The levator veli palatini muscle (LVP) plays a fundamental and pivotal role in speech and swallowing. Despite centuries of anatomical description, the LVP origin remains a subject of debate, with several prominent sources offering contradictory findings. This study seeks to clarify conflicting accounts by conducting, to our knowledge, the largest dissection study on LVP morphology to date. We examined 27 temporal bone specimens and 27 hemi-heads from cadaveric donors. All exhibited an LVP origin from the portion of the cartilaginous Eustachian tube inside the osseous Eustachian tube orifice, with other anatomical variants including smaller accessory muscle bellies originating from a thick fibrous tissue layer overlying the petrous bone (the most common variant, 16/27) or from the carotid sheath (5/27). Our results did not support prior claims of the LVP originating exclusively from the petrous bone. There was no significant difference based on age or sex in the type of variant exhibited (p < 0.05). We also found that most temporal bones exhibited an infratubal spine of variable size and that, as corroborated by dissection and inter-observational documentation, these tended to function as attachments for a thick fibrous tissue layer that is continuous with both the carotid sheath and Weber-Liel fascia. These findings contribute to clinical applications such as postoperative monitoring of cleft palate repair patients among whom LVP growth is functionally important. They are also applicable to vocal tract reconstructions in extinct hominins where minor differences in relative LVP length could have functional impacts on speech and respiration by influencing velar biomechanics.

Paranasal sinuses of living apes and humans grow with positive allometry, suggesting a novel mechanism for bone enlargement. Here, we examine the paranasal sinuses of the owl monkey ( Aotus spp.) and a tamarin ( Saguinus midas ) across postnatal development. The prediction that paranasal sinuses grow disproportionately faster than the main nasal chamber is tested. We used diffusible iodine-based contrast-enhanced computed tomography and histology to study sinuses in eight Aotus and three tamarins ranging from newborn to adult ages. Sinuses were segmented at the mucosa-air cavity interface and measured in volume. All sinuses were lined by a ciliated respiratory epithelium, except for the ethmoid air cells in Aotus , which are lined in part by olfactory epithelium. An age comparison indicates that only the maxillary sinus and ethmoid air cells are present in newborns, and two additional sinuses (invading the orbitosphenoid and the frontal bone), do not appear until late infancy or later. Comparing newborns and adults, the main nasal airway is 10 times larger in the adult Aotus and ~ 6.5 times larger in adult Saguinus . In contrast, the maxillary sinus far exceeds this magnitude of difference: 24 times larger in the adult Aotus and 46 times larger in adult Saguinus. The frontal sinuses add significantly to total paranasal space volume in both species, but this growth is likely delayed until juvenile age. Results suggest ethmoid air cells expand the least. These results support our prediction that most paranasal sinuses have a distinctly higher growth rate compared to the main nasal chamber.

Purpose: To document and assess the genicular arterial variation in a large multicenter cadaveric sample and to generate an anatomical classification with implications for genicular artery embolization (GAE). Materials and Methods: A total of 212 dissected donor body lower limbs from 3 medical school institutions were included. The descending genicular artery (DGA), superior lateral genicular artery, superior medial genicular artery, middle genicular artery, inferior lateral genicular artery, inferior medial genicular artery, and anterior tibial recurrent artery were identified for gross anatomical appearance, location of origin, diameter of vessels, and variation in branching patterns. Results: A total of 198 DGAs, 204 popliteal-origin genicular arteries, and 183 anterior tibial recurrent arteries were adequately preserved and reviewed. Three types (A: 26%, B: 71%, and C: 5%) of DGA branching patterns were proposed along with 6 types (I: 28%, II: 22%, III: 15%, IV: 15%, V: 10%, and VI: 6%) of popliteal-origin genicular artery branching variants. Right versus left comparisons did not reveal clinically significant differences in the vessel distance (P=.30 to.82). Conclusions: Despite the large number of possible anatomical variations of the genicular arteries, 6 main patterns corresponded to >96% of the cases. The description and classification of the genicular arterial anatomy may provide useful information to the interventional radiologist and add to the technical nuances of GAE.

