Temporalis Research Articles

Empowering Data Sharing in Neuroscience: A Deep Learning De-identification Method for Pediatric Brain MRIs.

Privacy concerns, such as identifiable facial features within brain scans, have hindered the availability of pediatric neuroimaging datasets for research. Consequently, pediatric neuroscience research lags adult counterparts, particularly in rare disease and under-represented populations. The removal of face regions (image defacing) can mitigate this, however existing defacing tools often fail with pediatric cases and diverse image types, leaving a critical gap in data accessibility. Given recent NIH data sharing mandates, novel solutions are a critical need. To develop an AI-powered tool for automatic defacing of pediatric brain MRIs, deep learning methodologies (nnU-Net) were employed using a large, diverse multi-institutional dataset of clinical radiology images. This included multi-parametric MRIs (T1w, T1w-contrast enhanced, T2w, T2w-FLAIR) with 976 total images from 208 brain tumor patients (Children's Brain Tumor Network, CBTN) and 36 clinical control patients (Scans with Limited Imaging Pathology, SLIP) ranging in age from 7 days to 21 years old. Face and ear removal accuracy for withheld testing data was the primary measure of model performance. Potential influences of defacing on downstream research usage were evaluated with standard image processing and AI-based pipelines. Group-level statistical trends were compared between original (non-defaced) and defaced images. Across image types, the model had high accuracy for removing face regions (mean accuracy, 98%; N=98 subjects/392 images), with lower performance for removal of ears (73%). Analysis of global and regional brain measures (SLIP cohort) showed minimal differences between original and defaced outputs (mean r S=0.93, all p < 0.0001). AI-generated whole brain and tumor volumes (CBTN cohort) and temporalis muscle metrics (volume, cross-sectional area, centile scores; SLIP cohort) were not significantly affected by image defacing (all r S>0.9, p<0.0001). The defacing model demonstrates efficacy in removing facial regions across multiple MRI types and exhibits minimal impact on downstream research usage. A software package with the trained model is freely provided for wider use and further development (pediatric-auto-defacer; https://github.com/d3b-center/pediatric-auto-defacer-public). By offering a solution tailored to pediatric cases and multiple MRI sequences, this defacing tool will expedite research efforts and promote broader adoption of data sharing practices within the neuroscience community. AI = artificial intelligence; CBTN = Children's Brain Tumor Network; CSA = cross-sectional area; SLIP = Scans with Limited Imaging Pathology; TMT = temporalis muscle thickness; NIH = National Institute of Health; LH = left hemisphere; RH = right hemisphere.

HE ROLE OF PHYSICAL THERAPY IN MANAGING SYMPTOMS OF TEMPOROMANDIBULAR JOINT DYSFUNCTION SECONDARY TO OSTEOARTHRITIS

The purpose of the study is to evaluate the effectiveness of the physical therapy in managing symptoms of temporomandibular joint dysfunction in patients with osteoarthritis. Materials and methods. 48 people with diagnosis of osteoarthritis of the temporomandibular joints were examined. In Group 1 (23 participants), correction involved wearing customized relieving splints. In addition to splint therapy, Group 2 received a course of physical therapy, which included therapeutic exercises targeting the masticatory muscles, facial muscles, tongue, and anterior neck muscles, as well as a course of transcutaneous electrical nerve stimulation (TENS) using the unipolar method on the masticatory and temporal muscles. The correction period for both groups was 1 month. Outcomes were evaluated using the Hamburg Test, the Helkimo Index, and the Jaw Functional Limitation Scale. Results. After the application of relaxing splints and the implementation of the physical therapy program, the total score of the "Hamburg test" decreased by 39.6% in group 1, and by 59.4% in group 2 (p&lt;0.05). The positive dynamics of the Helkimo index was 34.5% in group 1, 48.6% in group 2 (р&lt;0.05), passing within the parameters of moderate temporomandibular joint dysfunction. When re-evaluating the functional state of the temporomandibular region according to the Jaw Functional Limitation Scale, the improvement of chewing in group 1 was 28.8%, in group 2 – 62.3%, the mobility of the lower jaw was 21.9% and 44.3%, respectively, verbal and emotional communication – 26% and 41.7%, the total score – by 26.2% and 49.6%. The developed program of physical therapy against the background of wearing individual relief splints demonstrated a statistically significantly better effect (p&lt;0.05) on all the studied indicators of the functioning of the orofacial zone compared to the initial data and the results of the group that corrected the dysfunction of the temporomandibular joint with talc splints. Conclusion. Use the means of physical therapy can be recommended to increase the effectiveness of dental orthopedic correction in patients with osteoarthritis of the temporomandibular joint.

