[Experience in applying a free autograft from the fascia of the temporal muscle in tympanoplasty].
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The temporalis muscle flap is used in craniofacial reconstructive surgery to repair defects, to restore facial contours and to cover bone grafts. These possibilities of reconstruction are analysed in the light of 32 cases. After reviewing the anatomy and the surgical technique, this series is presented as a function of the various types of defect: cranio-orbital (9 cases), defects of the malar area (6 cases), maxillary defects (7 cases), mandibular defects (7 cases), malar and parotid soft tissues defects (2 cases), mastoid defects (1 case). This study indicates that the temporalis flap possesses several advantages: great vascular reliability, associated with simplicity of flap raising and an easily available tissue volume. The arc of rotation constitutes the limiting factor. Romberg's syndrome does not constitute an ideal indication of choice, as the muscle may be atrophied. Similarly, when the defect requires thin cover, it would be wiser to use a thinner flap, such as fascia temporalis superficialis. Donor site sequelae are negligible. Limitation of mouth opening (3 cases) and frontal paralysis (2 cases) are usually transient. The field of application of this flap can be extended by continuing the flap as far as the pericranium or calvarium, allowing complex reconstructions.
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The purpose of this study was to compare the electromyographic activity of masticatory muscles (temporal and masseter) with the use of an anterior repositioning splint and a centric relation superior repositioning splint. Twenty-six consecutive patients, who referred with the chief complaint of temporomandibular pain and/or headache were selected from one of the author's practices. All these subjects were diagnosed as having internal derangement of the temporomandibular joint. Ten normal subjects were used as controls. Surface electromyographic recordings were taken of each subject prior to the beginning of clinical therapy for the patients. The results show significantly less masseter and temporal muscle activity with anterior repositioning splint therapy compared to the centric relation superior repositioning splint therapy.
OBJECTIVE: The aim of this study was to evaluate the effectiveness of low-level laser therapy (LLLT) and transcutaneous electrical neural stimulation (TENS) on the improvement of mouth opening in patients with temporomandibular disorder (TMD). BACKGROUND DATA: TMDs are conditions that affect the form and/or function of the temporomandibular joint (TMJ), masticatory muscles, and dental apparatus. Often TMD is associated with pain localized in the TMJ and/or in the muscles of the face and neck. METHODS: This clinical trial was performed in 10 patients, 18-56 years old, diagnosed with TMD of multiple causes. All patients received both methods of treatment in two consecutive weeks. LLLT was delivered via a 670-nm diode laser, output power 50 mW, fluence 3 J per site/4 sites (masseter muscle, temporal muscle, mandibular condyle, and intrauricular). TENS therapy was applied with a two-electrode machine at 20 W, maximum frequency of 60 Hz, adjusted by the patient according to their sensitivity. The amplitude of mouth opening was recorded before treatment and immediately after using a millimeter rule; the measurements were performed from the incisal of the upper incisors to the incisal of the lower incisors. A paired t-test was applied to verify the significance of the results. RESULTS: A significant improvement in the range of motion for both therapies was observed immediately after treatment. Comparing the two methods, the values obtained after LLLT were significantly higher than those obtained after TENS (p < 0.01). CONCLUSIONS: Both methods are effective to improve mouth opening. Comparing the two methods, LLLT was more effective than TENS applications.
The muscle fiber fascicles of the temporo-masseter complex of the cat were minutely dissected. Some heads were embedded in paraffin while others were put into methyl-methacrylate resin and sections were made. The results of this anatomical study demonstrate that this complex consists of the masseter muscle, the temporal muscle and two well individualized transitional fascicles: the maxillomandibularis and zygomato-comandibularis muscles. The masseter and temporal muscles are composed of individualized compartments in which the orientation and aponeuroses of the fibers of which they are composed differ with regard to the centric occlusion plane. The masseter muscle consists of a superficial fascicle made up of two layers, an intermediate fascicle, and a deep fascicle composed of two layers. The temporal muscle consists of one anterior orbital part and one posterior temporal part. This structure is in accordance with the mammalian archetype described by Gaspard and Saban. These findings should lead towards a homology-based nomenclature founded on comparative anatomy studies of mammalian species. Such a classification would permit the comparison of results obtained from physiological and histochemical studies of these complex muscle fibers when they are published by different researchers.
