Masseter Muscle In Patients Research Articles

The Effect of Microdialysis Catheter Insertion on Glutamate and Serotonin Levels in Masseter Muscle in Patients with Myofascial Temporomandibular Disorders and Healthy Controls.

Myofascial temporomandibular disorders (TMD) are the most common cause of chronic pain in the orofacial region. Microdialysis has been used to study metabolic changes in the human masseter muscle. The insertion of the microdialysis probe causes acute tissue trauma that could affect the metabolic milieu and thereby influence the results when comparing healthy subjects to those with TMD. This study aimed to investigate the levels of serotonin and glutamate during the acute tissue trauma period in healthy subjects and in patients with TMD. Microdialysis was carried out in 15 patients with TMD and 15 controls, and samples were collected every 20 min during a period of 140 min. No significant alterations of serotonin or glutamate were observed over the 2 h period for the healthy subjects. For the TMD group, a significant decrease in serotonin was observed over time (p < 0.001), followed by a significant increase between 120 and 140 min (p < 0.001). For glutamate, a significant reduction was observed at 40 min compared to baseline. The results showed that there was a spontaneous increase of serotonin 2 h after the insertion of the catheter in patients with TMD. In conclusion, the results showed that there are differences in the masseter muscle levels of serotonin and glutamate during acute nociception in patients with myofascial TMD compared to healthy subjects.

Evaluation measure of 3d volumetry of masseter hypertrophy: association with modalities of imaging

Abstract Masseteric hypertrophy is a benign condition, asymptomatic and rare, characterized by the excessive development of the masseter muscle, which usually results in aesthetic complaints. The imaging exams for differential diagnosis of pathologies in the parotid-masseteric region is always recommended. This work aims the imaging characterization of masseteric hypertrophy through the report of two clinical cases combining different imaging modalities: panoramic radiography, magnetic resonance imaging, computed tomography, ultrasonography and 3D volumetry. Two male subjects with no family history of masseteric hypertrophy were referred to a diagnostic center in dentomaxillofacial radiology due to an increase in bilateral facial volume in the masseteric region. Images of the panoramic radiography showed an increase of the bilateral mandibular angle in both cases. Using computerized tomography, bilateral masseter muscle hypertrophy was demonstrated in the patients, and magnetic resonance scan and ultrasound examination were performed for better visualization and muscle measurement. 3D volumetry assessment of musculature showed as additional tool to evaluate the status of the masseter muscles in patients with Masseteric hypertrophy. Therefore, the association of imaging examinations allowed to perform the imaging characterization of masseteric hypertrophy with presence of bone exostosis.

Clinical effectiveness evaluation of laser therapy and dry needling in treatment of patients with myofascial pain in masseter muscle

Myofascial pain is considered a type of muscular TMD, being common in patients with musculoskeletal pain associated with active or latent trigger points. Among the therapeutic options, there are low-intensity laser therapy and dry needling. The aim of this study was to compare the efficacy of these two therapies in the masseter muscles of patients with myofascial pain. Ten patients diagnosed with myofascial pain, with or without limitation of mouth opening, were randomly divided into two groups for treatment with low intensity laser therapy (G1) (n = 5) or dry needling (G2) (n = 5). The pain symptomatology and the mouth opening measurement were evaluated weekly before the start of treatment, and one week after the final treatment. The comparison between G1 and G2 in relation to the improvement in mouth opening was not statistically significant (p&gt; 0.05). However, dry needling (G2) has shown numerically to be more effective than laser therapy in a shorter period comparing initial and final mouth opening. Regarding the pain symptomatology, both therapies were effective comparing the initial and final evaluations of patients with myofascial pain (p &lt;0.05).

The hemodynamic effects of occlusal splint therapy on the masseter muscle of patients with myofascial pain accompanied by bruxism

ABSTRACTObjective: The aim of this study was to investigate the hemodynamic effects of occlusal splint therapy on masseter muscles of patients with myofascial pain accompanied by bruxism with near-infrared spectroscopy (NIRS).Methods: Twenty-four patients were randomly divided into two groups, where the study group (n = 12) received occlusal splint therapy and the control group (n = 12) underwent no therapy. Measurements were categorized into four subgroups: painful or painless control and painful or painless splint. Percent changes in deoxyhemoglobin (Hb), oxyhemoglobin (HbO2), and OXY (HbO2-Hb) values were calculated during a 1-month period.Results: Statistically significant inter-session differences between painful-splint and painful-control groups were detected for NIRS oxygenation parameters, whereas inter-session differences between painless groups were statistically insignificant.Conclusion: The results suggest that occlusal splint usage causes a decrease in hyperemic response, which is indicative of a decrease in masseter muscle contraction strength.

