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Local muscle and tendon can be readily incorporated for facial reanimation procedures specifically related to the midface and peri-orbital area. Our objective is to describe temporalis muscle and tendon procedures that increase smile excursion including indications, modifications of these procedures, peri-operative care, and reported outcomes. Temporalis tendon and muscle procedures capitalize on the redundancy of the muscles of mastication to repurpose for facial reanimation. Temporalis tendon transfer is indicated for patients who benefit from immediate results with a low risk, low morbidity procedure that can improve lip symmetry at rest and with smiling. The technique has evolved to be more minimally invasive with one or two incisions in an outpatient surgery that provides the same or more benefit from the originally described technique. Provider and patient reported questionnaires as well as computer-based algorithms have been reported to assess subjective and objective outcomes for this procedure.

OBJECTIVES The aim of this study was to investigate if patients with temporomandibular disorders (TMD) prior to head and neck cancer (HNC) treatment are at higher risk of developing trismus after oncological treatment. MATERIALS AND METHODS Eighty-three study patients underwent detailed dental examination prior oncological treatment and 6 months after radiotherapy completion, including evaluation of temporomandibular jaw function, palpation of the jaw muscles, and measurement of mouth opening capacity. TMD criteria were based on both clinical examination findings and patient-reported symptoms. TMD at baseline was used in regression analysis in order to predict restricted mouth opening. RESULTS At the 6 months follow-up more than a third of the patients (35%) were examined with reduced mouth opening of >20% compared to baseline. A majority of the patients had bilateral tenderness of both the temporal and the masseter muscle. At the 6 months follow-up, 42% of the study patients reported mouth opening problems. About one-third of the patients suffered from fatigue and stiffness of the jaw as well as pain when mowing the jaw. Two questions from the validated symptom-specific Gothenburg Trismus Questionnaire were found to be related to a statistically significant increased risk of restricted mouth opening after radiotherapy; "During the last week, have you felt: Pain on moving the jaw?" (OR [95% CI] 5.9 (1.2-29.4) [p = 0.030]) and "During the last week, have you felt pain and tenderness in the muscles of mastication?" (OR [95% CI] 5.90 [1.19-29.40] [p = 0.030]). CONCLUSIONS TMD is common amongst HNC patients. Patients who suffer from pain in the jaw muscles and pain when moving the jaw before start of treatment are at higher risk of radiation-induced trismus after 6 months. Clinicians should strive for optimizing the patients pain treatment and oral health before, during, and after radiotherapy.

Trismus in post-radiotherapy patients is mostly secondary to fibrosis of buccal mucosa and muscles of mastication. After releasing trismus, mucosal defect needs to be covered with soft and supple tissue. We used a non-conventional method to cover this defect i.e. dumbbell-shape forearm free-flap based on a single radial artery.

Temporomandibular disorders usually represented as a group of painful as well as altered conditions involving the muscles of mastication and the muscles around the temporomandibular joint. Usually the patient are un aware of the condition. Temporomandibular joint disorders affects twenty five percent of the population. Temporomandibular disorders represent with musculoskeletal degenerative conditions of the joint which results in functional as well as morphological deformities of the temporomandibular joint. As temporomandibular disorders cases are complex with unique nature with respect to each case, so the diagnosis and treatment modality is quite different for each type of case. Keywords: Temporomandibular disorder, Management of temporomandibular disorder, Etiology of temporomandibular disorder, Internal disc derangement, Internal capsule, Glenoid fossa.

Stomatognathic system is an interaction of the muscles of mastication, dentition, neural component, and temporomandibular joint. Any dysfunction in this system may lead to temporomandibular disorders (TMDs). Various non-surgical modalities have been employed for treating TMDs. The aim of the study was to objectively evaluate the effects of low-level laser therapy (LLLT) in treatment of patients with TMDs. Sixty individuals diagnosed with TMDs were divided randomly into two groups (Group I—placebo and Group II -LLLT). A series of 20 sessions of LLLT applied both in closed mouth and maximum mouth opening position were given over a period of 08 weeks. Assessment was done in terms of improvement in mouth opening, pain, clicking, and deviation of mandible. The data collected were analyzed statistically. The results showed improvement in the pain reduction, improvement in the maximum mouth opening, reduction in deviation, and clicking in both groups but better treatment outcome in the low-level laser group. Though conservative measures improved the symptoms in TMD but LLLT has shown better results in comparison with the placebo group. Being non-surgical can be employed in combination with other modes for effectively treating such disorders. Keywords: Pain, Dysfunction, Temporomandibular joint disorders (TMDs), Low-level laser therapy (LLLT).