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Electromyographic (EMG) activity versus bite force was studied during a gradually increased isometric contraction up to maximal effort for patients with painful masseter muscles and referents. The masseter muscle, the anterior temporal muscle and the descending part of the trapezius muscle were chosen for the recordings. Bite force was registered with a bite force sensor placed between the first molars. The effects of double blind intramuscular injections of lidocaine and saline in the patients' masseter muscle were evaluated by EMG versus bite force and by assessment of discomfort. EMG activity during unilateral chewing was compared in terms of relative masticatory force between referents and patients by amplitude probability distribution analysis. Regression analyses showed intra-individually steeper slopes for high force levels than for low force levels for the masseter muscle. This was not observed for the anterior temporal muscle. These differences in slopes of the EMG versus force regressions for the masseter muscle and the anterior temporal muscle could be due to differences in recruitment pattern. The same intra-individual relationship between low and high force levels was found for referents and patients. An increased activity, especially among the patients, was found for the descending part of the trapezius muscle during stronger activity of the mandibular elevators. The EMG versus force relationship for low force levels of the masseter muscle was less steep after an intramuscular injection of lidocaine but not after saline. Both solutions for injection had a positive effect on the patients' assessments of discomfort one week after the injection. Three days after injection the patients who received lidocaine experienced a reduction in muscular discomfort. This reduction was not found among patients receiving saline. The amplitude probability distribution analysis revealed that the patients used greater relative masticatory forces than the referents during the chewing of an almond for all probability levels analysed below the peak load of the masseter muscles. Rough estimates of the peak masticatory forces in Newton (N) were for chewing an almond 364 N (referents); 373 N (patients) and for gum-chewing 239 N (referents); 238 N (patients) as regards the masseter muscle. The values were similar for the anterior temporal muscle.
Possible influence of masticatory muscles on facial growth was investigated in the rat by the formation of several experimental groups: excision of right masseter muscle of right temporal muscle, of both masseter muscles, of both temporal muscles and of both masseter and temporal muscles, section of inferior maxillary nerve and masseter transplantation. Results demonstrated that overall masticatory muscles provided equilibrium of masticatory function, any rupture of this equilibrium producing effects on mandibular growth and that of the facial mass.
OBJECTIVE: To reveal computed tomography (CT) features of patients with coronoid process hyperplasia without interference between the process and the zygomatic bone. STUDY DESIGN: A case-control study was designed. Thirteen cases without interference (2 male and 11 female, 28-56 years old) and 65 controls were sampled from a patient database. Differences in CT features were analyzed between the 2 groups regarding the following 7 points of 5 regions: configuration of the coronoid process, vertical level of the coronoid process, the distance between the bilateral zygomatic arches, thickness of the temporal muscle, anteroposterior width of the temporal muscle, thickness of the temporal muscle tendon, and thickness of the masseter muscle. Cluster analysis was applied to differentiate between individuals. RESULTS: All cases had bilateral hyperplastic change of the coronoid process. Differences were found between the cases and controls in 6 of 7 CT features with the exception of temporal muscle thickness. All incidences of significant difference showed larger values in the cases. All cases were clustered into the same group and were differentiated from the controls. CONCLUSION: CT features appeared to be effective for diagnosis of this condition, and these patients should be put into the same category under the diagnosis of coronoid process hyperplasia.
