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PubMed2003

Type A botulinum toxin in the treatment of chronic facial pain associated with masticatory hyperactivity.

PURPOSE: Chronic hyperactivity of the masticatory muscles is a common functional disorder associated with chronic facial pain and headache. The positive therapeutic effect of botulinum toxin type A on functional disorders and pain symptoms has been known in connection with the treatment of cervical dystonia. The purpose of this report is to assess whether the targeted reduction of masticatory muscular hyperactivity by local injection treatment with botulinum toxin type A can improve facial pain headache symptoms in the event that other treatment methods prove ineffective. MATERIALS AND METHODS: In an randomized blinded placebo-controlled study, 90 patients (60 verum and 30 placebo) with chronic facial pain were treated with botulinum toxin type A (Botox; Allergan, Ettlingen, Germany) injections into masticatory muscles. RESULTS: Ninety-one percent of patients who received botulinum toxin improved by a significant mean reduction of approximately 3.2 on a visual analog pain scale. By comparison with t test and chi(2) test, there was a significant difference compared with the placebo group (P <.01). CONCLUSIONS: The local injection of botulinum toxin type A constitutes an innovative and adequately efficient treatment method for chronic facial pain associated with hyperactivity of the masticatory muscles. An improvement in the painful symptoms can be expected in up to 90% of patients who do not respond to conservative treatment methods.

Botulinum Toxins, Type A↗

PubMed2004

Myosin gene mutation correlates with anatomical changes in the human lineage.

Powerful masticatory muscles are found in most primates, including chimpanzees and gorillas, and were part of a prominent adaptation of Australopithecus and Paranthropus, extinct genera of the family Hominidae. In contrast, masticatory muscles are considerably smaller in both modern and fossil members of Homo. The evolving hominid masticatory apparatus--traceable to a Late Miocene, chimpanzee-like morphology--shifted towards a pattern of gracilization nearly simultaneously with accelerated encephalization in early Homo. Here, we show that the gene encoding the predominant myosin heavy chain (MYH) expressed in these muscles was inactivated by a frameshifting mutation after the lineages leading to humans and chimpanzees diverged. Loss of this protein isoform is associated with marked size reductions in individual muscle fibres and entire masticatory muscles. Using the coding sequence for the myosin rod domains as a molecular clock, we estimate that this mutation appeared approximately 2.4 million years ago, predating the appearance of modern human body size and emigration of Homo from Africa. This represents the first proteomic distinction between humans and chimpanzees that can be correlated with a traceable anatomic imprint in the fossil record.

Amino Acid Sequence↗

PubMed2002

Comparative functional morphology of the masticatory apparatus in the long-snouted crocodiles.

The masticatory muscles and their related structures of the skull were observed in the Indian gavial (Gavialis gangeticus), the false gavial (Tomistoma schlegelii), and the African slender-snouted crocodile (Mecistops cataphractus) to detail some morphological differences in comparison with the other crocodile species, and to compare and elucidate the functional strategy of themasticatory apparatus in these long-snouted species. The Musculus pterygoideus posterior was relatively smaller in the three species compared with many short-snouted crocodiles. It suggests that the masticatory power in fish-eating long-snouted species is not so high as in the short-snouted crocodiles, while the masticatory muscles were morphologically different among the three long-snouted species as follows. The M. pterygoideus posterior of the false gavial was extended in the lateral side of the lower jaw unlike the Indian gavial. The M. pseudotemporalis and the Fenestra supratemporalis were largely developed in the Indian gavial, however we suggest that the other two species possess the weak bundles in this muscle. The false gavial and the African slender-snouted crocodile have the pterygoid bone well-developed extending dorso-ventrally and it is suggested that the M. adductor mandibulae posterior attached to the pterygoid bone may be much larger than the Indian gavial. These data morphologically clarify the masticatory mechanism in the long-snouted crocodiles different from the short-snouted species, and demonstrate that the evolutional strategy to share the functional role in the masticatory muscles have been differently established between the Indian gavial and the other two species. We also obtained the morphological data in the fossil skull of the Machikane crocodile (Toyotamaphymeia machikanense) and concluded from the fossil characters that the considerable developments of the M.pterygoideus posterior and the M.pseudotemporalis in this species had not morphologically been consistent with both the Indian and false gavials.

Alligators and Crocodiles↗

PubMed2001

Mapping energy metabolism in jaw and tongue muscles during chewing.