The Role of Coronoidectomy in Complex Mandibular Reconstruction With Free Fibular Flap

Introduction: Complex mandibular reconstruction is at risk of postoperative restricted mouth opening. Temporomandibular joint pseudoankylosis can cause significant disability, leading to restricted mouth opening and an inability to create a proper seal with the mouth. Treating this condition often requires aggressive surgical intervention, primarily restoring the structure and functionality of the mandible. Coronoidectomy plays a vital role in improving mouth opening capacity. Case Presentation: Four patients with temporomandibular joint pseudoankylosis were included in this case series. The patients reported being unable to move their remaining lower jaw, having a perpetually open mouth, and constant drooling. All patients had a history of reconstructive surgery due to tumor or malignancy and could only open the mouth less than 10 mm. They underwent coronoidectomy followed by free fibular flap reconstruction. Postoperatively, all 4 patients exhibited a movable mandible and achieved proper occlusion. The maximum mouth opening increased by 25 to 45 mm; all flaps appeared vital, sutures remained intact, and no active bleeding. Discussion: Coronoidectomy is crucial for enhancing the ability to open the mouth. All of the patients underwent a coronoidectomy surgery followed by free fibular flap reconstruction. Immediately after the surgery, the mandibular projection appears nearly symmetrical, the patient opens their mouth, and occlusion is achieved subjectively. From our presented cases, after coronoidectomy, all patients had movable mandibula, and mouth opening was achieved. Coronoid process resection frees the mandible from the temporalis. Coronoidectomy and separation of the temporalis muscle from the mandible have excellent clinical efficacy for improving mouth opening and movement. Conclusion: Coronoidectomy followed by a free fibular flap should be considered the best surgical option for patients with restricted mouth opening after complex mandibular reconstruction.

Variation and distribution in temporalis muscle innervation: A systematic review and meta-analysis of anatomical studies

Variation and distribution in temporalis muscle innervation: A systematic review and meta-analysis of anatomical studies

Correlations Between Mandibular Kinematics and Electromyography During the Masticatory Cycle: An Observational Study by Digital Analysis

The analysis of the masticatory cycle plays a fundamental role in studying the functions of the stomatognathic system and evaluating temporomandibular dysfunctions (TMD). The primary objective of this study is to investigate the complex interplay between mandibular kinematics and surface electromyography (sEMG) activity during the masticatory cycle using advanced 4D dentistry technology in 22 healthy subjects (without TMD). By employing electromyography, it becomes feasible to capture the electrical activity of the masticatory muscles throughout the chewing process. The BTS TMJOINT (© 2023 BTS Bioengineering, Garbagnate Milanese, MI, Italy) electromyograph was utilized in this study. Mandibular tracking, on the other hand, allows for recording the movements of the mandible during chewing and condylar slopes. This latest technology (ModJaw®, Tech in motion™, Villeurbanne, France) utilizes motion sensors placed on the jaw to accurately track three-dimensional movements, including jaw opening, closing, and lateral movements. Nowadays, in clinical gnathology, it is common practice to examine masticatory function by analyzing mandibular kinematics and muscle contraction as distinct entities. Similarly, the results obtained from these analyses are typically assessed independently. The investigation of a correlation between electromyography data and mandibular kinematics during the masticatory cycle could provide several advantages for clinicians in diagnosis and lead to a combined analysis of muscle activities and intraarticular dynamics. In conclusion, it can be inferred from the results obtained in the present study that the chewing cycle with a greater vertical movement results in increased masseter muscular activity, and condylar slopes are positively correlated to an increase in temporalis muscle activation. This comprehensive approach can provide valuable insights into the relationship between muscle activity and mandibular movement, enabling clinicians to gain a deeper understanding of the functional dynamics of the stomatognathic system.

Temporal muscle thickness is not a prognostic predictor in patients with high-grade glioma, an experience at two centers in China.

