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Internal derangement (ID) in the temporomandibular joint (TMJ) is defined as a mechanical problem of the joint that interferes with its function. It is attributed to an abnormal interaction among the articular disc, condyle, and joint eminence. The aim of this study is to evaluate diagnostic efficacy of non-invasive hand-carried ultrasonography instrumentation (US) to provide high-level images for a correct diagnosis of ID. Twenty-eight ID patients, 15 female and 13 males, were examined both clinically and by MRI images in order to achieve a diagnosis of ID (using Helkimo index). Then, they were submitted to US examination with a 12 MHz transducer by using hand-carried instrumentation by a clinician that was blind to their diagnosis and clinical data. TMJ US examination was performed with the mouth closed and mouth open, with proper technique. Each position was then evaluated with two different orientations of the transducer. US showed acceptable results in identifying bone structures. Lower values of diagnostic efficacy were obtained for disc position during joint movements with respect to MRI images. MRI still represents the gold standard for the identification of joint structures. If not corroborated by clinical and anamnestic data, the diagnostic efficacy of US in identifying the position of the disc during opening and closing jaw movements appears limited than compared to MRI.

Contagious yawning, emotional contagion and empathy are characterized by the activation of similar neurophysiological states or responses in an observed individual and an observer. For example, it is hard to keep one’s mouth closed when imagining someone yawning, or not feeling distressed while observing other individuals perceiving pain. The evolutionary origin of these widespread phenomena is unclear, since a direct benefit is not always apparent. We explore a game theoretical model for the evolution of mind-reading strategies, used to predict and respond to others’ behavior. In particular we explore the evolutionary scenarios favoring simulative strategies, which recruit overlapping neural circuits when performing as well as when observing a specific behavior. We show that these mechanisms are advantageous in complex environments, by allowing an observer to use information about its own behavior to interpret that of others. However, without inhibition of the recruited neural circuits, the observer would perform the corresponding downstream action, rather than produce the appropriate social response. We identify evolutionary trade-offs that could hinder this inhibition, leading to emotional contagion as a by-product of mind-reading. The interaction of this model with kinship is complex. We show that empathy likely evolved in a scenario where kin- and other indirect benefits co-opt strategies originally evolved for mind-reading, and that this model explains observed patterns of emotional contagion with kin or group members.

Clinical examination from front to rear of oral cavity, mouth closed then open. Inspection and bimanuel exam. Face examination but also cervical lymph nodes, skin and mucous. Early diagnosis of oral cancer. To reduce diagnostic wavering and patient's stress, physiological varants are important to know. In most cases, clinical examination is enough for diagnosis.

Summary Ten healthy volunteers received oxygen for 1 min, 2 min and 3 min at 10 l.min−1 via a face mask, or humidified oxygen at 60 l.min−1 via nasal prongs (OptiflowTM) with the mouth closed and with the mouth open. The mean (SD) end-tidal oxygen partial pressure after 3 min face mask and Optiflow oxygenation, with mouth closed and open, were: 88.5 (6.2) kPa; 85.6 (6.4) kPa and 48.7 (26.4) kPa, respectively, p = 0.001. The equivalent mean (SD) transcutaneous oxygen partial pressures were: 34.6 (5.4) kPa; 36.4 (6.5) kPa and 25.5 (15.7) kPa, respectively, p = 0.03. High-flow humidified nasal oxygenation for 3 min with the mouth closed was as effective as 3 min face mask oxygenation.

Body and women identity is expressed in narco-narrative novels. The chapter scrutinizes the conceptualization of the female body in the urban drug-trafficker’s world. Employing the psychoanalytic concepts of Eros and Thanatos in Rosario Tijeras, we can observe pulsions that result in cultural illness. Rosario’s mouth is a double-edged sword: she kisses before she kills; her mouth seduces and destroys. The mouth in the novel evidences the way she punishes herself, eating with guilt and gaining weight (overeating, satiating the mouth), and how she tries, without success, to mask her social identity by keeping her mouth closed in certain circumstances.

Suicide using a combination of a plastic bag over the head and inhalation of a non-irritating gas, such as helium, argon or nitrogen, has been reported in the literature. Here an unusual suicide method in a 17-year old man by suffocation from covering the face with household plastic wrap, combined with nitrous oxide inhalation, is presented. The case was reviewed based on police, autopsy and hospital reports. A PubMed search for scientific literature related to nitrous oxide abuse and suicide by suffocation was performed and our findings discussed in relation to the scientific literature found. The deceased was a 17-year old man who was found with the nose and mouth closed with a piece of kitchen plastic wrap. The plastic wrap had been removed prior to autopsy. Autopsy findings were suggestive of asphyxia, but were otherwise negative. Nitrous oxide was detected in the brain and lung tissue with headspace-gas chromatography-mass spectrometry (headspace-GCMS). The cause of death was assumed to be suffocation caused by plastic wrap covering the face, combined with nitrous oxide inhalation. Suicide was suspected because of a history of depression for several months. Nitrous oxide, also known as laughing gas, has a euphoric effect and is used as a recreational inhalant drug that can be purchased legally. Deaths caused by recreational nitrous oxide abuse are rare but may occur if used in combination with a plastic bag over the head. This is the first report of suicide by suffocation by external obstruction combined with nitrous oxide inhalation.