Objective: Our objective is to provide observations demonstrated with 3Dimensional Computed x-ray Stereoscopic Imaging (3DCTSI) in the evaluation of the anterior ethmoid and frontal sinus development from birth to age 18. Methods: This is a retrospective evaluation of patient’s CT studies performed over a fifteen-year period, reported as normal studies, and included 53 patients (142 sides) from birth to age 18. Results: At birth, there are two spaces covered by folds, the uncinate and bulla lamellae. The spaces communicate with the Middle Meatus (MM) through the emerging ethmoid infundibulum (EI) and the retrobulbar recess space (RBRS). In the first month after birth, an expansile and breakdown developmental phase blend and continue throughout the growth into the teenage years. The 3D images reveal dark lamellar structures, on the surface of the medial lamina papyracea as well as bridging the broken spatial outlines. The dark lamellae represent the mucosal lamina propria, in unossified lamellae and are the origin of permanent spatial walls. From ages 4 to 18 years, initially, the frontal recess (FR) and later the MM penetrate into the cancellous frontal bone creating the frontal Sinus (FS), the frontal septum (FS), Inter-Frontal Sinus Septal Cell (IFSSC), as well as the Fronto-Ethmoidal and Frontal Bulla Spaces. Conclusion: 3DCTSI is the first intuitive imaging modality to reveal the microanatomical development of the anterior ethmoid and frontal sinus anatomy.

Anatomy education has suffered greatly during the Covid‐19 pandemic, forcing medical institutions to switch from in‐person to remote learning. This entails sacrifice of the 3D learning component of the laboratory and creates a major experience gap in the curriculum. At the School of Health Professions of SUNY Downstate Health Sciences University, anatomy courses were delivered remotely over the past two summers for the physical therapy, physician assistant, and occupational therapy programs. Student evaluations reveal the perception of their respective cohorts having “lost out” on the value of in‐person experience in the anatomy lab compared to upper classmen who took this course before the pandemic lockdown. To bridge this gap, medical educators came together as a community to offer an in‐person, hands‐on anatomy experience to 94 health professional students. Weill Cornell Medicine hosted the event and provided 20 donor dissection bodies with a total of 16 participating faculty that included anatomy directors from SUNY Albany, University at Buffalo, Icahn and NYU Schools of Medicine, in addition to Emergency department and Rehabilitative Medicine Attendings and former students who are now in private practice. A review of the musculoskeletal system was offered in three distinct categories that involved demonstration of movements, the neurovascular elements involved, and clinicopathologies. The follow up survey reveals positive student responses in all three categories. They also credited the event with providing an appreciation of the three‐dimensionality of the region, citing that remote learning did not offer a full understanding of contiguous anatomical structures in 3D space. What was not measured in the survey were unexpected losses of corollary benefits to other courses that learning human dissection conferred. Program directors reported that some of these students underperformed in their respective programs which was unexpected based on their admissions profile compared to students who had the in‐person anatomy lab experience. What is missing when students do not have a 3‐D appreciation for the musculoskeletal system is their understanding of elements such as direction of muscle fibers (parallel vs pennate), line of pull, and eccentric versus concentric contractions. Human gross anatomy in the laboratory, aside from providing 3D learning, lays the foundation for the problem‐solving skills and professionalism that will be expected of them throughout their health professional careers. Thus, gross anatomy education is not solely a course to “memorize” the names of soft‐tissue structures in 3D space but instead also serves to develop and fortify professional behaviors that will prepare students beyond the laboratory and into the workplace.

