Lateral Pterygoid Research Articles

Contribution of Masticatory Muscle Pattern in Craniofacial Morphology: A Systematic Review

Context: The objective of this systematic review is to analyze the pattern of masticatory muscle and its effects on craniofacial structures. Method: Electronic search was conducted for relevant studies in last 20 years (from January 1, 2002 to December 31, 2021) on the following databases: PubMed, Google scholar, Web of Science, Cochrane Library, and Wiley Library database. Hand searching of selected orthodontic journals was also undertaken. The selected studies were assessed for the risk of bias in Cochrane collaboration risk of bias tool. The “traffic plot” and “weighted plot” risk of bias distribution are designed in the RoB 2 tool. Two authors extracted the data which was then analyzed by another reviewer to obtain the final data. Results: Six studies fulfilled inclusion criteria. The risk of bias was high for all the studies. The sample size of the studies, methodologies used, muscles under study, parameters of muscles, and statistical analysis performed were extracted. The methodologies and results of the studies were found to be heterogenous. Conclusions: It is found that the vertical craniofacial dimensions can be better appreciated by masseter than by medial pterygoid. The volume of masseter is superior predictor than its cross-sectional area. The volume of the medial pterygoid affects the ramus of the mandible and the length and width of the lateral pterygoid are significantly correlated with transverse skeletal dimensions.

Radiological anatomy of foramen rotundum and its surgical implications

IntroductionThe use of endoscopic sinus surgery in the field of otorhinolaryngology is due to many reasons such as better visualization, the complex anatomy of the skull base and the relations between vital vascular and nervous elements, the crucial preoperative knowledge about the detailed anatomy of the area, and the computed tomography that is a useful tool for them to plan the safest route of surgery. The foramen rotundum (FR) is the inherent bony structure in the skull base located in the greater wing of the sphenoid bone on the floor of the middle cranial fossa, located adjacent to the nasopharynx, and often invaded by nasopharyngeal cancer and other malignant brain tumors. The This study aims to give a detailed description of anatomical variations of FR, as well as its relationships with the surrounding vital structures, to instruct a preoperative planning for endoscopic surgery.MethodsThe distances between the foramen rotundum and fixed anatomical landmarks like the nasal floor and pterygoid process were measured in 200 foramen rotunda of 100 patients older than 18 years old and without known skull base pathology. The patients included in this study were demonstrated and evaluated separately using a multislice computed tomography (CT) technique with DICOM viewing software (Osirix or Horos).ResultsThe average horizontal distance between the FR and vidian canal (VC) on each side, vertical distance between FR and VC on each side, direct distance between the FR and VC on each side, FR diameter, rotundum angles, FRs and nasal floor angles, and FR and optic nerve distances calculated has no significant difference. The P values were 0.471, 0.521, 0.072, 0.283, 0.952, 0.661, and 0.663, respectively. The gender comparison in the present study showed no significant distances on both the right and left sides. The P values 0.765, 0.879, 0.621, 0.297, 0.992, and 0.227 were direct, horizontal, and direct distances, respectively.ConclusionsThis study provides more light on the anatomy of the foramen rotundum with the other anatomical/surgical key structures used in endonasal surgeries such as the lateral pterygoid plate and vidian canal.

Pattern of pterygomaxillary disarticulation associated with Le Fort I maxillary osteotomy

