Left Temporalis Research Articles

The association between change in temporal muscle mass and treatment of acromegaly

PurposeWe aimed to evaluate the relationship between temporal muscle thickness and GH/IGF-1 elevation and the effect of acromegaly treatment on temporal muscle thickness. MethodsPatients with acromegaly and healthy controls were included in the study. While laboratory parameters, clinical findings and temporal muscle thickness of acromegaly patients at the time of diagnosis and one year after treatment were evaluated, laboratory parameters and temporal muscle thickness of healthy controls were evaluated only during the period when they were included in the study. Temporal muscle thickness was measured using pituitary MRI. Temporal muscle thickness of patients with acromegaly was compared with healthy controls. We also evaluated how temporal muscle thickness changes with treatment in patients with acromegaly and the association between laboratory parameters and temporal muscle thickness. ResultsIn patients with acromegaly, measurements of left, right, and mean temporal muscle thickness at the time of diagnosis were found to be significantly higher than those of healthy controls' measurements at the time of their inclusion in the study (p = 0.007, p = 0.014 and p = 0.018, respectively). However, no significant difference was found when comparing the temporal muscle thickness of the 1st year of acromegaly treatment with the temporal muscle thickness of healthy controls at the time of their inclusion in the study (p = 0.155, p = 0.189, p = 0.198, respectively). In addition, a significant decrease was detected in the left, right and mean temporal muscle thicknesses of patients with acromegaly before and after treatment. While the temporal muscle thickness at the time of diagnosis was thicker in patients with acromegaly receiving surgical + medical treatment than in patients receiving exclusively surgical treatment, statistical significance was only found in the left temporal muscle thickness (p = 0.042). ConclusionTemporal muscle thickness was found to be associated with treatment modalities in patients with acromegaly.

Spontaneous Ruptured Brain Arteriovenous Malformation In Adolescent Patient: Case Report

Introduction: Brain arteriovenous malformations (bAVMs) are one of the most common causes of intracranial hemorrhage in the adolescent. AVMs are relatively rare as congenital intracranial abnormalities but these lesions are becoming frequently reported. AVMs generally has no any symptoms and only recognized after intracranial or subarachnoid hemorrhage occurs. This disease usually gives symptoms of headaches and seizures without cause. However, along with the development of medical technology, arteriovenous malformation lesions are common. Case report: This 24 year old woman in unconscious with right hemiparesis and atypical chronic progressive headache with vas 8-9, without aura. Previously the patient had a seizure with a duration of 5 minutes, rigid all over body. The patient had no prior history of trauma, infection, hypertension, diabetes or stroke. GCS E2M5Vaphasia with motoric aphasia, motoric and sensory deficits in the form of right hemiparesis, paresis of N. VII, increased physiological reflexes, and positive Babinsky reflex. CT-Scan Angiography imaging of the head showed intraparenchymal bleeding in the left temporoparietal lobe with perifocal edema, AVM in the left temporalis region with a nidus with a feeding artery from the left MCA and a draining vein from the left transverse sinus. The patient was referred for further vascular intervention. Discuss: AVMs was previously considered a congenital malformation with risk of bleeding in anomalous tissue or nidus occurring within the brain parenchyma. Rupture of the artery and discharge into the subarachnoid space causes a sudden increase in ICP, cerebral vascular vasospasm resulting in global and focal brain dysfunction. In addition, with the increasing use of non-invasive intracranial imaging, AVMs can be detected directly.

Electromyography Analysis of the Masseter Muscle's Activity in the Management of Oral Submucous Fibrosis.