Objectives/Hypothesis To explore the difference in the course of the lingual arteries between the tongue in the fully extended position and in the resting position in obstructive sleep apnea hypopnea syndrome (OSAHS) patients. Study Design Prospective nonrandomized study. Methods Seventeen patients with OSAHS were included in the study. Each patient received two lingual artery computed tomography angiography (CTA) examinations. For the first CTA examination, each subject was requested to keep the mouth closed with the tongue in a resting position. For the second CTA examination, each subject was asked to keep the mouth open with the tongue in a fully extended position. The difference in the distances between the bilateral lingual arteries and the depths of the lingual artery beneath the lingual surface, based on three reference marks, was analyzed with the tongue in a resting and extended position using the CTA images. Results Both the depths of the lingual artery beneath the lingual surface and the distances between the bilateral lingual arteries based on three reference marks in the fully extended position were all significantly smaller than those in the resting position (P

Objective to explore the effect of Histoacyl tissue glue (hereinafter referred to as tissue glue) on incision healing in breast surgery. Method review during October 2017 to October 2018, 500 cases of breast surgery to surgical treatment of cases, including 200 cases of tissue glue closed incision, 200 cases of absorbable suture material, 100 cases by traditional suture, comparing three sets of closing time of incision, postoperative hospital stay, complications, patients on art mouth closed satisfaction. Results: the three groups were superior to the absorbable suture material, group and the traditional suture group in the closing-length glue group with statistically significant differences (P

Ctenophores, or comb jellies, are a distinct phylum of marine zooplankton with eight meridional rows of giant locomotory comb plates. Comb plates are the largest ciliary structures known, and provide unique experimental advantages for investigating the biology of cilia. Here, I review published and unpublished work on how ctenophores exploit both motile and sensory functions of cilia for much of their behavior. The long-standing problem of ciliary coordination has been elucidated by experiments on a variety of ctenophores. The statocyst of ctenophores is an example of how mechanosensory properties of motile cilia orient animals to the direction of gravity. Excitation or inhibition of comb row beating provides adaptive locomotory responses, and global reversal of beat direction causes escape swimming. The diverse types of prey and feeding mechanisms of ctenophores are related to radiation in body form and morphology. The cydippid Pleurobrachia catches copepods on tentacles and undergoes unilateral ciliary reversal to sweep prey into its mouth. Mnemiopsis uses broad muscular lobes and ciliated auricles to capture and ingest prey. Beroe has giant smooth muscles and toothed macrocilia to rapidly engulf or bite through ctenophore prey, and uses reversible tissue adhesion to keep its mouth closed while swimming. Ciliary motor responses are calcium-dependent, triggered by voltage-activated calcium channels located along the length (reversed beating) or at the base (activation of beating) of ciliary membranes. Ciliary and muscular responses to stimuli are regulated by epithelial and mesogleal nerve nets with ultrastructurally identifiable synapses onto effector cells. Post-embryonic patterns of comb row development in larval and adult stages are described and compared with regeneration of comb plates after surgical removal. Truly, cilia and ctenophores, like love and marriage, go together like a horse and carriage.

We report the first record of opportunistic feeding behavior of one humpback whale during its winter migration through tropical waters off the central coast of Oaxaca, Mexico. Additionally, we recorded for the first time evidence of mixed feeding techniques, mainly consisting of lunging vertically, which is used in feeding grounds of the North Pacific and skimming lunge subsurface, which is used in feeding grounds of the South Pacific, with the latter one being specifically used for catching Munida sp. aggregations. The method described adds four new variants to the maneuver repertoire: 1) buzz prior to the prey capture, 2) type of targeted prey, Cupleiformes in this case, 3) emergence with the mouth closed, and 4) movement in the surface with the mouth closed. Based on the characteristics of this method we named it subsurface lunge feeding with terminal buzz . This is the southernmost feeding record that has been reported for the North Pacific humpback whales. Key words: Feeding, Breeding grounds, Oaxaca, Tropical Pacific.

Objective The objective of this study was to test whether or not there is an association between generalized joint hypermobility (measured using the Beighton score) and temporomandibular joint disk displacement in women who had sought medical attention for temporomandibular disorders (TMD). Study design We studied 66 women who were attending the clinic for TMD. The patients were examined for joint hypermobility, and Beighton scores were calculated. When it was suspected that a patient suffered arthropathic complaints, magnetic resonance imaging of both temporomandibular joints was performed with the mouth closed and at maximal opening. The Pearson chi-squared test was used to test for an association between generalized joint hypermobility and disk displacement. Results We were unable to confirm the existence of an association between generalized joint hypermobility and temporomandibular joint disk displacement in women (χ2 = 1.523; P = .02). Conclusion Generalized joint hypermobility may be a factor related to TMD, but we did not find an association between generalized joint hypermobility and anterior disk displacement in women.

[Purpose] Recent findings suggest there is an interesting interaction between the stomatognathic system and the musculoskeletal system. The aim of this study was therefore to examine the influence of the temporomandibular joint on the explosive strength of the lower limbs. [Subjects and Methods] An observational study was carried out. The subjects were 60 male football players who voluntarily participated in the investigation. After a warm-up phase of 10 minutes, each participant performed three Squat Jumps (SJ) with different mandible positions: mouth closed and mouth open. SJ heights were recorded using a Sensor Medica force platform and the FreeMed system. [Results] Sixty participants were enrolled in this study (age: 24 ± 7 yrs; height: 174 ± 4.6 cm; weight 63.7 ± 7.6 kg). The SJ heights with the mouth closed, 38.50 ± 4.0 cm, were shorter than those with the mouth open, 40.4 ± 4.1 cm. Statistical analysis showed there was a statistically significant difference between the performances. [Conclusion] This pilot study highlighted that occlusal factors can influence physical performance and this could have practical applications in sports and exercise science. However, our results have to be confirmed in studies with larger numbers of participants and supported by other investigations.

