RESUMO
BACKGROUND: Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure. PURPOSE: The purpose of the study was to measure the association between OI location and risk for sepsis at admission. STUDY DESIGN, SETTING, AND SAMPLE: This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18 years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample. PREDICTOR VARIABLE: The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral. MAIN OUTCOME VARIABLES: The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis. COVARIATES: Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay. ANALYSES: Descriptive and bivariate analyses were performed. A χ2 test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P < .05. RESULTS: The sample was composed of 168 subjects with a mean age of 42.8 ± 21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P = .004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio = 9.13, 95% confidence interval: 2.48 to 33.55, adjusted P = <.001). CONCLUSION AND RELEVANCE: The study findings suggest that the OI location is associated with the qSOFA score >0.
Assuntos
Infecção Focal Dentária , Sepse , Humanos , Sepse/etiologia , Masculino , Estudos Retrospectivos , Feminino , Pessoa de Meia-Idade , Infecção Focal Dentária/complicações , Fatores de Risco , Escores de Disfunção Orgânica , Adulto , IdosoRESUMO
INTRODUCTION: Transdifferentiation of chondrocytes into bone cells explains most condylar growth during prenatal and early postnatal stages, but the mechanisms regulating chondrocyte transdifferentiation during late postnatal growth remain unknown. This study aimed to quantify the effects of dietary loading on chondrocyte-derived osteogenesis during late postnatal condylar growth. METHODS: Two compound mouse lines were used to trace the fate of chondrocyte lineage in vivo. Twelve 3-week-old male Aggrecan-CreERT2 (AcanLineage); R26RTdTomato; 2.3 Col10a1-GFP and twelve 3-week-old male Col10a1-Cre (Col10a1Lineage); R26RTdTomato; 2.3Col1a1-GFP were randomly divided into experimental (soft-food diet, n = 6) and control (hard-food diet, n = 6) groups and kept for 6 weeks. One time, tamoxifen injections were given to AcanLineage mice at 3 weeks. Radiographic, microcomputed tomographic, and histomorphometric analyses were performed. RESULTS: Radiologic analysis showed that mice with a soft-food diet had smaller mandible lengths as well as decreased bone volume and density for their condylar process. Histologically, mice with soft diets had reduced activity in chondrocyte proliferation and maturation compared with the controls. Cell lineage tracing results showed the number of AcanLineage-derived bone cells (293.8 ± 39.8 vs 207.1 ± 44.6; P = 0.005), as well as total bone cells (445.6 ± 31.7 vs 360.7 ± 46.9; P = 0.004), was significantly higher in the hard-diet group than in the soft-diet group, whereas the number of non-AcanLineage-derived bone cells was not significantly different among groups (P = 0.938). Col10a1Lineage mice showed the same trend. CONCLUSIONS: Dietary loading directly affects condyle chondrogenesis and chondrocyte transdifferentiation, which alters the extent of condylar growth and remodeling.