The relationship between masseter muscle pain and T2 values in temporomandibular joint disorders

Myofascial pain in temporomandibular joint disorders (TMDs) is evoked by various factors, including edematous change. We investigated whether the pain pattern is related to edematous change by using T2 mapping generated by magnetic resonance imaging to detect water content in the tissue. One hundred and five patients diagnosed with TMDs, with or without unilateral masseter muscle pain, were divided into 6 groups according to their pain experience: pain on compression (23 cases), pain on movement (13 cases), spontaneous pain (4 cases), pain on compression and movement (14 cases), pain on compression and spontaneous pain (2 cases), and no pain (49 cases). Differences in the mean T2 values of the masseter muscle between the group with pain on only one side (5 unilateral pain groups) or pain-free on both the right and left sides (pain-free group) were compared with paired t tests. Significant differences were assumed at P < .05. Significant differences in mean T2 values were found between the painful and pain-free sides in the group with pain on compression. The findings of edematous change in the masseter muscle of patients with pain on compression may affect treatment planning and lead to investigation of treatment options for myofascial pain in TMDs.

PR231: The evaluation of thickness of masseter muscles in patients with periodontal disease

PR231: The evaluation of thickness of masseter muscles in patients with periodontal disease

Dry needling the masseter muscle in the treatment of myofascial pain: case reports

The aim of this study was to evaluate treatment with dry needling (AS) in the masseter muscle of patients diagnosed with myofascial pain as the pain symptoms and the mouth opening (AB). After sample size calculation, we selected 10 patients referred for treatment of temporomandibular disorders (TMD) diagnosed with MP, with or without limited mouth opening according to Axis I of the RDC/TMD, who underwent six DN sessions, once a week. Pain measurement using the Visual Analogue Scale (VAS) and an evaluation of the extent of mouth opening were done. All participants were female and the average age was 39.2 years, with 8 (80%) having a diagnosis of myofascial pain with limited mouth opening and 2 (20%) with only myofascial pain. Maximum unaided opening without pain before treatment was 31.9 mm and went to 36.2 mm, and the maximum unaided opening went from 39.6 mm to 43.1 mm. In both, however, could not find statistical significance (p&gt; 0.05). Regarding the mean weekly VAS value, this went from 8.3 before treatment to 2.3 a week later, with statistically significant results (p &lt; 0.05). In this study, the AS in the masseter muscle presented is a therapeutic alternative in the treatment of myofascial pain. KeywordsTemporomandibular joint; Temporomandibular Joint Disorders; Dry needling; Trigger points; Myofascial pain.

Surface electromyographic of masseter muscles in patients with cerebral palsy: A pilot study

Surface electromyographic of masseter muscles in patients with cerebral palsy: A pilot study

Genetic response in masseter muscle after orthognathic surgery in comparison with healthy controls – A Microarray study

One third of adult patients with orthognathic surgery of a prognathic or retrognathic mandible show relapse. The sagittal split osteotomy of the mandible leads to a displacement of both parts up to 10 mm without any changes of muscle attachment. Changed mandible length needs adaptation of muscle capacity because of changed force to moment ratio. The aim of this Microarray study was to analyze the general genetic response of masseter muscle in patients with retrognathism or prognathism of the mandible six months after surgery in comparison with healthy untreated controls. We found in tissue samples from masseter muscle a reduction of different entities between patients and controls but less in retrognathic than in prognathic patients (274/429). The different entities to controls in prognathia were reduced from 1862 to 1749 but increased in retrognathia from 1070 to 1563. We have to consider that the total amount of different entities to the controls is higher in patients with prognathic mandible (7364) because of their strong genetic controlled development compared with that in patients with retrognathic mandible (4126), which is more environmentally influenced.It can be concluded that function follows form after surgical change with high inheritance. In retrognathic patients the adaptation could be delayed or the capacity of regeneration potential is not sufficient.

