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Acetylsalicylic acid activates antinociceptive brain-stem reflex activity in headache patients and in healthy subjects.

The exteroceptive suppression (ES) of electrical activity in the temporal muscle is an inhibitory antinociceptive brain-stem reflex. We investigated whether aspirin can significantly modulate latencies or durations of the early (ES1) and late (ES2) exteroceptive suppression periods of electrical activity in the temporal muscle. Participating in the randomized double-blind crossover study were 20 patients with migraine without aura, 20 patients with tension-type headache, and 20 healthy subjects. ES1 and ES2 elicited by an electrical stimulus of 20 mA lasting 0.2 msec were recorded during maximal voluntary contraction of the mastication muscles before and 30 min after medication. In a randomized and double-blind fashion half of the subjects were given 1200 mg of aspirin in the form of an effervescent solution and the other half were given an identically tasting solution without aspirin. One week later the experiment was repeated with the substances exchanged in crossover fashion. The administration of placebo as well as aspirin caused a highly significant increase in ES1 duration (P less than or equal to 0.001). While aspirin caused a highly significant increase in ES2 duration (P less than or equal to 0.001) the taking of placebo showed no significant effect on ES2 duration. In giving aspirin as opposed to the placebo, there was a significant interaction between groups and drug effect on the latency of ES1; whereas in migraine patients and in patients with tension-type headache the latency of ES1 was reduced by administration of aspirin, it was increased in healthy subjects (P less than or equal to 0.05). Neither aspirin nor placebo significantly varied the ES2 latency.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Reliability and validity of a pressure threshold meter in recording tenderness in the masseter muscle and the anterior temporalis muscle.

The reliability and validity of an algometer pressure threshold meter (PTM) was evaluated on 45 individuals, 25 healthy volunteers and 20 patients with craniomandibular dysfunction. Tenderness upon palpation was measured at six points located on the masseter muscle, the anterior temporal muscle, and on the zygomatic arch. The validity of the PTM was evaluated by comparison of the PTM values obtained by one examiner with the finger palpation score obtained by another examiner (Part 1). A statistically significant correlation between PTM values and finger-palpation scores was found at all of the points recorded (p less than 0.05). A statistically significant difference between PTM values was obtained for the symptom-free group and the patient group. The reliability of the PTM was evaluated at six points by repeated recordings at each marked point (Part 2). High reliability coefficients (r = 0.79-0.94) were found at all the points. The study also showed that if the points were located with a certain inaccuracy (1.0 mm less than x less than 2.6 mm), the reliability coefficients were still of the same magnitude. The PTM can be recommended for evaluation of pressure pain thresholds in the masticatory system in clinical and experimental studies.

Adult↗

[The electromyographic activity of the masticatory muscles during temporomandibular joint clicking].

16 patients with painless temporomandibular joint clicking were investigated electromyographically. EMGs were recorded during open-close movement from the superior and inferior heads of the lateral pterygoid muscle, the anterior belly of the digastric muscle and the temporal muscle. TMJ clicking was recorded with a microphone located over the TMJ simultaneously with EMG and incisal movement and velocity. 13 of 16 patients showed various changes in EMG patterns. 3 patients showed no changes in EMG patterns. Evidence that a hyperactive muscle induces TMJ clicking, was not observed. These results indicate that there may be many types of adaptation for TMJ clicking from the viewpoint of the various EMG findings of masticatory muscles. It is suggested that most of the electromyographic changes are not the cause of painless TMJ clicking but their result.

Adolescent↗

Temporal and masseter muscle activity in children and adults with normal occlusion. An electromyographic investigation.

Temporal and masseter muscle activity was investigated in male subjects with normal occlusion, 11 years (n = 23) and 25 years (n = 21) of age. Integrated EMG recordings were analysed quantitatively during maximal biting in intercuspal position and during chewing of peanuts. The results of the investigation revealed the following: 1. Masseter muscle activity was greater in the older than in the younger age group. 2. Temporal muscle activity was the same in both age groups. 3. Masseter muscle activity was increased in relation to temporal muscle activity in the older subjects. In the younger subjects the same activity was found in the two muscles. 4. For the temporal muscle the chewing activity was positively correlated to maximal biting activity in both age groups. For the masseter muscle a clear correlation between chewing and biting activity was found in the younger age group only. The difference in EMG activity found between children and adults may be attributed to age changes and/or an exercising effect of the masseter muscle occurring during maturation.

Adolescent↗

Regional difference of blood flow in anesthetized rats during reduced gravity induced by parabolic flight.

