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Background Diffusion spectral imaging (DSI) could overcome the inherent limitation of diffusion tensor imaging (DTI), but its outcomes in masticatory muscle fiber-tracking have not been well-established. Therefore, the objective of this prospective study conducted in China was to evaluate and compare the performance of DTI and DSI in human masticatory muscles. Methods The differences and reproducibility of architecture characteristics and diffusion properties derived from DTI and DSI were evaluated in the masticatory muscles of healthy volunteers ( n  = 25). The quality of tracked fiber was analyzed based on anatomical information. To assess the sensitivity of DTI and DSI to muscular microenvironment changes, the architecture characteristics and diffusion properties of the masticatory muscles in patients with temporomandibular joint disorders (TMDs) ( n  = 25) between different subgroups according to the course of diseases were explored. The paired-samples t -test or Wilcoxon signed-rank test, Student’s t-test or Mann-Whitney U test, one-way ANOVA or the Kruskal-Wallis test, and the post-hoc multiple comparisons with false discovery rate adjustment were performed. Bland-Altman plots, within-subject coefficient of variation (CV), and relative absolute difference (RAD) were used to evaluate the reproducibility. Results In the healthy group, DSI generated significantly more fibers in all masticatory muscles (all P  < 0.001) and fewer low-quality fibers in most masticatory muscles ( P <  0.050) than DTI did. Moreover, higher values of mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were found in DSI (all P  < 0.001). Satisfactory coefficient of variation (< 10%), relative absolute difference (< 10%), and agreement exhibited by the Bland-Altman analysis were found between two scans in both DTI and DSI. Compared with DTI, DSI found additional significant changes in the masticatory muscles of TMDs patients. Conclusions Although both DTI and DSI allowed reproducible assessment of masticatory muscles, significant differences existed between them. DSI was more sensitive to the microenvironment changes of the masticatory muscles in TMDs patients.

Background Mandibular condylar hyperplasia (MCH) is a rare developmental disorder characterized by excessive growth of the mandibular condyle, leading to facial asymmetry, functional impairment, and dental malocclusion. Early radiological identification is essential for timely intervention, particularly when parotid gland involvement masks the underlying skeletal pathology. Case presentation A 15-year-old male presented with an 8–9 month history of painless left parotid swelling. MRI revealed a unique triad comprising a bulky left parotid gland measuring 4.3 × 3.2 cm compared to 3.1 × 2.4 cm on the right, left masseter hypertrophy with a volume of 28.3 cm³ versus 18.7 cm³ on the right representing a 51% increase, and left medial pterygoid hypertrophy measuring 15.2 cm³ versus 10.1 cm³ on the right showing a 50% increase. Quantitative analysis demonstrated significant left condylar enlargement with 31% height asymmetry, measuring 24.3 mm on the left versus 18.5 mm on the right, and increased anteroposterior diameter of 11.2 mm versus 8.3 mm. SPECT imaging was performed to assess growth activity, guiding subsequent management decisions between immediate surgical intervention versus conservative monitoring. Conclusion This case demonstrates how unilateral condylar hyperplasia can present primarily as parotid swelling, potentially misdirecting clinical attention. Quantitative volumetric analysis proved essential for diagnosis. The documented 31% condylar asymmetry with preserved function illustrates effective neuromuscular compensation, providing a 6–12 month window for intervention before symptom development. Early multidisciplinary collaboration is crucial for optimal outcomes.

Botulinum toxin type A (BoNT-A), a potent neurotoxin, is increasingly used to treat myogenic temporomandibular disorders (TMDs); however, the interplay between muscle atrophy and pain relief remains incompletely understood. This pilot study investigated how masseter and temporalis muscle thickness and pain intensity change over 12 weeks following BoNT-A injections in 15 patients (mean age 51.42 years) with myogenic TMD. Muscle thickness was measured via ultrasonography across multiple anatomical positions under both clenching and resting conditions at baseline and at 2, 4, 8, and 12 weeks post-injection. Significant thinning of both muscles occurred within 2 weeks, lasting until 12 weeks, but became less pronounced after the first month. Pain intensity showed parallel decreases, most notably early on, but these reductions were not consistently statistically significant. Correlation analyses revealed no strong persistent association between muscle thickness and pain except for a moderately positive correlation in the anterior temporalis at two weeks (r = 0.61, p = 0.04). BoNT-A induces rapid masticatory muscle atrophy and modest pain relief; however, these outcomes do not coincide. Pain relief was observed earlier than the full development of muscle atrophy and should be considered during TMD pain management.

