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C E Skinner

Publications and source records attributed to C E Skinner.

18 recordsLinked to original sources
PubMed2001

Complete pterygoidectomy--a novel method for the topographical investigation of the deep masticator space and its contents.

The complexity of the topographical anatomy of the infratemporal fossa (=masticator space) remains underappreciated because of limitations of the methods used to expose it; these methods are described and critiqued. The disposition of the lateral pterygoid (LPt) muscle in the masticator space obscures the anatomical relations of clinically significant neurovascular structures. Controversies regarding the nerve supply and actions of the two LPt heads are summarized. Since the LPt has been implicated in temporomandibular (joint) dysfunction (TMD), its precise relationships to the mandibular neurovascular structures is essential in understanding its role in TMD. We recently developed a method involving the en bloc removal of the LPt-tensor veli palatini complex along with all vital neurovascular structures. Further investigations using our method--in conjunction with contemporary imaging techniques (CT, MRI)--should help describe the detailed topography of masticatory structures. This information should help in understanding, differential diagnosis, and treatment of TMD.

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PubMed1998

Are the two heads of the human lateral pterygoid separate muscles? A perspective based on their nerve supply.

Based on biomechanic and electromyographic studies, it has been argued that the two heads of the human lateral pterygoid muscle (LPt) are reciprocally active during the masticatory cycle. Thus, it has been proposed that the heads be considered separate muscles. However, questions about the accuracy of these data have arisen. The authors hypothesized that partition cannot be complete without an independent nerve supply. To test this, complete unilateral lateral pterygoidectomies were performed on 20 dissection room cadavers. A novel approach, using an en bloc method, proved optimal to expose the detailed nerve supply to the LPt heads. In the two most frequently observed patterns (15 of the 20 specimens), the heads were supplied from a common source that was derived from either the long buccal or mandibular nerve, or from a loop that arose between the long buccal and lingual nerves. In a third pattern, independent branches to either head arose from the deep temporal, long buccal, or mandibular nerve. In only 20% of the specimens did the two heads receive exclusive innervation from separate sources. The most significant finding of the present study is that both LPt heads in humans are usually supplied by a common proximate source, but each head also receives independent nerves in every case. In the absence of precise information about the functional components in each nerve branch, these data appear to support Juniper's proposal to regard the two LPt heads as entirely separate muscles.

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PubMedDate not supplied

The effect of non-surgical management of TM disorders.

One hundred and ninety-three patients with varying occlusal discrepancies were diagnosed as having TM disorders with orofacial pain. They were divided into five groups with similar clinical symptomatology. There were 84 patients with clicking, 45 with headaches, 13 with neckaches, 39 with tenderness in the TMJ bilaterally and masticatory muscles and 12 with uncomfortable occlusal relationships. All were given an anterior deprogrammer to wear for a period of one week in order to relax the masticatory muscles and allow the jaw to return to a physiologic position. The follow-up occlusal device therapy varied according to clinical symptoms. The group with clicking wore anterior repositioning orthopedic devices to recapture the displaced articular disc, followed by a gradual return to a centric relation position. The other groups wore centric relation appliances providing even posterior cusp tip contacts and anterior guidance. All patients wore the appliances for varying periods, up to one year, with monthly adjustments. The clinical symptoms significantly decreased, and all but 4 patients who had to be treated surgically, had the malocclusion corrected at the same treatment position of the centric relation appliances that were worn for one year. The results suggest that short-term occlusal device therapy is effective as an interim method towards the correction of occlusal discrepancies, but should be followed by a final treatment that will maintain the jaw in an asymptomatic and physiologic position. Four-year re-evaluations revealed no reoccurrence of chronic symptoms after finalization treatment.

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