Temporal muscle thickness (TMT) serves as an indicator of sarcopenia and holds predictive value for various cancers. This study aims to evaluate the prognostic significance of TMT for high-grade glioma patients. A retrospective review of 172 high-grade glioma patients from January 2015 to December 2022 was conducted. TMT value was measured based on contrast-enhanced T1-weighted magnetic resonance images before surgery. Pearson analysis was used to evaluate potential correlations. Cox regression analysis was performed to evaluate overall survival for high-grade glioma patients. In our study, the cutoff value of TMT was determined as 7.4 mm. TMT value was not a significant prognostic predictor for high-grade glioma patients (hazard ratio [HR]: 1.151, 95% confidence interval [CI]: 0.9299-1.424, p = 0.196). World Health Organization (WHO) VI and high body mass index (BMI) value were significantly associated with poorer survival outcomes (HR: 2.6689, 95% CI: 1.5729-4.528, p < 0.001; HR: 1.120, 95% CI: 1.0356-1.211, p = 0.005). TMT did not show a significant association with other factors (p > 0.05). Notably, age demonstrated a significant difference between the thicker and thinner groups (p = 0.019). Our study revealed that WHO grade and BMI demonstrated significant prognostic value for survival outcomes. Consequently, TMT does not appear to be a significant or applicable predictor in patients with high WHO grades.

Biomechanical effects of functional clear aligners on the stomatognathic system in teens with class II malocclusion: a new model through finite element analysis

ObjectivesThe Functional Clear Aligner (FCA) is a novel orthodontic appliance designed for the treatment of Class II malocclusion with mandibular retrognathia in adolescents. The aim of this study was to investigate the biomechanical characteristics of the masticatory muscles, jawbone, and temporomandibular joint (TMJ) during mandibular advancement using either FCA or Class II elastics combined with clear aligner (Class II elastics) through finite element analysis.Materials and methodsA 3D finite element model of the ‘muscle-jawbone-TMJ-appliance’ system was constructed based on CBCT and MRI images of a boy with skeletal Class II malocclusion. Masticatory muscles included masseter, temporal, medial pterygoid, and lateral pterygoid muscles. The TMJ consists of the temporal bone’s glenoid fossa, disc, and mandibular condyle. To observe the biomechanical characteristics of the muscles and TMJ during orthodontic appliance wearing and the retention phase, two different protocols were used: Model 1: The mandibular advancement using FCA; Model 2: The mandibular advancement using Class II elastics.ResultsThe FCA group produced greater and more coordinated masticatory muscle forces compared to the Class II elastics group. Temporal and masseter muscles exhibited the most pronounced variation in muscle strength during mandibular advancement. The FCA group exhibited greater TMJ region stress compared to the Class II elastics group. Interestingly, the stress on the articular discs in both models decreased over time. Tensile stresses were observed in both the condyle and the posterior region of the articular fossa.ConclusionDuring skeletal Class II malocclusion treatment, masticatory muscle forces and stress on the TMJ were higher in the FCA group compared to the Class II elastics group. In both models, stress cushioning was provided by the articular disc.

Comparative analysis of myoelectric activity and mandibular movement in healthy and nonpainful articular temporomandibular disorder subjects.

Temporomandibular disorders (TMDs) are one of the leading causes of craniofacial pain, and a high incidence of TMDs in young adults has been reported. Previous studies have used surface electromyography (sEMG) and mandibular kinematic analysis for TMDs diagnosis. This study aimed to provide normal reference values of sEMG and mandibular kinematics in Han Chinese adults, compare the sex differences and assess their diagnosis value on pain-free articular TMDs. This observational study recruited healthy young adults with individual normal occlusion and nonpainful articular TMDs patients with disc displacement. The sEMG signals of the anterior temporalis (TA), masseter (MM), and sternocleidomastoid and digastric were recorded in the mandibular postural positions (MPP) and during maximal voluntary clenching (MVC) with K7 electromyograph. Mandibular kinematics, including maximum opening and opening/closing velocities, were assessed by K7 kinesiograph. The sEMG reference values ranged from 3.0 to 4.3 µV in the MPP (n = 90) in healthy subjects. The sEMG values during MVC, maximum opening, and opening velocity were significantly higher in males than in females. Also, these indices showed good diagnostic efficiency for pain-free articular TMDs (n = 26). Reference values and sex differences in sEMG and mandibular kinematics in healthy subjects were determined. Compared with them, articular TMDs patients showed significantly lower myoelectric activity during maximal biting and restricted mouth opening range and velocity, which may assist in TMDs diagnosis. By analyzing sEMG of masticatory muscle and mandibular kinematics data from healthy Han Chinese young adults and TMDs patients with disc displacement, this study evaluated the sex difference and their diagnosis value on nonpainful TMDs with disc displacement. NCT06372769.