Assuntos
Transdiferenciação Celular , Condrócitos , Côndilo Mandibular , Animais , Côndilo Mandibular/crescimento & desenvolvimento , Camundongos , Masculino , Dieta , Microtomografia por Raio-X , Osteogênese/fisiologiaRESUMO
STATEMENT OF PROBLEM: Studies that have analyzed the bond strength of resilient denture liners to milled denture bases are sparse, and the authors are unaware of research that has investigated the tensile bond strength of denture relining materials to 3D-printed denture bases. PURPOSE: The purpose of this in vitro study was to evaluate the tensile bond strength of both hard and soft denture reline materials on denture bases fabricated by 3D printing and computer-aided design and computer-aided manufacture (CAD-CAM) milling technology. MATERIAL AND METHODS: Injected, milled, and printed denture base specimens were fabricated (n=30) and bonded to 5 different denture reline materials: soft chairside reline (Coe Soft and PermaSoft), hard chairside reline (Tokuyama Rebase ii and Kooliner), and hard laboratory reline (ProBase Cold). Specimens of each reline material were divided into 5 groups (n=10) and were placed in distilled water for 24 hours before tensile testing. Maximum tensile stress values before failure were recorded, and the failure mode was also determined. The type of failure was analyzed by a scanning electron microscope. Statistics were analyzed with 2-way ANOVA and multiple comparison tests (α=.05). RESULTS: Overall, no statistically significant difference in tensile bond strength was found in the injected, milled, and printed denture groups. However, the printed denture base group demonstrated significantly lower values of tensile bond strength (P<.05) with PermaSoft, Tokuyama Rebase ii, and ProBase Cold groups than other denture base groups (milled and injected). The milled denture bases had the highest mean value of tensile bond strength with 4 of the 5 denture relining materials tested (Coe Soft, PermaSoft, Tokuyama Rebase ii, and Kooliner). No statistically significant difference (P>.05) was found among the injected, milled, and printed denture bases when relined with Kooliner. When comparing the denture reline type, the lowest values were seen with the soft chairside relining materials, and highest values with the hard laboratory reline material. Among the modes of failure, adhesive failures were observed predominantly with the printed denture base materials relined with soft chairside relining materials, while cohesive and mixed modes of failure were found in the milled and injected denture base groups. CONCLUSIONS: The printed denture bases had significantly lower tensile bond strength values than the injection and milled denture bases with the PermaSoft, Tokuyama Rebase ii, and ProBase Cold denture relines, while milled denture bases demonstrated the highest values of tensile bond strength for all chairside relining groups. In addition, the soft chairside relining materials showed the lowest tensile bond strength values regardless of the denture processing method with respect to the denture base type (injected, printed, and milled) compared with the hard relining materials.
Assuntos
Colagem Dentária , Reembasadores de Dentadura , Bases de Dentadura , Reembasamento de Dentadura , Desenho Assistido por Computador , Impressão TridimensionalRESUMO
STATEMENT OF PROBLEM: The accuracy of printed implant surgical guides can be affected by different factors that negatively impact the planned implant position. How print orientation, storage time, and conditions influence manufacturing accuracy remains uncertain. PURPOSE: The purpose of this in vitro study was to evaluate the influence of print orientation, storage conditions, and storage time on the intaglio surface accuracy of implant surgical guides manufactured by using a stereolithography (SLA) printer. MATERIAL AND METHODS: A tooth-supported maxillary implant surgical guide design (control file) was used to fabricate the specimens (N=40, n=10). Four groups were created based on the print orientation used: 0 (Group 0), 45 (Group 45), 70 (Group 70), and 90 degrees (Group 90). The specimens were fabricated using an SLA printer (Form 3B+) and a biocompatible dental resin (Surgical Guide Resin V1) following the manufacturer's recommended protocol. Each group was divided into 2 subgroups based on the storage conditions: light (L subgroup) and dark (D subgroup) settings. Each specimen was digitized by using a desktop scanner (Medit T710) at days 0, 1, 7, and 14. The control file and each digitized specimen were superimposed by using the best-fit technique with a metrology program (Geomagic Control X). The root mean square (RMS) error was used to calculate the discrepancies between the control files and specimen files. Three-way ANOVA and pairwise comparison Tukey tests were used to analyze trueness. The Levene test was used to assess precision (α=.05). RESULTS: Significant trueness discrepancies were found among the groups tested (P<.001), but no significant differences were found among the subgroups (P=.100) and the storage times analyzed (P=.609). Additionally, the Tukey test showed significant RMS error mean value discrepancies between Group 0 and Group 45 (P<.001), Group 0 and Group 90 (P<.001), Group 45 and Group 70 (P<.001), and Group 70 and Group 90 (P<.001). The Levene test revealed significant SD discrepancies among the groups tested (P<.05). CONCLUSIONS: The trueness and precision of the intaglio surface of the implant surgical guides manufactured by using the printer and material tested were affected by the print orientation. However, storage conditions over a 14-day period did not impact the intaglio accuracy of the specimens.
