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PubMed1999

Muscle bow traction method for dynamic facial reanimation.

A muscle bow traction method was developed for dynamic facial reanimation utilizing the masseter muscle and a fascial sling. The principle of this method is that the sling around the muscle pulls the oral commissure laterally and backward by the restoring force of the muscle from its relaxed position to its contracted position. The surgical procedure is simple. The sling is passed around the anterior half of the muscle so that the muscle can be bowed anteriorly at its center by the sling. One end of the sling is sutured to the center of the orbicularis oris and the dermis in front of the nasolabial fold, and the other end is sutured to the lower lip and oral commissure. This method was applied to 3 patients with facial palsy and to 1 patient with oral cancer. The restored motion of the oral commissure ranged from 5 to 8 mm when clenching the jaws. The concept of this method differs from those of other muscle transposition methods for facial reanimation in that the force acts at a right angle to the muscle contraction. The advantage of this method is that it is less invasive to the muscle and is a simpler procedure than other conventional muscle transposition methods.

Aged↗

PubMed1998

Mandibular nerve involvement in diabetic polyneuropathy and chronic inflammatory demyelinating polyneuropathy.

Sensory complaints in the area of the mandible and mouth often escape notice or remain undiagnosed. Using electromyographic recording of the trigeminal reflexes and motor responses, we sought trigeminal dysfunction in 50 patients with peripheral neuropathy, and tried to gain pathophysiological information on the mechanisms provoking trigeminal damage. Trigeminal reflex recordings (early and late blink reflex after supraorbital stimulation, early and late masseter inhibitory reflex after mental stimulation, and jaw jerk) disclosed abnormalities caused by sensory trigeminal neuropathy in 8 out of 15 patients with chronic inflammatory demyelinating polyneuropathy (CIDP), 13 out of 23 patients with severe diabetic polyneuropathy, and in none of 12 patients with mild diabetic polyneuropathy. Six patients had abnormal motor responses in facial or masseter muscles. The response affected most frequently was the masseter early inhibitory reflex (also called first silent period, SP1) after mental nerve stimulation, its latency being strongly delayed. We found these long delays not only in patients with CIDP, but also in diabetic patients with severe polyneuropathy. We conclude that peripheral polyneuropathies often cause subclinical damage to the trigeminal nerve, especially to its mandibular branch. We believe that the nerve fibers running along the alveolar-mandibular pathway are more exposed to damage because of their cramped anatomical route in the mandibular canal and below the internal pterygoid muscle and fascia.

Adolescent↗

PubMed1991

Sensory neurons and motoneurons of the jaw-closing reflex pathway in rats: a combined morphological and physiological study using the intracellular horseradish peroxidase technique.

Motoneurons and muscle spindle afferents of the rat masseter muscle were physiologically and morphologically characterized. Their soma-dendritic morphology and axonal course were investigated using the intracellular horseradish peroxidase method. Following electrical stimulation of the masseter nerve, individual motoneurons were identified by antidromic all-or-none action potentials and individual sensory neurons by orthodromic action potentials. Using threshold separation an excitatory input from muscle spindles to a masseter motoneuron was demonstrated. The short latency difference of 0.34 ms between the mean orthodromic response in the sensory neurons and the beginning of the synaptic potential in the masseter motoneuron suggests a monosynaptic connection between the spindle afferents and the motoneurons. Following intrasomatic horseradish peroxidase injection large multipolar cell bodies of masseter motoneurons were found within the motor nucleus. Their positions corresponded to the topographic organization of the motor trigeminal nucleus as described in retrograde tracing studies. Dendrites of masseter motoneurons were complex and could be found far beyond the nuclear borders. Distal dendrites extended to the mesencephalic trigeminal nucleus, the supratrigeminal nucleus, the lateral lemniscus and the reticular formation. Within the reticular formation dendrites were seen in the intertrigeminal nucleus and the peritrigeminal zone. Unipolar cell bodies of muscle spindle afferents were found in the mesencephalic trigeminal nucleus after intra-axonal injection of horseradish peroxidase. For all reconstructed sensory neurons a similar axonal course was found. Axonal terminals were found ipsilateral in the motor trigeminal nucleus, indicating a direct connection between sensory neurons and motoneurons. Further collaterals were found ipsilateral in the supratrigeminal nucleus and caudal to the motor trigeminal nucleus in the parvocellular reticular nucleus alpha. Since the latter termination areas are important for bilateral control of jaw-movements, the muscle spindle afferents are likely to participate not only in a monosynaptic motor reflex, but also in more complex neuronal circuits involved in jaw-movements.