Inflammation of the temporalis muscle and adjacent nerve tissue in giant cell arteritis: expanding the spectrum of inflammatory lesions.

To investigate the histopathological features of the temporalis muscle (TM) and adjacent nerve tissue in active cranial giant cell arteritis (C-GCA). Temporal artery biopsy (TAB) specimens containing fragments of the TM from patients with active C-GCA fulfilling the 2022 ACR/EULAR classification criteria (n = 11) were assessed by conventional histology and immunohistochemistry in comparison with non-GCA controls (n = 3). Clinical, laboratory and imaging features based on patient charts at time of biopsy were retrospectively recorded. The majority of the studied TAB specimens showed inflammation of the TM (10/11) and adjacent nerve fascicles (7/11) that was characterized by prominent endomysial lymphomonocytic infiltrates, whereas controls showed no inflammatory lesions and no disruption of the local architecture. Association of active C-GCA with sarcolemmal MHC class I (8/8) and MHC class II (6/11) upregulation suggests primary inflammation of the TM in a subset of patients. αB-Crystallin positivity (10/11) highlights areas of pre-necrotic myofibres within the TM. The presence of endomysial fibrosis, signs of atrophy and variations of muscle fibre size suggest a rather longstanding and potentially subclinical process of myoinflammation. Our results expand the spectrum of inflammatory lesions known to be associated with active C-GCA. Specifically, inflammatory infiltration of the TM and adjacent nerve structures could contribute to localized symptoms of the temporomandibular region and may be included in future concepts of pathophysiology.

CORRECTION OF THE SIGNS OF MYOFASCIAL DYSFUNCTION IN PERSONS WITH THE CONSEQUENCES OF FRACTURE OF THE JAW BY MEASURES OF PHYSICAL THERAPY

Purpose: to evaluate the effectiveness of the developed physical therapy program based on the dynamics of myofascial dysfunction parameters of the neck and orofacial area in patients with the consequences of a mandibular fracture. Methods. 77 people were examined. The control group consisted of 32 people without the consequences of injuries of the maxillofacial area and burdened dental status. Group 1 consisted of 24 people who underwent rehabilitation according to the general principles of rehabilitation of patients of the dental profile. Group 2 consisted of 21 people with the consequences of a fracture of the lower jaw, who underwent rehabilitation using therapeutic exercises for the muscles of mastication, face, neck, cervical collar zone, back , shoulder girdle; a course of massage (intraoral and classical) of the masticatory muscles, temporomandibular joint, neck, cervical collar zone; thermal procedures (dry heat) on the area of the temporomandibular joint; postisometric relaxation of masticatory muscles, neck muscles; kinesiological taping of the temporomandibular joint, masticatory muscles, neck; training (education) of the patient (reception of soft food, restriction of wide opening of the mouth, elimination of dental bad habits). Rehabilitation lasted three months. Effectiveness was assessed by complaints, examination results, palpation, measurement of chin-sternum distance, "Hamburg test", manual muscle test. Results. During the re-examination, no such complaints were found in people of group 2, such as complications in swallowing, sound phenomena and pain in the temporomandibular joint, pain in the masticatory muscles, complications in nasal breathing, and pain in the neck. Complications when chewing food were found only in 28.6%, restriction of mouth opening - 28.6%, "uncomfortable" position of the jaw - 9.5%. The psycho-emotional state and sleep improved; corresponding complaints were found in 14.3% and 23.8%. The expression of visual manifestations of dysfunction decreased in both main groups with an advantage in individuals of the group. Pathological palpable changes were not detected in the temporal, masticatory, bifidus and hypoglossal muscles in individuals of group 2. Other changes were detected in a small number of individuals - in the lateral pterygoid in 14.3%, medial pterygoid in 9.5%, sternoclavicular-mammoid in 14.3%, trapezoid in 28.6%. In people of group 2, the distance between the chin and sternum when the neck was bent decreased from 4.82±0.42 cm to 2.16±0.23 cm (p&lt;0.05). The decrease in manifestations of dysfunction in the temporomandibular joint during the "Hamburg test" was 11.9% in group 1, 38.3% in group 2, p&lt;0.05. There was an improvement in the strength of the masticatory muscles according to manual muscle test during the movements of raising and lowering the lower jaw, its deviation and protrusion. Group 1, which underwent rehabilitation with the use of independent classes and passive use of preformed physical factors, did not demonstrate an effect on indicators of myofascial dysfunction of the neck; the achieved improvement according to the studied parameters of the orofacial zone were statistically significantly worse than the parameters of group 2. Conclusions. The obtained result is a justification for the need to apply programs of active functional physical therapy for the correction of myofascial dysfunction of the orofacial zone and the neck area in patients with injuries of the jaw.