RESUMO
PURPOSE: To determine skeletal and occlusal surgical changes and long-term stability outcomes for patients diagnosed with juvenile idiopathic arthritis (JIA) after TMJ reconstruction with TMJ Concepts patient-fitted total joint prostheses (TJP) and concomitant maxillary orthognathic surgery. MATERIAL/METHODS: A retrospective cohort study was conducted of all patients diagnosed with JIA, receiving TJP, and concomitant maxillary orthognathic surgery between 1991 and 2019, at Baylor University Medical Center treated by 1 surgeon. Patient evaluations presurgery (T1), immediate postsurgery (T2), and at longest follow-up (LFU) (T3) were analyzed using 20 cephalometric landmarks to compute 29 linear and angular measurements to determine surgical changes, long-term skeletal and occlusal stability, as well as oropharyngeal airway changes. Comparative data were tested for significance (α = 0.05) using paired and unpaired t tests. RESULTS: Forty-two patients met the JIA inclusion criteria, with a median age of 17.5 years and median postsurgical follow-up of 26 months. There were significant surgical changes (T1-T2) (P ≤ .05) for all parameters associated with mandibular linear and angular surgical changes, except for the horizontal position of posterior nasal spine and the vertical/horizontal position of gonion, indicating highly stable surgical outcomes. There were significant improvements in the oropharyngeal airway dimensions. CONCLUSIONS: This study suggests that TMJ Concepts patient-fitted TJP for TMJ reconstruction in conjunction with maxillary orthognathic surgery for counterclockwise rotation of the maxillo-mandibular complex for the JIA patients provides long-term skeletal and occlusal stability as well as dimensional improvement in the oropharyngeal airway.
Assuntos
Artrite Juvenil , Prótese Articular , Cirurgia Ortognática , Transtornos da Articulação Temporomandibular , Adolescente , Artrite Juvenil/cirurgia , Humanos , Estudos Retrospectivos , Articulação Temporomandibular , Transtornos da Articulação Temporomandibular/cirurgiaRESUMO
PURPOSE: Patients with juvenile idiopathic arthritis (JIA) and TMJ involvement may have major dentofacial deformities, pain, and jaw dysfunction. The aim of this study was to evaluate surgical outcomes for JIA patients relative to TMJ pain, headache, jaw function, diet, disability, and quality-of-life (QOL) after TMJ reconstruction with patient-fitted total joint prostheses (TJP) and concomitant orthognathic surgery. METHODS: A retrospective cohort study was conducted on a JIA patient group (JIAG) with significant dentofacial deformity, reconstructed with TJP and concomitant orthognathic surgery, and was compared to a control group (CG) of non-JIA patients that received the same surgical protocol with similar surgical movements. Primary predictors were the 2 groups: JIAG and CG. Data were evaluated and compared presurgery and at longest follow-up using Likert analog scales for the primary variables: TMJ pain, headache, jaw function, diet, and disability. Maximum interincisal opening (MIO) was measured in mm. QOL was rated in JIAG as improved, same, or worse. Comparative data were tested for significance (α = 0.05) using Wilcoxon signed rank and paired T-tests. RESULTS: Forty JIAG patients (8 males, 32 females) met the inclusion criteria, median age 17.5 years, median follow-up 26.5 months, and 26 CG patients (1 male, 25 females), median age 35.5 years, follow-up 24 months. Significant improvements (P ≤ .05) occurred postsurgery for TMJ pain, headache, jaw function, diet, and disability for both groups. Mean increase MIO for JIAG was 36.4 to 43.3 mm, for CG was 35.2 to 37.8 mm. Thirty-eight JIA patients (95%) improved in QOL, 2 had no change, and none were worse. CONCLUSIONS: This study suggests that patient-fitted TJP for TMJ reconstruction in conjunction with orthognathic surgery for the JIA patient provides long-term improvement relative to TMJ pain, headache, jaw function, diet, disability, MIO, and QOL.