Robotic transmaxillary skull base surgery has been described using multiport systems. This cadaveric study investigates the feasibility of transmaxillary skull base surgery using a next-generation robot. An extended Caldwell-Luc antrostomy, measuring 3.3 cm by 4.0 cm, was performed in 15 min using a Kerrison rongeur and the robotic endoscope. A single-port, robotic system (da Vinci Sp®, Intuitive Surgical, Inc, Sunnyvale, CA, USA) was then deployed throught the extended Caldwell-Luc approach and provided sufficient reach, visualization, and maneuverability to work within the pterygopalatine fossa (PPF) and the infratemporal fossa (ITF) using three surgical instruments. The ITF dissection was easiest with two instruments using the third instrument to retract the muscles of mastication. This study demonstrates the feasibility of single-port robotic transmaxillary approaches to the lateral ITF. Using a single-port robotic system, the operating surgeon can for the first time work in the PPF and ITF using two functional arms for tumor dissection and a third to retract.

OBJECTIVEThe motor root of the trigeminal nerve runs close to the sensory root and receives considerable radiation during Gamma Knife radiosurgery (GKRS) for trigeminal neuralgia (TN). The object of this study was to evaluate via MRI the changes in the muscles of mastication before and after upfront GKRS in patients with idiopathic TN.METHODSIn this single-institution retrospective cohort study, all patients with idiopathic unilateral TN treated with primary GKRS at the University of Virginia in the period from 2007 to 2017 were included provided that they had pre- and post-GKRS MRI data. The thicknesses of the temporalis, pterygoid, and masseter muscles were measured on both pre- and post-GKRS MRI in a blinded fashion. Changes in the muscles like fatty infiltration, MRI signal, or atrophy were noted.RESULTSAmong the 68 patients eligible for inclusion in the study, 136 temporalis muscles, 136 medial pterygoid muscles, 136 lateral pterygoid muscles, and 136 masseter muscles were assessed. A subset of patients was found to have muscle atrophy even prior to GKRS. Pre-GKRS atrophy of the masseter, medial pterygoid, lateral pterygoid, and temporalis muscles was seen in 18 (26%), 16 (24%), 9 (13%), and 16 (24%) patients, respectively. Logistic regression analysis showed that distribution of pain in the V3 territory (p = 0.01, OR 5.43, 95% CI 1.46–20.12) and significant pain on chewing (p = 0.02, OR 5.32, 95% CI 1.25–22.48) were predictive of pre-GKRS atrophy. Reversal of atrophy of these muscles occurred after GKRS in a majority of the patients. The incidence of new-onset permanent post-GKRS muscle atrophy was 1.5%. The median follow-up was 39 months (range 6–108 months).CONCLUSIONSA subset of patients with TN with significant pain on chewing have pre-GKRS disuse atrophy of the muscles of mastication. A reversal of the atrophy occurs in a majority of the patients following GKRS. New-onset motor neuropathy post-GKRS was rare.

Recently, as we experienced a case of extranodal NHL originating from the masseter musclecompletely cured by chemotherapy with radiotherapy, we present the clinical, US, CT, andMR imaging findings in additional one case of biopsy-proved extranodal NHL (NK/T celllymphoma) involving predominantly the masseter muscle also review thoroughly our collectedcases of primary non-Hodgkin’s lymphoma involving the muscles of mastication and facialexpression. On the basis of our comprehensive review, we suggest two conclusions. First, primarymuscle lymphoma particularly originating from muscles of mastication and facial expression isextremely rare, but primary muscle lymphoma should be considered in the differential diagnosisof muscular masses. Second, primary muscle lymphoma particularly originating from muscles ofmastication and facial expression has similar clinical and radiological characteristics to primaryskeletal muscle lymphoma involving other sites. However, the prognosis is more favorablein primary muscle lymphoma originating from muscles of mastication and facial expressioncompared to primary skeletal muscle lymphoma involving other sites. Bangladesh Journal of Medical Science Vol.20(1) 2021 p.181-186

The new advancing technologies have created a storm in the long-existing canons of anatomic sciences with the bandwagon of recent anatomical discoveries such as the existence and identification of a bilateral foramen in the coronoid process of the mandible. The coronoid process being a thin flat triangular process varies in shape and size and gives attachment to the main muscles of mastication the temporalis and the masseter. The excitement of exploratory anatomic victory on mysteries related to the anatomy of the head-and-neck region specific to the coronoid process was further documented and elaborated as an incidental finding. The following manuscript presents an intriguing case of a pediatric patient aged 7 years with a morphologic variation of coronoid process with presence of foramina bilaterally along with few other variants, further attempting to emphasize its occurrence in the developmental years as a possibility of developmental variant trait.

