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Concept: Bones of the head and neck

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Recently we reported the development of prominent exostosis young adults' skulls (41%; 10-31 mm) emanating from the external occipital protuberance (EOP). These findings contrast existing reports that large enthesophytes are not seen in young adults. Here we show that a combination sex, the degree of forward head protraction (FHP) and age predicted the presence of enlarged EOP (EEOP) (n = 1200, age 18-86). While being a male and increased FHP had a positive effect on prominent exostosis, paradoxically, increase in age was linked to a decrease in enthesophyte size. Our latter findings provide a conundrum, as the frequency and severity of degenerative skeletal features in humans are associated typically with aging. Our findings and the literature provide evidence that mechanical load plays a vital role in the development and maintenance of the enthesis (insertion) and draws a direct link between aberrant loading of the enthesis and related pathologies. We hypothesize EEOP may be linked to sustained aberrant postures associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets. Our findings raise a concern about the future musculoskeletal health of the young adult population and reinforce the need for prevention intervention through posture improvement education.

Concepts: Biology, Prediction, Future, Occipital bone, Bones of the head and neck, Inion, Squama occipitalis, External occipital protuberance

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A 20-year-old man was transferred to this hospital because of recurrent ear pain for 8 months despite antibiotics, with new fever and headache. Imaging showed opacification of the middle ears and mastoid air cells and erosion of the right temporal bone.

Concepts: Cartilage, Skull, Middle ear, Temporal bone, French Revolution, Bones of the head and neck, Mastoiditis, Jimmy Eat World

28

The early treatment of Class III malocclusion with a protraction facemask can produce forward movement of the maxilla but is generally associated with posterior rotation of the mandible and dentoalveolar compensations. This article shows the dental and skeletal effects of intermaxillary elastics applied to temporary anchorage devices in the treatment of maxillary deficient Class III patients.

Concepts: Mouth, Maxilla, Dental anatomy, Sanskrit, Bones of the head and neck, Dental consonant

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PURPOSE: This study aimed to investigate the anatomy of the infraorbital foramen (IOF), infraorbital canal (IOC), and infraorbital groove (IOG) with regard to surgical and invasive procedures using three-dimensional reconstruction of CT scans. METHODS: The CT scans of 100 patients were evaluated retrospectively. The morphology of the IOF, IOC, and IOG as well as their relationships to different anatomic landmarks was assessed in a three-dimensional model. RESULTS: The mean length of the IOC and IOG and the angle of the IOC relative to IOG were 11.7 ± 1.9, 16.7 ± 2.4 mm, and 145.5° ± 8.5°, respectively. The mean angles of the IOC relative to vertical and horizontal planes were 13.2° ± 6.4° and 46.7° ± 7.6°, respectively. In the relationships between the IOF and different anatomic landmarks, the mean distances from the IOF to supraorbital notch/foramen, facial midline, and infraorbital rim were 5.6 ± 3.1 mm laterally, 26.5 ± 1.9 mm laterally, and 9.6 ± 1.7 mm inferiorly, respectively. The mean distance from the IOF to anterior nasal spine (ANS) was 35.0 ± 2.6 mm, and the mean angle of the axis that passed the IOF and ANS relative to horizontal plane was 28.8° ± 4.1°. In addition, the mean soft tissue thickness overlying the IOF was 11.4 ± 1.9 mm. CONCLUSIONS: These results provide detailed knowledge of the anatomical characteristics and clinical importance of the IOF. Such knowledge is of paramount importance for surgeons when performing maxillofacial surgery and regional block anesthesia.

Concepts: Surgery, Anatomy, Anatomical terms of location, Foramina of the skull, Horizontal plane, Bones of the head and neck, Infraorbital foramen, Infraorbital canal

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BACKGROUND: Reduction malarplasty via an intraoral approach for correction of a prominent malar complex is quite popular in the Orient. However, one point of fixation in the anterior zygoma body area, the most widely used method, sometimes is insufficient and likely to result in malunion and cheek drooping. We designed a new assisted fixation technique to strengthen the effect of fixation. METHODS: Two parallel oblique vertical ostectomies were performed on the zygomatic body with a groove left in the inner osteotomy line. The zygomatic arch root was cut obliquely through a small sideburn incision just in front of articular tubercle, medial to lateral and anterior to posterior. The freed malar complex was medially and superiorly repositioned with the zygomatic body wedged in the groove, followed by fixation with one miniplate or wire. Finally, the periosteum in the zygomatic area was pulled and sutured to the deep temporal fascia. RESULTS: Most patients were satisfied with their results. No inferiorly displaced malunion occurred in the zygomatic body. There were no serious complications such as nonunion or permanent facial nerve injury. Minor complications, including palpable step-off, mild asymmetry, hematoma, and mild cheek drooping, occurred in some cases. CONCLUSION: Our assisted fixation method, combined with subperiosteal lifting, can provide ideal effects and sufficient fixation in malar reduction to prevent many complications such as malunion and cheek drooping. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Concepts: Evidence-based medicine, Temporal bone, Buccal branch of the facial nerve, Bones of the head and neck, Zygomatic bone, Zygomatic arch, Zygoma, Zygomatic process

10

The literature implies that large enthesophytes are exclusive to genetically predisposed individuals and to Spondyloarthropathies sufferers. Accordingly, the aim of this investigation and report was to assess the involvement of genetic predisposition, inflammatory and/or mechanical influences in the development of large enthesophytes in a sample population of teenagers presenting with large enthesophytes emanating from the external occipital protuberance.

