Reliability and temporal variation of masseter muscle thickness measurements utilizing ultrasonography

Investigation of masticatory muscle thickness and mechanosensitivity of cervical and masticatory muscles in myofascial temporomandibular disorder patients with bruxism: A cross-sectional study

OBJECTIVE

Bruxism is a common problem associated with temporomandibular disorders (TMD). The aim of this study was to compare a patient group with Myofascial TMD and bruxism and a healthy control group in terms of masseter and temporal muscle thickness (clenching and resting), mechanosensitivity of neck and jaw muscles, craniofacial pain, and disability and emotional stress status.

METHODS

The study included 31 patients with myofascial TMD and bruxism (19 females, 12 males) with a mean age of 29.96 ± 8.12 years (range, 18-45 years), and a control group of 31 healthy subjects (19 females, 12 males) with a mean age of 27.58 ± 9.39 years years (range, 18-45 years). Masseter and temporal muscle thicknesses were evaluated with a mobile ultrasound device both at rest and when clenching the jaw. The mechanosensitivity values between the upper trapezius, obliquus capitis inferior, masseter and temporal muscles were measured with a digital algometer device. Craniofacial pain and disability level were evaluated with the Craniofacial Pain and Disability Index (CFPDI), and emotional stress levels with the Perceived Stress Scale-14 (PSS-14).

RESULTS

No difference was determined between the two groups in respect of the clenching and resting ratios of muscle thickness in any muscle (p > 0.05). The mechanosensitivity values in all muscles were lower in the myofascial TMD group than in the healthy group (p < 0.05). The CFPDI and PSS-14 scores were higher in the myofascial TMD group (p < 0.05). There was a moderate positive correlation between CFPDI, PSS-14 and Bruxism Frequency Score (p < 0.05).

CONCLUSION

The difference in mechanosensitivity and CFPDI values between the myofascial TMD patients with bruxism and the healthy control group indicates that the problem in this patient group has effects in the craniocervical and cervical regions. In addition, the correlation between CFPDI, PSS-14 and Bruxism Frequency Score in myofascial TMD patients suggests that this problem may be affected by the interaction of different parameters.

Ultrasonographic evaluation of the masseter muscle in temporomandibular disorders patients with myofascial pain: A case-control observational study

OBJECTIVE

To investigate ultrasonographic changes of masseter muscle (MM) in patients with myofascial pain disorder (MPD) and possible correlations with clinical features.

METHODS

The study included 20 MPD patients and 20 healthy volunteers. Masseter muscle thickness (MMT) and the echogenic pattern were ultrasonographically evaluated. The maximum interincisal opening (MIO), duration of symptoms, and pain level were evaluated for correlations with MMT.

RESULTS

At relaxation, MMT was greater in the test group (p < 0.05); however, the percentage of increase in MMT from relaxation to contraction was greater in controls (p < 0.05). In MPD patients, the echogenic pattern differed significantly from controls. In MPD patients, a strong positive correlation was found between MMT and pain level, while a moderate negative correlation was found between MMT and both the duration of symptoms and MIO.

CONCLUSION

Ultrasound is an adjunctive method for complementing the assessment of the MM condition in MPD patients.

Ultrasound Imaging of Head/Neck Muscles and Their Fasciae: An Observational Study

Background: Masticatory muscle thickness provides objective measurements of the temporomandibular motor function, which may change in patients with oral myofascial pain. Moreover, they are considered as being part of the craniocervical unit by a crucial relationship with cervical muscles and their fasciae. In this study, we aimed to assess by ultrasound (US) imaging the fasciae of the masseter, temporal, and sternocleidomastoid muscles to understand their mean thickness and eventual variation in relationship with the muscles, sides, and sex.

Methods: We studied 16 healthy volunteers without temporomandibular joint dysfunction. Concerning each subject were evaluated the range of motion of the temporomandibular joint and of the neck, the thickness of muscles and their fasciae of both sides, and the delta of muscle thickness.

Results: All the motor evaluations of the subjects showed normal ranges. The US results showed that the fasciae have a mean thickness of 0.50 ± 0.1 mm, which did not change during muscle contraction. The evaluated muscles presented a symmetry between right and left (p > 0.05), even if the delta of muscle (US) thickness had a huge range between different subjects, for example in the masseter muscle from 0.7 to 4.2 mm.

