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Pericranial muscle tenderness and pressure-pain threshold in the temporal region during common migraine.

Twenty-six patients were examined during attacks of common migraine as well as during headache-free interval. Pericranial tenderness was scored blindly by a systematic manual palpation on both occasions by the same observer. Pressure-pain threshold (PPT) in a fixed location over the temporal muscle was determined by the use of a pressure algometer. A 28% increase in total tenderness score was observed during attacks (P less than 0.01). During unilateral attacks, tenderness scores were significantly higher on the ipsilateral side as compared to the contralateral (P less than 0.01). A positive correlation was observed between tenderness on the two sides (P less than 0.05) and the two occasions (P less than 0.01). PPT showed no changes during migraine attacks and there was no difference in PPT between the ipsilateral and contralateral side. A positive correlation was observed between PPT on the two sides and the two occasions (P less than 0.01). PPT was not correlated to the tenderness scores obtained by manual palpation. The absence of a decrease in PPT and the presence of several tender areas in multiple regions, particularly where pain was spontaneously reported to be located, suggest the presence of either a multi-focal peripheral pathological process or referred pain from other structures in the head and neck region.

Adult↗

Localization and morphometric analysis of masticatory muscle afferent neurons in the nucleus of the mesencephalic root of the trigeminal nerve in the cat.

Injections of horseradish peroxidase (HRP) were made into the ipsilateral temporal muscle and contralateral masseter muscle of 10 cats in order to identify and characterize neurons in the nucleus of the mesencephalic root of the trigeminal nerve that innervate muscle receptors in the orofacial periphery. Neurons labelled by HRP injections and unlabelled cells from 5 control cats were measured with a computer-based image analyzer, and their position was mapped on a stereotaxic graph. Cells that innervate the masseter and temporal muscles were identified throughout the rostrocaudal extent of the nucleus. There was no indication of a somatotopic pattern nor of a specific segregation within the nucleus for cells innervating muscle receptors. The nucleus contained small, rounded unipolar neurons located primarily in the dorsal border of the periaqueductal gray (PAG) matter in the rostral part of the nucleus and larger oval unipolar neurons which were scattered throughout the nucleus, but were predominant in the pontine portion of the nucleus. HRP injections labelled both large and small cells, as well as occasional multipolar cells. The last-mentioned tended to be located in the lateral margins of the PAG. The mean geometric values obtained for the control group were: area 552.7 microns2 perimeter 110.3 microns; maximum diameter 36.0 microns. and diameter of an equivalent circle 26.1 microns. The mean values of the labelled neurons were: area 606.6 microns2; perimeter 100.1 microns; maximum diameter 36.0 microns, and diameter of an equivalent circle 27.2 microns.

Animals↗

Anatomic basis for vascularized outer-table calvarial bone flaps.

The vascularization of the scalp and calvarium was studied in cadavers to better define the design of vascularized split- or full-thickness calvarial bone flaps. Selective dye injections of the superficial temporal and internal maxillary arteries established a horizontal and vertical network of vessels within and between each layer of the scalp. The periosteum of the frontoparietal region continues over the temporal aponeurosis as a separate, distinct layer, the innominate fascia, which is irrigated by numerous proximal branches of the superficial and deep temporal arteries. The periosteum can sustain the outer table of the calvarium by means of multiple small, vertical perforators. Between the periosteum and the outer table is a thin areolar layer of subperiosteum which continues beneath the temporal muscle. We feel that vascularized outer-table calvarial flaps can safely be pedicled using only the temporal aponeurosis, innominate fascia, and periosteum without including the galea or temporal muscle.

Blood Vessels↗

Electromyographic activity of the jaw-closing muscles during jaw opening in patients with masseter muscle contracture.

Contracture of the jaw-closing muscles is one of the causes of limitation of jaw opening. This study examined whether there is any difference between the EMG activities of jaw-closing muscles during jaw opening in healthy people and in patients with masseter muscle contracture (MMC), who do not have a history of trauma or infection. The patient group consisted of eleven females, 18 to 62 years old with no history of trauma or infections, with limited mouth opening due to MMC. The control group included eleven healthy females, 23 to 50 years old. The EMG activity was recorded bilaterally in the central portion of masseter muscles (Mm), the anterior portion of temporal muscles (Tm), and the anterior belly of digastric muscles (Dm). Nine out of the patient group showed obvious EMG activity in Mm during jaw opening which was different from typical EMG patterns during jaw opening of up to 40 mm in the control group. Among the nine patients, eight showed antagonistic contraction in Tm as well as Mm. The mean integral value of Mm and Tm during jaw opening in the patient group was significantly higher than in the control group (P<0.01). These results suggest that EMG activity during jaw opening in MMC patients with no history of trauma or infections is different from that in healthy people.

