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Bone growth and periosteal migration control masseter muscle orientation in pigs (Sus scrofa).

During growth the muscles of mastication alter their lines of action. Research on long bones indicates that the apparent migration of muscle attachments is due to the movement of the periosteum relative to the underlying bone. To assess whether the pig masseter muscle follows the periosteum during growth, implants of titanium granules in a gelatin matrix were placed simultaneously in various parts of the masseter muscle and its periosteal and bony attachments. Growth movements of these tissues were followed radiographically for 2 months. Granule position was verified histologically. Periosteal movement was the dominant growth process at the insertion of the masseter. All implants migrated caudally relative to the mandible. However, a strong position effect was seen dorsoventrally: implants placed high in the ascending ramus migrated dorsally as well as caudally; low implants migrated only caudally. This differential migration, ascribed to the influence of the condyle, accounts for the increasing horizontal orientation of dorsal fibers. A similar differential was seen along the rostrocaudal axis of the ramus. In contrast to the insertion, the origin of the masseter from the zygomatic arch shows no periosteal movement. Rather, the entire bone-muscle complex becomes displaced by sutural growth, leading to increasing vertical orientation of the masseter. Thus two different aspects of skull growth are responsible for the change in muscle anatomy.

Animals↗

Cortical network for representing the teeth and tongue in primates.

Sensory information from the tongue and teeth is used to evaluate and distinguish food and nonfood items in the mouth, reject some and masticate and swallow others. While it is known that primates have a complex array of 10 or more somatosensory areas that contribute to the analysis of sensory information from the hand, less is known about what cortical areas are involved in processing information from receptors of the tongue and teeth. The tongue contains taste receptors, as well as mechanoreceptors. Afferents from taste receptors and mechanoreceptors of the tongue access different ascending systems in the brainstem. However, it is uncertain how these two sources of information are processed in cortex. Here the parts of somatosensory areas 3b, 3a, and presumptive 1 that represent the mechanoreceptors of the teeth and tongue are identified, and evidence is presented that the representations of the tongue also get information from the taste nucleus of the thalamus, VPMpc. As areas 3b, 3a, and 1 project to other areas of somatosensory cortex, and those areas to additional areas, some or all of the currently defined somatosensory areas of cortex may be involved in processing gustatory, as well as tactile, information from the tongue and thus have a role in the biologically important function of evaluating food in the mouth.

Animals↗

Symptomatic macroglossia and tongue myositis in polymyositis: treatment with corticosteroids and intravenous immunoglobulin.

Symptomatic macroglossia occurs in some rare congenital muscle diseases, such as Becker's and Duchenne's dystrophies or Pompe's disease. Herein we describe a case of symptomatic macroglossia with myositis of the tongue occurring in a patient with polymyositis. Tongue myositis was evidenced by dysarthria, frequent biting during mastication, swallowing difficulties without aspiration, and noisy breathing. Magnetic resonance imaging showed homogeneous hypertrophy of the tongue, especially the mouth's floor muscles. The diagnosis of tongue myositis was established by electromyography and biopsy. No other cause for the macroglossia was found. Symptoms resolved quickly with corticosteroid and intravenous immunoglobulin treatment. To our knowledge, this is the first reported case of symptomatic tongue myositis occurring in the course of polymyositis.

Humans↗

Gastrointestinal bezoars.

Of 99 patients with 117 gastrointestinal bezoars, 69 had undergone previous surgery, the most common operation being bilateral truncal vagotomy with pyloroplasty (55 patients). An excessive intake of vegetable fibre was found in 38 patients and poor mastication in 27. Thirty bezoars presented with gastric symptoms and patients had endoscopy as the diagnostic technique; 87 caused symptoms of intestinal obstruction with the diagnosis made by plain abdominal radiography. Medical treatment by enzymic or endoscopic fragmentation was used for 17 of 30 gastric bezoars; surgery was required in the remainder. Intestinal bezoars causing obstruction can be fragmented and 'milked' to the caecum. The stomach should be explored for associated gastric bezoars.

