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Is lower limb muscle synchrony during landing affected by gender? Implications for variations in ACL injury rates.

This study examined whether lower limb muscle synchrony during abrupt landings was affected by gender, thereby predisposing females to a higher incidence of non-contact anterior cruciate ligament (ACL) injuries than males. Seven males and 11 females landed in single-limb stance on a force platform after receiving a chest-height netball pass and decelerating abruptly. Ground reaction force and electromyographic data for rectus femoris, vastus lateralis, vastus medialis, semimembranosus (SM), biceps femoris, and gastrocnemius were sampled (1000 Hz) during landing. Subjects' sagittal plane motion was also filmed (200 Hz). Knee joint reaction forces and sagittal planar net moments of force were estimated using Newtonian equations of motion and inverse dynamics. Tibiofemoral shear forces (F(s)) were obtained and muscle bursts temporally analysed with respect to initial foot-ground contact (IC) and peak F(s) times. Males displayed significantly delayed SM onset relative to IC (113+/-46 ms) compared to females (173+/-54 ms; p=0.03), and significantly delayed SM peak activity relative to peak F(s) (54+/-27 ms) compared to females (77+/-15 ms; p=0.03). Delayed SM activity during landing was suggested to allow peak muscle activity to better coincide with high anterior F(s), thereby acting as an ACL synergist via increased joint compression and posterior tibial drawer. It was concluded that females displayed muscle synchrony less protective of the ACL than males, possibly increasing their susceptibility to non-contact ACL injuries.

Adult↗

Exteroceptive suppression of temporalis muscle activity: findings in headache.

Exteroceptive suppression of temporalis muscle activity was proposed by Schoenen and co-workers in 1987 as a tool in headache diagnosis and research. Their finding of a decreased or abolished second silent period (ES2) in chronic tension-type headache sufferers has been confirmed by several independent laboratories during the last five years. Temporalis silent periods have also been studied in various other types of headaches. Their modulation by neuropsychological factors and pharmacological agents has also been investigated as well as their retest reliability. The pathophysiological concept of muscle contraction in tension-type headache has been challenged by studies using temporalis silent periods. The exteroceptive suppression of temporalis muscle activity points unequivocally towards a central pathogenetic mechanism, although it remains unclear whether the abnormalities of temporalis ES2 represent the primary dysfunction or a secondary phenomenon in chronic tension-type headache.

Electric Stimulation↗

Pseudomeningocele as a complication of teratoma resection and aseptic meningitis following craniofacial reconstruction: a case report.

This is a report of two extremely unusual complications of craniofacial surgery on a single patient. A 14-year-old female underwent resection of a recurrent teratoma four times within the first 9 years of life. This left her with two large cranial cavities in the left temple and posterior to the orbit communicating with the subarachnoid space constituting a pseudomeningocele and pulsatile mass in the left temple--an unusual complication. Following resection of the pseudoepithelial cavity linings, the spaces were filled with a split temporalis muscle. Two weeks following surgery, she developed signs and symptoms of meningitis with negative cultures from the drain sites and lumbar puncture. Six days following an unsuccessful attempt to treat her with wide spectrum antibiotics, she was treated with dexamethasone. As a result, there was a dramatic disappearance of signs and symptoms in less than 36 hours; she has not experienced any recurrence since. We feel that this aseptic meningitis was the result of cerebrospinal fluid exposure to muscle--a rare, yet, previously reported complication. The details of the case history and discussion of complications and the way in which they can be avoided, are subjects of this report.

Adolescent↗

Modified temporalis anchorage in craniomandibular reankylosis.

This study evaluates the long-term outcomes and clinical results of costochondral graft and temporalis muscle flap interpositioning with submandibular anchorage in the management of TMJ re-ankylosis. Thirty-one patients, 9 children and 22 adults, with recurrence of ankylosis after gap arthroplasty, with a mouth opening less than 5 mm were evaluated. The management protocol consisted of resection of the ankylotic mass through an Al-Kayat and Bramley incision; contralateral coronoidectomy in unilateral cases; replacement of the condyle in children by means of a costochondral graft through Risdon's approach and interpositional temporalis muscle flap and submandibular anchorage of the temporalis flap in children and adults. Regular clinical and radiological follow up was done for 6 years during which the average mouth opening of 38 mm was maintained, with good occlusion and proper function. The temporalis muscle flap was seen to be an ideal interpositional material due to its close proximity to the site, good vascular supply, ease of access to the condyle area and minimal risk of nerve damage. Submandibular anchorage of the broad temporalis muscle flap prevents reankylosis by inhibiting flap contraction, and decreases need for rigorous physiotherapy.

