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Quantitative evaluation of the tonic vibration reflex (TVR) in the masseter muscle.

PURPOSE: This study evaluated the efficacy of the tonic vibration reflex (TVR) elicited by high-frequency vibration in evaluating masticatory muscle excitability. SUBJECTS AND METHODS: The experiment was performed on 16 male adult volunteers, 20 to 45 years of age, without spontaneous pain or tenderness in the masticatory muscles. The subjects were seated in a chair in a fixed head position with the mouth kept open with a bite block. TVR was elicited by vibratory stimulation applied to the mandible (approximately 15 m/s2, 160 Hz). An electromyogram (EMG) was recorded bilaterally from the masseter muscles and analyzed quantitatively using an arbitrary index (TVR index) calculated from the response. Bite force was measured during clenching using a pressure-sensitive foil. RESULTS: Wide variations in the TVR index (maximum, 22.7%; minimum, 0.9%, average, 7.7%) were observed among individuals. The mean index for five subjects with a clenching habit was significantly higher than that for 11 subjects without a history of clenching. Tolperisone HCl (100 mg taken orally), a gamma-drive depressant, was found to reduce the response for 2 hours. There was a negative correlation (r = -.504, P < .05) between bite force and TVR index when the values on both sides were compared. CONCLUSIONS: The TVR may be of use in evaluating masseter muscle excitability.

Adult↗

Innocuous jaw movements increase c-fos expression in trigeminal sensory nuclei produced by masseter muscle inflammation.

Muscle tenderness and pain during movements are prominent symptoms associated with persistent jaw muscle pain. However, there is virtually no information on how trigeminal neurons respond to jaw movements (JM) or muscle palpation in the presence of muscle tissue injury or myositis. In this study, we investigated the effects of innocuous JM in the presence of acute masseteric inflammation on postsynaptic responses in the trigeminal brainstem nuclei by examining the expression of c-fos. In one group of rats, unilateral injections of an inflammatory substance, mustard oil (MO: 20%, 25 microl) were made into a masseter muscle. In another group, controlled and systematic JM were provided following MO injection. Three additional groups of rats were used to control for anesthetic, JM, and injection procedure. MO injected in the masseter muscle induced a high level of Fos protein expression in four principal trigeminal regions: the subnucleus caudalis (Vc), the ventral and dorsal regions of the Vc/Vi (subnucleus interpolaris) transition zone, and the paratrigeminal nucleus (PTN). Movements following MO injection consistently produced a significantly greater level of Fos expression in all these areas, especially in the Vc/Vi transition region and caudal Vc on the ipsilateral side. Importantly, movements also induced a significantly greater level of Fos expression in the caudal Vc on the contralateral side. The present results provide the first documentation that innocuous JM in the presence of muscle inflammation significantly increase the MO-induced c-fos expression in the trigeminal brainstem nuclei, which may explain the greater pain experienced during movement of inflamed or injured muscles.

Animals↗

The short-term effect of stabilization-type splints on the local asymmetry of masseter muscle sites.

Patients with temporomandibular disorders (TMD) may present with a cluster of joint and muscle disorders characterized primarily by pain, joint sounds and irregular or deviating jaw function. Maxillary stabilization-type splints represent the best standard therapy, so the purpose of this study was to evaluate changes in local cross-sectional dimensions (LCSD) of masseter muscle sites associated with short-term application of 'splint therapy' using the diagnostic approach of high-resolution gray-scale ultrasonography. The study included 29 patients who had signs and symptoms of temporomandibular disorders. Ultrasonographic investigation was performed with a linear (B-scan) 7.5 MHz small-part transducer to visualize the antero-superior, antero-inferior, medio-superior, medio-inferior, postero-superior and postero-inferior sites of the masseter muscle. To assess local muscle asymmetry patterns and to evaluate the respective effect of occluding splints, the 'absolute asymmetry index (AAI)' was used, with the mean maximum muscle diameter of the respective right and left sides calculated from three consecutive measurements before and after splint therapy. Comparing the pre-treatment with the 2-month follow-up values revealed a significant decrease in the overall mean asymmetry indices at the anterior (P < 0.01), medial (P < 0.05) and posterior (P < 0.05) muscle sites. There was no significant change in LCSDs at the various muscle sites (P > 0.05). The results of this study suggest stabilization-type splints to be effective in reducing local muscle asymmetries. Further studies are warranted to evaluate muscle-site specific effects in patient and non-patient groups and to relate these effects to pre-treatment variables like bite force, preferred chewing side, facial morphology and occlusion.

Adult↗

Modulation of stretch-evoked reflexes in single motor units in human masseter muscle by experimental pain.

