OBJECTIVE: To study the clinical characteristics of mandibular movement and masticatory muscle function in preoperative and postoperative patients with unilateral mandibular tumors in the region of mandibular body and ramus by combining digital mandibular movement records with electromyography, and to preliminarily explore the relationship and mechanism between movement and masticatory muscle function. METHODS: Six preoperative patients with tumor in unilateral body and ramus of mandible were included, and three postoperative patients with unilateral segmental resection and reconstruction of mandibular bone were included. The mandibular movement recording system and surface electromyography system were used to collect the movement trajectory of the patients' mandibular marginal movement and chewing movement, and the surface electromyography of bilateral masseter and temporalis was recorded concurrently. The surface electromyography of bilateral masseter and temporalis was collected when the patients were at relaxation and at maximal voluntary clenching (MVC). The motion trajectory was observed on the digital virtual model, and the motion amplitude and direction of mandibular marginal movements were analyzed. The characteristics of masticatory electromyogram (EMG) activity in affected and unaffected sides at relaxation, MVC and bilateral mastication were analyzed, and the asymmetry indexes and activity indexes were calculated. RESULTS: The preoperative mean maximum opening of the patients was (35.20±6.87) mm. Three patients had mild mouth opening limitation, and all the patients' mouth opening trajectory was skewed to the affected side. During lateral movements, the mean range of motion of the affected side [(10.34±1.27) mm] and that of the healthy side [(6.94±2.41) mm] were significantly different. The maximum opening of the postoperative patients was (30.65±17.32) mm, and the mandibular marginal movement characteristics were consistent with those of the patients before surgery. During MVC in the preoperative patients, the median EMG activities of the masseter muscle [44.20 (5.70, 197.90) μV] and the temporalis muscle [42.15 (22.90, 155.00) μV] on the affected side were slightly lower than those of the masseter [45.60 (7.50, 235.40) μV] and the temporalis muscle [63.30 (44.10, 126.70) μV] on the healthy side. In the postoperative patients, individualized changes occurred. Some patients suffered from weakened electromyographic activity on the affected side, while some other ones showed hyperelectromyographic activity on the affected side. CONCLUSION Both benign and malignant tumors as well as their surgery can cause abnormal mandibular movements and change of electromyographic activity of bilateral masseter and temporalis muscles.
Electromyography ; Humans ; Mandible ; Mandibular Neoplasms ; Masseter Muscle ; Mastication ; Masticatory Muscles ; Movement ; Temporal Muscle

BACKGROUND: Atrophy of muscle and fat often contributes to temporal hollowing after pterional craniotomy. However, the main cause is from the bony defect. Several methods to prevent temporal hollowing have been introduced, all with specific limitations. Autologous bone grafts are most ideal for cranial defect reconstruction. The authors investigated the effectiveness of bony defect coverage and temporal augmentation using pterional craniotomy bone flap. METHODS: This study was conducted in 100 patients who underwent brain tumor excision through pterional approach from 2015 to 2016. Group 1 underwent pterional craniotomy with temporal augmentation and group 2 without temporal augmentation. In group 1, after splitting the calvarial bone at the diploic space, the inner table was used for covering the bone defect and as an onlay graft for temporal augmentation. The outcome is evaluated by computed tomography at 1-year follow-up. RESULTS: The mean operative time for temporal augmentation was 45 minutes. The mean follow-up was 12 months. The ratio of temporal thickness of operated side to non-operated side was 0.99 in group 1 and 0.44 in group 2, which was statistically different. The mean visual analogue scale score was 1.77 in group 1 and 6.85 in group 2. CONCLUSION: This study demonstrated a surgical technique using autologous bone graft for successfully preventing the temporal hollowing and improved patient satisfaction.
Atrophy ; Bone Transplantation ; Brain Neoplasms ; Craniotomy* ; Follow-Up Studies ; Humans ; Inlays* ; Operative Time ; Patient Satisfaction ; Temporal Bone ; Temporal Muscle ; Transplants*

BACKGROUND: The purpose of this study was to evaluate the clinical outcomes of treatment of non-odontogenic atypical orofacial pain using botulinum toxin-A. METHODS: This study involved seven patients (seven females, mean age 65.1 years) who had non-odontogenic orofacial pain (neuropathic pain and atypical orofacial pain) and visited the Seoul National University Bundang Hospital between 2015 and 2017. All medication therapies were preceded by botulinum toxin-A injections, followed by injections in the insignificant effects of medication therapies. Five of the seven patients received intraoral injections in the gingival vestibule or mucosa, while the remaining two received extraoral injections in the masseter and temporal muscle areas. RESULTS: In five of the seven patients, pain after botulinum toxin-A injection was significantly reduced. Most of the patients who underwent surgery for dental implantation or facial nerve reconstruction recovered after injections. However, the pain did not disappear in two patients who reported experiencing persistent pain without any cause. CONCLUSIONS: The use of botulinum toxin-A for the treatment of non-odontogenic neuropathic orofacial pain is clinically useful. It is more effective to administer botulinum toxin-A in combination with other medications and physical therapy to improve pain. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40902-018-0159-z) contains supplementary material, which is available to authorized users.
Botulinum Toxins ; Dental Implantation ; Dental Implants ; Facial Nerve ; Facial Pain ; Female ; Humans ; Mucous Membrane ; Retrospective Studies ; Seoul ; Temporal Muscle