Adolescent↗

V-tunnel drill system in craniofacial surgery: a new technique for anchoring the detached temporalis muscle.

A new method for internal fixation of the temporalis muscle in craniofacial surgery has been developed using the V-tunnel drill system, which eliminates the necessity for pins and screws to resuspend the detached temporalis muscle. This system consists of a conventional drill and a specially designed V-tunnel guide. The guide is used to drill multiple series of double-stitching holes, which connect to form a V-shaped tunnel in the external table. The PDS suture is pulled through the V-tunnel, thereby securely anchoring the temporalis muscle to the bone by consecutive stitches. The sutures can be easily positioned after drilling the tunnel and stitched through the V without endangering the cerebrum. This versatile V-tunnel drill procedure is very easy and simple and has many foreseeable applications.

Humans↗

Skeletal muscle ECF pH error signal for exercise ventilatory control.

An autonomic reflex linking exercising skeletal muscle metabolism to central ventilatory control is thought to be mediated by neural afferents having free endings that terminate in the interstitial fluid of muscle. To determine whether changes in muscle extracellular fluid pH (pHe) can provide an error signal for exercise ventilatory control, pHe was measured during electrically induced contraction by 31P-magnetic resonance spectroscopy and the chemical shift of a phosphorylated, pH-sensitive marker that distributes to the extracellular fluid (phenylphosphonic acid). Seven lightly anesthetized rats underwent unilateral continuous 5-Hz sciatic nerve stimulation in an 8.45-T nuclear magnetic resonance magnet, which resulted in a mixed lactic acidosis and respiratory alkalosis, with no net change in arterial pH. Skeletal muscle intracellular pH fell from 7.30 +/- 0.03 units at rest to 6.72 +/- 0.05 units at 2.4 min of stimulation and then rose to 7.05 +/- 0.01 units (P < 0.05), despite ongoing stimulation and muscle contraction. Despite arterial hypocapnia, pHe showed an immediate drop from its resting baseline of 7.40 +/- 0.01 to 7.16 +/- 0.04 units (P < 0.05) and remained acidic throughout the stimulation protocol. During the on- and off-transients for 5-Hz stimulation, changes in the pH gradient between intracellular and extracellular compartments suggested time-dependent recruitment of sarcolemmal ion-transport mechanisms. pHe of exercising skeletal muscle meets temporal and qualitative criteria necessary for a ventilatory metaboreflex mediator in a setting where arterial pH does not.

Acid-Base Equilibrium↗

Arteriovenous malformation in the temporalis muscle.

An 18-year-old man presented with an arteriovenous malformation (AVM) in the temporalis muscle. It was shown by magnetic resonance imaging (MRI) and confirmed by intra-arterial angiography. The lesion was completely resected and the defect reconstructed with titanium mesh and cancellous bone.

Adolescent↗

Long-term viability of the temporalis muscle/fascia flap used for temporomandibular joint reconstruction.

Temporalis muscle/fascia axial flaps (TFs) were used in 115 temporomandibular joints (TMJs) in 81 patients to correct ankylosis (n = 25 joints), traumatic defects (n = 8), congenital anomalies (n = 4), defects resulting from tumor resection (n = 2), degenerative joint disease (n = 52), autoimmune arthritides (n = 21), and lateral capsule flaccidity (n = 3). The follow-up period ranged from 6 months to 5.5 years. Seven patients (8.6% of the group; 10 TMJs) were reevaluated for recurrent symptoms (pain and decreased motion), with a mean of 1.7 years (range = 1 to 3 years) postoperatively. Four of these patients (seven TMJs) had magnetic resonance imaging (MRI) as part of their diagnostic workup and four patients (five TMJs) required a second operative procedure. This study reports the results of the MRI, intraoperative, and histologic evaluations of the TFs in these seven patients. The MRIs showed vascularized tissue between the condyle and roof of the glenoid fossa in all seven joints examined. The signal was consistent with muscle and/or fat as opposed to scar tissue. All flaps examined at the time of surgery (arthroscopy, n = 1; arthrotomy, n = 4) were in place and had the gross appearance of normal muscle. Histologic examination of biopsies of four flaps indicated the presence of viable muscle with normal-appearing nuclei. The results of this study indicate that the TF does survive when it is carefully dissected and inferiorly based to preserve blood supply.

Fascia↗

Extended vascularized temporalis muscle-fascia flap.

