jaws

下巴
  • 文章类型: Case Reports
    动脉瘤性骨囊肿是一种病因不明的罕见溶骨性病变,通常在下肢观察到,只有1-2%的报告在颌骨。我们介绍了一名27岁的男性患者的病例,该患者因精神区域感觉异常和下颌体积增加而转诊口腔颌面外科和创伤学服务。体格检查显示中线移位和硬一致性。影像学检查显示下颌皮质破裂,有射线可透/低密度病变。切开活检材料的组织病理学检查导致中央巨细胞病变的诊断。病人接受了手术切除,标本的组织病理学分析显示主要为实体病变,以不同大小的充满血液的空间为特征,不被上皮或内皮覆盖,随着梭形细胞的存在,多核巨细胞,和嗜碱性骨样物质,结论诊断为混合型动脉瘤样骨囊肿。尽管不常见,在年轻患者颌骨体积增加的鉴别诊断中,应考虑动脉瘤性骨囊肿。
    Aneurysmal bone cyst is a rare osteolytic lesion of uncertain etiology, commonly observed in the lower limbs, with only 1-2% of reports in gnathic bones. We present the case of a 27-year-old male patient referred to the oral and maxillofacial surgery and traumatology service due to complaints of paresthesia in the mental region and increased mandibular volume. Physical examination revealed midline shift and hard consistency. Imaging examinations demonstrated a radiolucent/hypodense lesion with disruption of the mandibular cortices. The histopathological examination of incisional biopsy material led to the diagnosis of a central giant cell lesion. The patient underwent surgical resection, and the histopathological analysis of the specimen revealed a predominantly solid lesion, characterized by blood-filled spaces of varying size, not covered by epithelium or endothelium, with the presence of spindle cells, multinucleated giant cells, and basophilic osteoid material, concluding the diagnosis of mixed-type aneurysmal bone cyst. Despite being uncommon, aneurysmal bone cysts should be considered in the differential diagnosis of volumetric increase in the gnathic bones of young patients.
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  • 文章类型: Systematic Review
    背景:肌纤维瘤是由肌样细胞和肌成纤维细胞组成的罕见良性肿瘤。本研究旨在系统地回顾病例报告以及口腔颌面部区域发生的一系列肌纤维瘤(MF)和肌纤维瘤病(MFT),以描述其主要临床病理特征。
    方法:本系统评价是根据系统评价和荟萃分析指南的首选报告项目进行的。2023年在四个数据库中进行了电子搜索:MEDLINE/PubMed,WebofScience,Scopus,和EMBASE。还进行了手动搜索和灰色文献中的搜索。根据原始报告将病变分类为MF或MFT。
    结果:本系统综述共纳入169例。男性受到的影响稍微大一点,有一个无痛的结节.当发生在软组织中时,MF通常在牙龈中发育(平均年龄:29.23±21.93岁),并且在骨内发育,它在后下颌骨中更常见(平均年龄:14.33±15.62岁)。MFT主要发生在下颌骨中,主要被描述为以血管外皮细胞瘤样模式组织的梭形细胞团,具有明显的血管活性。病变主要为平滑肌肌动蛋白和波形蛋白免疫标志物阳性。在大多数情况下,手术切除是首选治疗方法,仅在3例中观察到复发。
    结论:MF和MFT影响更多男性,临床过程缓慢。骨内肿瘤和MFT似乎更频繁地发生在年轻个体中。这些病变似乎预后良好,复发率低。
    BACKGROUND: Myofibromas are rare benign neoplasms composed of myoid cells and myofibroblasts. This study aimed to systematically review case reports and a series of myofibromas (MF) and myofibromatosis (MFT) occurring in the oral and maxillofacial regions in order to describe their main clinicopathological features.
    METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Electronic searches were conducted in 2023 in four databases: MEDLINE/PubMed, Web of Science, Scopus, and EMBASE. A manual search and a search in the grey literature were also conducted. The lesions were classified as MF or MFT according to their original report.
