Temporalis Research Articles

The preliminary study of the effects of individual musculoskeletally stable position in the treatment of temporomandibular disorders

BackgroundTemporomandibular Disorders (TMD) is the dysfunction of group of muscles and bones in the joint area, the main symptoms of TMD are the pain of the chewing muscles and (or) the temporomandibular joints, mandibular movement disorders and joint noise. This study was designed to explore the therapeutic effects following Individual Musculoskeletally Stable (IMS) position stabilization splint therapy for TMD patients using Fricton index, cone beam computed tomography (CBCT) and surface-Electromyogram (sEMG).MethodsIn this study, we enrolled 31 TMD patients (ranging from 18 to 26 years old, including 7 males and 24 females), first Fricton index was used to evaluate the clinical curative effect of TMD with the treatment of IMS stabilization splint; then CBCT was used to observe the TMJ condylar position changes of TMD before and after the treatment of IMS stabilization splint; finally sEMG was used to observe the changes of electromyography of anterior temporalis (AT) and masseter muscles (MM) of TMD before and after the treatment of IMS stabilization splint.ResultsThe course of treatment was 6–8 months, with an average of 7.6 months. After the IMS stabilization splint treatment, TMD symptoms relieved, especially in pain, mandibular movement disorder, but still slightly inferior in the treatment of joint noise. And there was a statistically significant difference in the anterior and inner joint space, the condyle had the tendency of moving forward and outward. AT presented reduction significantly of EMG value at rest position after treatment.ConclusionsIMS stabilization splint is a therapeutic reversible treatment for TMD, especially for pain and mandibular movement disorder; it produces effects of forward and outward condylar movement and elimination of the masticatory muscles antagonism.

The utility and outcomes of the temporalis muscle flap for palate reconstruction after maxillectomy for malignancy

Back groundA common pedicled facial technique in head and neck reconstruction is the TMF It can be utilised to replace missing tissues in a variety of conditions, including oral deformities of the hard and soft palate.Aim of the study was to document the utility and outcomes with the reconstruction of the palate using TM flaps following Maxillectomy For maxillary sinus malignancies MethodologyThe study included 24 patients who were operated on for cancer maxilla and eligible for maxillectomy and reconstruction of the Palate using temporalis flap. Follow-up was planned for at least 12 months postoperative. Postoperative physical and speech therapy are initiated to help improve speech and swallow outcomes and to prevent trismus ResultsThe current study included 24 cases with Maxillary sinus cancer with a mean age of 42.34±4.67. The mean operative time was 5.4±1.22 hours with no reported intraoperative bleeding or injury of important structures .No cases of facial palsy or trismus were reported while partial flap loss was reported in one case where oronasal fistula was evident. The donor site complications were minimal where seroma occurred in two patients and alopecia , wound infection and dehiscence were reported in one case each. The donor site depression was evident in 25% of cases ConclusionTMF is an excellent option for the reconstruction of many craniofacial defects, it is easy to be harvested with good blood supply with minimal postoperative complications

EP574 - Outcomes of temporalis muscle based facial reanimation surgery: A systematic review and meta-analysis

Abstract Aims Despite encouraging findings of temporalis based facial reanimation surgery without the need for nerve grafting, there remains a need for a comprehensive evaluation of the impact of temporalis based facial reanimation surgery on key outcome measures. Methods Comprehensive search in MEDLINE and Embase databases were done up to 25th February 2023. The inclusion criteria for this study focused on articles that examined facial reanimation surgery utilising the temporalis muscle. Postoperative changes in smile excursion and angle of mouth while smiling were pooled using the DerSimonian and Laird random effects model. Narrative synthesis was conducted for other outcomes including assessments of spontaneous smile, subjective evaluation of facial symmetry using validated rating tools, functional outcomes, aesthetic outcomes, and patient-reported outcomes owing to heterogeneity in reporting of outcomes. Results 24 studies were included in the analysis. Conflicting evidence was demonstrated regarding emotional smile outcomes and its definition. The pooled changes in smile excursion post-surgery was 7.06mm (95 CI 3.73-10.40, P<0.001; I2= 0%) and in angle of mouth while was 11.76 degree (95 CI 8.80-14.71, P<0.001; I2= 0%). Significant improvement was reported across validated rating scales of symmetry, functional outcomes, aesthetic outcomes, and patient-reported outcomes while superiority compared to other procedures remain inconclusive. Conclusion Overall, temporalis-based facial reanimation surgery is a promising option for addressing the negative effects of facial nerve paralysis on patients' quality of life. The study highlights the uncertainty surrounding the technique and the need for further studies.