To examine a hypothesis that change in regional blood flow due to decreased hydrostatic pressure gradient and redistribution of blood during reduced gravity (rG) is different between organs, changes in cerebrocortical blood flow (CBF) and blood flow in the temporal muscle (MBF) with exposure to rG were measured in anesthetized rats in head-up tilt and flat positions during parabolic flight. Carotid arterial pressure (CAP), jugular venous pressure (JVP), and abdominal aortic pressure were also measured simultaneously. In the head-up tilt group, CBF increased by 15 +/- 3% within 3 s of entry into rG and rapidly recovered during rG. MBF also increased, but the change was significantly greater than that of CBF. JVP increased by 1.8 +/- 0.5 mmHg, probably due to loss of hydrostatic pressure gradient, since the measuring point of JVP was 2-3 cm above the hydrostatic indifference point. CAP and abdominal aortic pressure increased by 16.7 +/- 2 and 7.7 +/- 2 mmHg, respectively, compared with the 1-G condition. Muscle vascular resistance [(CAP-JVP)/MBF] decreased on entry into rG, but no significant change was observed in cerebrocortical vascular resistance [(CAP-JVP)/CBF]. In the flat group, no significant change was observed in all the variables. The results indicate that arteriolar vasodilatation occurs in the temporal muscle but not in the cerebral cortex. Thus the blood flow control mechanism at the onset of rG is different between intra- and extracranial organs.

Adaptation, Physiological↗

Comparison of different materials for interposition arthroplasty in treatment of temporomandibular joint ankylosis surgery: long-term follow-up in 25 cases.

A variety of interposition materials have been used to prevent recurrence after arthroplasty in treatment of temporomandibular joint ankylosis. The purpose of this retrospective study of our experience was to compare the different materials (skin, temporal muscle, homologous cartilage) used for interposition arthroplasty over a period of 22 years. A total of 25 patients (32 joints) with at least 3 years of follow-up were included. Good results were achieved in 92% of cases using total full thickness skin graft and 83% of cases using temporal muscle flap. Homologous cartilage gave poor results.

Adolescent↗

Pain-pressure threshold in painful jaw muscles following trigger point injection.

Pain and tenderness at trigger points and referral sites may be modified in subjects with myofascial pain in the head and neck region by injecting local anesthetic into active trigger points, but the effect of injection on jaw muscle pain-pressure thresholds has not been measured. The mechanism by which trigger-point injection affects muscle tenderness is also unclear and may be related to the "hyper-stimulation analgesia" induced by stimulation of an acupuncture point. A pressure algometer was used before and after an active trigger point injection in the masseter to measure the pain-pressure threshold in the masseter and temporal muscles of 10 subjects with jaw muscle pain of myogenous origin. The pain-pressure threshold in the masseter and temporal muscles was also measured in a matched control group before and after an acupuncture-point injection in the masseter. The pain-pressure threshold was significantly lower in myofascial pain subjects than in control subjects at all recording sites. Pain-pressure thresholds increased minimally in the masseter after trigger-point injection, whereas the temporal region was relatively unaffected. In the control group, the pain-pressure threshold increased significantly at all recording sites in the masseter after acupuncture-point injection. Although local anesthetic injection acts peripherally at the painful site and centrally where pain is sustained, pain-pressure thresholds were not dramatically increased in myofascial pain subjects, in contrast to controls. This suggests that in subjects with myofascial pain, there was continued excitability in peripheral tissues and/or central neural areas which may have contributed to the persistence of jaw muscle tenderness.

Acupuncture Points↗

[A method for recording the human periodontal muscular reflex].

Principal block-diagram and characteristics of devices recording the parameters of periodontal muscular reflex in humans are presented. Twenty healthy volunteers aged 20 to 30 years with full dentition and normal occlusion and temporomandibular articulations unchanged were studied. Parameters of periodontal muscular reflex showed no bilateral asymmetry. Temporal muscles displayed 15 +/- 0.87 s latencies, masseters 13 +/- 0.8 latencies. Silent periods in temporal muscles were 22 +/- 0.89 ms and in masseters 24 +/- 0.75 ms. In patients with mandibular fractures the time of periodontal muscular reflex was increased up to 3-4-fold as compared to that in normal subjects. The indices of the reflex are clearly different in normal and pathological conditions. This technique is useful both in scientific and diagnostic purposes.

Adult↗

Non-anastomotic bypass surgery for childhood moyamoya disease using dural pedicle insertion over the brain surface combined with encephalogaleomyosynangiosis.

