Temporal Fossa Research Articles

The structural features of the sculls of animals of a series of Carnivore

Predators is medium-sized and large mammal leading a terrestrial way of life. They are mostly carnivorous animals, the nature of nutrition of which indicate certain devices are reflected in the structure of the scull. The aim of the work is to conduct a comparative anatomical study of the structure of the scull and to determine the craniometric indicators in animals of families Feline (Domestic cat), Canine (Domestic dog, Wolf, Fox ordinary) and Mustelidae (stone marten, forest polecat, badger ordinary) a squad of Carnivore. Comparative anatomical, craniological and statistical methods of research were used. It was found that the scull of test animals is of a General anatomical structure (wide temporal fossa, a deep masseteric fossa, well-defined nuchal and external sagittal crests, the presence of angular process on mandible, relatively large tympanic bullas, underdeveloped lacrimal bone) and species differences (topography of split of the external sagittal crest, shape of mandibular angular process, the presence of intratympanical part of the temporal bone). Absolute craniometrical indices of badger more of indicators of marten, since they directly depend on the weight and body size of these animals. There are most vary the overall length of the scull (1.69 times; P < 0.001), length of bony palate (1.82 times; P < 0.001), length of the external sagittal crest (3.67 times; P < 0.001), width of bony palate at the level of the first premolar and the last molar (2.33 times; P < 0.001), width of choans on the level of hook-shaped processes of pterygoid bone (1.75 times; P < 0.01), width of choans at the level of the caudal edge of the Palatine bone (2 times; P < 0.05), the total height of the scull (2.36 times; P < 0.001). Most of the relative craniometric indicators of the badger scull, compared with such in martens, are almost the same, due to the close specificity of nutrition and environmental characteristics in natural biocenosis. Due to the well-developed external sagittal crest, the height of the brain relative to the total height of the scull in badger (61.02 ± 4.73%) is 1.51 times less (P < 0.001) than in marten (92 ± 6.12%). The relative length of the external sagittal crest to the total length of the badger scull is 2.17 times longer (P < 0.001) (53.1 ± 3.09 versus 24.42 ± 1.41%), compared with marten, due to the more powerful development of masticatory muscles, temporal in particular.

Reliability of 3D dental and skeletal landmarks on CBCT images.

To quantify reliability of three-dimensional skeletal landmarks and a comprehensive set of dental landmarks in cone-beam computed tomography (CBCT) and to determine the shapes of envelope of error. Three judges located 31 skeletal landmarks and 60 dental landmarks on the pre- and posttreatment CBCT images of 22 patients. Landmark error was determined by calculating the distance of deviation of landmark locations around their average. Standard deviation and mean radial spherical error were calculated. Scatterplots were constructed to characterize envelope of error. The midline landmarks of the cranial base were highly reliable. Bilateral skeletal landmarks tended to have larger error than midline landmarks. Among the nonconventional landmarks, fronto-zygomatic suture, condyle, and mental foramen showed relatively high reliability. However, foramen spinosum and temporal fossa showed larger errors. Gonion was the least reliable landmark. Most dental landmarks were located more reliably than skeletal landmarks. The highest reliability was found at incisal edges. Mesiobuccal cusp of first molars also showed high reliability. There were differences in the size and shape of the distributions of errors of different landmarks. Most landmarks showed elongated envelopes. Bilateral structures tended to show greater errors than midline structures. Most dental landmarks were more reliable than skeletal landmarks.

Extirpation of primary malignancies in the pterygopalatine and infratemporal fossa via modified maxillary swing approach

Five patients with primary malignancies in the pterygopalatine fossa (PPF) and infra temporal fossa (ITF) were enrolled in this retrospective study between January 2012 and January 2018. After malignancies proven by biopsy and evaluation with CT and MRI scan, all patients received modified maxillary swing (MMS) approach for extirpation of malignant tumors in the PPF and ITF under general anesthesia. En bloc resection with wide surgical margins was successfully performed in all cases. Negative margins were observed in 4 cases and positive margins were found in one patient with adenoid cystic carcinoma who received postoperative radiotherapy. The most common complication was facial numbness. During the follow-up period (range 12 to 57 months), one patient suffered from recurrence while others did not. The advantages of MMS include wide surgical field, full exposure and easy manipulation. The MMS approach is expected to become an standard method for monobloc resection of malignancies in the PPF and ITF.