Effectiveness of Laser Therapy in Treatment of Temporomandibular Joint and Muscle Pain.

Background/Objectives: Temporomandibular joint disorders (TMDs) express a condition derived from a broad spectrum of etiological factors and clinical manifestations. Many treatment options have been developed for TMDs; nevertheless, conservative and non-invasive approaches ought to be prioritized. Laser therapy is an effective treatment for pain management due to its non-invasive nature and capacity for tissue regeneration. This review aimed at bringing an overview of the present evidence regarding the efficiency of laser therapy on myofascial or temporomandibular joint disorders pain. Methods: The search was conducted in four electronic databases: PubMed, Web of Science, Embase, and Scopus, of studies published between January 1997 and January 2023. The following terms have been extensively searched: "laser treatment", pain management", "temporomandibular joint disorders", "masseter muscle pain", "pterygoid muscle pain", and "temporal muscle pain". The inclusion criteria were original papers, available in full text, and written in English. Cohen's Kappa coefficient was used to assess the inter-rater reliability for article selection. The methodological quality was assessed with the Cochrane Risk of Bias tool for randomized controlled trials and the National Heart, Lung, and Blood Institute's quality assessment tool for before-after studies with no control group. Results: Out of 846 identified records, 7 studies were included, of which 5 were randomized controlled trials. The inter-rater reliability for article selection showed an almost perfect agreement (Cohen's Kappa = 0.832, p < 0.001). The protocol of laser application was not standardized; the laser wavelength ranged from 633 to 940 nm, with a power output range from 25 to 1600 mW. The number of sessions varied from 3 to 12, with a frequency of application from 1 time per week to 3 times per week. All studies reported pain reduction after laser therapy. Conclusions: Laser therapy is an efficient method to treat TMDs related to muscle pain. To accomplish the desired results, a standard procedure must be followed; however, the protocol is still not fully designed.

Contributions of jaw functional orthopedics in temporomandibular joint ankylosis (TMA) – clinical case report

Temporomandibular joint (TMJ) ankylosis is one of the most disabling pathological conditions that can occur in the maxillofacial region, often occurring at an early age, limiting growth and causing facial deformity, which significantly affects the quality of life of the individual. The objective of the study was to evaluate the contribution of Jaw Functional Orthopedics (JFO) in TMJ ankylosis after the surgical phase. The case of a 7-year-old female patient diagnosed with bilateral condylar ankylosis (fibrous ankylosis on the right side and bony ankylosis on the left side) is presented. On clinical examination, facial asymmetry, retrognathia, muscle contraction and opening limitation were observed. Treatment consisted of temporalis muscle flap rotation surgery with condylectomy and coronoidectomy, physical therapy, and functional therapy with OFM. The clinical results at 4 months of follow-up suggest significant progress in oral opening and protrusion. The patient showed a high degree of satisfaction with the results obtained. She is currently continuing with the use of orthopedic appliances to correct the sequelae of ankylosis and improve mandibular kinematics.

Application of Ultrasonic Bone Scalpel in Surgery for Masticatory Muscle Tendon-Aponeurosis Hyperplasia.

Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a disease that presents as a hard trismus due to hyperplasia of the masseter and temporalis aponeurosis. Standard surgical methods for MMTAH include masseter resection, temporalis aponeurosis, and coronoidectomy. The operation of resecting the tendon aponeurosis attached to the posterior surface of the coronoid process carries the risk of bleeding and nerve damage because it cannot be observed directly. Therefore, the authors introduce a safer method by using an ultrasonic bone scalpel for this procedure. The authors used an ultrasonic bone scalpel with a long neck blade to scrape the posterior side of the coronoid process from the bottom to the top. The authors have treated 4 cases using this technique, and in all cases, the surgical procedure was performed safely and easily. In conclusion, ultrasonic bone scalpels are effective in MMTAH surgery for removing the attachment of the stiffened temporalis muscle tendon and aponeurosis.