Mandibular step body osteotomy has been out of favour since more stable ramus osteotomies were refined and used for jaw deformities. Mandibular body osteotomy still has certain indications for which it is preferable over ramus osteotomies. Mandibular body osteotomy is best suited to correct prognathism caused by mandibular body excess with a retained tooth or in presence of extraction space, with good posterior occlusion, when ramus osteotomies and setback will lead to loss of the last tooth and non-obtuse gonial angle. Other indications are apertognathia, mandibu­lar asymmetry and small advancements of the anterior mandible. Here we present a case 24 year male with a skeletal class III malocclusion managed with an intra­oral mandibular step osteotomy and setback of 8 mm. One-year followup has shown minimum neurosensory and odontogenic complications associated with mandibular step osteotomy and very high satisfaction among the patient. We also present a brief review of the indications, modifi­cations and refinement of the technique and summarize current published clinical usage. This is a very stable osteotomy with favourable fracture pattern and does not involve stripping or change in position of muscles of mastication thereby ensures long term stability and minimal risk of relapse. This surgery also has minimal effect on airway narrowing compared to the ramus osteotomy setback. For some specific indications not suited to a sagittal split ramus osteotomy, mandibular body step osteotomy still has relevance and usage.

Introduction: The Coronoid process is a triangular upward projection from antero-superior part of ramus of mandible giving attachment to two important muscles of mastication. Aims: The aim of our study was to observe the variations in shape and size of coronoid process and establish the morphometric profile in Indian population. Materials and Methods: The material for this study comprised of 500 adult human mandibles. The shape of coronoid process was observed and its height and length were measured. Results: Three variants of coronoid process were observed (round, triangular and hook) with incidence percentage 46, 42 and 12 respectively. The mean value of height and length of coronoid process came out to be 60.62 mm and 12.53 mm respectively. Conclusions: This morphometric treatise provides valuable inputs relevant for anthropological comparisons, forensic investigations and reconstructive procedures. Keywords: Mandible, Coronoid process, Rounded, Triangular, Hook.

Temporomandibular joints (TMJ) are the bilateral synovial articulation between temporal bone and lower jaw, seen on each side of the jaws. Temporomandibular joint disorders (TMD) can be defined as the tenderness of the jaws and dysfunction of the associated muscles of mastication and the temporomandibular joints, which connect the mandible to the skull. The exact cause of TMD still remains mysterious and unclear. However, the possible attributes of TMD are arthritis, trauma or blow to the TMJ, excessive gum chewing and bruxism. Patients are usually treated with ice packs, gentle massage at the jaw area and prescription of nonsteroidal anti-inflammatory drugs (NSAIDs). This study sought to evaluate the incidence rate, age and gender differences of TMD among patients reporting to Saveetha Dental College and Hospital. The following parameters were evaluated based on the dental records; age, gender and types of TMD. Excel tabulation and SPSS version 23 was used for data analysis. The prevalence of temporomandibular disorders was higher in female patients (51.9%) than male patients (48.1%). The most frequent age group affected by temporomandibular disorders was 31-40 years (36.7%). Disc-condyle disorder (75.9%) is the most frequent sub-type of temporomandibular disorders present in the patients. There was no statistically significant correlation between age and TMD (p=0.847); and gender and TMD (p=0.365). It can be concluded that within the limits of study, TMD was present in adulthood and was more common in women, with disc-condyle disorder being the most prevalent type.