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseterand temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMFwas statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMFwas statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMFwas statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMFwas statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Electromyographic Evaluation of Masseter and Temporalis Muscle Activity in Distal Extension Edentulous Patients After Replacing with Implants—A Prospective Clinical Trial

Aim: To assess the changes in muscle activity after replacing the missing teeth or teeth with implants in distal extension edentulous patients and to evaluate the patient’s satisfaction levels. Materials and Methods: This was a single-group experimental study, based on convenience sampling with a sample size of 40 patients. Only unilateral mandibular distal extension edentulous sites were included and endo-osseous dental implants were placed in delayed protocol. Electrical activities of the masseter and temporalis muscles were recorded at rest and clench before, immediately, and one month after the cementation using electromyography. Patient satisfaction was analyzed through a questionnaire. Descriptive statistics an inferential statistics with repeated measures of ANOVA followed by the Bonferroni post hoc test were done to analyze the study data. P value < .05 would be considered statistically significant for all the analyses. Results: Right temporalis showed significantly higher surface electromyography (sEMG) activity at one-month post cementation than baseline at rest and clench. Similarly, the left temporalis has shown significant sEMG activity at one-month post cementation than baseline at clench. However, there was no statistical difference with the right and left masseter. The implant-supported prosthesis was well received by the majority of patients. Conclusion: Definitive improvement in the electrical activity of the temporalis before and after the replacement of prosthesis was noticed with positive patient satisfaction levels with implant-supported prosthesis.

Bichectomy Surgery and EMG Masticatory Muscles Function in Adult Women: A Longitudinal Study

Bichectomy Surgery and EMG Masticatory Muscles Function in Adult Women: A Longitudinal Study

Bioelectrical activity in temporalis and masseter muscles across different gnathic types

Relevance. Discrepancies in the bioelectrical activity of the masseter muscle were observed through surface electromyography analysis. Despite the availability of scientific literature on the morphological and anatomical variances in the mastication muscles and subcutaneous adipose tissue across different gnathic types, these differences are often overlooked in the interpretation of surface electromyography absolute values.Materials and methods. A clinical evaluation, including the measurement of craniofacial parameters and an electromyography study of the right and left temporalis (RTA and LTA) and masseter muscles (RM and LM), was conducted on 73 individuals aged 21 to 24. Subjects were categorized based on upper and lower face gnathic type indices into three groups of 10: Group 1 (brachyfacial type), Group 2 (mesofacial type), and Group 3 (dolichofacial type). The study compared the surface electromyography-derived IMPACT index and average amplitude values of the muscles across groups, alongside analyzing the correlation between electromyographic values and gnathic type indices (GPDu.f./t-t and GPDl.f./ko-ko), with statistically significant differences noted at p ≤ 0.017.Results. Differences in RM and LM parameters, and the IMPACT index during the "Maximal Voluntary Gnathic Clenching of the Jaws" (MVC) test were statistically significant among the groups. An increase in both the IMPACT index and average masseter muscle values was noted in dolichofacial subjects. Significant variations in LM values during the MVC test were observed between dolichofacial and mesofacial subjects. In the MVC test, groups 1 and 3 demonstrated a moderately strong positive correlation between the IMPACT index and GPDu.f./t-t and GPDl.f./ko-ko, while a strong positive correlation was identified between the RM parameter and GPDu.f./t-t and GPDl.f./ko-ko.Conclusion. In the MVC test, the RM and LM parameters, as well as the average IMPACT index, were notably higher in dolichofacial subjects compared to other groups. A direct correlation between the mean right masseter bioelectrical activity and the average IMPACT index with the upper and lower facial gnathic indices was observed in brachyfacial and dolichofacial subjects in the MVC test.

