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PubMed2006

The galea fascia flap in orbital reconstruction: innovative harvest technique.

AIM: To report the treatment of a recurrent adenoid-cystic carcinoma of the lacrimal gland required orbital exenteration with an en bloc resection of the lateral orbital rim and wall and an anterior portion of the temporal muscle. Reconstruction was planned with both the objectives of a shortened healing time for faster epithetic reconstruction and no visible scars. METHOD: After a cranially extended temporal approach, the dissection of the superficial galea layer was connected with the subcutaneous dissection of the upper and lower eyelid after subciliary incisions. RESULTS: Ample exposure of the temporal, frontal and orbital region was obtained, facilitating the orbital exenteration with en bloc resection of the lateral orbital rim and wall and the anterior portion of the temporal muscle. The epithelialization of the eye socket covered with the galea fascia flap was accelerated, providing faster epithetic reconstruction, without visible scars. CONCLUSIONS: Healing time is accelerated, providing faster epithetic rehabilitation without visible scars, which is important in the postoperative rehabilitation ladder after eye exenteration for both patient and surgeon. Further more ablative surgery within this region gets safer and easier due to the ample exposure of this innovative surgical technique. Further evaluation of the effectiveness and safety of this new approach is advisable.

Carcinoma, Adenoid Cystic↗
PubMed1999

Electromyography of the perioral and masticatory muscles in orthodontic patients with atypical swallowing.

Subjects with an open bite and an atypical swallowing pattern before (n = 20) and after (n = 10) orthodontic treatment and subjects with a normal swallowing pattern (n = 15) were examined. The electromyographic (EMG) activity of the upper and lower lips in the region of the modiolus and of the mentalis, masseter and temporal muscles was evaluated during the swallowing of saliva and of water and after the chewing of peanuts as well as during maximal biting in intercuspal position. During swallowing the atypical swallowers exhibited larger EMG activities of the perioral muscles and smaller EMG activities of the masticatory muscles than the control subjects. During maximal biting in intercuspal position, major EMG activity of the masseter and temporal muscles and minor EMG activity of the perioral muscles were recorded in both groups. No normalization of the electromyographic swallowing pattern could be observed during orthodontic treatment (closure of the open bite).

Adolescent↗
PubMed1990

[Effects of positions of experimental premature contacts on jaw function].

The effects of different positions of experimental premature contacts on the jaw function were investigated on 6 subjects. The metal castings of 100-microns thickness were fabricated to make experimental premature contacts on each of 4 mandibular posterior teeth (from the first premolar to the second molar on the preferable masticatory side). The EMG activity of the masseter, anterior and posterior temporal muscles during maximum clenching and gum chewing as well as the mandibular movement during gum chewing were evaluated. The experimental premature contacts reduced the muscle activity, especially on the contralateral side during maximum clenching. As the premature contact was moved more posteriorly, the following results were observed. 1. The activity of the posterior temporal muscle was decreased on the ipsilateral side while it increased on the contralateral side during maximum clenching in many subjects. 2. The duration of the occlusion phase during the ipsilateral chewing was shortened in many subjects. 3. During ipsilateral chewing, a larger muscle activity was produced during the closing phase and the muscle activity produced during the occlusion phase was the least on the first molar. 4. In any chewing side, the closing and opening paths tended to go toward the chewing side.

Adult↗
PubMed1998

[Reconstructive strategies in head and neck cancer: case history review from 1992 to 1997 (154 cases)].