Ultrasonographic Assessment of Masseter and Anterior Temporal Muscle Thickness and Internal Structure in Young Adult Patients With Bruxism.

The current study is a comparative cross-sectional analysis study to determine the thickness and internal structure of the masseter muscle (MM) and anterior temporal muscle (ATM) in patients with bruxism by ultrasonography (USG). A total of 100 patients (36 males, 64 females), 50 with bruxism and 50 without bruxism, aged 20-30 years were included in the study. All patients were investigated with MM and ATM USG. The thickness of the muscles was measured at rest and during clenching and the internal structure at rest was classified as Type I, II, and III. Differences in the internal structure between bruxism and non-bruxism groups were determined using the Chi-square test (p < 0.05). The most common internal structure in bruxism was Type 2 in MM (74%) and Type 1 in ATM (46%), whereas in non-bruxism, Type 1 in MM (58%) and Type 1 in ATM (80%) were found most frequently. While there was a statistically significant difference in the internal echogenic pattern in the right MM and ATM in bruxism (p < 0.05), no significant difference was observed on the left side (p > 0.05). Bruxism patients had higher rest and clench thicknesses than non-bruxism patients on both sides in MM and ATM, however, this did not result in a statistically significant difference (p > 0.05). The results obtained showed that the evaluation of internal structure and thickness differences via USG is crucial in understanding the nature of the bruxism process affecting the masseter and ATM, facilitating its clinical diagnosis and leading to its treatment.

Temporomandibular joint space variation and masticatory muscle activation during clenching with full versus partial covering occlusal splints

ObjectivesOcclusal splints are the main therapeutic choice in the treatment of temporomandibular disorders (TMD). However, their precise working mechanism is unclear. This study aimed to compare the biomechanical effect of three commercially available splint designs (full covering splint, anterior bite splint and posterior bite splint) during biting in a sample of healthy subjects.Materials and methodsMagnetic resonance imaging (MRI) was combined with jaw tracking to measure the minimal intraarticular distance (MID) of 20 human temporomandibular joints (TMJ) whilst simultaneously recording the electromyogram (EMG) of the masticatory muscles. The changes caused by clenching with a bite force of 100 N without splint (baseline) and on each splint were calculated. Repeated measures ANOVA was performed on the means of the MID variations and EMG amplitudes.ResultsClenching on the anterior bite splint resulted in two times less activation of the anterior temporalis muscle than baseline (p = 0.003), full covering (p = 0.011) and posterior bite splint (p = 0.011). MID was reduced by clenching in all conditions, but the reduction was almost three times larger with the anterior bite splint compared to no splint (p = 0.011). The full covering splint and the posterior bite splint did not differ significantly in EMG activation of both masseter and temporalis muscles and MID variation.ConclusionsThis study showed that splint designs have a different impact on the MID and EMG activation while clenching. The anterior bite splint had a greater impact on the reduction of the muscle activation, whereas clenching on the anterior bite splint led to bigger reduction of MID and thus had the greatest influence on alteration in the condylar position.Clinical relevanceThe design of the splint can affect MID and muscle activation and is a variable to consider in the treatment of patients with TMD according to their symptoms.

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.

Temporal Augmentation Effect of Reduction Malarplasty: Application of our Bracing Technique with Zygomatic Arch Elevation.

