Magnetic resonance imaging of human mandibular elevator muscles after repetitive maximal clenching exercise

Correlation between Changes in the Transverse Relaxation Time and Electromyographic Measurements of the Superficial Masseter and Temporal Muscles

We analyzed the correlations between the T₂ shift and integrated electromyographic (iEMG) values in the masseter and temporal muscles. Six healthy adults engaged in a clenching task over two durations at various bite forces. We evaluated the mean T₂ shift per voxel and assessed their correlations with iEMG using a linear mixed model. The regression coefficients were different for each muscle type, similar for the left and right sides, and decreased upon doubling duration.

In vivo Cross-sectional Area of Human Jaw Muscles Varies with Section Location and Jaw Position

Muscle cross-sectional area (CSA) is used as a measure for maximum muscle force. This CSA is commonly determined at one location within the muscle and for one jaw position. The purpose of this study was to establish a method to standardize the analysis of the CSA of the masticatory muscles in vivo, and to compare the CSAs along their entire length for two different jaw positions (opened and closed). The CSAs in the planes perpendicular to the long axes of the masseter, medial, and lateral pterygoid muscles were measured in ten normal young adult subjects by magnetic resonance imaging. Our results showed large differences among the muscles and a non-uniform change in CSA after jaw-opening. The method enables the CSA measurement to be standardized in vivo, and allows for a correct comparison of CSAs in different skull morphologies.

The usefulness of diagnostic imaging for the assessment of pain symptoms in temporomandibular disorders

The causes of pain symptoms in the temporomandibular joint (TMJ) and masticatory muscle (MM) regions may not be determined by clinical examination alone. In this review, we document that pain symptoms of the TMJ and MM regions in patients with temporomandibular disorders (TMDs) are associated with computed tomography and magnetic resonance (MR) findings of internal derangement, joint effusion, osteoarthritis, and bone marrow edema. However, it is emphasized that these imaging findings must not be regarded as the unique and dominant factors in defining TMJ pain. High signal intensity and prominent enhancement of the posterior disk attachment on fat saturation T2-weighted imaging and dynamic MR imaging with contrast material are closely correlated with the severity of TMJ pain. Magnetic transfer contrast, MR spectroscopy, diffusion tensor imaging, and ultrasonography findings have helped identify intramuscular edema and contracture as one of the causes of MM pain and fatigue. Recently, changes in brain as detected by functional MR neuroimaging have been associated with changes in the TMJ and MM regions. The thalamus, the primary somatosensory cortex, the insula, and the anterior and mid-cinglate cortices are most frequently associated with TMD pain.

Relationship between masseter muscle size and maxillary morphology

The aim of this study was to investigate the relationship between masseter muscle size and craniofacial morphology, focusing on the maxilla. Twenty-four patients (11 males and 13 females; mean age 27.6 ± 5.6 years) underwent cephalometric analyses. Ultrasonography was used to measure the cross-sectional area (CSA) of the masseter muscle and bite force was measured using pressure sensitive film. The results showed that CSA-relaxed was positively correlated with upper anterior face height (UAFH)/total anterior face height (TAFH) and negatively with lower anterior face height (LAFH)/TAFH and LAFH (P < 0.05). CSA-clenched was correlated positively with SN-palatal, FH-palatal, UAFH/TAFH, and lower posterior face height (LPFH)/total posterior face height (TPFH) and negatively with LAFH/TAFH, LAFH, upper posterior face height (UPFH)/TPFH, and UPFH (P < 0.05). Bite force was positively correlated with LPFH/TPFH and negatively with UPFH/TPFH (P < 0.05). As the masseter became larger, the anterior maxillary region tended to shift downwards relative to the cranial base, whereas the posterior region tended to shift upwards. The decrease in LAFH/TAFH and increase in LPFH/TPFH as the size of the masseter muscle increases may be influenced not only by the inclination of the mandibular plane but also by the clockwise rotation of the maxilla.

Quantitative analysis of masticatory activity during unilateral mastication using muscle fMRI

OBJECTIVE

Quantitative analysis of the activities of all masticatory muscles is required to elucidate the mechanism of stomatognathic dysfunction. Electromyography can be used to record the activity of masticatory muscles, but quantification of the overall activity of every masticatory muscle has not been accomplished because of methodological limitations. In this study, we used muscle functional magnetic resonance imaging for simultaneous quantification of the overall activities of the masseter, medial pterygoid and lateral pterygoid muscles during unilateral gum chewing.

METHODS

Seven healthy male volunteers participated in the study. We evaluated changes in the mean proton transverse relaxation time in the bilateral masseter, medial pterygoid and lateral pterygoid muscles before and after unilateral gum chewing, and to quantify the overall activity of these muscles simultaneously during unilateral gum chewing.

RESULTS

After 5 min of chewing, the activity of the ipsilateral masseter was highest among the six muscles, followed by the ipsilateral medial pterygoid, contralateral lateral pterygoid and contralateral masseter muscles.

CONCLUSION

These results affirm the importance of the ipsilateral masseter muscle and quantitatively demonstrate the important contribution of the ipsilateral medial pterygoid and contralateral lateral pterygoid muscles during unilateral mastication.

Clinical significance of magnetization transfer contrast imaging for edematous changes in masticatory muscle

OBJECTIVE

To evaluate inflammatory changes in masticatory muscles by magnetization transfer contrast (MTC) imaging.

