary sinus. Phylogenetic evaluation of the fossil with extant catarrhine taxa strongly supports the early loss of the sinus in cercopithecoids. The results suggest that the maxillary sinus found in the genus Macaca is not homologous with that of other eutherians, which may provide insights into the origin and function (if any) of the paranasal pneumatizations.

Growth pattern of the maxillary sinus in the miniature pig (Sus scrofa)

The biological role of the paranasal sinuses is obscure, can be elucidated through a cross-sectional growth study of the maxillary sinus in miniature pigs. The maxillary sinus area was obtained from lateral cephalograms of left skull halves of 103 female miniature pigs of known ages, from newborn to 24 months. Out of several nonlinear models, the growth of the maxillary sinus was best described with the Gompertz model. The first derivative of the Gompertz curve revealed an increase in the growth rates of the maxillary sinus until 4 months, after which sinus growth slowed down. The eruption of the permanent molars did not seem to have a significant influence on this growth pattern. Furthermore, growth in maxillary sinus size in the miniature pig does not follow growth in skull size closely, which showed the highest growth rates in newborn animals. In addition, a correlation analysis revealed that the relationship between maxillary sinus area and different characteristics of the masticatory apparatus (including linear cranial dimensions, and the dry weight of the masseter and zygomatico-mandibularis muscles) were influenced greatly by skull size. These results suggest that the existence of pneumatic cavities within the mammalian skull is not satisfactorily explained solely by an architectural theory. Epigenetic factors are likely to influence the final shape of the maxillary sinus.

Isometric scaling of maxillary sinus volume in hominoids

Previous hypotheses of maxillary sinus size evolution have proposed one or more changes in the volume of the structure across hominoid phylogeny. These hypotheses have been used subsequently to support the phylogenetic placement of fossil taxa relative to the living Hominoidea. The null hypothesis, that no change in sinus volume independent of size has occurred in ape evolution, is evaluated here by scaling analysis. Mixed sex samples of adult dry crania for the extant ape genera were examined by computer tomography imaging and the volume of the maxillary sinus was obtained. Sinus volume was then regressed, using both least squares and reduced major axis models, against cranial size variables. The results clearly demonstrate that the null hypothesis of no change in relative sinus volume cannot be rejected; thus, there is no support for hypotheses that maxillary sinus volume, independent of cranial size, has changed in the course of hominoid evolution. This result, in turn, has implications for the phylogenetic placement of fossil taxa and highlights the need for the careful delineation of character states in studies of hominoid systematics.

A longitudinal study of the growth pattern of the maxillary sinus in the pig-tailed macaque (Macaca nemestrina)

The ontogeny of sexual dimorphism in maxillary sinus size in a nonhuman primate was studied longitudinally for a period of 8 years in 25 female and 25 male Macaca nemestrina via lateral cephalograms. The maxillary sinus was traced and its area digitized. The growth of female maxillary sinuses was described with a Gompertz model; the best fit to the male data was obtained by the logistic model. Growth curves and confidence intervals revealed that the sinuses grew in a similar fashion for 3-4 years in both sexes. After this, female sinuses achieved a plateau in their development while male sinuses continued to grow. Confidence intervals suggested that size dimorphism appeared at the age of 6.3 years. Lowess regression indicated growth spurts in both sexes. Females experienced an earlier and smaller spurt than males. Sexual dimorphism in maxillary sinus size seems to represent a combination of differences in velocity and length of growth. This study indicates that growth of the maxillary sinus follows closely the growth in body size. Nevertheless, due to the variation in sinus size in Macaca, it is questionable if body size is the main determinant of maxillary sinus size. It is suggested that Macaca, with its wide geographic range and different environments, is an especially appropriate genus to use to test hypotheses about the evolution of skull pneumatization in primates.

Influence of craniofacial morphology on primate paranasal pneumatization

In order to test the hypothesis that variation in the maxillary sinus volume (MSV) of anthropoid primates is related to skull architecture, a mixed sex sample of adult primate crania covering Hominoidea, Cercopithecoidea and Ceboidea was examined using CT scans. MSV was regressed against basicranial length, using reduced major axis analysis. 2 distinct scaling patterns emerged: while a large MSV seems to be a primitive condition of Anthropoidea, it is clearly reduced in Cercopithecoidea. Although some correlations exist between MSV and different indices of the facial skeleton, they are relatively weak and differed among the 3 groups. A full appreciation of epigenetic factors and the relation of the paranasal sinuses to different cranial components is necessary to highlight the biological role of skull pneumatization.