A broad midface is usually accompanied by temporal depression. Traditional reduction malarplasty may visually improve the temporal depression by the inward reduction of zygomatic arch, but also has a high risk of soft tissue sagging. Our bracing technique has been reported to have an anti-sagging effect and may have a temporal augmentation effect as observed during our long-term clinical practice. Data of patients who received reduction malarplasty with our bracing technique from September 2015 to July 2023 were retrospectively collected. The pre-op and post-op CT images of those who met the inclusion criteria were used for three-dimensional reconstruction and measurements of the thickness and volume of the temporal soft tissue as well as the elevation distance of zygomatic arch. Fifty-eight patients with an average follow-up of 18.4 ± 9.1months were included. Despite mild thinning of the temporalis muscle after reduction malarplasty, the overall thickness of the temporal soft tissue significantly increased due to the significant thickening of the temporal adipose-fascial layer. There was a 0.5ml-increase in the temporal volume although without statistical difference. No significant correlation was detected between the elevation distance of zygomatic arch and the temporal thickness or volume change. The bracing technique of reduction malarplasty not only plays an anti-sagging role, but also has a temporal augmentation effect through the superior bracing by the elevation and rigid fixation of the zygomatic arch. It adds brilliance to the traditional technique and can be suggested especially when the patients are disturbed by temporal depression. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ultrasonographic assessment of the lateral pterygoid muscle for BoNT-A injection.

The upper head of the lateral pterygoid muscle (LPM) is known to insert into the capsule of the temporomandibular joint and articular disc, and therefore its relationship with temporomandibular disorders (TMD) has been consistently suggested. The aim of the study was to determine the anatomical features of the LPM using ultrasonographic (US) imaging. Around 120 hemifaces from 60 healthy Korean volunteers were included in this study. US images were taken with the subject's mouth 2 cm open. The transducer was placed at a position where the infratemporal fossa could be observed through the mandibular notch, and its position was recorded. The locations of the coronoid process (CorP), lateral margin of the condylar process (ConP), and midpoint of CorP and ConP (MP) were measured with reference to the ala-tragus line. The thicknesses of the skin and subcutaneous tissue, the masseter muscle, the temporalis muscle, and the depth of the LPM were measured at the MP. The masseter muscle, temporalis muscle, and LPM were observed in all cases and located in order from superficial to deep. The MP was located 39.6 ± 3.3 mm anterior and 7.8 ± 1.6 mm inferior to the tragus. The thicknesses of the skin and subcutaneous tissue, the masseter muscle, the temporalis muscle, and the depth of the LPM at the MP were 9.7 ± 1.0, 10.3 ± 1.3, 10.9 ± 1.6, and 30.9 ± 1.9 mm, respectively. The information reported in this study may be useful for determining the location of the LPM and adjacent anatomical structures in TMD patients and provide accurate and safe injection guidelines.

TRLR-01 THE PROGNOSTIC UTILITY OF TEMPORALIS MUSCLE THICKNESS MEASURED ON MAGNETIC RESONANCE SCANS IN PATIENTS WITH INTRA-AXIAL MALIGNANT BRAIN TUMOURS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract OBJECTIVE Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms. METHODS Following the PRISMA guidelines, we systematically searched PubMed, Embase, Scopus, and Cochrane databases for relevant studies from inception until June 17, 2022. Event ratios with 95% confidence intervals (CI) were analyzed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence. RESULTS Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46–0.76) (GRADE low), progression-free survival (PFS) (HR 0.40; 95% CI 0.26–0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168–0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60–1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67–0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19–0.60) (GRADE moderate) and progression-free survival (HR 0.23; 95% CI 0.09–0.56) (GRADE high). CONCLUSION TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision-making between patients and clinicians.

