Deep Temporal Regions Research Articles

Deep Temporal Artery Anatomy: Implications for Improving the Safety of Deep Temporal Injections.

Knowledge of the anatomy of the deep temporal artery (DTA) is critical to ensure safe filling of the deep temporal region. However, current treatment guidelines still focus on how to avoid the superficial temporal artery and the middle temporal vein, and an understanding of the safety of avoiding DTA injury is lacking. The purpose of this study was to determine the positioning and course of the DTA to help clinicians safely perform the injection and filling in the temporal region. Computed tomography (CT) scans and dissections of the skulls of 34 fresh frozen cadavers perfused with lead oxide were performed. Reconstruction and trajectory analysis of all DTA branches were performed using Mimics and MATLAB software. In this study, the DTA was identified in all samples, which originated from the maxillary artery of the external carotid artery system. According to image reconstruction and anatomical observations, the distribution of the anterior and posterior branches of the DTA had two different distribution patterns. The anatomical level of the DTA is located between the temporal muscle and the periosteal layer. Compared with observations in previous studies, the anterior branch of the DTA is slightly different, and we found that its course is closer to the frontal area in Asian specimens. The anatomical information on the DTA described in this study may help improve awareness of the safety of temporal injection by aesthetic physicians. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. .

English

Superficial temporal space lies between the temporal fasciae. Abscess in the temporal and infratemporal space is very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscesses can be seen in the superficial or deep temporal regions. A 65 - year - old male patient reported with a complaint of painful swelling over the right cheek and restricted mouth opening with a history of extraction of second mandibular molar before four weeks. On examination, an ill-defined diffuse swelling was seen. Treatment was started with IV empirical antibiotics and planned for surgical drainage. Surgical drainage of the abscess in the temporal space was done along with debridement of the necrosed temporalis muscle. Infections of the maxillofacial region are of great significance to general dentists and maxillofacial surgeons. They are of clinical importance as they are commonly encountered, and are also challenging as timely intervention is needed to prevent fatal complications. The infections arising from the tooth are initially confined to the alveolar bone and surrounding periosteum. They spread along the path of the least resistance to the cortical plates. Once the infection penetrates the cortical plates, they reach the muscle plane.1 If the infection perforated is above the muscle attachments, it’s confined to an intraoral abscess. If the cortical plates are perforated below the muscular attachments, extraoral swelling develops. The next barrier is the periosteum which is strong and elastic in nature. Once the periosteum is breached, infections reach the soft tissue planes, the fascia. Most of the infections are confined to a particular space and the surrounding fascia. Based on the toxins produced by the microorganisms, the infection can spread to adjacent spaces and even retrograde. Common deep space infections are Ludwig's angina followed by peritonsillar, submandibular, and parotid abscesses. 2 Infratemporal and temporal space infections are rarely compared to other deep space infections. Many etiological factors form the base for the infections of deep spaces, dental caries, extraction of infected, non-infected tooth maxillary sinusitis, tonsillitis, maxillary sinus fracture, temporomandibular arthroscopy, drug-induced infections. Infections of odontogenic origin, spreading along infratemporal and temporal space are most common with maxillary molars followed by mandibular molars. We report a case of retrograde spread of buccal space infection into temporal space secondary to mandibular tooth extraction.

A rare case of temporal and infratemporal space abscess secondary to masseteric space infection

Abscess in the temporal and infratemporal space are very rare. They develop as a result of the extraction of infected maxillary molars. Temporal space infections or abscess can be seen in the superficial or deep temporal regions. A 27-year-old lady who had undergone extraction of 2nd mandibular molar five days ago came with complaints of painful swelling over left cheek and restricted mouth opening. On examination, an ill-defined diffuse parotid swelling was seen and treated with empirical antibiotics for which patient didn't respond. On examination, a diffuse hourglass swelling was seen extending from left parotid region to temporal region. CT scan revealed a bulky parotid gland with abscess involving parotid, masticator, infratemporal and temporal scalp region with reactive cervical lymphadenopathy on the left side. Surgical drainage of the abscess was done from the temporal space; subsequently, all other space abscess resolved. On conclusion, masseteric space infection leads to infratemporal and temporal space abscess as they communicate. Drainage of abscess from temporal space is adequate to resolve the abscess from other masticator spaces.

Chronic Temporal Abscess as a Result of Mandibular Molar Extraction

Temporal space infections are seen as a swelling of the superficial and/or deep temporal regions. They are sporadically reported and usually develop before or after extraction of infected maxillary molars. A 50-year-old woman had undergone extraction of her mandibular right second molar tooth in a different clinic, and after a month she visited our department because of the temporal and buccal space abscess which had not responded the antibiotic therapy. Painful swelling and trismus were diagnosed on her right temporal and buccal region with a general malaise. A CT scan revealed an inflammatory area into the temporal and buccal space. Treatment with surgical intervention and intramuscular penicillin G did not provide improvement. Antibiotic was switched on to moxifloxacin 400 mg in a day orally for 7 days. After this treatment, both temporal and facial swellings, trismus and her malaise were completely resolved.