Technological progress in reconstructive surgery, in particular the use of pedunculated or free flaps, has given new impetus to head and neck dissection. This stems from the fact that such techniques provide greater oncological radicality, reduce the number of severe post-operative complications and give better quality of life. The present study examines 154 patients suffering from upper aero-digestive tract neoplasms (131 males and 23 females; age range 23-82 years) who had undergone radical surgery. Reconstruction was performed with flaps in 154 cases: 119 pedunculated flaps (102 large myocutaneous pectoral and 17 temporal muscle flaps) and 35 free flaps (18 radial osteofasciocutaneous, 13 radial fasciocutaneous and 4 omentum flaps). Analysis of the individual districts showed that the flap of choice was the temporal muscle flap when surgery involved the soft parts of the orbital-maxilly-zigomatic area and the rhinopharynx. This is because it is highly moldable and reliable. In surgery of the oral cavity and oropharynx the grand pectoral flap is most frequently used as it provides enough tissue for the reconstruction, adequately protects the vascular-nerve axis in the neck and it is quick and easy. However, the functional results are not the best and there is some alteration in the initial phases of deglutition. To reduce these problems, the authors encourage the use of free flaps which provide good results from both the functional and esthetic points of view. They are, however, more difficult to perform and this leads the authors to conclude that they should only be selected for certain patients (long life expectancy, female, young, etc.). In the center where the authors work the flap of choice is the radial fasciocutaneous or osteofasciocutaneous flap. In surgery of the hypopharynx and larynx reconstruction is normally performed with a grand pectoral myocutaneous flap, sculpted as needed for the individual case. In this region, reconstruction proves functionally satisfactory even when there is a minimum of residual mucosa. Finally, for reconstructive surgery of the apex, the omentum free flap was used as it is malleable and can be used to reconstruct broad areas of dissection. The esthetic and functional results, the low incidence of complications and the greater quality of life suggest that this type of flap be extended to the surgery of locally advanced tumors in combination with an accurate, valid reconstructive solution.

Adult↗
PubMed1991

Electromyographic and computer analyses of patients suffering from chronic myofascial pain-dysfunction syndrome: before and after treatment with immediate complete anterior guidance development.

Seven women patients at Tufts University School of Dental Medicine were evaluated for the subjective symptoms of a myofascial pain dysfunction. Each patient was evaluated by an occlusal analysis of the T-Scan computer to determine posterior disclusion time during excursive movements, and EMG analysis of the masseter and temporalis muscles. Each patient was then treated occlusally by developing immediate complete anterior guidance. This adjustment process involved the removal of all lateral and protrusive interferences prior to habitual closure adjustments. No attempt was made to retrude the mandible in centric relation, and splints were not used to deprogram the musculature before adjustment. In this study, protrusive movements and interferences were not examined, and there was no control group. Posttreatment EMG and T-Scan computer analyses revealed that by shortening disclusion times to less than 0.5 second in any lateral excursions, muscle function returned to normal in all seven patients in approximately 1 month's time. A direct correlation seemed to exist between contractile muscle activity and disclusion time. Lengthy disclusion time leads to excessive muscle activity that introduces spasm and fatigue of the masseter and temporal muscles. These results indicated that a partial explanation of the etiology of MPDS may be the time the molars and nonworking premolars remain in contact during excursive movements--a phenomenon termed "disclusion time."

Adult↗
PubMed2006

Overall activity of all masticatory muscles during lateral excursion.

Quantification of the overall activity of every masticatory muscle is requisite for the analysis of stomatognathic function, which has not been accomplished by conventional electromyography. We used positron emission tomography and 18F-fluoro-deoxy-glucose to quantify the overall activity of every masticatory muscle during lateral excursion, and to evaluate the relative contribution of each masticatory muscle to lateral excursion. The present study suggested that lateral and medial pterygoid muscles are more responsible for lateral excursion than are masseter and temporal muscles. In particular, the contralateral lateral pterygoid muscle plays a major role, followed by the contralateral medial pterygoid muscle.

Adult↗
PubMed1998

Effects of a myofunctional appliance on orofacial muscle activity and structures.

The aim of the study was to examine the effect of an oral shield treatment on orofacial muscle activity and facial morphology in children with lip and/or tongue dysfunction. The sample consisted of 7 girls and 2 boys, 7 to 12 years old. EMG recordings with and without the shield in situ were obtained when the shield was placed, and 3, 6, and 12 months later. Lateral cephalograms were obtained at the initial and 1-year stages. The lip muscles showed dominant activity when the subjects were sucking on an empty straw and during swallowing; this was strongest during the first 3 months. The mentalis, buccinator, and digastric muscles generally showed weaker activity. The anterior temporal muscle showed dominant activity during maximal clench, but after the 3-month stage a significant decrease was noted. After 1 year of treatment, no significant changes in overjet or overbite were observed. Most of the craniofacial growth changes were normal for the age group. The results indicate that treatment with an oral shield caused a decrease in orofacial muscle activity during oral functions. Although there was a slight average retraction of the maxillary incisors, the change in position was not statistically significant.