Adolescent↗

Parameters of open-close-clench cycles in children.

The results of this study indicate that the latency and silent periods of OCC cycles do not vary among groups representing distinct dentitional stages. The mean latency period durations obtained from the OCC cycles of the subjects in this study ranged from 16.6 to 19.5 msec and demonstrated the smallest SD of all parameters measured. The mean silent period durations ranged from 11.6 to 15.4 msec. Since the neurophysiologic responses do not vary, the reflex elicited by tooth contact in OCC cycles is not based on tooth form or quantity. The results further indicate that, with the exception of the latency period of the anterior temporal muscles, the activities of the right and left components of the masticatory muscles examined are significantly correlated to each other during OCC cycles. This suggests a role for the anterior temporal muscle in bringing about adjustments of the masticatory system in the intercuspal position.

Adolescent↗

Zygomatic approach to skull-base lesions.

A modification of the preauricular skull-base approach is described. After sectioning and downward displacement of the zygomatic arch, the coronoid process of the mandible is dissected and sectioned at its base. The temporal muscle, with its coronoid insertion, is then retracted upward. This approach provides direct and unobstructed access to the temporal and infratemporal fossae. Adequate vascularity of the temporal muscle is maintained. The exposure encompasses the internal carotid artery in the neck for vascular control. Extensive reconstruction is eliminated. The described technique was used in seven patients with lesions of the skull base. There was no operative mortality, and morbidity consisted of temporary restriction of mandibular opening in two patients.

Adult↗

Effect of anterior repositioning splints on the electromyographic activities of masseter and anterior temporalis muscles.

The effect of anterior repositioning (AR) splint therapy on masticatory muscle activity was investigated in seventeen patients with internal derangement; disk displacement with reduction in particular. Integrated electromyography (EMG) recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in intercuspal position before and after eight week treatment period, EMG recordings were taken for each subject prior to the beginning of clinical therapy and final EMG recordings were made without AR splint to provide a standard for comparison. The results of the investigation revealed the following: 1. AR splint therapy did not cause any significant modification of the EMG activity in the recorded muscles during maximal biting in intercuspal position; 2. Before and after treatment the EMG activity from the masseter muscle was less than from the temporal muscle; 3. AR splint therapy resulted in reduction of the pain (88.2%) and jaw joint sounds (64.7%) and mean vertical opening which was 42.17 mm before treatment increased to 45.06 mm.

Adult↗

Comparative morphology of the muscles of mastication in the giant panda and the Asiatic black bear.

The morphological differences in the muscles of mastication between the giant panda (Ailuropoda melanoleuca) and the Asiatic black bear (Ursus thibetanus) were sought to confirm the adaptational strategy of these muscles in the giant panda. We measured some skull characteristics and weighed the muscles of mastication, and macroscopically observed the muscles of mastication in the two species. The noticeable differences between the two species are classified as follows: (1) The size ratio of the zygomatic width was much larger in the giant panda than in the Asiatic black bear. (2) The weight ratio of the two pterygoid muscles was also much larger in the giant panda than in the Asiatic black bear. (3) The lateral slips of the temporal muscles are thicker and stronger in the Asiatic black bear than in the giant panda. (4) The deep layer of the masseter muscle was rostrocaudally divided, and a complicated running of tendons is observed in the giant panda. (5) The two pterygoid muscles were much larger and well-developed in the giant panda than in the Asiatic black bear. The points (1) and (4) may be related to the generation of the force necessary to chew the bamboo in the giant panda. We thought that the large mass of the masseter and temporal muscles are needed in this species. In the points of (2) and (5), the two pterygoid muscles were obviously different in form and weight ratio between the two species. We suggest that the two pterygoid muscles may act as an additional force generator to dorsoventrally press and crush bamboo stems.

Animals↗

Chronic tension-type headache: amitriptyline reduces clinical headache-duration and experimental pain sensitivity but does not alter pericranial muscle activity readings.

In a double-blind, placebo-controlled trial, the effect of 75 mg of a slow-release formulation of amitriptyline on the clinical severity of chronic tension-type headache and on headache-associated neurophysiological parameters (EMG activity, exteroceptive suppression of temporal muscle activity, contingent negative variation (CNV) and experimental pain sensitivity) was investigated. All of the patients treated had a history of headaches of many years' standing and many of them had failed attempts at treatment. In the amitriptyline group, a significant reduction in daily headache duration was already found in the 3rd week of treatment, while in the placebo group no significant changes in headache duration were to be seen. In week 6 the amitriptyline group had a significantly shorter daily duration of headache than did the placebo group. Treatment did not result in any significant effects on EMG recordings of pericranial muscle activity either during relaxation or contraction, on exteroceptive suppression of the temporal muscle and on CNV. The sensitivity to suprathreshold experimental pain, however, was significantly reduced. The data show a statistically relevant reduction of daily headache duration. However, they also show that amitriptyline can only partly alleviate chronic headaches but cannot cure them.

