Comparison of endoscopic tympanoplasty, cartilage vs. temporalis fascia in chronic suppurative otitis media with inactive mucosal disease: A prospective randomised study.

BACKGROUND: The introduction of endoscopy into middle ear has open up new opportunities for minimal invasive temporal bone surgery. The present study was planned to compare anatomical and functional outcome in patients who underwent endoscope assisted tympanoplasty using cartilage and temporalis fascia graft. METHODS: The present prospective observational randomized study was carried out in the Department of Otorhinolaryngology of a tertiary care teaching hospital of Rajasthan, India from September 2020 to July 2021. Fifty patients of age group 18-60 years, with diagnosis of chronic otitis media having inactive mucosal disease were enrolled in the study and divided into two groups viz. cartilage (group I) and temporalis fascia group (group II). Each patient postoperatively underwent otoscopic examination of ear and pure tone audiometery at 8 weeks and 3rd month. Local wound condition, graft uptake and healing and hearing were assessed and compared. RESULTS: Graft uptake was 92% in cartilage group and 84% in temporalis fascia group. Air conduction and air-bone gap of patients in both the groups showed significant improvement after 3 months of surgery. (p˂0.05) Regarding bone conduction, both groups had shown non-significant changes. (p > 0.05) Hearing gain was comparable on both groups which was 6.71dB in cartilage group vs. 5.9 dB in other group. CONCLUSIONS: The present study showed that graft placement time for temporalis fascia graft was less than cartilage graft, but the difference was insignificant. Hearing improvement, graft uptake and clinical improvement were found to be statistically insignificant between both groups.

Temporalis muscle thickness as a predictor of functional outcome after reperfusion therapies for acute ischemic stroke: a retrospective, cohort study.

BACKGROUND: Sarcopenia, defined as the loss of skeletal muscle mass, has been associated with a worse functional outcome after stroke. Measurement of temporal muscle thickness (TMT) has been introduced as an easily obtainable surrogate marker to identify patients with sarcopenia. Our study aims to investigate the correlation between pre-stroke sarcopenia, measured by TMT assessment, and functional outcome in patients treated with revascularization procedures for acute ischemic stroke. METHODS: We included consecutive adult patients who underwent thrombolysis, endovascular thrombectomy or both for acute ischemic stroke at our Centre from January 2020 to June 2022. Besides collecting baseline clinical and neuroradiological features, TMT was measured on brain computed tomography scans according to a standardized protocol. Modified Rankin Scale (mRS) scores at 3 months represented the main endpoint of functional outcome. RESULTS: A total of 261 patients were available for the analysis. In univariate models, patients with excellent outcomes (mRS = 0-1) were younger, had higher TMT values and lower pre-event disability and stroke severity. In multivariate models higher TMT values resulted independently associated with reduced mortality (Odds Ratio 0.708, 95% Confidence Interval 0.538-0.930, p = 0.013). Age, diabetes, brain bleeding events and stroke severity were found to be predictors of mortality, too. CONCLUSIONS: Our retrospective analysis shows that in patients who underwent revascularization treatments for ischemic stroke TMT is as an independent predictor of survival easily obtainable from the baseline CT scan. Further investigation is required to confirm the role of sarcopenia assessment and TMT measurement in the prognostication toolkit of this disease.

Prospective evaluation of nasal septal perforation repair with absorbable plate and temporalis fascia in early adolescent patients.