Feasibility of eliciting the H reflex in the masseter muscle in patients under general anesthesia.

To explore the feasibility of eliciting the brainstem H reflex in the masseter muscle in patients under general anesthesia. We electrically stimulated the masseteric nerve, a branch of the trigeminal nerve, and recorded ipsilateral masseteric and temporalis muscle responses. We tested eight patients who presented with trigeminal neuralgia; one patient had a temporal bone tumor and one patient had a brainstem arteriovenous malformation. All responses were elicited when patients were under general anesthesia and before the initiation of surgery. The H reflex in the masseter muscle was reliably elicited in 70% of the patients. The reflexes met the usual criteria for the H reflex because they were elicited below the threshold of the direct M response, and their amplitudes decreased when the M response increased with stronger stimuli. The mean onset latencies of the masseter H reflex and the M response were 5.4±1.3ms and 2.6±0.6ms, respectively. In the present study, we provide evidence of the feasibility of eliciting the H reflex in the masseter muscles of patients under general anesthesia. The H reflex of the masseter muscle may represent a new method available for intraoperative monitoring. Specifically, this method may be important for the monitoring of brainstem functional integrity, particularly in the midbrain and mid-pons, in addition to the trigeminal nerve path.

Morphofunctional compensation of masseter muscles in unilateral posterior crossbite patients.

Unilateral posterior crossbite is a widespread, asymmetric malocclusion characterized by an inverse relationship of the upper and lower buccal dental cusps, in the molar and premolar regions, on one side only of the dental arch. Patients with unilateral posterior crossbite exhibit an altered chewing cycles and the crossbite side masseter results to be less active with respect to the contralateral one. Few studies about morphological features of masticatory muscle in malocclusion disorders exist and most of these have been performed on animal models. The aim of the present study was to evaluate morphological and protein expression characteristics of masseter muscles in patients affected by unilateral posterior crossbite, by histological and immunofluorescence techniques. We have used antibody against PAX-7, marker of satellite cells, and against α-, β-, γ-, δ-, ε- and ζ-sarcoglycans which are transmembrane glycoproteins involved in sarcolemma stabilization. By statistical analysis we have evaluated differences in amount of myonucley between contralateral and ipsilateral side. Results have shown: i) altered fibers morphology and atrophy of ipsilateral muscle if compared to the contralateral one; ii) higher number of myonuclei and PAX-7 positive cells in contralateral side than ipsilateral one; iii) higher pattern of fluorescence for all tested sarcoglycans in contralateral side than ipsilateral one. Results show that in unilateral posterior crossbite hypertrophic response of contralateral masseter and atrophic events in ipsilateral masseter take place; by that, in unilateral posterior crossbite malocclusion masticatory muscles modify their morphology depending on the function. That could be relevant in understanding and healing of malocclusion disorders; in fact, the altered balance about structure and function between ipsilateral and contralateral muscles could, long-term, lead and/ or worsen skeletal asymmetries.

The Internal Geometry of the Masseter Muscle: A 3D Map to Guide in Vivo Ultrasound

Masticatory muscle disorders (MMDs), a subcategory of temporomandibular disorders (TMDs), are often associated with acute and chronic muscle pain, which limits the range of mandibular motion. The masseter muscle (MM), is a muscle of mastication associated with TMDs, and ultrasonography (US) has been used previously to examine it in patients with and without TMDs. For example, Ariji et al. (2004) found that compared to normal subjects, the MMs of patients with MMD were thicker, and showed indications of changed internal morphology. The intramuscular echogenic bands showed reduced or absent echogenicity in patients with MMD, suggesting changes in the internal fascia/tendon complex and/or the effects of intramuscular edema on the US images. Ultrasound can provide clinicians with evidence for the MM’s intramuscular organization, dynamic changes during activation, and muscle pathology, but in order to develop a muscle-specific US protocol, the normal geometry and architecture should be known. Previous anatomical studies of MM are largely descriptive, although its aponeurotic contents and distribution have been quantified via magnetic resonance imaging (Cioffi et al., 2012). No volumetric studies have mapped the MM’s musculo-aponeurotic geometry in 3D however. Therefore, the aim of this studywas to quantify the spatial organization of the muscle’s musculo-aponeurotic components as a basis for developing future US protocols. Eight (5M/3F) formalin-embalmed specimens (average age 74.9 15.9 years) were used. The skin and fascia overlying MM were removed to expose the fiber bundles (FBs) and aponeuroses of the superficial surface of the muscle. Each FB was delineated and digitized at 1-2mm intervals using a MicroScribe Digitizer. The aponeuroses and bony attachment sites were also digitized. Following digitization, the aponeuroses and FBs were removed to reveal the next layer. This process of dissection and digitization was repeated throughout the muscle volume. The data were reconstructed into 3D models using Autodesk Maya . The 3D model of each specimen was used to determine the relationship of the FBs and aponeuroses. The digitized data were used to quantify muscle architectural parameters: fiber-bundle length (FBL), pennation angle (PA), muscle volume (MV), and physiological cross-sectional area (PCSA). The muscle geometry and architectural parameters were compared between muscles.