Pterygomaxillary disarticulation (PMD) contributes to surgical complications of Le Fort 1 osteotomy and is associated with undesirable fractures of the pterygoid plates. The aim of this paper was to investigate the patterns of PMD in Le Fort I osteotomies using Rowe's disimpaction forceps, and to evaluate correlations with age and anatomical measurements. Cone-beam computed tomography (CBCT) scans of 70 consecutive orthognathic patients were retrospectively evaluated to study four patterns of PMD: Type 1 - PMD at, or anterior to, the pterygomaxillary junction (PMJ); Type 2 - PMD posterior to the PMJ; Type 3 - PMJ separation with comminuted fracture of the pterygoid plates; Type 4 - disarticulation of the maxilla involving the pterygoid plates above the level of the osteotomy line. The preoperative anteroposterior and mediolateral thicknesses of the PMJ and the length of the medial and lateral pterygoid plates were assessed. Satisfactory PMD was achieved in all cases and no severe complications were reported, including vascular, dental, mucosal, or neural damage. The most common PMD was Type 1 (54.3%), followed by Type 2 (40%). Comminuted fracture of the pterygoid plates was limited to 5.7% of cases, and no Type 4 was detected. A weak correlation was detected between PMJ thickness and PMD pattern (p = 0.04). No statistically significant correlation was detected between patients’ age and type of PMD. PMD of Le Fort I maxillary osteotomy using a Smith spreader and Rowe's disimpaction forceps proved safe, with minimal damage to the pterygoid plates.

Relationship of the neurovascular structures of the infratemporal fossae in black Zimbabweans: A cadaveric study

The Maxillary Artery (MA) is known to vary in its relationship to lateral pterygoid muscle (LPM) and its relationship to inferior alveolar nerve (IAN) and lingual nerve (LN). The variation poses surgical challenges and complications in anesthetic injection. This cadaveric study sought to describe the anatomy of the inferior alveolar nerve, lingual nerve and maxillary artery in infratemporal fossa and its associated variations. Thirty hemi- sections from 15 male cadavers were used. Dissection of the infratemporal fossae was done to expose the MA, LPM, IAN and LN. The relationship of MA to LPM was noted, roots of IAN were noted and relationship of structures were scrutinized. Pictures were taken for further analysis. Out of 30 hemi-sections, dissected 43.3% had a medial relationship to LPM while 56.7% of MA had a lateral relationship. Three (20%) of the cadavers showed asymmetry whereby MA passed on the medial side of LPM on one side while the other side it passed on the lateral aspect. Most of the hemi- sections (86.7%) had IAN originating with one (1) root, 3 hemi-sections (10%) with two roots and one (3.3%) with three roots. Only one hemi-section showed presence of a communicating branch between IAN and LN. The variations in MA in this population displays patterns comparable to other populations. There was high prevalence of MA passing lateral to LPM, which is consistent with studies done elsewhere. There were variations of IAN originating with multiple roots and presence of communicating branch between IAN and LN, which was consistent with case reports in literature.

Evolutionary Steps in the Development of a Patient-specific Temporomandibular Joint Prosthesis

Study Design Descriptive study (/review containing supporting case studies). Objective The temporomandibular joint has some distinctive features that were not taken into account during the initial development of temporomandibular joint prostheses, such as laterotrusive movements that are necessary for the proper grinding of food as well as synchronous and congruent movements made in conjunction with the healthy, contralateral joint. The aim of this article is to describe the development of a novel type of TMJ prosthesis that optimizes temporomandibular joint replacement. Methods The development was initiated by using contemporary technologies like computer-aided design customization, additive manufacturing, and surface treatments. Biocompatibility, proper fixation, and wear resistance, being prerequisites for the longevity of prostheses, were investigated next. Individual variables (condylar path, condylar axis angle, Bennet shift) were introduced as the main basis for physiological movements with the restoration of all functions. Early post-operative results ranging from 1 month to 4.5 years (11 patients, average follow-up period was 23.3 months) were assessed. Results The experience with 16 individualized total joint replacements in 11 patients is presented. The 3-year follow-up results of two-patient detailed studies are discussed, which show evidence of the promising restoration of all mandibular movements, when preoperatively present. Conclusions By incorporating various innovative and novel features (scaffold for re-attachment of lateral pterygoid, patient-specific functional parametrization, saddle-like design for retention, …) into a novel TMJ prosthesis concept, a major advance in function-reconstructive temporomandibular joint replacement was achieved. Early in vivo results (1 year after surgery) showed promising outcomes, involving both high increases in mandibular movements and decreases in pain scores.