A typical assessment for sarcopenia involves the use of abdominal computed tomography (CT) for calculating the skeletal muscle index (SMI) at the level of the third lumbar vertebra (L3). However, abdominal CT is not regularly performed on patients with head and neck cancer (HNC). We investigated whether masticatory SMI (M-SMI) measurements based on head and neck CT scans can be used to conduct sarcopenia assessments by evaluating whether M-SMI is correlated with L3-SMI. Abdominal and head and neck CT images of patients with trauma (n = 50) and HNC (n = 52) were analyzed retrospectively. Both manual delineation and threshold selection methods were used to measure cross-sectional areas of masticatory muscles and those of muscles at the L3 level on CT images. Muscle cross-sectional areas were normalized to height squared to calculate SMI, and a multivariate linear regression model was established to evaluate the correlation between the M-SMI and L3-SMI. Receiver operating characteristic curve analysis was used to assess the ability of the M-SMI to identify sarcopenia, and Cox logistic regression was used to identify predictors of sarcopenia. Patients with HNC had significantly lower M-SMI and L3-SMI than did patients with trauma (p = 0.011 and 0.03, respectively). M-SMI and L3-SMI were strongly correlated (r = 0.901, p < 0.001); in the multivariate model that included sex, the correlation was stronger (r = 0.913, p < 0.001). The associations of sarcopenia with a lower M-SMI (p < 0.001), male sex (p = 0.028), and advanced age (p = 0.011) were significant, and multivariate logistic analysis demonstrated that an M-SMI of <5.5 was an independent predictor of sarcopenia (hazard ratio = 5.37, p < 0.001). M-SMI assessment in routine head and neck CT scans is feasible and can be an alternative for detecting sarcopenia in patients with HNC.

Dysphagia is reported in advanced stages of Duchenne muscular dystrophy (DMD). The population of DMD is changing due to an increasing survival. We aimed to describe the dysphagia in consecutive stages and to assess the underlying mechanisms of dysphagia in DMD, in order to develop mechanism based recommendations for safe swallowing. In this cross-sectional study, participants were divided into: early and late ambulatory stage (AS, n  = 6), early non-ambulatory stage (ENAS, n  = 7), and late non-ambulatory stage (LNAS, n  = 11). Quantitative oral muscle ultrasound was performed to quantify echo intensity. Swallowing was assessed with a video fluoroscopic swallow study, surface electromyography (sEMG) of the submental muscle group and tongue pressure. Differences in outcome parameters among the three DMD stages were tested with analysis of variance. Oral muscles related to swallowing were progressively affected, starting in the AS with the geniohyoid muscle. Tongue (pseudo) hypertrophy was found in 70 % of patients in the ENAS and LNAS. Oral phase problems and post-swallow residue were observed, mostly in the LNAS with solid food. sEMG and tongue pressure data of swallowing solid food revealed the lowest sEMG amplitude, the longest duration and lowest tongue pressure in the LNAS. In case of swallowing problems in DMD, based on the disturbed mechanisms of swallowing, it is suggested to (1) adjust meals in terms of less solid food, and (2) drink water after meals to clear the oropharyngeal area.

Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is a disease associated with a mouth opening limitation. Here, we conducted a bioinformatics analysis to examine gene expression patterns in patients with MMTAH in comparison to those with facial deformity (FD). Seven MMTAH patients and three FD patients were recruited. We conducted RNA sequencing analysis, quantitative reverse transcription polymerase chain reaction and immunoblot analysis. Of the identified 19,767 mapped read tags that showed clear differential expression, 2,471 genes were significantly up-regulated and 2,849 genes were significantly down-regulated in patients with MMTAH compared to those in patients with FD. Among the up-regulated genes, ten genes were significantly increased. The distribution of up-regulated and down-regulated genes at different ages tended to be similar. Moreover, the protein levels of Ankyrin Repeat Domain 2, Troponin T1 and myosin heavy chain 7, which are associated with slow twitch fibers and mechanical loading, were strongly expressed in patients with MMTAH compared to those in patients with FD. The gene expression pattern in MMTAH patients was similar regardless of age. As the transition of fast-to-slow twitch in the skeletal muscle is induced by mechanical loading, and up-regulation of slow twitch molecules was observed in MMTAH patients, mechanical loading is suggested to be implicated in MMTAH.