Frequency of Obstructive Sleep Apnea Syndrome in Dental Patients with Tooth Wear

To estimate the frequency of obstructive sleep apnea syndrome (OSAS) in dental patients with tooth wear, and to assess the role of dentists in the identification of patients at risk of OSAS. Dental patients with tooth wear and treated with occlusal splint were prospectively recruited to perform sleep study. The severity of tooth wear was established by the treating dentist before patient referral to sleep disorders unit. Sleep questionnaires, anthropometric measurements, and validated respiratory polygraphy were performed. All patients with dental wear were offered a sleepiness analysis. Of 31 recruited patients, 30 (77% males) participated in this study. Patients' mean age was 58.5 ± 10.7 years (range: 35-90 years) and the body mass index was 27.9 ± 3.4 kg/m(2). Tooth wear was mild in 13 patients, moderate in 8 and severe in 9. The mean apnea-hypopnea index (AHI) was 32.4 ± 24.9. AHI < 5 was reported in 2 patients, AHI of 5-29 in 17, and AHI ≥ 30 in 11. A statistically significant association was found between AHI severity and tooth wear severity (Spearman R = 0.505; p = 0.004). Tooth wear could be a tool to identify those patients at risk of having OSAS. This highlights the importance of dental professionals to identify and refer patients with OSAS.

The electrical activity of the temporal and masseter muscles in patients with TMD and unilateral posterior crossbite.

The aim of this study was to assess the influence of unilateral posterior crossbite on the electrical activity of the temporal and masseter muscles in patients with subjective symptoms of temporomandibular dysfunctions (TMD). The sample consisted of 50 patients (22 female and 28 male) aged 18.4 to 26.3 years (mean 20.84, SD 1.14) with subjective symptoms of TMD and unilateral posterior crossbite malocclusion and 100 patients without subjective symptoms of TMD and malocclusion (54 female and 46 male) aged between 18.4 and 28.7 years (mean 21.42, SD 1.06). The anamnestic interviews were conducted according to a three-point anamnestic index of temporomandibular dysfunction (Ai). Electromyographical (EMG) recordings were performed using a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany). Recordings were carried out in the mandibular rest position and during maximum voluntary contraction (MVC). Analysis of the results of the EMG recordings confirmed the influence of unilateral posterior crossbite on variations in spontaneous muscle activity in the mandibular rest position and maximum voluntary contraction. In addition, there was a significant increase in the Asymmetry Index (As) and Torque Coefficient (Tc), responsible for a laterodeviating effect on the mandible caused by unbalanced right and left masseter and temporal muscles.

Muscle fatigue in the temporal and masseter muscles in patients with temporomandibular dysfunction.

The aim of this study is to evaluate muscle fatigue in the temporal and masseter muscles in patients with temporomandibular dysfunction (TMD). Two hundred volunteers aged 19.3 to 27.8 years (mean 21.50, SD 0.97) participated in this study. Electromyographical (EMG) recordings were performed using a DAB-Bluetooth Instrument (Zebris Medical GmbH, Germany). Muscle fatigue was evaluated on the basis of a maximum effort test. The test was performed during a 10-second maximum isometric contraction (MVC) of the jaws. An analysis of changes in the mean power frequency of the two pairs of temporal and masseter muscles (MPF%) revealed significant differences in the groups of patients with varying degrees of temporomandibular disorders according to Di (P < 0.0000). The study showed an increase in the muscle fatigue of the temporal and masseter muscles correlated with the intensity of temporomandibular dysfunction symptoms in patients. The use of surface electromyography in assessing muscle fatigue is an excellent diagnostic tool for identifying patients with temporomandibular dysfunction.