The decision of which surgical approach to use for the treatment of a multifocal craniofacial abscess is still a controversial matter. A failure to control disease progress in the craniofacial region can potentially put the patient's life at risk. Therefore, understanding the various ways to approach the craniofacial region helps surgeons to obtain satisfactory results in such cases. In this report, we describe a patient who visited the emergency department with a large swelling in his right cheek. A blood test and computed tomography revealed odontogenic maxillary sinusitis. The patient developed sepsis due to a progressive multifocal abscess. An abscess was seen in the temporal muscle, infratemporal fossa, and interorbital region. To control this multifocal abscess, we used the facial dismasking flap (FDF) approach. After debridement using the FDF approach, we succeeded in obtaining sufficient drainage of the abscess, and the patient recovered from sepsis. The advantages of the FDF approach are that it provides a wide surgical field, extending from the parietal region to the mid-facial region, and that it leaves no aesthetically displeasing scars on the face. The FDF approach may be one of the best options to approach multifocal abscesses in the craniofacial region.
Abscess* ; Cheek ; Cicatrix ; Debridement ; Drainage ; Emergency Service, Hospital ; Facial Bones ; Hematologic Tests ; Humans ; Maxillary Sinus ; Maxillary Sinusitis ; Orbit ; Parietal Lobe ; Sepsis ; Surgeons ; Temporal Muscle

Botulinum toxin (BoNT) injections have been used not only in the field of cosmetic surgery such as forehead and eye wrinkle treatment but also in the treatment of chronic migraine, dystonia, spasticity, temporomandibular disorders (TMD). BoNT injections are the only approved therapies to date for prophylactic treatment of chronic migraine patients. Unlike the previously known paralysis of motor neurons, the mechanism of action for migraine is to block the release of non-cholinergic neurotransmitters such as substance P, CGRP, and glutamate, which are associated with peripheral sensitization and neurogenic inflammation in the sensory nerve, it is hypothesized that the signal is blocked. This review focuses on the analgesic effects of BoNT and suggests the direction for the development of injection methods for chronic migraine patients.
Botulinum Toxins* ; Dystonia ; Forehead ; Glutamic Acid ; Headache Disorders ; Humans ; Migraine Disorders* ; Motor Neurons ; Muscle Spasticity ; Neurogenic Inflammation ; Neurotransmitter Agents ; Paralysis ; Substance P ; Surgery, Plastic ; Temporal Lobe* ; Temporomandibular Joint Disorders

BACKGROUND: Frontotemporal dementia (FTD) with motor neuron disease (MND) is a syndrome of progressive changes in behavior, language, muscle weakness and atrophy due to loss of function of neurons in the frontal and temporal lobes and in motor neurons. Etiology and pathogenesis of FTD with MND are still uncertain. CASE REPORT: A 71-year-old man presented with a 2-year history of progressive muscle weakness and cognitive deficits. We diagnosed this patient as FTD with MND by neurological examination, electromyography, brain imaging and neuro-psychological evaluation. We also confirmed antiphospholipid syndrome (APS) in this patient as a way to rule out secondary causes of MND. CONCLUSIONS: This was a very rare case of FTD with MND in APS. We should focus study on the possible role of autoimmune pathogenesis in FTD with MND.
Aged ; Antiphospholipid Syndrome* ; Atrophy ; Cognition Disorders ; Electromyography ; Frontotemporal Dementia* ; Humans ; Motor Neuron Disease* ; Motor Neurons* ; Muscle Weakness ; Neuroimaging ; Neurologic Examination ; Neurons ; Temporal Lobe

BACKGROUND: Facial nerve palsy in patients with leprosy brings a variety of discomfort functionally and cosmetically. Although the distortion of the lips is less frequent than that of the eyes, when it occurs, it happens either unilaterally or bilaterally and shows a different dynamic from that in eyes. The lower lip droop causes saliva to flow out of the mouth when eating and exposes the gum and teeth. MATERIALS AND METHODS: All patients were previously treated using the TMT procedure yet symptoms recurred within an unacceptable timeframe. Therefore, we retreated patients using the masseter muscle plication. We performed the masseter muscle plication to the lateral portion of the lower lip muscle to give it power without dividing the anterior segment of masster muscle from mandibular border. RESULTS: Complete closure of the mouth was observed in 6 patients with a moderate degree of lower lip droop. One patient that presented with severe lower lip droop bilaterally showed only partial closure. CONCLUSIONS: Without dividing anterior half segment of masseter muscle from mandibular border, the direct plication of the anterior border of masseter muscle and lower lip muscles was very effective method to correct the lower lip droop and to close the mouth in recurrent patients after temporal muscle transfer.
Eating ; Facial Nerve ; Gingiva ; Humans ; Leprosy ; Lip* ; Masseter Muscle* ; Methods ; Mouth ; Muscles ; Paralysis* ; Saliva ; Temporal Muscle ; Tooth