Adolescent↗

Unconjugated methoxylated catecholamine metabolites in human saliva. Quantitation methodology and comparison with plasma levels.

A newly developed method for the simultaneous extraction and quantitation of the unconjugated levels of the catecholamine metabolites vanilmandelic acid (VMA), 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) and homovanillic acid (HVA) in plasma by high performance liquid chromatography with electrochemical detection was modified and applied to studies of human saliva. The assay had a mean coefficient of variation under 3% for each of the metabolites. Levels of plasma VMA, MHPG and HVA were measured in 28 normal subjects and compared to their saliva levels, obtained before and after stimulation by mastication. Significant correlations were found between plasma and saliva MHPG and HVA, but there was no correlation between plasma and saliva VMA. Salivary MHPG and HVA can be reproducibly assayed and may be useful tools for indications of changes in central and peripheral catecholamine metabolism.

Catecholamines↗

Severe aortic regurgitation: a rare presentation of giant cell arteritis.

A 53-year-old patient with no past history of rheumatic fever or lues presented with severe aortic regurgitation, underwent hemodynamic evaluation, and subsequently, an uneventful aortic valve replacement. The initial pathological interpretation was nonspecific aortitis. Six months following surgery arthralgia, muscular pain, difficulty in mastication, and fatigue occurred. There was no fever, however, sedimentation rate was 100/130. Cardiac examination was normal. Review of the pathological specimens revealed granulomatous arteritis with giant cells, typical of giant cell arteritis. Though the association of aortic regurgitation and giant cell arteritis is well recognized, only two such cases of severe aortic regurgitation requiring valve replacements have yet been described, of them, one probably had Takayasu's arteritis. An accurate diagnosis is of importance since steroid treatment is effective, and if introduced early, the inflammatory process may be arrested.

Aorta↗

Expression of the melanin-concentrating hormone (MCH) receptor mRNA in the rat brain.

The melanin-concentrating hormone (MCH) system is thought to be an important regulator of food intake. Recently the orphan G protein-coupled receptor SLC-1 was identified as the MCH receptor (MCHR). Preliminary analyses of MCHR mRNA distribution have supported a role for the MCH system in nutritional homeostasis. We report here a complete anatomical distribution of the MCHR mRNA. We have found high levels of expression of MCHR mRNA in most anatomical areas implicated in control of olfaction, with the exception of the main olfactory bulb. Dense labeling was also detected in the hippocampal formation, subiculum, and basolateral amygdala, all of which are important in learning and memory, and in the shell of the nucleus accumbens, a substrate for motivated behavior and feeding. Within the hypothalamus, MCHR mRNA was moderately expressed in the ventromedial nucleus, arcuate nucleus, and zona incerta, all of which serve key roles in the neuronal circuitry of feeding. In the brainstem, strong expression was observed in the locus coeruleus, which is implicated in arousal, as well as in nuclei that contribute to orofacial function and mastication, including the facial, hypoglossal, motor trigeminal, and dorsal motor vagus nuclei. In most regions there was a good correspondence between MCHR mRNA distribution and that of MCH-immunoreactive fibers. Taken together, these data suggest that MCH may act at various levels of the brain to integrate various aspects of feeding behavior. However, the extensive MCHR distribution throughout the brain suggests that this receptor may play a role in other functions, most notably reinforcement, arousal, sensorimotor integration, and autonomic control.

Amygdala↗

Subnuclear organization of the ophidian trigeminal motor nucleus. I. Localization of neurons and synaptic bouton distribution.