Conclusions: Ultrasound imaging is a suitable and reliable tool to study the muscles and fasciae of the head and neck region, permitting also the evaluation of the ability of the muscles to contract. Finally, identifying functional asymmetry that could become symptomatic, US imaging could allow an early rehabilitation treatment.

Assessments of Muscle Thickness and Tonicity of the Masseter and Sternocleidomastoid Muscles and Maximum Mouth Opening in Patients with Temporomandibular Disorder

The purpose of this study was to compare the muscle thickness and tone of the masseter and sternocleidomastoid (SCM) muscles and maximum mouth opening (MMO) in subjects with and without temporomandibular disorders (TMD), and perform a correlation comparison on the results of the TMD group. Sixty patients were allocated to the TMD group (n = 30) or the non-TMD group (n = 30). Ultrasound imaging, myotonometer, and vernier calipers were used to determine the related changes in muscle thickness and muscle tone in masseter and SCM, and MMO, respectively. The TMD group revealed a significant decrease than the non-TMD group in the muscle thickness of masseter and SCM, respectively (p < 0.001), with a significant increase in frequency (p < 0.001) and stiffness (p < 0.001) in the masseter muscle tone, with a significant increase in frequency (p < 0.001) and stiffness (p = 0.005) in the SCM muscle tone, a significant decrease in the MMO (p < 0.001). There was a moderate negative correlation between the relaxed state of masseter muscle thickness and stiffness of SCM muscle tone (r = −0.40, p = 0.002), and a moderate negative correlation between the relaxed state of SCM muscle thickness and frequency of SCM muscle tone (r = −0.42, p = 0.001). There was a moderate negative correlation between the clenching state of SCM muscle thickness and the frequency of SCM muscle tone (r = −0.47, p < 0.001). In addition, a moderate negative correlation between MMO and frequency of SCM muscle tone (r = −0.44, p < 0.001). The muscle thickness was decreased, and the muscle tone was increased in the masseter and SCM muscle, respectively. Additionally, MMO was decreased in patients with TMD compared with non-TMD.

Ultrasound measurements of superficial and deep masticatory muscles in various postures: reliability and influencers

Masticatory muscle thickness provides objective measurements of the oral motor function, which may change in patients with oral myofascial pain. In this study, we aimed to establish a reliable ultrasound (US) protocol for imaging the superficial and deep masticatory muscles and to identify the potential influencers of the measurements. Forty-eight healthy participants without orofacial pain were enrolled. The intra-and inter-rater reliabilities of US measurements for masseter, temporalis, and lateral pterygoid muscles were assessed. Intraclass correlation coefficients for all muscles were greater than 0.6. The generalised estimating equation was used to analyse the impact of age, gender, laterality, and body mass index on the measurements, whereby age and body mass index were likely to be associated with an increase in masticatory muscle thickness. The thickness tended to be lesser in females. Laterality seemed to exert minimal influence on masticatory muscle thickness. Our study shows acceptable reliability of US in the evaluation of superficial and deep masticatory muscle thickness. Future studies are warranted to validate the usefulness of US imaging in patients with oral myofascial pain syndrome.

Influence of lower complete denture use on masseter muscles and masticatory function: A longitudinal study

BACKGROUND

Edentulism can reduce mastication, leading to changes in food pattern, with possible consequences to masticatory muscle thickness.

OBJECTIVES

This study verified masticatory function and oral perception in subjects who did not use lower CDs, and whether the insertion of new upper and lower CDs would improve such variables.

METHODS

Fifteen edentulous elderly who wore only the upper CD were selected and received new upper and lower CD. Volunteers were evaluated at baseline and after 1, 3 and 6 months of new prosthesis use. Masticatory performance (MP) was assessed by the sieving method (X₅₀ values). Masseter thickness (MT) was evaluated by ultrasonography. Oral sensorial ability (OSA) was assessed by oral stereognosis test and maximum tongue pressure (MTP) was verified by pressure sensors. Data were submitted to repeated measures ANOVA and Tukey-Kramer posthoc tests (α = 0.05). Correlation between OSA and MTP was verified by Person's correlation.

RESULTS

X₅₀ and MTP decreased (P < 0.05) after 1 month and remained stable (P > 0.05) for next assessments. After 3 months, MT in rest position was increased (P < 0.05), while during maximum voluntary contraction 1 month was enough to increase MT (P < 0.05). There were no differences for OSA (P > 0.05) and no correlation between OSA and MTP.

