Sometimes it is the unexpected event that leads to the most interesting answers.
Patient KB was a healthy sport-minded 6 year-old.
In Canada that means ice hockey above all else. He had an Angle Class 1 occlusion with potential mild crowding of the maxillary incisors Fig 2. Otherwise his only dental problem was severe grinding of his teeth at night, something he had done for several years. There was extensive flattening of the cusps of the posterior teeth as a result.
The birth history was relevant. There had been prolonged labour and a difficult birth with severe compression of the occiput. This can lead to displacement of the temporal bones with lateral displacement of the squamous portions of these bones. This in turn results in the ears being flared, in this case on both sides. There was no history of other possible cranial difficulties or problems with suckling or swallowing, poor sleeping patterns, constant crying, restlessness, airway difficulties etc.
At 4 years of age he started to play organized hockey. At this age, falling on ice is normal but the kids are well padded, they wear helmets and everyone, including the kids, take falls as part of the game. They do not have far to fall but what is not well protected is landing on their tail bones. The shock to the pelvis is transmitted up the spine to the occipital condyles. As a result, jamming of these condyles may develop. This is transmitted to the whole occiput and the temporal bones with a resulting loss of cranial mobility at an age when growth of the cranium is still very active. The three parts of the occiput do not fuse until about 6-7 years of age.
The unusual turn of events was that as a probable result of the loss of cranial flexibility he took to chewing things during the day. This included his baseball mitt and even his hockey puck Fig 3. Even more odd was that when watching TV he took to chewing buttons off his clothing then stuffing them down behind the couch in the small boy hope that no one would notice.