23-year review of spheno-orbital meningioma: clinical, radiological, and pathological insights from 100 cases

BackgroundSpheno-orbital meningioma (SOM) represents a unique variant of sphenoid wing meningiomas, distinguished by its propensity for bone infiltration and cranio-orbital involvement. SOM exhibits a considerable incidence of misdiagnosis and recurrence.PurposesTo elucidate the clinical, radiological, and pathological characteristics of SOM.MethodsReview of electronic medical records, histopathology, radiological images and follow-up information of 100 SOM patients.ResultsOf the 100 patients (28 males, 72 females) with SOM, mean age was 46.8 ± 12.6 years and prevalent symptoms were proptosis (99%). All the CT scans showed hyperostosis with 89.3% of the hyperostosis having an irregular edge. In MRI scans, dural tail sign was observed across all patients and the cranio-orbital tumors often penetrated temporal muscle (74.1%), extraocular muscle (74.1%) and lacrimal gland (63%). All the 100 patients underwent surgical intervention, and among them, 62 individuals received postoperative radiotherapy. Grade I resections had a lower recurrence rate(16.7%), which further decreased with the addition of radiotherapy(13.9%). In contrast, all patients with grade II or higher grade resections without radiotherapy experienced recurrence, indicating a higher risk associated with less complete tumor removal. The pathological examination revealed that intraorbital sections exhibited comparable tumor density to intraorbital SOM tumors, along with increased fibrous density but decreased vascular distribution.ConclusionsRadiological characteristics of SOM included cranio-orbital tumors, hyperostosis of the sphenoid wing with an irregular edge, and dural tail sign. Combination of gross total resection and adjuvant radiotherapy was recommended to minimize recurrence rate. Intracranial SOM tumors tended to be softer and more bleed-prone than intraorbital sections, necessitating surgical precision.

Three-dimensional evaluation of facial asymmetry and its association to occlusal and muscular imbalance in young women.

Diagnosing asymmetries and restoring functional balance are challenges in facial rehabilitation and aesthetic procedures. This cross-sectional observational study aimed to evaluate whether occlusal imbalance and the electromyographic activity of the masseter and temporalis muscles in young women may be associated with facial asymmetry. Fifty women (mean age ± standard deviation: 22.5 ± 2.7), without temporomandibular dysfunction and with balanced facial profiles, were divided into two groups categorized by receiver operating characteristic analysis: symmetric (n=25) and asymmetric (n=25). The variables included the evaluation of asymmetry through clinical examination, quantification of asymmetry using stereophotogrammetry through the root mean square method, asymmetry of occlusal contacts, and electromyographic activity of the masseter and temporal muscles in both latero-lateral and antero-posterior directions. The mean asymmetry indices were compared using Welch's t-test and the Mann-Whitney test. The impact of occlusal and muscular imbalance on facial asymmetry was assessed through linear regression analysis. A significant difference was observed between the groups in the asymmetry of occlusal contacts, with a considerable effect size (p<0.01 - Cohen's d=0.73). The imbalance in the electromyographic activities of the masseter and temporal muscles was considered a predictor of facial asymmetry (F=4.00, p<0.02, R²=0.15). Occlusal imbalance and electromyographic activity of the masseter and temporal muscles are associated with facial asymmetry. Key words:Facial asymmetry, masticatory muscles, stereophotogrammetry, occlusion, electromyography.

Recent Research in Singing

Abstract: This “Recent Research in Singing” article chronicles three academic documents authored during 2023 and 2024. Dissertations by Osman, Amanda, “Lost Voices: A Survey of Knowledge of Temporal Mandibular Joint Disorder and Muscle Tension Dysphonia in the Professional Voice Studio”; Sowell, Bradley Thomas, “An Analysis of Ben Moore’s Comedy Songs Using J. Peter Burkholder’s Music-Borrowing Techniques”; and You, Mengxi, “A Comprehensive Study of Alexander Tcherepnin’s Op. 71, Seven Songs on Chinese Poems With Musical Analysis and Historical Context.” Each includes a complete bibliographic citation and an Author/ProQuest abstract.