OBJECTIVE: Decompressive craniectomy (DC) is a widely used surgical procedure for control of severely increased intracranial pressure in various conditions. The goal of this study is to evaluate the effectiveness of the addition of resection of temporalis muscle and fascia in DC particularly in the treatment of traumatic brain injury. METHODS: Twenty patients underwent temporalis muscle and fascia resection in addition to conventional DC and duroplasty due to massive brain swelling in a single tertiary hospital from 2013 to 2015 were enrolled. Twenty other patients who received the standard techniques by other neurosurgeons in the same period were gathered for the control group. Postoperative computed tomography (CT) as well as functional outcome in both groups were analyzed retrospectively. RESULTS: CT volumetry showed a significant increase of 85.19 mL (p<0.001) of extracranial herniation volume in the research group compared with the control group. Using modified Rankin Scale and Glasgow Outcome Scale, there was no statistically significant difference in functional outcome between the two groups. CONCLUSION: Although preliminary, the procedure appears to show a meaningful increase in extracranial herniation volume with minimal masticatory and cosmetic impairment.
Brain Edema ; Brain Injuries* ; Decompressive Craniectomy* ; Fascia* ; Glasgow Outcome Scale ; Humans ; Intracranial Pressure ; Neurosurgeons ; Retrospective Studies ; Temporal Muscle* ; Tertiary Care Centers

OBJECTIVEThis study was performed to investigate the electromyographic (EMG) activity of the masseter muscle and the anterior temporalis muscle, as well as the masticatory efficiency after insertion of the dentures in edentulous individuals whose maxillomandibular horizontal relationship records were obtained with three different methods.

METHODSTen edentulous individuals were enrolled in this study. Three types of complete dentures for these 10 edentulous patients were made according to their different maxillomandibular horizontal relationship records. The maxillomandibular horizontal relationship of complete dentures was recorded by three methods. In the first method (A), the maxillomandibular horizontal relationship was determined at the gothic arch tracing apex. In the second method (B), the relationship was 1 mm anterior to the tracing apex with the gothic arch. In the last method (C), the horizontal jaw relation was recorded by natural chewing. The muscular activities of the three complete dentures were examined by EMG. The masticatory efficiency was evaluated based on the absorbance. The differences among the dentures were statistically analyzed with SPSS 17.0.

RESULTSThe muscular activities of dentures B and C were much higher than that of denture A during clenching in the center occlusion and during chewing (P<0.05). The highest asymmetry index was found indenture C, which was significantly higher than those of dentures A and B (P<0.05). A statistically significant increase in the absorbance was observed between dentures B and C (P<0.05); otherwise, no statistically significant differences were observed (P>0.05) between B and C.

CONCLUSIONSGiven the limitations of this experimental design, in edentulous individuals the maxillomandibular horizontal relationship recorded at 1 mm anterior to the tracing apex with the gothic arch can improve the function of masticatory muscles and strengthen masticatory performance.

Dental Occlusion, Centric ; Denture, Complete ; Electromyography ; Humans ; Mastication ; Mouth, Edentulous ; Temporal Muscle

OBJECTIVETo investigate the effect of the biofeedback in regulating the myoelectric activities of the masseter muscles.

METHODSTwenty orthodontic patients aged from 10 to 14 years with Angle Class II malocclusion, retrusive mandible, and an ANB angle > 6° were enrolled in this study. The muscular activities of the anterior temporal muscle and the masseter muscle were evaluated before, during, and after biofeedback treatment by assessing the average integrated electromyogram and temporal/masseter (T/M) ratio in the clenching status.

RESULTSThe patients' myoelectric activities of the anterior temporal muscle was significantly increased after biofeedback treatment (P<0.05). The patients' T/M ratio in the clenching status was increased after the treatment (1.76 ± 1.46 before treatment, 4.71 ± 4.03 immediately after treatment, and 2.57 ± 2.07 at 1 day after treatment; t=4.86, P<0.05).

CONCLUSIONBiofeedback treatment can regulate the activities of the anterior temporal and masseter muscles and increase the T/M ratio in the clenching status.

Adolescent ; Biofeedback, Psychology ; Child ; Electromyography ; Humans ; Malocclusion, Angle Class II ; Mandible ; Masseter Muscle ; physiology ; Temporal Muscle ; physiology