The Effect of Simple Melodic Lines on Aesthetic Experience: Brain Response to Structural Manipulations

This fMRI study investigates the effect of melody on aesthetic experience in listeners naïve to formal musical knowledge. Using simple melodic lines, whose syntactic structure was manipulated, we created systematic acoustic dissonance. Two stimulus categories were created: canonical (syntactically “correct,” in the Western culture) and modified (made of an altered version of the canonical melodies). The stimuli were presented under two tasks: listening and aesthetic judgment. Data were analyzed as a function of stimulus structure (canonical and modified) and stimulus aesthetics, as appraised by each participant during scanning. The critical contrast modified versus canonical stimuli produced enhanced activation of deep temporal regions, including the parahippocampus, suggesting that melody manipulation induced feelings of unpleasantness in the listeners. This was supported by our behavioral data indicating decreased aesthetic preference for the modified melodies. Medial temporal activation could also have been evoked by stimulus structural novelty determining increased memory load for the modified stimuli. The analysis of melodies judged as beautiful revealed that aesthetic judgment of simple melodies relied on a fine-structural analysis of the stimuli subserved by a left frontal activation and, possibly, on meaning attribution at the charge of right superior temporal sulcus for increasingly pleasurable stimuli.

Septic Arthritis of the Temporomandibular Joint: Case Reports and Review of the Literature

BackgroundSeptic arthritis of the temporomandibular (TM) joint is rare, but it is associated with high risk for significant morbidity. ObjectiveWe reviewed the available literature regarding the presentation, evaluation, treatment, and clinical course of TM joint septic arthritis, focusing on elements relevant to emergency physicians. Case ReportsIn the first case, a healthy 6-year-old boy presented with fever and trismus; computed tomography with contrast revealed a TM joint effusion. After empiric intravenous antibiotics, intraoperative arthrocentesis of the TM joint returned 1 mL of flocculent fluid, which was cultured and grew pan-sensitive Streptococcus pyogenes. He was discharged home with amoxicillin/clavulanate and experienced complete resolution of his symptoms. In the second case, more than 3 weeks after extraction of her third molars, an 18-year-old woman presented with facial pain, swelling, and trismus and was found to have a loculated abscess involving the left masseteric and pterygomandibular spaces with extension to the left deep temporal region and the skull base. She experienced a complicated postoperative course and required multiple procedures and intravenous antibiotics for growth of multiple bacteria. More than a month later she underwent TM joint arthrotomy for TM joint septic arthritis, and she was found to have acute osteomyelitis. She continued to require multiple treatment modalities; 20 months after her initial presentation, she underwent left total TM joint arthroplasty for fibrous ankylosis of the TM joint. ConclusionSeptic arthritis of the TM joint may be caused by hematogenous spread of distant infection or local spread of deep masticator space infections. Patients may present with TM joint septic arthritis acutely or sub-acutely. Septic arthritis of the TM joint should be considered in the differential diagnosis of patients who present with trismus and pain or fever.

Encefalitis por anticuerpos contra el receptor NMDA. Descripción de una paciente sin tumor asociado y revisión de la bibliografía

A severe form of acute encephalitis associated to antibodies against the N-methyl D-aspartate (NMDA) receptor has recently been reported. This clinical picture occurs in young people, not always with an underlying tumour and, despite the initial severity, if identified and treated at an early stage, complete recovery without any kind of sequelae can be achieved. We report on a new case and review the body of knowledge currently available on this recently identified condition. A 22-year-old female who visited our centre due to a progressive conduct disorder. Over the days that followed, deterioration in the level of consciousness made it necessary to put her on assisted respiration. Magnetic resonance imaging of the head showed hyperintense lesions mainly in deep temporal regions. A study of the cerebrospinal fluid revealed pleocytosis with a predominance of lymphocytes and antibodies against the NMDA receptor. In the complementary study no underlying tumour was observed. Treatment with corticosteroids and immunoglobulins brought about a slow but steady improvement. After a one-year follow-up there have been no recurrences, no tumours have appeared and the patient has gone back to her usual day-to-day activities. Even a significant temporal atrophy that developed at the beginning of the clinical picture has gradually been seen to resolve itself in neuroimaging studies performed as a control measure. Encephalitis due to anti-NMDA antibodies is a disease that has only recently been characterised, but which, according to currently available data, is relatively frequent. Clinically well defined, suspicion of this condition will make it possible to reach a definitive diagnosis and to establish early treatment.