Multimodal Management of Ruptured Internal Carotid Artery Blood Blister-like Aneurysm: Technical Notes and Case Series of Surgical Muscle Wrapping and Fenestration Clipping Combined with Flow-Diverter Embolization

To evaluate the effects of a multimodal management technique combining surgical muscle wrapping, clipping, and flow-diverter stent (FDS) placement in patients with ruptured blood blister-like aneurysms (BBAs) in the internal carotid artery (ICA). In a retrospective case series review from 2020 to 2023, 3 patients with ruptured ICA BBAs underwent multimodal management, an approach combining muscle wrapping, surgical clipping, and FDS embolization. The aneurysm sac was initially packed and wrapped with multiple tailored temporalis muscle grafts and then secured using fenestration clips, with good preservation of the ICA branches. The FDS was placed 2-3weeks after the clipping. All 3 patients had right ICA BBAs (mean age, 52years). The modified Hunt and Hess grades ranged from 2 to 3, and the Fisher grades ranged from 3 to 4. The mean angiography follow-up time was 27.7months (15, 31, and 37months). There were no instances of symptomatic vasospasm or visible ischemic stroke during follow-up computed tomography. No patient required cerebrospinal fluid shunt implantation, and all achieved favorable neurological outcomes (modified Rankin scale 0-1). Follow-up digital subtraction angiography revealed no evidence of aneurysm recurrence or significant ICA stenosis. We discuss a promising multimodal management approach for ruptured ICA BBAs combining muscle wrapping, surgical clipping, and FDS embolization. This technique was safe and effective in preventing re-rupture, achieving positive short-term clinical outcomes. Further research and more extensive studies are required to validate the long-term efficacy of this approach.

Comparison of muscle response in patients treated with rigid and flexible fixed functional appliances.

The present study was undertaken to evaluate and compare muscle activity after the treatment with rigid and flexible fixed functional appliance. The study was conducted on 14 skeletal Class II malocclusion patients in the age group of 13-17 years, divided into two groups comprising 7 patients in each group. Group I was treated with a rigid fixed functional appliance (MPA IV), and Group II was treated with a flexible fixed functional appliance (Churro Jumper). Masseter and anterior temporalis muscle activities were recorded using needle electromyography (EMG) at postural rest, saliva swallowing, and clenching during five intervals (T0 to T4) during fixed functional appliance treatment. Unpaired t-test, Mann-Whitney U, and Wilcoxon sign rank test were applied for statistical analysis, and a P value of <.05 was considered statistically significant. Group I (MPA IV) showed a significant increase in EMG activity during postural rest position (P = 0.003, P = 0.001), swallowing (P = 0.013, P = 0.005), and clenching (P = 0.001, P = 0.002) in masseter and anterior temporalis muscle, respectively. Group II (Churro jumper) also showed a significant increase in EMG activity during postural rest position (P = 0.000, P = 0.000), swallowing (P = 0.001, P = 0.000), and clenching (P = 0.001, P = 0.000) in masseter and anterior temporalis muscle, respectively. Both rigid (MPA IV) and flexible (Churro Jumper) fixed functional appliances caused a significant increase in EMG activity of masseter and anterior temporalis muscle during postural rest position, swallowing, and clenching in 6 months of the observation period, but the flexible appliance (Churro Jumper) showed more significant increase.

Temporalis muscle thickness as a predictor of functional outcome after reperfusion therapies for acute ischemic stroke: a retrospective, cohort study.

