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Introduction: The Modified Mallampati Tongue Score (MMT) is commonly used in anesthesiology for the pre-anesthetic assessment of the airway in patients. This score roughly estimates the size and position of the tongue relative to the oral cavity, with higher scores associated with difficult intubation and increased incidence of breathing interferences, such as obstructive sleep apnea. The distance from the tongue base to roof of the mouth decreases from MMT-I to MMT-IV. The tongue shape and position impact the airway patency in the hypopharynx, contributing to changes in craniofacial head posture followed by changes in craniofacial morphology. This present study examines the pattern of associations between the Modified Mallampati Tongue Score positions and 1) the postural relationship of the cranium, hyoid bone, cervical column, and tongue 2) size, shape, and position of the craniofacial components, as depicted in a lateral cephalogram. Methods: This retrospective study was performed on 200 subjects (145 female, 55 male) prior to starting orthodontic treatment. MMT was assessed from one photograph of maximum mouth opening and tongue protrusion. Pretreatment cephalograms were analyzed to evaluate craniocervical posture, resting tongue position, hyoid bone position, or sagittal and vertical skeletal relationships. MMT (I-IV) was also compared to basic demographics (age, gender, race/ethnicity). One-way ANOVA, Chi-square test, and correlation analysis were used for statistical analysis. Probability values <0.05 were accepted as significant. Results: A total of 200 patients (72.5% Female, 27.5% Male, 54% African American), with a mean age of 20 (Range 7-73), were included for the study. MMT-III was most prevalent (34%). MMT was not associated with age, gender, or race/ethnicity. Mean cephalometric measurements of hyoid position (p=0.06-0.03), mandibular position (p=0.006), ANB (p=0.009), and SNB (p=0.023, were shown to have significant differences with MMT. MMT positively correlated with the ANB (p=0.001), Wits (p=0.016), vertical position of the hyoid bone to neck (p=0.004) and mandible (p=0.048); and inversely correlated with the SNB (p=0.003) and Pog:Na-Perp (p=0.045). Conclusion: A higher MMT correlates to a Class II skeletal morphology and extended craniofacial posture. Preliminary results suggest high tongue position influences Class II craniofacial morphology, enhancing maxillary prognathic growth and mandibular deficiency. This indicates that MMT can be a potential predictor of craniofacial growth patterns, strengthening the prognosis and long-term stability of orthodontic treatment. / Oral Biology

The study of human cranial morphology has a long and contentious history. This study is the first large scale analysis of ecoregion specific human cranial modularity and integration. It utilizes an analysis of morphometric craniofacial variation and ecoregion affinity to better understand the environmental contribution to biological shape. This study tested three hypotheses. First, that there was variation in craniofacial shape that was linked to an individual’s ecoregion. Second, that there were ecoregion specific patterns of cranial modularity. And third, that the patterns of cranial integration (or the level of covariation between any two modules) were also associated with an individual’s ecoregion, and that different environments would result in different patterns of modular dependence and independence. Three-dimensional scans of 298 human crania were collected from museums, representing four higher level ecoregions and 11 lower-level ecoregions. Each cranium was mapped and placed within two hierarchical ecoregions. By examining ecoregions, instead of individual climatic variables, this analysis gives a more complete picture of how the environment is influencing cranial variation. Modules, or relatively independent morphological regions of the crania, were identified and their level of integration was assessed for every ecoregion. Modular integration is an analysis of the relative strength of the covariation between any two modules, and previous research theorized that changes in integration reflected changes in modular independence during development (Bastir and Rosas, 2005; Hall, 2005; Raff, 1996). The variation in strength between modules, both intrapopulation and interpopulation, were assessed and various explanations were explored. This analysis found that each ecoregion exhibited significantly different craniofacial shape from one another. Patterns of integration were also variable by ecoregion, suggesting that the ecological shape variation observed was solidified early in development. This study also identified the presence of a nasal module in each ecoregion. Overall, the findings of this study demonstrate that human crania are variable by ecoregion and that environmental conditions have led to ecoregion specific patterns of cranial modular integration. / Anthropology

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