Temporalis Muscle Thickness Research Articles

Temporalis Muscle Thickness as an Indicator of Sarcopenia Is Associated With Long-term Motor Outcomes in Parkinson's Disease.

To investigate the relationship between temporalis muscle thickness (TMT) at baseline as a surrogate marker for sarcopenia and long-term motor outcomes in patients with Parkinson's disease (PD). We enrolled 249 patients with drug-naïve early-stage PD (119 males and 130 females, follow-up > 3 years). Baseline TMT of each patient was measured on the axial plane of T1-weighted images. The association between baseline TMT and long-term motor outcomes in PD was assessed using Cox regression models for levodopa-induced dyskinesia, wearing-off, and freezing of gait and a linear mixed model for the longitudinal increases in levodopa-equivalent dose per body weight over time. Statistical analyses were performed separately for sex if an interaction effect between TMT and sex was assumed. TMT differed substantially between the sexes, and male PD patients had higher TMT (6.69 ± 1.39 mm) than female PD patients (5.64 ± 1.34 mm, p < .001). Cox regression models demonstrated that baseline TMT was not associated with the risk of developing levodopa-induced dyskinesia, wearing-off, or freezing of gait during the follow-up period. The linear mixed model was applied separately for sex and demonstrated that higher TMT at baseline was associated with slower increases in levodopa-equivalent dose per body weight in male PD patients, but not in female PD patients. This study demonstrated that baseline TMT could be an indicator of the longitudinal requirement for dopaminergic medications in male patients with PD, suggesting that sarcopenia may have a detrimental effect on disease progression in PD in a sex-specific manner.

The Effect of Frailty and Patient Comorbidities on Outcomes After Acute Subdural Hemorrhage: A Preliminary Analysis

Frailty is associated with worse outcomes across a variety of neurosurgical diseases. However, its effect on acute subdural hemorrhage (aSDH) outcomes is unclear. The goal of this study is to compare 3 measures of frailty with the gold standard (i.e., initial Glasgow Coma Scale [iGCS] score) for predicting outcomes after aSDH. Patients who presented between January 2016 and June 2018 were retrospectively identified based on International Classification of Diseases codes for aSDH. Patients' modified Frailty Index (mFI), temporalis muscle thickness (TMT), and age-adjusted Charlson Comorbidity Index (CCI) were calculated. Primary end points were death and discharge home. Of 167 patients included, the mean age was 63.4 ± 1.9 years, the average CCI was 3.4 ± 0.2, mFI was 1.4 ± 0.1, TMT was 7.1 ± 0.2 mm, and iGCS score was 11.9 ± 0.3. Sixty-nine patients (41.3%) were discharged home and 32 (19.2%) died during hospitalization. In multivariate analysis, decreasing iGCS score (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.74-0.96; P= 0.0112) and midline shift (OR, 1.27; 95% CI, 1.08-1.50; P= 0.0048), but not age or frailty, predicted mortality. In addition to iGCS score (OR, 1.26; 95% CI, 1.10-1.44; P= 0.0011), lower CCI (OR, 0.32; 95% CI, 0.14-0.74; P= 0.0071) and larger TMT (OR, 2.63; 95% CI, 1.16-5.99; P= 0.0210) independently predicted increased rates of discharge home. mFI was not independently associated with either primary end point in multivariate analysis. iGCS score predicts both mortality and discharge location after aSDH better than do age or frailty. However, CCI and TMT, but not mFI, are useful prognostic indicators of discharge to home after aSDH. The iGCS score should continue to be the primary prediction tool for patients with aSDH; however, frailty may be useful for resource allocation, especially when nearing discharge.

Temporalis muscle thickness as surrogate marker of activation of motor component of trigeminovascular system in Migraine patients (4153)

Temporalis muscle thickness as surrogate marker of activation of motor component of trigeminovascular system in Migraine patients (4153)

INNV-21. IN NEWLY-DIAGNOSED GLIOBLASTOMA, FRAILTY/SARCOPENIA PREDICTS 30D MORBIDITY &amp; 30D, 90D, AND OVERALL MORTALITY AS ACCURATELY AS CURRENT STANDARDS