Assuntos
Artrite Juvenil , Prótese Articular , Cirurgia Ortognática , Transtornos da Articulação Temporomandibular , Adolescente , Adulto , Artrite Juvenil/complicações , Artrite Juvenil/cirurgia , Feminino , Humanos , Masculino , Qualidade de Vida , Estudos Retrospectivos , Articulação Temporomandibular/cirurgiaRESUMO
FAM20C (family with sequence similarity 20 - member C) is a protein kinase that phosphorylates secretory proteins, including the proteins that are essential to the formation and mineralization of calcified tissues. Previously, we reported that inactivation of Fam20c in mice led to hypophosphatemic rickets/osteomalacia along with increased circulating fibroblast growth factor 23 (FGF23) levels and dental defects. In this study, we examined whether a high-phosphate (hPi) diet could rescue the skeletal defects in Fam20c-deficient mice. Fam20c conditional knockout (cKO) mice were generated by crossing female Fam20c-floxed mice (Fam20cfl/fl) with male Sox2-Cre;Fam20cfl/+ mice. The pregnant female Fam20cfi/fl mice were fed either a normal or hPi diet until the litters were weaned. The cKO and control offspring were continuously given a normal or hPi diet for 4 weeks after weaning. Plain X-ray radiography, micro-CT, histology, immunohistochemistry (FGF23, DMP1, OPN, and SOX9), and in situ hybridization (type II and type X collagen) analyses were performed to evaluate the effects of an hPi diet on the mouse skeleton. Plain X-ray radiography and micro-CT radiography analyses showed that the hPi diet improved the shape and mineral density of the Fam20c-deficient femurs/tibiae, and rescued the growth plate defects in the long bone. Histology analyses further demonstrated that an hPi diet nearly completely rescued the growth plate-widening defects in the long bone and restored the expanded hypertrophic zone to nearly normal width. These results suggested that the hPi diet significantly improved the skeletal development of the Fam20c-deficient mice, implying that hypophosphatemia partially contributed to the skeletal defects in Fam20c-deficient subjects.
Assuntos
Desenvolvimento Ósseo/efeitos dos fármacos , Osso e Ossos/embriologia , Hipofosfatemia , Fosfatos/farmacologia , Animais , Osso e Ossos/efeitos dos fármacos , Osso e Ossos/patologia , Proteínas de Ligação ao Cálcio/genética , Dieta , Proteínas da Matriz Extracelular/genética , Fator de Crescimento de Fibroblastos 23 , Lâmina de Crescimento/efeitos dos fármacos , Lâmina de Crescimento/embriologia , Lâmina de Crescimento/patologia , Hipofosfatemia/tratamento farmacológico , Hipofosfatemia/genética , Camundongos , Camundongos Knockout , Fosfatos/metabolismo , Fatores de Transcrição SOXB1/genéticaRESUMO
PURPOSE: Standing electric scooters (e-scooters) are rapidly becoming popular modes of transportation in many urban areas across the United States. However, this increase in popularity has resulted in an increase in traumatic injuries associated with these modes of expedient travel. The purpose of the present study was to determine the types of craniofacial trauma directly related to e-scooter use in a major urban center (Dallas, TX). MATERIALS AND METHODS: We performed a retrospective case series and examined the medical records of the patients who had presented to the emergency department (ED) for trauma related to e-scooter use. Descriptive statistics were calculated for all variables on patient presentation, including incident notes and patient interviews, demographic information, diagnostic tests, trauma (ie, location, type, severity), treatment (ie, type, admission, outpatient referral, follow-up data), and contributing factors (ie, reported or detected alcohol use, use of protective equipment). RESULTS: A total of 90 patients (56 males, 34 females; mean age, 31.8 years) had presented with scooter-related trauma to the ED during the first 7 months of scooters after their introduction to the metropolitan area. A total of 52 admissions (58% of all admissions) involved injuries of the head and face. The patients had presented with a myriad of craniofacial trauma, ranging from abrasions, lacerations, and concussions to intracranial hemorrhage and Le Fort II and III fractures. Of the 52 craniofacial injuries, 30 (58%) were considered severe (ie, fracture, internal hemorrhage, concussion, loss of consciousness), and 22 (42%) were considered minor (ie, lacerations, contusion, abrasion, dental). Alcohol use had been involved in 18% of all scooter-related trauma admissions, and no rider had reported wearing a helmet. CONCLUSIONS: Injuries to the head and face were commonly found with e-scooter admissions in this sample, and the high prevalence of extremity injuries suggested that patients were breaking their fall during the crash. Craniofacial trauma related to e-scooter use could be significantly reduced by the wearing of a protective helmet.