Large defects that comprise both the maxilla and mandible prove to be difficult reconstructive endeavors and commonly require two free tissue transfers. Three cases are presented to discuss an option for simultaneous reconstruction of maxillary and mandibular defects using a single osteocutaneous fibula free flap. The first case describes a 16-year-old male with a history of extensive facial trauma sustained in a boat propeller accident resulting in a class IId maxillary and 5 cm mandibular defect status post three failed reconstructive surgeries; the second, a 33-year-old male with recurrent rhabdomyosarcoma of the muscles of mastication with resultant hemi-mandibulectomy and class IId maxillary defects; and lastly, a 48-year-old male presenting after a failed scapular free flap to reconstruct defects resulting from a self-inflicted gunshot wound, which included a 5 cm defect of the right mandibular body and 4.5 cm defect of the inferior maxillary bone. In all cases, a single osteocutaneous fibula free flap was used in two bone segments; one to obturate the maxillary defect and restore alveolar bone and the other to reconstruct the mandibular defect. The most recent patient was able to undergo implantable dental rehabilitation. Postoperatively, the free flaps were viable and masticatory function was restored in all patients during a follow-up range of 2-4 years.

Background: Trismus is a restricted mouth opening due to the tonic contraction of muscles of mastication. It may occur mostly in HNF cancer patients undergoing radiation therapy treatment. This study was undertaken with the purpose of finding out the prevalence of trismus in patients undergoing radiation therapy. Method: 89 patients with HNF cancer patients receiving radiation therapy were included in the study. Inter incisal distance was measured using sliding digital vernier calliper. Patients with ≥ 35mm mouth opening were considered as trismus cases. Result: Out of 89 patients included 72 were diagnosed as trismus; hence the prevalence was 81%. Conclusion: Prevalence of Trismus is very high ( 81 %) in patients undergoing radiotherapy secondary to HNF cancer. Early diagnosis of trismus in these patients can help in time management and also planning of preventive strategies.

Background and Objectives: The loss of natural teeth causes many problems; one of major problems that are associated with edentulousness is the hypotonicity of muscles of mastication and decreasing the ability of the patient to chew food properly. Treatment of edentulous patients with complete denture will increase the muscle tonicity and chewing activity. The purpose of this study is to clinically compare patient's chewing ability between lingualized occlusion complete denture and bilaterally balanced occlusion complete dentures. Materials and methods: Two sets of complete dentures with different occlusions were fabricated for ten patients. The patients received bilaterally balanced occlusion (BBO) complete denture and lingualized occlusion (LO) complete denture in random order. The patients wear each set of complete denture for one month. During this month, chewing activity tests were performed for the patients in four different time intervals. The results of these tests were analyzed using t-test and paired t-test to compare between the lingualized occlusion and bilaterally balanced occlusion complete denture and also to compare the results of each time interval with each other. Results: The mean amount of the walnuts that passed through the sieve in LO dentures were (1.78g), during the fourth visit while it was (1.18g) in BBO. There were statistically significant difference between LO and BBO schemes of complete denture when measuring the amount of the chewed walnuts that passed through the sieve in second, third and fourth visit (p=0.037, 0.001 and 0.000). Conclusion: Within the limitations of this study, it has beenconcluded that the chewing ability was higher in patients who were provided with complete dentures fabricated with the LO scheme as compared to those patients who received complete dentures made with BBO scheme. This was due to the fact that LO technique resulted in functionally better complete dentures as compared to the ones made by BBO technique

Temporomandibular disorders (TMD) are a group of musculoskeletal and neuromuscular conditions that involve the temporomandibular joint (TMJ), the masticatory muscles, and branches of the trigeminal nerve. TMD is the most common chronic oral facial pain disorder. Pain associated with TMD can be clinically expressed as myogenous or arthrogenous in etiology. The myogenous variant of TMD is characterized by pain in the muscles of mastication. The arthrogenous form of TMD is caused by pain in the joint leading to synovitis, capsulitis, or arthritis. Classically, mastication activity aggravates musculoskeletal pain. TMD pain is frequently associated with biomechanical dysfunction of the temporomandibular joint. This includes clicking or locking of the TMJ due to an anterior displaced disk, resulting in limited range of motion of the mandible. The diagnosis is based on the presence of symptoms such as periauricular pain related to mastication, joint noises (popping/clicking), limited mandible opening, jaw locking, and headaches. Orofacial pain includes several diagnoses: odontogenic, musculoskeletal, neurovascular, persistent idiopathic facial pain (PIFP), neuropathic pain, neuralgia, TMD, and headache. When there is a persistent and intense nociceptive input in a sensitized central nervous system, the patient becomes more reactive and experiences more pain with less provocation. Practitioners should have knowledge of this type of heterotopic pain when determining the origins of orofacial pain. Without deep understanding of the trigeminal system and mechanisms differentiating nociceptive and non-nociceptive pain, clinicians will most likely treat the reported symptoms instead of the underlying cause.