The purpose was to evaluate quantitatively the magnetic resonance contrast enhancement of normal extraocular muscles and the use of temporal muscles as a reference of enhancement. Eighty extraocular and 20 temporal muscles were taken into analysis. Before contrast administration, mean intensity of extraocular muscles was found to be higher than that of temporal muscles (p < 0.000). With contrast agent, all extraocular muscles were enhanced more (111% enhancement) than the temporal muscles (45% enhancement, p < 0.000). Lateral recti had the lowest signal intensity, both in pre- and postcontrast images (p < 0.005). Normal extraocular muscles showed prominent enhancement on contrast-enhanced T(1)-weighted images. Temporal muscles were also enhanced in all subjects, urging the observers to compare the enhancement of extraocular muscles not with the latter.
Electromyographic recordings from the anterior temporal muscle fibers bilaterally, the posterior temporal muscle fibers bilaterally, the superficial masseter muscle bilaterally, and the left medial pterygoid muscle were used to study the effects of changing the location, size, and direction of effort on specific contact points during maximal clenching tasks in human subjects. Vertical clenching efforts in the natural or simulated intercuspal position generally showed the highest muscle activities for all the muscles recorded. When the contact point moved posteriorly along the arch from incisors to molars, the activity in the ipsilateral temporal muscles was seen to increase, while the activity in the ipsilateral medial pterygoid and the masseter muscles bilaterally was seen to decrease during vertical clenching tasks. Eccentric efforts on specific contact points generally resulted in lower activity than the corresponding vertical effort. This was usually seen in all muscles, but not all values were significant. The ipsilateral temporal and contralateral pterygoid muscles showed the most activity during maximal clenches in lateral direction with little contribution from the other muscles. The temporal muscles showed the most activity in retrusive clenching, with activity in the other muscles nearly nonexistent. The medial pterygoid and masseter muscles were found to be the most active muscles during protrusive and incisal clenching, while the temporal muscle activity was low. When the size and number of contacts were increased anteriorly, a generalized increase in muscle activity was seen. The same trend occurred posteriorly but was not as consistent or significant. Cross-arch contacts were associated with a slight but significant bilateral increase in masseter muscle activity and an increase in temporal muscle activity ipsilateral to the cross-arch contact when maximum vertical clenches were performed. However, no significant increases were observed when the effort was directed laterally. The findings of this electromyographic study on change of the contact point, size of contact point, and the direction of effort applied on a contact point confirm their specific associations with the activity of muscle groups. Significant data have also been made available for a biomechanic approach of the investigation of degenerative joint changes.
PURPOSE: To study the influence of botulinum toxin on masticatory muscle activity in temporomandibular joint model osteoarthritis(TMJOA). METHODS: 30 adult rabbits were examined with EMG, and TMJOA was established by collagenase injection, then divided into experimental group and control group. EMG of masticatory muscles was recorded during postural position and clenching at the end of 4 weeks, 8 weeks and 12 weeks. Botulinum toxin was injected into the masseter muscle and temporal muscle in the experimental group. Those of the control group were only with TMJOA. All data were analyzed with group t test in SPSS 11.0. RESULTS: During postural position, EMG activity of masticatory muscles in the control group was significantly higher than that of the normal at each examination(P<0.05). EMG activity in th experimental group was lower than normal at the end of 4 weeks and 8 weeks(P<0.05), but at the end of 12 weeks, the two groups showed no difference(P>0.05). During clenching, EMG activity in the control group was lower than normal at each measurement(P<0.05), EMG activity in the experimental group was lower than normal at the end of 4 weeks and 8 weeks(P<0.05), but showed no difference at the end of 12 weeks. CONCLUSION: Botulinum toxin can change and improve masticatory muscle function of TMJOA in rabbit.