As young children, our parents generally tried to instill in us a sense of what is right and what is wrong. Stealing a toy from a store is wrong, but buying it with money is right; driving through a red light is wrong, but driving through a green is fine; and spreading slanderous lies about some in your class is wrong, but keeping your mouth closed, even though you don’t like them, is right. In most things in life, we understand these limitations and most of us try to abide by them. We don’t always get it right—we are only human after all—but we can usually stay out of trouble without too much difficulty.

The Lake St Lucia Estuarine System, South Africa, has been under pressure due to recent drought conditions, which led to extreme low lake levels, hypersaline conditions and closure of the mouth. The estuary mouth closed in June 2002 and has remained so for more than two-and-a-half years. A lack of information on biotic responses during extended closed-mouth conditions prompted a study to ascertain the current status of the fish fauna in the system. Fish were sampled with seine and gill-nets at six sites spread throughout the system. At the time of sampling in December 2004, the system had become partitioned into four isolated compartments. A total of 4 475 fish comprising 30 species were recorded during the survey. The CPUEs were generally low, except for those of Oreochromis mossambicus, Liza dumerili and Ambassis ambassis. The freshwater cichlid O. mossambicus made up 45% of the total catch. The species composition in each of the four compartments of the system were very different. Historical data indic...

Ongoing drought conditions along the northern coast of KwaZulu-Natal resulted in the St Lucia Estuary mouth closing, and to evaporation leading to extremely low lake levels and the development of hypersaline conditions in most parts of the system. The mouth closed in June 2002 and has remained closed for more than three years. The St Lucia Estuarine System is an important nursery ground for juveniles of many marine fish species. Ezemvelo KZN Wildlife initiated a once-off survey to investigate the effects of the drought on the fish fauna and to establish if any fish were breeding in the system under the existing drought conditions. Fish were sampled at six sites throughout the system, using seine and gill-nets. In December 2004, the system had become partitioned into four isolated compartments, and at this time a total of 4 475 individuals comprising 30 species were recorded. An analysis of size class data indicated the presence of juveniles of at least 12 species, including nine estuarineassociated marine...

Although oral myiasis is a rare condition in non-tropical countries comparing to those in tropical zone, the manifestation of myiasis could not be overlooked, especially among oral cancer patients who are unable to keep their mouth closed and maintain good oral hygiene. The diagnosis of myiasis is confirmed clinically by detecting the maggots and traditional management of mechanical removal of the larvae by using turpentine oil has been observed. The houseflies may carry larvae (maggots) and lay them down on exposed wounds. In this case an intruding oral cancer spreading through facial skin not covered with a surgical dressing was infested into larvae, and caused myiasis. Local application of turpentine oil was utilized to eliminate maggots but the procedure carries a risk of toxicity.

Taxonomic analysis of a group of morphologically similar ponyfishes (Perciformes: Leiognathidae) establishes the Leiognathus splendens complex comprising four valid species: L. jonesi James, 1971, widely distributed in the Indo-West Pacific, from Mauritius to Papua New Guinea, north to Hainan I. (China), and south to Brisbane, Australia; L. kupanensis sp. nov., currently known only from Kupang, Timor, Indonesia; L. rapsoni Munro, 1964, currently known only from India, Indonesia, and Papua New Guinea, and L. splendens Cuvier, 1829, widely distributed in the eastern Indian and western Pacific oceans, from India to Papua New Guinea, and from southern Japan to northern Australia. The L. splendens complex can be defined by the following combination of characters: body depth 42-60% of standard length; mouth protruding downward; slender, minute teeth uniserially on jaws; lower margin of orbit above the horizontal through the gape when mouth closed; breast almost completely scaled; lateral line complete, and a dark blotch on top of spinous dorsal fin. Diagnostic characters of the members are as follows: L. jonesi—anterior dorsolateral body surface with a semicir- cular naked area on nape, and a paler dark blotch on spinous dorsal fin; L. kupanensis—anterior dorsolateral body surface widely naked; L. rapsoni—cheek scaled; L. splendens—anterior dorsolateral body surface completely scaled and a jet black blotch on spinous dorsal fin.

According to textbooks, the function of a sneeze is to send a strong blast of air through the nose to remove foreign bodies. Three simple tests are described that show that the current views are wrong. The pressure developed in the mouth/pharynx of the author during a sneeze was recorded as about 135 mm Hg reached in about 0.1 s. A forced maximal expiration but with the nose and mouth closed produced a nasal secretion although of smaller amount than in the sneez, in spite of a greater pressure; this is probably because the speed of tension development was much slower than in the sneeze. It is proposed that the high pressure stimulates secretory neurons via branches in the roof of the mouth. The nasal secretion dilutes irritant material in the nose and thus prevents it getting into the lungs.