Aim: This study was designed to evaluate marginal bone level change around microthreaded platform switched implant in the aesthetic zone. Subjects and methods: Eighteen implant fixture were inserted in 16 patients with missing single tooth in upper anterior area and divided equally into two groups. The patients were selected from those attending outpatient clinic, Oral and Maxillofacial Surgery Department, at the Faculty of Dental Medicine, Boys, Cairo, Al-Azhar University. Clinical examination was made to all patients as: Inspection and palpation of muscles of mastication, tempromandibular joint , lymph nodes, occlusion, condition of the existing teeth and oral mucosa and available inter arch space. Preoperative periapical radiograph as well as, cone beam CT radiograghy for evaluation of the implant site. The patients were assessed clinically at the operative day and post-operatively for 6 months to evaluate implant stability with osstell, Probing depth (PD) and PES/WES score. Marginal bone loss was measured 6 months post-operatively using CBCT radiography. Results: The mean value of vertical bone loss after 6 months was 0.52± 0.15 in group I and 0.92± 0.26 in group II . This bone loss was increased in group II more than group I with statistical significant difference. The mean value of PES/WES total was 13.44± 1.81 in group II and 15.67±1.66 in Group I. This value was decreased in group II more than group I with statistical significant difference. Conclusion: The use of micro threads on the implant neck with platform switch was most effective design to maintain and preserve marginal bone level.

Context: Trismus is a tonic contraction of the muscles of mastication resulting from any abnormal condition or disease with mouth opening of ≤35 mm. Maxillofacial surgeries cause fibrosis and subsequent scar contracture in the muscles of mastication that lead to a detrimental impact on quality of life; difficulty in activities such as biting, chewing, swallowing. Aim:The studyaims to assess the effects of TheraBite Jaw Rehabilitation System on trisums post maxillofacial surgeries. Methods: A convenience sample of 20 patients attended to maxillofacial clinic; they suffer from trismus post maxillofacial surgeries. Patients trained of using TheraBite Jaw Rehabilitation for one month. The outcome measured every week by using TheraBite scale of Mouth range of motion, Eat-10 assessment scale and visual analogue scale. Results: There was improvement of mouth opening (MO) after regular use of TheraBite Jaw Rehabilitation, improvement of score of Eat-10 assessment scale, and decrease of pain dramatically. Conclusion: Patients suffer from trismus exhibit an improvement of moth opening, score EAT-10 and decrease pain. Recommendation:Applying educational sessions by nurses for patients to early use of TheraBit Jaw rehabilitation system post maxillofacial surgeries.

Aim This study aims to compare surface electromyographic activities (EMG) of four muscles, that is anterior temporalis (AT), masseter (MST), sternocleidomastoid (SCM) and anterior belly of digastric (ABD), between chronic periodontitis patients and periodontally healthy individuals as well as to correlate these EMG findings with periodontal parameters. Methods Thirty chronic periodontitis patients were recruited in Group I and 30 periodontally healthy individuals in Group II. Clenching and resting EMG for 4 muscles (AT, MST, SCM and ABD) were recorded for each participant. These EMG values were compared between the groups and correlated with periodontal parameters (plaque index, modified sulcular bleeding index, probing depth and clinical attachment loss). Results Resting EMG (rEMG) showed no significant difference between the groups for any muscle. Clenching EMG (cEMG) values were significantly lower in Group I than Group II for AT and MST (P = .001), but not so for SCM and ABD. Within Group I, AT and MST showed a significant negative correlation of cEMG with probing depth and clinical attachment loss (P Conclusion Electrical muscle activities of AT and MST are lower in chronic periodontitis than periodontally healthy individuals.

One of the goals that the prosthodontist has to achieve is to construct retentive and stable denture that subsequently enhances both function and esthetics. Subjective and objective contemplate provide controversial results of denture liners influence on the masticatory ability. While results of some considerations indicated that chewing efficiency remarkably improves the chewing ability. Flexible acrylic resin liners offer better denture adaptation, patient satisfaction as well as denture retention due to its light weight and engaging more desirable undercuts. Aim of this study was to assess the flexible lining acrylic resin material?s influence on the chewing efficiency and activity of masticatory muscles in complete denture wearers. Materials and methods: Twenty six completely edentulous patients were selected and were divided into two groups, Group I: patients wearing conventional heat cured acrylic complete denture. Group II: patients wearing conventional heat cured acrylic complete denture relined by soft acrylic versacryl. Chewing efficiency and Electromyography records taken for both groups at time of insertion, after first, second and third month. Results: time taken during swallowing decreased for patients wearing complete dentures lined with soft acrylic versacryl than conventional complete dentures. EMG activity for both the masseter and temporalis muscles were increased after the relining the complete denture with soft liner (versacryl). However, EMG activity of the masseter muscle was higher than the temporalis muscle in both groups.

