[Series on masticatory muscles--introduction].
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Stretch reflexes play a vital role in fine-tuning movements and in automatically maintaining posture. This article briefly reviews the operation of the stretch reflex in the human masticatory system. The conventional approach of stretching muscles in an open-loop manner has yielded much valuable information on the operation of this reflex. In particular, it has revealed that stretching the jaw-closing muscles evokes a reflex response with two major components. The short-latency reflex is favoured when stretches are brisk, but slower stretches evoke an additional long-latency component. In the hand muscles, the long-latency response is transcortical: in the masticatory muscles, it is not. In addition to its role in servo-control of muscle length during chewing, the stretch reflex in the jaw-closing muscles maintains the vertical position of the mandible during vigorous head movements such as those that occur during running, jumping, hopping and other vigorous whole-body movements in which the head moves briskly up and down. This is an interesting model system in which to investigate stretch reflexes with natural stimuli under unrestrained, physiological conditions.
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The EMG activities of the masseter muscles and the anterior and posterior parts of the temporalis muscles were investigated in different vertical and sagittal jaw relations. Surface EMG recordings were made. Relative muscle activities were quantified by means of the Activity Index and the Asymmetry Index. Ten subjects with a healthy masticatory system were asked to clench at 10% and 50% of their maximum voluntary clenching level. Registrations were made during clenching in the intercuspal position, on a thin stabilization splint (SSP, 1-2 mm increase of vertical dimension at first molar), on a thick stabilization splint (3 mm thicker at the incisal edge relative to SSP), and on a protrusive re-positioning splint (3 mm protrusive to SSP). The masseter EMG amplitudes were the same for all the jaw positions investigated. However, at the 10% clenching level, the temporalis muscle activity decreased after the vertical dimension was raised and decreased further after the mandible was protrusively positioned (p less than 0.01). An independent function for the posterior and the anterior parts of the temporalis muscle was not found in any of the intermaxillary jaw relations investigated. At the 50% clenching level, a decrease in anterior temporalis muscle activity was observed only with the protrusive position in relation to the other three positions. Also at this level, the index relating the activity of the anterior to that of the posterior part of the temporalis muscle was not different between jaw positions. Raising the vertical dimension and protrusive positioning of the mandible decrease the activity of the temporalis muscles. This may be a factor related to the therapeutic effect of the stabilization splint in the treatment of craniomandibular disorder patients.
Computed tomography (CT), due to its excellent resolution capacity, is a suitable method to examine the soft and bony structures of the masticatory system. The aim of this study was to compare densities and sizes of the masseter and medial and lateral pterygoid muscles obtained by CT between the symptomatic and asymptomatic side in patients with internal derangement of the temporomandibular joint (TMJ). The aim was also to correlate these variables to sex and age, duration of the symptoms, diagnosis and dentition. The material consisted of 33 patients (26 women, 7 men, mean age 37 years, range 14-74 years) whose TMJs were examined by CT and whose coronal CT scans were available. Diagnosis in the symptomatic TMJ was confirmed in operation. No statistically significant difference was seen in mean densities and sizes of the masticatory muscles between the symptomatic and asymptomatic side. The duration of the symptoms, however, correlated positively to the density of the lateral pterygoid muscles in patients with complete dentition. The age of the patients in this group correlated negatively to the size of the masseter muscles. It can be concluded that patients with internal derangements of TMJ with a long duration of symptoms have structural changes in their masticatory muscles which are detectable by CT.
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