Microsurgical Resection of a Ventral Pontine Cavernoma via Supratrigeminal Zone by Anterior Transpetrosal Approach: 2-Dimensional Operative Video.

Brainstem cavernomas with recurrent bleeding and gradual neurological deterioration should be considered an indication for surgical treatment. However, surgery is challenging for cavernous hemangiomas located in the ventral part of the pons. In such cases, safe surgical access to the brainstem is limited and obtaining a good surgical field, regardless of the approach selected, is often difficult. Here, we show a 73-year-old man with a history of 3 episodes of intracranial bleeding associated with a cavernous hemangioma located in the right ventral pons. The hemangioma was removed via the supratrigeminal zone of the brainstem using an anterior transpetrosal approach (ATPA). ATPA was first described in 1985 for upper petroclival lesions by Kawase T.1 This approach requires epidural subtemporal procedures to expose the petrous apex adequately. The petrous apex must be totally resected and the dura of the temporal lobe and posterior fossa is then cut to ligate the superior petrosal sinus and tentorium. In this procedure, the most important things are to preserve the internal carotid artery (C2 segment) and greater superficial petrosal nerve (GSPN). To identify the GSPN, facial nerve integrity monitor (Medtronic Inc, Dublin, Ireland) is very useful. In the extradural bone removal, Sonopet Ultrasonic Aspirator (Stryker Ltd, Portage, Michigan) is a very excellent surgical tool for avoiding the injury of the internal carotid artery. As demonstrated by Cavalcanti DD2, ATPA is particularly useful for accessing lesions located in the upper ventral pons via the supratrigeminal zone because it provides a wide and shallow surgical field above the trigeminal nerve without requiring retraction of the cerebellum. We received written informed consent from the patient for this publication.

The endoscopic transpterional port approach: anatomy, technique, and initial clinical experience.

The evolution of microsurgical and endoscopic techniques has allowed the development of less invasive transcranial approaches. The authors describe a purely endoscopic transpterional port craniotomy to access lesions involving the cavernous sinus and the anterolateral skull base. Through single- or dual-port incisions and with direct endoscopic visualization, the authors performed an endoscopic transpterional port approach (ETPA) using a 4-mm straight endoscope in 8 sides of 4 formalin-fixed cadaveric heads injected with colored latex. A main working port incision is made just below the superior temporal line and behind the hairline. An optional 0.5- to 1-cm second skin port incision is made on the lateral supraorbital region, allowing multiangle endoscopic visualization and maneuverability. A 1.5- to 2-cm craniotomy centered over the pterion is done through the main port, which allows an extradural exposure of the cavernous sinus region and extra/intradural exposure of the frontal and temporal cranial fossae. The authors present a pilot surgical series of 17 ETPA procedures and analyze the surgical indications and clinical outcomes retrospectively. The initial stage of this work on cadavers provided familiarity with the technique, standardized its steps, and showed its anatomical limits. The clinical ETPA was applied to gain access into the cavernous sinus, as well as for aneurysm clipping and meningioma resection. Overall, perioperative complications occurred in 1 patient (6%), there was no mortality, and at last follow-up all patients had a modified Rankin Scale score of 0 or 1. The ETPA provides a less invasive, focused, and direct route to the cavernous sinus, and to the frontal and temporal cranial fossae, and it is feasible in clinical practice for selected indications with good results.