Investigators have used positron emission tomography with 18F-fluoro-D-deoxyglucose to obtain information not only for the diagnosis of cancers, but also for researching physiology in skeletal muscles. The aim of this study was to evaluate the activities of the jaw and tongue muscles during gum-chewing. Five volunteers aged 32-61 years were studied by positron emission tomography. They were requested to chew two pieces of chewing gum for 30 min after intravenous injection of 18F-fluoro-D-deoxyglucose. 18F-fluoro-D-deoxyglucose uptake in the intrinsic tongue muscle was significantly (p < 0.05) higher than that in the masseter, temporal, and medial pterygoid muscles. Heterogeneous uptake of 18F-fluoro-D-deoxyglucose was observed in the masticatory muscles. In addition, the tongue exhibited higher activity than the masticatory muscles. In conclusion, positron emission tomography with 18F-fluoro-D-deoxyglucose appeared to be a useful technique for investigating the physiologic activities of the skeletal muscles, which have been difficult to examine by conventional methods.

Adult↗

PubMed2002

[Disturbance of jaw-opening due to extension of syringobulbia to the pons--a case report].

We report a patient with syringobulbia extending to the pons, who could not open his mouth widely. He had been involved in the traffic accident at 16 years of age. Since them he had suffered numbness in the left neck and arm. At age 30, he became unable to open the mouth widely with pain in the left jaw joint. He also noted dysphagia and tinnitus. Neurologically, there were vocal cord paresis, dysesthesia of the face, ageusia and cerebellar ataxia all on the left side. Brain MRI revealed syringobulbia which extended to the pons. Spinal MRI revealed syringomyelia through the entire spinal cord. The syrinx of the spinal cord seemed to connect with the brainstem lesion. EMG of the masticatory muscles revealed paradoxical activity in the left masticatory muscles. We concluded that disturbance of jaw-opening in this case was caused by syringobulbia, the lesion of which could involve masticatory central pattern generator in the brainstem.

Adult↗

PubMedDate not supplied

[The usage of E.M.G. in the dental research and the clinical practice].

The first part of this review, refers to the use of electromyography (EMG) in studying the stomatognathic system. EMG is used for the study of function and fatigue of the masticatory muscles, the recording of centric relation etc. The behavior of the masticatory muscles (especially of the masseter and the temporalis) in the cases of TMJ dysfunction are also reviewed. In the second part, there is a description of the use of EMG biofeedback in the treatment of TMJ dysfunction, myofacial pain and bruxism. Finally, there is reference to the portable modular EMG biofeedback units.

Biofeedback, Psychology↗

PubMed1994

Masticatory performance, muscle activity, and occlusal force in preorthognathic surgery patients.

Previous studies have indicated that patients scheduled for orthognathic surgery tend to have lower maximum bite forces and exert lower forces during mastication. The effect of these deficits on masticatory performance have not been previously assessed. Masticatory performance was analyzed in four groups: male and female orthognathic surgery patients prior to presurgical orthodontics (n = 12 and 23), and male and female controls (n = 27 and 31). Mastication performance was analyzed by having the subjects chew 5-g pieces of carrot for 20 cycles and measuring the resulting median particle size with a standard sieve method. Masticatory performance showed the same trends as maximum bite force and masticatory forces: male controls had the best and patients the poorest masticatory performance. There was a weak correlation between masticatory performance and maximum bite force at the molar positions. Masticatory performance also weakly correlated to electromyographic signals during mastication of a constant bolus (gummy bears) for all muscles except the left posterior temporalis. Correlations were generally not present or were very weak between masticatory performance, estimated masticatory forces, and muscle efficiency, suggesting that muscle efficiency and forces generated during mastication are not the primary factors that determine masticatory performance. Other factors contributing to a person's ability to chew food might include occlusal relationships and mechanical advantage.

Adolescent↗

PubMed1995

Electromyographic signal changes during exercise in human chronic jaw-muscle pain.

Twelve individuals (2 males, 10 females) with chronic masticatory muscle pain and 11 individuals (2 males, 9 females) without, had their bite force and surface electromyography from the right and left superficial masseter and anterior temporalis muscles recorded before, during and after a 30-s sustained submaximal clenching task. This task was performed at 50% of the force level of each subject's maximum voluntary contraction (MVC) for 30 s. Brief (3 s) 50% MVC efforts were recorded at 15-s intervals, three times before and six times after the sustained clench. Each subject performed this pattern of activities three times with a 15-min rest between each trial. The centre frequency (CF) of the electromyographic power spectrum was calculated by fast Fourier transformations. The mean CF at the end of the 30-s clench and the rate of change at the CF during the clenching task were analysed between groups, sides and muscles. The data indicated that the masseter CF decreased at a significantly faster rate for the first clenching trial in the muscle-pain group. Conversely, the rate of change of the temporalis CF did not significantly differ for the two groups during the three clenching trials. By the third trial the CF of the exercised masseter in the non-pain group exhibited a similar rate of change to that in the pain group. This suggests that both repeated exercise and the presence of chronic inflammation increase the rate of change of the electromyographic signal of the contracting masseter. The mechanism underlying this increased change is unknown.