Among the Reptilia the morphology of the trigeminal (V) motor nucleus is a rather good indicator of the sophistication of jaw kinetics. As it becomes more complex, the nucleus shifts ventrolaterally and becomes divisible into subnuclear groups. The cottonmouth moccasin, a pit viper with very finely developed jaw musculature and kinetics, has a very large V motor nucleus. It is divisible into three subnuclei: the ventral and intermediate, containing predominantly large neurons (40--60 micrometers), and the dorsal subnucleus, containing only small neurons (20 micrometers). Ultrastructural study has indicated that these subnuclei can also be characterized according to the types of boutons synapsing on the cells. The soma of neurons in the ventral and intermediate subnuclei have up to 50% of their profile covered with clusters of boutons. The neurons of the dorsal subnucleus usually have only one cluster of two to three boutons per profile. Both cell types have more boutons containing spherical vesicles in axo-dendritic synapses than those containing flattened vesicles, and approximately equal numbers of these boutons in axosomatic contacts. However, the small cells have proportionately more boutons containing spherical vesicles synapsing on them. Boutons similar to those described in mammalian spinal cord were identified in the snake V motor nucleus. Small terminals containing spherical (S) or flattened (F) vesicles and terminals associated with postsynaptic cisternae (C) or with dense bodies (T) are commonly found in the ventral and intermediate subnuclei. C- and T-boutons are rare in the dorsal subnucleus. Large terminals with multiple active sites and postsynaptic dense bodies (M) and their associated, small, preterminal boutons (P) were not observed in the snake V motor nucleus. Boutons containing only large granular vesicles (G) were also not observed. We suggest that the ventral and intermediate subnuclei consists of alpha- and possibly beta-motoneurons and the dorsal subnucleus contains gamma-motoneurons. This anatomical segregation of function may be important to the physiology of ophidian mastication, which is quite different from that of mammals. However, there do exist several morphological similarities to mammals, suggesting that the snake brainstem may be a good model for comparative structure-function correlations.

Animals↗

Distribution and central projections of primary afferent neurons that innervate the masseter muscle and mandibular periodontium: a double-label study.

A double-label strategy was used to determine the distribution and central projections of primary afferent neurons that innervate the periodontium and muscles of mastication in cats. Central injections of either Fast Blue (FB) or a mixture of wheat germ agglutinin-conjugated horseradish peroxidase (WGA-HRP) and HRP were made into one of three cytoarchitectonically distinct regions of the spinal trigeminal nucleus. These regions included the subnucleus oralis (Vo), the subnucleus interpolaris (Vi), and the medullary dorsal horn (MDH). In each case, injections were also made into the periodontium of the ipsilateral mandibular teeth or into the ipsilateral masseter muscle. FB injections preceded the peroxidase injections by at least 48 hours and total survival time ranged from 72 to 96 hours. Animals were perfused with phosphate-buffered paraformaldehyde (4%; pH 7.2). Serial frozen sections were made through the brainstem and trigeminal ganglion. Tetramethylbenzidine was used as a chromagen to demonstrate HRP and sections were viewed with brightfield and epifluorescent illumination. Cells containing peripherally injected tracer were observed in the lateral portion of the ganglion and in the mesencephalic nucleus (Vmes). Double-labeled ganglion cells were observed in most cats that received periodontal injections in combination with central injections in the dorsal part of spinal trigeminal nucleus regardless of the rostrocaudal level of the central injection. In the animals that received intramuscular injections, double-labeled ganglion cells were observed only in the animals that received central injections caudal to the Vo. Double-labeled Vmes perikarya were observed in cats that received either intramuscular or periodontal injections in combination with central injections into the MDH and Vo but not in animals that received injections into the Vi. These results demonstrate that ganglion cell periodontal afferents project to the three major rostrocaudal subdivisions of the spinal trigeminal nucleus while ganglion cell muscle afferents have more limited central projections to caudal regions of the nucleus. Masseter and periodontal Vmes afferents also project ot the spinal trigeminal nucleus--specifically, to the Vo and MDH. These findings are consistent with physiological observations regarding the role of periodontal and masseteric afferents in oral and facial reflexes and somesthetic mechanisms.