Action Potentials↗

PubMed2003

Sex differences in rabbit masseter motoneuron firing behavior.

To evaluate whether sex differences in the proportions of fibers of different phenotypes in the masseter muscle might be the result of differences in the behavior of their motoneurons, we studied the firing patterns of masseter motoneurons in adult male and female rabbits. Activity in individual motoneurons was determined from high spatial resolution EMG recordings made during cortically evoked rhythmic activation of the masticatory muscles. Although some motoneurons could be said to fire according to slow-tonic or fast-phasic patterns, most did not. In both sexes a substantial range of median firing rates and median firing durations was found. In adult males, masseter motoneurons fired more rapidly than those recorded from adult females. No significant sex differences in motoneuron firing duration were found. These results are consistent with the hypothesis that androgen-induced differences in rabbit masseter muscle fiber phenotype are a reflection of differences in motoneuron firing rate. Whether this effect of androgen is directly upon the motoneurons or is the result of a response of muscle fibers to androgen remains to be investigated.

Action Potentials↗

PubMed1982

The effect of a long-acting local anaesthetic agent (Marcaine) on the masticatory muscle in rats.

Marcaine, a long-acting local anaesthetic was administered subcutaneously over the rat's superficial masseter muscle. Rapid muscle fibre destruction with infiltration of mononuclear and polymorphonuclear leukocytes and degeneration of muscle fibers are the notable morphological changes following treatment with Marcaine. However, this degeneration was rapidly replaced by a regeneration process. Sequential injections of Marcaine produced even more serious muscle damage. However, successive injections of the drug did not prevent the regeneration process.

Anesthesia, Dental↗

PubMed1994

Receptive field properties of trigeminothalamic neurons in the rostral trigeminal sensory nuclei of cats.

This study described topographic and receptive field representation in the region of the rostral trigeminal nuclei, and evaluated whether thalamic neurons from the principal sensory nucleus relay muscle afferent information to the thalamus. Extracellular single-unit activity was recorded from anesthetized cats. Units were tested for responses to natural stimuli (i.e., air bursts, brushing, light pressure, and pinch) applied to the face and oral cavity, electrical stimulation of the masseter nerve, and ramp-and-hold movements of the jaw. The receptive fields and physiological properties for 110 units were studied; we were able to verify the recording site for 96 of these units. Most of the units had discrete receptive fields in the oral cavity, skin, hair, and masseter muscle. Only 2 units received convergent inputs. Stimulation of the ipsilateral and contralateral ventroposteromedial nucleus of the thalamus was performed to identify antidromically activated units. The results showed that the dorsal principal sensory nucleus received its input primarily from the oral cavity. Most of the units (85%) that were activated by antidromic stimulation from the ipsilateral thalamus were located in this nucleus. In contrast, 82% of the units that projected to the contralateral thalamus were located in the ventral principal sensory nucleus. A complete somatotopic representation of the ipsilateral face and oral cavity was observed in the ventral principal sensory nucleus. Although 24 units had muscle receptive fields, none were activated by stimulation of the ipsilateral thalamus, and only 1 responded to stimulation of the contralateral thalamus. Most of the units that were not antidromically driven were recorded outside of the cytoarchitectural boundaries of the principal sensory nucleus. Retrograde labeling of the rostral trigeminal nuclei indicated that most of the neurons in the dorsal principal sensory nucleus projected to the ipsilateral thalamus, whereas those in the ventral principal sensory nucleus projected to the contralateral thalamus. Taken together, these observations do not support the presence of a substantial relay for muscle afferent input from the dorsal principal sensory nucleus to the ventrobasal thalamus in cats.