OBJECTIVES: In the pediatric population, nasal septal perforations (NSP) are rare, and management is not well described. The use of various techniques has been reported in adults, including the use of interposition grafts, however this technique has not been described in the pediatric population. Our hypothesis is that the closure rate using absorbable d-lactide and l-lactide (each 50 %), polymer (PDLLA) plates as interposition grafts with temporalis fascia for NSP repair in the pediatric population will be an effective method compared to previous techniques. METHODS: Chart review was performed on patients who underwent NSP repair before June 2021, results were compared to a prospective evaluation of an interposition plate graft for repair at a tertiary care children's hospital. RESULTS: Fifteen patients via previous techniques and 5 patients via PDLLA and fascia graft were reviewed. Etiology of perforations included 45 % idiopathic, 25 % traumatic, and 15 % iatrogenic. In the previous techniques group, 10 were male, mean (median) age 14.4 years (15.2). Average size of NSP was 12.6 mm ± 6.6 mm (SD). 14/15 (93 %) patients had resolution of symptoms at 10-week follow-up, and 2/15 (13 %) required repeat repair. Five prospective patients were repaired with a PDLLA and fascia interposition graft, 4 were female, mean (median) age 14.6 years (Nassif and Scott, 2021 Feb 1) [14]. Average size of NSP was 11 mm ± 2.2 mm (SD). 100 % had resolution of symptoms at 10-week follow-up, 0 needed repeat surgery. No significant difference was found in size of NSP or in need for repeat procedure (p > 0.05) between the groups. CONCLUSION: Use of absorbable PDLLA interposition grafts with temporalis fascia for NSP repair in the pediatric population is effective at closing and resolving symptoms associated with NSP.

Assessment of Electromyographic Changes in Masseter and Temporalis Muscles for Patients Undergoing Lower Third Molar Surgery: A Prospective Study.

Introduction Lower third molar impaction surgery is one of the most common minor oral surgical procedures done. Trismus has been one of the most common and disturbing postoperative sequelae for patients. The study aimed to evaluate the electrical activity of the masseter and temporalis muscles after mandibular third molar surgery. Materials and methods The research was conducted at Saveetha Dental College and hospitals in the Department of Oral and Maxillofacial Surgery. The study consisted of 20 individuals. The EMG (electromyography) activities of both masseter muscles in each patient were measured before the tooth extraction surgery, postoperatively after 72 hours, and after seven days. The inter-incisal distance was also measured at similar follow-up intervals. Data were analyzed using IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp., with p-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used for the comparison of electrical activity between masseter and temporalis on both the operated and non-operated sides during preoperative, postoperative, 72-hour, and postoperative seven-day periods. Results It has been found that the electrical activity of the temporalis is higher than that of the masseter muscle measured at all the intervals of the follow-up period, with statistically significant values (p=0.001). It was noted that all the patients have reduced mouth opening when compared with preoperative (mean mouth opening = 45.6 mm), postoperative 72 hours (mean mouth opening = 31.2 mm), and postoperative seven days (mean mouth opening =35.6 mm). When a comparison was done between temporalis and masseter, the masseter took longer to return to pre-operative electrical activity, which might also imply that for prolonged trismus seen in patients after lower third molar surgery, it is the masseter that is affected and needs recovery for trismus to be resolved.  Conclusion  Based on the results obtained, it can be concluded that there was a reduction in the electrical activity of both the masseter and temporalis post-third molar impaction surgery. It was also found that there was a reduction in mouth opening in patients who underwent lower third molar extraction surgery. Masseter muscle took longer to return to its preoperative electrical activity than temporalis muscle, implying that targeted therapies to accelerate the healing of masseter muscle may prevent prolonged trismus in patients who undergo lower third molar impaction surgery.

To Study the Outcome of Cartilage Tympanoplasty Type I in Patients with Medium and Large Perforations Using 0.5 mm Sliced Conchal Cartilage Reinforced with Temporalis Fascia Grafts with 5 Years Follow-up.

Aims: To study the outcome of cartilage tympanoplasty type I in patients with medium and large perforations using 0.5 mm sliced conchal cartilage reinforced with temporalis fascia grafts with 5 years follow-up. Study Design: Retrospective clinical study. Patients and Method: 120 patients with dry tympanic membrane perforation medium and large size and intact ossicular chain, and with no history of previous ear surgery were selected. An underlay type one tympanoplasty, using 0.5 mm sliced conchal cartilage reinforced with temporalis fascia, was performed during 2018-19. A successful anatomical outcome was considered to comprise full, intact healing of the graft without perforation these patients were evaluated for at least 5 years post-operatively till 2023. Results: In this study graft uptake rate was 95.33% for medium size and 93.66% for large perforations at 3 months and after 5 years of follow-up 92.77% medium size and large size perforations were 89.67.66% (P < 0.001). Residual perforations were there in about 7.29% in medium and 10.33% in large size perfrations. Conclusion: Sliced conchal cartilage reinforced with temporalis fascia is a reliable technique for tympanoplasty, with improved graft uptake results in medium and large perforations in the long-term, also the residual perforations is significantly lower.