Afferent Pathways↗

Differential innervation of protruder and retractor muscles of the tongue in rat.

Protrusion and retraction of the tongue are essential components of such orofacial behaviors as mastication, respiration, and swallowing. Stimulation of the medial branch of the hypoglossal nerve yields tongue protrusion, while stimulation of the lateral branch yields tongue retraction in rat. We exploited the transsynaptic transport capabilities of pseudorabies virus to determine specific circuits that innervate protruder and retractor muscles of the rat tongue. Each group of muscles is innervated by distinct populations of hypoglossal motoneurons: caudal ventral and ventrolateral motoneurons form the largest proportion of those innervating protruders, whereas rostral dorsal motoneurons innervate retractors. Our primary finding was differential innervation of protruder and retractor motoneurons by premotoneurons in the lateral tegmental field: premotoneurons innervating protruder motoneurons were more ventral and ventromedial than those innervating retractor motoneurons. In addition, protruder motoneurons received projections from the ipsilateral lateral parabrachial nucleus but not spinal trigeminal nucleus or medial and ventral subnuclei of the solitary tract; the converse was true for retractor motoneurons. These results suggest segregation of functional networks that control hypoglossal motoneurons. The dorsal medulla, in or around the solitary tract, contains neurons specific to retractor motoneurons, and the region ventrolateral to the hypoglossal nucleus contains circuitry specific to protruder motoneurons. Common innervation of medial and lateral branch motoneurons is provided by premotoneurons in the raphe and gigantocellular reticular formation of the medial medulla. The midline medullary nuclei with diverse projections may coordinate complex behavior or modulate general motoneuron excitability, whereas the lateral reticular formation, with anatomically discrete projections, may control motoneurons that contribute to distinct orofacial behaviors.

Animals↗

Ultrastructural basis for synaptic transmission between jaw-muscle spindle afferents and trigeminothalamic neurons in the rostral trigeminal sensory nuclei of the rat.

Trigeminothalamic neurons were retrogradely labeled by injection of horseradish peroxidase into the ventroposteromedial nucleus of the thalamus in rats. Jaw-muscle spindle afferent axons were then physiologically identified and intracellularly stained with biotinamide. The ultrastructure of labeled spindle afferent boutons was then studied in the caudolateral supratrigeminal region (Vsup) and dorsomedial trigeminal principal sensory nucleus (Vpdm). A total of 418 stained spindle afferent boutons were identified in Vsup and Vpdm; approximately 75% of these synapsed with dendrites, 10% synapsed with somata, and 15% synapsed with axons. Most jaw-muscle spindle afferent boutons were postsynaptic to unlabeled P-type boutons. Reciprocal synapses between spindle afferent boutons and unlabeled boutons were occasionally observed. A few dendrites in Vsup and Vpdm received synapses from multiple spindle afferent boutons. Conversely, some large (from 3 x 6 to 4 x 8 microns) and giant (from > 4 x 8 to 5 x 10 microns) spindle afferent boutons simultaneously contacted two to five dendrites and/or somata. Jaw-muscle spindle afferent boutons also formed synapses with retrogradely labeled trigeminothalamic neurons in Vsup and Vpdm. Numerous unlabeled S-and F-type boutons converged onto the same trigeminothalamic dendrite or soma contacted by a spindle afferent bouton. A small number of synaptic triads consisting of an unlabeled P-type bouton, a spindle afferent bouton, and either a dendrite or soma were also encountered. These data indicate that sensory feedback from the masticatory muscles is subject to presynaptic inhibition and integration prior to reaching the thalamus. This pathway is likely to be important in the relay of proprioceptive and kinesthetic information from the muscles of mastication to the thalamus.

Afferent Pathways↗

Management of neurotropic low-grade B-cell lymphoma: report of two cases.