Abstract INTRODUCTION Identification of novel prognostic biomarkers for glioblastoma (GBM) could stratify patients between aggressive or palliative treatments. Frailty, as measured by sarcopenia (lack of muscle mass), has been proven to predict survival in cancers. We evaluate whether the frailty/sarcopenia phenotype (FSP) predicts morbidity and mortality in GBM, and compare it to other survival markers. METHODS In 257 patients undergoing initial diagnostic surgery for GBM, FSP was defined by temporalis muscle thickness from preoperative MRI; patients were grouped into tertiles (thirds) based on size, which corresponded to the severity of FSP. Morbidity and mortality hazard ratios were calculated from surgery using multivariate analysis, accounting for age, gender, past medical history, tumor focality / laterality / eloquence / volume, extent of resection, MGMT / IDH status, and initiation of postoperative chemo/radiation. Morbidity was defined as any of these events within 30d: DVT, PE, SSI, UTI, MI, urinary retention, ileus, readmission. RESULTS FSP at diagnostic surgery predicted any morbidity (OR2.98, P= 0.005) at 30d. FSP at diagnostic surgery was the only risk factor associated with 30d mortality (OR10.0, P= 0.030), and was also strongly associated with 90d mortality (OR25.0, P= 0.003). FSP at diagnostic surgery was associated with decreased overall survival (OR0.41, P&lt; 0.001) at a level comparable to other mortality predictors, including temozolomide/EBRT (OR0.27), gross total resection (OR0.54), favorable MGMT (OR0.44) or IDH (OR0.44) mutations. Kaplan-Meier curves display overall survival based on severity of FSP. CONCLUSION FSP is a preoperative, simple, accurate, and non-invasive methodology to predict 30d morbidity &amp; 30-day, 90-day, and overall mortality from diagnosis in GBM. FSP is independent of age (not an age surrogate), demographic, oncologic, genetic, surgical, and therapeutic factors. Mortality prediction is comparable to temozolamid/EBRT, total resection, MGMT, and IDH. It is a low cost, intuitive, and potentially universal methodology to guide treatment decision making.

Temporalis Muscle Reduction Using Botulinum Toxin Type A for a Desirable Upper Face Circumference.

The temporal fossa is the concave area below the superior temporal line, which is the part of the temporal bone that forms the floor of the temple. The temporalis muscle originates from the temporal fossa and is surrounded by two fascial planes. The temporalis muscle assists in closing the mouth or keeping it closed and also in chewing. Temporalis muscle hypertrophy can cause prominence and protrusion of the temples with a consequent bulging appearance to the head and the upper face. This condition may also cause twitching of the temples when the mouth is closed or during chewing leading to an undesirable appearance. These issues can be effectively corrected using botulinum toxin (BTX). This study involved the injection of BTX into the temporalis muscle in 20 patients between June and September 2018. Prior to the procedure, the temporalis muscle thickness (TMT) was measured using an ultrasound imaging device (Prosound Alpha7; Hitachi Aloka Medical). TMT was measured at a point located 4 cm horizontally and 5 cm vertically away from the jugale, which was used as the reference point (Point 2 in [Fig. 1]). The upper face circumference was measured using the same reference point. As shown in [Fig. 1], botulinum toxin type A (BTX-A, Botox) (25 units/0.5 mL) was injected at five points using the jugale (an anatomical landmark on the skull that marks the meeting point of the temporal and frontal processes of the zygomatic bone) as the reference point. The TMT and the upper face circumference were measured at the same locations a month after the procedure. The pre- and post-procedure measurements were compared. The TMT was 6.2 ± 2.2 mm before procedure and 2.8 ± 1.7 mm a month after procedure. The upper face circumference was 50.2 ± 9.2 cm before procedure and 49.1 ± 10.7 mm a month after procedure ([Fig. 2]).

Cosmetic Reconstruction of Frontotemporal Depression Using Polyethylene Implant after Pterional Craniotomy.

Purpose Pterional craniotomy is a useful approach for the treatment of a variety of intracranial pathologies. However, it can result in temporal hollowing, which causes significant craniomaxillofacial asymmetry and esthetic deformity. The present study was performed to determine the postoperative outcomes of patients following frontotemporal depression reconstruction using a high-density porous polyethylene (HDPE) implant (Medpor®; Stryker, Kalamazoo, MI) after pterional craniotomy. Materials and Methods The patients had undergone reconstruction of frontotemporal depression using Medpor® implants after pterional craniotomy at our medical institution during the period from February 2010 to March 2014. We evaluated the thickness and volume of both the temporalis muscle and Medpor® implant through a retrospective review of the medical records and computed tomography (CT) scans of 92 patients. Results The mean temporalis muscle thickness ratio (muscle thickness of the affected side/nonaffected side) was 0.61 ± 0.16. The mean reconstructed temporalis muscle thickness ratio (muscle and Medpor® implant thickness of affected side/muscle thickness of nonaffected side) was 1.15 ± 0.02. The mean temporalis muscle volume ratio (muscle volume of affected side/nonaffected side) was 0.67 ± 0.02. The mean reconstructed temporalis muscle volume ratio (muscle and Medpor® implant volume of affected side/muscle volume of nonaffected side) was 1.18 ± 0.02. Conclusions Temporalis muscle thickness and volume were significantly decreased on the affected side after pterional craniotomy. Reconstruction of frontotemporal lesions using Medpor® implants after the pterional approach improved temporal hollowing without additional complications.