BACKGROUND: Anastomotic bypass surgery for childhood moyamoya disease provides more rapid improvement of blood circulation than indirect non-anastomotic bypass surgery, but there are several problems, such as the technical difficulty of the operation, the extended period of anesthesia, and temporary occlusion of blood flow in the vessels of the brain surface. METHODS: We describe a new non-anastomotic bypass procedure using dural pedicle insertion over the brain surface combined with encephalogaleomyosynangiosis and preservation of the superficial temporal artery (STA). We treated nine patients with childhood moyamoya disease admitted to our institution from 1989 through 1994. The operative field was determined based on the ischemic site identified by preoperative neuroimaging methods. Our procedure was performed in a total of 15 hemispheres, and the patients have been followed up for 5 months to 5 years after operation. RESULTS: Cerebral angiography, cerebral blood flow measurements, and clinical symptoms and signs were improved at the operation site in all patients. Because the STA and the superficial portion of the temporal muscle attached to the skin flap were preserved, the skin at the operation site was not depressed and no necrosis, infection, or alopecia developed. CONCLUSION: Childhood moyamoya disease is progressive, so repeated bypass surgery may be required. Therefore, non-anastomotic bypass surgery is better for the first operation because the STA is preserved. The present procedure using temporal muscle, galea, and dura can be extended over a wider brain surface than the operative field, and is suitable for establishing collateral circulation in the frontal lobe. Blood flow in the skin flap is maintained, so the cosmetic result is satisfactory.

Cerebral Angiography↗

Evaluation of pericranial myofascial nociception by pressure algometry. Reproducibility and factors of variation.

Pressure pain detection threshold and pressure pain tolerance threshold were measured in the temples and on the fingers in 40 healthy volunteers, equally distributed as to sex and handedness. Lower pressure pain thresholds were found over the temporal muscle than in a neighbouring temporal location without interposed myofascial tissue (p less than 0.001), indicating that nociception from myofascial tissue contributes to the pressure pain threshold. Pressure pain tolerance was more reproducible within the individual subject but differed more between subjects than pressure pain detection. Pressure pain thresholds were higher on the fingers than in the temples (p less than 10(-5)) and, in general, thresholds were higher in males than in females (p = 0.02-0.09). Finally, pressure pain thresholds were lateralized in dextrals but not in sinistrals. The information that can be obtained from pressure pain detection and tolerance thresholds is discussed and examination of both threshold types is recommended in future studies.

Adult↗

Growth patterns of the rabbit masticatory muscles.

The post-natal growth of the masticatory muscles in the rabbit was examined. By means of anatomical dissection and measurement, total muscle length, muscle fiber length, and muscle weight were determined in animals varying in age between one week and 36 months and exhibiting a 50-fold weight increase. Growth data were fitted by linear regression models with facial skull length used as the independent variable. Many deviations occur from size-dependent isometric growth. The muscles can be divided into three groups, according to their pattern of weight increase: The jaw openers grow negatively allometrically, and their contribution to total muscle weight decreases with time; the temporal muscle grows negatively allometrically, but its relative weight proportion remains about the same; the masseter and medial pterygoid muscles have positively allometric growth, and their contribution to total muscle weight increases strongly. Generally, the length of the muscles and of their fibers increases at lower rates than does the length of the facial skull. After weaning, the rate of longitudinal growth drops steeply in some muscles. Total fiber area or physiological cross-section (PCS) of muscles is computed from weight and fiber length. It increases positively allometrically in the jaw closers and negatively allometrically in the jaw openers. In the lateral pterygoid muscle, the increase of PCS changes from negatively- to positively-allometric growth after weaning. The study demonstrates that individual oral muscles follow different patterns of longitudinal and cross-sectional growth, so that their functional capacities (force, range of contraction) and mutual functional relationships are age-dependent.

Animals↗

[A clinical and physiological evaluation of prosthodontic treatment by removable partial dentures with free-end saddles--a 3.5-year follow-up study].

The aim of this study was to evaluate the longitudinal clinical and physiological changes in jaw elevator muscle activity of partially edentulous patients, for approximately 3.5 years after treatment by removable partial dentures with free-end saddles. Seven patients (4 males and 3 females, aged 38-68 years) who visited a university dental hospital, and were found to have no signs and symptoms of TMJ disorders, participated in the follow-up study. The functional impression method with wax was used in the treatment process of these patients. At the follow-up times of 0.5, 1, 2, 3, and 3.5 years after denture deriverly, EMG activities using bipolar surface electrodes were recorded from masseter and anterior temporal muscle on both sides during maximal voluntary clenching and tapping, and at the same time the maximal bite force was also recorded using the Dental Prescale System. The integrated EMG, the correlation coefficient between muscle activities of both sides, bite force, and the location of the occlusal load center, were analyzed using repeated measured ANOVA. A comparison between each measuring session was carried out using Bonferroni's method. Results were as follows: i) The muscle function of partially edentulous patients was clearly activated by wearing a removable partial denture, and the activation was kept at the same level until 3.5 years after denture deriverly. ii) The activation of jaw elevator muscles by wearing a denture was greater in masseter muscle than in anterior temporal muscle. This finding reflected the effect of the recovered occlusal contact. iii) The occlusal load center of the recovered dentition by a removable partial denture shifted antero-posteriorly close to the end abutment teeth.