TOPOGRAPHIC AND ANATOMICAL PECULIARITIES OF THE LATERAL REGION OF THE HEAD IN HUMAN FETUSES

HEAD IN HUMAN FETUSESAbstract. In order to clarify the topographical and anatomical peculiarities and variant anatomy of the structures of the lateral region of the head in the fetal period of human ontogenesis, 24 specimens of human fetuses aged from 4 to 10 months of intrauterine development were studied using a complex of morphological research methods (anthropometry, macroscopy, computer tomography, morphometry, reconstruction). We found anatomical variants of the masseter and temporal muscles in human fetuses. Thus, in a 5-month-old fetus, separate muscle bundles were found, which went from the right masseter to the right temporal muscle. In a 6-month-old fetus, the deep part of the left masseter muscle was fused to the left temporal muscle. In human fetuses, the temporal fascia in the direction of the zygomatic arch splits into two layers, between which there are accumulations of adipose tissue. In late fetuses, a formed sub-aponeurotic fi brous space was found. At the end of the fetal period, a deep fi brous space is observed between the periosteum and the inner edge of the temporal muscle. The cellular spaces of the temporal area in front are connected with the buccal fat pad, which creates the prerequisites for the spread of infl ammatory processes. The topographic and anatomical features of the temporal region of human fetuses are: weak development of the temporal muscle and small depth of the temporal fossa – in the middle part from 3.0 to 6.0 mm (depending on the age of the fetus); weakly developed tendinous part of the temporal muscle, which does not reach the temporal line of the parietal bone. The bony base of the temporal area is represented by the squamous part of the temporal bone, the greater wing of the sphenoid bone, part of the parietal and frontal bones, on the inner surface of which arterial grooves and impressions of cerebral gyri are hardly visible, and sometimes not at all clear or absent. Anatomical variants of the structure of the temporal and masticatory muscles, as well as the temporal fascia, can cause complications and errors during the diagnosis and surgical treatment of infl ammatory processes in the postnatal period of human ontogenesis.

Investigation of electromyography of the masseter and temporal muscles in children with Down syndrome aged 2 to 12 years during maximal voluntary isometric contraction and rest

Background. Muscle weakness and low muscle tone may cause chewing and swallowing disorders in people with Down syndrome. This study investigated the electromyography of the masseter and temporal muscles in children with Down syndrome, aged 2 to 12, during maximal voluntary isometric contraction and rest. Methods. The current descriptive-analytical and case-control study investigated the electromyography frequency indicators of the masseter and temporal muscles at maximum voluntary contraction and resting states in 15 children aged 2 to 12 with Down syndrome and 15 normal children of the same age. Results. The average frequency of the mean and median in the electrical signal of the masseter and temporal muscles on the left and right sides and in two different positions in children with Down syndrome is lower than in normal children. In comparing the average frequency of the mean, except for the left and right temporal muscles in the maximum voluntary isometric contraction and the left master muscle during rest, there is a significant difference in the rest. Also, in comparing the average frequency of the median, except for the left and right temporal muscles in the resting state, there are non-significant differences in the rest of the cases. Conclusion. The average frequency of the electrical signal of the masseter and temporal muscles in children with Down syndrome is lower than that of normal children. Unlike typically developing children, those with Down syndrome struggle with chewing and swallowing. Practical Implications. The data obtained from this study contributes to the enhancement of interventions and treatments for patients with Down syndrome.

Padrão de contração voluntária máxima em pacientes com disfunção temporomandibular antes e após terapia fonoaudiológica com e sem uso de bandagem elástica

ABSTRACT Purpose: to verify if there is an electromyographic difference during maximal (maximum) voluntary contraction of the masseter and temporalis muscles in patients with temporomandibular disorders, before and after speech therapy intervention with and without the use of therapeutic elastic bandages. Methods: an analysis of secondary data from a clinical intervention study, carried out with 17 adult volunteers, diagnosed with temporomandibular muscle dysfunction with or without disc displacement with reduction. The Bandage Group received manual therapy associated with elastic bandages and the No Bandage Group received only manual therapy. Surface electromyography was performed to record the Maximum Voluntary Contraction before and after four weeks of speech therapy intervention. For exploratory analysis, the Mann Whitney and Wilcoxon paired tests were used, with P<0.05. Results: in the Bandage Group, there was a statistically significant decrease in electrical activity during Maximum Voluntary Contraction in the masseter and temporalis muscles on the left side at the post-therapeutic moment. Comparing the pre- and post-intervention between Bandage Group and No Bandage Group, a statistical difference was found in the electrical activity values of the Maximum Voluntary Contraction in the left temporal muscle. Conclusion: manual myofunctional speech therapy, associated or not with the use of therapeutic elastic bandages, impacts the muscle activity of the masseter and temporal muscles during Maximum Voluntary Contraction, whether the values demonstrate relaxation and/or equivalence of the electromyographic values of the masticatory muscles.