OBJECTIVE: Many studies report a significant relationship between the one-leg standing time with the eyes open and the occlusal relationship. To determine the association between proprioception (the periodontal membrane vs muscle spindle) to the one-leg standing time, the authors compared the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. METHODS: The study participants were 107 healthy, elderly patients. The authors measured the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. RESULTS: The one-leg standing time was significantly shorter with the mouth opened (21·1±19·1 seconds) than with the mouth closed (25·1±21·4 seconds). Patients whose one-leg standing time was equal or shorter with the mouth opened than with the mouth closed were not different from the other patients with regard to age, handgrip strength, BMI, and the number of remaining teeth. DISCUSSION: The vertical mandibular position may affect body balance. Language: en

When mandibular dentures are fabricated, marginal sealing should be taken into consid- eration for the stability of the denture. We selected specimens of the medial pterygoid muscle showing insertion of an independent small muscle bundle at its insertion site, and evaluated the anatomical rela- tionship between the morphology of the insertion site and the denture. The insertion of the pterygoid muscle was classified according to the insertion morphology of the independent small muscle bundle into three types using the retromolar pad as a reference: Type I, insertion of the independent muscle bundle posterior to the retromolar pad; Type II, insertion immediately below the retromolar pad; and Type III, insertion into the fascia of the mylohyoid muscle. Types II and III muscles seem to affect the denture because of their closeness to the mandibular denture. In the oral cavity, the independent small muscle bundle studied appeared as a streak-like structure. When such a structure is detected during examina- tion for denture fabrication, the following consideration is necessary. Since the medial pterygoid muscle is a mouth-closing muscle, this independent small muscle bundle may contract during mouth closing, appearing more markedly in the oral cavity. Therefore, examination should be performed not only with the mouth closed but also with assumed centric occlusion.

We previously reported that superimposition of 3-dimensional (3D) images reconstructed from computed tomographic images of skeletonized skulls on photographs of the actual skulls afforded a match of skull contours, thereby demonstrating that superimposition of 3D-reconstructed images provides results identical to those obtained with actual skulls. The current superimposition procedure requires a skeletonized skull with mouth closed and thus is not applicable to personal identification using a skull with residual soft tissue or the mouth fixed open, such as those found in mummified or burned bodies. In this study, we scanned using computed tomography the skulls of mummified and immersed body with mandibles fixed open by residual soft tissue, created 3D-reconstructed skull images, which were digitally processed by computer software to close the mandible, and superimposed the images on antemortem facial photographs. The results demonstrated morphological consistency between the 3D-reconstructed skull images and facial photographs, indicating the applicability of the method to personal identification.

Amongst volatile compounds (VCs) present in exhaled breath, ammonia has held great promise and yet it has confounded researchers due to its inherent reactivity. Herein we have evaluated various factors in both breath instrumentation and the breath collection process in an effort to reduce variability. We found that the temperature of breath sampler and breath sensor, mouth rinse pH, and mode of breathing to be important factors. The influence of the rinses is heavily dependent upon the pH of the rinse. The basic rinse (pH 8.0) caused a mean increase of the ammonia concentration by 410 ± 221 ppb. The neutral rinse (pH 7.0), slightly acidic rinse (pH 5.8), and acidic rinse (pH 2.5) caused a mean decrease of the ammonia concentration by 498 ± 355 ppb, 527 ± 198 ppb, and 596 ± 385 ppb, respectively. Mode of breathing (mouth-open versus mouth-closed) demonstrated itself to have a large impact on the rate of recovery of breath ammonia after a water rinse. Within 30 min, breath ammonia returned to 98 ± 16% that of the baseline with mouth open breathing, while mouth closed breathing allowed breath ammonia to return to 53 ± 14% of baseline. These results contribute to a growing body of literature that will improve reproducibly in ammonia and other VCs. (Some figures may appear in colour only in the online journal)

Two species of the holocentrid fish genusMyripristis are described as new from Japan, both with a single pair of tooth patches outside the gape at tip of lower jaw, the third anal spine longer than the fourth, and 28–29 lateral-line scales:M. kochiensis from Kashiwa-jima, Kochi Prefecture, previously misidentified asM. murdjan, is distinct in having small scales in axil of pectoral fins, 32–36 gill rakers, interorbital space 4.45–5.1 in head, and lower jaw not strongly projecting when mouth closed;M. greenfieldi, from the Ryukyu Islands and Ogasawara Islands to Kochi Prefecture, previously misidentified asM. woodsi andM. randalli, is distinct in lacking scales in the pectoral axil, having 35–52 cteni on largest body scales, 43–47 gill rakers, and longest dorsal spine 2.0–2.25 in head.