    RESULTS: A total of 169 cases were included in this systematic review. Men were slightly more affected, with a painless nodule. When occurring in soft tissue, MF usually developed in the gingiva (mean age:29.23 ± 21.93 years) and when it was intra-osseous, it occurred more frequently in the posterior mandible (mean age:14.33 ± 15.62 years). MFT occurred mainly in the mandible and was predominantly described as well-circumscribed masses of spindle cells organized in fascicles with a prominent vascular activity in a hemangiopericytoma-like pattern. The lesions were mainly positive for smooth muscle actin and vimentin immunomarkers. Surgical excision was the treatment of choice in the majority of cases and recurrence was observed in only three cases.
    CONCLUSIONS: MF and MFT affect more men, with an indolent clinical course. Intra-osseous tumors and MFT seem to occur more frequently in younger individuals. These lesions seem to have a good prognosis and low recurrence.
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  • 文章类型: Journal Article
    牙源性粘液瘤是良性牙源性肿瘤之一,具有侵袭性行为,并表现出缓慢和无症状的扩张,生命的第二个到第三个十年是最有针对性的年龄组。具有很高的女性优势,关于管理,手术治疗是关于这种牙源性病理学的唯一选择,有多种治疗选择。这项研究旨在分析在单个机构中治疗的37例牙源性粘液瘤患者。
    总共,在苏丹的KTDH治疗了37例牙源性粘液瘤患者,并进行了回顾性分析。通过对所有牙源性粘液瘤患者的病历及相关变量的分析,数据使用SPSS统计程序(第23版)进行分析。
    大多数病例为女性(26例70.27%),男性约为(11例29.73%)。在大多数情况下,上颌骨的影响大于下颌骨(25例,67.57%)主要在后段(32例,86.49)。受影响最大的年龄组是病例组(0-20),约为18例(48.65%)。总的来说,其中35例出现肿胀(94.59%),而14例发现牙齿活动度(37.84%)和感觉异常仅在一例(2.70%)中是阳性发现。总的来说,12例(32.43%)患者有与病变相关的拔牙史,复发阳性(64,86%)。
    牙源性粘液瘤是局部侵袭性的。没有手术治疗的黄金标准方案,因此要考虑到每种情况的特征以及相关的术后损伤的复发率,选择最适合和最可靠的治疗方案。
    UNASSIGNED: Odontogenic myxoma is one of the benign mesenchymal odontogenic tumours with aggressive behaviour and showed slow and asymptomatic expansion, the second until the third decade of life is the most targeted age group. With high female preponderance, about the management, surgical management is the only option concerning this odontogenic pathology with a variety of treatment options. This study aims to analyse a series of 37 patients with odontogenic myxoma treated in a single institution.
    UNASSIGNED: In total, 37 patients with odontogenic myxoma were treated at KTDH in Sudan and were retrospectively reviewed. With the analysis of medical records of all patients diagnosed with odontogenic myxoma and the related variables, data were analysed using the SPSS statistical program (version 23).
    UNASSIGNED: Most of the cases were females (26 patients 70.27%), and males were about (11 patients 29.73%). In most of the cases maxilla was affected more than the mandible (25 cases, 67.57%) mostly in its posterior segment (32 cases, 86.49). The most age group affected was the group of cases (0-20) which were about 18 cases (48.65%). In total, 35 of the cases noticed swelling (94.59%), while 14 noticed tooth mobility (37.84%) and paraesthesia was a positive finding in just one case (2.70%). In total, 12 patients (32.43%) had a positive history of tooth extraction related to the lesion, and recurrence was positive in (64, 86%).
    UNASSIGNED: Odontogenic myxoma is locally aggressive. There is no gold standard protocol for surgical treatment so choosing the most suitable and reliable treatment option relay on the operator taking into consideration the characteristic of each case and the recurrence rate with the associated postoperative impairments.