Adult↗

Effects of intraischemic hypothermia on cerebral damage in a model of reversible focal ischemia.

Considerable evidence indicates that brain temperature during ischemia affects the extent and distribution of ischemic injury. However, only limited data have been presented concerning the influence of temperature on ischemic damage after reversible focal cerebral ischemia. Because focal ischemic events of this type resemble conditions observed in the clinic, studies were undertaken to examine the effects of mild and moderate hypothermia on the extent of cerebral infarction after focal neocortical ischemia. Under halothane anesthesia, the left middle cerebral artery and both carotid arteries were occluded reversibly for a period of 3 hours in adult Sprague-Dawley rats. The animals were killed 3 days later. Brain sections were stained with triphenyltetrazolium chloride and analyzed for infarction using a computerized image analysis system. Temporal muscle temperature and rectal temperature were monitored continuously. The following groups with different intraischemic temporal muscle temperatures were analyzed: 1) control, 35.8 to 36.2 degrees C; 2) mild hypothermia, 33.0 to 33.5 degrees C; and 3) moderate hypothermia, 27.5 to 29.2 degrees C. The volumes of infarction were 214.5 +/- 17.9, 166.5 +/- 6.8, and 108.2 +/- 5.9 mm3 (mean +/- SEM) for the control, mild hypothermia, and moderate hypothermia groups, respectively. These findings demonstrate that both mild and moderate hypothermia reduce the impact of temporary focal ischemia in Sprague-Dawley rats.

Animals↗

Striatal hyperthermia associated with arousal: intracranial thermorecordings in behaving rats.

Humans and experimental animals show strong increases in body temperature in response to a variety of stimuli presumed to have stress as their common denominator. To assess the brain's role in this 'emotional' hyperthermia, temperatures were continuously recorded in dorsal and ventral striatum and in deep temporal muscle of freely moving rats exposed to different arousing and mild stress stimuli (placement in the test cage, 20-s sound stimulation, i.v. saline injection, 3-min social interaction with conspecific, and 3-min tail-pinch). The stimuli caused brain hyperthermia of differing degrees but similar pattern, in both the dorsal and ventral striatum. Ventral striatum had approximately 0.4 degrees C higher basal temperature than dorsal striatum, each of these brain temperatures was higher than that in deep temporal muscle. Maximal increases in brain temperature ( approximately 0.8-1.2 degrees C for 20-40 min) occurred upon placement in the test cages, during tail-pinch and during social interaction, all of which were accompanied by behavioral activation. These increases developed with short onset latencies (up to 5-15 s) and always preceded increases in muscle temperature. Significant but smaller increases in brain temperature ( approximately 0.2 degrees C for 4-6 min) were detected after sound stimulation and i.v. saline injection that induced minimal changes in behavior and no change in muscle temperature. Thus, it appears that brain hyperthermia can be triggered by quite different arousing or stressful stimuli that disturb an organism's homeostasis and demand adaptive responding. Although the exact mechanisms of local heat production in brain tissue remain to be confirmed, neuronal activation appears to be the primary triggering force behind changes in brain temperature that are sufficient to affect body temperature. Because most neural processes are temperature-dependent, change in local temperature may result in dramatic modulation of the efficiency of neural processes in situations critical for life-support and during adaptive behavior.

Acoustic Stimulation↗

Effects of ifenprodil, a polyamine site NMDA receptor antagonist, on reperfusion injury after transient focal cerebral ischemia.