Mandibular length is measured on cephalographs to depict changes during growth and after orthodontic treatment, and is often defined between condylion (Co, most posterior superior point on the condylar outline) and pogonion (Pog, most anterior point on the chin). The aim of this study was to assess the accuracy of identifying condylar anatomy, thus the validity of using Co-Pog to evaluate mandibular growth. The sample included 34 children from a prospective study on the early treatment of distoclusions. Two lateral head films were taken of each child, the first with the mouth closed (MC), the second with the mouth open (MO). Three examiners, two orthodontists (U.H. and K.H.) and a dental radiologist (R.B.), rated the condyle as identifiable, nonidentifiable, and interpreted. The rating was applied to the left (L) and right (R) condyles, or to only one outline (O) when the R and L structures appeared superimposed and were not distinguished separately. Besides Co-Pog, the orthodontists traced sella-nasion (SN) and incisor tip-menton (I-Me) to evaluate variability in measurements that do not include Co. One operator (J.G.) measured all distances. Agreement among the three examiners was best in rating the MO radiographs (50%): 4.1% identifiable, 5.9% nonidentifiable or interpreted; in the MC films, they agreed in 32.3% of the cases, but only one of the ratings was identifiable (2.9%). The highest agreement was in identifying the left condyle on the MO film (35.3%). Intraclass correlation coefficients for CO-Pog ranged from r = 0.73 (L side) to r = 0.92 (O) for one orthodontist, and for the other from r = 0.76 (O) to r = 0.85 (L). Both orthodontists had high correlations for SN and I-Me between MC and MO (0.94r0.98). The variability between examiners in recognizing condylar anatomy, particularly on radiographs taken with the mouth closed, suggests that the identification of condylar anatomy must be rated in studies of mandibular growth. Researchers measuring mandibular length in investigations of mandibular growth after orthodontic therapy should differentiate between cases where the condyle is readily identified, and those where condylar anatomy is interpreted.

The River Murray in Australia drains an area of one million square kilometres, but in 1981 the mouth closed for some weeks. It is important that this be prevented, as the environmental consequences of permanent closure are severe. The size of the mouth is influenced by wind and wave activity at the mouth, and by the river flow, which is controlled by a system of weirs and barrages. We have been able to demonstrate using recursive estimation techniques that river flow is the most important explanatory variable for mouth size, so that the proper management of flow alone has the potential to prevent future closures.

Aim: The aim of this study was to evaluate the effectiveness of the laser in the treatment of hyperemia (edema) as assessed by a TMJ Doppler on 22 consecutive joints showing TMJ Hyperemia. Materials and Methods: The hyperemia of the joint was first evaluated using a TMJ Doppler device (Great Lakes Orthodontic Products - Buffalo NY) and it was recorded as severe, moderate or mild. The DioBeam 830 low level laser (830nm, 150mw continuous wave laser with a 1 cm beam, manufactured by CMS Dental Copenhagen, Denmark); 16 J/cm 2 (8 J/cm 2 with mouth open and 8 J/cm 2 with the mouth closed). The treatment time was 2 minutes per joint. The hyperemia was assessed immediately following the treatment. Results: 22 joints have been evaluated on 16 patients. 12 had severe hyperemia, 9 had moderate hyperemia and 1 had mild hyperemia. All 22 joints showed complete resolution of the hyperemia immediately after laser therapy. There were no negative clinical results associated with the treatments.Conclusion: Low Level Laser Therapy (LLLT) was an effective tool in the treatment of hyperemia of the TMJ.

This study investigated the effects of head-neck extension on abnormalities of laryngeal mask airway (LMA) function resulting from opening the mouth.A single, experienced LMA user inserted the LMA in 15 patients scheduled for elective oral surgery. Oropharyngeal leak pressure and intracuff pressure were sequentially documented in 5 mouth conditions in order (0 minutes, mouth closed plus 0° extension; 3 minutes, mouth open plus 0° extension; 6 minutes, mouth open plus 15° extension; 9 minutes, mouth open plus 30° extension; and 12 minutes, mouth open plus 45° extension).Oropharyngeal leak pressures with the mouth open plus 0° extension (30.7 ± 5.6 cm H(2)O, P.001), mouth open plus 15° extension (29.1 ± 6.8 cm H(2)O, P.001), and mouth open plus 30° extension (25.7 ± 6.1 cm H(2)O, P.001) were significantly higher than with the mouth closed plus 0° extension (19.7 ± 2.8 cm H(2)O). Compared with the position with the mouth closed plus 0° extension (60.0 ± 0 cm H(2)O), intracuff pressures were also higher with the mouth open plus 0° extension (84.5 ± 14.1 cm H(2)O, P.001), mouth open plus 15° extension (77.4 ± 11.0 cm H(2)O, P.001), and mouth open plus 30° extension (73.6 ± 9.6 cm H(2)O, P.001). Both measurement values returned to control levels when the position with the mouth open plus 45° extension was assumed (oropharyngeal leak pressure, 64.5 ± 6.5 cm H(2)O [P = .212]; intracuff pressure, 20.2 ± 4.9 cm H(2)O [P = .969]).In procedures requiring the patient to have an open mouth under general anesthesia using LMA, 45° head-neck extension achieves acceptable airway conditions.

Frogs and toads mostly call with their mouths shut, unlike many other vertebrates. Sound is generated when air crosses the larynx, but there is no direct airflow to the external environment and radiation occurs at the skin. This study directly compares the acoustic output obtained from euthanized frogs with the mouth open against the output obtained with the mouth closed during activation of the larynx by airflow. With the mouth closed, the vocal sac was inflated and the acoustic energy was concentrated in the same harmonics as in the advertisement call, whereas with the mouth open, energy was spread in a wide range of harmonics. The acoustic output at the dominant frequency was more intense with the mouth closed than with the mouth open. More sound was radiated through the vocal sac and head than through the rest of the body. The spectral differences between open and closed mouth treatments matched the differences observed between natural advertisement calls, produced with the mouth closed, and distress calls, produced with the mouth open. By calling with the mouth closed, treefrogs can potentially produce advertisement calls with the energy concentrated in a narrower frequency range than with the mouth open.