Ludwig Angina in Pregnancy: Treatment Outcome in 12 Patients and Review of Literature

Ludwig angina is a rare but severe life-threatening cellulitis, classically of odontogenic origin, characterized by an extensive and a rapidly progressive inflammation of subcutaneous tissue of the face and severe systemic toxicity. Its prognosis is potentially worse in pregnancy given the higher vulnerability of both mother and fetus to infection and to the consequences of therapies. Early diagnosis and timely treatment are of paramount importance in the prognosis of this condition but could be however challenging as it is infrequently observed in current daily practice. Moreover, literature dealing with Ludwig’s angina in pregnancy is scarce, consisting mostly in isolated case reports from developed countries. The aim of this article was to improve awareness on Ludwig angina in pregnancy through a report of experience in 12 patients and a literature review on the diagnosis and treatment of this clinical entity. To this end, medical records of 12 patients with Ludwig angina in pregnancy were analysed retrospectively and the diagnosis and treatment approaches discussed through a literature review. Age of pregnancy ranged from 27 to 37 weeks. In all the patients, the cellulitis origin was a carious molar of the mandible. The infection spread extended to the neck (4 patients), the thorax (3 patients) and the temporal fossa (2 patients). One patient presented with necrotizing fasciitis extending from the submandibular and submental regions to the thorax. Bacteriological examination of pus which was possible and successful in 4 patients only, showed staphylococcus aureus (2 patients) staphylococcus SP (1 patient) and staphylococcus epidermidis (1 patient). Death occurred in 2 mothers and in 7 fetus giving mortality rates of 16.7% and 58.3% respectively. Direct causes of death in mothers were sepsis shock and air way compromise. In 6 out of the 7 mothers who had dead fetus, the infection extended beyond the mouth floor. Oral health care providers should be aware for proper treatment of dental infections. They should also be alert for early recognition and multidisciplinary treatment of Ludwig angina in pregnancy in collaboration with obstetricians, specialists of intensive care and infectious diseases.

The generic taxonomy of the Australian Magpie and Australo-Papuan butcherbirds is not all black-and-white

Summary. Recent phylogenetic analyses showing that Australian Magpie and Black Butcherbird are sister taxa and together comprise the sister group of other Australo-Papuan butcherbirds have justified an expanded Cracticus. This treatment reflects earlier arguments that Australian Magpie's distinctive traits are simply adaptations to terrestrialism and not a sound basis for recognition of a monotypic Gymnorhina. Acknowledging the expediency of a broad Cracticus, we reviewed data from anatomy, plumage, nidification and voice to reassess the optimal number of genera for the group, in particular whether Melloria is warranted for Black Butcherbird. Australian Magpie has multiple unique traits, including many without obvious adaptive significance for terrestrial foraging or open habitat. It shares with Black Butcherbird glossy black plumage, long tarsus and deep temporal fossa, and short currawong-like calls. Black Butcherbird's rounded wing is possibly adaptive for closed-forest habitats. We recommend use of Gy...

The cranio-mandibular complex of the nightjar Systellura longirostris (Aves, Caprimulgiformes): functional relationship between osteology, myology and feeding

Here we address the morphology of the cranial musculoskeletal in the South American Band-winged nightjar (Systellura longirostris, Caprimulgiformes, Aves) with the focus upon in how the mouth closure and opening mechanism is. Bony characters such as the thinness of the interorbital septum and the reduction of the postorbital process co-assist the location of large eyes, although correlations between eye size brain mass and body mass revealed that the Band-winged nightjar’s eye is bigger than expected. The reduction of the processus orbitalis of the os quadratum would allow the great mouth opening given by a large maxillary protraction. Systellura longirostris shows a zona flexoria intramandibularis with marked reduction in bone ossification that helps to the lateral opening of the jaws. In Systellura longirostris, the m. pseudotemporalis profundus, m. adductor mandibulae externus superficialis, and m. adductor mandibulae externus medialis are absent. The adductor muscles represent 66.614% of the total mandibular muscle mass. Physiological Cross Sectional Area (PCSA) values of the adductor muscles are high and the fibers are relatively long compared to other zoophagous birds, another condition that favors adduction. The m. adductor mandibulae externus profundus is the largest jaw muscle regarding its mass but its osteological correlate on the neurocranium, the fossa temporalis, is absent. In the absence of some muscles in charge of the bill closing, an elastic instability model for jaw closing is proposed.

Dosimetric Comparison of Proton Radiation Therapy, Volumetric Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy Based on Intracranial Tumor Location.