Adult↗

[Functional morphology of the maxillomandibular apparatus in the mini-Lewe minipig. 6. Intramuscular nerve ramifications in the masticatory muscles of adult animals].

The masseter muscle is innervated by branches of 3 nerves. The zygomaticomandibular muscle must be regarded as part of the masseter as it is supplied by 2 branches of the massetericus nerve. Two branches of the medial pterygoid nerve enter the medial pterygoid muscle medially. The lateral pterygoid muscle is supplied by the lateral pterygoid nerve, which enters the muscle dorsally perpendicular to the muscle fibres. Five branches of the profound temporal nerves enter the temporal muscle from the ventral and medial sides. The branches of all nerves proceed parallel to each other in the dorsal direction towards the origin of the muscle.

Animals↗

Comparison of the electromyographic activity of individuals with canine guidance and group function occlusion.

The purpose of this study was to investigate occlusal schemes (canine guidance and group function) in relation to masticatory muscle activity. It was performed on 30 subjects, 15 with canine guidance and 15 with group function. Bilateral electromyographic recordings of masseter and anterior temporal muscles were obtained by surface electrodes during gum chewing and sliding laterally from centric relation while the teeth were in contact. The obtained data for both groups were compared statistically. Electromyograms were also evaluated visually. There was no significant difference in results between the occlusal schemes. However, canine guidance showed a narrower chewing model than group function and reduced anterior temporal muscle activity during sliding. This suggests that in the presence of healthy and good supportive canine teeth, canine guidance occlusion will be preferable.

Adolescent↗

Electromyographic evidence of local muscle fatigue in a subgroup of patients with myogenous craniomandibular disorders.

Ten female patients with myogenous craniomandibular disorders who had complete dentitions and mainly unilateral muscle pain and tenderness to palpation, and 10 healthy female controls, participated in the study. The surface electromyographic signals of masseter and anterior temporal muscles were recorded during 30-s test contractions at 50% of the maximum voluntary clenching effort. A force transducer placed between the central incisors recorded the maximum voluntary bite force. The patients exerted a lower maximum voluntary bite force than the controls (p less than 0.05). In the patients the electromyographic signals of the painful muscles were weaker than those of the painless muscles (p less than 0.01). The signals of the control subjects were stronger than those of the painless muscles of the patients (p less than 0.01). The mean power frequency of the signals, recorded at the start of the 30-s contractions, showed no differences between the painful and painless muscles and between the muscles of the patients and of the controls. The rate of mean power frequency shift in the electromyographic signal, as a response to the 30-s test contraction, was normalized with respect to the amplitude of that signal to account for its amplitude dependency. The painful muscles showed a higher normalized rate of mean power frequency shift than the painless muscles and the muscles of the control subjects (p less than 0.01). These results confirm the presence of an impaired condition in the painful muscles of this group of patients with myogenous craniomandibular disorders.

Adolescent↗

An evaluation of anterior temporal and masseter muscle activity in appliance therapy.

Needle electromyography (NEMG) was used to compare the effects of the Hawley bite plane (HBP) and superior repositioning splint (SRS) on the ipsilateral masseter and anterior temporal muscles at rest and in maximum closure. Twenty adult subjects were randomly divided into two groups of 10. One group wore the HBP for 8 hours per day and the other group wore SRS for the same time period. After 2 weeks of use, NEMG was conducted on the ipsilateral masseter and temporal muscles with and without the device in place. Each group then wore the other appliance for an identical period and underwent NEMG. Both appliance designs produced decreases in electromyographic responses during use. Individuals in the HBP group showed a 48.6% decrease in anterior temporal activity and a 34.1% decrease in masseter muscle activity. The SRS group demonstrated 23.5% and 16.2% decreases in anterior temporal and masseter muscles activities, respectively. This is the first report of the use of NEMG as a mode of assessment of muscle activity in human or animal subjects.

Adult↗

Influence of variation in anteroposterior occlusal contacts on electromyographic activity.

A full upper stabilization splint divided into three pairs of occlusal bilateral blocks was made for eight healthy young adult subjects. The three pairs of blocks allowed the location of the centric occlusal contacts to vary and to be distributed over equivalent periodontal surfaces. The electromyographic activity of the masseter and temporal muscles was recorded with surface electrodes during maximum voluntary clenching over the centric occlusal blocks. The electromyographic activity from the elevator muscles with the anterior blocks was significantly less than with the intermediate and posterior occlusal blocks. With use of the intermediate blocks, the activity from the elevator muscles was significantly less than with the posterior blocks. The elevator activity with the posterior blocks was similar to that with the full coverage splint.