Assessment of cross-sectional thickness and activity of masseter, anterior temporalis and orbicularis oris muscles in oral submucous fibrosis patients and healthy controls: an ultrasonography and electromyography study

Oral submucous fibrosis (OSMF) is an insidious chronic disease that is associated with significant functional morbidity and an increased risk for malignancy. It initially affects the lamina propria of the oral mucosa, and, as the disease progresses, it involves the submucosa and deeper tissue, including muscles of the oral cavity, resulting in loss of fibroelasticity. OSMF is a pre-malignant condition mainly caused by areca nut chewing. The aim of this study was to find out the involvement of muscles of mastication and facial expression in patients with OSMF by assessing the cross-sectional thickness and activity of the masseter, anterior temporalis and orbicularis oris muscles by ultrasonography and electromyography and comparing with healthy controls and also to find out any correlation between the ultrasonographic cross-sectional thicknesses of the masseter, anterior temporalis and orbicularis oris muscles with electromyographic activity. 40 patients with OSMF were included in the study group, and the patients were divided into four groups on the basis of interincisal mouth opening, i.e. Group I (mouth opening >35 mm), Group II (mouth opening between 30 and 35 mm), Group III (mouth opening between 20 and 30 mm) and Group IV (mouth opening <20 mm). Ultrasonographic cross-sectional thickness and electromyographic activity (amplitude and duration) of the masseter, anterior temporalis and orbicualris oris muscles were recorded in patients with OSMF and 20 controls. Intergroup comparison of ultrasonographic cross-sectional thickness and activity (amplitude and duration) was done, and Pearson's correlation coefficient was applied to find out any relation between ultrasonographic and electromyographic findings. Thickness and activity of the masseter muscle was significantly reduced in Group IV (mouth opening <20 mm) when compared with the control group. The anterior temporalis and orbicularis oris muscles remained unaffected. A positive correlation was observed between the thicknesses of the masseter muscle and the amplitude in Groups I, II and III; the anterior temporalis muscle in Group II and the control group; and the orbicularis oris muscle in Groups II, III and IV. It was concluded that, among the muscles studied, there was an early involvement of the masseter muscle in patients with OSMF compared with that of other muscles.

Clinical significance of T2 mapping MRI for the evaluation of masseter muscle pain in patients with temporomandibular joint disorders

Objectives Masticatory muscle pain is one of the typical symptoms of temporomandibular joint disorders (TMD). T2 mapping (distribution of T2 values) is a notable MRI technique for evaluating water contents in tissues. We investigated the clinical significance of T2 mapping for the evaluation of masticator muscle conditions by comparing the difference in the T2 values between the painful and pain-free sides of the masseter muscle in patients with TMD.

Contribution of anti-ryanodine receptor antibody to impairment of excitation–contraction coupling in myasthenia gravis

ObjectiveThe aim of this study was to elucidate the relationship between the impairment of excitation–contraction (E–C) coupling and anti-ryanodine receptor (RyR) antibody in patients with myasthenia gravis (MG). MethodsMasseteric compound muscle action potential (CMAP) and mandibular movement-related potentials (MRPs) were recorded simultaneously after stimulating the trigeminal motor nerve with a needle electrode. The E–C coupling time (ECCT) was calculated as the latency difference between CMAP and MRP. For each patient, we selected a representative data set when there was no abnormal decrement in response to repetitive nerve stimulation. The 26 data sets were divided into an anti-RyR-positive group (n=12) and an anti-RyR-negative group (n=14). ResultsMasseteric ECCT was significantly longer (p=0.017) in anti-RyR-positive group (median, mean, range; 3.6, 3.8, 3.0–5.9ms) than in anti-RyR-negative group (3.1, 3.1, 2.7–4.0) although there were no significant differences in masseteric CMAP amplitude and % decrement between the two groups. The bite force was significantly lower in anti-RyR-positive group than in normal controls. ConclusionsPresence of anti-RyR antibodies is associated with significantly prolonged masseteric ECCT compared to absence of the antibodies in MG. SignificanceAnti-RyR antibody contributes to E–C coupling impairment in the masseter muscle in patients with MG.