Background The infratemporal fossa (ITF) represents an area densely packed with neurovascular structures within irregular boundaries. The goal of this study was to classify the ITF into zones corresponding to its anatomical spaces and the order in which they are encountered during an endonasal approach (anteroposterior axis). Methods Six cadaveric specimens (12 sides) with injected colored latex were dissected. Following an endoscopic medial maxillectomy and Denker's approach, a progressive exploration of the masticator space and upper parapharyngeal space was completed. A classification of the ITF based on well-defined spaces was ascertained. Results The ITF was divided into five zones: Zone 1 (retromaxillary space)-space lying between the posterolateral wall of the maxillary sinus and the temporalis and pterygoid muscles. Zone 2 (superior interpterygoid space)-area including the superior head of the lateral pterygoid muscle, V3 , and foramen ovale. Zone 3 (inferior interpterygoid space)-includes the inferior head of lateral pterygoid muscle, medial pterygoid, and temporalis muscles, and the space enclosed by these muscles. Zone 4 (temporo-masseteric space)-space lateral to the temporalis muscle (comprising fat mostly). Zone 5 (tubopharyngeal space)-includes the Eustachian tube, tensor, and levator veli palatini muscles, and structures in upper parapharyngeal space. Conclusion The ITF can be visualized as five zones based on spaces enclosed by the masticator muscles and upper parapharyngeal structures. This novel classification system is useful to guide endoscopic approaches to the ITF, while decreasing the potential for injury of neurovascular structures and pterygoid muscles.

Em situações de acidente, os traumas faciais têm ocupado lugar de destaque, e as fraturas mandibulares compreendem o maior percentual de injúrias tratadas pelos cirurgiões bucomaxilofaciais. Intervenções fisioterapêuticas vêm sendo somadas à reabilitação pós-operatória, otimizando a atividade muscular pós-trauma, colaborando na recuperação das funções mastigatórias, de fonação, deglutição e posturais. Objetivo: o presente estudo objetivou comparar a evolução longitudinal da atividade elétrica do músculo masseter por meio de exame eletromiográfico em um indivíduo politraumatizado submetido à fisioterapia e outro com fratura de mandíbula sem tratamento fisioterapêutico. Sujeitos e método: para tal pesquisa, analisou-se um voluntário politraumatizado submetido a tratamento fisioterapêutico, um voluntário com fratura de mandíbula sem tratamento fisioterapêutico e três voluntários sem fraturas como grupo controle. Foi realizada uma primeira coleta de dados eletromiográficos nos primeiros dias após alta do serviço de cirurgia responsável pelo tratamento das fraturas e uma segunda coleta 60 dias após. No indivíduo submetido ao tratamento fisioterápico, realizou-se ainda uma terceira coleta após 90 dias. Resultados: o voluntário politraumatizado submetido ao tratamento fisioterapêutico, em 90 dias, obteve atividade elétrica do músculo masseter, semelhante ao grupo controle. Já o voluntário com fretura mandibular não submetido ao tratamento fisioterapêutico apresentou resultados semelhantes ao grupo controle após 60 dias de alta hospitalar. Considerações finais: conclui-se que a intervenção fisioterapêutica em pacientes politraumatizados é de grande relevância, devolvendo a condição muscular fisiológica de mastigação, no que tange à atividade elétrica, num prazo de até 90 dias, apresentando, além disso, vantagens na redução da sintomatologia desarmonizadora da função.

Temporomandibular joint disorders (TMDs) encompass a wide array of ailments affecting the temporomandibular joint (TMJ), muscles of mastication, and the allied structural framework. Myofascial pain, internal derangement of the joint, and degenerative joint diseases constitute the majority of TMDs. TMDs usually have a multifactorial etiology, and treatment modalities range from conservative therapies to surgical interventions. Low-level laser therapy (LLLT) has evolved as an efficient non-invasive therapeutic modality in TMDs. Previously conducted systematic reviews and meta-analyses have shown variable results regarding the efficiency of LLLT in TMJ disorder patients. Hence, this systematic review was carried out as an attempt to evaluate the efficacy of LLLT in the treatment of temporomandibular joint disorder patients.