(1) Background: Selecting patients that will benefit the most from proton radiotherapy (PRT) is of major importance. This study sought to assess dose reductions to numerous organs-at-risk (OARs) with PRT, as compared to three-dimensional conformal radiotherapy (3DCRT) and volumetric-modulated arc therapy (VMAT), as a function of tumor location. (2) Materials/Methods: Patients with intracranial neoplasms (all treated with PRT) were stratified into five location-based groups (frontal, suprasellar, temporal, parietal, posterior cranial fossa; n = 10 per group). Each patient was re-planned for 3DCRT and intensity-modulated radiotherapy (IMRT) using similar methodology, including the originally planned target and organ-at-risk (OAR) dose constraints. (3) Results: In parietal tumors, PRT showed the most pronounced dose reductions. PRT lowered doses to nearly every OAR, most notably the optical system and several contralateral structures (subventricular zone, thalamus, hippocampus). For frontal lobe cases, the greatest relative dose reductions in mean dose (Dmean) with PRT were to the infratentorial normal brain, contralateral hippocampus, brainstem, pituitary gland and contralateral optic nerve. For suprasellar lesions, PRT afforded the greatest relative Dmean reductions to the infratentorial brain, supratentorial brain, and the whole brain. Similar results could be observed in temporal and posterior cranial fossa disease. (4) Conclusions: The effectiveness and degree of PRT dose-sparing to various OARs depends on intracranial tumor location. These data will help to refine selection of patients receiving PRT, cost-effectiveness, and future clinical toxicity assessment.

Post-Neurosurgical Temporal Deformities: Various Techniques for Correction and Associated Complications.

An irregular craniofacial contour along the temporal fossa, known commonly as 'temporal hollowing deformity,' (THD) can arise from multiple etiologies. In fact, up to half of all patients who undergo neurosurgical pterional dissections develop some form of temporal contour deformities. Unfortunately, temporal hollowing correction remains surgically challenging with many techniques resulting in high rates of failure and/or morbidity. Herein, we describe anatomy contributing to postsurgical temporal deformity as well as time-tested prevention and surgical correction techniques. In addition, a review of 25 articles summarizing various techniques and complication profiles associated with temporal hollowing correction are presented. Complications included infection, implant malposition, revision surgery, pain, and implant removal because of implant-related complications Augmentation with either autologous fat or dermal filler is associated with the highest number of reported complications, including catastrophic events such as stroke, pulmonary embolism, and death. No such complications were reported with use of alloplastic material, use of autologous bone, or free tissue transfer. Furthermore, careful attention to adequate temporalis muscle resuspension and position remain paramount for stable restoration of craniofacial symmetry. Catastrophic complications were associated with injection augmentation of both fat and dermal filler in the temporal region. In contrast, use of alloplastic materials was not found to be associated with any catastrophic complications. As such, for the most severe cases of THD, we prefer to employ alloplastic reconstruction.

An unusual journey of a periocular date palm thorn

An 8-year-old boy presented with a left lower lid swelling of one month duration. His parents gave a history of date palm thorn injury on left side of the forehead three months back which was removed partially by a local doctor. On examination, there was a left infraorbital swelling with diffuse oedema of the left sided cheek and temporal fossa. A scar mark (entry wound) was detected over the left eyebrow. Three-D configuration of contrast enhanced computed tomography (CECT) of the orbit showed a linear foreign body behind the zygomatic bone. The lower lid mass was excised, the date palm thorn was recovered from a pocket behind the zygomatic bone. Histopathology of the excised mass showed presence of granulation tissue. We describe the management of such a rare case along with review of literature.

Hémangioendothéliome intra-orbitaire et intracrânien : à propos d’un cas pédiatrique

Introduction Epithelioid hemangioendothelioma (EHE) is a rare tumor of intermediate malignancy. Observation We report a case of intracranial and intraorbitar EHE. A 3-year-old girl presented with a 3-month history of progressive left exophthalmia. Neuroradiologic imaging (CT scan and MRI) showed an intraorbitar process with an intense enhancement extending to temporal fossa, ethmoidal bone, nasal fossa, maxillary sinus and cavernous sinus. The angiogram was normal. The tumor was operated through subfrontal approach but only a partial resection was performed. The histological diagnosis was epithelioid hemangioendothelioma. The patient was neurologically intact 2 months after surgery without exophtalmia. However 4 months after surgery, he displayed a fall of the right eye vision with intense headache. Control CT scan showed persistence of important tumoral residue. Discussion–conclusion Epithelioid hemangioendothelioma is a hemorrhagic tumor. Total removal must be possible. Otherwise, we recommend a complementary chemoradiotherapy and close follow-up. We propose this interesting case history of a tragical evolution of EHE in contradiction with what has already been reported.

