Novel application of human morphomics to quantify temporal soft tissues in Pierre Robin and Treacher Collins.

INTRODUCTION: Pierre Robin sequence (PR) and Treacher Collins syndrome (TC) are congenital disorders associated with multiple craniofacial abnormalities. The mandibular malformations linked with these maladies are closely associated with the form and function of the temporalis muscle. Despite these associations, a paucity of research has been directed at quantifying how these malformations affect the tissues of the temporal region. In this paper, we seek to quantify differences in the temporalis muscle and the temporal fat pad using a novel CT-derived analytic program to examine craniofacial morphomic indices within these patient groups in comparison to normal age-matched controls. We posit that the temporalis muscle and temporal fat pad, like other derivatives of the first branchial arch, are hypoplastic in patients with TC and PR compared to age-matched controls. METHODS: High-throughput image analysis was used to reconstruct the 3-dimensional (3D) anatomy and quantify morphomic measures of the temporalis muscle and temporal fat pad in children with PR, TC, and age-matched controls. These steps were completed in a semi-automated method using algorithms programmed in MATLAB v13.0. The 3D reconstructions were analyzed in 3 children with PR (6 temporal regions), 3 children with TC (6 temporal regions), and a control group of 19 children (38 temporal regions). We also quantified the same measurements in a localized "core" sample in the area of greatest thickness, providing a more consistent sample of the tissue position. Relationships between the temporal muscle and fat pad values and craniofacial abnormality type were assessed using Wilcoxon nonparametric test using exact distribution, with a P value of less than 0.05 being deemed significant. RESULTS: The mean age of our patients was 6.0 years in PR and 4.5 years in TC cohorts. We were able to establish an automated methodology to quantify the temporalis muscle and temporal fat pad based on CT characteristics. Localized temporalis volume and localized temporalis area were significantly smaller in children with PR than in the control group. Total temporalis fat volume and localized temporalis area were significantly less in children with TC than in the control group. When compared to each other, the PR group had small morphomic values compared to TC group. CONCLUSIONS: There are significant morphomic differences in the temporalis muscle and the temporal fat pad in children with either PR or TC when compared to age-matched control group which can be measured from pre-existing CT scans. Specifically, both of these test groups show decreases in the morphomic measures of the temporalis region. The quantification of these changes corroborates and objectifies the clinical findings associated with these congenital deformities while simultaneously allowing for preoperative planning. Furthermore, this finding confirms that the hypoplasia seen in these patient populations is not only hypoplasia of the mandible but also of the surrounding functional matrix, which includes the temporalis muscle and temporal fat pad.

Unduly extensive mandibular insertion of temporalis muscle: A case report.

PURPOSE: Anomalous extensive attachment of temporalis muscle covering the mandibular incisure is rarely reported in literature. Such variations of temporalis muscle are of immense significance in operative procedures of maxillo-facial region, utilization of temporalis muscle fl ap and accurate interpretation of radiographs. MATERIALS AND METHODS: Dissection of the head and neck region during the course of undergraduate teaching programme revealed unduly extensive attachment of temporalis muscle fibres in the left side in an adult Indian male cadaver. The temporal and infra-temporal regions were carefully dissected to delineate the temporalis muscle with special emphasis on the branches of maxillary artery and mandibular nerve. The morphological details of the temporalis muscle were recorded and appropriate photographs taken. RESULTS: The mandibular notch was 3.1 cm wide. The extra fleshy fibres of the temporalis muscle completely occupied the mandibular notch and further descended for insertion onto the coronoid process, and external and internal surfaces of the ramus of mandible. The masseteric nerves and vessels pierced the anomalous fibres of temporalis muscle in the mandibular notch. CONCLUSION: The present study highlights the morphological details of an unduly extensive attachment of temporalis muscle and discusses its importance in reconstructive procedures of maxillo-facial region. Detailed information of the variations of temporalis muscle is also important in accurate interpretation of modern imaging procedures.

Temporomandibular region in the Franceschetti's Syndrome. Anatomical study.

Franceschetti's syndrome is a rare, non-fatal, hereditary malformation, usually bilateral, which symmetrically affects orbits, mandible and ear. The authors propose an anatomical description of the temporomandibular region after the dissection of a newborn baby suffering from Franceschetti's Syndrome, dead soon after the birth. A discussion on the different etiopathogenical theories is made. The authors conclude that an alteration of the development of nerve trigeminal branches is the cause of the malformations.

The hourglass facial deformity.

The "Hourglass Facial Deformity" is the result of bilateral irradiation of the orbits and anterior cranial base during infancy. The deformity is uniformly characterized by a distinctly misshapen upper face at the level of the orbits, with depression of the temporal region, hypotelorism, and flattened nasal root. These patients exhibited varying degrees of frontal bossing. Since they had previous enucleation, the orbital soft-tissue can be dissected off the eye socket, lateral orbital walls, and if necessary, the orbital cone, through a bicoronal incision. The deformity is then easily corrected with implantation of acrylic alloplastic material. Four cases are presented which had varying degrees of the same deformity and were successfully corrected using the operative procedure described. No complications have been encountered. Two patients required eye socket revisions.

Eletromiografia dos músculos masseter e temporal após o tratamento conservador da fratura da cabeça da mandíbula

O presente trabalho analisa, através da técnica eletromiográfica, o comportamento dos músculos masseter e temporal em posição de repouso e em vários movimentos selecionados da mandíbula em indivíduos isentos de alterações dentárias e da articulação temporomandibular e determina, através de um estudo comparativo, a existência de mudanças na atividade desses músculos em indivíduos portadores de fratura da cabeça da mandíbula tratados pelo método conservador. A amostra constou de 20 indivíduos divididos em dois grupos, analisados no Instituto de Eletromiografia Clínica, no período compreendido entre março e maio de 1981. Através da análise estatística constatou-se que ocorrem mudanças na atividade dos músculos masseter e temporal em indivíduos que sofreram fratura da cabeça da mandíbula em alguns movimentos mandibulares.