It is suggested that the combination of the pharyngeal narrowing rate during the Bernouilli effect producing maneuver (BEPM) with the body mass index (BMI) might be a promising predictive method for obstructive sleep apnea syndrome (OSAS).An attempt was made to clarify the possibility that the dynamic narrowing of the pharynx evaluated by nasopharyngoscopy with BEPM, a forced inspiration through the nose with the mouth closed, might be a reliable clinical daytime predictor for identifying patients at risk of developing OSAS.Subjects were 57 patients complaining of snoring and sleepiness during daytime. Endoscopic images of the retropalatal pharynx were obtained and their area was measured by NIH imaging. The pharyngeal narrowing rate during quiet nasal breathing and that during BEPM were compared to assess pharyngeal dynamics. To increase the sensitivity of this method, BMI was added to the pharyngeal narrowing rate during BEPM.The criterion of BEPM at a cut-off value of 50% with BMI at a cut-off value of 25 kg/m(2) achieved a sensitivity of 93%, while the specificity was 67% in differentiating simple snorers from OSAS patients (apnea index5). In addition, the likelihood ratio of the method was found to be 2.81.

Many hearing aid users experience physical discomfort when wearing their device. The main contributor to this problem is believed to be deformation of the ear and ear canal caused by movement of the mandible. Physical discomfort results from added pressure on soft tissue areas in the ear. Identifying features that can predict potential deformation is therefore important for identifying problematic cases in advance. A study on the physical deformation of the human ear and canal due to movement of the mandible is presented. The study is based on laser scannings of 30 pairs of ear impressions from 9 female and 21 male subjects. Two impressions have been taken from each subject, one with open mouth, and one with the mouth closed. All impressions are registered using non-rigid surface registration and a shape model is built. From each pair of impressions a deformation field is generated and propagated to the shape model, enabling the building of a deformation model in the reference frame of the shape model. A relationship between the two models is established, showing that the shape variation can explain approximately 50% of the variation in the deformation model. An hypothesis test for significance of the deformations for each deformation field reveals that all subjects have significant deformation at Tragus and in the canal. Furthermore, a relation between the magnitude of the deformation and the gender of the subject is demonstrated. The results are successfully validated by comparing the outcome to the anatomy by using a single set of high resolution histological sectionings of the region of interest.

There is a series of tools useful for gathering diagnostic information on patients with temporomandibular joint disorders. Tracings of the joint movement (axiography) provide useful information about the motion of the joints. Since the availability of electronic axiographic tracers, the movement of the condyles can be resolved with high resolution both in space and in time. In order to obtain information about the anatomical relation of the joint surfaces and the disc, magnetic resonance tomography imaging (MRI) is routinely carried out. It is common practice to take MR images of the joints with the mouth closed and fully open. In order to correlate the MR images with the axiographic tracings, a series of images can provide much more information. In this study we examined patients with distinct temporomandibular joint (TMJ) clicks. In one case, the click occurs once a day, while in the other case the click happens every time the mouth is opened. In order to obtain information about both motion and anatomical relation of the TMJ at and around the position where the clicks occur, we recorded a series of MRI scans with the mouth gradually opened and before and after joint clicks. Real-time axiographic tracings during the click were taken with an optimized system where the polar moments were reduced as much as possible to follow the movement during the click. These tracings were correlated with the MRI scans to determine the exact internal conditions of the TMJ and the changes during the click. In particular cases, the additional information provided by this procedure can be useful in deciding whether and which therapeutic intervention is advisable.

These are the words we sigh after, picturing the princess in the castle, the prince vanquishing the dragon, the child, quiet, sound asleep. Quiet seems to be a theme in books of manners for children, I’ve found. Chew your food with your mouth closed (quietly). Sit next to your sister (quietly) without biting her. Do not speak (be quiet) until spoken to, and when you do speak, speak quietly.

We describe a method for the automatic identification of facial features (eyes, nose, mouth and chin) and the precise localization of their fiducial points (e.g. nose tip, mouth and eye corners) in color images of face foregrounds. The algorithm requires as input 2D color images, representing face foregrounds with homogeneous background; it is scale-independent, it deals with either frontal, rotated (up to 30°) or slightly tilted (up to 10°) faces, and it is robust to different facial expressions, requiring the mouth closed and the eyes opened, and no wearing glasses. The method proceeds with subsequent refinements: first, it identifies the sub images containing each feature, afterwards, it processes the single features separately by a blend of techniques which use both color and shape information. The system has been tested on three databases: the XM2VTS database, the University of Stirling database, and ours, for a total of 1650 images. The obtained results are described quantitatively and discussed.

Anterior mandibular positioning devices are seldom used at present in the treatment of obstructive sleep apnoea syndrome (OSAS). The aim of our study was to evaluate the efficiency, the side-effects and the patient compliance with one type of device made in Switzerland, the Serenox®. This device is designed to keep the mouth closed with the mandible forward, avoiding the vibration of the soft palate. Between January 1996 and October 1997, 15 patients with OSAS were treated using a Serenox®. One of them stopped using the device after 6 weeks due to the persistence of temporomandibular joint pain. Serenox® was successful in 13 of the remaining 14 patients. The median pretreatment apnoea/hypopnoea index (AHI) of 36.25/h was decreased to 5.5/h after treatment (P < 0.002). Snoring and daytime sleepiness were notably reduced. The side-effects were frequent but mild and disappeared after a few weeks of adaptation. In conclusion, 87% (13/15) of the patients were treated successfully. Indications for the use of a mandibular positioning device include snoring, upper airway resistance syndrome and light to mild OSAS without severe obesity.