Assuntos
Ciclismo , Fraturas Ósseas , Lacerações , Adulto , Ciclismo/lesões , Cidades , Feminino , Fraturas Ósseas/etiologia , Dispositivos de Proteção da Cabeça , Humanos , Lacerações/etiologia , Masculino , Estudos Retrospectivos , Estados UnidosRESUMO
An estimated 3% of US pregnancies are affected by maternal thyroid dysfunction, with between one and three of every 1000 pregnancies being complicated by overactive maternal thyroid levels. Excess thyroid hormones are linked to neurological impairment and excessive craniofacial variation, affecting both endochondral and intramembranous bone. Using a geometric morphometric approach, this study evaluates the role of in utero thyroxine overexposure on the growth of offspring mandibles in a sample of 241 mice. Canonical variate analysis utilized 16 unilateral mandibular landmarks obtained from 3D micro-computed tomography to assess shape changes between unexposed controls (nâ =â 63) and exposed mice (nâ =â 178). By evaluating shape changes in the mandible among three age groups (15, 20 and 25â days postnatal) and different dosage levels (low, medium and high), this study found that excess maternal thyroxine alters offspring mandibular shape in both age- and dosage-dependent manners. Group differences in overall shape were significant (Pâ <â 0.001), and showed major changes in regions of the mandible associated with muscle attachment (coronoid process, gonial angle) and regions of growth largely governed by articulation with the cranial base (condyle) and occlusion (alveolus). These results compliment recent studies demonstrating that maternal thyroxine levels can alter the cranial base and cranial vault of offspring, contributing to a better understanding of both normal and abnormal mandibular development, as well as the medical implications of craniofacial growth and development.
Assuntos
Mandíbula/diagnóstico por imagem , Mandíbula/crescimento & desenvolvimento , Efeitos Tardios da Exposição Pré-Natal/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal/diagnóstico por imagem , Tiroxina/toxicidade , Animais , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/efeitos dos fármacos , Ossos Faciais/crescimento & desenvolvimento , Feminino , Masculino , Mandíbula/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL , Gravidez , Crânio/diagnóstico por imagem , Crânio/efeitos dos fármacos , Crânio/crescimento & desenvolvimento , Microtomografia por Raio-X/métodosRESUMO
INTRODUCTION: Artifacts created by the presence of metal objects in the jaw negatively affect the cone-beam computed tomographic image quality. This study compares artifacts produced by metal objects outside of the field of view (FOV) in a small FOV CBCT image with those produced in a large FOV image in which the metal object is within the FOV. METHODS: We methodically placed 4 titanium implant-sized rods and 4 zirconium crown-sized disks on 1 side of a human cadaver mandible. Using the Accuitomo 170 CBCT machine (J Morita, Irvine, CA), a total of 18 scans (9 with a small FOV and 9 with a large FOV) were made. Ten axial slices from each scan were transferred to ImageJ software (National Institutes of Health, Bethesda, MD) for analysis. The mean standard deviation of all voxel values of a fixed region of interest (ie, uniform air located lingual to tooth #30) was compared between small and large FOV slices. Two blinded observers subjectively rated the images for diagnostic quality and the presence of artifacts. RESULTS: The Wilcoxon signed rank test showed that the standard deviation for both small and large FOV slices increases as the number of metal objects increases. The mean of the standard deviation for small and large FOVs is 3.6 and 2.5, respectively (P = .0000). Fifty-three percent of the small FOV slices had more artifacts in the subjective analysis. One hundred percent of the small FOV slices were rated as higher quality. CONCLUSION: Metal objects outside of the FOV in the contralateral quadrant do affect the quality of small FOV images. However, small FOV images have a higher resolution compared with large FOV images.