Adult↗

PubMed2002

Masticatory performance in patients with myasthenia gravis.

Masticatory muscle electromyograms (EMGs) were recorded while patients with bulbar myasthenia gravis chewed artificial food and compared with those of patients with ocular myasthenia gravis, patients in clinical remission who had previously suffered from bulbar myasthenia gravis and healthy individuals. Masticatory performance and EMGs were significantly smaller in the bulbar group. There were no indications of subclinical masticatory muscle weakness in patients with bulbar myasthenia gravis in remission and in patients with ocular myasthenia gravis. Patients with bulbar myasthenia gravis barely compensated for muscular weakness by chewing at a higher percentage of their maximal EMG. These quantitative findings, when combined with subjective reports of masticatory muscle weakness, show that a need to support the jaw is characteristic of patients with bulbar myasthenia gravis who produce low EMG activity.

Adult↗

PubMed1993

Monosynaptic innervation of trigeminal motor neurones involved in mastication by neurones of the parvicellular reticular formation.

In order to determine whether neurones in the parvicellular reticular formation are in direct synaptic contact with motor neurones innervating masticatory muscles, a combined retrograde and anterograde transport study was carried out in the rat at both light and electron microscopic levels. The animals received injections of the retrograde tracers wheat germ agglutinin conjugated to horseradish peroxidase or cholera toxin B conjugated to horseradish peroxidase into the masticatory muscles and of the anterograde tracer biocytin into the ipsilateral parvicellular reticular formation. The trigeminal motor nucleus was then examined for both anterograde and retrograde labelling in the light and electron microscopes. Retrogradely labelled motor neurones were identified in the trigeminal motor nucleus. They were large and their locations within the nucleus depended on the muscle injected. In addition, terminals anterogradely labelled with the biocytin that was injected in the parvicellular reticular formation were identified throughout the motor nucleus. At the electron microscopic level, the retrogradely labelled cells were found to receive input both from distinct types of unlabelled terminals and from terminals that were anterogradely labelled from the parvicellular reticular formation. The labelled terminals comprised one of the four classes of afferent terminals, being 1-2 microns in diameter and densely packed with spherical vesicles. They formed mostly asymmetrical but also symmetrical synapses with the labelled perikarya and dendrites. Anterogradely labelled terminals were also observed to form both symmetrical and asymmetrical synaptic contacts with unlabelled structures in the motor nucleus. It is concluded that neurones in the parvicellular reticular formation form direct synaptic contact with motor neurones of masticatory muscles. This pathway may represent the anatomical substrate by which the reticular formation exerts at least part of its influence on mastication. Since the parvicellular reticular formation receives input from the substantia nigra pars reticulata, it is possible that this pathway represents a system whereby the basal ganglia directly influence orofacial movement.

Animals↗

PubMed1989

Immediate electromyographic response in masseter and temporal muscles to bite plates and stabilization splints.

The immediate influence on masticatory muscle activity of bite plates and stabilization splints was investigated in control subjects and patients with craniomandibular disorders. Electromyographic surface recordings were performed from the masseter and temporal muscles bilaterally with and without the appliances in situ. In the rest position, no significant change in average activity was registered in any muscle with either appliance. Activity during maximal biting on stabilization splints was not different from that without the appliance while bite plates caused a decrease in activity in both muscles in both groups. The reduced maximal activity was probably due to the smaller number and exclusively anterior positioned occlusal contacts on the bite plate.

Adult↗

PubMed1990

Length-tension relations of the masticatory elevator muscles in normal subjects and pain dysfunction patients.

Myofascial pain and dysfunction is the primary diagnosis in a large proportion of facial pain complaints. Myofascial disease can present in the form of trigger points, fibromyositis, myositis, muscle spasm, and muscle weakness. The purpose of this study is to research for quantifiable physiological differences between groups of normal subjects and myofascial pain dysfunction (MPD) patients. The first specific aim was to determine the opening of the jaw at which maximal isometric tension can be produced by the jaw closing muscles, with the hypothesis that this opening of maximal tension would be less for a group of MPD patients than for a group of normal subjects being tested. The second aim was to test the hypothesis that the maximal isometric bite forces for the two groups would differ. Patients with mandibular dysfunction are reported to have a lower maximal bite than normal subjects. Bite force was measured with the T-Scan system. An 80 micron horseshoe-shaped sensor connected to a dedicated IBM XT computer recorded the data. A self-contained printer produced the hard copy for later analysis. Vertical dimension or jaw opening was increased in 0.5-mm increments using double flat plane appliances standardized by the Relator. A MANOVA was used for statistical analysis of the data. MPD patients had significantly higher bite forces at 8.0, 8.5, 9, and 9.5 mm. Normal subjects had higher force values at 5.0 mm. There was no significant difference in mean maximal bite force between groups.