Sarcopenia, defined as the loss of skeletal muscle mass, has been associated with a worse functional outcome after stroke. Measurement of temporal muscle thickness (TMT) has been introduced as an easily obtainable surrogate marker to identify patients with sarcopenia. Our study aims to investigate the correlation between pre-stroke sarcopenia, measured by TMT assessment, and functional outcome in patients treated with revascularization procedures for acute ischemic stroke. We included consecutive adult patients who underwent thrombolysis, endovascular thrombectomy or both for acute ischemic stroke at our Centre from January 2020 to June 2022. Besides collecting baseline clinical and neuroradiological features, TMT was measured on brain computed tomography scans according to a standardized protocol. Modified Rankin Scale (mRS) scores at 3months represented the main endpoint of functional outcome. A total of 261 patients were available for the analysis. In univariate models, patients with excellent outcomes (mRS = 0-1) were younger, had higher TMT values and lower pre-event disability and stroke severity. In multivariate models higher TMT values resulted independently associated with reduced mortality (Odds Ratio 0.708, 95% Confidence Interval 0.538-0.930, p = 0.013). Age, diabetes, brain bleeding events and stroke severity were found to be predictors of mortality, too. Our retrospective analysis shows that in patients who underwent revascularization treatments for ischemic stroke TMT is as an independent predictor of survival easily obtainable from the baseline CT scan. Further investigation is required to confirm the role of sarcopenia assessment and TMT measurement in the prognostication toolkit of this disease.

КРИТЕРИИ ЭФФЕКТИВНОСТИ ЛЕЧЕНИЯ ПАЦИЕНТОВ С МИОФАСЦИАЛЬНЫМ БОЛЕВЫМ СИНДРОМОМ ЖЕВАТЕЛЬНОЙ МУСКУЛАТУРЫ

There are quite a lot of predictor factors for the development of myofascial pain syndrome of the chewing muscles. At the moment, there is no single pathogenetic theory of the development of this pathology. Accordingly, uniform criteria for evaluating the effectiveness of the therapy have not been developed, which was the purpose of this study. The aim of the study is to develop and implement criteria for the effectiveness of treatment of patients with myofascial masticatory muscle pain syndrome. Materials and methods. 45 people with myofascial masticatory muscle pain syndrome were examined and treated. Screening diagnostics of 30 conditionally healthy people was carried out to obtain control values. The study was conducted in three stages – assessment of stress levels according to the data of filling out a questionnaire on the level of susceptibility to stress, clinical examination – determination of qualitative and quantitative criteria, ultrasound and electromyographic examination. Relief of myofascial pain syndrome of the masticatory muscles was performed by injections of botulinum toxin type A into the masticatory and temporal muscles. The dynamics was assessed at the time of 14 days and 1 month. Results. The developed criteria clearly reflect the effectiveness of the therapy. Statistically significant results of the effectiveness of treatment have been obtained, allowing timely optimal therapy and preventing the development of chronic disorders of the temporomandibular joint. Understanding the combined influence of the psychoemotional state and somatic factors led to the development of uniform criteria for the effectiveness of treatment of this category of patients. The analysis and dynamics of changes in qualitative and quantitative indicators reflect the current trend towards the development of minimally invasive approaches to diagnosis and treatment based on the principles of biofeedback, which prevent the chronization of the process and the development of temporomandibular joint dysfunction.

Temporoparietal Fascial Flap Combined With Vascularized Outer Table Calvarial Bone Graft and Entire Temporalis Muscle: A Stable Pedicled Flap for Orbital Floor Reconstruction After Total Maxillectomy.

Orbital reconstruction after total maxillectomy is essential to maintain ocular function and facial contour. Free flap transfer with simultaneous orbital bone reconstruction is a straightforward approach; however, it is challenging in medically unstable patients with multimorbidity. The authors developed an easily harvested temporoparietal fascial flap combined with vascularized outer table calvarial bone and entire temporalis muscle. The authors applied this technique in an 81-year-old patient with multiple comorbidities who required orbital floor reconstruction following total maxillectomy. Intraoperative indocyanine green fluorescence imaging confirmed excellent perfusion of the temporoparietal fascia, entire temporalis muscle, and calvarial bone. Although the patient developed postoperative local wound infection, the vascularized bone graft resisted infection and preserved the orbital structure without bone exposure. Our technique is minimally invasive and results in a well-vascularized flap for orbital reconstruction after total maxillectomy involving the orbital bone, and particularly beneficial in patients with multimorbidity or at high risk of local infection.

Advanced Sensing System for Sleep Bruxism across Multiple Postures via EMG and Machine Learning.