Assuntos
Artefatos , Tomografia Computadorizada de Feixe Cônico , Humanos , Mandíbula/diagnóstico por imagem , Dente Molar , Imagens de Fantasmas , ZircônioRESUMO
INTRODUCTION: The purpose of this study is to evaluate the amount of residual obturation material of retroinstrumented surgically resected roots using controlled memory files and to evaluate the incidence of adverse treatment outcomes. METHODS: Thirty maxillary anterior teeth in human cadavers were selected, and nonsurgical root canal treatment was performed on these teeth. A standardized 4-mm osteotomy and a 3-mm root resection with as close to 0° bevel as possible were made on each tooth. A microsurgical diamond tip was used to create a 1- to 2-mm starting point for each retropreparation. A 25/06 and 30/06 VTaper 2H were bent at about 90° angle to mimic the clinical and anatomic restrictions and used to create a retropreparation to a depth of 14 mm. Micro-computed tomography scans were taken and analyzed for volume and percentage of residual obturation material at 5 and 10 mm. In addition, the incidences of instrument separation and crack and ledge formation in the teeth were recorded. RESULTS: The median volume of residual obturation at 5 and 10 mm was 0.18 mm3 (interquartile range, 0.36 mm3) and 1.97 mm3 (interquartile range, 1.99 mm3), respectively. The overall incidence of file separation during retropreparation was 13.33% (4/30). Among the cases analyzed with micro-computed tomography, none showed crack or ledge formation. CONCLUSIONS: Retroinstrumentation of surgically resected roots using controlled memory files cleans the canal effectively with relatively low adverse treatment outcomes. Although this novel technique is limited in application, it is a safe and effective way to achieve a deep, clean retropreparation.
Assuntos
Materiais Restauradores do Canal Radicular , Preparo de Canal Radicular , Apicectomia , Cadáver , Cavidade Pulpar , Humanos , Obturação do Canal Radicular , Microtomografia por Raio-XRESUMO
The late Neandertal sample from Vindija (Croatia) has been described as transitional between the earlier Central European Neandertals from Krapina (Croatia) and modern humans. However, the morphological differences indicating this transition may rather be the result of different sex and/or age compositions between the samples. This study tests the hypothesis that the metric differences between the Krapina and Vindija mandibular samples are due to sample bias. Mandibles are the focus of this paper because past studies have posited this region as particularly indicative of the Vindija sample's transitional nature. The results indicate that the metric differences between the Krapina and Vindija mandibular samples are not due to sample bias. This conclusion is consistent with an earlier analysis of sample bias for the Vindija supraorbital sample.
Assuntos
Antropologia Física/estatística & dados numéricos , Fósseis , Hominidae , Mandíbula/anatomia & histologia , Adulto , Animais , Antropometria , Evolução Biológica , Croácia , HumanosRESUMO
BACKGROUND: Although craniofacial sex differences have been extensively studied in humans, relatively little is known about when various dimorphic features manifest during postnatal life. Using cross-sectional data derived from the 3D Facial Norms data repository, we tested for sexual dimorphism of craniofacial soft-tissue morphology at different ages. METHODS: One thousand five hundred fifty-five individuals, pre-screened for craniofacial conditions, between 3 and 25 years of age were placed in to one of six age-defined categories: early childhood, late childhood, puberty, adolescence, young adult, and adult. At each age group, sex differences were tested by ANCOVA for 29 traditional soft-tissue anthropometric measurements collected from 3D facial scans. Additionally, sex differences in shape were tested using a geometric morphometric analysis of 24 3D facial landmarks. RESULTS: Significant (p < 0.05) sex differences were observed in every age group for measurements covering multiple aspects of the craniofacial complex. The magnitude of the dimorphism generally increased with age, with large spikes in the nasal, cranial, and facial measurements observed after puberty. Significant facial shape differences (p < 0.05) were also seen at each age, with some dimorphic features already present in young children (eye fissure inclination) and others emerging only after puberty (mandibular position). CONCLUSIONS: Several craniofacial soft-tissue sex differences were already present in the youngest age group studied, indicating that these differences emerged prior to 3 years of age. The results paint a complex and heterogeneous picture, with different groups of traits exhibiting distinct patterns of dimorphism during ontogeny. The definitive adult male and female facial shape was present following puberty, but arose from numerous distinct changes taking place at earlier stages.