Biomechanical validation of structural optimized patient-specific mandibular reconstruction plate orienting additive manufacturing

Background and objectiveOwing to the unexpected in vivo fracture failure of the original design, structural optimized patient-specific mandibular reconstruction plates (PSMRPs) were created to boost the biomechanical performance of bridging segmental bony defect in the mandibular reconstruction after tumor resection. This work aimed to validate the biomechanical benefit of the structural optimized PSMRPs relative to the original design and compare the biomechanical performance between PSMRP1 with generic contour customization and PSMRP2 with a tangent arc upper margin in mandibular angle region. MethodsFinite Element Analysis (FEA) was used to evaluate the biomechanical behavior of mandibular reconstruction assemblies (MRAs) concerning these two structural optimized PSMRPs by simulating momentary left group clenching and incisal clenching tasks. Bonded contact was set between mandibular bone and fixation screws and between PSMRP and fixation screws in the MRA, while the frictionless connection was allocated between mandibular bone and PSMRP. The loads were applied on four principal muscles, including masseter, temporalis, lateral and medial pterygoid, whose magnitudes along the three orthogonal directions. The mandibular condyles were retrained in all three directions, and either the left molars or incisors area were restrained from moving vertically. ResultsThe peak von Mises stresses of structural optimized PSMRPs (264 MPa, 296 MPa) were way lower than that of the initial PSMRP design (393 MPa), with 33 and 25% reduction during left group clenching. The peak magnitude of von Mises stress, minimum principal stress, and maximum principal strain of PSMRP1 (264 MPa, 254 MPa; -297 MPa, -285 MPa; 0.0020, 0.0020) was lower than that of PSMRP2 (296 MPa, 286 MPa; -319 MPa, -306 MPa; 0.0022, 0.0020), while the peak maximum principal stress of PSMRP1 (275 MPa, 257 MPa) was higher than that of PSMRP2 (254 MPa, 235 MPa) during both left group clenching and incisal clenching tasks. ConclusionsThe structural optimized PSMRPs reveal their biomechanical advantage compared with the original design. The PSMRP1 presents better biomechanical performance to the patient-specific mandibular reconstruction than PSMRP2 as a result of its superior safety, preferable flexibility, and comparable stability. The PSMRP2 provides biomechanical benefit in reducing the maximum tension than PSMRP1, indicated by lower peak maximum principal stress, through tangent arc upper margin in mandibular angle region.

Biomechanical comparative analysis of temporomandibular joint, glenoid fossa and head of the condyle of conventional models prothesis with new PEEK design

This article reviews the design of the temporomandibular joint (TMJ) prostheses used for TMJ joint replacement from 2000 to 2020. The TMJ is a complex joint, with distinct anatomical and functional characteristics making it challenging to maintain. Many authors from the early 20th century reported techniques for TMJ reconstruction, with the goal of restoring its shape and ideal function. Many prototypes have been developed in pursuit of an ideal prosthesis that adheres to the principles of biomechanics and biocompatibility, with good long-term performance and lower cost.The TMJ prosthesis is divided in two parts: the glenoid fossa and the mandibular ramus component.These two parts are fixed with metal screws in the glenoid fossa and fixed in the zygomatic arch with 4 or 5 screws. The mandibular part is fixed to the mandible ramus with 8 or 9 titanium screws.In our review, since 2000 to 2020, little has changed to improve the design and allow for natural mandible movement. From 2000 to 2006, 48 TMJ surgeries were performed using UHMWPE with this design. All patients had good results, preserving opening mouth and lateral movements.All the designs are similar in principle. The glenoid fossa, which resembles a box, limiting the rotation and translation movement. It is known that lateral movements are lost in function as the lateral pterygoid muscle is detached.

The Role of the Lateral Pterygoid Muscle in Articular Disc Displacement: A Cross-sectional Magnetic Resonance Imaging Study.