The use of an extended vascularized temporalis muscle flap is described. The deep layer of the temporalis fascia is partially everted over the temporalis muscle preserving its vascularity. A composite flap comprising temporalis muscle and its fascia attached along its superior border, is rotated for reconstruction of postoperative defects in the middle cranial fossa floor and mastoidectomy cavities. The versatility of this flap is discussed.

Cholesteatoma↗

Electromyographic activity of the human lateral pterygoid muscle during contralateral and protrusive jaw movements.

Understanding of the normal function of the lateral pterygoid muscle is limited. The principal aim here was to determine whether there is a progressive increase in lateral pterygoid activity as the mandibular condyle moves downwards and forwards as would be expected if the muscle is concerned with the precise horizontal positioning of the mandible. In eight humans, recordings were made of the activity of the superior (SHLP) and inferior (IHLP) heads of the lateral pterygoid and the masseter, anterior temporal, posterior temporal and digastric muscles, together with the movement of the palpated lateral condylar pole (JAWS-3D tracking system) during trials of a contralateral and a protrusive jaw movement. Recording sites in SHLP and, in one participant, IHLP were verified by computed tomography. In each participant there was a progressive increase in the rectified and smoothed SHLP and IHLP activity in association with condylar movement during the contralateral and protrusive jaw movement. Further, irregularities in condylar movement, which reflected variations in the rate at which the jaw was moved, were correlated in time with prominent bursts of SHLP and IHLP activity. In all participants there was a consistently high correlation coefficient between the rectified and smoothed SHLP and IHLP activity and condylar displacement during the contralateral or protrusive jaw movements. For example, the mean (+/-SD) correlation between anterior condylar translation during contralateral excursion and SHLP activity was 0.91+/-0.09, and for IHLP 0.96+/-0.02. For the masseter, anterior temporal, posterior temporal and digastric muscles, mean r-values were, respectively, 0.10+/-0.77; -0.14+/-0.72; 0.24+/-0.78; 0.54+/-0.47. When treated as a group the correlation coefficients for SHLP and IHLP were statistically significantly different from the correlation coefficients for the other muscles treated as a group (ANOVA; p < 0.002 for correlation with anterior translation). These observations support the notion that the lateral pterygoid provides the principal driving force for moving the jaw forwards or laterally in protrusive or lateral excursive condylar movements. Further, the data suggest that the muscle plays a part in the fine control of jaw movements.

Adult↗

Temporalis muscle as a disc replacement in the temporomandibular joint of sheep.

Temporalis muscle flaps were evaluated in sheep. Flaps placed following discectomy were examined at 2, 4, 12, and 24 weeks. Histologic evaluation showed avascular necrosis and subsequent displacement and loss of tissue from the joint resulting in close contact between the condyle and fossa. Muscle flaps placed lateral to the joint in operative controls were examined at 4, 12, and 24 weeks. This muscle remained viable while undergoing fibrous replacement. Although the surface layers of the condyle and fossa were initially lost, the tissues were reformed with time. This experiment showed that in the sheep, temporalis muscle does not withstand functional loading within the joint. However, despite the lack of interpositional material, the condyle and fossa can remodel.

Animals↗

The use of the temporalis muscle flap in facial and craniofacial reconstructive surgery. A review of 182 cases.

The authors report on their 16-year experience of reconstruction with the temporalis myofascial flap in 182 cases. All aspects of reconstructive cranio-maxillofacial surgery are covered: trauma, deformities, tumours, TMJ ankylosis, facial paralysis. The temporalis myofascial flap was used both as a single and as a composite flap with cranial bone, coronoid process or skin island. Major complications were not observed. On the basis of their experience, the authors confirm the reliability, versatility and reproducibility of the use of this flap. This is due both to its rich blood supply and to its proximity to the reconstruction site. It is suggested that the use of the temporalis muscle flap should be taken into consideration before deciding on more extensive reconstructive procedures.

Adolescent↗

Reconstruction of a lower eyelid defect using the temporalis muscle.

Massive defects of the cheek and simultaneous involvement of both eyelids preclude the use of local flaps and standard techniques for total lower eyelid replacement. Regional flaps may not provide enough coverage nor bulk, or they may require multiple delay procedures. Sagittal splitting of the temporalis muscle and anterior rotation of its lateral head deserves consideration for reconstruction of uncommon, large periorbital defects. A case is presented in which globe salvage was possible using this technique as a single stage procedure.

Adenocarcinoma, Mucinous↗

Giant mucocele of the frontal sinus.