To the Editor. — We read with interest the recent study by Kubicka et al,1 who assessed oral cavity pressure in patients receiving highly humidified and heated gas (Vapotherm [Vapotherm, Inc, Stevensville, MD]). They found that significant pressure could be generated only with the infant's mouth closed. We had also hypothesized that high-flow gas does not generate significant airway-distending pressure. In the Neonatal Infant Center at the Children's Hospital of Philadelphia, we chose to study infants already being treated with high-flow nasal cannula with Vapotherm at least 6 hours after initiation of this therapy. We used a 2F flexible, solid-state pressure catheter (Millar Instruments, Inc, Houston, TX) that was passed transnasally to the distance of ∼2 cm past the nares at the beginning …

This is a review of the muscular anatomy of the nose. Areas of inconsistency in the main anatomy texts are highlighted and concentrate particularly on the omission of three identifiable muscles from modern textbooks. Two topographical areas of the nose in need of further anatomical development are identified. In a sample of 121 subjects from the general population, 40% were found to be incapable of flaring the nostrils voluntarily or subconsciously in conjunction with energetic inspiration with the mouth closed. The authors recommend systematic clinical assessment of the nasal musculature be incorporated in the pre- and postoperative examination of the rhinoplasty patient. The division of the nose into five sections for assessment is proposed and the muscles contributing to each area are defined together with their individual surgical relevance.

Various methods have been conventionally applied for studies of the nasal cycle. Most of these studies have been through either clinical observations by rhinologists or by the use of physiological apparatuses. The purposes of the present study are to develop a different and simplified technique for measuring the nasal cycle and to determine the extent to which the new technique works with actual cases. Five adult subjects were required to hold a 8 x 6 mirror horizontally under the nostrilsin and to breathe through the nose with the mouth closed. The length of time required for the exhalation vapor to condense on the mirror was measured every 15 minutes from 9 a.m. to 5 p.m. LR index scores (L-R/L+R) were calculated on the bases of left and right time, and maximum entropy method spectral analysis was used to determine the nasal cycle. The results showed that three of the subjects demonstrated significant periodicities equivalent to about three or four hour ultradian rhythms. Some of the problems with individual differences and with this new method were discussed.

Bony defects of the external auditory canal (EAC) may arise from a tumor, infection, inflammation, trauma, complications from ear surgery, or congenital disease. Congenital bony defects of the EAC are known as a patent Huschke’s foramen. Here, we describe a 76-year-old male patient who presented an otalgia in his right ear. Physical examination revealed a dome shaped swelling of the anterior EAC wall, which repeated swelling and retraction as the patient’s mouth closed and opened. Computed tomography revealed a bony defect of the anterior EAC wall. We believe that the patent Huschke’s foramen allowed spontaneous herniation of the temporomandibular joint into the EAC. Korean J Otorhinolaryngol-Head Neck Surg 2010;53:175-8 Key WordsZZHuschke’s foramen·External auditory canal·Temporomandibular joint·Otalgia.

Three hundred and fifty consecutive patients (322 non-obstetric, 28 obstetric; 185 female) were assessed before operation using the modified Mallampati test and by measuring thyromental and sternomental distances, forward protrusion of the mandible and interincisor gap with the mouth fully open. Tracheal intubation was difficult in 17(4.9%) patients, of whom four (1.14%) had a grade III or IV view on laryngoscopy. A sternomental distance of 12.5 cm or less with the head fully extended on the neck and the mouth closed predicted 14 of the 17 patients in whom tracheal intubation was difficult. As a screening test, sternomental distance appeared to be more sensitive (82.4%) and more specific (88.6%) than thyromental distance (64.7% and 81.4%, respectively), the modified Mallampati test (64.7% and 66.1%, respectively) and forward protrusion of the mandible (29.4% and 85.0%, respectively). The interincisor gap ranged from 2.0 to 5.0 cm in all patients except one. There was no correlation between the interincisor gap and the view on laryngoscopy ( P > 0.05, one-way ANOVA). There was also no difference in mean interincisor gap between those patients who presented no difficulty with tracheal intubation and those who did ( P = 0.7–0.8, two sample t test). Sternomental distance may be a useful bedside screening test for preoperative prediction of difficult tracheal intubation.

The frog tongue contains the chemoreceptor sensitive to water, the role of which has not been clarified. If the water on the tongue reflexly keeps the mouth closed as suggested by Zotterman, reflex discharges should be evoked in the nerve innervating the mandible elevator muscles. So far as we have studied, however, pronounced reflex discharges were evoked in the nerve innervating the submental and submaxillary muscles, but not in the nerves innervating the elevator muscles. This result suggests that the chemoreceptor sensitive to water in the frog tongue plays a role in the nostril closing mechanism.

In the present study, a behavioral program for training feeding skills was evaluated using a multiple-baseline experimental design. Six hospitalized mentally retarded-behaviorally disordered children served as subjects. Three groups of two subjects each were instructed in three feeding skills: chewing with mouth closed, appropriate utensil use, and appropriate napkin use. Training consisted of praise for appropriate display of target behaviors; on occurrence of inappropriate behavior, the following sequence was carried out: 10-second time-out; instruction in appropriate behavior including modeling and manual guidance; and behavioral rehearsal. Results indicated positive behavior change in training sessions and in immediately succeeding sessions during which training was withheld. Furthermore, behavioral gains were judged to be clinically significant by a group of independent observers. Modest generalization and maintenance of training effects were also evidenced.