Concepts: Sample, Genetics, Sampling, Educational psychology, Adolescence, Developmental psychology, Bones of the head and neck, Inion

4

A 2-year-old male free-ranging white-tailed deer (Odocoileus virginianus) was diagnosed with bilateral expansile tumors of antler origin. The deer was found dead by a landowner in High Springs, Florida. Two roughly spherical, multilobular, broad-based, bony, velvet-covered masses originated from each antler pedicle. These masses replaced or displaced many of the bones and soft tissues of the skull and extended through the left cribriform plate and the right petrous temporal bone, compressing portions of the brain. Microscopically, the masses closely resembled normal-growing antler, containing all the elements thereof but with areas of necrosis and hemorrhage suggestive of ischemia or trauma. Tumorlike outgrowths termed antleromas have been described in free-ranging and captive cervids and typically are associated with disruptions in the seasonal rise and fall of circulating testosterone necessary for normal antler growth, casting, and regeneration.

Concepts: Deer, Skull, White-tailed deer, Hunting, Elk, Capreolinae, Mule deer, Bones of the head and neck

3

Assessment of development is an important component of age estimation in juveniles. One area that has not been fully investigated as a possible aging method is the development of the frontal sinus. The frontal sinuses form when the ectocranial table of the frontal bone separates from the endocranial table forming an air pocket in the bone. The endocranial table ceases growth with the brain, while the ectocranial table is displaced anteriorly as the facial bones continue growth. In order to examine growth and the utility of the frontal sinuses for age estimation, 392 radiographs were examined (♀=159 and ♂=233) from the Juvenile Radiograph Database at North Carolina State University and the Patricia Database from Mercyhurst University. The sample included individuals who range in age from 0 to 18 years old. Anterior view radiographs were examined and were then grouped based upon the presence or absence of the frontal sinus. Based on this, individuals were divided into four age categories. A one-way ANOVA was performed to test whether developmental phase was related to age. Results from the ANOVA show that developmental phase is significantly related to age (p <.0001). An ordinal logistic regression was conducted to examine whether developmental phase could be used to predict age. The results of the logistic regression suggest that developmental phase is an accurate indicator of age (p <.0001, df = 1, Chi-Squared = 537.2428); however, the age ranges received can be quite wide and should be utilized alongside other established methods of age estimation. This article is protected by copyright. All rights reserved.

Concepts: Regression analysis, Logistic regression, Statistics, Skull, All rights reserved, Copyright, Bones of the head and neck, Frontal sinus

2

At the Abony-Turjányos dűlő site, located in Central Hungary, a rescue excavation was carried out. More than 400 features were excavated and dated to the Protoboleráz horizon, at the beginning of the Late Copper Age in the Carpathian Basin, between 3780-3650 cal BC. Besides the domestic and economic units, there were two special areas, with nine-nine pits that differed from the other archaeological features of the site. In the northern pit group seven pits contained human remains belonging to 48 individuals. Some of them were buried carefully, while others were thrown into the pits. The aim of this study is to present the results of the paleopathological and molecular analysis of human remains from this Late Copper Age site. The ratio of neonates to adults was high, 33.3%. Examination of the skeletons revealed a large number of pathological cases, enabling reconstruction of the health profile of the buried individuals. Based on the appearance and frequency of healed ante- and peri mortem trauma, inter-personal (intra-group) violence was characteristic in the Abony Late Copper Age population. However other traces of paleopathology were observed on the bones that appear not to have been caused by warfare or inter-group violence. The remains of one individual demonstrated a rare set of bone lesions that indicate the possible presence of leprosy (Hansen’s disease). The most characteristic lesions occurred on the bones of the face, including erosion of the nasal aperture, atrophy of the anterior nasal spine, inflammation of the nasal bone and porosity on both the maxilla and the bones of the lower legs. In a further four cases, leprosy infection is suspected but other infections cannot be excluded. The morphologically diagnosed possible leprosy case significantly modifies our knowledge about the timescale and geographic spread of this specific infectious disease. However, it is not possible to determine the potential connections between the cases of possible leprosy and the special burial circumstances.

Concepts: Bone, Disease, Infectious disease, Infection, Tuberculosis, Ratio, Hungary, Bones of the head and neck

2

In 1978, a nearly complete hominin fossil cranium was recovered from loess deposits at the site of Dali in Shaanxi Province, northwestern China. It was subsequently briefly described in both English and Chinese publications. Here we present a comprehensive univariate and nonmetric description of the specimen and provide comparisons with key Middle Pleistocene Homo erectus and non-erectus hominins from Eurasia and Africa. In both respects we find affinities with Chinese H. erectus as well as African and European Middle Pleistocene hominins typically referred to as Homo heidelbergensis. Specifically, the Dali specimen possesses a low cranial height, relatively short and arched parietal bones, an angled occipital bone, and a nonprominent articular tubercle relative to the preglenoid surface all of which distinguish it from Afro/European Middle Pleistocene Homo and align it with Asian H. erectus. At the same time, it displays a more derived morphology of the supraorbital torus and supratoral sulcus and a thinner tympanic plate than H. erectus, a relatively long upper (lambda-inion) occipital plane with a clear separation of inion and opisthocranion, and an absolute and relative increase in brain size, all of which align it with African and European Middle Pleistocene Homo. Finally, traits such as the form of the frontal keel and the relatively short, broad midface align Dali specifically with other Chinese specimens from the Middle Pleistocene and Late Pleistocene, including H. erectus, and differentiate these from the Afro/European specimens of this time period. Am J Phys Anthropol, 2013. © 2012 Wiley Periodicals, Inc.

Concepts: Human, Skull, Neanderthal, Occipital bone, Parietal bone, Human evolution, Bones of the head and neck, Homo erectus