METHODS

Gradient-recalled echo (GRE) and MTC-GRE images of relaxed masticatory muscles in 28 healthy volunteers were obtained before and after exercise. At the same time, muscle stiffness and pain in the masseter muscles were also measured. Magnetization transfer ratios (MTRs) of the muscles were calculated from the GRE and MTC-GRE images. The MTRs of the masticatory muscles in 50 patients with temporomandibular disorder were compared with those in the volunteers.

RESULTS

Immediately after the exercise, the MTRs of the masseter muscles significantly decreased (P < 0.05), whereas muscle stiffness and pain increased in the healthy volunteers. In patients with masseter muscle pain, the MTRs of the masseter muscles were significantly lower than in the healthy volunteers (P < 0.05).

CONCLUSIONS

Magnetization transfer contrast imaging strongly reflects the masticatory muscle edematous changes, possibly leading to masseter muscle pain.

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.

Quantification of masticatory muscle atrophy after high-dose radiotherapy

PURPOSE

To determine the rate of change in the cross-sectional area of the masticatory muscles after radiotherapy.

METHODS AND MATERIALS

Eligible patients had undergone unilateral radiotherapy between 1993 and 2000 and had a baseline CT scan, a comparable follow-up CT scan a minimum of 1 year later, and no recurrence of cancer. Fourteen patients had their CT series scanned into digital image files. Two anatomically selected CT slices were bisected by the midline sagittal plane and stored under randomly assigned file names. Three observers measured the masseter and medial pterygoid areas on two occasions.

RESULTS

The intraobserver reliability of the muscle area measurements was 96.3% for the masseter and 97.1% for the medial pterygoid. The interobserver reliability of the muscle area measurements was 96.7% for the masseter and 96.3% for the medial pterygoid. On the treated side, the muscles received a median dose of 56 Gy (range 47-63) in 2.0-0.4-Gy fractions. With a median follow-up of 2.9 years (range 1-7.6), mixed-effects regression analysis demonstrated a significant area of reduction of -0.17 cm(2)/y (p = 0.0001) for the masseter and -0.13 cm(2)/y (p = 0.001) for the medial pterygoid. The controlled rate of muscle atrophy was 3.9%/y (95% confidence interval 1.4-6.4) for the masseter and 2.3%/y (95% confidence interval -0.6 to 5.1) for the medial pterygoid.

CONCLUSION

Standard therapeutic radiation doses appear to cause significant masticatory muscle atrophy.

Signal intensity changes in T2-weighted MR image of the human trapezius muscle upon cold pressor stimulation

OBJECTIVE

The ability to measure hemodynamics of skeletal muscle proper is one of the major goals for muscle pain researchers. The aim of the present study was to evaluate the ability of signal intensity (SI) in T2-weighted trapezius muscle magnetic resonance imaging (MRI) to detect intramuscular hemodynamic changes during cold pressor stimulation (CPS).

MATERIALS AND METHODS

Fifteen healthy volunteers (mean age, 25.9+/-2.1 years) participated in this study. T2-weighted MRI was acquired using a 1.5 tesla MR unit with a body array coil. The slice level was set perpendicular to the muscle long axis at the mid-point of the horizontal portion of the right trapezius muscle. Cold pressor stimulation (4 degrees C) was applied to each subject's right foot and ankle for 2 min. The SI changes were recorded continuously for 7 min before, 2 min during, and 6 min after withdrawal of cold pressor stimulation. Six of these subjects also underwent a mock-CPS trial.

RESULTS

The mean SI level in T2-weighted trapezius muscle MRI significantly increased during CPS (P<0.0001, one way repeated measure ANOVA) and returned to the baseline level after cold pressor withdrawal. No statistically significant signal changes were observed across the mock-CPS trial subjects. These findings are identical to the cold pressor-induced hemodynamic changes documented in the trapezius muscle by near-infrared spectroscopy evaluation.

CONCLUSIONS

SI measurement in T2-weighted trapezius muscle MRI is sufficiently sensitive to detect intramuscular hemodynamic changes during CPS.

Correlation of the near-infrared spectroscopy signals with signal intensity in T(2)-weighted magnetic resonance imaging of the human masseter muscle

The purpose of this study was to compare and contrast blood volume changes transcutaneously measured using near-infrared (NIR) spectroscopy against water signal intensity changes taken from a transverse T(2)-weighted MR image of the masseter muscle in healthy human subjects before, during and after contraction. Eight healthy non-smoking males with no history of chronic muscle pain or vascular headaches participated (mean age: 23.9+/-0.6 years). The MRI data were gathered using a turbo spin echo sequence (TR: 2300 ms; TE: 90 ms; FOV: 188x300 mm; scanning time: 30 s; slice thickness: 10 mm) and the slice level was set at the mid-point between the origin and insertion of the masseter. Intramuscular haemoglobin (Hb) levels and water content of the right masseter muscle were continuously monitored for 2 min before, 30 s during and 15 min after a maximum voluntary clenching (MVC) task. Both the near-infrared and MRI data were baseline-corrected and normalized and mean levels were established and plotted. Plots of the data showed that both near-infrared-based total Hb and T(2)-weighted MRI-based signal-intensity levels clearly decreased during contraction and a clear post-contraction rebound response was evident after the contraction. The near-infrared data were found to be highly correlated with MRI-based signal-intensity data (Pearson's r=0.909, P<0.0001). In conclusion, these data provide powerful evidence that near-infrared data (total Hb), transcutaneously taken from the masseter muscle in humans, will reflect the intramuscular water signal intensity changes seen using a T(2)-weighted MRI imaging method.