CONCLUSION

Masticatory performance and masseter thickness of elderly who did not use the lower dentures were improved after 2 months using new upper and lower CDs. However, new CDs in both dental arch decreased MTP. Brazilian Registry of Clinical Trials (ReBEC #RBR-37gdst).

Assessment of Masseter Muscle Appearance and Thickness in Edentulous and Dentate Patients by Ultrasonography

Objectives:

The purpose of the present study was to examine ultrasonographic appearances of Masseter Muscle (MM) in dentate and edentulous patients without Temporomandibular Disorder (TMD).

Materials and Methods:

The thickness of the MM in 25 dentate (mean age: 30,68 ± 10,49) and 24 edentulous (mean age: 61,46 ± 9,71) patients, who visited routine dental examination, was measured at rest and at maximum contraction bilaterally. Examinations were performed using an Aloka Prosound α6 (Hitachi Aloka Medical Systems, Tokyo, Japan) equipped with an 8 MHz-wide bandwidth linear active matrix transducer (ranging from 1 to 15 MHz). The visibility and width of the internal echogenic bands of the MM were also assessed and the muscle appearance was classified as I of III types. Type I, characterized by the clear visibility of the fine bands; Type II, thickening echogenicity of the bands; Type III, disappearance or reduction in a number of the bands.

Results:

MM thickness at rest and contraction in the dentate group were significantly higher than the edentulous group (p <0.05). Type I was the most common echogenic type in both dentate (right:16 (64%), left; 15 (60%)) and edentulous patients (right; 22 (91.7%), left; 18 (75%)). In a dentate group, type II was significantly higher than the edentulous group in both the right and left sides (p <0.05; p <0.01, respectively). Age and gender seemed to have no significant effect on the echogenic type (p ˃0.05).

Conclusion:

There were significant differences in the thickness at rest and contraction between the dentate and edentulous groups. It was clarified that ultrasonographic features of the MM in dentate and edentulous patients were different.

Does Botulinum Toxin Injection into Masseter Muscles Affect Subcutaneous Thickness?

BACKGROUND

Botulinum toxin (BoNT) is widely used to treat masseter muscle hypertrophy. Changes in the muscle thickness have been found in many studies, but there has been no report on changes in the thickness from the skin surface to the masseter muscle.

OBJECTIVES

We aimed to use ultrasonography to measure not only changes in the muscle thickness but also changes in subcutaneous thickness.

METHODS

This study enrolled 20 volunteer patients: 10 were assigned to an experimental group (injected with each side 25 U of botulinum toxin into both masseter muscles) and 10 to a control group (injected with normal saline). The thicknesses were measured before the injection and at 4, 8, and 12 weeks after the injection both at rest and during maximum muscle contraction.

RESULTS

The subcutaneous thickness did not differ significantly over time either at rest (P = 0.063) or during maximal contraction (P = 0.392), or between the experimental and control groups at rest (P = 0.392) or during maximum contraction (P = 0.259). The muscle thickness in the experimental group differed significantly over time.

CONCLUSIONS

Botulinum toxin injection only changes the muscle thickness and does not affect the subcutaneous thickness from the skin surface to the masseter muscle.

Integration of ultrasound imaging into pre-clinical dental education

INTRODUCTION

Patients have complex healthcare needs and typically require more than one healthcare discipline to address issues regarding their health. Interprofessional teams of healthcare professionals may be able to address these complex needs and improve patient outcomes by combining resources. To evaluate the feasibility of integrating ultrasound into a dental school curriculum to teach anatomy as part of an interprofessional education experience, the current study surveyed first-year dental students to determine their perceptions of the integration of ultrasound techniques into the curriculum.

MATERIALS AND METHODS

Ultrasound laboratory exercises were developed for first-year dental students as part of their anatomy course. The exercises were focused on head, neck and abdominal anatomy. To assess student perception of the integration of ultrasound into the dental curriculum, a survey was created specifically for the current study.

RESULTS

Between 2013 and 2015, two classes of first-year dental students participated in the ultrasound laboratory exercise and completed the survey (n = 83). Student survey responses suggested ultrasound was a valuable teaching tool because it allowed them to visualise anatomical structures using live imaging. They also agreed that the ultrasound laboratory exercises were an efficient learning tool, but the majority did not believe that they would use ultrasound regularly in their future practice.

CONCLUSIONS

Results of the current study suggested first-year dental students were satisfied with the integration of ultrasound techniques into the dental curriculum. Survey results indicated that the students enjoyed the ultrasound laboratory exercise and felt ultrasound was an effective learning tool.