Giant mucocele of the frontal sinus is a rare pathology of benign entity caused by retention of mucous secretions in the sinus. It may expand and erode the surrounding structures such as bones and cerebral parenchyma. The authors describe a patient with frontal giant mucocele involving the orbit, the ethmoid, and intracranial portion of the dura. The main presenting symptoms were diplopia and proptosis. A computed tomography scan and magnetic resonance imaging were performed to permit differential diagnosis from other pathologies such as ossifying fibroma, fibrous dysplasia, and other neoplasms. A single stage maxillofacial and neurosurgical approach to treatment was taken consisting in the removal of the mucocele and reconstruction of the eroded bones with cranial bone grafts. The dura was repaired with temporalis muscle fascia sealed with fibrin glue. Two years after surgery, the patient shows no recurrence and satisfactory morphologic and functional results.

Aged↗

[Electromyography. Aid in diagnosis, therapy and therapy evaluation in temporomandibular dysfunction].

Electromyography (EMG) has been applied in studies on patients with temporomandibular dysfunction (TMD), usually with surface electrodes, focusing on rest position of the mandible, hyperactivity and hypo-activity of the muscles, muscle balance, muscle symmetry, reflex activity and parafunctional activity. The contribution of the use of EMG to the diagnostics of individual patients is considered to be marginal, at the most. However, EMG can be valuable in research on TMD if methodological pitfalls are avoided.

Electrodes↗

Simultaneous modulation of the exteroceptive suppression periods in the trapezius and temporalis muscles by experimental muscle pain.

OBJECTIVE: To investigate whether the exteroceptive suppression (ES) periods in the trapezius and temporalis muscles could be simultaneously modulated by either experimental trapezius muscle pain or temporalis muscle pain. METHODS: Fourteen healthy volunteers participated in two sessions with randomised injections of either hypertonic or isotonic saline into the right trapezius muscle or right temporalis muscle. The pain intensity was continuously scored on a 10 cm electronic visual analogue scale. During muscle contraction, the early (ES1) and late (ES2) reflex in the temporalis and late (ES2) reflex in the trapezius elicited by electrical stimulation of the right infraorbital nerve were recorded pre-, during-, and post-injection. RESULTS: Hypertonic saline injection induced local muscle pain and referred pain with the maximal pain intensity of 6.3+/-0.5 cm in the right trapezius and 6.7+/-0.6 cm in the right temporalis muscles. Injection of either hypertonic or isotonic saline into the right trapezius muscle was associated with significantly shortened ES2 duration and offset time in the injected right trapezius muscle. Only injection of hypertonic saline into the right trapezius muscle could significantly reduce the ES2 offset time and decrease the degree of suppression of ES2 in the right temporalis and left trapezius muscles. Injection of either hypertonic or isotonic saline into the right trapezius muscle evoked no changes in ES2 parameters in the left temporalis muscle. Injection of hypertonic saline, but not isotonic saline, into the right temporalis muscle caused a significantly shorter ES2 offset time and shorter ES2 duration bilaterally in the temporalis and trapezius muscles. CONCLUSIONS: The findings of the present study provide evidence for a bi-directional effects reflecting convergence of muscle afferents from the trigeminal and upper cervical neural systems in humans, which may partly underlie the manifestations of pain referral between these two areas.

Adult↗

[The temporo-mandibular articulation].

The standing posture of humans has created both morphological and functional adaptations in the temporo-mandibular joint and the masticatory function. This biped state is the one of the most important characteristic of human evolution. It is furthermore the agent determining most of the functional changes in the whole body. This survey will be carried out in several levels including, a descriptive anatomy, biomechanics, radiological imaging, functioning in the articulation of TMJ. The descriptive anatomic picture will be obtained by the traditional dissection techniques. 20 TMJ joints are dissected from 10 cadavers: 7 cadavers, 65-75 year old, 3 cadavers, 60-65 year old. The x-rays are lateral view and the subjects of the radiological imaging are young's, adults and olds: 1, 3 y-old Male; 1, 7 y-old Female; 1, 14 y-old Female; 10, 19-23 y-old Male; 1, 26 y-old Female; 1, 34 y-old Male; 1, 75 y-old Female. The anatomic elements in the TMJ well resembled the ones described in the literature of the capsule, the ligament, the masticator muscles (masseter, temporal, medial and lateral pterygoids). The temporo-mandibular ligament proved to be difficult to separate from the capsule in some of the specimens. Sometimes it was not always found after a dissection.

Adolescent↗