Diagnosis of bruxism is challenging because not all contractions of the masticatory muscles can be classified as bruxism. Conventional methods for sleep bruxism detection vary in effectiveness. Some provide objective data through EMG, ECG, or EEG; others, such as dental implants, are less accessible for daily practice. These methods have targeted the masseter as the key muscle for bruxism detection. However, it is important to consider that the temporalis muscle is also active during bruxism among masticatory muscles. Moreover, studies have predominantly examined sleep bruxism in the supine position, but other anatomical positions are also associated with sleep. In this research, we have collected EMG data to detect the maximum voluntary contraction of the temporalis and masseter muscles in three primary anatomical positions associated with sleep, i.e., supine and left and right lateral recumbent positions. A total of 10 time domain features were extracted, and six machine learning classifiers were compared, with random forest outperforming others. The models achieved better accuracies in the detection of sleep bruxism with the temporalis muscle. An accuracy of 93.33% was specifically found for the left lateral recumbent position among the specified anatomical positions. These results indicate a promising direction of machine learning in clinical applications, facilitating enhanced diagnosis and management of sleep bruxism.

Effect of passive jaw opening on the electromyographic activity of the temporalis, masseter, digastric, and infrahyoid muscles in healthy adults

ABSTRACT Objective To investigate the surface electromyography (EMG) activity of the temporalis, masseter, digastric, and infrahyoid muscles during passive jaw opening in healthy adults. Methods The EMG activity of the masseter, temporalis, digastric anterior belly, and infrahyoid muscles on the right side was recorded during the four jaw-opening tasks: active opening to 20 mm (AO20); active opening to 40 mm (AO40); passive opening to 40 mm with a rubber mouth prop on the right posterior teeth (POR40); and passive opening to 40 mm with a mouth prop on the left posterior teeth (POL40). Results The EMG amplitude of the digastric anterior belly and infrahyoid muscles in either POL40 or POR40 was significantly less than that in AO20 or AO40, respectively. Conclusion Passive jaw opening reduces the EMG activity of the digastric and infrahyoid muscles significantly and could help reduce the load on these muscles during prolonged mouth-opening conditions.

Dynamic Repair Surgery for Late-Stage Facial Paralysis: Advances in Restoring Movement and Function.

Purpose: Facial paralysis results from congenital or acquired facial nerve damage, leading to significant cosmetic and functional deficits. Surgical resection of parotid and midface tumors can cause facial paralysis, necessitating effective treatment strategies. This review addresses the challenge of restoring movement and function in late-stage facial paralysis, focusing on dynamic repair techniques involving nerve and muscle transplantation. Methods: The review encompasses studies on dynamic repair surgery for late facial paralysis, including techniques such as local muscle flap with pedicle transfer, vascularized nerve flap with pedicle transfer, and multiple muscle flap procedures. A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, covering studies from 2000 to 2024. Keywords included "dynamic repair", "late-stage facial paralysis", "nerve and muscle transplantation", "muscle flap", and "tendon transposition". Included were clinical studies, systematic reviews, and meta-analyses reporting surgical outcomes. Exclusion criteria included studies with insufficient data and non-peer-reviewed articles. Results: Dynamic repair techniques involving nerve and muscle transplantation are essential for treating late-stage facial paralysis. Each surgical method has strengths and limitations. The masseter muscle flap demonstrates high success rates, although it can cause horizontal tension and jaw contour issues. The temporalis muscle flap is effective for smile restoration but may lead to temporal concavity. The gracilis muscle flap is widely used, especially with dual nerve innervation, showing high success in spontaneous smiles but requiring a longer recovery period. The latissimus dorsi flap is effective but can cause edema and shoulder issues. The serratus anterior free flap offers flexibility with precise vector positioning but may not achieve adequate lip elevation and can cause cheek swelling. Combined multi-flap surgeries provide more natural facial expressions but increase surgical complexity and require advanced microsurgical skills. Conclusions: Dual nerve innervation shows promise for restoring spontaneous smiles. One-stage surgery offers faster recovery and reduced financial burden. Comprehensive patient evaluation is crucial to select the most suitable surgical method. Dynamic repair techniques involving nerve and muscle transplantation provide effective solutions for restoring function and aesthetics in late-stage facial paralysis. Future research should focus on long-term outcomes, patient satisfaction, and standardizing surgical protocols to optimize treatment strategies.

Correction of Post-Surgical Temporal Hollowing with Adipo-Dermal Grafts: A Case Series.