Afferent Pathways↗

PubMed1988

The somatotopy of the masticatory neurons in the rat trigeminal motor nucleus as revealed by HRP study.

Young adult albino rats of Wistar strain were used for the present study. 0.5 to 15 microliters of 20-50% of horseradish peroxidase (HRP) were injected into each individual muscle of mastication to label neurons in the trigeminal motor nucleus (TMON) for light microscopic study. The results reveal that: (1) Many HRP-labeled, multipolar neurons are observed in the motor nucleus in each jaw-closing muscle (JCM) with less in each the jaw-opening muscle (JOM). (2) The motor neurons innervating each masticatory muscle in the motor nucleus show a somatotopic arrangement: (a) those innervating the temporalis muscle are located in the medial and dorsomedial parts; (b) those innervating the masseter muscle are located in the intermediate and lateral; (c) those innervating the medial and lateral pterygoid muscles are located in the lateral, ventrolateral and ventromedial parts, respectively; and (d) those innervating the mylohyoid and the anterior belly of the digastric muscles are located in the most ventromedial part of the caudal one-third of the nucleus. Axons of most masticatory motor neurons run ventrolaterally in between the motor and the chief sensory nuclei of the trigeminal nerve. However, those of the mylohyoid and anterior belly of the digastric muscles ascend dorsally to the dorsal aspect of the caudal nucleus and then turn ventrolaterally to join the motor root of the trigeminal nerve. Furthermore, the dendrites of the motor neuron of JCM converge dorsocaudally to the supratrigeminal region. The diameters of neurons of each JCM display a bimodal distribution. However, an unimodal distribution is present in the motor neurons from each JCM. It is suggested that the motor nucleus innervating the JCM is comprised of comprised of alpha- and gamma-motor neurons. It, thus, may provide a neural basis for the regulation of the muscle tone and biting force.

Animals↗

PubMed1988

A comparison of reflex depressions of activity in jaw-closing muscles evoked by intra- and peri-oral stimuli in man.

The effects on activity in the masseter muscle of applying electrical stimuli to discrete areas within the mouth or on peri-oral skin were studied electromyographically in 8 subjects. In all subjects, the intra-oral stimuli produced two phases of depressed masseteric activity with mean latencies of 14 ms and 47 ms. By contrast, this shorter latency response was generally not obtained with peri-oral stimuli: responses evoked from vermilion-border skin had an intermediate latency (mean 25 ms) and consisted of either one or two periods of depressed activity, while the responses to stimulation of the hairy skin of the lip generally consisted of a single phase of depressed activity, the time course of which was similar to the later phase produced by intra-oral stimuli (mean latency, 48 ms). These findings were consistently obtained with both single and short trains of electrical stimuli and contrast with reports that intra- and peri-oral stimuli produce similar reflexes. The finding that the short-latency reflex depression of masseteric activity could be evoked only by stimulating nerves supplying intra-oral tissues is consistent with the notion that this reflex may play a role in functions such as mastication, and indeed may indicate that the reflex exists specifically for such a purpose.

Adult↗

PubMed1993

Intramuscular hemangioma of the head and neck.

Intramuscular hemangiomas (IMH) are uncommon tumors in the head and neck region, occurring most often in the trunk and extremities. Preoperative misdiagnosis is common because of the deep location of these tumors. Ten recent cases of head and neck IMH are presented, five of which involve the masseter muscle--the most frequent site of involvement in the head and neck. Masseter IMH occurred almost exclusively in the pediatric age group. The clinical presentation, radiographic and histologic findings, treatment, complications, and outcome of these patients are presented. The vital role of preoperative diagnosis using magnetic resonance imaging (MRI) is discussed, as well as a review of the natural history of IMH and indications for surgical intervention.

