Experience with pedicled temporal muscle flaps in radical mastoid and tympanoplasty operations.
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Focal myositis is a rare inflammatory disease of the skeletal muscle that may involve any part of the body. We present a 19-year-old man with a short history of a painful pseudotumor in the right temporal region. MRI pictures showed a swollen right temporal muscle and muscle biopsy revealed the characteristic histological and immunocytochemical findings of polymyositis.
In 15 children and 15 adults the influence of muscle length on the EMG-recordings of the anterior temporal and superficial masseter muscles was investigated. Myoelectric activity was measured by surface electromyography during maximal clenching in habitual occlusion. The quantitative EMG analysis was performed by means of a computer program which allowed calculation of a) the integrated value and b) the mean frequency of the power spectrum (MPF) from the raw signal after Fourier transformation. Muscle length was determined with the aid of lateral cephalometric films. Using a correlation analysis this investigation revealed the following results: Under standardized functional conditions short muscles work with a higher activity and a higher MPF than long muscles. In children as well as in adults muscle activity and MPF show close negative correlations with the parameter "muscle length". These relations are directly proportional.
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Little is known about physiology and morphology of motoneurons and spindle afferents innervating the temporalis and on synaptic connections made between the two. The present study was aimed at investigating the above issues at the light microscopic level by using the intracellular recording and horseradish peroxidase or biotinamide labeling techniques and by the use of succinylcholine (SCh) for the classification of spindle afferents in the cat. Temporalis motoneurons had dendritic trees that ranged from a spherical form to an egg-shaped form. The shape deformation was more prominent for the dendritic trees made by motoneurons located closer to the nuclear border. No axon collaterals of the motoneurons were detected. On the basis of the values for the dynamic index after SCh infusion, temporalis spindle afferents were classified into two populations: presumptive groups Ia and II. The spindle afferents terminated mainly in the supratrigeminal nucleus (Vsup), region h, and the dorsolateral subdivision (Vmo.dl) of the trigeminal motor nucleus (Vmo). The proportion of group Ia afferent terminals was lower in the Vsup than that of group II afferents. In the Vmo.dl, the proportion of group Ia afferent terminals was nearly even throughout the nucleus, but that of group II afferent terminals increased in the more outlying regions. The proportion of terminal distribution in the central region of Vmo.dl was higher for group Ia than group II. The frequency of contacts (presumptive synapses) made by a single spindle afferent on a motoneuron was higher for group Ia than group II. The present study provided evidence that the central organization of spindle afferent neurons is different between groups Ia and II.
In modification of a method published by Schoenen et al., early (ES 1) and late (ES 2) exteroceptive suppression periods elicited by perioral electrical trigeminus-stimulation during teeth-clenching were recorded with surface electrodes over the temporalis muscles. 29 patients with chronic tension headache, 20 with migraine, 7 patients with combined tension headache and migraine and 19 controls were examined. Duration of the late suppression period for the mean of three single shocks was highly significantly reduced in chronic tension headache sufferers and patients with combined tension headache and migraine when compared with migraine cases or controls. These results are in agreement with those of Schoenen et al. EMG analysis of temporalis late exteroceptive suppression is a helpful diagnostic method in primary headache. The reduction of ES 2 in chronic tension headache sufferers might suggest a deficient activation or excessive inhibition of the motoric trigeminus nucleus by pontobulbar inhibitory neurons which receive a strong input from limbic and nociceptive structures.
The muscle and superficial fascia of the temporal area differ in their physical characteristics, vascular supply and clinical applications. Both can be employed independently or simultaneously as regional flaps in the reconstruction of a variety of complex craniofacial defects. The present paper reviews the anatomy, surgical technique and utilisation of temporal flaps.
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