Middle paleolithic human deciduous incisor from Grotta del Cavallo, Italy.

OBJECTIVES: In this contribution, we present a morphological description and comparative morphometric analysis of Cavallo D, a human tooth unearthed from the Mousterian FIII sublayer of Grotta del Cavallo (Apulia, Italy). MATERIALS AND METHODS: We used microCT data to provide a detailed morphological description and morphometric analysis of the Cavallo D human tooth based on traditional diameter measurements and 3D enamel thickness. Moreover, new AMS radiocarbon dating of charcoals from layers FII was carried out. RESULTS: Morphological features observed in Cavallo D align the tooth to Neandertals. Similarly, the large size of the tooth (e.g., BL diameter) and the relatively thinner enamel thickness are typical Neandertal traits. 14 C datings of layer FII attribute the tooth to a time range of 45,600-42,900 cal BP (at 68% level of probability). DISCUSSION: Up to now, the Rdi1 Cavallo D represents the most recent Neandertal human remain in southern Italy related to a radiocarbon dated stratigraphy. Moreover, since deciduous teeth have been less investigated than the permanent ones, this contribution brings new data to increase our knowledge on the variability of the Neandertal deciduous dentition.

Piscivory in a Miocene Cetotheriidae of Peru: first record of fossilized stomach content for an extinct baleen-bearing whale.

Instead of teeth, modern mysticetes bear hair-fringed keratinous baleen plates that permit various bulk-filtering predation techniques (from subsurface skimming to lateral benthic suction and engulfment) devoted to various target prey (from small invertebrates to schooling fish). Current knowledge about the feeding ecology of extant cetaceans is revealed by stomach content analyses and observations of behavior. Unfortunately, no fossil stomach contents of ancient mysticetes have been described so far; the investigation of the diet of fossil baleen whales, including the Neogene family Cetotheriidae, remains thus largely speculative. We report on an aggregate of fossil fish remains found within a mysticete skeleton belonging to an undescribed late Miocene (Tortonian) cetotheriid from the Pisco Formation (Peru). Micro-computed tomography allowed us to interpret it as the fossilized content of the forestomach of the host whale and to identify the prey as belonging to the extant clupeiform genus Sardinops. Our discovery represents the first direct evidence of piscivory in an ancient edentulous mysticete. Since among modern mysticetes only Balaenopteridae are known to ordinarily consume fish, this fossil record may indicate that part of the cetotheriids experimented some degree of balaenopterid-like engulfment feeding. Moreover, this report corresponds to one of the geologically oldest records of Sardinops worldwide, occurring near the Tortonian peak of oceanic primary productivity and cooling phase. Therefore, our discovery evokes a link between the rise of Cetotheriidae; the setup of modern coastal upwelling systems; and the radiation of epipelagic, small-sized, schooling clupeiform fish in such highly productive environments.

Syndromic craniosynostosis in a modern-age skeleton from Siena, Italy.

The skeleton of a female adult found in archaeological excavations carried out in Siena (central Italy) and dated back to the modern age showed a severe skull malformation due to the premature bilateral closure of the coronal suture, which determined a deformed brachycephalic skull. This craniosynostosis was associated with other malformations, such as shallow orbits, hypertelorism, mandibular prognathism, and consequent malocclusion, but there was absence of anomalies in the remaining bones of the extremities. These features did not seem to be related to an isolated condition but to a more complex genetic syndrome, suggesting a possible case of Crouzon syndrome. Besides representing a rare finding in archaeological material, the present case provides the opportunity to observe in an adult subject lesions typical of this congenital disorder, which is at present surgically corrected in infantile age.

Cone-Beam Computed Tomography vs. Multi-Slice Computed Tomography in paleoimaging: where we stand.

Paleopathology and anthropology are fields of research which have benefited from the use of diagnostic imaging since its introduction in the clinical setting. The deriving discipline, that is, paleoimaging, has effectively employed several diagnostic techniques. However, while Multi-Slice Computed Tomography (MSCT) has found its role in paleoimaging, Cone-Beam Computed Tomography (CBCT), despite its several advantages with regard to MSCT, is still struggling to find a clear position in this field. The aim of our study is to evaluate the possible advantages CBCT could bring to paleoimaging. We describe the characteristics and role of CBCT in clinical applications, in forensic and legal medicine, and in paleopathology. We report the study of an ancient mandible by means of CBCT and MSCT, in order to compare the quality of the images in terms of spatial resolution. CBCT allows to obtain good quality images of mineralized tissues. Moreover, the possibility of imaging metallic manufacts makes the technique suitable for the study not only of bony remains, but also of museum and archaeological artifacts. Our study highlights the strengths of CBCT as a valid imaging technique for the study of ancient bone remains and manufacts. A revision of the current uses of CBCT is provided and gives insights into the possible role it can cover in bioarchaeological studies. Further evaluation is needed in terms of possible applications of this technique to paleopathology. We strongly encourage the use of CBCT in paleoimaging, and suggest a broader application of the technique to the study of archaeological samples.

Discovering a new anatomy: exploration of oral mucosa with ultra-high frequency ultrasound.