A temporomandibular disorder (TMD) is considered to be multifactorial with several treatment modalities available to provide symptomatic relief. The use of non-invasive biological techniques with minimal or no side effects is highly recommended. The present study evaluated the effectiveness of low-level laser therapy (LLLT), therapeutic ultrasound (Th.US), and transcutaneous electric nerve stimulation (TENS) for the management of TMDs. A total of 45 patients (16 males and 29 females) with an age range between 20 and 50 years having temporomandibular joint (TMJ) disorder with TMJ pain, joint sounds, limited mouth opening, and pain in muscles of mastication were included in the study. The patients were randomly divided into 3 equal groups where group I was given class IV A low-level laser therapy (indium gallium arsenide phosphide [InGaAsP]) at a wavelength of 940 nm biweekly for 4 weeks. Group II was given therapeutic ultrasound in continuous mode at a frequency of 1 MHz and intensity of 1–1.25 W/cm2 for 3 min/session (3 sessions of 3 min each in every visit). The patients in group III were given TENS therapy with low-intensity current for a duration of 30 min, with a pulse rate of 0.11 Hz biweekly. All the patients were followed up twice a week until 1 month corresponding to total eight visits in 4 weeks to check for reduction in pain intensity, number of tender points, joint sounds, and maximal possible mouth opening. There was a statistically significant greater reduction in pain (p

The texture of foods is affected by concurrent auditory sensations. To improve the texture of nursing care foods, we developed a pseudo-mastication sound presentation device based on electromyogram (EMG) signals from the muscles of mastication. EMG signals have enabled us to promptly present care recipients with pseudo-mastication sounds. However, actual mastication sounds vary in intensity and duration more than EMG signals. Here, we investigated changes in EMG signals and actual mastication sounds during the mastication of two food types (rice crackers and Japanese pickles) to improve our device. We found that the intensity and duration of mastication sounds decreased as the number of mastication strokes increased. Furthermore, the intensity and duration of mastication sounds and the latency between the onset of EMG signals and the onset of mastication sounds also varied by food type. For EMG signals, only the intensity varied by food type. Based on our findings, we modified our pseudo-mastication sound presentation device to enable control of the intensity and duration of pseudo-mastication sounds based on the number of mastication strokes and food type. Reproducing more natural pseudo-mastication sounds can improve care recipients' motivation for ingesting nursing care foods, thus preventing malnutrition and frailty.

BACKGROUND The aim of this study was to investigate how common temporomandibular disorder (TMD) symptoms are among head and neck cancer (HNC) patients before and after oncological treatment. METHODS Eighty-nine patients with HNC receiving radiotherapy were enrolled in the study. Patients were examined before radiotherapy and at 6 and 12 months after radiotherapy to evaluate the function and tenderness of the temporomandibular jaw and the muscles of mastication as well as the patient-reported symptoms. RESULTS At 6 months after radiotherapy, there was a large increase in the number of patients reporting problems with opening their mouth, fatigue, stiffness, and pain of the jaw. Sixty-eight percent of the patients had symptoms of TMD before oncological treatment and 94% and 81% had symptoms at the 6- and 12-month follow-up, respectively. CONCLUSION The signs and symptoms of TMD escalate after radiotherapy, with symptoms peaking at 6 months after radiotherapy. Most commonly, patients suffer from restricted mouth opening, stiffness, fatigue, and pain of the jaw.

Objective To describe acute compartment syndrome (CS) of the muscles of mastication in a working dog associated with a traumatic training event. Case summary A 2.5-year-old male Belgian Malinois was evaluated for acute blindness, severe diffuse swelling of the head, and inability to close the jaw following a traumatic incident during a bite training drill. During the exercise, the maxillary canine teeth were locked on a bite sleeve. Magnetic resonance imaging of the head and ocular system identified diffuse muscle swelling and hyperintensity, most severe in the muscles of mastication. Ocular abnormalities were not identified. Rhabdomyolysis, CS, and indirect optic nerve injury were supported by measurement of increased intramuscular pressure. Bilateral decompressive fasciotomies over the masseter and temporalis muscles resulted in immediate and marked resolution of the swelling and jaw movement. Blindness, however, did not resolve. New or unique information provided CS involving the muscles of mastication may occur as a complication of bite training and may result in irreversible and even life-threatening complications. Emergent decompressive fasciotomy is indicated to reverse swelling; however, visual deficits may not resolve.