The objective of the study is to determine the role of Lateral Pterygoid Muscle LPM in the articular disc displacement ADD, which is considered controversial due to the variations in the pattern of insertion of the Superior Lateral Pterygoid Muscle SPLM. It is well understood that the superior head of the lateral pterygoid muscle has only a single insertion pattern among individuals, in which the muscle is attached to the articular disc and capsule. However, recent findings in many studies have shown a noticeable variation in the insertion pattern of the upper LPM. MRI examinations were collected at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Scans of 61 patients (41 females, 20 males; mean age 33 years old) with symptoms of temporomandibular dysfunction were reviewed retrospectively. The direction of their articular disc displacement was evaluated through sagittal and coronal views in both open and closed mouth positions. There was no statistical significance found between the LPM attachment types and TMJ disc position. The chi-square test also showed no significant difference between the type of LPM attachment and the condylar location. Forty-five percent of the articular discs were located between the articular eminence and the glenoid fossa. The majority of the disc displacement was in the anterior direction. There was no statistically significant association found between the type of LPM attachments and the direction of disc displacement.

Lateral Pterygoid Muscle Ossification After Intraoral Condylectomy.

Lateral pterygoid muscle ossification has not been reported in condylectomy patients. This study aimed to explore the incidence, risk factors, and imaging characteristics of 38 cases with lateral pterygoid muscle ossification among 54 patients after condylectomy via intraoral approach. This retrospective study included 54 patients following simultaneous orthognathic surgery and condylectomy with coronoid process resection via intraoral approach. The authors evaluated the preoperative, 1 week, 6 months, and 1 year or more postoperative computed tomographic (CT) scans for the presence of lateral pterygoid muscle ossification and its characteristics. Sex, age at the time of surgery, disease course, affected side, preoperative alkaline phosphatase, pathology diagnosis, the height of the removed condyle, condylar shape, operator, preoperative temporomandibular joint movement, and clinical symptoms were assessed as risk factors for ossification. No incidence of lateral pterygoid muscle ossification was found on preoperative CT images. Various small-size osseous masses were observed in the lateral pterygoid muscles on postoperative 6 months CT images in 38/54 patients (70.37%) after condylectomy. But no apparent enlargement of the osseous masses was found. No patients complained of clinical discomfort or functional disorder during the follow-up period (23.11 ± 13.16 months). No significant risk factors for ossification were found. Lateral pterygoid muscle ossification is relatively common in patients after condylectomy via intraoral approach. However, its enlargement is self-limited and remains stable 6 months after surgery. it has no adverse effects on the temporomandibular joint functional movement.

Assessment of the effects of digit sucking habit on the masticatory musculature using motion mode Ultrasonography

Objective : This study assessed the effect of active digit sucking on muscle thickness and fractional shortening of the masseter, lateral pterygoid, and temporalis in a population of Nigerian children using motion mode ultrasonography.Methods : The sample consisted of 100 selected children aged 7-12 years, divided into two equal groups of digit sucking and nonsucking. Participants were matched for age groups and gender. Ultrasonography evaluation (2 D and motion mode) of the masticatory muscles was performed using a linear probe of 7.5 MHz. The muscle thickness at contraction/relaxation and fractional shortening was determined. Independent t-test, Pearson correlation coefficient, and Two-way ANOVA were used for data analysis.Results : Whilst temporalis and lateral pterygoid muscles demonstrated a significant increase in thickness during relaxation (p<0.0001), a significant reduction in fractional shortening was observed (p<0.0001) in the sucking when compared to the non-sucking group.Similarly, only the temporalis muscle was significantly reduced during the contraction phase (p<0.01). For masseter mid-belly, both right and left sides in digit sucking subjects showed a significant increase in the thickness at contraction. At the same time, a reduction was observed in fractional shortening (p<0.05). Males and females with digit habit showed significantly greater muscle thickness in temporalis and lateral pterygoid during contraction and relaxation phases, whereas a reduction was observed in fractional shortening. Significant associations were observed between the frequency of sucking and muscle thickness in masseter and temporalis in fractional shortening (p<0.05).Conclusion : Our findings corroborate the assumption that persistent digit sucking in children can affect the morphology and function of the masticatory muscles.