Effects of athletic tape on orofacial pain and jaw movements after 24 hours of use: a randomized clinical trial.

To analyze the sensation of pain and the range of mandibular movements of adult individuals with temporomandibular disorder, before and after the application of the athletic tape. This is a double-blind randomized clinical trial, in which 22 adults with temporomandibular disorder participated, randomly allocated into two groups, with group A comprising 10 women and one man (mean age 28.2±8.3 years) and group B comprising nine women and two men (mean age 26.2±3.9 years). Group A was submitted to the application of the athletic tape on the masseter with 40% stretch and the group B to the application of the athletic tape on the masseter without stretching. All participants underwent the application of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD). Pain threshold assessment was performed using an algometer to apply pressure to measurement points. The measurement of mandibular movements was performed using a caliper. The athletic tape was glued using the I technique, with a fixed point over the insertion and a movable point over the origin of the masseter muscle. Participants remained with the athletic tape for 24 hours and were re-evaluated. There was pain relief in the group A in the temporomandibular joint on the right and at the origin of the masseter on the left. The group B showed a reduction in pain in the left anterior temporal region. No differences were found in mandibular movements after intervention, as well as no difference was found in the comparison by groups. The use of the athletic tape over the masseter muscle, with stretching, for 24 hours produced relief from the sensation of pain, on the origin of the right masseter and in the right temporomandibular joint, and, without stretching, in the left anterior temporal muscle. There was no difference in the range of mandibular movements.

Analysis of definite awake bruxism using a portable electromyography device.

This study aimed to compare awake bruxism events between subjective and objective evaluations using a questionnaire survey and a modified portable electromyography (EMG) device, and to examine correlations between sleep quality and awake bruxism. The Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and awareness of awake bruxism as clarified via interviews were conducted on 34 participants as subjective evaluations. The EMG device was used to record left temporal muscle activity for 6.5 h (from 09:00 to 15:30) and the number of awake bruxism episodes per hour. The participants were then classified into "bruxer" and "non-bruxer" groups based on the number of awake bruxism episodes. The mean number of awake bruxism episodes per hour was 33.6 ± 21.4, and 23% of the participants who reported having no awareness of awake bruxism in the interviews were defined as "bruxers" in the objective evaluations. In the bruxer group, positive correlations were found between the number of awake bruxism episodes and both ESS and PSQI scores. These findings suggest that objective measurements using a portable EMG device can increase the diagnostic accuracy for awake bruxism, and that sleep quality is a major risk factor for awake bruxism.

Isolated unilateral temporalis muscle hypertrophy of unknown etiology: a case report and literature review.

The initial instance of isolated unilateral temporalis muscle hypertrophy (IUTMH) was reported in 1990. Since then, only few cases have been documented. The cause of this condition remains ambiguous; however, it is presumed to be linked to compensatory and stress-induced hypertrophy. We introduce a rare case of the diagnosis and treatment of IUTMH. A 39-year-old woman presented with a steadily enlarging pain-free swelling on the left side of her face, first noticed a month ago. Apart from a hyperthyroidism medication regimen her medical history was unremarkable. She had no history of temporomandibular joint disease, bruxism, surgery, or trauma. However, she complained of having been under substantial stress lately. Contrast-enhanced magnetic resonance imaging revealed asymmetric temporalis muscle hypertrophy. The treatment plan consisted of administering type A botulinum toxin injections into left temporalis muscle, supplemented by lifestyle changes and relaxation techniques. At a follow-up visit 9 months after the injections, the muscle contour was normalized both in physical and in radiologic examinations. While further supportive evidence is needed, it can be anticipated that cosmetic treatment with botulinum toxin, rather than surgical interventions, will become the standard treatment of IUTMH.