The interaction between muscle pain and motor function of the jaw has been examined in recent years, but the nature of the modulation of the short-latency stretch reflex by pain is not fully understood. In this study, the reflex responses to stretch were measured in single low-threshold motor units that were kept discharging at a constant frequency, before, during and after the induction of experimental pain in one masseter muscle by controlled infusion of hypertonic saline. The probability of evoking a reflex response in individual motor units in the painful muscle at near-monosynaptic latency was reduced by a mean of about 20%. However, the overall reflex response in the surface electromyogram of both the ipsi- and contralateral masseter muscles was greater during pain. This was apparently a secondary response to the pain-induced increase in pre-stimulus activity in the motoneurone pools of both muscles, because increased motoneurone excitability may facilitate stretch reflexes. It is concluded that the most likely explanation for the reduced reflex response of low-threshold masseter motor units during experimental pain is a tonic reduction in the fusimotor drive to the masseter spindles.

Adult↗

Exteroceptive suppression of temporalis and masseter muscle activity is enhanced in offspring of hypertensives.

Exteroceptive suppression of temporalis and masseter muscle activity was examined in young men with and without a parental history of hypertension. Recent clinical studies suggest that the second exteroceptive suppression period is attenuated in several chronic pain disorders and that this brainstem reflex may serve as a noninvasive index of endogenous pain control. In the present study, offspring of hypertensives exhibited a significant protraction of the late exteroceptive suppression period for both muscle sites, suggesting that the decreased pain sensitivity previously observed in individuals at risk for hypertension may be related to enhanced central pain modulation.

Electromyography↗

Heterogeneity of fiber and sarcomere length in the human masseter muscle.

This study deals with regional differences in the architectural design of the human masseter muscle. For a number of defined muscle regions the three-dimensional coordinates of origin and insertion points, and the lengths of the muscle fibers and the sarcomeres were determined in the closed jaw position. Measurements were made from cadavers and the data were used as input for a model predicting sarcomere length at other mandibular positions. At a closed jaw average muscle fiber length of the muscle regions ranged between 19.0-30.3 mm. The fibers appeared to be considerably longer (35%) anteriorly than posteriorly in the muscle, and deeply situated fibers were on average 5% shorter than superficially situated ones. Average sarcomere length of the regions ranged between 2.27-2.55 microns, indicating that at a closed jaw position sarcomeres are at suboptimum length and have different positions on the length-tension curve. In the deep layer of the muscle sarcomeres were significantly shorter (6%) than in the superficial layer. Within the superficial layer sarcomere lengths did not differ significantly, but in the deep layer sarcomeres were shorter (8%) posteriorly than anteriorly in the muscle. The model shows that jaw displacement had a different effect on sarcomere length in the muscle regions. When the jaw was rotated about a transverse axis (open/close rotation) sarcomere excursions were relatively small in the posterior muscle regions and large in the anterior regions. The reverse was true when the jaw was rotated contralaterally about a vertical axis. It is concluded that, due to heterogeneity in fiber and sarcomere lengths, the distribution of maximal isometric tension across the muscle at full effort is not uniform.

Aged↗

Effect of intravenous infusion of an alpha-adrenergic blocking agent on the haemodynamic changes in human masseter muscle induced by cold pressor stimulation.

This study evaluated the effect of intravenous infusion of a non-selective alpha-adrenergic blocking agent on masseter muscle haemodynamics induced by 4 degrees C cold pressor stimulation (CPS) of the right foot and ankle, which reportedly evokes a rapidly increasing sympathetic nerve activity in human skeletal muscle. Nine healthy non-smoking males (mean age 23.7+/-2.1 year) with no history of chronic muscle pain or migraine participated. The haemoglobin (Hb) concentration in the right masseter was continuously recorded by non-invasive, near-infrared spectroscopy. Heart rate and blood pressure were also recorded. The experiment involved the following sequence: (1) a placebo (physiological saline) with a CPS trial; (2) a 30-sec maximal voluntary clenching (MVC)-only trial; and (3) an alpha-adrenergic blocking agent with a CPS trial. The saline and drug trials each involved continuous recording for 1 min before, 2 min during and 5 min after the CPS. Physiological saline (20 ml) or phentolamine mesylate (20 ml) were infused at the rate of 2 ml/min. This infusion was begun 15 min before baseline recording and participants were not aware which solution (saline or phentolamine) was being infused. For the MVC trial, each participant performed a 30-sec MVC of his jaw-closing muscles followed by a 15-min rest between each trial. The individual Hb data were adjusted so that the baseline at the beginning of the experiment was equal to zero and all data were normalized as a percentage of the individual's highest absolute Hb change seen after the MVC. The mean baseline Hb concentrations 1 min before CPS were significantly higher in the alpha-blocker trial (83.6%) than in the placebo saline trial (P < 0.001). The change in mean Hb concentration from baseline during CPS in the alpha-blocker trial was significantly less than in the placebo trial (P = 0.006). Mean heart rate before CPS was also significantly higher in the alpha-blocker trial (85.2 beats/min) than in the placebo trial (69.6 beats/min) (P < 0.001). There were no significant differences in the mean systolic and diastolic blood pressures between the placebo and alpha-blocker trials in any time period. The results suggest that non-selective alpha-adrenoceptor blockade increases the blood volume in the masseter muscle. This change might be due to a combination of peripheral vasodilation and an increase in cardiac output.