PURPOSE/OBJECTIVE(S): Trismus is caused by injury to the masticatory muscles resulting from cancer or its treatment. Contouring these muscles to reduce dose and radiation related trismus can be problematic due to interobserver variability. This study aimed to evaluate the reduction in interobserver variability achievable with a new contouring atlas.MATERIALS/METHODS: The atlas included: medial and lateral pterygoids (MP, LP), masseter (M) and temporalis (T) muscles, and the temporo-mandibular joint (TMJ). Seven clinicians delineated five paired structures on CT scans from 5 patients without the atlas. After ≥5 weeks, contouring was repeated using the atlas. Using contours generated by the clinicians on the same 5 CT scans as reference, dice similarity coefficient (DSC), mean distance-to-agreement (DTA) and centre of mass (COM) difference were compared with and without the atlas. Comparison was also performed split by training grade. Mean and standard deviation (SD) values were measured.RESULTS: The atlas reduced interobserver variability for all structures. Mean DTA significantly improved for MP (p = 0.01), M (p CONCLUSION: A new atlas for contouring masticatory muscles during radiotherapy planning for head and neck cancer reduces interobserver variability and could be used as an educational tool.

Objective Introduction: A stable state of musculoskeletal system is provided by harmony of occlusion, the anatomy of temporomandibular joints, and the activity of the masticatory muscles under the control of peripheral and central nervous system. Surface electromyography (EMG) is a well-used modality and is used in dentistry to access the status of the muscles of mastication. The aim of the research was to evaluate the EMG-characteristic of masticatory muscles in patients with TMD and Angle Class II malocclusion. Patients and methods Materials and methods: The study comprised 23 patients with Angle Class II malocclusion and TMD. The average age of the subjects was 26,5 ± 2,3 years. Malocclusion was evaluated according to Angle classification, TMD - according to the Research Diagnostic Criteria (RDC/TMD). Registration of EMG-activity of masseter and anterior temporalis muscles was performed during maximum voluntary clenching, clenching on the right and left sides. Results Results: EMG-activity of masticatory muscles are characterized by: 1) increased values of EMG-activity of temporal and masseter muscles - peak and average amplitude in tests of unilateral clenching and maximum clenching (values are greater than 2000 μV); 2) in unilateral clenching of jaws (on the left or right) the increased EMG-activity was detected on the balancing side; 3) in unilateral clenching of jaws (on the left or right) the increased muscle activity on the working side with disproportional (asymmetric) load distribution between masseter and temporal muscles has been found. Conclusion Conclusions: Patients with Angle Class II malocclusion and TMD were found features of EMG-activity of masticatory muscles.

The aim of this paper was to present the first report of Prosopis nigra poisoning of cattle in Argentina. Outbreaks occurred in five farms located in Salta and Santiago del Estero provinces. All animals were examined, euthanized and necropsied. Clinical signs included tongue protrusion, twitches and tremors of muscles of mastication, weight loss and lethargy. Severe atrophy of the masseter, buccinator and lingual muscles was observed, along with neuronal vacuolation in the nuclei of the trigeminal, facial, and hypoglossus nerves. These findings and the clinical signs are consistent with results obtained in animals, spontaneously and experimentally intoxicated with Prosopis juliflora in previous studies. Several species of this genus are native to Argentina. Farmers should be warned about the suspected toxicity by Prosopis nigra, since this species has wide geographical distribution in the country.

A 48-year-old man was brought to our unit with deteriorating consciousness but no available history. His Glasgow Coma Scale score was 11/15 (E3, V4, M4). A limited neurological examination identified neck stiffness with normal upper and lower limbs except for extensor plantar responses. Cranial nerve examination was also limited, but with no obvious ophthalmoplegia, facial weakness, wasting of muscles of mastication or jaw drop. Following intubation, he was found to have persistently elevated inflammatory markers but negative blood and urine cultures. MR scan of brain with contrast showed multiple ring-enhancing lesions and meningeal enhancement without hydrocephalus (figure 1). Cerebrospinal fluid (CSF) analysis showed a raised protein, with lymphocytosis and low glucose. Nucleic acid amplification test of CSF for tuberculosis was positive. Figure 1 MR scan of brain showing multiple …