Adolescent↗

PubMed2000

Plasma and serum serotonin levels and their relationship to orofacial pain and anxiety in fibromyalgia.

AIMS: Serum serotonin levels (S-5-HT) have been reported to be reduced in patients with fibromyalgia and to show a negative correlation with pain. We hypothesized that one mechanism behind this could be that platelets are activated to release 5-HT into the plasma compartment (P-5-HT), which then binds to nociceptors. The aims of this study were therefore to investigate the relation between P-5-HT and S-5-HT and their relationship versus orofacial pain and anxiety in fibromyalgia. METHODS: Twelve patients with fibromyalgia, 12 patients with rheumatoid arthritis, and 12 healthy individuals participated in the study. Pain measures used were pain intensity assessed with a visual analog scale, pain drawings, and influence of pain on daily living activities (ADL). The Spielberger State and Trait Anxiety Inventory (STAI) scale was used for self-rating of anxiety levels. The participants were examined clinically, and the pressure pain threshold (PPT) over the masseter muscle was assessed. Finally, venous blood was collected for analysis of P-5-HT and S-5-HT. RESULTS: The ratio between P-5-HT and S-5-HT was calculated to determine the relative plasma fraction of serotonin (RPS). Patients with fibromyalgia showed significantly lower S-5-HT than did patients with rheumatoid arthritis. They also showed significantly higher STAI scores and tender point index of orofacial muscles and significantly lower PPT than the healthy individuals. High RPS was associated with high ADL and STAI scores. CONCLUSION: This study indicates that a high level of plasma serotonin in relation to serum level is associated with pain discomfort and increased anxiety in fibromyalgia.

Activities of Daily Living↗

PubMed1999

EMG reactivity and oral habits among facial pain patients in a scheduled-waiting competitive task.

For individuals with temporomandibular disorder (TMD) it has been theorized that stressful events trigger oral habits (e.g., teeth grinding), thereby increasing masticatory muscle tension and subsequent pain. Recent research involving adjunctive behaviors found an increase in masseter surface EMG (sEMG) and oral habits when students with TMD symptomatology were placed on a fixed-time reinforcement schedule. The current study used a treatment-seeking community sample with TMD symptomatology in a competitive task designed to be a more naturalistic Fixed Time task. The experiment consisted of Adaptation, Free-Play, Scheduled-Play, and Recovery phases. During the Scheduled-Play phase participants played, and waited to play, an electronic poker game. Results indicated that masseter muscle tension in the Scheduled-Play phase was significantly higher (p < .001) than in any other phase. Moreover, during the Scheduled-Play phase masseter sEMG was higher (p < .001) when participants waited to play. Self-reported oral habits and overall affect were significantly higher (p's < .05) in the Free-Play and Scheduled-Play phases relative to Adaptation and Recovery. The observation that masseter sEMG was elevated during the Scheduled-Play phase relative to all other phases, and within the Scheduled-Play phase sEMG was highest while waiting, suggests that adjunctive oral habits may lead to TMD symptomatology.

Affect↗

PubMed1993

Botulinum A toxin effects on rat jaw muscle spindles.

Botulinum A toxin (Botox) is used for the treatment of many muscular dystonias. However, the relief of the sustained and abnormal postures induced by Botox administration is not fully explained. In this work the possibility was considered that Botox can produce a block not only at the alpha motor endings, but also at the gamma motor endings, consequently reducing the spindle inflow to the alpha motoneurons, which have a great role in maintaining the tonic myotatic reflex. Jaw muscle spindle discharge was recorded before and after Botox injection in the deep masseter muscle. The drug consistently reduced the spindle afferent discharge. Such an effect is suggested to be direct on gamma endings as: i) muscle tension was not modified by Botox during the recording time; ii) saline administration never changed the spindle discharge. The Botox effect on muscle spindles suggests that the relief from dystonias could be due not only to a partial motor paralysis, but also to a decrease of the reflex muscular tone.