Sagittal splitting of the temporalis muscle for encephalo-myo-synangiosis to prevent ischemic complications due to a swollen temporalis muscle without inhibiting collateral developments in patients with moyamoya disease.

Encephalo-myo-synangiosis (EMS) is an effective revascularization procedure for the treatment of moyamoya disease (MMD). However, the temporalis muscle used for EMS sometimes swells and causes ischemic complications by compressing the underlying brain. This study aimed to elucidate the effect of sagittal splitting (SS) of the muscle for prevention of ischemic complications and its impact on the postoperative development of collateral vessels. In this historical case-control study, we analyzed 60 hemispheres in adult patients with MMD who underwent EMS using the temporalis muscle from December 1998 to November 2017. The muscle was divided anteroposteriorly by coronal splitting, and the anterior, posterior, or both parts of the muscle were used for EMS in 17, 4, and 39 hemispheres, respectively. In cases performed after 2006, the muscle was halved by SS, and the medial half was used for EMS to reduce the muscle volume (n = 47). The degree of postoperative muscle swelling was evaluated by measuring the maximum thickness of the muscle on CT scans obtained 3 to 7 days after surgery. The collateral developments of the anterior deep temporal artery (aDTA), posterior deep temporal artery (pDTA), and middle temporal artery (MTA) were assessed using digital subtraction angiography and MR angiography performed 6 months or more after surgery. SS significantly reduced the temporalis muscle thickness from 12.1 ± 5.0 mm to 7.1 ± 3.0 mm (p < 0.01). Neurological deterioration due to the swollen temporalis muscle developed in 4 of the 13 hemispheres without SS (cerebral infarction in 1, reversible neurological deficit in 2, and convulsion in 1) but in none with SS. There were no significant differences in the postoperative collateral developments of the aDTA, pDTA, and MTA between hemispheres with and without SS. The MTA more frequently developed in hemispheres with EMS in which the posterior part of the muscle was used (30/37) than those in which this part was not used (4/16) (p < 0.01). SS of the temporalis muscle might prevent neurological deterioration caused by the swollen temporalis muscle by reducing its volume without inhibiting the development of the collateral vessels.

Influence of mandibular tori on stomatognathic system function

Objectives: To verify the influence of prominent mandibular tori on the functioning of the stomatognathic system. Methods: The participants included 40 individuals, divided into two groups: those with mandibular tori (GI group: 20 subjects) and those without mandibular tori (GII group: 20 subjects). The authors used the Myosystem-Br1 electromyography system to analyze electromyographic (EMG) activity. For muscle thickness, images of the masseter and temporalis muscles were captured using the NanoMaxx ultrasound. The maximal molar bite force was obtained by means of the Kratos digital dynamometer. Results: The EMG activity was higher in the masseter muscles in the GI group, compared with the GII group, in all clinical conditions assessed except for the mandibular at rest. In dynamic conditions, this higher EMG activity was also observed in the temporalis muscles. The GI group presented significantly less temporalis muscle thickness than seen in the GII group. The maximal bite force was significantly higher in the GI group. Conclusions: Mandibular tori promoted morphological and functional changes in the stomatognathic system.

Temporalis muscle morphomics: the psoas of the craniofacial skeleton

BackgroundThe psoas muscle has been shown to predict patient outcomes based on the quantification of muscle area using computed tomography (CT) scans. The accuracy of morphomic analysis on other muscles has not been clearly delineated. In this study, we determine the correlation between temporalis muscle mass, psoas muscle area, age, body mass index (BMI), and gender. MethodsTemporalis and psoas muscle dimensions were determined on all trauma patients who had both abdominal and maxillofacial CT scans at the University of Michigan between 2004 and 2011. Age, BMI, and gender were obtained through chart review. Univariate and multivariate analyses were performed to determine the relative relationship between morphomic data of the temporalis and psoas muscles and the ability of such information to correspond with clinical variables, such as BMI, age, and gender. ResultsA total of 646 patients were included in the present study. Among the 249 (38.5%) women and 397 (61.5%) men, the average age was 49.2 y. Average BMI was 27.9 kg/m². Total psoas muscle area directly correlated with mean temporalis muscle thickness (r = 0.57, P < 0.001). There was an indirect correlation between age and psoas muscle area (r = −0.52, P < 0.001) and temporalis muscle thickness (r = −0.36, P < 0.001). Neither psoas nor temporalis measurements correlated strongly with BMI (r = 0.18, P < 0.001; r = 0.14, P = 0.002), although stronger correlations were found in a more “frail,” subgroup as defined by a BMI of <20 (r = 0.59, P = 0.002). ConclusionsWe demonstrate that dimensions of the temporalis muscle can be quantified and may serve as a proxy for age. Going forward, we aim to assess the utility of temporalis and psoas morphomics in predicting complication rates among trauma patients admitted to the hospital to predict outcomes in the future.