The nasopharynx is a region at the nexus of several vital physiological systems, including the nasal cavity, oral cavity, braincase, middle ear, and cervical vertebrae. It has undergone pronounced morphological change over the course of tetrapod, mammalian, and human evolution. However, despite its place in evolutionary history, the nasopharynx has received relatively little attention. This special issue focuses on "the evolution, development, and functional morphology of the nasopharynx and its boundaries." Topics covered here include evolutionary developmental biology (or evo-devo), nasopharyngeal adaptions in bats, the importance of the nasopharynx and adjacent structures over the course of human evolution, normal development, middle ear morphology, clinical importance, and the study of the nasopharynx throughout history. Contributions to this special issue range among reviews and syntheses, descriptive analyses, phylogenetic analysis, traditional morphometrics, three-dimensional geometric morphometrics, and computational fluid dynamics. Here, we discuss the central importance of the nasopharynx as can be seen through vertebrate paleontology and comparative morphology. It is via the composite evolutionary history of the nasopharyngeal boundaries that our origins may be better understood, starting with the derivation of the choanae from the median olfactory pit of jawless fish nearly half a billion years ago to the basicranial flexion and facial reduction that distinguish Homo sapiens from all other living mammals. Indeed, the nasopharynx must be acknowledged for its importance in the processes of encephalization and acquisition of speech that have become the hallmark of our species.

The late archeologist Glynn Isaac first applied the term "muddle in the middle" to a poorly understood period in the Middle Pleistocene human fossil record. This study uses the nasopharyngeal boundaries as a source of traits that may inform this unclear period of human evolution. The nasopharynx lies at the nexus of several vital physiological systems, yet relatively little is known about its importance in human evolution. We analyzed a geographically diverse contemporary Homo sapiens growth series (n = 180 adults, 237 nonadults), Homo neanderthalensis (La Chapelle aux Saints 1, La Ferrassie 1, Forbes Quarry 1, Monte Circeo 1, and Saccopastore 1), mid-Pleistocene Homo (Atapuerca 5, Kabwe 1, Petralona 1, and Steinheim 1), and two Homo erectus sensu lato (KNM-ER 3733 and Sangiran 17). Methods include traditional (Analysis 1) and 3D geometric morphometric analysis (Analysis 2). H. erectus exhibited tall, narrow nasopharyngeal shape, a robust, ancestral morphology. Kabwe 1 and Petralona 1 plotted among H. sapiens in Analysis 2, exhibiting relatively shorter and vertical cartilaginous Eustachian tubes and vertical medial pterygoid plates. Atapuerca 5 and Steinheim 1 exhibited horizontal vomeral orientation similar to H. neanderthalensis, indicating greater relative soft palate length and anteroposterior nasopharynx expansion. They may exhibit synapomorphies with H. neanderthalensis, supporting the accretionary hypothesis. Species-level differences were found among H. sapiens and H. neanderthalensis, including relatively longer dilator tubae muscles and extreme facial airorhynchy among Neanderthals. Furthermore, H. neanderthalensis were autapomorphic in exhibiting horizontal pterygoid plate orientation similar to human infants, suggesting that they may have had inferiorly low placement of the torus tubarius and Eustachian tube orifice on the lateral nasopharyngeal wall in life. This study supports use of osseous nasopharyngeal boundaries both for morphological characters and understanding evolution of otitis media susceptibility in living humans.

The nasopharynx has been understudied relative to neighboring anatomical regions. It is a highly complex, integrated space whose function, development, and evolution remains unclear after nearly 5,000 years of study. Historically, most work on the nasopharynx was done with a focus on adjacent structures. It has most often been mentioned in relation to the middle ear (via the Eustachian tube) in ancient texts and has only later been given a designation as one of three portions of a tripartite pharynx among adult humans. As human dissection became practiced more widely in Renaissance Europe, understanding of the nasopharyngeal boundaries improved. With further advancements in the study of nasopharyngeal development, evolution, and anatomical variation from the 19th century up until the present, this region has been shown to be functionally vital and still complicated to define.