Gender differences and age-related white matter changes of the human brain: A diffusion tensor imaging study

Cerebral white matter undergoes various changes with normal aging. This study investigated the association between age, gender, and the global and regional fractional anisotropy (FA) and mean diffusivity (MD) in 145 adults (30 to 80 years old) using diffusion tensor magnetic resonance imaging. We studied sixteen regions of interest in both hemispheres to search for regions that display age- and gender-related white matter changes and also performed a complementary voxel-based analysis without any hypothesis a priori. On a global scale, our results indicate that the full brain FA was negatively correlated with age. The regional analysis showed that the anterior corpus callosum, the bilateral anterior and posterior internal capsule, and the posterior periventricular regions had the most significant age-related FA decrease. On the other hand, the FA in the temporal and occipital regions was not correlated with age. However, in contrast to males, females overall had a significantly lower FA in the right deep temporal regions. More gender differences in precentral, cingulate, and anterior temporal white matter areas were also found, suggesting that microstructural white matter organization in these regions may have a sexual dimorphism. Such differences were mainly due to the increase in diffusion perpendicular to fiber tracts.

A Case of Relapsing Glioblastoma Multiforme Responding to Vinorelbine

Childhood malignant gliomas are rare and their clinical behavior is almost as aggressive as in adults: they resist treatment, progress rapidly and often spread. Therapeutic strategies at relapse deserve an experimental approach, since none of the conventional-dose treatments have demonstrated a clear superiority over the others and no randomized trials have proved that high-dose chemotherapy is better than conventional treatment. Vinorelbine is a semi-synthetic vinca alkaloid with an in vitro and in vivo experimentally proven broad spectrum of activity, including against malignant brain glioma. We report our experience with a 19-year-old girl with glioblastoma multiforme (GBM) of the deep temporal region recurring 6 months after completing an intensive treatment that included preradiation chemotherapy (chemotherapy as a preradiation "sandwich" phase) with a myeloablative course of thiotepa, tumor bed radiotherapy and postradiation maintenance chemotherapy. The GBM proved fully responsive to intravenous vinorelbine, with a subsequent progression-free interval lasting more than 24 months. This case report suggests that vinorelbine is effective against high-grade pediatric glioma and, since this evidence has only one precedent in the literature (and given the generally poor prognosis for this tumor), even this single success seems worth reporting.

Role of stereotactic aspiration in the management of tuberculous brain abscess

BACKGROUND Intracranial tuberculous abscesses are uncommon clinical entities, even in countries where tuberculosis is endemic. Surgical excision and antituberculous treatment is the treatment of choice. The role of stereotactic aspiration in the management of these lesions is highlighted in this communication. METHODS Three patients, all receiving treatment for pulmonary tuberculosis, presented with symptoms of raised intracranial pressure and neurological deficits. Computed tomography (CT) scans revealed cystic lesions with enhancing rim in the thalamus in two patients and multiple coalescing cystic lesions in the deep temporal region in another. RESULTS Stereotactic aspiration of the cyst and biopsy of the cyst wall were performed in all. In two, the pus revealed acid fast bacilli (AFB). In another, though the pus did not reveal any AFB, the wall showed tuberculous granuloma. Antituberculous treatment was continued in all the patients. Follow-up CT revealed resolution of the lesions in all patients. CONCLUSION Stereotactic aspiration is an useful alternative modality of management of tuberculous abscesses in a selected group of patients.

Intracranial Tuberculoma with Difficult Preoperative Diagnosis

Intracranial tuberculoma is a relatively rare tumor in developed countries. A 41-year-old Japanese male with a personal history of pulmonary tuberculosis at the age of 20 was referred because of continuous headache. Computed tomography scan revealed multilocular ring-like enhancement in the right deep temporal region with massive brain edema. Angiography showed an avascular mass with narrowing of the carotid bifurcation. The preoperative diagnosis was glioblastoma. This mass was successfully removed and the histological diagnosis was tuberculoma. This case suggested that tuberculoma is still one of the differential diagnoses of an enhanced mass lesion even without any active extracranial tuberculous lesion.

Recent Studies of the Rhinencephalon in Relation to Temporal Lobe Epilepsy and Behavior Disorders

Publisher Summary This chapter reviews the recent studies of the rhinencephalon in relation to temporal lobe epilepsy and behavior disorders. There is a review of the willed movements and abnormalities of movement, observing the interrelations between the rhinencephalon and the deep centers of the thalamus. Basal ganglia may play a part in such neural integration. On the basis of Sherrington's conclusion that mind is not a form of energy, a theory has evolved as to how non-energy mind can act on matter, and looks to telepathy as the supporting evidence. The principle of uncertainty is used to show that a minute influence can act upon a synaptic junction and modify behavior. This point of view has been criticized because the principle of uncertainty is entirely irrelevant to the question of causal determination. The attention is drawn to the role of the tonic background in the formation of associations essential to the learning process, stressing the view that the importance of repetition has been greatly exaggerated, and that an organization of associated neurons excited at sub-threshold levels is an almost necessary consequence of the structure and known physiological properties of the cerebral cortex. The interplay of such systems might provide a mechanism for a large proportion of the selective activities of mind. It is particularly in the anterior deep temporal regions, that the integration of body functions, visceral and somatic, is performed, and where complex intellectual functions important for conscious awareness of experience and rational responsiveness are achieved.