Global Postural Exercise Program Versus Muscle Energy Technique on Management of Temporomandibular Joint Disorders

Objective: To compare between the effects of global postural exercise program against muscle energy technique on maximum pressure pain threshold, maximal mouth opening range of motion as well as quality of life on patients with temporomandibular joint disorders. Methods: 63 patients having temporomandibular disorders were randomized into three groups; Group (A) were given global postural exercise program in addition to conventional therapy (in the form of LASER and hot packs), Group (B) were given muscle energy technique as well as traditional therapy and the Group (C) control were given traditional therapy only. All patients were examined by the pressure algometer, paquimeter and Arabic version of Oral health impact profile 14 questionnaire as well as the duration of treatment were 6 weeks. Results: there were no significant statistical differences revealed pretreatment for all variables, Mmaximal mouth opening range of motion, quality of life scale, as well as pain) as in mouth opening (P=0.130), OHIP-14 (P=0.642), right temporalis muscles (P=0.384), left temporalis muscles (P=0.930), right masseter muscles (P=0.790), left masseter muscles (P=0.064), right trapezius muscle (P=0.403), and left trapezius muscle (P=0.058) among groups where (P>0.05). While after-treatment and follow up , there were significant statistical differences were P value was (P<0.05), in mouth opening (P=0.0001 and P=0.0001, respectively), OHIP-14 (P=0.0001 and P=0.0001, respectively), right temporalis muscles (P=0.035 and P=0.020, respectively), left temporalis muscles (P=0.0001 and P=0.0001, respectively), right masseter muscles (P=0.001 and P=0.0001, respectively), left masseter muscles (P=0.004 and P=0.035, respectively), right trapezius muscle (P=0.0001 and P=0.0001, respectively), and left trapezius muscle (P=0.031 and P=0.001, respectively) between groups. Conclusion: Both Muscle energy technique and global postural exercise program improved mouth opening, pressure pain threshold, as well as quality of life in temporomandibular joint disorders patients, with the superiority of muscle energy technique over global postural exercise program.

Criterion-based assessment of masticatory muscle hypertonia severity in children with cerebral palsy

Relevance. In children, muscle hypertonia, including sustained stiffness of the chewing muscles, accompanies the spastic form of cerebral palsy. Considering hypertonia severity is necessary to develop treatment tactics and schemes. This paper proposes a reasonable criterion-based assessment of the above pathology severity based on clinical and functional examination data.Material and methods. To develop grading of muscle hypertonia severity, we examined 30 children with spastic cerebral palsy and 30 healthy children of the same age to obtain normalized parameters. Based on the questionnaire data, the study analyzed the functions of chewing, swallowing, and speech formation, assessed the condition of the hard dental tissues by clinical examination, and obtained active and passive mouth-opening data. Electromyography calculated the average amplitude of the right and left temporal and masticatory muscles and the total biopotential.Results. Clinical and functional evaluation data showed a direct correlation. The more complex the situation in the oral cavity was, the higher the amplitude of the chewing muscles was.Conclusion. The correlation allowed the development of the criterion-based assessment of moderate and significant masticatory muscle hypertonia severity, which management of this patient type should consider.

The relationship between the facial type and the state of chewing muscles in children with cerebral palsy

Relevance. The modern development of practical dentistry and the emergence of new techniques and methods of diagnosis and treatment determine the necessity and expediency of studying the anatomical features of the head, skull, structure of dental arches, and dental segments in general. Knowledge of the patterns and characteristics of the skull structure and their relationship with morphometric, clinical and functional parameters will allow the diagnosis of various forms of maxillofacial disorders based on comorbidity.Materials and methods. The study examined 30 children aged 6 to 12 y.o. to determine the relationship between the type of face and the state of the chewing muscles in children with cerebral palsy. Maxillofacial anthropometric measurements were made, e.g., the bitragional length (t-t) and the distance between the tragion and subnasale landmarks (t-sn); the gnathic index of the face was calculated, and the mouth opening range was measured. The surface electromyography determined the mean biopotential amplitude of the right and left proper masticatory and temporal muscles using the "bruxism" test.Results. The anthropometric measurement data indicate the prevalence of a brachygnathic facial type in children with cerebral palsy. The electromyographic study data evidence spasticity of the masticatory muscles.Conclusion. The obtained data indicate functional overload of the chewing muscles. Masticatory muscles' hypertonicity determined the brachygnathic facial type in children with cerebral palsy.