Neuromandibular integration in humans and chimpanzees: Implications for dental and mandibular reduction in Homo.

Although the evolution of the hominin masticatory apparatus has been linked to diet and food processing, the physical connection between neurocranium and lower jaw suggests a role of encephalization in the trend of dental and mandibular reduction. Here, the hypothesis that tooth size and mandibular robusticity are influenced by morphological changes in the neurocranium was tested. Three-dimensional landmarks, alveolar lengths, and mandibular robusticity data were recorded on a sample of chimpanzee and human skulls. The morphological integration between the neurocranium and the lower jaw was analyzed by means of Singular Warps Analysis. Redundancy Analysis was performed to understand if the pattern of neuromandibular integration affects tooth size and mandibular robusticity. There is significant morphological covariation between neurocranium and lower jaw in both chimpanzees and humans. In humans, changes in the temporal fossa seem to produce alterations of the relative orientation of jaw parts, while the influence of similar neurocranial changes in chimpanzees are more localized. In both species, postcanine alveolar lengths and mandibular robusticity are associated with shape changes of the temporal fossa. The results of this study support the hypothesis that the neurocranium is able to affect the evolution and development of the lower jaw, although most likely through functional integration of mandible, teeth, and muscles within the masticatory apparatus. This study highlights the relative influence of structural constraints and adaptive factors in the evolution of the human skull.

Clinical Presentation and Anatomical Location of Orbital Plasmacytomas.

To evaluate the clinical and anatomical location of orbital plasmacytomas and assess local control following therapy. The American Society of Ophthalmic Plastic and Reconstructive Surgery Oncology Database was queried to identify patients diagnosed with orbital plasmacytoma. These patients' records were reviewed for demographic characteristics, clinical and radiologic findings, treatments, and outcomes. Thirty patients from 4 institutions (24 from MD Anderson Cancer Center, 3 from SUNY Downstate Medical Center, 2 from University of California, Los Angeles, and 1 from Oregon Health and Science University) were identified. Eighteen patients (60%) were diagnosed with multiple myeloma (MM) before and 11 (37%) were diagnosed with MM immediately after orbital plasmacytoma. Based on imaging, 4 distinct anatomical patterns were identified: 1) bony plasmacytoma affecting the superotemporal orbit, epidural space, and temporal fossa (15 patients; 50%); 2) discrete orbital plasmacytoma (7 patients; 23%); 3) infiltrative plasmacytoma either originating from a sinus (4 patients; 13%); or 4) originating from the orbital floor and infiltrating facial soft tissue (4 patients; 13%). Of the 29 patients with available treatment data, 2 had radiation only, 3 had chemotherapy only, 6 had chemoradiation, and 18 had stem cell transplant following chemoradiation (n = 17) or only chemotherapy (n = 1). Following treatment, 10 patients achieved complete and 11 achieved partial responses. Orbital plasmacytomas were found exclusively in patients with MM diagnosed before or immediately after orbital plasmacytoma. Plasmacytomas can have 4 distinct anatomical patterns of origin. Following treatment, all patients had good to excellent local control of their orbital lesions.