Endoscopic Transmaxillary Approach for Sclerotherapy of an Infratemporal Fossa Venous Malformation

Disfiguring or symptomatic venous and lymphatic malformations are often treated with sclerotherapy. A 10-year-old girl with a history of epilepsy and migraines presented with progressive facial pain along the mandibular division of the trigeminal nerve. Magnetic resonance imaging identified a lobulated, enhancing lesion within the lateral pterygoid muscle, consistent with a venous malformation. It could not be safely approached transcutaneously; therefore, an endoscopic transmaxillary approach was offered. The lesion was localized with neuronavigation, and digital subtraction venography was employed to confirm entry into the lesion. Primary drainage via the pterygoid plexus toward the left retromandibular vein without any connections to the cavernous sinus or left orbit was identified. At this point, foam sclerosant was injected. Postoperatively, the facial pain resolved, and magnetic resonance imaging demonstrated an excellent response to the sclerotherapy. To our knowledge, this is the first report of an endoscopic transmaxillary approach for sclerotherapy of an infratemporal fossa venous malformation.

Magnetic resonance image texture analysis of the lateral pterygoid muscle in patients with rheumatoid arthritis: a preliminary report.

Magnetic resonance imaging (MRI) is useful for assessing temporomandibular disorders (TMDs). However, few studies have attempted texture analysis of the lateral pterygoid muscle in patients with rheumatoid arthritis (RA). This study aims to investigate the usefulness of MRI texture analysis of the lateral pterygoid muscle of patients with RA of the temporomandibular joint (TMJ). We analyzed the data from 36 patients (18 non-RA patients and 18 RA patients) who complained of pain and underwent MRI between April 2008 and August 2021. From the MRI scans of these patients, 279 radiomics features were extracted using STIR image data of the ROIs on the lateral pterygoid muscle of patients with RA and analyzed using MaZda ver. 3.3. Seven gray-level co-occurrence matrix features (Sum entropy, Sum variance) were picked up using the Fisher coefficient, for comparison between the RA and non-RA groups. Data analysis was performed using the Mann-Whitney U test A P value of < 0.05 was considered as statistically significant. All seven lateral pterygoid muscle radiomic features indicated significant differences between the non-RA and RA groups (P < 0.05). MRI texture analysis shows potential for application in radiomics diagnosis of RA in TMJ.

Anatomic distribution of local recurrence of nasopharyngeal carcinoma in the Era of IMRT: Suggestion of modification of clinical target volume delineation.

e18060 Background: Target volume delineation in nasopharyngeal carcinoma (NPC) remains a challenge because of the narrow therapeutic margin. There are no-well established guidelines for clinical target volume (CTV) delineation with long-term follow-up. Current consensus continues to rely heavily on bony structure and experience from conventional two and three- dimensional radiation. The aim of our study, is to clarify different anatomic distribution of local recurrence of NPC based on various T stages and spread patterns, provide a high-risk map of local recurrence of NPC, and thus provide suggestion for modification of CTV delineation based on T stages and spread patterns. Methods: We retrospectively enrolled 869 patients with newly diagnosed nonmetastatic NPC treated with definitive IMRT in our institution. With a median follow-up of 54.4 months, 72 patients developed local failure. All the cases of local failure were reviewed and those of local residual disease were excluded. After that, 52 cases with tracaeble primary radiotherapy plans and MR imaging of local recurrence were included in this study. Gross tumor volume of local recurrence (GTVr) and normal structures were delineated in each recurrent patient on primary CT of radiotherapy. The overlap of normal structures with GTVr were analyzed, as well as the stepwise patterns of tumor spread in NPC, based on different T stages and relapsed risk (≥5%, ≥10%, ≥20%, etc). Results: The anatomic distributions of local recurrence of various primary T stages were compared between early and late stages of NPC. Of note, these structures were significantly highly involved in T3/4 cases, compared with T1/2 cases, including lateral pterygoid muscle, inferior orbital fissure，posterior ethmoid sinus，cavernous sinus as well as hypoglossal canal. As for tumor spread patterns of local relapse, most cases relapsed in the nasopharynx and retropharyngeal lymph node (38.5%), followed by anterior-lateral tumor extension (via nasal cavity-pterygoid process-pterygopalatine fossa, 17.31%), posterior tumor extension (via prevertebral muscle-clivus, 13.46%), anterior-superior extension (via nasal cavity-ethmoid sinus-sphenoidal sinus,13.46%), superior extension(via foramen lacerum-cavernous sinus, 11.54%), etc. Finally, we depicted a map of high-risk area based on different T stages and relapsed risk (≥5%, ≥10%, ≥20%). Conclusions: Comprehensive analysis of local recurrence distributions and tumor spread patterns in real-world IMRT provides important reference for modification of CTV delineation for primary NPC. Certain structures such as cavernous sinus and lateral pterygoid muscle are not routinely recommended in the delineation of high-risk CTV for T1-2 disease. Future individualized delineations should be based on relapsed risk and tumor spread patterns.