The SARS‐CoV‐2 (COVID‐19) outbreak adversely affected medical school education and drastically reduced in‐person learning, specifically affecting gross anatomy laboratory dissection. Depending on the academic calendar schedule, some schools were interrupted in the middle of anatomy teaching while others had more lead time to prepare but schools suddenly faced an imposed demand for a transition to distance learning. SUNY Downstate had its anatomy education interrupted due to the Covid‐19 shut down. To gap the previous laboratory experience of students and complete the semester anatomy curriculum, a series of dissected abdominal videos were created and distributed to all first‐year medical students (n=208). The video‐based curriculum and the current student experience taking anatomy without cadaveric dissections were assessed via pre/post‐tests and a five‐question survey. A paired single tailed t‐test comparing student responses (n=164) in the pre‐ versus post‐test was statistically significant (P < 0.002) while 92% of students (n=136) reported that their previous time dissecting prepared them to learn through videos without the benefit of hands‐on dissection. Icahn School of Medicine adopted digital Grant's Dissector utilizing their accompanying narrated videos. Faculty voiced over the narration, however, permitting emphasis of material, directing pacing of course, and tying content to lecture and physical exams. Complete anatomy was used to augment the experience, with 3D virtual dissections and enhance the visualization of the structures, however the videos remained as the driver of content delivery. Weill Cornell Medicine created, and customized anatomy prosected material videotaping the show and tell sessions integrating powerpoint slides to tie in lecture content and clinical correlates. Results from all three schools highlight the technical success of implementing an anatomy video‐based curriculum in response to COVID‐19. Survey findings describe a unique cohort of students who were compelled to participate in a video‐based curriculum after having learned anatomy in a donor body laboratory environment and student performance on summative exams in general equaled or exceeded scores from previous years. Overall, anatomy education through videos, digital platforms, and apps can offer a reliable stop‐gap solution in the absence of traditional cadaveric dissection in a short‐term, provisional model. However, the experience of learning anatomy from a human body in laboratory is irreplaceable and the future now seems to point to a combination of these modalities, and others, such as virtual reality or augmented reality, yet to be adapted and customized to our educational settings.

Middle ear disease or otitis media (OM) is among the most common pediatric conditions globally. It is nearly ubiquitous among every human population, usually occurring within the first three postnatal years. The etiology of OM is known to be rooted in the short, horizontal cartilaginous Eustachian tubes (CET) of infants which are mechanically inefficient relative to those of adults. Yet, despite the presence of OM among all human populations, Inuit and Aboriginal Australian communities have been documented as exhibiting some of the highest rates globally. Little information exists on the normal morphology of the bony nasopharyngeal boundaries of these groups. We tested whether they could be distinguished from other human populations in the orientation of the cartilaginous Eustachian tube and dilator tubae (DT) belly of the tensor veli palatini muscle (TVP), the sole dilatory apparatus of the CET. Any morphological feature distinguishing groups with higher rates of OM may impact susceptibility.

Introduction. The carotid region is encountered in vascular and neurological surgery and carries a potential for vascular and cranial nerve trauma. The carotid bifurcation is an especially important landmark and difficult to predict based on currently established landmarks. This study is a detailed analysis of the carotid region and proposes a novel methodology to predict the height of the bifurcation. Materials and Methods. Superficial and deep dissections were performed on the anterior triangle of the neck to expose the carotid region in twenty-one formalin-fixed donor cadavers. Musculoskeletal and neurovascular structures were assessed in relation to the carotid bifurcation and the medial border of the clavicle (MBC). Results. The carotid bifurcation occurred, on average, 11.4mm higher on the left (p < 0.001; 95% CI: 9.28, 13.54). The superior thyroid artery (p < 0.001), facial vein (p < 0.001), and cranial nerve XII (p < 0.001) were all more distal on the left side when measured from the MBC while the angle of the mandible and stylohyoid muscle remained symmetric. Left- and right-sided vascular structures were symmetric when measured from the carotid bifurcation. Conclusions. Neurovascular structures within the carotid region are likely to be anatomically superior on the left side while vessels are likely to remain symmetric in relation to the carotid bifurcation. When measured from the MBC, the bifurcation height can be predicted by multiplying the distance between the MBC and mastoid process by 0.65 (right side) or 0.74 (left side). This novel methodological estimation may be easily learned and directly implemented in clinical practice.