Adolescent↗

PubMed1999

A unified concept of idiopathic orofacial pain: clinical features.

The main features of atypical facial pain, stomatodynia, atypical odontalgia, and masticatory muscle and temporomandibular joint (TMJ) disorders are compared in this article, which included a search of articles indexed in MEDLINE. The fact that their terminology has been the subject of many debates can be considered a consequence of taxonomic difficulties and uncertainties. Epidemiologic studies indicate marked female predominance for all types of idiopathic orofacial pain. There is also a difference in the age of maximal prevalence between masticatory muscle and TMJ disorders and the other entities. The clinical presentations display several symptoms in common. Pain is oral, perioral, or facial and does not follow a nervous pathway. It has been present for the last 4 to 6 months or has returned periodically in the same form over a period of several months or years. The pain is continuous, has no major paroxysmal character, and is present throughout all or part of the day. It is generally absent during sleep. Clinical, radiographic, or laboratory examination does not reveal any obvious organic cause of pain. There is also a frequent presence of certain psychologic factors, personality traits, or life events. Based on these shared characteristics, a unified concept is proposed. Each of these entities belongs to a group of idiopathic orofacial pain and could be expressed in either the jaws, the buccal mucosa, the teeth, the masticatory muscles, or the TMJ.

Chronic Disease↗

PubMed1982

Primate experiments on mandibular growth direction.

Induced oral respiration in eight growing monkeys led to a lowering of the chin, a steeper mandibular plane angle, and an increase in the gonial angle as compared with eight control animals. The posterior border of the mandible maintained its normal inclination relative to the skull. The mandible underwent a posterior rotation in the experimental animals and an anterior rotation in the controls. The findings suggest that the position of the chin and the inclination of the mandibular plane are controlled by the balance between the suprahyoid and the orofacial muscles. Since the posterior border of the ramus undergoes gradual remodeling and maintains its normal inclination, it is assumed that the masticatory muscles are not significantly affected by the altered respiratory function. It is therefore concluded that the ramus with the masticatory muscles and the chin with its suprahyoid and orofacial muscles represent two relatively independent systems.

Animals↗

PubMed2004

Craniofacial morphology and growth in the ferret: effects from alteration of masticatory function.

INTRODUCTION: Our hypothesis is that any effects on craniofacial growth and morphology induced by altering the masticatory function will vary according to the species involved. The general aim of this thesis was to test the possible effects of altering the masticatory function on craniofacial growth and morphology, as well as features of masticatory muscles in ferrets. To better elucidate these mechanisms involved, the anatomy of the skull, craniofacial growth pattern and development of occlusion in the ferret were investigated to serve as baseline data. MATERIALS AND METHODS: The description of the anatomy and the radiographic features of the skull was based on observations of 100 skulls of adult ferrets of both sexes. The craniofacial growth pattern was studied in 16 young ferrets of both sexes using serial cephalograms taken on 5 occasions according to age: 25 days, 35 days, 55 days, 80 days and 300 days. To follow the development of occlusion, these animals underwent dental examinations every other day. Forty male ferrets were divided into two groups from the age of 5 weeks. One group was fed hard pellets (hard-diet group), and the other the same diet but softened with water (soft-diet group). After six months, specimens of masticatory muscles were dissected and analysed histochemically, and cephalograms were analysed cephalometrically. RESULTS: The ferret skull is relatively elongated with a short facial region, being longer and broader in males than in females. The viscero- and neurocranium follow an orderly pattern of expansive growth. The growth of the mandible is mainly characterized by an anteroposterior body elongation, and enlargement of the coronoid process. Craniofacial growth in ferrets ceases earlier in female than in male animals. The deciduous teeth erupted between the 19th and 31st postnatal day, and exfoliated approximately between days 51 and 76. The time of eruption of the permanent teeth ranged from 42 to 77 days. The female ferrets were generally ahead of the males regarding the eruption age of permanent teeth. The alteration of the masticatory function by feeding the animals a soft diet caused a hard palate plane more distant from the cranial base plane, smaller inter-frontal and inter-parietal widths, and a slenderer zygomatic arch, as well as a generally shorter and narrower coronoid process. Variations of most variables are greater in animals fed on soft diet. The mean cross-sectional area of type I and type II fibres in the temporalis and the masseter, and type II fibres in the digastricus, as well as the number of capillaries per fibre were significantly smaller in the soft-diet animals. CONCLUSION: Altered masticatory function has induced changes in masticatory muscles and certain effects on craniofacial growth in ferrets. These changes are not the same as those reported in other species (e.g. rats). It appears that reduced masticatory function leads to smaller fibres in the elevators and transverse skull dimensions. The different effects are presumably related to the differences in craniofacial anatomy and growth pattern, as well as the masticatory system, in the various species studied previously.

