Neil S. Norton

The Prevalence of Concha Bullosa and Nasal Septal Deviation and Their Relationship to Maxillary Sinusitis by Volumetric Tomography

The objective of this study was to determine the prevalence of concha bullosa and nasal septal deviation and their potential relationships to maxillary sinusitis. 883 CT scans taken at Creighton University School of Dentistry from 2005 to 2008 were retrospectively reviewed for the presence of concha bullosa, nasal septal deviation, and maxillary sinusitis. 67.5% of patients exhibited pneumatization of at least one concha, 19.4% of patients had a deviated septum, and 50.0% had mucosal thickening consistent with maxillary sinusitis. 49.3% of patients who had concha bullosa also had evidence of maxillary sinusitis. Only 19.5% of patients with concha bullosa also had nasal septal deviation, whereas 19.7% of patients with sinusitis also presented with nasal septal deviation. Although concha bullosa is a common occurrence in the nasal cavity, there did not appear to be a statistically significant relationship between the presence of concha bullosa or nasal septal deviation and maxillary sinusitis.

Behavioral and physiological sex differences observed in an animal model of fulminant hepatic encephalopathy in the rat.

Hepatic encephalopathy is characterized by a number of neuropsychiatric and motor disturbances observed in patients with liver dysfunction. The purpose of this study is to fully characterize behavioral and physiological sex differences in an animal model of fulminant hepatic encephalopathy (FHE). Male and female rats were administered thioacetamide (600 mg/kg) via i.p. (intraperitoneal) injection at Hours 0 and 24 and allowed to progress into the four stages of FHE. Male rats reached all four stages of FHE significantly earlier than female rats (p < 0.05). The performance of the male rats deteriorated more quickly (p < 0.05) than that of the females in all of the sensory and motor behavioral tests. Sex differences were observed in the liver enzymes of the FHE rats. The levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase were significantly greater (p < 0.05) in male rats in all four stages of FHE. Significant increases were also observed in the levels of direct and total bilirubin (p < 0.05). Neuronal damage was observed in the CA1 and CA2 regions of the hippocampus. In the CA1 region, male rats displayed greater pathological changes in Stages III and IV (p < 0.05) than female rats. The damage in the CA2 region was only observed in Stage IV male rats. Our data indicate that observable behavioral and physiological sex differences occur in thioacetamide-induced FHE in the rat.

The development of a core syllabus for the teaching of head and neck anatomy to medical students

The study of human anatomy has traditionally served as a fundamental component in the basic science education of medical students, yet there exists a remarkable lack of firm guidance on essential features that must be included in a gross anatomy course, which would constitute a “Core Syllabus” of absolutely mandatory structures and related clinical pathologies. While universal agreement on the details of a core syllabus is elusive, there is a general consensus that a core syllabus aims to identify the minimum level of knowledge expected of recently qualified medical graduates in order to carry out clinical procedures safely and effectively, while avoiding overloading students with unnecessary facts that have less immediate application to their future careers as clinicians. This paper aims to identify consensus standards of essential features of Head and Neck anatomy via a Delphi Panel consisting of anatomists and clinicians who evaluated syllabus content structures (greater than 1,000) as “essential”, “important”, “acceptable”, or “not required.” The goal is to provide guidance for program/course directors who intend to provide the optimal balance between establishing a comprehensive list of clinically relevant essential structures and an overwhelming litany, which would otherwise overburden trainees in their initial years of medical school with superficial rote learning, which potentially dilutes the key and enduring fundamental lessons that prepare students for training in any medical field. Clin. Anat. 27:321–330, 2014.

Multiple enamel pearls in two siblings detected by volumetric computed tomography

A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two siblings incidentally recognized during volumetric CT examination. Although the pathogenesis of ectopic enamel formation is not known, possible mechanisms to account for this phenomenon are discussed in the context of current knowledge regarding root genesis. The radiographic presentation of enamel pearls and its clinical significance is also discussed. The observation of multiple enamel pearls in two siblings raises the possibility of a hereditary association in the formation of enamel pearls.

Master in oral biology program: A path to addressing the need for future dental educators

In dental education, the anatomical sciences, which include gross anatomy, histology, embryology, and neuroanatomy, encompass an important component of the basic science curriculum. At Creighton University School of Dentistry, strength in anatomic science education has been coupled with a solid applicant pool to develop a novel Master of Science in Oral Biology, Anatomic Sciences track degree program. The program provides a heavy emphasis on developing teaching skills in predoctoral students as well as exposure to research processes to encourage the cohort to pursuing a career in academic dentistry. The individuals considered for this program are applicants for admission to the School of Dentistry that have not been accepted into the entering dental class for that year. The students undertake a two year curriculum, studying anatomic sciences with a special emphasis on teaching. The students also must complete a research project that requires a thesis. The students in the program are guaranteed acceptance to dental school upon successful completion of the program. After six years, the first ten students have received their Master of Science degrees and continued in dental school. The program is favorably viewed by the faculty and participating students. It is also considered successful by metrics. Nine of the ten graduates have said they would like to participate in academic dentistry in some capacity during their careers. Anat Sci Educ 10: 607–612.