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  • 文章类型: Journal Article
    目的:比较不同治疗方式治疗颌面部骨骼中心性巨细胞肉芽肿的长期效果。初次切除可能导致重大缺陷。替代治疗包括药理学试剂。到目前为止,在使用各种治疗方案方面还没有达成共识,很少有研究报告澄清长期结果。
    方法:这项回顾性研究对22例患者25个病灶进行了临床评估,放射学和组织学特征,治疗前和病变复发。成功定义为消退/钙化,失败定义为复发,进展或无反应。
    结果:在介绍的患者中,77%的人年龄在40岁以下。前下颌骨和左后上颌骨的病变患病率较高。大多数病例表现出疼痛,牙齿活动或粘膜扩张。上颌骨的外观主要是单眼的,下颌骨的是多房性的,也表现出更高的皮质穿孔患病率。高达80%的病变被分类为侵袭性的。7例使用病灶内类固醇/降钙素。平均随访39.8个月。2例复发。71%的病例接受了药物治疗,观察到钙化/消退。
    结论:我们的分析表明,使用联合方法获得更好的结果,包括大的侵袭性病变的药物和手术治疗。药物治疗导致缩小或明确定义的病变,从而减少了广泛的骨切除的需要。糖皮质激素和降钙素的双重治疗没有显示出更好的结果,但是应该评估一个更大的队列。
    结论:有几种治疗中枢巨细胞肉芽肿的方案,但大多数还没有完全建立起来。重要的是报告有助于建立行之有效的协议的结果。本报告试图建立联合方法的相关性:药物治疗,然后手术切除。
    OBJECTIVE: To compare long-term results of different treatment modalities in central giant cell granuloma of the maxillofacial-skeleton. Primary resection may result in major defects. Alternative treatments include pharmacological agents. As yet there has been no consensus on the use of the variety of treatment options, and few studies have reported clarifying long-term results.
    METHODS: This retrospective study on 22 patients with 25 lesions evaluated clinical, radiological and histological features, treatment preformed and lesion recurrence. Success was defined as regression/calcification and failure as recurrence, progression or un-responsiveness.
    RESULTS: Of the presenting patients, 77% were under age 40. Lesion prevalence was higher in the anterior mandible and left posterior maxilla. Most cases exhibited pain, tooth-mobility or mucosal-expansion. The appearance was predominantly unilocular in the maxilla and multilocular in the mandible, which also exhibited higher prevalence of cortical perforation. Up to 80% of lesions were classified as aggressive. Intralesional steroids/calcitonin were used in 7 cases. Mean follow-up was 39.8 months. Two cases showed recurrence. In 71% of the cases treated pharmacologically, calcification/regression were observed.
    CONCLUSIONS: Our analysis indicates better outcomes using a combined approach, including both pharmacological and surgical treatments in large aggressive lesions. Pharmacological treatment resulted in decreased size or well-defined lesions, thus reducing the need for extensive bone resection. Dual treatment with corticosteroids and calcitonin showed no superior outcomes, but a larger cohort should be assessed.
    CONCLUSIONS: There are several protocols for treatment of central-giant-cell-granuloma lesions, but most are not fully established. It is important to report results that contribute to the establishment of proven protocols. This report attempts to establish the relevance of the combined approach: pharmacological treatment followed by surgical resection.
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  • 文章类型: Journal Article
    背景:药物相关的颌骨坏死是抗再吸收/抗血管生成药物治疗患者中最常见的并发症。可能与MRONJ发病相关的药物清单不断增加;我们旨在报告第三代表皮生长因子受体酪氨酸激酶抑制剂(Osimertinib)可能导致本文所述病例中的双侧上颌坏死。
    方法:在2023年6月,一名具有两种不同上颌骨暴露的肿瘤患者被提请我们注意。他的病史显示Denosumab和Osimertinib治疗两年,后者在拔牙前不悬挂。经过三个周期的抗生素治疗后,临床医生进行了骨清除和骨清创术。
    结果:组织学检查证实了MRONJ的临床诊断,排除了转移发生,而粘膜完全愈合后15天。
    结论:为了预防MRONJ,患者在拔牙前暂停Denosumab超过六个月;因此,未能停用奥希替尼导致我们认为它是一个可能的病因因素.从文献分析来看,目前仅有1例报告肺癌患者可能发生奥希替尼相关的MRONJ.我们的案例是进一步的报告,可以作为肿瘤学家和牙医共同分享关于此类患者口腔管理的决定的警报,也告诉他们这个可能的风险。此外,这份报告可能引发科学界有必要对类似的可疑病例进行进一步的指导方针评估,其中药物相互作用,单悬架,和可能的可移除假体相关的额外创伤应考虑原因或共同原因。
    BACKGROUND: Medication-related osteonecrosis of the jaws is the most frequent complication in patients treated or in therapy with antiresorptive/antiangiogenetic drugs. The list of medications possibly related to MRONJ onset is constantly growing; we aimed to report on a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (Osimertinib) as possibly responsible for bilateral maxillary necrosis onset in the herein-described case.