Adult↗

Relationship between myoelectric activity in masticatory muscles and bite force.

Myoelectric activity in the anterior and posterior temporalis and in the masseter muscle was assessed in five subjects biting unilaterally on a bite fork at 50, 100 and 200 N for 60 s. The bite fork was placed between the right first premolars and the first molars. The ipsilateral muscle activity was recorded first, and the contralateral side was evaluated 1 wk later. The relationship between exerted force and EMG-activity was expressed as ratios between EMG-activity and related bite force. EMG-activity increased with increasing force for all muscles tested. Linearity was found for the anterior temporal muscle, but not for the other muscles. Four of the subjects participated in an endurance test, exerting maximum bite force on the right side for as long as possible. The EMG activity of the right masseter muscle was closely related to bite force, in contrast to the other tested muscles. The activity of the left muscles increased at the end of the endurance test.

Adult↗

The effect of stimulus strength on the jaw-jerk response in man.

The jaw-jerk response was elicited in seven adult male subjects by tapping on the chin in a downward direction. The magnitude of the applied taps was varied subjectively by the operator, and the downward acceleration of the mandible measured by means of a calibrated piezo-electric accelerometer fixed to the lower anterior teeth. The taps were applied during voluntary clenching by the subject, controlled by means of a force transducer placed between upper and lower teeth. The electrical response of masseter and temporal muscles was found to increase both with increasing stimulus strength and with voluntary clenching force. However, only by averaging a number of responses were clear relationships demonstrated, there being other variables, affecting the muscles independently, which it has not been possible to identify and control. It is concluded therefore, that quantitative analysis of the electromyograms of the jaw closing muscles following chin-tap stimuli is not a satisfactory method for testing for abnormality in excitability of the neuromuscular system involved in the jaw-jerk response.

Adolescent↗

Medial pterygoid muscle activity during chewing and clenching.

Specific activity of the human medial pterygoid muscle in relation to jaw movements and occlusion during mastication and clenching tasks is unclear. EMG activity of the medial pterygoid, masseter, anterior, and posterior temporal muscles was recorded simultaneously with three dimensional incisor point movement of the mandible. Data were sampled and analyzed by an on-line computer system. Patterns of medial pterygoid muscle activity were consistent for ipsilateral chewing and demonstrated activity of the muscle on the chewing side that peaked near the onset of intercuspation. The muscle on the contralateral side was active at the onset of intercuspation for subjects with a chopping stroke and inactive for those with a more lateral stroke guided into intercuspation on cuspal inclines. Activity in the early part of the closing phase was associated with a marked jaw movement toward the chewing side. There was generally less activity in protrusive than intercuspal clenching when occlusion was normal but more activity if marked incisal wear was present or multiple tooth contacts could be attained on protrusion. Intercuspal clenching initiated less activity when force was directed posteriorly and more activity when directed anteriorly than vertical intercuspal clenching.

Adolescent↗

Influence of antineoplastic therapy on function of the masticatory system, tooth development, and cariogenic status: a case report.

Antineoplastic therapy causes developmental disturbances in the dental enamel and root if children are treated during tooth development. Increased caries activity has also been reported. The effect of anticancer therapy on the function of the masticatory system (i.e. jaws, dentition, masticatory muscles) is not well known. A case report of a 9-year-old girl with right auricular rhabdomyosarcoma is presented. She received irradiation of 50 Gy to the right auricular area and chemotherapy. A year and a half after cessation of cancer therapy, she was disease free and the clinical stomatognathic examination combined with electromyogram (EMG) registration of the masseter and temporal muscles and magnetic resonance imaging (MRI) examination of the temporomandibular joints (TMJ) revealed a strongly restricted mouth opening capacity, painful right TMJ, and flattened head of the right mandibular condyle. Muscle atrophy in the right masseter muscle was clearly visible but EMG activities of the masseter and temporal muscles, however, were higher on the right than on the left. More severe developmental defects, and worse gingival and cariological health were observed on the right side than on the left side. She developed 12 carious lesions and all the lesions were on the right maxilla or mandible or on anterior teeth. The left side was not affected. Intensive prophylactic dental care after cancer treatment is important in order to prevent caries and gingival inflammation. Stomatognathic treatment (i.e. management of occlusal and dysfunctional problems) may improve the mouth opening capacity and relieve pain.

Antineoplastic Combined Chemotherapy Protocols↗