A Comparison Between Skeletal Class II and Class III Malocclusion Patients in Terms of the Masticatory Muscles' Activity: A Cross-Sectional Study.

Background This study aimed to determine if individuals with skeletal Class II and skeletal Class III malocclusions had different levels of masticatory muscle activity. Materials and methods This cross-sectional study, conducted at the University of Damascus, investigated the myoelectric activity of perioral muscles in patients with Class II and III malocclusions. The sample size of 60 patients was determined according to a prior sample size calculation. Patients were selected based on specific inclusion and exclusion criteria and divided into Class II and III groups. Electromyography was used to monitor the activity of various muscles, including the temporalis, masseter, orbicularis oris, buccinator, mentalis, and digastric muscles. Results The study found similar muscle activity within the same group in the temporalis, masseter, buccinator, digastric, and orbicularis oris muscles. No significant differences were observed between the Class II and III groups for several oral and perioral muscles (P > 0.05). However, the mean activity of the digastric muscle was significantly greater in the Class II group (P < 0.05), whereas the mean activity of the mentalis muscle was smaller in the Class II group (P < 0.05). Conclusions Perioral muscles influence facial complex development and jaw relationship, affecting orthodontic treatment. Digastric muscle activity is greater in Class II patients, while mental muscle activity is smaller in Class III patients. Further studies are needed for older age groups and other skeletal malocclusion types.

Temporalis Muscle Changes Following Botulinum Toxin A Injections in Masseter Hypertrophy Patients: A Randomized Triple-Blinded Trial.

BACKGROUND: This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS: The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS: Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION: BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Revisiting the Use of Deep Temporalis Fascia Grafts in Ophthalmology.

PURPOSE: To report new indications for deep temporalis fascia (DTF) grafts in the ophthalmic field. METHODS: Monocentric retrospective interventional case series study. All the patients who underwent a DTF graft in an unpublished new indication over the study period (May 2020-October 2023) were included. For each patient, gender, age, graft indication, outcomes, complications, and follow-up duration were collected. In most cases, the DTF graft was covered by a vascularized flap. RESULTS: Eight patients underwent a DTF graft over the study period. The indications were: radiotherapy-induced scleral necrosis in three cases, tendinoplasty to replace the inferior rectus muscle tendon invaded by a locally advanced conjunctival carcinoma in one case, Ahmed glaucoma valve tube exposure in one case, intraocular lens with scleral fixation exposure in one case, orbital cerebrospinal fluid fistula (orbitorrhea) in one case, and post-traumatic complete corneal graft loss in one case. The DTF graft was successful in 87.5% of cases after a mean follow-up of 11.4 months. No complications were observed. CONCLUSIONS: DTF graft is a highly versatile graft that can be easily harvested. New indications for DTF grafts may include the repair of radiotherapy-induced scleral necrosis, the creation of oculomotor tendon and the temporary packing of large ocular tissue loss in an emergency context. Further studies with a longer follow-up are needed to confirm our preliminary results.

The "fascia taco" for nasal septum perforation closure-A retrospective Cohort study on success rates and patient reported outcomes.