Background: Surgical dissection and partial detachment of the temporalis muscle during neurosurgical procedures might result in a temporal depression known as "temporal hollowing". Reconstructive procedures to correct this condition include the implantation of synthetic materials (e.g., hydroxyapatite, methacrylate or polyethylene), injection of autologous fat or fillers as well as the use of flaps (e.g., temporo-parietal local flap and latissimus dorsi free flap). However, none of these techniques proved to be an ideal option due to a high complication rate or need for invasive and complex surgery. Adipo-dermal grafts are autologous; the resorption rate seems to be limited and the complexity of the procedure is minor. Moreover, autologous fat grafting can be performed to enhance the final outcome by correcting residual contour deformities. Methods: In this series of five patients, an institutional experience is presented using multi-layered adipo-dermal grafts harvested from the supra-pubic area for the restoration of volume and contour in post-surgical temporal hollowing. During the last follow-up, patients were asked to express their satisfaction, which was assessed by a survey. Results: this approach demonstrates a marked improvement in temporal hollowing associated with a low complication rate and good patient satisfaction. Conclusions: the aim of this consecutive case series is to emphasize the effectiveness of this surgical technique as one of the options to address temporal hollowing.

A Novel Combined Cartilage-Fascia Technique for Anterior Perforation in Type-1 Underlay Tympanoplasty

Background: Biomaterials and surgical techniques for reconstructive tympanic membrane surgery are under development. Objectives: The objective of this study is to analyze the functional and surgical outcomes of a novel fascia with cartilage reinforcement technique for anterior tympanic membrane perforation in tympanoplasty. Methods: Records of 198 patients with anterior tympanic membrane perforation who underwent tympanoplasty between August 2018 and March 2021 were prospectively reviewed. Patients with dry anterior quadrant perforations of the tympanic membrane were included and underwent tympanoplasty using two methods: Type 1 tympanoplasty with temporalis fascia only, and tympanoplasty with fascia and cartilage reinforcement. Postoperative functional and surgical outcomes were analyzed. Results: Comparing the pre-operative and post-operative air conduction levels and air-bone gaps showed significant improvement in both groups (P &lt; 0.001). Additionally, no significant difference was observed between air-bone gap closure (P = 0.316) and increase in air conduction levels (P = 0.222) according to graft type. Conclusions: Both temporalis muscle fascia and temporalis muscle fascia with cartilage reinforcement revealed satisfactory functional and surgical outcomes. Furthermore, the novel combined cartilage-fascia technique had a comparable graft take rate and hearing results in anterior perforations, with no significant change in tympanic membrane vibratory properties.

African wild dog (Lycaon pictus) masticatory apparatus and oral cavity morphology.

African wild dogs (Lycaon pictus) are unique among canids in their specialized hunting strategies and social organization. Unlike other, more omnivorous canids, L. pictus is a hypercarnivore that consumes almost exclusively meat, particularly prey larger than its body size, which it hunts through cooperative, exhaustive predation tactics. Its bite force is also among the highest reported for carnivorans. Here, we dissected an adult male L. pictus specimen and conducted diffusion iodine contrast-enhanced computed tomography (diceCT) scans to evaluate and describe its masticatory and oral cavity musculature. Muscles of mastication in L. pictus are separated by deep layers of thick intermuscular fascia and deep insertions. The superficial surface of m. masseter is entirely covered by an extremely thick masseteric fascia. Deep to m. masseter pars reflexa and superficialis are additional bellies, m. masseter pars profunda and zygomaticomandibularis. Musculus temporalis in L. pictus, divides into suprazygomatic, superficial, and deep bellies separated by a deep layer of thick intermuscular fascia, and it inserts along the entire rostral margin of the mandibular ramus. Musculus digastricus appears to comprise a single, large fusiform belly which appears to receive its innervation exclusively from CN V3 (nervus mandibularis, division of nervus trigeminus). Musculus pterygoideus medialis and lateralis are each composed of a single, deep belly. However, despite its great bite force, the jaw adductor muscle mass in L. pictus is not increased for its body size over other canid taxa. This finding suggests there are other architectural adaptations to hypercarnivory beyond increased muscle volume (e.g., pennation angle, greater strength, optimization of lever arms for mechanical advantage).