Otitis media (OM) or middle ear disease is a prevalent pediatric condition generally related to early growth of the cartilaginous Eustachian tube (CET). This study used a developmental series of dry crania to reconstruct CET and dilator tubae (DT, the muscle opening the CET) morphology. Timing and directionality of CET and upper respiratory tract (URT) growth were investigated. Traditional and 3D geometric morphometrics (GM) were used to assess bony landmarks on the crania. The series was divided using dental eruption into seven growth stages ranging from before eruption of deciduous dentition (approximately the first 6 postnatal months) to eruption of the first permanent maxillary molar (after approximately 6 years). Bony endpoints of the CET and DT were used to calculate their morphology. GM analysis showed substantial shape differences between newborns, early infants, and all later developmental stages. Univariate measures showed the largest growth change between birth and 6 months. Subsequently, CET morphology changed little in the latter half of year 1, instead maturing gradually until approximately 3 years whereas DT relative length and orientation finish growth by the end of year 1. Incongruence in slower CET growth and faster DT growth could impact CET function between 6 and 12 months and be a contributing factor of OM. Tubal aeration may improve after this time when both CET and DT morphology mature, coinciding with clinically reported drop-off in ear infections.

United States medical schools are moving to multiple choice‐style assessments, away from traditional fill‐in, for anatomy practical exams. Practical exams for medical students have long consisted of identifying anatomical structures and writing the answer on an answer sheet. This study reports several aspects of this change at two medical schools: New York Medical College and SUNY Downstate Health Sciences University. The report also documents the evolution of opinion of faculty, teaching assistants [TAs] and students with respect to the benefits of each testing modality. Student t‐tests were used to compare test score data between the two testing modalities employed at each institution. Results showed there were no statistically significant differences between fill‐in and MCQ mean scores for NY Med (5 years of fill‐in vs 5 years of MCQ) and Downstate (5 years of fill‐in vs one year of MCQ), 0.5 and 0.7 (p < 0.05), respectively. Resistance and support for the transition from faculty, TAs and students were common from both schools irrespective of constancy in student performance between the two testing formats. The quantitative results were surprising as an expected increase in the statistical mean in the MCQ format did not occur. Logistical and pedagogical merits of each exam format were assessed. Faculty and TAs resistant to MCQ exams predicted that offering choices would provide an advantage, as there would be a 25% chance of having a correct choice against the binary of a correct or incorrect written answer. TAs felt that a fill‐in format tapped into a higher cognitive level to reach the correct answer. Students with English as their second language, on the other hand, strongly supported the MCQ exam format. MCQ exams had the benefit of being corrected within 10 minutes of submission with Item Analysis accompanying the report allowing identification of poorly tagged questions and providing the opportunity to make corrections in real time for the entire class. Effectively assessing medical student competence must be addressed in contemporary curriculum design but is MCQ a reliable way to do so?