Animals↗

PubMed1986

Electromyographic screening of myogenous and arthrogenous TMJ dysfunction patients.

Sixty patients, clinically examined for TMJ dysfunction, were also electromyographically screened. The TMJ dysfunction pain in forty patients was evaluated to be mainly of a myogenous origin and in fourteen patients of a mainly arthrogenous origin. Due to lack of findings in the clinical examination six patients were not to be classified into either of the two groups. They were excluded from the EMG study. For the EMG examination the patients were asked to clench for 30 s in the intercuspal position at 50% of the maximum EMG activity of the masseter muscles. Surface electromyograms of the right and the left masseter and anterior part of the temporalis muscles were monitored. The amplitude of the EMG signal, the duration of the silent period and the changes in the frequency composition of the signal during the 30 s contraction were analysed. Statistically significant differences between the two patient groups were found in EMG amplitude and in silent period duration. However, the difference in silent period duration was due to the dependency of the silent period on the activation level of the muscle. No statistically significant difference in silent period was found when this dependency was corrected for in the data. The EMG parameters related to muscular fatigue phenomena did not show any difference between the two groups. The difference in EMG amplitude and consequently the difference in silent period duration support the clinically made distinction into mainly a myogenous or mainly an arthrogenous origin of TMJ dysfunction pain.

Adult↗

PubMed1996

Differentiation of subgroups of type 2B with Sudan black B staining in rat skeletal muscle.

Using tibialis anterior, gastrocnemius lateralis, and masseter muscles of a male and a female normal Wistar rat, we examined the sensitivity of SBB staining to these muscles. We recognized that type 2A, 2B, and other types (type I, 2C and 2X) were darkly, lightly, and moderately stained by the SBB staining. Type 2B fibers identified by mATPase could be divided clearly into two subgroups by SBB staining. The dark population was type 2Bd that corresponded to type 2X, and the moderate one was 2Bm. Therefore, through the SBB staining it was possible to identify type 2Bd (2X) and 2Bm, as it is with SDH staining.

Animals↗

PubMed1995

[Muscle relaxation by transcutaneous electric nerve stimulation (TENS) in bruxism. An electromyographic study].

In recent years transcutaneous electrical neuromuscular stimulation (TENS) has become increasingly more common in the treatment of functional diseases of the masticatory muscles and currently the practitioner can choose among a variety of stimulators. In an electromyographic study of 17 adults suffering from nocturnal bruxism and of a control group consisting of 18 adults without any functional disturbances of the masticatory muscles, the effect of this kind of neuromuscular stimulation on the temporal and masseter muscle was examined. The myoelectric signals were registered before and after TENS treatment in 3 different positions of the mandible. Each person was treated 3 times with both the Myo-Monitor (Myo-Tronics, Seattle) and the TNS SM2 MF stimulator (schwa-medico, Giessen). The different effects of continuous low frequency and intermittent high frequency muscular stimulation were studied simultaneously. Muscular activity was determined by computer aided integration of the electromyographically measured raw signals. A fourier analysis of the power spectrum yielded information on the frequency behavior of the studied muscles resulting from the TENS treatment. A statistical analysis of the results led to the following significant conclusions: 1. TENS treatment decreased the values of the registered integrated signals on all test persons, however, the treatment increased the median frequency and the mean power frequency (MPF). Since this effect is contrary to muscle fatigue, these electromyographic results can be interpreted as providing objective proof of a relaxation in the treated muscles. 2. The electromyographic changes after TENS treatment were similar when using either the Myo-Monitor or the TNS SM2 MF stimulator. In addition, the 2 different types of stimulation (high or low frequency) showed the same effects. 3. Compared to the persons in the control group, there was no significant increased muscular activity in patients with nocturnal bruxism. Following TENS treatment both groups showed the same alterations in the electromyograms. The results of the study provide further evidence that TENS treatment is an adequate supportive procedure in the treatment of nocturnal bruxism.