OBJECTIVES: Ultra-high frequency ultrasound (UHFUS) is a recently developed diagnostic technique involving the use of ultrasound frequencies up to 70 MHz, allowing to obtain 30 µm resolution of targets located within 1 cm from the surface. Oral mucosa can be affected by diverse pathological conditions, which are currently investigated by means of clinical examination. In this scenario, intraoral UHFUS can provide additional information and support clinical assessment of oral mucosa. In this preliminary study, typical features of normal oral mucosa are described, in order to set a benchmark for the future identification of oral soft tissue alterations. METHODS: Twenty healthy subjects (10 males and 10 females, mean age 30 years) were enrolled and underwent intraoral UHFUS examination. In all the subjects, tongue, buccal mucosa, gingiva, lip mucosa, and palate were scanned, and images acquired. Intraoral UHFUS scan included Brightness-mode and Doppler mode acquisitions performed with a standardized protocol. UHFUS images were postprocessed and analyzed using a dedicated software. UHFUS-based biomarkers (epithelial thickness, echogenicity, and vascularization) were employed for image description. RESULTS: Normal oral anatomy of the different sites analyzed was described. For all the sites, UHFUS biomarkers were characterized, and information on typical aspect of oral mucosa was retrieved. CONCLUSIONS: In this explorative study, we suggest a potential role for intraoral UHFUS in the study of oral mucosa, giving insights into the possibility to improve the assessment, diagnosis, and management of the conditions involving oral mucosa. UHFUS seems a promising tool, which could potentially support clinical examination in daily oral medicine practice.

Cone Beam CT study of a case of eosinophilic granuloma of the mandible in a young patient.

Eosinophilic granuloma (EG) is a rare bony disease deriving from abnormal proliferation of histiocytes, and is the most common form of presentation of Langerhans cell histiocytosis. EG predominantly affects the axial skeleton. However, when localised in the head and neck district, mandibular lesions account for the majority of cases. Mandibular lesions can mimic other pathological conditions, making biopsy fundamental for differential diagnosis. Treatment depends on the severity of the disease, ranging from pharmacological treatment to surgical approach. However, EG is also reported to possibly undergo spontaneous resolution. In this case report, we describe a rare case of EG with particularly aggressive behaviour in a young patient. Initially, local pharmacological treatment with intralesional administration of corticosteroids lead to worsening of the symptoms, increase in lesion's dimensions, and disruption of the cortical bone. A more invasive therapeutic approach involving radical surgery was then performed, with consequent resolution of the disease.

Feasibility of a combination of intraoral UHFUS and CBCT in the study of peri-implantitis.

OBJECTIVES: The aim of this study was to investigate the combination of intraoral ultra-high-frequency ultrasonography (UHFUS) and cone beam computed tomography (CBCT) in the evaluation of hard and soft tissues in a case of peri-implantitis. STUDY DESIGN: A 57-year-old patient was referred for pain and numbness of the chin after implant placement and the subsequent guided bone regeneration (GBR) procedure. Clinical examination revealed hard tumefaction of the mandibular mucosa, with mild mobility of the implants. Assessment with UHFUS was undertaken for the study of the width, degree of tissue alteration, and vascularity of the swollen mucosa, and CBCT was used to evaluate the bone surrounding the implants and the possible impingement of the inferior alveolar nerve. RESULTS: A combination of CBCT and UHFUS was effective in the evaluation of GBR complications in peri-implantitis, revealing alterations in the periosteum secondary to suboptimal GBR treatment. This was the first study to use UHFUS to evaluate the characteristics of oral soft tissues. CONCLUSIONS: UHFUS is a promising tool for the diagnosis of complicated soft tissue diseases. When used with CBCT, it can provide useful information on oral and maxillofacial diseases involving hard and soft tissue in a noninvasive way, with reduced radiation dose exposure.

Augmented reality as an aid in maxillofacial surgery: validation of a wearable system allowing maxillary repositioning.

AIM: We present a newly designed, localiser-free, head-mounted system featuring augmented reality as an aid to maxillofacial bone surgery, and assess the potential utility of the device by conducting a feasibility study and validation. METHODS: Our head-mounted wearable system facilitating augmented surgery was developed as a stand-alone, video-based, see-through device in which the visual features were adapted to facilitate maxillofacial bone surgery. We implement a strategy designed to present augmented reality information to the operating surgeon. LeFort1 osteotomy was chosen as the test procedure. The system is designed to exhibit virtual planning overlaying the details of a real patient. We implemented a method allowing performance of waferless, augmented-reality assisted bone repositioning. In vitro testing was conducted on a physical replica of a human skull, and the augmented reality system was used to perform LeFort1 maxillary repositioning. Surgical accuracy was measured with the aid of an optical navigation system that recorded the coordinates of three reference points (located in anterior, posterior right, and posterior left positions) on the repositioned maxilla. The outcomes were compared with those expected to be achievable in a three-dimensional environment. Data were derived using three levels of surgical planning, of increasing complexity, and for nine different operators with varying levels of surgical skill. RESULTS: The mean error was 1.70 ± 0.51 mm. The axial errors were 0.89 ± 0.54 mm on the sagittal axis, 0.60 ± 0.20 mm on the frontal axis, and 1.06 ± 0.40 mm on the craniocaudal axis. The simplest plan was associated with a slightly lower mean error (1.58 ± 0.37 mm) compared with the more complex plans (medium: 1.82 ± 0.71 mm; difficult: 1.70 ± 0.45 mm). The mean error for the anterior reference point was lower (1.33 ± 0.58 mm) than those for both the posterior right (1.72 ± 0.24 mm) and posterior left points (2.05 ± 0.47 mm). No significant difference in terms of error was noticed among operators, despite variations in surgical experience. Feedback from surgeons was acceptable; all tests were completed within 15 min and the tool was considered to be both comfortable and usable in practice. CONCLUSION: We used a new localiser-free, head-mounted, wearable, stereoscopic, video see-through display to develop a useful strategy affording surgeons access to augmented reality information. Our device appears to be accurate when used to assist in waferless maxillary repositioning. Our results suggest that the method can potentially be extended for use with many surgical procedures on the facial skeleton. Further, our positive results suggest that it would be appropriate to proceed to in vivo testing to assess surgical accuracy under real clinical conditions.