Masseter muscle measurement performed by ultrasound: a systematic review

The aim of this study was to systematically review the existing scientific literature and evidence about (a) the validation of masseter muscle ultrasonography for accurate assessment of muscle thickness and (b) the reproducibility of masseter muscle thickness measures. An electronic literature search was conducted using determined keywords on specific databases. Preliminary search revealed 298 articles listed in Medline, Scopus and Web of Science. 60 duplicates were rejected, leaving 238 articles for review. After reading titles and abstracts, 31 articles remained. 23 articles were assessed for eligibility. These articles were categorized as follows: thickness, cross-section, volume and the length of the masseter muscle measured by ultrasonography. It is possible to verify the thickness of the masseter muscle in males and females in relaxation (10-15 and 9-13 mm, respectively) and contraction (14-19 and 12-15 mm, respectively). A similar tendency can also be evidenced in other measurements. Many studies evaluate masseter muscle dimensions to relate it to cephalometric analysis as such to evaluate morphological variations. It can be concluded that ultrasound is a reliable clinical tool for masseter muscle measurements, yet there is a need for standardization of methods and parameters to be recorded.

Evidências de medidas de normalidade para a espessura do músculo masseter avaliadas com ultrassonografia: estudo de revisão

O objetivo foi estudar medidas de normalidade para espessura do músculo masseter, bem como os métodos de mensuração da espessura por ultrassonografia. Foi realizada uma revisão a partir das bases de dados MEDLINE, LILACS, JCR e PubMed. Foram utilizadas publicações até junho de 2013. Foram incluídos trabalhos que envolveram indivíduos adultos jovens considerados hígidos quanto ao sistema estomatognático - sem a presença de sinais e sintomas de distúrbios na articulação temporomandibular. Foram encontrados 166 artigos. Pela leitura do titulo foram excluídos os artigos repetidos, restando 108 estudos. Após a leitura do titulo e a exclusão de artigos que não estavam relacionados ao assunto, foram obtidos 54 trabalhos. A leitura dos resumos permitiu a obtenção de 22 estudos. Na análise das medidas foram utilizados os testes t para amostras pareadas e independentes, verificado os intervalos de confiança e confeccionados gráficos forest plot para estudar a heterogeneidade dos trabalhos. Constatou-se que o músculo masseter em homens demonstra ser mais espesso quando comparado ao das mulheres, tanto no repouso quanto em contração. A comparação do estado de repouso entre os gêneros não revelou diferença significante. O mesmo ocorreu em contração. Também verificou-se a associação de outros métodos com a ultrassonografia. A amostra probabilística obtida revelou valores para o estado de contração e repouso. Houve diferença nas medidas entre os gêneros. Foi constatada significante heterogeneidade nos dados dos estudos. A mensuração da espessura do músculo masseter com a ultrassonografia apresenta-se nos diversos estudos como um método objetivo, preciso e com reprodutibilidade.

Intramuscular changes of soft and hard areas after low-level static contraction of the masseter muscle and the correlations with muscle hardness and increase in water content: evaluations with sonographic elastography and magnetic resonance imaging

OBJECTIVES

To investigate the intramuscular changes on sonographic elastography (SE) after low-level static contraction of the masseter muscle, and to clarify the relationship with the total hardness and edematous change.

STUDY DESIGN

Ten healthy volunteers performed sustained bilateral biting at 20% of maximal voluntary contraction for 10 min. The SE and magnetic resonance (MR) scans of the masseter muscles were performed before, immediately after, and 10 min after exercise. The masseter muscle elasticity index (MEI) ratio, muscle thickness, and intramuscular soft and hard areas distribution were evaluated on SE images. The signal to noise ratio (SNR), indicating the water content, was measured on MR images.

RESULTS

The soft area ratio showed significant correlations with the water content expressed as SNR. The hard area ratio showed significant correlations with the total muscle hardness expressed as the MEI ratio.

CONCLUSION

Intramuscular soft and hard areas could be used both clinically and experimentally.

Recent advances of ultrasound imaging in dentistry--a review of the literature

Ultrasonography as an imaging modality in dentistry has been extensively explored in recent years due to several advantages that diagnostic ultrasound provides. It is a non-invasive, inexpensive, painless method and unlike X-ray, it does not cause harmful ionizing radiation. Ultrasound has a promising future as a diagnostic imaging tool in all specialties in dentistry, for both hard and soft tissue detection. The aim of this review is to provide the scientific community and clinicians with an overview of the most recent advances of ultrasound imaging in dentistry. The use of ultrasound is described and discussed in the fields of dental scanning, caries detection, dental fractures, soft tissue and periapical lesions, maxillofacial fractures, periodontal bony defects, gingival and muscle thickness, temporomandibular disorders, and implant dentistry.