Cephalometry↗
PubMedDate not supplied

The effect of the Schwartz-Jampel syndrome on masticatory and facial musculatures--an electromyographic analysis.

This study had the goal to perform an electromyography evaluation of the orbicularis oris, orbicularis oculi, masseter, and temporal muscles of two siblings with Schwartz-Jampel syndrome (SJS), in different clinical activities, comparing them to healthy controls (C). The Schwartz-Jampel syndrome is a rare genetic disorder (71 cases reported in worldwide literature), in which myotonia may be observed in the facial muscles, determining a standard facie that shows an appearance of someone who is sad and weeping For the electromyography (EMG), a Myotronics--K61 electromyographer, was used, with superficial and disposable silver chloride electrodes. By means of the analysis of the obtained results, we observed significant statistical differences for the masseter muscle and for orbicularis oculi muscles (p < 0.01) among the studied groups, in which the individuals with SJS presented greater muscular activity than the normal ones, used as healthy controls. The statistical difference between the two groups was not significant for the temporal muscle, as well as for the orbicularis oris muscle, although the EMG averages were much greater in patients who were bringers of the syndrome. This high muscular activity may be related to the facial osseous alterations, evidenced in both patients with SJS, such as the mandibular migrognathia, with an atrophy of the mandibular cortex and a consequent approximation between the inferior dental root apices and the mandible base, as well as the presence of hypoplastic condyles in terms of size and height.

Adolescent↗
PubMed1981

[Influence of masticatory muscle insertions on the mandibular structure of the newborn infant].

The influence of the muscular insertions on the mandibular structure in new born infants has been studied with the aid of microradiographical analysis applied to 80 microns thick undecalcified sections and in paraffin sections after decalcification. The left side of the mandibles was cut into sections parallel to the vestibular surface of the bone (fig. 1) and the right side, in frontal sections (fig. 2). The tendinous fibres of the temporal muscle are inserted into the apex of the coronoïd process, which is, at this age, constituted by chondroïd tissue (fig. 3). The continued differentiation of this tissue within the coronoïd process, permits the migration of the temporal muscle insertion. Microradiographical analysis has been used to show the changes of the calcified tissue aspects in the masseter and medial pterygoïd muscle insertions (fig. 4 and 5). The insertion of the lateral pterygoïd muscle doesn't transform the bone tissue morphology (fig. 6-A and 6-B).

Humans↗
PubMed1992

[Comparison of 2 materials in the reconstruction of the tympanic membrane. Our experience in 300 patients].

The authors evaluated the results obtained from the tympanic membrane reconstruction in 300 patients affected by simple, purulent or cholesteatomatous chronic middle ear otitis. In this tympanic membrane reconstruction they used: jugular vein strip of a calf and temporal muscle fascia in 150 cases. On pathological basis (simple, purulent and cholestéatomatous otitis) they used the overlay or the underlay method. In 5 years that follows, the materials (vein and fascia), if properly used, would give similar results. For such reasons the authors proposed: temporal muscle fascia autotransplantation with underlay method in partial myringoplasty; heterotransplantation of modelled jugular vein strip with overlay method in subtotal or total myringoplasty.

Fascia↗
PubMed2001

Changes in the masticatory jaw movement following orthodontic traction of an impacted and transposed upper canine and occlusal adjustment.