Physical testing in patients with acute whiplash-associated disorders: A within session test-retest reliability study

BackgroundPeople with whiplash-associated disorders (WAD) commonly present with a variety of physical impairments. However, the reliability of physical tests has not been established for patients with acute WAD. ObjectiveTo assess test-retest reliability of different physical tests in acute WAD. DesignIntra-rater test-retest reliability. MethodsPatients with acute WAD were recruited. Physical tests were used to evaluate articular, muscular and neural systems in two blocks of measurements separated by 10 min. Bland-Altman plots were performed to assess intrarater agreement, which included calculation of the mean difference (d) between rates, the 95% CI for d, the standard deviation of the differences and the 95% limits of agreement. Reliability was calculated via the standard error of measurement, the minimal detectable change, percent of agreement, the intraclass-correlation coefficient, and kappa coefficient. Results47 patients participated. Test-retest reliability was excellent or good for almost all measures, except for extension ROM, ULTT for the radial nerve, and active cervical extension and upper cervical rotation performed in 4-point kneeling, which presented moderate reliability. Systematic bias was found in cervical ROM in flexion, left and right lateral-flexion, left and right rotation; left ULTT for radial nerve; right trapezius, suboccipitalis and temporalis muscles, left temporalis; C3, both sides of C1–C2, left C3–C4. ConclusionThe majority of physical tests achieved good or excellent test-retest intra-rater reliability when tested in patients with acute WAD. Findings must be considered with caution for those tests which demonstrated systematic bias. Additional research is warranted to evaluate inter-rater reliability.

Electromyographic analysis of the stomatognathic system of children with Molar-incisor hypomineralization.

Molar-incisor hypomineralization (MIH) is a qualitative defect of dental enamel that affects one or more permanent first molars, with or without involvement of the incisor teeth. This condition leads to challenges to dental care and treatment planning. Based on the hypothesis that children who have MIH possibly present alterations in postural and masticatory activities and considering the absence of studies investigating these parameters, the present study evaluated the functionality of the stomatognathic system considering the mentioned aspects. The comparison of individuals with (MIHG; n = 32) and without MIH (CG; n = 32) was evaluated by electromyographic activity of the masseter and temporal muscles (right and left), as well as evaluation of the masticatory cycles during habitual mastication. MIHG showed muscle hyperactivity in postural and dynamic conditions compared to the CG; higher electromyographic values for MIHG when compared to CG in the following postural conditions: at rest for the right temporal (p = 0.00) and left temporal muscles (p = 0.03); in the protrusion to the right temporal muscle (p = 0.02); in the right laterality for the right masseter (p = 0.00) and left temporal muscles (p = 0.01); in the left laterality for the right masseter (p = 0.03) and left temporal (p = 0.04) muscles. In dynamic conditions with consistent food, significance was observed for the left temporal (p = 0.01); and with soft food for the right (p = 0.01) and left temporal muscles (p = 0.04). Children with MIH seem to have impaired functionality of the stomatognathic system. Children with MIH have alterations in the stomatognathic system.

Alcohol and fatal penetration of the cranium by an airgun pellet—a case study from Poland