Endoscopic Endonasal Approach to the Anteromedial Temporal Fossa and Mobilization of the Lateral Wall of the Cavernous Sinus Through the Inferior Orbital Fissure and V1-V2 Corridor: An Anatomic Study and Clinical Considerations

The aim of this study was to identify key anatomic landmarks useful in gaining access to the anteromedial temporal region via the corridor formed by the inferior orbital fissure (IOF), the ophthalmic branch of thetrigeminal nerve (V1), and the maxillary branch of the trigeminal nerve (V2) via an endoscopic endonasal approach (EEA). An anatomic dissection of 6 cadaver heads was performed to confirm the feasibility and applicability of an EEA for accessing the anteromedial temporal region. After middle turbinectomy, the lateral recess of the sphenoid sinus was opened, the orbital apex was exposed, and the posterior wall of the maxillary sinus was removed, in sequence. The IOF and the pterygopalatine fossa (PPF) were then identified. After opening the foramen rotundum (FR) and removing the bony structure between the FR, V2 was transposed downward. The orbital muscle of Müller was removed. The PPF was mobilized downward exposing the greater wing of the sphenoid bone (GWS). The GWS between V1 and V2 was drilled, therefore exposing the temporal dura. With blunt dissection, the medial temporal dura was peeled away from the cavernous sinus to increase access to the anteromedial temporal region. The anteromedial temporal fossa was exposed by drilling the V1-V2 triangle corridor via an EEA. Endoscopic endonasal exposure of the anteromedial temporal fossa is feasible and requires limited endonasal work. This approach may be considered as an alternate surgical corridor to the temporomesial lobe that offers the advantages of a direct route with less temporal lobe retraction.

Temporomandibular joint regeneration: proposal of a novel treatment for condylar resorption after orthognathic surgery using transplantation of autologous nasal septum chondrocytes, and the first human case report

BackgroundUpon orthognathic mandibular advancement surgery the adjacent soft tissues can displace the distal bone segment and increase the load on the temporomandibular joint causing loss of its integrity. Remodeling of the condyle and temporal fossa with destruction of condylar cartilage and subchondral bone leads to postsurgical condylar resorption, with arthralgia and functional limitations. Patients with severe lesions are refractory to conservative treatments, leading to more invasive therapies that range from simple arthrocentesis to open surgery and prosthesis. Although aggressive and with a high risk for the patient, surgical invasive treatments are not always efficient in managing the degenerative lesions.MethodsWe propose a regenerative medicine approach using in-vitro expanded autologous cells from nasal septum applied to the first proof-of-concept patient. After the required quality controls, the cells were injected into each joint by arthrocentesis. Results were monitored by functional assays and image analysis using computed tomography.ResultsThe cell injection fully reverted the condylar resorption, leading to functional and structural regeneration after 6 months. Computed tomography images showed new cortical bone formation filling the former cavity space, and a partial recovery of condylar and temporal bones. The superposition of the condyle models showed the regeneration of the bone defect, reconstructing the condyle original form.ConclusionsWe propose a new treatment of condylar resorption subsequent to orthognathic surgery, presently treated only by alloplastic total joint replacement. We propose an intra-articular injection of autologous in-vitro expanded cells from the nasal septum. The proof-of-concept treatment of a selected patient that had no alternative therapeutic proposal has given promising results, reaching full regeneration of both the condylar cartilage and bone at 6 months after the therapy, which was fully maintained after 1 year. This first case is being followed by inclusion of new patients with a similar pathological profile to complete an ongoing stage I/II study.Trial registrationThis clinical trial is approved by the National Commission of Ethics in Medical Research (CONEP), Brazil, CAAE 12484813.0.0000.5245, and retrospectively registered in the Brazilian National Clinical Trials Registry and in the USA Clinical Trials Registry under the Universal Trial Number (UTN) U1111–1194-6997.