Objective: Nasal septum perforation (NSP) is a common condition affecting ~1.2% of the general population and is still considered challenging to treat. Therapeutic strategies range from conservative local treatments and septal button closures to over 40 different surgical approaches. This study aimed to present a novel secure approach. Methods: We describe our novel and unique NSP closure approach using a "fascia taco," in which conchal cartilage is enveloped by temporalis fascia like a taco and splints are left in place for 6-8 weeks. A review of patient charts was conducted and questionnaires including the German-SNOT-22 and D-NOSE were sent by mail to all eligible patients who received a fascia taco between 2016 and 2021. Results: Thirty-three patients were identified. The questionnaire response rate was 54.5%. The mean operative time (cut to sew) for all patients who only underwent NSP closure was 90.4 min. The overall success rate in terms of postoperative NSP closure was 81.8%. We found an apparent but nonsignificant association between closure failure and smoking (failure rate 66.6% in smokers vs. 15.4% in nonsmokers; X 2 = 3.4188, p = .064). Questionnaire analysis showed a significant postoperative reduction of mean values in D-NOSE from 60.8 to 33.1 (p = .009) and in German-SNOT-22 from 38.6 to 21.2 (p = .005). Conclusion: The fascia taco technique is an easy-to-apply, safe procedure for NSP closure that is short in duration and associated with a low morbidity, resulting in excellent patient satisfaction. Level of Evidence: 4.

Free temporalis muscle fascia graft in dural reconstruction following surgical resection of intermediate and malignant skull base tumors: A 10-year experience from a single center.

BACKGROUND: Data from patients with post-ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were retrospectively analyzed. METHODS: The primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively. RESULTS: Eighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05). CONCLUSIONS: Post-ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature.

Contribution of the complex comprising the masticatory fascia, disc, and capsule to temporomandibular joint stabilization: An anatomical study.

BACKGROUND: Anterior displacement of the temporomandibular joint (TMJ) disc is the most typical pathological condition of TMJ disorders. Structures attached to the articular disc may support the disc in various directions and contribute to stabilizing the TMJ. However, the relationship between the articular disc, capsule, and masticatory muscles remains unclear. Therefore, this study aimed to clarify the relationship between the masticatory muscles, related masticatory fascia, articular disc, and capsule. METHODS: We examined 10 halves from adult Japanese cadavers, with five halves macroscopically analyzed and the remaining five histologically analyzed. The TMJ was dissected from the lateral aspect for gross anatomical analysis. For histological analysis, the relationship between the temporal and masseteric fasciae and the articular capsule was observed in the coronal section. Additionally, we evaluated relationships among the disc, capsule, temporal fascia, and masseteric fascia in 10 living and healthy volunteers using magnetic resonance imaging. RESULTS: The articular disc was attached to the capsule without a clear border. The capsule continued into the masseteric and temporal fasciae. Consequently, the articular disc, capsule, masseteric, and temporal fasciae were considered a single complex. CONCLUSIONS: The single complex of the temporalis, masseter, capsule, masticatory fascia, and disc may antagonize the force in the posterolateral direction through the fascia.

Ultrasonographic examination of masticatory muscles in patients with TMJ arthralgia and headache attributed to temporomandibular disorders.

This study used ultrasonography to compare the thickness and cross-sectional area of the masticatory muscles in patients with temporomandibular joint arthralgia and investigated the differences according to sex and the co-occurrence of headache attributed to temporomandibular disorders (HATMD). The observational study comprised 100 consecutive patients with TMJ arthralgia (71 females and 29 males; mean age, 40.01 ± 17.67 years) divided into two groups: Group 1, including 86 patients with arthralgia alone (60 females; 41.15 ± 17.65 years); and Group 2, including 14 patients with concurrent arthralgia and HATMD (11 females; 33.00 ± 16.72 years). The diagnosis of TMJ arthralgia was based on the diagnostic criteria for temporomandibular disorders. The parameters of the masticatory muscles examined by ultrasonography were subjected to statistical analysis. The pain area (2.23 ± 1.75 vs. 5.79 ± 2.39, p-value = 0.002) and visual analog scale (VAS) score (3.41 ± 1.82 vs. 5.57 ± 12.14, p-value = 0.002) were significantly higher in Group 2 than in Group 1. Muscle thickness (12.58 ± 4.24 mm) and cross-sectional area (4.46 ± 2.57 cm2) were larger in the masseter muscle than in the other three masticatory muscles (p-value < 0.001). When examining sex-based differences, the thickness and area of the masseter and lower temporalis muscles were significantly larger in males (all p-value < 0.05). The area of the masseter muscle (4.67 ± 2.69 vs. 3.18 ± 0.92, p-value = 0.004) and lower temporalis muscle (3.76 ± 0.95 vs. 3.21 ± 1.02, p-value = 0.049) was significantly smaller in Group 2 than in Group 1. An increase in VAS was significantly negatively correlated with the thickness of the masseter (r = - 0.268) and lower temporalis (r = - 0.215), and the cross-sectional area of the masseter (r = - 0.329) and lower temporalis (r = - 0.293). The masseter and lower temporalis muscles were significantly thinner in females than in males, and their volumes were smaller in patients with TMJ arthralgia and HATMD than in those with TMJ arthralgia alone. HATMD and decreased masseter and lower temporalis muscle volume were associated with increased pain intensity.