In a 10-year-old female with an impacted and completely transposed upper left canine, posterior temporal muscle activity and jaw movement during mastication were examined before and after orthodontic traction of the canine, alignment of teeth, and occlusal adjustment of the canine. After the orthodontic treatment, but before the occlusal adjustment, esthetic improvement in the static occlusion was achieved. The posterior temporal muscle on the non-chewing side exhibited earlier bursts in the electromyography. Jaw movement trajectory of the jaw-closing phase at a level close to the maximum intercuspation position was more to the medial side on the frontal view, and the jaw-closing velocity in the lateral direction was slower during left-sided chewing. Following occlusal adjustment of the transposed canine, however, the muscle activity and jaw movement patterns were improved to normal patterns. We suggest that it might be advisable to perform occlusal adjustment at an early stage during the retention period in such cases.

Journal Article↗
PubMed1994

[Effects of occlusal position on masticatory muscle activity].

The effects of different occlusal position on the masticatory muscle function were investigated on 5 subjects. Two types of maxillary stabilization splints were fabricated in order to change the occlusal position. One type of the splints was to increase the occlusal height and the other was to shift the occlusal position laterally. The EMG activities of the masseter (M) and the anterior and posterior temporal muscles (AT, PT) were measured in various occlusal positions at 50% of maximal voluntary activity of the M and AT. The results were as follows: 1. When the occlusal height was increased. 1) The activity of the PT decreased in most subjects. 2) Asymmetry index (AI) of each tested muscle did not always indicate a similar value. 2. When the occlusal position was shifted laterally, 1) The activities of the ipsilateral AT and PT were higher than those of the contralateral side. 2) The AI of the AT and the PT changed gradually when the occlusal height was large while they changed greatly near the intercuspal position (IP) when the occlusal height was smaller. Therefore, the symmetry of the temporal muscle activity was thought to be influenced sensitively by the lateral shift of jaw position near the IP.

Adult↗
PubMed2001

Image evaluation of suprazygomatic masticator space lesions.

In order to understand lesions involving the suprazygomatic masticator space (SZMS) demonstrated on computered tomography (CT) or magnetic resonance (MR) images, we collected 45 cases of lesions in SZMS. There were hematomas in 26 cases, tumors in 16 cases, and abscesses in 3 cases. The location of these lesions in compartments of the SZMS and adjacent structures was analyzed. Most commonly hematoma was found in the deep loose connective tissue (80.8%), followed by the superficial dense connective tissue (61.5%). Only 2 SZMS hematoma involved the superficial fat pad. Five patients had air accumulation in the SZMS, and all were in the deep fat pad and with maxillary sinus fracture. Of the sixteen cases which were tumors, 12 were extended from adjacent structures, and four were primary tumor. In cases of tumor, compartments of SZMS involved most frequently were temporal muscles (15 of 16 cases), followed by deep fat pad (8 of 16 cases). The connective tissue layer of SZMS is a communication pathway for superficial spread of infection, hematoma, or tumor invasion to or from the scalp and face. Compartments of deep fat pad and temporal muscle are also pathways for the spread of disease to or from the face, intracranium and orbit. The primary tumors in infratemporal fossa and SZMS are rare. Malignant tumors in SZMS usually come from surrounding spaces.

Adolescent↗
PubMed2004

Neuromuscular coordination of masticatory muscles in subjects with two types of implant-supported prostheses.

OBJECTIVES: To compare the electromyographic (EMG) characteristics of masticatory muscles in patients with fixed implant-supported prostheses and implant overdentures. MATERIAL AND METHODS: Nineteen subjects aged 45-79 years were examined. Fourteen were edentulous and had been successfully rehabilitated with (a) maxillary and mandibular implant-supported fixed prostheses (seven patients); (b) mandibular implant overdentures and maxillary complete dentures (seven patients). Five control subjects had natural dentition or single/partial (no more than two teeth) tooth or implant fixed dentures. Surface EMG of the masseter and temporal muscles was performed during unilateral gum chewing and during maximum teeth clenching. To reduce biological and instrumental noise, all values were standardized as percentage of a maximum clenching on cotton rolls. RESULTS: During clenching, temporal muscle symmetry was larger in control subjects and fixed implant-supported prosthesis patients than in overdenture patients (analysis of variance, P=0.005). No differences were found in masseter muscle symmetry or in muscular torque. Muscle activities (integrated areas of the EMG potentials over time) were significantly larger in control subjects than in implant-supported prosthesis patients (P=0.014). In both patient groups, a poor neuromuscular coordination during chewing, with altered muscular patterns, and a smaller left-right symmetry than in control subjects were found (P=0.05). No differences in masticatory frequency were found. CONCLUSION: Surface EMG analysis of clenching and chewing showed that fixed implant-supported prostheses and implant overdentures were functionally equivalent. Neuromuscular coordination during chewing was inferior to that found in subjects with natural dentition.