Growth pattern of the maxillary sinus in the Japanese macaque (Macaca fuscata): reflections on the structural role of the paranasal sinuses

To investigate the claim that the primate paranasal sinuses possess not a functional but a structural role associated with the skull architecture (Blaney, 1990), the relationship between the maxillary sinus and the skull architecture was studied ontogenetically in 30 skulls of male and female Japanese macaques (Macaca fuscata). Coronal CT scan series and computerised 3-dimensional images served to evaluate the maxillary sinus. The definitive hemispherical shape of the sinus was already achieved after the completion of the primary dentition. Sinus volume increased with a trend indicating positive allometry. When compared with an ontogenetic data set of orang-utan (Koppe et al. 1995), however, the growth rate of the maxillary sinus of M. fuscata was significantly less. The maxillary sinus both of male and female macaques enlarged according to a common growth pattern. However, no sexual dimorphism could be established for the maxillary sinus size. Although the volume of the right maxillary sinus was normally bigger than that of the left side, the results suggested that asymmetry in maxillary sinus volume is related neither to skull size nor sex. Whereas a correlation analysis showed close relationships between the maxillary sinus volume and external cranial dimensions, the partial correlation coefficients revealed that these relationships were highly influenced by skull size. Although it cannot be ruled out that the paranasal sinuses are to some extent linked to the skull architecture, this study does not support a solely structural role for these air cavities.

The course of the mandibular canal in the growing miniature pig

Miniature pigs are extensively used as laboratory animals in studies concerning craniofacial growth and adaptation. However, in contrast to the vast amount of literature regarding the overall growth pattern of the pig's mandible, little is known about the internal structures of the mandible such as the mandibular canal. In order to investigate the position of the mandibular canal (MC) and the thickness of its buccal and lingual walls, a cross-sectional study was performed on female miniature pigs MINI-LEWE covering the period from newborn to adult. The position of the MC was analyzed at bony segments that were obtained by cutting the drys mandibles interdentally. At each segment a central point of the MC was defined and its relation to the buccal and lingual margin of the mandible was measured. Located at the lower part of the mandibular corpus, the MC runs in the form of an arch within the sagittal plane in anterior direction, getting enlarged into the form of an ampulla in the molar and premolar region. Whereas during the primary dentition the biggest size of the MC was found behind the third deciduous molar, during the secondary dentition the biggest size of the MC was seen in the region of the first and second permanent molar. With regard the buccolingual aspect, the central point of the MC was found mainly in the center of the mandibular corpus. Between the 2nd and 5th month as well as at the beginning of the 18th month the thickest canal wall existed on the buccal side. In the period of the eruption of the succedaneous teeth, however, the lingual wall was thicker than the buccal wall. Results suggest that the definite course of the MC achieves relatively early in the miniature pig with the completion of the primary dentition. There were no major changes of the position of the MC in the postnatal period suggesting that the age factor has only a minor effect on the location of the MC.

The relationship between the palatal form and the maxillary sinus in orang-utan

The relationship between the palatal form and the maxillary sinus was studied in 40 skulls of male and female Bornean orangutans (Pongo satyrus borneensis) ontogenetically. Univariate analyses of the measurements of the palate and the maxillary sinus showed that the sexual dimorphism appeared earlier in palatal length than in the maxillary sinus volume. Bivariate statistical analyses, including correlation and linear regression analyses, revealed close relationships between the characteristics of the palate and the maxillary sinus for both the growth period and the adult status. Partial correlation coefficients showed, however, that these relations were highly influenced by the skull size. Except significant correlations between the maxillary sinus width and the palatal volume in the adult status, all partial correlation coefficients were clearly below the Pearson's correlation coefficients. In contrast to the situation in humans, this study suggests that under physiological conditions the influence of the palatal form on the maxillary sinus size in the orang-utan is very small. Alterations of the craniofacial morphology during the evolution of the hominids, such as facial reduction and decrease of the maxillary sinus size, are considered important factors which led to changes of the relations between the palatal form and the maxillary sinus.

Growth pattern of the maxillary sinus in orang-utan based on measurements of CT scans

The postnatal growth of the maxillary sinus was analyzed in 20 male and 20 female skulls of orang-utan (Pongo satyrus borneensis) in 5 age steps. Coronal CT scans were carried out of all skulls using a computed tomograph Siemens SOMATOM DR. The distances between the CT scans were always 4 mm. The outline of the maxillary sinus was surrounded on the CT scans with a planimeter and then the volumes were calculated. Using a growth model introduced by Fanghänel (1974), growth functions for the volume measurements for male and female animals were calculated separately. The growth curves showed a particular course, which was characterized by a quick rise until the age of 15 years. After the age of 20 years the curves for females orang-utan became gradually flat. At the age of 21 to 23 years the confidence intervals of the growth curves for male and female orang-utan began to drift apart, indicating the appearance of a sexual dimorphism. Using the basicranial length as an indicator of skull size, it becomes evident, that the sexual difference in the maxillary sinus' volume is probably based on the fact, that the maxillary sinus' volume of the male orang-utan increases further on following a common growth pattern.

Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years

Of 118 child and adolescent schizophrenic patients (ICD-9: 295.x; mean onset age 16.0 years), 97 (82.2%) could be completely investigated at follow-up (mean interval 7.4 years; mean age 23.1 years). At follow-up 30% of the patients were semi-dependent or dependent, 72% still required psychiatric treatment, 44% were at least moderately impaired with regard to educational/occupational functions and 58% with regard to social functions; 73% had experienced at least one further schizophrenic episode. Comparison with schizophrenia beginning in adulthood showed that the impairment in social function was much greater in the younger group of patients. These results support the belief that schizophrenic psychoses starting in adolescence have a worse outcome than those beginning in adulthood. The most efficient indicators for a worse outcome were long duration of inpatient treatment at first admission, a high number of symptoms and low social competence at discharge.