The effects of botulinum toxin A injection on the lateral pterygoid muscle in patients with a painful temporomandibular joint click: a randomized clinical trial study

BackgroundTemporomandibular disorder (TMD) is the main cause of non-dental pain in orofacial area. The most common symptoms of TMD are joint pain, joint sound and limitation of jaw function. Botulinum toxin (BTX) injection is considered a potential treatment for TMD due to its pain-relieving properties and its ability to reduce muscle activity. Most of the studies are case series and further investigations are required to prove the efficacy of this treatment modality. Thus, in this study, we aimed to investigate the effect of BTX-A injection on the lateral pterygoid (LP) muscle and to evaluate its efficacy regarding TMD.Materials and methodsThirty-eight patients (19 women and 19 men; mean age of 26.53 years) with painful unilateral temporomandibular joint click and LP muscle tenderness were enrolled in this study. They were divided into two groups; one received an extraoral BTX-A injection in the LP muscle, and the other received a placebo injection. Pain severity, jaw movements, click severity, and Helkimo index were recorded at the first visit, as well as one week, one month, and three months after the intervention. Data were analyzed using repeated-measures analysis of variance and t-tests.ResultsThe results showed that click severity was not significantly different between the BTX-A and placebo groups (P = 0.07). Pain and Helkimo index decreased significantly in the BTX group (P = 0.00 and P = 0.006, respectively); however, there was no significant difference between the two groups (P = 0.22 and P = 1, respectively). There was a significant difference in lateral movements between the groups (P = 0.00) but not in protrusive movement (P = 0.095).ConclusionsIt can be concluded that although some studies have stated that BTX injection can make the click sound disappear, in this study, we did not find a significant difference between the two groups. Furthermore, our results showed that click and pain severity decreased, but the difference was not statistically significant. Therefore, further studies with a higher dosage of BTX and more participants are recommended.Trial registration The local Ethics Committee of Shiraz University of Medical Sciences approved this research (IR.SUMS.REC. 01/10/2018 and IRCT20130521013406N3).

Botulinum toxin injections in jaw-opening dystonia. The lateral pterygoid – maxillary artery problem

It has been suggested that the variations in the trajectory of the maxillary artery (MA) near the lateral pterygoid muscle (LPM) play a critical role in Botulinum neurotoxin (BoNT) injections in patients with jaw-opening/deviation dystonia (JOD). In the case of a lateral course to the LPM, an extraoral injection entails risks of MA injury, pain, and hematoma. Previous reports suggest geographical differences in variations of the MA-LPM relationship. We aimed to determine these variations in Turkish individuals and highlight the need to establish a consensus on approach to LPM injections. In 284 individuals, contrast-enhanced magnetic resonance angiography (MRA) images were evaluated by two radiologists on both sides for the variations in the course of the MA in the infratemporal fossa. Images of 44 were excluded due to trauma, arteriovenous malformation, mass, surgery, and imaging artifacts. Of the included, 62.1% were female. In 480 evaluations of 240 individuals, the MA passed lateral to the LPM in 65.6% (n = 315). No sex difference was noted. In 51 individuals (21.3%), the MA course differed on the right and left sides (medial–lateral asymmetry). These results confirm that the lateral course of the MA is more frequent. In patients with JOD, the trajectory of the MA should be determined with imaging prior to extraoral BoNT injections. In the case of a lateral course, an intraoral approach seems to be safer to avoid a potential MA injury.