Transcatheter Arterial Embolization of the Shoulder is an emerging procedure for pain and limited range of motion secondary to adhesive capsulitis and shoulder tendinopathy refractory to conservative treatments. This study adds to the limited literature on anatomical variations of the arterial supply to the glenohumeral joint. The shoulder has a complex vascular network, and a better understanding of the vascular anatomy can help in preventing non-target embolization, increasing the utility of this procedure. A mixed sex sample of medically embalmed donor bodies from 3 medical schools were utilized for this study. 63 cadaveric limbs were dissected for gross anatomical appearance. The location of origin, diameter of the branches off the axillary artery including the Thoracoacromial Artery, Subscapular Artery, Circumflex Scapular Artery, Anterior Humeral Circumflex Artery and Posterior Humeral Circumflex Artery, were reviewed. The location of origin, diameter of vessels and variation in patterns were documented using a Neiko 01409A electronic Vernier digital caliper with an accuracy to 1/10 of a mm. 57 Limbs were adequately preserved. Consistent variations in the arterial origin of the suprascapular artery were noted. Branching type patterns were identified for the Thoracoacromial Artery, Subscapular Artery, Circumflex Scapular Artery, Anterior Humeral Circumflex Artery and Posterior Humeral Circumflex Artery, with detailed arteriograms summarizing the scapular anastomoses contribution to the glenohumeral joint. Right versus left analysis revealed significant variations in origin and branching patterns. Transcatheter Arterial Embolization of the Shoulder is an increasingly utilized technique that requires a thorough understanding of the glenohumeral vascular anatomy in order to optimize selective embolization and to reduce the risk of non-target tissue embolization. Our results in combination with imaging findings can help interventionalist tackle the early reported struggles visualizing the relevant anatomy as there is a lack of detailed anatomy most notably at the cadaveric level.

To analyze the variations of the genicular arteries in a large multicenter cadaveric sample, as well as to propose a simple anatomic classification of such variations based on the obtained results and to discuss its implications for the Genicular Artery Embolization procedure. 212 cadaveric lower limbs were dissected. The descending genicular artery, superior lateral genicular artery, superior medial genicular artery, middle genicular artery, inferior lateral genicular artery, inferior medial genicular artery and anterior tibial recurrent artery were reviewed for gross anatomical appearance, location of origin, diameter of vessels, territorial supply and variation in branching patterns. Incidences were calculated by percentage. A total of 198 descending genicular arteries, 204 popliteal origin genicular arteries and 183 anterior tibial recurrent arteries were adequately preserved and reviewed. Three types (A-C) for the Descending Genicular Artery and six patterns (I–VI) for the Middle Geniculate Arteries branch origins were established in the classification. The origin of the SMGA (47.0 mm) was the furthest from the reference line, followed by SLGA (40.2 mm), MGA (22.2), IMGA (-0.8), and ILGA (-6.5). There are no significant differences in vessel diameter and pattern incidences by laterality or sex. Despite the large number of possible anatomical variations of the genicular arteries, six main patterns for the MGA corresponded to over 96% of the cases. Furthermore, a simplified classification of the DGA is proposed focused on GAE. Evaluation of anatomy in a systematic fashion, following a standard classification, will make GAE a faster, safer, and more effective procedure.

Strong anatomical acumen is critical in today's procedural dermatologic practice. Accruing the necessary skill set for the dermatologic resident to become a successful practitioner requires acquiring the foundational knowledge of the underlying craniofacial anatomy with the goal of facilitating and translating basic principles of cutaneous surgical procedures. Most dermatologic residency programs provide hands‐on surgical experience supplemented with academic lectures and surgical texts. In response to growing demand from the dermatology residents at SUNY Downstate Medical Center the co‐investigators recently combined efforts to organize and instruct a cadaveric head and neck dissection course with photo documentation. Feedback from residents strongly advocated for dissection sequence to be video captured in order to re‐visit protocol, assess understanding and implement practice procedures. This study reports on the creation of a digitally annotated facial dissection high definition video with clinically relevant correlates providing a comprehensive review and enhancing anatomical education to dermatology residents. Specifically, the dermatologic resident was guided through a complete fascial dissection sequence to delineate key anatomical landmarks, detailing facial planes and fat compartments pertinent to dermatologic procedures and surgeries. Pre‐ and Post‐assessment tests provided an evaluation of the impact the digital educational material had on the dermatologic residents. Resident perception reflected an increase in confidence and understanding of the surgical approaches required for successful outcomes. Video distribution to residents would permit mastery of craniofacial anatomy, which remains indispensable for proper and safe cutaneous and cosmetic procedures for the 21st century dermatologist.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