Investigations on the growth pattern of the maxillary sinus in Japanese human fetuses

The growth pattern of the maxillary sinus was analyzed using 18 human fetuses of both sexes between 9 and 21 weeks of age postconception. The paraffin embedded specimens were cut in series in the frontal and the transversal plane, respectively. The inner surface of the maxillary sinuses was redrawn and surrounded with a digitizer and then the volumes were calculated. A correlation analysis as well as a simple linear regression analysis between the values of the maxillary sinus, different linear values of the nasal cavity and the crown-rump length (CRL) served to prove possible growth relations. The maxillary sinus' Anlage was already identifiable in the 29.8 mm (CRL) fetus. From this first appearance, the maxillary sinus expands not only in posterior direction but also in anterior direction from 11 weeks onwards. The maxillary sinus volume increased from 0.0008 mm3 at the age of 9 weeks to more than 9 mm3 at the age of 21 weeks. The results of the statistical analysis indicated, that the relationship between the maxillary sinus' Anlage and the nasal cavity were strongly influenced by the body size (CRL). This study suggests, that the growth of the maxillary sinus follows special regularities in the early fetal development.

Morphometric studies on the facial skeleton of humans and pongids based on CT-scans

The changes of the skull, which we can observe during the anthropogenesis, are reflected especially in the different skull proportions. We carried out metric measurements at the median level on 10 adult skulls each of humans, chimpanzees and gorillas as well as 11 skulls of orangutans. All skulls were scanned with a CT at the median level. We measured the lines and angles of the scans and the means and the standard deviations were calculated. We carried out a correlation analysis to observe the relation of their characteristics. We showed that there is a relation between the length of the skull base and the facial length in all species. From the results of the correlation analysis, we can also conclude that a relation exists between the degree of prognathism and the different length measurements of the facial skeleton. We also found a bending of the facial skeleton in relation to the cranial base towards the ventral side, also known as klinorhynchy, in all observed species. The highest degree of klinorhynchy was found in humans and the lowest in orangutans. We will discuss the different definition of the term klinorhynchy and its importance in the evolution of the hominoids.

On the postnatal growth of the canalis mandibulae in the miniature pig

The shape and the growth of the canalis mandibulae in female miniature pigs, MINI-LEWE, were analysed in 11 postnatal age steps. The lower jaw halves were cut frontally in a defined position and the heights and widths of the canalis mandibulae were measured. Changes in the shape of the canalis mandibulae in the frontal saw cuts were observed with regard to the dentition. After the eruption of the deciduous teeth there was no further change in shape. Growth curves of the mandibular canal's measures reached a peak during the eruption of the deciduous teeth and the first molar, decreasing significantly afterwards. A close correlation was observed between the measures of canal height and canal width. On the other hand there was only a slight correlation with the external measures of the mandible, which suggests that there are different growth processes.

[Study of the degree of pneumatization of the viscerocranium in man and pongidae]

The volumes of the paranasal sinuses of 41 adult skulls of humans, gorillas, chimpanzees and orangutans, were examined with use of a Computertomograph type SOMATOM DR. The percentage distribution of the volumes of the different paranasal sinuses showed that the maxillary sinus always had the greatest volume. The maxillary sinus of the humans showed the smallest volume percentage in comparison with the pongids. The typical differences between humans and pongids were observed in the ethmoidal cells and the sphenoidal sinus. The ethmoidal cells of the gorilla and the orangutan have to be defined as rudimentary. Those of the humans come to more than 20% of the total volume of the paranasal sinuses of all hominoids. Differing from the humans, the sphenoidal sinus of the pongids pneumatizes almost the whole sphenoid bone. This volume percentage of the pongids is twice as high as that of the humans. In addition, an index was calculated from the volume of the facial skeleton volume and the total volume of the paranasal sinuses and defined as the degree of pneumatization. We found that the gorilla has the highest degree of pneumatization followed by the chimpanzee, the orangutan, and the humans. The lowest degree of pneumatization of the humans may be related to the reduction of the jaws.

[Prevalence and follow-up of psychiatric disorders in childhood and adolescence. Results of a prospective epidemiologic longitudinal study from ages 8-18 years]

In a prospective longitudinal epidemiological study with assessments at age 8, 13 and 18 the prevalence rate for psychiatric disorders remained constant at about 16%. The sex ratio for severe disorders was male dominated even in adolescence, which was a consequence of the high rate of unsocialized disturbances of conduct in boys. Persistence of psychiatric disorders between age 13 and 18 was about 50%, as had previously been the case between age 8 and 13. One child in four suffered from a psychiatric disorder for at least 10 years. In childhood, conduct disorders had a very poor prognosis and emotional disorders a very good one. In adolescence, the course of disorders depended on an interaction between diagnosis and gender. Boys with unsocialized disturbances and girls with emotional problems had a poor prognosis.