    METHODS: In June 2023, an oncologic patient with two different maxillary bone exposures was referred to our attention. His medical history revealed a two-year Denosumab regimen along with Osimertinib, the latter not suspended before teeth extractions. The clinicians performed a sequestrum removal and bone debridement after three cycles of antibiotic therapy.
    RESULTS: Histologic examinations confirmed the clinical diagnosis of MRONJ excluding a metastatic occurrence, while complete mucosal healing was achieved after 15 days.
    CONCLUSIONS: The patient suspended Denosumab for more than six months before teeth extraction for MRONJ prevention; hence, failure to discontinue Osimertinib led us to consider it a possible etiological factor. From a literature analysis, only one case has already been published reporting a possible Osimertinib-related occurrence of MRONJ in lung cancer patients. Our case is a further report that could be intended as an alert both for oncologists and dentists to share decisions about the oral management of such patients together, also informing them about this possible risk. Also, this report could trigger in the scientific community the necessity to evaluate further guidelines for similar doubtful cases in which the drug interaction, the mono-suspension, and the possible removable prosthesis-related additional trauma should be considered causes or con-causes.
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  • 文章类型: Multicenter Study
    背景:本研究旨在探讨口腔颌面部转移瘤的临床病理特征。
    方法:在这项回顾性研究中,活检记录来自巴西口腔颌面诊断转诊中心,危地马拉,墨西哥,和南非。
    结果:共评估120例。其中,53.78%受影响的女性患者,平均年龄为57.64岁。骨内病变更常见,特别是在下颌骨的后部(49.58%)。临床上,大多数病例表现为症状性肿胀,平均进化时间为25个月。在大多数情况下,临床诊断假设是恶性病变。乳腺癌是女性最常见的原发肿瘤,而肺起源在男性中最常见。在大多数情况下,原发癌为腺癌(44.73%).随访期29例,在这些之外,20人因疾病死亡。
    结论:虽然这是一种罕见的情况,临床医生应该意识到任何口腔病变都有转移的可能性,特别是在有癌症病史的个体中。这项研究的发现可以帮助临床医生及时诊断这些病变并随后进行肿瘤学评估和治疗。
    BACKGROUND: This study aimed to investigate the clinicopathological features of metastases in the oral and maxillofacial regions.
    METHODS: In this retrospective study, biopsy records were obtained from referral centers for oral and maxillofacial diagnosis in Brazil, Guatemala, Mexico, and South Africa.
    RESULTS: A total of 120 cases were evaluated. Of these, 53.78% affected female patients, with a mean age of 57.64 years. Intraosseous lesions were more frequent, particularly in the posterior region of the mandible (49.58%). Clinically, most cases presented with symptomatic swelling, with an average evolution time of 25 months. The clinical diagnostic hypothesis in most instances was that of a malignant lesion. Breast cancer was the most common primary tumor location in females, while lung origin was most common in males. In most cases, the primary cancer was an adenocarcinoma (44.73%). The follow-up period was available for 29 cases, and out of these, 20 had died due to the disease.
    CONCLUSIONS: Although this is a rare condition, clinicians should be aware that any oral lesions have the possibility of being metastatic, particularly in individuals with a previous history of cancer. The findings from this study could assist clinicians in prompt diagnosing these lesions and subsequent conducting oncologic assessments and treatment.