Ultrasonographic Evaluation of Inflammatory Changes in the Masseter Muscle

Objectives: To evaluate the efficacy of ultrasonography in diagnosing inflammatory changes of masseter muscle in patients having facial cellulitis or abscess clinically. Materials and methods: A total of 20 patients diagnosed clinically as having unilateral cellulitis or abscess of massetric region were selected and subjected to ultrasonography (Medison SA 9900 ultrasonographic machine) for evaluating thickness of masseter muscle on affected and the normal contralateral side of patient. Results: The mean thickness of masseter muscle on affected side was 1.5295, whereas on unaffected side was 1.1745, which clearly shows an increase in thickness of muscle on affected side. Conclusion: Trismus, resultant of soft tissue infections requires different treatment modalities according to the etiology. Thus, a potent diagnostic tool which can minimize the dilemma regarding the treatment selection is warranted. These findings highlight the significance of ultrasonography as important diagnostic tool to rule out the involvement of masseter muscle in inflammatory swelling of facial region.

Highlights of Archives of Facial Plastic Surgery

Archives of Facial Plastic SurgeryVol. 13, No. 5 Free AccessHighlights of Archives of Facial Plastic SurgeryPublished Online:1 Sep 2011AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail Evaluation of Dynamic Morphological Changes in Masseter Muscle in Patients Undergoing Mandibular Angle Sagittal Split OsteotomyGang Chai, MD, PhD, and colleagues use computed tomography (CT) to evaluate morphological dynamic changes of masseter muscle after mandibular angle sagittal split osteotomy (MASO). MASO aims to change a square face to a slender, more feminine face. Although this procedure has a known effect on masseter bulk, the authors aim to determine how the muscle changes and to quantify the degree of change over time to better predict long-term outcome. Using 3-dimensional reconstructions of CT scans, they found a progressive decrease in masseter volume over 18 months. They also found that the highest loss of volume is in the inferior aspect of the muscle.See page 301Toward Personalized Nasal Surgery Using Computational Fluid DynamicsJohn S. Rhee, MD, MPH, and colleagues use computational fluiddynamics (CFD) and virtual surgery (VS) to assess functional outcomes of nasal surgery. They generated 3-dimensional models of the nasal airway using presurgical and postsurgical computed tomographic images, which they then digitally altered to generate different changes in the nasal anatomy. When comparing these models with presurgical images, they found that the postsurgical CFD analysis on all VS models predicted similar reduction in overall nasal resistance, as well as more balanced airflow distribution between sides. However, inferior turbinate reduction alone produced little positive change. This may be a helpful tool to enable surgeons to predict how much a patient may benefit from nasal surgery.See page 305Evaluation of the Midforehead Brow-lift OperationBenjamin Powell, MD, and colleagues present a retrospective review of 21 patients who underwent midforehead brow-lift for brow ptosis with follow-up of at least 6 months. They used 4 independent evaluators to compare preoperative and postoperative photographs for brow symmetry, elevation, incision scar, and overall appearance. The evaluators were plastic surgeons and laypeople. They found that the midforehead brow-lift offered excellent aesthetic results in all patients, without any of the patients receiving the lowest score of “poor” results. They also present a review of the literature.See page 337Comprehensive Analysis of the Anterolateral Thigh Flap Vascular AnatomyRahul Seth, MD, and colleagues present a detailed characterization of the anterolateral thigh microvascular free tissue flap, which has become a frequently used free flap for head and neck reconstruction. While this has been studied in Asian populations, there is a lack of comprehensive analysis of anthropomorphic parameters of this flap in the Western population. They assessed computerized tomography angiograms of 196 lower extremities for volumetric characteristics and vascular anatomical variations. They found a degree of predictability in both the vasculature and thickness, and the details of their study can be helpful to the reconstructive surgeon.See page 347Escapando de la Crítica (Escaping Criticism) by Pere Borrell del Caso (1835-1910).See page 368This issue's Highlights were written by Richard A. Zoumalan, MD.FiguresReferencesRelatedDetails Volume 13Issue 5Sep 2011 InformationCopyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Highlights of Archives of Facial Plastic Surgery.Archives of Facial Plastic Surgery.Sep 2011.299-299.http://doi.org/10.1001/archfaci.2011.59Published in Volume: 13 Issue 5: September 1, 2011PDF download