Adrenergic alpha-Antagonists↗

Condylar translation and the function of the superficial masseter muscle in the rhesus monkey (M. mulatta).

The relationship between translation of the mandibular condyle during symmetrical mandibular rotation, i.e., symmetrical jaw depression and elevation, and the function of the superficial masseter muscle was examined in light of relative torque and the length-tension relationship for muscle. Lateral cephalograms of live adult rhesus monkeys (Macaca mulatta) were analyzed using two models: (1) Model A, normal symmetrical jaw rotation accompanied by condylar translation; and (2) Model B, mandibular rotation about an axis fixed at the position of the condyles during centric occlusion. The decrease in relative torque and the excursion of the superficial masseter at mouth-open positions are significantly greater in Model B than in Model A. Symmetrical rotation of the jaw about a fixed axis would result in a 35% greater loss of maximum producible tension at maximum gape than rotation associated with condylar translation. These results suggest that condylar translation during mandibular depression and elevation functions to minimize reduction in relative torque and excursion of superficial masseter muscle, thereby maintaining optimal potential for exerting maximum tension during jaw closure.

Animals↗

Melanoma in the masseter muscle.

This case report presents two very unusual cases of melanomas arising within the masseter muscle. Both were metastases of unknown origin arising in young, healthy patients and presenting as asymptomatic lesions. No primary lesions were found in either case. A comprehensive search of the world literature revealed no previous similar cases.

Adult↗

Stimulated jitter in the masseter muscle: normative values.

Nineteen healthy volunteers (median age, 25; range, 18-51 years) were enrolled in a study to obtain normative values for stimulated jitter in the masseter muscle. Axonal microstimulation was performed via a monopolar needle electrode introduced in the masseter 2-2.5 cm above the mandibular angle on the line connecting it with the lateral canthus. The recording single-fiber electromyography (SFEMG) electrode was inserted anteriorly in the twitching area of the muscle. The mean consecutive difference (MCD) values for the 426 endplates studied followed a distribution skewed to the left, with a minimum value of 4.3 micros, maximal 44.7 micros, and a maximum of distribution at 11 micros. Mean pooled MCD measured 16.0 micros, and the mean of mean MCD per study was 13.6 micros. The value of the 95th upper percentile for an individual fiber was 29.3 micros. We suggest an upper normal limit for mean MCD per study of 21 micros and upper normal limit of MCD for individual fibers of 30 micros. The stimulated jitter study of masseter muscle is easy and reliable.

Adolescent↗

Sex differences in rabbit masseter muscle function.

The proportions of fibers of different phenotypes in the rabbit masseter muscle differ strikingly in adult males and females. Muscles from females contain similar proportions of small fibers that express both the slow/beta and cardiac alpha myosin heavy chain (MyHC) isoforms and larger fibers containing the IIa MyHC isoform. In muscles from males, nearly 80% of fibers are of the IIa phenotype. To evaluate the functional significance of these sex differences, we used finely graded intramuscular microstimulation to study the contractile properties of masseter motor units in >6-month-old male and female rabbits. Twitch forces and torques in males were significantly greater in magnitude than those of females. Greater proportions of units that produced larger forces/torques were encountered in the males. The same motor units produced force or torque more rapidly in males than in females, principally because units in which twitch rise times were >22 ms were found only in females. The forces applied to the mandible and the torques generated about the right mandibular condyle were studied during cortically evoked rhythmic activation of the masticatory muscles. The overall range of torque rise times and the magnitudes of the peak torques did not differ between sexes. The mean rise time was significantly shorter and the mean peak torque was significantly greater in males. We conclude that sex differences in fiber phenotype proportions are reflected in sex differences in motor unit properties and in the function of these motor units during rhythmic activation.

Animals↗

Reliability of maximum static work efforts by the human masseter muscle.

To study the reliability of nonfatiguing maximum voluntary static work efforts by the masseter muscle, six healthy subjects exercised teeth clenching in centric occlusion. Maximum voluntary teeth clenching was performed for 10 seconds on 2 different days, each with two trials, and maximum static work efforts (without artificial feedback-control) were quantified by integrated surface electromyography. Reliability was determined by factorial analyses of variance and intraclass correlations. Data reduction showed that maximum voluntary static work efforts were reproduced reliably during the four different trials.