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  • 文章类型: Journal Article
    昆虫使用下颌骨来完成各种任务,包括食品加工,材料运输,鸟巢建筑,育卵护理,和战斗。尽管功能存在多样性,下颌骨运动通常被认为被限制为绕单个固定轴旋转。这里,我们在一个使用下颌骨进行广泛任务的物种中对这种“铰链关节假说”进行了直接定量测试:Attavollenweideri切叶蚁。使用多相机装置在三个维度上重建了来自活体受约束蚂蚁的下颌骨运动。刚体运动学分析揭示了强有力的证据,下颌骨运动占据了一个运动空间,需要一个以上的旋转自由度:在大的张开角度,下颌骨的运动以偏航为主。但是在小的开口角度,下颌骨偏航和俯仰。偏航和俯仰的结合使下颌骨可以“纵横交错”:下颌骨闭合时,下颌骨中的任何一个都可以位于顶部。我们观察到自由切割的蚂蚁纵横交错,这表明它在功能上很重要。结合最近关于其他昆虫关节关节多样性的报道,我们的结果表明,昆虫下颌骨运动学比传统假设的更加多样化,因此值得进一步详细调查。本文是“动物的食品加工和营养同化”主题的一部分。
    Insects use their mandibles for a variety of tasks, including food processing, material transport, nest building, brood care, and fighting. Despite this functional diversity, mandible motion is typically thought to be constrained to rotation about a single fixed axis. Here, we conduct a direct quantitative test of this \'hinge joint hypothesis\' in a species that uses its mandibles for a wide range of tasks: Atta vollenweideri leaf-cutter ants. Mandible movements from live restrained ants were reconstructed in three dimensions using a multi-camera rig. Rigid body kinematic analyses revealed strong evidence that mandible movement occupies a kinematic space that requires more than one rotational degree of freedom: at large opening angles, mandible motion is dominated by yaw. But at small opening angles, mandibles both yaw and pitch. The combination of yaw and pitch allows mandibles to \'criss-cross\': either mandible can be on top when mandibles are closed. We observed criss-crossing in freely cutting ants, suggesting that it is functionally important. Combined with recent reports on the diversity of joint articulations in other insects, our results show that insect mandible kinematics are more diverse than traditionally assumed, and thus worthy of further detailed investigation. This article is part of the theme issue \'Food processing and nutritional assimilation in animals\'.
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  • 文章类型: Journal Article
    目的:确定相对频率,诊断为颌骨囊肿的患者的人口统计学和病理学特征。
    方法:回顾了2000年至2020年参与机构的活检记录,以诊断为囊肿类别的病变。人口统计数据,收集囊肿的位置和病理诊断。使用IBMSPSS软件28.0版通过适当的统计学分析数据。
    结果:来自148,353例,诊断为囊肿类别25628例(17.28%)。患者的平均年龄±SD=42.62±19.36岁。儿科患者(年龄≤16岁)占9.63%,而老年患者(年龄≥65岁)占所有患者的14.22%。男女比例为1.27:1。大多数病变在下颌骨中遇到。最常见的囊肿是根性囊肿,其次是牙源性角化囊肿和牙源性角化囊肿。在儿科小组中,牙质囊肿是最普遍的,而在老年组,最常见的是根性囊肿。
    结论:一般来说,这项研究的结果与以前的研究一致。这项研究为临床医生制定临床鉴别诊断以及病理学家提供了宝贵的数据库。
    To determine the relative frequency, demographic and pathologic profiles of patients diagnosed with cysts of the jaws.
    Biopsy records of the participating institutions from 2000 to 2020 were reviewed for lesions diagnosed in the cyst category. Demographic data, the location of the cysts and pathologic diagnoses were collected. Data were analyzed by appropriate statistics using IBM SPSS software version 28.0.
    From 148,353 accessioned cases, 25,628 cases (17.28%) were diagnosed in the cyst category. Mean age of the patients ± SD = 42.62 ± 19.36 years. Paediatric patients (aged ≤ 16 years) accounted for 9.63%, while geriatric patients (aged ≥ 65) comprised 14.22% of all the patients. The male-to-female ratio was 1.27:1. The majority of the lesions were encountered in the mandible. The most prevalent cyst was radicular cyst followed by dentigerous cyst and odontogenic keratocyst. In the paediatric group, dentigerous cyst was the most prevalent, whereas in the geriatric group, radicular cyst was the most common.
    In general, the results of this study are in accordance with previous studies. This study provides an invaluable database for clinicians when formulating clinical differential diagnoses as well as for pathologists in rendering the final diagnosis.