Volumetric Change in the Masseter and Lateral Pterygoid after Mandibular Setback.

In this study, we evaluated changes in the masseter and lateral pterygoid muscles in the prognathic mandible group after a mandibular setback by comparing the volume-to-length ratios. Preoperative and postoperative 1-year computed tomography was used to calculate the volume-to-length ratio of the lateral pterygoid and masseter muscle in 60 Korean individuals. Three-dimensional images were reconstructed, the results of which showed no significant differences in the volume-to-length ratios of the masseter and lateral pterygoid muscles after a mandibular setback (p > 0.05). This result was found for both vertical ramus osteotomy and sagittal split ramus osteotomy, and for both males and females. No significant differences in the volume-to-length ratio of the masseter and lateral pterygoid muscles were found up to 1 year after a mandibular setback. Therefore, this study can contribute to the prediction of soft-tissue profiles after mandibular setback.

Frontal sinus pneumatization: An isolated finding or a sign of concomitant anatomical variation?

To determine the association between frontal sinus pneumatisation and concomitant anatomical variations in paranasal sinuses as seen on computed tomography. A total of 403 patients who underwent paranasal sinus computed tomography were allocated to three groups according to the degree of frontal sinus pneumatisation (type 1 - hypoplasia; type 2 - medium size; and type 3 - hyperplasia). In this unique model, the prevalence of ipsilateral variations on paranasal sinuses on each side of the head were analysed separately within each pneumatisation group. The type 3 frontal sinus pneumatisation group showed a greater association with ipsilateral variations of the sphenoid bone. Variations included pneumatisation of the anterior clinoid process, lateral sphenoid recess, pterygoid process and greater wing, and exposure of Vidian canal. This group also showed significant associations with male gender, and the presence of frontal and Onodi cells. Interpretation of the paranasal sinus variations is imperative for pre-operative evaluation in functional endoscopic sinus surgery, particularly in patients with frontal sinus hyperplasia. Attention to variation on the ipsilateral side is informative.

How to Make a Vampire: Part II. Getting Ready to Feed

The mammalian feeding system is made up of multiple components that influence facial variation, including the masticatory muscles, bony jaw apparatus, and teeth. However, it is not fully understood how the development of these components are coordinated and are impacted by life history and diet.Bats are the only mammals that continue to nurse until they are almost adult size, and often after they become volant. Common vampire bats (Desmodus rotundus) have a relatively prolonged juvenile period among bats, can nurse up to nine months, and later solely subsist off of blood. Feeding system maturity may therefore be delayed in bats, and particularly delayed in Desmodus, as a result of their lengthy juvenile period and liquid diet. In this study, we examine the developmental maturity of the cranium and feeding apparatus in the late fetus of a common vampire bat (Desmodus rotundus) relative to an adult (its mother).The heads of each specimen were microCT scanned twice. Conventional microCT was used to image mineralized tissues. Diffusible iodine‐based contrast‐enhanced CT (diceCT) imaging was used to image soft tissues. Cranial length and palate length measurements were acquired from unstained scans to evaluate size and jaw apparatus development. Masticatory muscles (e.g., medial pterygoid, zygomaticomandibularis) and permanent tooth crypt volumes were acquired from stained tissue scans to evaluate masticatory muscle and tooth development. Developmental maturity of these structures was assessed by calculating a percentage of the growth completed (i.e., [fetal muscle volume/adult muscle volume]*100).In the fetus, permanent tooth crypt volume is already comparable to the adult condition despite cranial length and palate length being &lt;75% of adult size. Masticatory muscle volume maturity is highest in the lateral pterygoid muscle (~35%), whereas other masticatory muscles are far less developed (e.g., medial pterygoid volume maturity, ~20%; temporalis profundus volume maturity, ~20%; temporalis medius volume maturity, ~6%).These results reveal highly precocious permanent tooth development in Desmodus. Although this may facilitate transition to hematophagy, Desmodus do not fly until eight to ten weeks, so the precocious incisors may primarily aid the infant to grip its mother’s skin. Differential development of the masticatory muscles may also be influenced by the need for young bats to use their mouths to help anchor themselves to their mother early in life. This may explain the advanced maturity of the lateral pterygoid muscle, which would protrude the jaw and help to facilitate a more secure grip.