Adult↗

Intramuscular and skin surface temperatures of the resting human superficial masseter muscle.

The intramuscular and skin surface temperature of the central part of the superficial masseter muscle was measured with thermocouples in 25 individuals with none or mild signs of craniomandibular disorders. The intramuscular temperature averaged 35.7 degrees C, varying between 34.6 and 36.5 degrees C. The average difference between the right and left sides was 0.4 degrees C. The skin surface temperature averaged 33.2 degrees C, varying between 31.1 and 35.4 degrees C. The average difference between sides for this temperature was also 0.4 degrees C. The correlation between intramuscular and skin surface temperature was weak, and the average difference was 2.5 degrees C, with a range from 0.4 to 4.6 degrees C. The spatial variation in skin surface temperature 5 mm around the central measuring point was small. The reproducibility of both intramuscular and skin surface measurements, as assessed by the standard deviation for a single measurement, was acceptable.

Adult↗

Pressure pain threshold with and without iontophoretic anesthesia of the masseter muscle in asymptomatic males.

AIMS: The pressure pain threshold (PPT) in the superficial masseter muscle was measured with and without cutaneous anesthesia to determine whether there would be a difference in PPT scores. METHODS: In 14 healthy male subjects, cutaneous tissues in the target areas were anesthetized with lidocaine with the help of an iontophoretic device. As a control, physiologic saline solution was applied iontophoretically to the contralateral masseter site. The subject and the PPT examiner did not know which side contained anesthesia, and the selection of which side to anesthetize was done in a random fashion. Multiple PPT measurements were made in the target sites before and immediately after the iontophoretic anesthesia. RESULTS: The PPT level on the lidocaine side was not statistically different from the PPT level recorded on the control side (339.0 +/- 87.6 kPa and 337.5 +/- 77.7 kPa, respectively). CONCLUSION: Pressure pain sensation in the human masseter is not derived predominantly from the cutaneous tissues, but from the muscle itself.

Adult↗

Bite force, endurance and masseter muscle fatigue in healthy edentulous subjects and those with TMD.

It is well known that bite force and EMG activity are considerably reduced in edentulous patients, but the susceptibility of their jaw-closing muscles to localized fatigue is less certain. This information is even less clear for edentulous subjects who have TMD. Eleven healthy edentulous subjects and 10 edentulous subjects with TMD participated in this study. Maximum bite force was measured first, with the transducer placed on the canine-first premolar region bilaterally, and then two rapid relaxations were made from a brief voluntary clench to 50% of maximum. A sustained voluntary clench of 50% of maximum was then maintained and endurance time was noted. EMG was recorded from both masseter muscles and the median frequency of the power spectrum of the EMG from 2 s at the beginning of the sustained clench and 2 s at the end was subsequently calculated. Two more rapid relaxations from brief clenches were performed immediately after the sustained clench. The mean maximum bite force in the healthy group was 115 N (SD +/-41) and in the TMD group was 75 N (SD +/-22), this difference being significant (P = 0.0013). The mean endurance time in the healthy group was 86 s (SD +/-51) and in the TMD group was 63 s (SD +/-20). The percentage change in the median frequency in the healthy group as a result of the sustained contraction was 6% (left) and 8.6% (right) and in the TMD group was 13.9% (left) and 12.8% (right). The percentage change in the mean relaxation half time for the healthy group was 28.5% and for the TMD group was 72%, a significant difference (P = 0.0046). It was apparent that the maximum bite force was low in edentulous subjects and was further reduced in edentulous TMD subjects; endurance time was reduced in TMD subjects; fatigue resistance of the masseter muscles was reduced in TMD subjects.

Aged↗

Temporalis and masseter muscle activity in patients with anterior open bite and craniomandibular disorders.

Activity in temporalis and masseter muscles, and traits of facial morphology and occlusal stability were studied in 22 patients (19 women, 3 men; 15-45 yr of age) with anterior open bite and symptoms and signs of craniomandibular disorders. Facial morphology was assessed by profile radiographs, occlusal stability by tooth contacts, and craniomandibular function by clinical and radiological examination. Electromyographic activity was recorded by surface electrodes after primary treatment with a reflex-releasing, stabilizing splint. Maximal voluntary contraction was reduced compared to reference values, particularly in subjects with muscular affection, but maximal activity increased significantly when biting on the splint. Maximal voluntary contraction was positively correlated to molar contact and negatively to anterior face height, mandibular inclination, vertical jaw relation and gonial angle. Relative loading of the muscles was markedly increased during resting posture. It was concluded that reduced occlusal stability and long-face morphology were associated with weak elevator muscle activity with disposition overload and tenderness. The results also indicated that increase of occlusal stability might lead to increased muscle strength and possibly reduce risk of physical strain.

Adolescent↗