Head and Neck Pathology and Radiology 2011

Beyond an examination of the dentition and surrounding periodontal tissues, one of the most important tasks of the dental clinician is the accurate diagnosis and management of patients with nontooth-related conditions of the head and neck. For patients with these conditions, it is imperative that the dental clinician performs a comprehensive evaluation and assessment on patients to increase the potential for a successful outcome. The skills of a myriad of specialists will be involved, including those in oral and maxillofacial pathology, radiology, oral medicine, head and neck anatomy, and the primary care provider. In this special issue dedicated to head and neck pathology and radiology, the manuscripts selected for publication further demonstrate the significance of the relationship described between the specialists and primary care provider. The article by D. C. Lorenzoni et al. highlights radiology and discusses the radiation doses that are associated with plain radiographs, cone beam computed tomography (CBCT), and conventional computed tomography (CT), placing a special emphasis on orthodontics. A. Sharma and V. P. Singh thoroughly summarize a study detecting supernumerary teeth in Indian children in 300 cases using clinical and radiographic examination. In one of their two articles in this special issue, L. Feller and J. Lemmer provide an extensive review on oral leukoplakia and its relationship to human papillomavirus (HPV). P. Bhirangi et al. elaborate on the technical steps for the prosthetic rehabilitation of an edentulous glossectomy patient. In the other article, L. Feller and J. Lemmer critically review cell transformation and the evolution of a field of precancerization as it relates to oral leukoplakia.

Contemporary Issues in Head and Neck Pathology and Radiology

The comprehensive evaluation, assessment, and management of patients with non-tooth-related conditions of the head and neck area are essential aspects of the practice of dental medicine. The manuscripts selected for publication in this special issue serve to illustrate the importance of close cooperation between oral and maxillofacial pathology, radiology, oral medicine, and head and neck anatomy in both the initial diagnostic and subsequent treatment phases when evaluating and treating patients with non-tooth-related conditions of the oral and maxillofacial complex. I would like to genuinely thank my Guest Editors, Dr. Neil S. Norton from Creighton University in Omaha, Neb, USA Dr. Preetha P. Kanjirath, from the University of Michigan at Ann Arbor, Mich, USA and Dr. Tarnjit Saini, Brooke Army Medical Center Fort Sam Houston, in San Antonio, Tex, USA for their assistance. Without their involvement and thoughtful discussions, this special issue would not have been possible. I also extend my thanks to the authors who have contributed to this special issue, as well as to the many reviewers who graciously volunteered with the peer-review process. In the lead article in this special edition, “Bone Diseases of the Jaws”, by P. J. Slootweg, provides an overview of the more common and/or important lesions occurring in the oral and maxillofacial complex, while emphasizing the considerable overlap in clinical, histological, and radiological features among these entities. Y. Morimoto and colleagues review the usefulness of ultrasound imaging for the detection of noninvasive and soft tissue-related diseases and introduce three new potential applications of ultrasonography: guided fine-needle aspiration, measurement of tongue cancer thickness, and diagnosis of metastasis to cervical lymph nodes. Subsequent manuscripts explore the relationship between craniofacial pathology and anatomy. L. Sonnesen summarizes recent studies on the link between morphological deviations of the cervical vertebral column and craniofacial morphology, while Guest Coeditor Neil S. Norton and colleagues employ volumetric tomography to review the anatomy of the greater palatine canal and also to rule out a statistically significant association between the prevalence of maxillary sinus disease and the presence of concha bullosa and/or nasal septal deviation. R. A. Mesquita and colleagues critically review the available literature on the nonsurgical treatment of oral leukoplakia, while E. de S. Tolentino and colleagues present a well-documented case of an ameloblastic fibroma that illustrates the need to integrate radiology, oral and maxillofacial pathology, and head and neck anatomy in both the initial diagnosis and subsequent treatment of lesions of the maxillofacial complex. On behalf of my Guest Coeditors and myself, I hope that you will find the manuscripts that comprise this special issue both interesting and informative. Paul C. Edwards Preetha P. Kanjirath Tarnjit Saini Neil S. Norton

Lesions of Autonomic Nerves

The autonomic nervous system (ANS) is the involuntary, sometimes referred to as the automatic or unconscious, portion of the nervous system that plays a crucial role in maintaining homeostasis. It is responsible for controlling and regulating most bodily functions, including temperature, blood pressure, respiration, bladder, bowel, and sexual functions. It is a rapidly responding system that innervates major organ systems and tissues, including cardiac muscle, smooth muscle, and glands. The ANS is divided into the sympathetic and parasympathetic components. Symptoms associated with lesions of the ANS depend on whether they affect sympathetic or parasympathetic function and their anatomical location, such as nuclei in the central nervous system, nerve projections, or end organs.