The prognostic utility of temporalis muscle thickness measured on magnetic resonance scans in patients with intra-axial malignant brain tumours: A systematic review and meta-analysis.

Introduction: Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms. Method: We searched Medline, Embase, Scopus and Cochrane databases for relevant studies. Event ratios with 95% confidence intervals (CI) were analysed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence. Results: Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46-0.76) (GRADE low), progression free survival (PFS) (HR 0.40; 95% CI 0.26-0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168-0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60-1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67-0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19-0.60) (GRADE moderate) and progression free survival (HR 0.23; 95% CI 0.09-0.56) (GRADE high). Conclusion: TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision making between patients and clinicians.

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120 dB which was improved to 13.387 ± 5.253 dB postoperatively at 12 weeks which was statistically significant. The mean postoperative ABG closure was 8.700 dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Modified Osteotomy for TMJ Ankylosis in Paediatric Patients with Deficient Interpositional Temporalis Muscle Mass and Buccal Fat Pad - A case Series and Literature Review.

Ankylosis of the temporomandibular joint (TMJ) is a bony or fibrous fusion of the articular surfaces of the mandibular condyle and the glenoid fossa. Gap arthroplasty, Interpositional arthroplasty, Condyle reconstruction with autogenic or alloplastic grafts and total joint replacement are some common modalities of management. In this article, we discuss a series of three cases of unilateral TMJ ankylosis in paediatric patients, managed by gap arthroplasty using a modified osteotomy cut. The modification was adapted due to inadequate interpositionable temporalis muscle or buccal fat on the affected side and chances of adaptive remodelling of the CCG (Costochondral graft), if placed were rendered negative.

Our Experience of Comparison of Hearing Outcomes in Patients Undergoing Type-1 Tympanoplasty with Different Graft Materials.

The present study was undertaken to compare the results of various autogenous tissues: temporalis fascia, sliced tragal cartilage and fascia lata as graft materials for type I tympanoplasty in terms of hearing improvement in safe type of chronic suppurative otitis media. A total of 75 cases with central perforation were considered in the study. Of the 75 cases, temporalis fascia graft was used in 25 cases (Group-A), fascia lata graft in 25 cases (Group-B), and sliced tragal cartilage graft in 25 cases (Group-C). The results were evaluated in the form of hearing improvement with respect to the graft materials. A significant association was observed between the groups, that is, temporalis fascia (Group-A), fascia lata (Group-B), and sliced tragal cartilage (Group-C) in terms of improvement in AB gap (P = 0.047). Improvement in AB gap was statistically significant between groups B and A, but not between the other groups. In the present study, fascia lata showed better graft uptake as compared to temporalis fascia and sliced tragal cartilage. The hearing assessment at post-operative 3rd month showed statistically significant hearing improvement with fascia lata when compared to temporalis fascia.

Comparison of ultrasonography-based masticatory muscle thickness between temporomandibular disorders bruxers and temporomandibular disorders non-bruxers.

To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = - 1.018, 95% confidence interval [CI] - 1.855 to - 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = - 0.201, 95% CI - 0.299 to - 0.103, p = 0.011), increased age (B = - 0.003, 95% CI - 0.005 to 0.000, p = 0.038), and muscle stiffness (B = - 1.373, 95% CI - 2.369 to - 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.