Botulinum toxin injection in masseter muscle evokes musculoskeletal impairment of the masticatory system

The masticatory system is a finely coordinated machine, where minimal deregulation induces alterations of the whole system. Botulinum toxin type A (BoNTA) injection in masseter muscle is widely used as a clinical/aesthetic procedure. However, the non‐desirable effects of masseter muscle paralysis in neighbor masticatory muscles or mandibular bone are unknown. In the current work, we aimed to evaluate musculoskeletal loss at the masticatory system after BoNTA‐injection in masseter muscle of adult mice.Unilateral paralysis of masseter muscles was induced in male BalbC mice (8 weeks‐old) by single‐injection of BoNTA (0.2U/10 µL) in the right muscle and saline solution in the left muscle. Masticatory muscles (masseter, temporalis, lateral‐ and medial‐pterygoid) and mandibles were dissected after 2‐7‐14d for molecular measurements (qPCR), histology, or morphology (microcomputed tomography). All procedures were approved by the IACUC‐Universidad de Chile (# 20381‐ODO‐UCH). T‐test or Wilcoxon‐test were used for statistical comparisons between BoNTA‐ and Control‐side (n=3‐10, p&lt;0,05).The expression of molecular markers of atrophy (Atrogin1, Murf1) and regeneration (myogenin) significantly increased in the BoNTA‐side, as early as 2‐7d, in the intervened masseter but also in the ipsilateral temporalis and medial pterygoid muscles. There was a time‐dependent reduction in masseter fibers diameter from 2d to 14d. Masseter, temporalis, and medial pterygoid’s volumes significantly reduced in the BoNTA‐injected side at 14d. Interestingly, the volume of lateral pterygoid increased in the BoNTA side, with no change in atrophy/regeneration markers. Microstructural analysis of mandibular condyles demonstrated a progressive bone loss in the BoNTA‐injected side, starting as early as 7d and worsening 14d after the intervention.In conclusion, BoNTA injection in the masseter muscle impairs the whole masticatory system, inducing atrophy of masseter but also the ipsilateral temporalis and medial pterygoid, and even early‐bone loss of the mandibular condyle at the injected side. Then, clinical uses of BoNTA in masticatory muscles should be avoided or carried out under strict morpho‐functional monitoring.

Ultrasound-guided lateral pterygoid muscle botulinum toxin: an injection for recurrent temporomandibular joint dislocation in a brain injury patient.

Botulinum toxin type A (BTX-A) injection using nerve stimulation or electromyography for recurrent temporomandibular joint (TMJ) dislocation has been reported for several years. However, using the available equipment like a nerve stimulator or an electromyograph is uncommon, and ultrasound guidance is convenient and requires no additional resources. In this report, we used ultrasound as a tool to achieve BTX-A injections in a patient with a traumatic brain injury to treat her TMJ dislocation. One week after the injections, she had no more dislocation. She remained symptom free during the 3months of follow-up, and her clinical symptoms improved without significant complications. This is the first report using ultrasound guidance for BTX-A injections to treat recurrent TMJ dislocation. This treatment is an effective and safe technique that could be performed timely and locally without referral to a center with electromyography facilities.