Mastication improvement after partial implant-supported prosthesis use

Partially edentulous patients may be rehabilitated by the placement of removable dental prostheses, implant-supported removable dental prostheses, or partial implant fixed dental prostheses. However, it is unclear the impact of each prosthesis type over the masticatory aspects, which represents the objective of this paired clinical trial. Twelve patients sequentially received and used each of these 3 prosthesis types for 2 months, after which maximum bite force was assessed by a strain sensor and food comminution index was determined with the sieving method. Masseter and temporal muscle thicknesses during rest and maximal clenching were also evaluated by ultrasonography. Each maxillary arch received a new complete denture that was used throughout the study. Data were analyzed by analysis of variance for repeated measures, followed by the Tukey test (p < .05). Maximum bite force and food comminution index increased (p < .0001) after implant-supported dental prosthesis and implant fixed dental prosthesis use, with the higher improvement found after the latter's use. Regardless of implant-retained prosthesis type, masseter muscle thickness during maximal clenching also increased (p < .05) after implant insertion. Partial implant-supported prostheses significantly improved masseter muscle thickness and mastication, and the magnitude of this effect was related to prosthesis type.

Three-dimensional evaluation of masseter muscle in different vertical facial patterns: a cross-sectional study in growing children

The aim of the present study was to analyze the anatomical three-dimensional (3D) characteristics of masseter muscle in growing subjects with different vertical patterns by using an ultrasound (US) method. The sample comprised 60 prepuberal subjects (33 males, 27 females) with a mean age of 11.5 ± 1.6 years with late mixed or permanent dentition and Class I molar and skeletal relationship. For each subject, a lateral cephalogram was required, and according to the mandibular plane angle (Frankfort horizontal plane/mandibular plane angle [FMA]), the subjects were divided into three groups of different underlying vertical facial patterns: brachyfacial: FMA < 22°, mesofacial: 22° ≤ FMA ≤ 28°, and dolichofacial: FMA > 28°. For each subject, an US scan was carried out to analyze the width, the thickness, the cross-sectional area, and the volume of the masseter muscle. Mean differences in measurements between vertical facial subgroups were contrasted by means of analysis of variance (ANOVA) with Tukey's post hoc tests (p < 0.05). Measurements of the whole masseter in dolichofacial patients were significantly smaller when compared with brachyfacial and mesofacial individuals during relaxation and contraction. The volume of the masseter decreased significantly by 10% going from the brachyfacial group to the mesofacial group and from the mesofacial group to the dolichofacial group with no difference between the left and the right sides. A significant negative correlation was found between the US measurements and the divergency (FMA°). Ultrasound is a technique indicated in children for evaluating muscles of mastication in vivo. Growing patients with a dolichofacial vertical pattern present with a reduced dimension of the masseter when compared with brachyfacial and mesofacial subjects.

Avaliação eletromiográfica e ultrassonográfica do músculo masseter em indivíduos normais: estudo piloto

TEMA: estudos recentes utilizaram a ultrassonografia com o objetivo de medir cortes musculares. OBJETIVO: caracterizar o controle motor e a morfologia do músculo masseter em indivíduos normais, verificando a compatibilidade entre a eletromiografia de superfície e a ultrassonografia. MÉTODO: cinco indivíduos adultos, sem alterações no sistema estomatognático. Os procedimentos adotados para a avaliação dos participantes foram: 1. Eletromiografia de Superfície; 2. Ultrassonografia. RESULTADOS: houve alta correlação apenas para a comparação entre hemifaces direita e esquerda no exame de ultrassonografia (repouso 0,95; máxima intercuspidação dentária 0,86). CONCLUSÃO: os resultados indicam não haver correlação entre os métodos testados, sugerindo que os exames são complementares e não excludentes.