Vocal segregates are short non-lexical utterances such as ‘mm-hmm’. They are frequently observed in natural dialogue, which they help to regulate and maintain. Twenty-five naive subjects were asked to identify the meanings of isolated vocal segregates recorded by unfamiliar speakers. The segregates were recorded both with natural articulation, which enables the differentiation of vowel sounds, and with the speaker's mouth closed. Responses were made using a seven-alternative forced choice procedure. Mean identification accuracy was 69.4% significantly above chance level, and performance was higher for vocal segregates which contained vowel sounds. The possible role of vocal segregates in human-computer interaction is discussed.

It has been reported by hunters that certain birds become temporarily deaf. Ewald suggested that the deafness is caused by a change of intralabyrinthine pressure resulting indirectly from opening the mouth. In order to test Ewald's hypothesis, the electrical responses of the cochlea to sound stimulation were observed in the pigeon with mouth open and with mouth closed. The results show that the cochlear responses are reduced when the mouth is opened. Even slight movements of the lower jaw, such as those sometimes associated with breathing, produce a noticeable effect. The maximum effect, occurring when the mouth is wide open, varies from 8 to more than 10 db. The effect occurs for all frequencies used, from 100 to 10,000 cycles. It is suggested that the primary source of the effect is tension on the ear drum rather than a change in intralabyrinthine pressure. It may be concluded that movements of the mouth of the pigeon, even such movements as those of eating, drinking and singing, impair the hearing of the bird to a considerable extent.

THE NATURAL instinct of the newborn infant is to breathe through the nose with the mouth closed. Where this is not possible, owing to nasal obstruction, the child is in acute distress and at times cyanosed, depending for its existence on intermittent oral respiration. Possibly the insertion of an oral airway will lead to improvement in the child's condition, until an investigation of the cause of the nasal obstruction can be made. The finding of bilateral choanal atresia whilst explaining the difficulty does nothing in itself to alleviate matters so that a decision has then to be made as to how best to manage the situation. It has been usual in the past to attempt to defer curative treatment until the child is at least 6 months of age and consequently larger. Not only is this of no immediate help to the child, but we feel is unjustifiable in the

The attack behavior of captive Canada geese (Branta canadensis canadensis) in winter was studied. An analysis of responses deals mainly with the head and neck units, and utilizes evidence from several independent sources. The general nature of agonistic behavior under certain experimental conditions is described. A wild-reared goose from one flock when introduced to another integrated flock generally approaches this flock (approach may become extinguished rapidly if this animal is consistently attacked on each introduction). The integrated flock reacts characteristically to this approach, and obviously at a certain distance can discriminate between a member of its own group and an introduced stranger. As the spacial arrangement of the flock birds changes a particular group of males assembles, and from this group usually one male attacks the non-group goose. Attack behavior was arbitrarily divided into the following stages depending on the presence or absence of locomotion: approach, pre-attack, locomotory attack and post-attack. Each phase was characterized by a particular neck position, and the greatest variation in this regard occurred just prior to locomotory attack. To this extent only was there a "typical" chain of responses from flock approach to the termination of an attack. A particular combination of components (mouth open, neck tightly coiled, and head "aimed" at the opponent) appear as high threshold elements in the attack response. At times when attack probability is demonstrably low, the reciprocal of these components (i.e., mouth closed, neck extended horizontally and head directed away from the rival) frequently appears. The latter component group also appears ill-adapted for the delivery of a powerful blow by head or wings. It is suggested that complex responses consist of several behavioral components, and that any analysis of a response or between responses must incorporate all of these components. To interpret on the basis of a single component may, and often does, lead to over-simplification and possibly distortion. The coil-down neck position appears in the attacking bird and at times in the bird to be attacked. Using all components in an evaluation, the latter seems to be a protective response, and hence, there does not appear to be causal affinity between these responses. In locomotory attack, two morphologically dissimilar neck positions are recorded. The probability of their occurrence is correlated with the neck position found prior to locomotory attack. The proximity between rivals at different stages of attack was measured. Neck positions that appear to represent relatively high attack intensity proved to have relatively low mean separation distances between rivals before attack and vice versa. Proximity measures after attack do not indicate any clear trend. Wing-flapping appears frequently in locomotory attack for both captive and wild geese, whether on land or water. Flapping appears to increase the probability of contact between rivals, and may represent an increase in the intensity of the response. As clearly a high threshold element in locomotory attack, it seems to make its appearance under conditions of "high stimulus contrast".

In the present study the effectiveness of a token reinforcement program in improving mealtime behaviors of four mentally retarded, behaviorally disordered children was evaluated using the multiple baseline design across behaviors. Participants were residents on an inpatient psychiatric hospital program for children. Target behaviors included appropriate utensil use, appropriate napkin use, chewing with mouth closed, and good posture. Training was implemented in a group setting and consisted of verbal instructions, modeling, manual prompts, and token reinforcement delivered at preprogrammed variable intervals signaled by a tape recording. Results showed acquisition of target behaviors in 20 to 40 sessions. Further, behavioral gains were judged to be clinically significant by a group of independent observers.