Adult↗

PubMed1983

Histologic changes in rat masticatory muscles subsequent to experimental increase of the occlusal vertical dimension.

Histologic changes in various masticatory muscles were studied in Wistar rats from 12 hours to 84 days after an experimental increase of the occlusal vertical dimension. The increases applied (1 to 2 mm) were based on the amount of interocclusal space (1 mm) in the rat. A sequence of tissue reaction from early acute inflammatory destruction of myofibers to healing with myofiber regeneration was most pronounced in the deep masseter muscle of the 2 mm group (12 hours to 21 days). A similar sequence was also observed to a lesser degree in the superficial masseter and anterior temporal muscles, while no changes were detectable in the posterior temporal, medial pterygoid, and anterior digastric muscles of this group. Variable severity of tissue response in different masticatory muscles might be attributable to the amount of stretching of myofibers as a result of an increased occlusal vertical dimension. On the other hand, degenerative atrophy of myofibers in the lateral pterygoid muscle occurred within 2 days with no sign of inflammation, and these condensed myofibers persisted as late as 84 days. Based on these findings, it was suggested that displacement of the mandibular condyle would exert an important influence on the prognosis after an increase in the occlusal vertical dimension. Only a transient acute inflammation occurred in the deep and superficial masseter muscles in the 1 mm group. Except for a small number of condensed myofibers in the lateral pterygoid muscle, degenerative changes of myofibers were not revealed. Therefore, increasing the occlusal vertical dimension within the extent of the interocclusal space might be regarded as appropriate for prosthodontic practices.

Animals↗

PubMed1990

Masseteric muscle spasm as a normal response to suxamethonium.

The myotonic response of the masseter muscles following various doses of suxamethonium was measured using a unique myotonometer in 50 apparently healthy patients, the majority of whom showed a myotonic response which lasted less than 100 s. A maximum increase in masseter tone was found to be greater than 1 kg in five patients, and 12 patients developed a maximum tone of greater than 500 g. An increased masseter tone of this degree might be interpreted as "masseteric muscle spasm" by the anaesthetist. The value of masseteric muscle "spasm" as an early sign of malignant hyperthermia is questioned.

Adult↗

PubMed1997

Phasic and tonic stretch reflexes in muscles with few muscle spindles: human jaw-opener muscles.

We investigated phasic and tonic stretch reflexes in human jaw-opener muscles, which have few, if any, muscle spindles. Jaw-unloading reflexes were recorded for both opener and closer muscles. Surface electromyographic (EMG) activity was obtained from left and right digastric and superficial masseter muscles, and jaw orientation and torques were recorded. Unloading of jaw-opener muscles elicited a short-latency decrease in EMG activity (averaging 20 ms) followed by a short-duration silent period in these muscles and sometimes a short burst of activity in their antagonists. Similar behavior in response to unloading was observed for spindle-rich jaw-closer muscles, although the latency of the silent period was statistically shorter than that observed for jaw-opener muscles (averaging 13 ms). Control studies suggest that the jaw-opener reflex was not due to inputs from either cutaneous or periodontal mechanoreceptors. In the unloading response of the jaw openers, the tonic level of EMG activity observed after transition to the new jaw orientation was monotonically related to the residual torque and orientation. This is consistent with the idea that the tonic stretch reflex might mediate the change in muscle activation. In addition, the values of the static net joint torque and jaw orientation after the dynamic phase of unloading were related by a monotonic function resembling the invariant characteristic recorded in human limb joints. The torque-angle characteristics associated with different initial jaw orientations were similar in shape but spatially shifted, consistent with the idea that voluntary changes in jaw orientation might be associated with a change in a single parameter, which might be identified as the threshold of the tonic stretch reflex. It is suggested that functionally significant phasic and tonic stretch reflexes might not be mediated exclusively by muscle spindle afferents. Thus, the hypothesis that central modifications in the threshold of the tonic stretch reflex underlie the control of movement may be applied to the jaw system.

Electromyography↗