Impact of botulinum toxin type A on tooth movement and bone remodeling in male Wistar rats

ObjectiveWe evaluated whether the use of botulinum neurotoxin type A (BTX-A) in masticatory muscles influences tooth movement and bone remodeling. DesignSeventy-seven male Wistar rats were allocated to the groups: S - Saline (n=20); SM - Saline with movement (n=20); BT - Botulinum toxin (n=18); BTM - Botulinum toxin with movement (n=19). On day 1, 0.02mL of sterile 0.9% saline was administered to groups S and SM and BTX-A (1U in 0.02mL of saline) to groups BT and BTM, in the masseter and temporal muscles laterally. On day 30, a nickel titanium spring was installed to move the first maxillary molar and euthanasia was performed on days 32 and 51. Tooth displacement, maxillary and mandibular bone volumes, collagen neoformation, bone and root resorptions, and masseter morphometry were assessed. Statistical analysis was conducted (p < 0.05). ResultsA higher percentage of type I collagen was observed in the BT than in the S group on day 51 and lower mass, length, and diameter of the masseter fibers in BT and BTM (p < 0.05). Tooth displacement, bone volume, bone and root resorptions, hyaline area, and masseter height showed no difference among groups with and without BTX-A, regardless of tooth movement (p > 0.05). ConclusionsBTX-A did not interfere with tooth displacement, bone volume, and dental and periodontal tissues related to tooth movement in rats; it increased mature collagen in animals without tooth movement; and it caused a decrease in the mass, length, and diameter of the masseter fibers.

Efficacy of Proprioceptive Neuromuscular Facilitation on Jaw Function in Bruxism Among Post Stroke Survivor: A Case Study

A 49-year-old male who was a known case of Type 2 diabetes mellitus and hypertensive had a history of an acute infarct in the left ganglia capsular region and a chronic infarct in the left parieto-occipital lobe, which was conservatively managed and was referred for physiotherapy rehabilitation for strengthening the right upper and lower limb. During the physiotherapy intervention, abnormal teeth grinding was observed, and the patient was asked about parafunctional behaviour. Upon examination, there was a restriction in the jaw range of motion assessed by measuring the jaw range using the vernier caliper and tightness in the masticatory muscle, as evidenced by palpating the masseter muscle. Proprioceptive neuromuscular facilitation and ultrasound therapy were given for 1 session per week for 2 weeks to treat bruxism along with standardized stroke protocol. At the end of 2 weeks after the intervention, there was an increase in jaw opening and reduced masticatory muscle activity. Jaw opening was measured using a vernier caliper, and masticatory activity was measured using electromyography of the masseter and temporalis muscles. This study suggests the importance of treating bruxism to prevent complications related to it. It concludes that proprioceptive neuromuscular facilitation and ultrasound therapy were effective in improving mouth opening and reducing the masticatory activity in bruxism among stroke patients with ganglia capsular involvement.

Developing Approaches to Optimise Reparative Histogenesis of the Tympanic Membrane Tissues: History, the State-of-Art and Perspectives of Reparative Otosurgery

The paper describes the issues to optimize reparative histogenesis of the tympanic membrane tissues (history, state-of-the art and perspectives) based on data from national and foreign scientific literature. One of the causes of hearing loss is the violated integrity of the tympanic membrane, resulting from its injury or the developing inflammatory processes in the middle ear. It has been established that small perforations of the tympanic membrane can spontaneously close in the reparative stage of acute purulent otitis media or when the exacerbation of chronic purulent otitis media subsides. Restoration of large perforations of the tympanic cavity requires surgical intervention. Since 17th century, plastic surgery options for the tympanic membrane perforations with various biological and non-biological materials have been developing. However, until the beginning of the XX century, the approaches used did not lead to complete histio- and organotypic restoration of the tympanic membrane, but only ensured closure of the defect. At the present stage, otosurgeons use various plastic materials to restore the integrity of the eardrum: autografts; allografts; implants made of non-biological material. Nylon mesh, cotton-adhesive discs, and knotless knitted fabric made of polyamide fiber are applied as implants. Biological transplants applied include the skin of the inner surface of the shoulder and the occipital-temporal region, the wall of the vein, the fascia of the temporal muscle, the dura mater, the perichondrium, nanostructured bioplastic material created on the basis of hyaluronic acid hydrocolloid and a peptide complex, etc. The use of these modern options in most cases leads to organotypic and, in some cases, histiotypic restoration of the eardrum structure, ensuring complete epithelialization of its outer and inner surfaces. However, there are a number of unresolved issues regarding the diverse materials application for plastic surgery, as well as the timing of reconstructive surgeries on the middle ear.

Restoration of Functioning of Ankylosed TMJ by Inter Positional Arthroplasty with Temporalis Muscle Flap – A Case Report

Restoration of Functioning of Ankylosed TMJ by Inter Positional Arthroplasty with Temporalis Muscle Flap – A Case Report