Adaptation, Physiological↗
PubMed2005

One-stage reconstruction of a large defect of the lower lip and oral commissure.

Large lower lip defects including the oral commissure are very difficult to reconstruct and obtain an aesthetic appearance and an acceptable function. We report two patients who had a large defect in the lower lip including oral commissure and were treated using free radial forearm flap and temporal muscle transfer in one-stage. For the cutaneous defects, in one a local flap was elevated from the adjacent cheek and in the other a turned over area of the forearm flap was used. In each case, the reconstructed lower lip could maintain adequate elevation of oral the commissure using the temporal muscle was worked. The first case which used a local flap externally could avoid sialorrhea and had good sensation, and could close the mouth firmly soon after surgery. The appearance was acceptable. In the other case, leakage of oral contact and air occurred at the oral commissure because of the thickness of the forearm flap but improved after minor correction some 8 months after the surgery.

Aged↗
PubMed1994

Muscle palpation with controlled finger pressure: new equipment for the study of tender myofascial tissues.

While manual palpation is the most important method for evaluation of tender myofascial tissues, it lacks reliability. Therefore, we have developed an instrument, called a 'palpometer', which allows the measurement of pressure exerted during palpation. The palpometer consists of a thin pressure-sensitive plastic device attached to the palpating finger, and of a scale recording the pressure applied to the device. Known forces were applied to the pressure sensitive device under various experimental conditions and the corresponding values were read on the palpometer scale. Then 14 observers, blinded to the palpometer scale, palpated the temporal muscle on the same subject twice, with an interval of 1 week. A highly significant correlation was found between palpometer recordings and forces applied to the pressure-sensitive device (P < 0.0001). Exerted force at a given palpometer value varied 3.1% within and 7.2% between 2 observers. During palpation of the temporal muscle pressure intensities within the 14 observers did not differ significantly from week to week (P = 0.68). Between the 14 observers pressure intensities varied considerably with a range of 73.5-196 arbitrary units. Thus, a reliable instrument for measuring pressure intensities during palpation of myofascial tissue has been developed. The large variation in palpation pressures between observers indicates that palpation of tender myofascial tissue may be considerably improved by use of the palpometer. This instrument will be indispensable in research studies employing palpation and in the training of physicians to diagnose myofascial pain disorders.

Adult↗
PubMed2001

Cosmetic and functional reconstruction achieved using a split myofascial bone flap for pterional craniotomy. Technical note.

Cosmetic deformities that appear following pterional craniotomy are usually caused by temporal muscle atrophy, injury to the frontotemporal branch of the facial nerve, or bone pits in the craniotomy line. To resolve these problems during pterional craniotomy, an alternative method was developed in which a split myofascial bone flap and a free bone flap are used. The authors have used this method in the treatment of 40 patients over the last 3 years. Excellent cosmetic and functional results have been obtained. This method can provide wide exposure similar to that achieved using Yaşargil's interfascial pterional craniotomy, without limiting the operative field with a bulky temporal muscle flap.

Bone and Bones↗
PubMedDate not supplied

[Comparison of telethermography and electromyography in instrumental symptomologic evaluation of the anterior temporalis and the masseter].

In 10 young subjects without pain or tenderness over the masseter and anterior temporal muscles left and right, skin surface temperature was measured over the area of these muscles, these subjects then underwent to an electromyographic examination for masseters and temporals. The findings obtained by these two different diagnostic tools were compared. From these comparison it comes out that in a large percentage of our sample they showed the same diagnostic result.

Child↗