Electromyographic activity and thickness of masticatory muscles in children with unilateral posterior crossbite

The aim of this study was to assess the electromyographic (EMG) activity and thickness of the masseter and anterior temporalis muscles in children with unilateral posterior crossbite (PCB). Thirty-six children (22 boys, 14 girls, and mean age of 8.8 +/- 1.1 years) were divided into the following groups: The case group with 20 PCB patients (10 on the left side, 10 on the right side); the control group with 16 normal occlusion (NOccl) subjects. EMG activity was recorded with bipolar surface electrodes at rest and during maximal clenching. The muscle thickness was measured with real-time ultrasound. Data were compared between groups and between sides. The correlation between EMG activity and muscle thickness was also evaluated. The data were analyzed using the Shapiro-Wilks test, Pearson's correlation and Spearman as appropriate, paired and unpaired t- test, and Mann-Whitney test. The results revealed that the masseter of the crossbite side was more active than that of the non-crossbite side in PCB group during maximal clenching. The comparisons of EMG activity between PCB and NOccl groups revealed some variability in the results, depending on the crossbite side. The ultrasonographic evaluation did not show statistically significant differences between groups, nor between sides in the PCB and NOccl groups. Significant correlation between EMG activity and thickness was observed only in the left masseter in the NOccl group. In conclusion, these findings showed that asymmetric muscle activity of the masticatory muscles was not related to the thickness of these muscles in children with PCB.

The use of ultrasound in the investigation of the muscles of mastication

The aim of this article was to review the literature concerning ultrasonography imaging (US) of the muscles of mastication and to discuss its use, advantages and disadvantages and the findings of the authors. A web search was performed using the terms "ultrasound" and "muscles". US has been shown to be a reliable method of great utility in the field of diagnosis of alterations in the muscles of mastication and for the study of changes during growth and aging. It should be preferred in comparison to computerized axial tomography (CT) and magnetic resonance imaging (MRI) because of its safety and cost advantages since it is as reliable and precise as these other techniques. Although various techniques have been used in ultrasonographic scanning, this article discusses those techniques most commonly adopted by the authors.

Masseter muscle thickness and mechanical advantage in relation to vertical craniofacial morphology in children

OBJECTIVE

To investigate the relationship between vertical craniofacial morphology and masseter muscle thickness and mechanical advantage in children.

MATERIAL AND METHODS

The sample comprised 72 children (36 F, 36 M), 8.5-9.5 years of age, with various malocclusions and no previous orthodontic treatment. The thickness of the masseter was measured bilaterally by means of ultrasonography, and the recordings were performed both in relaxation and under contraction. Mechanical advantage was measured on the lateral cephalograms as the ratio between the masseter moment and the bite force moment arms. Two linear ratios and three angular measurements were used to describe vertical craniofacial morphology.

RESULTS

The mean masseter thickness was greater in the male group (p<0.05) in both relaxed and contracted conditions. There were no significant sex differences for the mechanical advantage or for the measurements of vertical craniofacial morphology. In females, there is a positive association between masseter muscle thickness and its mechanical advantage. Multiple regression analysis showed a positive association between posterior to anterior facial height ratio in both genders and a negative association between masseter thickness and the intermaxillary angle in females.

CONCLUSIONS

There is a significant association between posterior to anterior facial height and the masseter muscle in children. The importance of the masseter muscle is more evident in the vertical facial morphology of females.

Outer shape changes of human masseter with contraction by ultrasound morphometry

OBJECTIVE

The multipennate masseter has a complex internal architecture, which suggests the contraction is not uniform within the muscle. The heterogeneous contraction may cause inequable changes of the muscle's outer shape. This study aimed to elucidate the outer shape changes of the whole masseter with clenching by multipoint measurement of serial ultrasound images.

DESIGN

Serial coronal images (perpendicular to the FH plane, 3 mm interval) of the right masseter of five healthy men were obtained with a real-time ultrasonograph equipped with a 13 MHz linear-array transducer. To define the relationship between the transducer and cranium, we used a 3D mechanical stage with a face-bow. Registrations were made during muscle relaxation and maximal clenching. The distance between the lateral and medial outlines of the muscle was measured at intervals of 1mm from the origin to insertion in each image as the thickness at the corresponding measured point.

RESULTS

The thickness of the relaxed and contracted muscle (R and C) and its difference (Delta) varied among the measured points. Muscle thickness at most measured sites increased with clenching, whereas it decreased at several sites, mainly near the origin and insertion. There were positive correlations in every subject both between R and C, and between C and Delta. On the other hand, the correlation between R and Delta were negative or weak.

CONCLUSION

Changes of thickness with clenching showed great disparity within the masseter, which may result from the complexity of the contraction properties due to the multipennate structure and functional heterogeneity.