Limited mouth opening is a characteristic of masticatory muscle tendon-aponeurosis hyperplasia (MMTAH). Although genetic involvement is suspected where familial onset is frequently observed, the genetic background of MMTAH is yet to be elucidated. In this study, we conducted whole genome sequencing of 10 patients with MMTAH and their family members when available. We also conducted RNA sequencing of normal temporal tendon (as disease region) and Achilles tendon (as control region) from commercially available pig samples. We identified 51 genes that had rare variants in patients with MMTAH and were highly expressed in the temporal tendons of pigs. Among the 51 genes, 37 genes have not been reported to be causative for human genetic diseases so far. As an implication of genetic involvement in the pathogenesis of MMTAH, 21 of these 37 genes were identified in two independent families. In particular, PCDH1 and BAIAP3 were identified in one affected individual in a family and consistently segregated in unrelated family, indicating they could be candidate causative genes of MMTAH. Our findings will help elucidate the genetic landscape of MMTAH and provide insights into future possibilities for tendon regeneration treatment.

[Abstract] There is still considerable controversy surrounding the impact of mastication on obesity. The aim of this study was to identify the interplay between the masticatory muscles, teeth, and general muscular fitness and how they contribute to body adiposity in a general German population. This cross-sectional study included 616 participants (300 male, 316 female, age 31 - 93 years) from the population-based Study of Health in Pomerania. The cross-sectional areas of the masseter, medial and lateral pterygoid muscles were measured using magnetic resonance imaging (MRI), muscular fitness assessed by hand grip strength (HGS) and body fat distribution was measured by bioelectrical impedance analysis (BIA) and MRI. The overall prevalence of obesity was high in our cohort. The cross-sectional area of the masseter muscles was positively associated with the number of teeth, body mass index (BMI) and HGS, and negatively associated with the BIA-assessed body fat when adjusted for age, sex, teeth, and BMI. Especially the correlation was strong (p < 0.001). Analogous relationships were observed between the masseter, HGS and MRI-assessed subcutaneous fat. These associations were most pronounced with masseter, but also significant with both pterygoid muscles. Though the masticatory muscles were affected by the number of teeth, teeth had no impact on the relations between masseter muscle and adiposity. Physical fitness and masticatory performance are associated with body shape, controlled and directed by the relevant muscles.

Abstract Background Little is known about the spectrum of underlying disorders in dogs with unilateral masticatory muscle (MM) atrophy. Objectives To evaluate the clinical presentation, magnetic resonance imaging (MRI) findings, and outcome of dogs with unilateral MM atrophy. Animals Sixty-three client-owned dogs. Methods The medical database was retrospectively reviewed for dogs that underwent MRI for evaluation of unilateral MM atrophy. Imaging studies were reviewed and follow-up information was obtained from telephone interviews. Results Presumptive trigeminal nerve sheath tumor (pTNST) was diagnosed in 30 dogs (47.6%); survival time varied from 1 day to 21 months (median, 5 months). Other extra-axial mass lesions were observed in 13 dogs (20.6%); survival time varied from 6 days to 25 months (median, 2.5 months). In 18 dogs (28.6%), no abnormalities were observed on MRI; neurological signs only progressed in 1 dog. Diagnosis had a significant influence on the type of neurological abnormalities, with additional neurological deficits observed in most dogs with pTNST and in all dogs with other extra-axial mass lesions. Diagnosis had a significant effect on euthanasia at the time of diagnosis and likelihood of neurological deterioration. Dogs with mass lesions were more likely to be euthanized or experience neurological deterioration, whereas these outcomes occurred less often in dogs in which no causative lesion could be identified. Conclusions and Clinical Importance Trigeminal nerve sheath tumors should not be considered the only cause of unilateral MM atrophy. Our results illustrate the importance of performing a neurological examination and MRI when evaluating dogs with unilateral MM atrophy.

Objective. The masticatory muscles are the most important contributor to bite force, and the temporomandibular joint (TMJ) receives direct occlusal loading. The present study aimed to investigate condylar remodeling after masseter muscle atrophy in rats. Methods. Sixty 5-week-old female Sprague-Dawley rats were divided into the following 3 groups: the control group, soft diet (SD) group, and botulinum toxin (BTX) group. The cross-sectional area (CSA) of the masseter muscles was investigated as well as atrogin-1/MuRF-1 expression. Changes in the condylar head were evaluated by H-E, toluidine blue staining, and contour measurements. The biomechanical sensitive factors PTHrP Ihh, Col2a1, and ColX of condylar cartilage were detected by immunohistochemical staining and western blotting. Furthermore, micro-CT and tartrate-resistant acid phosphatase (TRAP) staining were performed to determine the osteopenia in subchondral bone. Results. The histological and protein analysis demonstrated muscle hypofunction in the SD and BTX groups. Condylar cartilage contour was diminished due to different treatments; the immunohistochemistry and protein examination showed that the expressions of PTHrP, Ihh, Col2a1, and ColX were suppressed in condylar cartilage. A steady osteoporosis in subchondral bone was found only in the BTX group. Conclusion. The current results suggested that a steady relationship between muscular dysfunction and condylar remodeling exists.