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  • 文章类型: Journal Article
    背景:墨西哥利乐,墨西哥Astyanax,包括干涉表面居住和洞穴居住形态,能够进行强大的研究,旨在揭示与洞穴相关性状进化有关的基因。与水面鱼相比,洞穴鱼在他们的头骨里有几个极端的特征,比如突出的下颚,一个更宽的缺口,和牙齿数量的增加。这些特征在单个洞穴鱼之间甚至在不同的洞穴鱼种群之间都是高度可变的。
    结果:为了研究这些特征,我们创造了一种新的摄食行为试验,其中可以获得咬伤印象。我们确定,随着牙痕数量的增加,咬伤的鱼会留下更大的咬伤印象。利用从表面和洞穴鱼杂交产生杂种的能力,我们通过对F2杂种进行定量性状基因座(QTL)分析,研究了这些分离的口面性状的基因。我们发现了重要的咬伤QTL(咬伤与咬伤覆盖)映射到Astyanax基因组的单个区域。在这个基因组区域内,多个基因表现出编码区突变,一些在骨骼发育中具有已知作用。Further,我们确定有证据表明该基因组区域处于自然选择状态。
    结论:这项工作强调了洞穴鱼作为一种有价值的口面模式的遗传模型,并将提供对颌骨和牙齿发育的遗传调节因子的见解。
    The Mexican tetra, Astyanax mexicanus, includes interfertile surface-dwelling and cave-dwelling morphs, enabling powerful studies aimed at uncovering genes involved in the evolution of cave-associated traits. Compared to surface fish, cavefish harbor several extreme traits within their skull, such as a protruding lower jaw, a wider gape, and an increase in tooth number. These features are highly variable between individual cavefish and even across different cavefish populations.
    To investigate these traits, we created a novel feeding behavior assay wherein bite impressions could be obtained. We determined that fish with an underbite leave larger bite impressions with an increase in the number of tooth marks. Capitalizing on the ability to produce hybrids from surface and cavefish crosses, we investigated genes underlying these segregating orofacial traits by performing Quantitative Trait Loci (QTL) analysis with F2 hybrids. We discovered significant QTL for bite (underbite vs. overbite) that mapped to a single region of the Astyanax genome. Within this genomic region, multiple genes exhibit coding region mutations, some with known roles in bone development. Further, we determined that there is evidence that this genomic region is under natural selection.
    This work highlights cavefish as a valuable genetic model for orofacial patterning and will provide insight into the genetic regulators of jaw and tooth development.
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  • 文章类型: Journal Article
    鸟类相对于脑箱移动上喙的能力的价值已经在进食和唱歌等重要任务中得到了体现。在啄木鸟中,这种头颅运动被认为会阻碍啄食,因为用力击打需要头部作为刚性单元。这里,我们通过比较啄木鸟在日常活动(如食物处理)中的上喙旋转来测试他们的颅骨运动是否受到限制,与来自密切相关的物种的人打电话并大张旗鼓,这些物种也有大量食虫性饮食,但不在木头上。啄木鸟和非啄木鸟食虫动物的上喙旋转均高达8度。然而,两组的上喙旋转方向差异很大,啄木鸟主要显示凹陷,非啄木鸟显示隆起。啄木鸟的上喙旋转发散可能是由于颅面铰链的解剖学改变导致的,从而降低了海拔,通过下颌骨减压肌的尾部方向迫使喙凹陷,或者两者兼而有之。我们的结果表明,啄食不会导致啄木鸟上喙基础的平原硬化,但它仍然显着影响颅骨运动的表现方式。
    The value of birds\' ability to move the upper beak relative to the braincase has been shown in vital tasks like feeding and singing. In woodpeckers, such cranial kinesis has been thought to hinder pecking as delivering forceful blows calls for a head functioning as a rigid unit. Here, we tested whether cranial kinesis is constrained in woodpeckers by comparing upper beak rotation during their daily activities such as food handling, calling and gaping with those from closely related species that also have a largely insectivorous diet but do not peck at wood. Both woodpeckers and non-woodpecker insectivores displayed upper beak rotations of up to 8 degrees. However, the direction of upper beak rotation differed significantly between the two groups, with woodpeckers displaying primarily depressions and non-woodpeckers displaying elevations. The divergent upper beak rotation of woodpeckers may be caused either by anatomical modifications to the craniofacial hinge that reduce elevation, by the caudal orientation of the mandible depressor muscle forcing beak depressions, or by both. Our results suggest that pecking does not result in plain rigidification at the upper beak\'s basis of woodpeckers, but it nevertheless significantly influences the way cranial kinesis is manifested.
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