ABSTRACTNeanderthals are among the best studied and yet most enigmatic fossil human groups with aspects of their anatomy and functional morphology remaining poorly understood. We present the first anatomical reconstruction of the Neanderthal cartilaginous Eustachian tube (CET), a vital component of the upper respiratory tract and nexus for the middle ear and postnasal airway. The Eustachian (auditory, pharyngotympanic) tube, comprised of a bony and cartilaginous (CET) portion, is integral to normal physiological functions such as middle ear aeration and pressure equilibration. Findings indicate that Neanderthal tubal morphology may have predisposed them to high rates of middle ear disease (otitis media [OM]). In living humans, mechanical CET dysfunction underlies OM in infants and young children, with sequelae including hearing loss, meningitis, and pneumonia. Despite proven linkage of CET malfunction with OM, the role of CET morphology in Neanderthal health and disease remains unstudied. We reconstructed Neanderthal CET morphology, comparing their crania to a modern human growth series. Methods included geometric morphometrics and univariate measures among Procrustes‐fitted coordinates. Results showed Neanderthal adults exhibiting primitively tall and narrow nasopharynges with infant‐like horizontal CET and choanal orientation. As horizontal CET orientation is associated with increased OM incidence in infants and children until around age six, its appearance in Neanderthal adults strongly indicates persistence of high OM susceptibility at this time. This could have compromised fitness and disease load relative to sympatric modern humans, affecting Neanderthals' ability to compete within their ecological niche, and potentially contributing to their rapid extinction. Anat Rec, 302:2109–2125, 2019. © 2019 American Association for Anatomy

Among modern humans, otitis media (benign otitis media with effusion and acute otitis media, AOM) is the second most common pediatric clinical conditions. Acute otitis media is a fatal disease that can result in meningitis and pneumonia if untreated. Osteological signs of this disease may be found in erosion patterns on the middle ear ossicles, ossification of the tympanic membrane, and a lack of mastoid pneumatization. Recent studies report that nearly all known Neanderthal ossicles exhibit erosion patterns consistent with chronic AOM. To account for the anatomical basis of this apparent disease susceptibility, we assessed the morphological configuration of the cartilaginous Eustachian tube (CET) and dilator tubae (DT) musculature among a modern human growth series ranging from newborns to adults (n=442) and a sample of Neanderthals (La Chapelle aux Saints 1, La Ferrassie 1, Forbes Quarry 1, Saccopastore 1, Guattari 1) and mid‐Pleistocene pre‐Neanderthals (Atapuerca 5 and Steinheim 1). We performed morphometric analysis of the bony upper respiratory tract boundaries. A total of 31 bilateral and midline 3D landmarks were used and coordinate data were subjected to Procrustes‐fitting for geometric morphometric analysis and calculation of univariate measures.Neanderthals exhibited tall narrow choanae and greater overall robusticity. La Ferrassie 1 and Forbes Quarry 1 possessed extremely infant‐like CET orientation relative to the Frankfurt Horizontal Plane while other specimens had adult‐like or intermediate orientation. Choanal orientation among all Neanderthals was horizontal as among human infants. This trait occurred alongside a relatively adult‐like elongation and vertical orientation of the DT whereas the pre‐Neanderthals were distinguished primarily by an extremely short DT relative to Neanderthals and modern humans.The morphological configuration of Neanderthals was unlike any modern human population or growth stage. Differences between these groups appear to be species‐level with Neanderthals retaining infant‐like horizontal orientation of both the choanae and (among some) CET into adulthood. Neanderthal children were probably susceptible to AOM for longer periods of development. While modern human children experience steep reduction in disease occurrence at approximately six years of age with changes in both CET length and orientation, Neanderthal children would have remained susceptible as there was no such growth change in CET orientation. This could have impacted population‐wide fitness when sympatric modern humans invaded Neanderthal habitats and competed for limited resources. AOM should thus be considered among the many potential factors involved in the extinction of the Neanderthals.Support or Funding InformationNational Science Foundation, Grant number 1128901This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.