Polyamines and N-methyl-D-aspartate (NMDA) receptors are both thought to play an important role in secondary neuronal injury after cerebral ischemia. Ifenprodil, known as a noncompetitive inhibitor of polyamine sites at the NMDA receptor, was studied after transient focal cerebral ischemia occurred. Spontaneously hypertensive male rats, each weighing between 250 and 350 g, underwent 3 hours of tandem middle cerebral artery (MCA) and common carotid artery occlusion followed by reperfusion for a period of 3 hours or 21 hours. Intravenous ifenprodil (10 microg/kg/minute) or saline infusion was started immediately after the onset of MCA occlusion and continued throughout the ischemic period. Physiological parameters including blood pressure, blood gas levels, blood glucose, hemoglobin, and rectal and temporal muscle temperatures were monitored. Six rats from each group were evaluated at 6 hours postocclusion for brain water content, an indicator of brain edema, and Evans blue dye extravasation for blood-brain barrier breakdown. Infarct volume was also measured in six rats from each group at 6 and 24 hours postocclusion. Ifenprodil treatment significantly reduced brain edema (82.5 +/- 0.4% vs. 83.5 +/- 0.4%, p < 0.05) and infarct volume (132 +/- 14 mm3 vs. 168 +/- 25 mm3, p < 0.05) compared with saline treatment, with no alterations in temporal muscle (brain) or rectal (body) temperature (35.9 +/- 0.4 degrees C vs. 36.2 +/- 0.2 degrees C; 37.7 +/- 0.4 degrees C vs. 37.6 +/- 0.6 degrees C; not significant). These results demonstrate that ifenprodil has neuroprotective properties after ischemia/reperfusion injury in the absence of hypothermia. This indicates that antagonists selective for the polyamine site of the NMDA receptors may be a viable treatment option and helps to explain some of the pathophysiological mechanisms involved in secondary injury after transient focal cerebral ischemia has occurred.

Adrenergic alpha-Antagonists↗

Surgical treatment of TMJ ankylosis: our experience (60 cases).

Limitation of mouth opening can be caused by bony or fibrous ankylosis of the temporomandibular joint as sequela to trauma, infection, autoimmune disease, or failed surgery. Various procedures have been reported for treatment of temporomandibular joint (TMJ) ankylosis; this article aims to describe the diagnostic protocol and the surgical procedures adopted at the department of Maxillo-Facial Surgery of Rome University "La Sapienza". Between 1980 and 2000, 123 patients affected by TMJ ankylosis came under our observation; 60 of them (25 females and 35 males of 30 years average age) underwent surgery; bilateral TMJ ankylosis was observed in 21 cases, right-sided in 20 cases, left-sided in 19 cases. In 12 cases coronoid processes were involved. Etiopathogenesis was traumatic in 48 cases, septic in 5 cases, auto-immune (RA and seronegative spondyloarthropathies) in 5 cases; after block removing, arthroplasty was performed with pedunculated flap of temporal muscle (10 cases), Silastic material (11 cases), or lyophilized dura mater (2 cases). Simple condylar shaving was used in the remaining 36 cases. All patients under treatment showed a distinctive improvement both in articular functionality and symptoms; secondary surgery was necessary in seven cases due to the onset of articular complications from previous surgery. Silastic removal was necessary in five cases due to its inducement of foreign body granuloma. Follow-up was performed at 12, 24, and 48 months and 5 years postoperatively. In our opinion the gold standard surgery of TMJ ankylosis today is represented by shaving of articular surfaces and subsequent arthroplasty with or without temporal muscle myofascial flap interposition, whereas the use of Silastic as alloplastic material could be associated to an increased persistence of the local symptoms and a higher risk of foreign body granuloma and it may favor ankylosis relapse and hinder rehabilitation.

Adolescent↗

Pain, tenderness, wheal and flare induced by substance-P, bradykinin and 5-hydroxytryptamine in humans.

The algesic effect of substance-P with and without the addition of bradykinin or 5-hydroxytryptamine was studied in 13 healthy volunteers. Test substances dissolved in saline were injected into the temporal muscle and the forearm skin and the effects compared with those of saline. In the temporal muscle, none of the test substances induced more pain than saline, but substance-P with bradykinin lowered the pressure pain threshold by 18% (p less than 0.02). All test substances induced pain wheal and flare in the forearm skin. Substance-P induced a more pronounced flare reaction than bradykinin, whereas the latter induced more pain than substance-P. This dissociation between pain and flare may indicate that C-fibres in the human skin represent more than one type of nociceptor.

Adult↗

Restoration of selective facial nerve function by the nerve-muscle pedicle technique.

The nerve-muscle pedicle technique for selective reinnervation of paralyzed facial muscles, when combined with a modified muscle-fascia sling and neurotization from the temporal muscle, has been applied in 26 patients to date. The success rate has been 88 per cent for restoration of tonus and 77 per cent for restoration of voluntary motion as well. This procedure offers several significant advantages over other accepted means of reinnervation in patients in whom the seventh nerve itself is not available as a source for restoration of function. It also may have value as a method for rapid restoration of tonus while other means of reinnervation take effect.

Facial Muscles↗