Did temporomandibular gap arthroplasty with temporalis interpositional flap improve function and pain in patients with end-stage joint disease? A 5-year retrospective follow-up.

The primary aim of this study was to investigate whether patients with end-stage temporomandibular joint (TMJ) disease treated with gap arthroplasty with temporalis interpositional flap (GAT) had improved maximal interincisal opening (MIO) and TMJ pain in a long-term perspective. All patients with severe osteoarthritis, or fibrous or bony ankyloses, and subjected to GAT between 2008 and 2015 were included. The criteria of treatment success were TMJ pain VAS score ≤4 and MIO ≥30 mm. Reoperation was considered as a failure. Forty-four patients (mean age 47 years) were included in this retrospective descriptive case series and followed up for up to 7 years (mean 4.5). Comorbidities were frequent (n = 34) and most commonly rheumatic disease (n = 17). The indications for surgery were ankylosis (n = 32) or severe osteoarthritis (n = 12). Of the 44 included patients, 84% (n = 37) had a history of earlier TMJ surgery. The preoperative mean values for TMJ pain and MIO (VAS 7 and 23 mm, respectively) changed significantly (p < 0.001) to postoperative means of VAS 3 and 34 mm, respecitvely. The success rate was 59% (n = 26). When compared with a previous 2-year follow-up, the success rate was found to have decreased over time (p = 0.0097). The rate of successful treatment outcome in terms of MIO alone was 82% (n = 36). The most common reason for treatment failure was residual pain. In conclusion, the success-rate after GAT did not show long-term stability and continued to drop over time in this patient cohort. TMJ pain seems to be the main reason for failure.

The impact of measurement technique and sampling on estimates of skeletal muscle fibre architecture.

Skeletal muscle fibre architecture provides important insights into performance of vertebrate locomotor and feeding behaviours. Chemical digestion and in situ sectioning of muscle bellies along their lengths to expose fibres, fibre orientation and intramuscular tendon, are two classical methods for estimating architectural variables such as fibre length (Lf) and physiological cross-sectional area (PCSA). It has recently been proposed that Lf estimates are systematically shorter and hence less accurate using in situ sectioning. Here we addressed this hypothesis by comparing Lf estimates between the two methods for the superficial masseter and temporalis muscles in a sample of strepsirrhine and platyrrhine primates. Means or single-specimen Lf estimates using chemical digestion were greater in 17/32 comparisons (53.13%), indicating the probability of achieving longer fibres using chemical digestion is no greater than chance in these taxonomic samples. We further explored the impact of sampling on scaling of Lf and PCSA in platyrrhines applying a bootstrapping approach. We found that sampling-both numbers of individuals within species and representation of species across the clade significantly influence scaling results of Lf and PCSA in platyrrhines. We show that intraspecific and clade sampling strategies can account for differences between previously published platyrrhine scaling studies. We suggest that differences in these two methodological approaches to assessing muscle architecture are relatively less consequential when estimating Lf and PCSA for comparative studies, whereas achieving more reliable estimates within species through larger samples and representation of the full clade space are important considerations in comparative studies of fibre architecture and scaling.

Management of Ectropion Associated With a Malunited Zygomaticomaxillary Complex Fracture: A Case Report.

We report the case of a 35-year-old male patient who presented with a right zygomaticomaxillary complex fracture, which was five months old. It was associated with ectropion over the right eye. Diagnosis was made by clinical examination and confirmed by computed tomography, which included a three-dimensional reconstruction view. The patient was concerned about a projecting deformity over the right side of his face and blurring of vision. Surgical rationale of treatment was to easily access the surgical site for the correction of deformity and to achieve the desired facial contour and ectropion correction with uneventful postoperative healing. Deformity at the right zygomatic arch was exposed by a hemicoronal incision. Ectropion over the lower eyelid was addressed by performing Z-plasty. Outcomes were esthetically pleasing with no loss of motor and sensory functions loss. The patient was followed up for six months.