BackgroundAirguns with the energy of ejected pellets below 17 J are not considered weapons in Poland, can be purchased without permission, and do not require registration. The mere possession of this kind of airgun does not entail any legal consequences, unless it is used for an unauthorized purpose. Sports and recreational shooting do not have to take place within shooting ranges. However, the improper use of this type of weapon can lead to serious injuries and death. In addition, the impact of high blood alcohol content on pain perception can lead to a lack of awareness of the gunshot.Case presentationA 36-year-old woman died a few hours after a head injury inflicted by a 5.50-mm caliber pellet fired from an air gun. The first pellet penetrated perpendicularly through the left temporal bone to the brain. The gunshot tract of this head wound was 6 cm long and ran horizontally and perpendicularly to the surface of the squamous part of the temporal bone. The tract ran through the skin of the skull, the left temporal muscle, and the squamous part of the temporal bone (where the bone was only 1.5 mm thick). The pellet then penetrated the cerebral dura mater, cerebral pia mater on the borderline of the left temporal and frontal lobes, and left lateral wall of the sphenoidal sinus. The victim did not complain of pain due to a high level of alcohol intoxication (0.35 blood alcohol content). The pellet from the second shot (on the foot) penetrated the right foot and was inflicted by the victim.ConclusionThe victim died not earlier than 3 h after being shot as a result of intracranial injuries that caused hemorrhage. The outcomes of this study indicated that high alcohol content resulted in reduced awareness of the victim and no apparent symptoms of developing intracranial injuries.

Microfilariae infection by Acanthocheilonema reconditum and Dirofilaria immitis and their molecular detection in a dog with lymphoma: Case report

Objective: Microfilariae parasites are common in tropical regions, and some species are reported as potentially zoonotic. The diagnosis of filarial infection in dogs by cytology or hematologic tech¬niques showed lower sensibility and specificity, which may result in misdiagnosis. Thus, molecular techniques seem to be an alternative to identifying and detecting microfilariae infections. On the other hand, lymphoma is one of the main tumors in domestic animals, with a high prevalence in domestic canines. This study aims to report a mixed infection with microfilariae in a dog with lymphoma, emphasizing its diagnosis and the possible role of this infection in the development of the neoplasia. Materials and Methods: An 8-year-old male mixed breed dog was referred to consultation due to the presence of lethargy, recumbency, skin ulceration lesions, nonspecific pain manifestations, emesis, myoclonus in the left temporalis muscle, and seizures. Routine blood and biochemistry tests were normal, and cytology of the skin evidenced a microfilariae infection. The dog died due to a cardiorespiratory arrest, and tissue sampling was done for histopathology and molecular analysis at the necropsy examination. Results: Skin lesions were related to a microfilarial pyogranuloma related to Acanthocheilonema reconditum. Histopathology of the spleen and liver revealed a diffuse lymphoma composed of blast cells and large lymphocytes, distributed diffusely in the parenchyma and surrounding the vasculature. In the skin, microfilariae were seen in some superficial capillaries. Conclusion: This study describes a microfilariae mixed infection with A. reconditum and Dirofilaria immitis in a dog with a lymphoma and its molecular detection. To the knowledge of the authors, this is the first report of a mixed microfilariae infection in a tumor of a dog and highlights the use of molecular techniques, i.e., polymerase chain reaction, for an accurate diagnosis.

Osteoplastic Pterional Craniotomy: Success Rate of Surgery in Patient Aspect.

To evaluate the effect of osteoplastic pterional craniotomy on temporal hollowing and its sequelae. A total of 97 patients who underwent pterional craniotomy for an aneurysm were analyzed retrospectively. Of these 97 patients, 63 underwent surgery via the conventional pterional approach and 34 underwent surgery via the osteoplastic pterional approach. The temporal muscle volume was calculated bilaterally on CT images obtained in the sixth postoperative month. The results obtained in the conventional and osteoplastic approaches were compared. Of the 97 included patients, 45 were female and 52 were male. The mean patient age was 50.37 years. In the conventional group, 31 were female and 32 were male. In the osteoplastic group, 14 were female and 20 were male. The temporal muscle volume difference between the operated and non-operated side was not statistically significant in the osteoplastic group. However, the volume was slightly lesser on the operated side than on the non-operated side in the conventional group. The osteoplastic pterional approach is superior to the conventional approach in preserving the muscle volume and function. Patients who underwent osteoplastic craniotomy demonstrated higher levels of satisfaction with their facial appearance compared to those who underwent craniotomy using the conventional pterional approach.