Muscular activity of the superficial masseter muscle and anterior portion of the temporal muscle before, during, and after treatment, with gradual advancement of the mandible, was evaluated by assessing the average integrated electromyogram (EMG) with the mandible in retruded position (RP) and incisal edge-to-edge (EE) position on 23 consecutive subjects with skeletal Class II malocclusion. Toward the end of active treatment and follow-up, the RP position and EE position coincided. At any given registration, the EMG activity of the masseter muscle was at least twice (P < .001) that of the anterior portion of the temporal muscle. The EMG activity in RP for the anterior portion of the temporal muscle was not affected significantly, whereas the EMG activity at EE position decreased significantly (P < .05) during the initial treatment, but, thereafter, it increased continuously. The difference in EMG activity between six months of follow-up and pretreatment level reached statistical significance (P < .05). For the masseter muscle, the EMG activity at both RP and EE position was reduced about 20% during the initial treatment but returned to the pretreatment level during active treatment and exceeded pretreatment level by approximately 30% to 50% at two and six months of follow-up, respectively. In conclusion, it seemed that gradual advancement affected the anterior portion of the temporal muscle to a minor extent, whereas the effect on the masseter muscle was significant.
The external forms of head of the adult suncus and mouse resemble each other, but those of their newborns differ. In the newborn suncus, the upper view of external form of the head is narrow in width and long antero-posteriorly as is the cranial bone, but the adult form is almost triangular in shape based on the posterior portion of the head. In contrast, the external forms of the newborn and the adult are similar in the mouse. The postnatal changes of external form seem to be related to the development of the masticatory muscles in the suncus. Therefore, the present report comparatively studied the development of the masticatory muscles in suncus and mouse. To examine the developmental change of the volume of muscles on two animals, serial sections from fetus through adult were prepared by a commonly used staining method. Muscle volume was determined by the number of voxcels obtained from an image processor. Endplates stained by AchE staining and the course of muscle fibers of the masseter and temporal muscle (especially the MT1-temporal muscle in suncus) were also studied in the two animals. Ten measuring points on each craniofacial bone related with muscle growth were selected and the lengths between each point were measured to confirm the development of the musculoskeletal system in suncus. In suncus, the suncus masticatory muscles, both MT1-temporal and masseter muscle, were shown to have a multipinnate structure. This type of structure increases the physiological cross-sectional area to increase the masticatory force. The direction of these muscles, as a whole, run anteroposteriorly in this animal. Comparing the growth patterns between newborn and adult, the volumes of temporal and masseter muscle increase in the suncus more than those of in the mouse. The diameters of the temporal and masseter muscle fibers increase greatly after birth in the suncus in comparison with those of the mouse, though the fetus and newborn of both animals have approximately the same diameters. The differences in external forms of the head between newborn and adult in the suncus in comparison with those in the mouse may be caused by the greater increase in the volumes of temporal and masseter muscle, resulting in a remarkable increase in the forces of muscular contractions in the suncus. Postnatal dry weight of each masticatory muscle was measured in the suncus. The weights of the MT1-temporal and masseter muscle increased more than those of other muscles, especially from 14 days through 28 days. The results obtained here thus may be closely correlated to the growth of the diameters of muscle fibers. The whole parietal bone was not covered with the MT1-temporal muscle at 7 days after birth, but was covered at 14 days. Sagittal and nuchal crests were not observed at the former stage but was clearly evident at the latter in the suncus. In the suncus, the length and width of the MT1-temporal muscle became larger in the second week after birth than in the later weeks. In the suncus, during from 7 days through 14 days after birth the growth rate of the portion between Etf and Dwp was enhanced compared to that of other portions. In this term the length of the MT1-temporal muscle also grew noticeably. The distance between Etf and Dwp corresponds to the length of MT1-temporal muscle at the ventral portion. The growth between Etf and Dwp precedes that of muscle volume in the suncus. In conclusion, the developmental change of the cranial bone between Etf and Dwp precedes that of the masticatory muscles in the suncus. The formation of the well-developed sagittal and nuchal crests and the expansion of muscle attachment may well have led to the increase of muscle volume. As a result, the difference of external forms of head between newborn and adult in the suncus has been shown clearly to be due to the developmental changes of the volume of each masticatory muscle from 14 days through adult after birth, while such a difference is not seen in mouse.