BACKGROUND: Low-grade lymphomas do not commonly involve the central or peripheral nervous system. METHODS: Case report and review of the literature of two cases of B-cell lymphoma of the extranodal marginal zone type involving the head and neck region with evidence of extensive neurotropism are detailed in this report. RESULTS: One patient was initially seen with a mass in the temporalis muscle and the other with a masticator space mass. The clinical course was indolent in both cases, although associated imaging studies suggested a more aggressive tumor. Both patients were treated with moderate-dose radiotherapy only. At the time of writing, one patient has no evidence of disease 6.5 years after treatment and the other at 6 months. CONCLUSIONS: This suggests that some marginal zone lymphomas exhibit a low-grade clinical course despite an aggressive radiographic pattern of perineural and neurotropic spread. This type of lymphoma might be effectively treated with moderate-dose radiotherapy.

Aged↗

Surgical variables affecting swallowing in patients treated for oral/oropharyngeal cancer.

BACKGROUND: Postoperative swallowing function may be influenced by a number of treatment variables; this study examines the relationship of various treatment factors to measures of swallow function. METHODS: Swallowing was examined with the modified barium swallow procedure in 144 patients surgically treated for oral or oropharyngeal cancer 3 months after healing. Univariate and multivariate correlations were used to examine the relationship between swallowing function and treatment. RESULTS: Percent tongue base resected and total volume resected were most often correlated with swallowing function in the univariate analyses. Multivariate analyses identified the following combinations with the strongest correlations: (1) percent tongue base resected and closure type for liquids; (2) percent tongue base resected and unreconstructed mandible for pastes; (3) total volume resected, percent lateral floor of mouth resected, and postoperative radiotherapy dose for masticated boluses. CONCLUSIONS: Total volume resected and percent tongue base resected had a profound impact on postoperative swallowing function. Combinations of percent tongue base resected with other surgical variables had the strongest relationships with overall swallowing function.

Adult↗

Reconstruction of the hard palate using the radial forearm free flap: indications and outcomes.

BACKGROUND: Although prosthetic obturation is the "gold standard" for restoration of hard-palate defects, obturators can be problematic. We present 10 cases of palatal reconstruction with the radial forearm free flap and compare patient satisfaction with defect-matched patients rehabilitated with prosthetic obturation. METHODS: Twelve patients who underwent radial forearm free flap (RFFF) reconstruction of a hard-palate defect and eight patients, with similar-sized defects who were rehabilitated with a prosthetic obturator, were evaluated for donor site and recipient site complications, diet, and patient satisfaction. RESULTS: All the patients in both groups were able to resume an unrestricted diet with normal mastication and articulation. Both groups achieved equivalent satisfaction scores with regard to appearance, chewing, and taste; however, the patients reconstructed with an RFFF reported higher satisfaction scores in speech, comfort, convenience, and social interaction. CONCLUSIONS: RFFF reconstruction of hard-palate defects provides a functional alternative to conventional prosthetic obturators.

Female↗

Histamine receptor and its regulation of energy metabolism.

In a series of studies on brain functions of histamine, probes to manipulate activities of histaminergic neuronal systems were applied to assess histaminergic function in non-obese normal, and lean and obese Zucker rats. Food intake was suppressed by both activation of H1-receptors and inhibition of H3-receptors in the ventromedial hypothalamic nucleus (VMH) and the paraventricular nucleus, each of which is a satiety center. Feeding circadian rhythm was decreased in its amplitude through histaminergic modulation in the hypothalamus. Histamine neurons in the mesencephalic trigeminal nucleus (Me5) were involved in regulation of masticatory functions, particularly eating speed, while histamine-containing neurons in the VMH controlled intake volume of meals. Energy deficiency in the brain enhanced satiation through histaminergic activation of VMH neurons, which in turn produced glycogenolysis in the hypothalamus to maintain homoestatic control of glucose supply. A very-low-calorie conventional Japanese diet, which is a fiber rich and low energy food source, enhanced satiation by increased mastication and because of the low energy supply of the diet. Hypothalamic histamine neurons were activated by high ambient temperature and also by interleukin-1 beta, an endogenous pyrogen, to maintain homeostatic thermoregulation. Behavioral and metabolic abnormalities of Zucker obese rats were mediated by a deficit in hypothalamic neuronal histamine, and the Zucker rat was evaluated as an animal model of histamine deficiency. Transplantation of the lean fetal hypothalamus into the third cerebroventricle of host obese Zuckers attenuated the abnormalities.