Cranial morphology of the Early Cretaceous bird Confuciusornis

ABSTRACTConfuciusornis sanctus has been heralded as a bird with an ancestrally diapsid skull, although this does not match its phylogenetic position as determined by other skeletal features. Based on 13 cranial specimens in European collections, we demonstrate that the observed scaffolding in the temporal region is highly derived and comparable to some of 21–23 cases of secondary bridges across the temporal fossa that evolved in modern birds. In Confuciusornis, the temporal fossa is crossed by a secondary temporal bar (absent in Eoconfuciusornis) that is continuous with the braincase but discontinuous with the postorbital process. A small postorbital bone (if present) is covered by this secondary ossification. The postorbital process is continuous with a prominent supraorbital rim and extends to the jugal as in sally-striking birds, including some Podargidae (Podargus), Leptosomidae, Brachypteraciidae, Coraciidae, Bucconidae, and Galbulidae, which tend to have wide gapes, large jaws with deep cranial rostra (and the nasal opening in a caudal position), and require additional attachments of musculus adductor mandibulae externus for fast and powerful snatching of the prey. The best modern analogue for the secondary temporal scaffolding seen in Confuciusornis is provided by Podargus, in which the long postorbital process is propped up by the temporal bar in addition the secondary bridge across the temporal fossa. The cranial evidence identifies Confuciusornis sanctus as a sally-striking predator.Citation for this article: Elzanowski, A., D. S. Peters, and G. Mayr. 2018. Cranial morphology of the Early Cretaceous bird Confuciusornis. Journal of Vertebrate Paleontology. DOI: 10.1080/02724634.2018.1439832.

Pilot Study Examining the Safety and Efficacy of Calcium Hydroxylapatite Filler With Integral Lidocaine Over a 12-Month Period to Correct Temporal Fossa Volume Loss.

Age-related volume loss in the temporal fossae is due to thinning of the epidermis, loss of subcutaneous structural volume, and change in the bony architecture. Temporal concavities are important areas of 3-dimensional volume restoration. The temporal fossae is becoming an increasingly popular area for patients seeking soft tissue augmentation with injectable fillers such as calcium hydroxylapatite with integral lidocaine [CaHA (+)]. This pilot study aims to define the safety, efficacy, technique, and patient-reported outcomes for injectable CaHA (+) to correct volume loss in the temporal fossae over a 12-month period. This was a single-investigator, nonblinded study involving 20 participants. Participants received filler injection into their temporal fossae, with follow-up evaluations at Day 14, 6 weeks, and 3, 6, 9, and 12 months. CaHA (+) results in statistically significant improvement in temporal fossae appearance lasting up to 12 months. Subjects reported "moderate" global aesthetic improvement over the 12-month period. As the cosmetic field continues to advance, it is important for practitioners to have access to research regarding the efficacy and safety of injectables. These results show that CaHA (+) is an effective and safe option to correct temporal fossae volume loss associated with high patient satisfaction.

Laser phototherapy in acute posttraumatic trismus - Case-series study.

There are very few studies on laser phototherapy (LPT) in acute temporomandibular disorders (TMDs). Our objective is to assess the effectiveness of laser phototherapy (LPT) on the limitation of the mouth opening due to an acute mandibular trauma. Fourteen women of 41 ± 3 years and 24 men of 38 ± 3 years, with no history of TMD and having sustained a mandibular trauma within the prior 20 hours, were treated exclusively by using an 810-nm laser beam in a continuous wave mode, with an output power of 1 W. At a speed of 2 cm/s, it scanned twice, for 60 seconds, with a pause in between of 2 minutes, a large cutaneous area (25 cm2), covering the temporomandibular joint (TMJ), the masseter muscle and a part of the temporalis fossa; also, it scanned just once, for 7 seconds, a small mucous area (3 cm2), covering the internal pterygoid muscle. The clinical outcomes were evaluated by comparing the maximum unassisted opening (MUO), measured at the baseline and immediately after the end of the LPT procedure. The MUO improvement of 24.6 ± 4.4 mm represented a highly significant difference (p < .0001) between the measurements, in all the patients, regardless of gender. By scanning with an 810-nm laser beam, within less than 20 hours after the trauma, large areas of all the involved tissues and not just a few points, as described until now, the limited mouth opening in acute posttraumatic trismus was immediately and greatly resolved.

Temporal Fossa Abscess Caused by Apical Periodontitis: A Case Report

According to the progress of the antibiotic medicine, the severe infection case is decreasing recently. We recently experienced a case of temporal fossa abscess caused by periapical periodontitis the upper left side of the second molar. A 79-year-old woman visited to Showa University Dental Hospital complaining of the painful swelling at the left side of the temporal and trismus. The routine blood test exhibited a severe inflammation. We performed drainage treatment at temporal skin and normal oral bacterial flora was detected by the bacteriological examination. Under treatment included the administration of antibiotics, the inflammation healed without serious complication and she recovered completely.