Animals↗

PubMed1981

Adaptation of the masseter and temporalis muscles following alteration in length, with or without surgical detachment.

Histochemical properties, muscle fiber cross-sectional area, muscle fiber length, and the oxidative capacity of masticatory muscles of female rhesus monkeys were assessed following alteration in functional length by an intraoral appliance or by detachment of the muscle. Experimental groups received the appliance only (A); the appliance and subsequent detachment of the masseter (AD); the appliance and detached masseter, but with surgical reattachment of the masseter to the pterygomasseteric sling (ADR); no appliance, but detachment and reattachment of masseter (DR); or an appliance which was removed after 24 weeks to study posttreatment responses (PT). Animals were sacrificed and the muscles were studied at intervals from 4 to 48 weeks after initiation of the experimental period. The results of these studies led to the following conclusions: (1) Stretching the masseter and temporalis muscles within physiological limits did not significantly alter the proportion of fiber types, although oxidative capacity of the fibers was reduced. (2) Fibers with "intermediate" myofibrillar ATPase activity were no more prevalent in experimental than control muscles. (3) The cross-sectional area of Type I fibers of masseter muscles decreased following some experimental procedures, indicating that recruitment of these fibers is the most sensitive to altered jaw function. (4) Minimal alteration of muscle capillarity was induced by any of the experimental procedures. (5) The lengths of masseter muscle fibers in Group PT and of temporalis muscle fibers in groups AD and ADR were greater than in control animals.

Adaptation, Physiological↗

PubMed2001

Controlled study of EMG activity of the jaw closers and openers during mastication in patients with myasthenia gravis.

Mastication was evaluated in patients with bulbar myasthenia gravis and compared with that of patients with ocular myasthenia gravis, patients in remission who previously suffered from bulbar symptoms, and healthy controls. Bulbar myasthenia gravis may impair mastication due to weakness of the masticatory muscles. The aim of the study was to objectively evaluate the influence of myasthenia gravis on mastication. The subjects chewed a piece of breakfast cake and chewed 1 min on a piece of chewing gum. Surface EMG of the masseter muscle, temporalis muscle and jaw opener muscles was recorded. Statistical analysis revealed that bulbar patients produced significantly less EMG activity in the closing phase of a chewing cycle in both experiments. The EMG of the masseter muscle expressed as percentage of the maximum EMG during maximal clenching showed significantly higher values in the bulbar group than in the other groups. This was not found for the temporalis muscle. It was suggested that bulbar patients use a strategy of limited effort to produce a bolus that can be swallowed. The ocular patients and the patients in remission showed no subclinical impairments in muscle function during chewing.

Adult↗

PubMed2000

Electromyographic activity in patients with temporomandibular disorders.

Evaluation of masticatory muscle activity by surface electromyography (EMG) is a valuable tool for diagnosing dysfunction of the masticatory apparatus. However, controversy exists with regard to the usefulness of the EMG for patients with temporomandibular disorders (TMD). Forty patients with TMD were subjected to surface EMG of the masticatory muscles. These patients had consulted because of temporomandibular pain and clicks. In most cases (75%), the symptoms affected the patient's left side. Overall mean resting activity was 2.52 microV+/-1.25 microV (s.d.), which is slightly higher than in comparable healthy subjects (1.92+/-1.20 microV). Mean resting activity was highest in the anterior digastric muscle (3.49 microV) on the left side. Overall mean activity during clenching was 66.77+/-35.22 microV, which is about half that observed in healthy subjects (110.30+/-82.97 microV). During leftward movement of the jaw, activity was on average highest in the left digastric, while during rightward movement, activity was on average highest in the right anterior temporal (AT). Our results thus indicate that patients with temporomandibular joint (TMJ) disorder show: (1) a slight increase in basal tone; (2) a significantly reduced capacity for clenching; and (3) an apparently paradoxical inhibition of the dysfunctional-side AT during movement of the mandible towards that side.

Adolescent↗