How to Minimize Ischemic Complication Related to Swollen Temporalis Muscle Following Indirect Revascularization Surgery in Moyamoya Disease: A Technical Report

There are several reports in the literature of postoperative ischemic events due to swelling of the temporalis muscle after indirect revascularization surgery. Here, we report our surgical technique for preventing ischemic events during the acute postoperative recovery period in moyamoya patients. We used various types of titanium mesh to cover the bony defect area in 8 patients (10 operations) with moyamoya disease. The mesh was cut and manipulated according to the shape of the bony defect. Surgical results were favorable, with no newly developed ischemic event or infarction in the acute recovery period. The mesh formed an outer table of skull, so there was no compressive effect on the temporalis muscle and no cosmetic defects. The titanium mesh appears to be effective and useful for prevention of ischemic insult in the treatment of moyamoya disease. The choice of this procedure depends on both the operative findings of temporalis muscle thickness and the status of ischemic vulnerability of moyamoya brain.

Evaluation of Changes in Muscle Thickness, Bite Force and Facial Asymmetry during Early Treatment of Functional Posterior Crossbite

To determine morphological and functional effects on masticatory system of early treatment of functional posterior crossbite in young children. 23 children were divided into two groups: deciduous (DecG, n = 11) and early mixed dentition (MixG, n = 12), which received slow maxillary expansion. Maximal bite force, ultrasonographic masticatory muscle thickness and facial asymmetry were evaluated in three stages: before the start of treatment (s1), after three months of retention (s2), and after three months of observation (s3). The results were analyzed by Mann-Whitney U-test, correlation test, repeated measures ANOVA and backward stepwise multiple regression. Bite force and temporalis thickness increased from s1 to s2 and s3 in both groups (p < 0.05). Body mass index (BMI) increased significantly from s1 to s3 only in the MixG, but the masseter thickness did not differ among the stages. The correlation between the angle of the eye and the angle of the mouth in relation to the mid-sagital plane increased from s1 to s3. Masticatory muscle thickness contributed significantly to bite force magnitude in all stages, whereas age and BMl showed no significant contribution to its variation. Bite force and temporalis muscle thickness increased significantly in children after early treatment of functional crossbite.

The Relationship Between the Zygomatic Arch and the Floor of the Middle Cranial Fossa

Access to the floor of the middle cranial fossa (MCF) is often required for approaches to cranial base lesions. This study measures the craniocaudal distance between the zygomatic arch (ZA) and the floor of the MCF from a random sample of high-resolution computed tomography scans of the cranial base. Forty computed tomography scans were imported into an OsiriX station and reconstructed in multiple planes. The most caudal point of the MCF was determined in each computed tomography scan. The distances between that point and the root of the zygoma and the middle point of the ZA were calculated. The thickness of the temporalis muscle and the vertical height of the zygoma were also calculated. A 2-tailed, paired Student t test was used to compare right and left measurements with a 95% confidence interval and P value <.05 as statistically significant. The foramen ovale was consistently the lowest point of the MCF. The average root-to-floor measurement was 5.05 +/- 0.42 mm above the floor of the MCF and distance of the mid-zygoma to the floor was 1.94 +/- 0.61 mm above the floor of MCF. The average temporalis muscle thickness and vertical height of the ZA were 22.22 +/- 0.36 mm and 8.10 +/- 0.13 mm, respectively. The muscle-to-floor measurement (muscle thickness + mid-zygoma-to-floor measurement) was 24.16 +/- 0.74 mm. The routine use of a zygomatic osteotomy in approaches to the MCF does not provide very much increased exposure. However, in patients with exceptionally thick temporalis muscles or a high ZA, a zygomatic osteotomy may be helpful in providing exposure of the floor of the MCF.