Animals↗

Post-extraction complications seen at a referral dental clinic in Dar Es Salaam, Tanzania.

AIM: To investigate the types and magnitude of post extraction complications. SETTING: A referral hospital in Dar es Salaam, Tanzania. SUBJECTS: All dental patients who had their teeth extracted at the Muhimbili Medical Centre dental outpatient clinic during the study period (May September 1999). A total of 3,818 extractions were performed under local anaesthetic in 3,732 patients. METHOD: Oral examination of all patients who reported back with post-extraction problems. RESULTS: The frequency of post extraction complications was low (1.1 per cent), and was mainly due to; infected sockets (48.7 per cent), followed by bleeding sockets (41.0 per cent) and retained roots (10.3 per cent). There were eight 'other' complications suffered by 11 patients: necrotising fasciitis (n=l), herpes zoster (n=l), Ludwig's angina (n=l), infections of the submandibular (n=l), parapharyngeal (n=2), masticator (n=2) and submasseteric spaces (n =2), and reaction to local anaesthesia (2ml of 2 per cent lignocaine hydrochloride) (n=1). CONCLUSION: The results of this study indicate that post-extraction complications are few, mostly minor, self-limiting and easily treatable. The study does not support routine antibiotic prophylaxis or special pre-extraction procedures, even in this patient population with poor oral hygiene and high HIV seroprevalence.

Abscess↗

The strength of LTI carbon dental implants.

In vitro mechanical tests have been performed on a variety of LTI pyrolytic carbon blade-type dental implants, and the test results have been analyzed using an analytical model. Tensile stresses at fracture were calculated to be about 5 X 10(4) psi and 8 X 10(3) psi in the LTI carbon coating and the graphite substrate, respectively. These values are close to their respective fracture strengths. The fracture loads predicted by the model are in good agreement with data obtained from the mechanical tests and are higher than forces expected in mastication.

Carbon↗

Effect of sensory input from the tongue on jaw movement in normal feeding in the opossum.

Opossums were presented with solid and liquid foods. The movements of the jaw and tongue were recorded cineradiographically together with recordings of the EMG activity in muscles opening the jaw and moving the base of the tongue (hyoid). The jaw opening in each cycle was in two stages--01 and 02; 01 had a constant amplitude irrespective of the food ingested. Ingestion of liquid (which involved continuous accumulation of a liquid bolus in the valleculae prior to swallowing) was associated with cycles of oral movement in which 02 was small; tongue retraction was associated with this opening. In contrast, solid and semisolid food ingestion was associated with large angles of jaw opening in 02 that also coincided with the tongue retraction. In this latter case a characteristic pattern of EMG activity, in which all the muscles moving the hyoid were simultaneously active, was added to the pattern seen in lapping; this additional activity had an EMG pattern that was consistent with a jaw opening reflex. The findings contrast with other reports that the jaw opening reflex is suppressed in mastication. Experimentally induced tongue contact with a variety of solid surfaces during lapping (an activity involving accumulation of a liquid bolus in the valleculae) induced neither increased jaw opening nor the additional EMG pattern. However, in situations when there was no bolus in the valleculae, additional jaw opening activity was elicited when the tongue contracted solids intra- or extra-orally. It is suggested that the ability of sensory input, from the anterior tongue, to elicit a jaw opening reflex and to change the type of jaw/tongue cycle was dependent upon the extent of bolus accumulation in the valleculae and therefore indirectly upon the consistency of the food.

Animal Feed↗