Assessment of the masseter stiffness in patients during conservative therapy for masticatory muscle disorders with shear wave elastography.

BACKGROUND: The complex structure of the stomatognathic system plays a vital role in chewing, digestion, speaking, breathing, facial expression and swallowing. Its complexity is the primary reason for creating multidisciplinary teams to manage temporomandibular disorders (TMD). We aimed to assess the masseter stiffness in patients undergoing conservative therapy for masticatory muscle disorders and evaluate the efficacy of manual therapy and stabilization occlusal splint in the treatment of masticatory muscle disorders. METHODS: This uncontrolled prospective cohort study included 35 patients with masticatory muscle disorders. The study lasted for eight weeks. The patients were treated with manual therapy and stabilization occlusal splint and evaluated using shear wave elastography of the masseter muscles and patient-reported outcome measures (PROMs) to assess pain, anxiety, quality of sleep, satisfaction with life and perceived stress. RESULTS: After the treatment, the stiffness of both masseter muscles decreased significantly (by 4.21 kPa). The patients reported a significant reduction in pain. At baseline, the median scores ranged from 5 to 8; after treatment, they ranged from 0 to 1 (p < 0.0001). The patients also reported significant improvement in terms of all patient-reported outcome measures. The reduction in stiffness corresponded to the improvement in pain and PROMs, as shown by correlations which were insignificant for all measures. CONCLUSIONS: Conservative therapy of masticatory muscle disorders involving manual therapy and stabilization occlusal splint is effective. It reduces the masseter stiffness as objectively shown in shear wave elastography and improves subjective PROMs scores, including numerical pain assessment and selected questionnaires. Shear wave elastography has the potential for broad application in clinical practice to monitor masticatory muscle disorders treatment effects due to its objectivity and non-invasive character. Further research is recommended on larger patient populations and longer follow-up. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov ( NCT03844854 ). First posted date: 19/02/2019.

Ovarian Hyperstimulation Syndrome as a Growing Diagnostic Problem in Emergency Department Settings: A Case Report.

BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) is a common complication of an in-vitro fertilization (IVF) procedure, which is usually clinically insignificant. However, without monitoring, it can progress into a life-threatening condition. With the increasing popularity of IVF technology, patients with OHSS may begin visiting emergency departments (EDs) more frequently. CASE REPORT: We report the case of a patient admitted to the ED presenting with severe abdominal pain, cough, and nausea. An ultrasound examination was inconclusive. Computer tomography revealed enlarged ovaries and fluid in the pleural cavities, around the liver and spleen, between the bowel loops, and in the pelvis. This prompted physicians to review the patient's fertility issues. Consequently, the diagnosis of OHSS was made. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: When the physician knows that the patient is undergoing IVF, the diagnosis of OHSS can be straightforward; without this information, it can be difficult. Having in mind the growing demand for infertility treatment, we present this case to increase awareness of possible clinical findings and complications of OHSS as a rare consequence of IVF. OHSS diagnosed via ultrasound can reduce the emotional, financial, and health burden of infertile couples and help them to fulfill their procreation plans without unnecessary delay.

Advancements in alveolar bone reconstruction: A systematic review of bone block utilization in dental practice.

Alveolar reconstructive surgery employs a variety of surgical techniques and biomaterials, with a particular focus on bone blocks as a crucial methodology for restoring and augmenting deficient bone structures. Bone blocks are often employed to support periodontal health or as a foundation for future prosthetic rehabilitation with dental implants. This systematic review investigated recent advances in bone blocks for alveolar bone reconstruction, comparing autologous, allogeneic and xenogeneic types. A search of PubMed identified 56 records, of which 21 were included in the qualitative analysis. The studies involved 685 patients in total. Bone blocks are pivotal for three-dimensional bone regeneration, providing a stable scaffold for achieving the desired bone volume during healing. Autologous bone, harvested from the patient, boasts high biocompatibility, excellent osteogenic properties and minimal immunologic risks. However, its drawbacks include the need for an additional surgical site and extended procedural times. Allogeneic bone blocks involve transferring bone between individuals, offering increased graft availability and customization options without requiring a second surgical site. However, they exhibit moderate resorption rates and carry a heightened risk of immunologic reactions and disease transmission. Innovative techniques, such as tunneling, laser osteotomy, graft customization, and platelet-rich fibrin (PRF) application on wound during surgical treatment show promise in enhancing alveolar bone reconstruction efficacy. In conclusion, despite the traditional preference for autologous bone, the review suggests that alternative materials, particularly individualized allogeneic bone blocks, coupled with modern techniques, could emerge as a standard procedure for regenerating alveolar bone defects due to their satisfactory results and potential advantages.

Distance of the cervical part of the internal carotid artery from the selected anatomical structures in the parapharyngeal space and its relation to patient characteristics.

Anomalies of the internal carotid artery (ICA) can increase the risk of haemorrhage during common surgical procedures. The aim of this literature review was to summarize the current state of knowledge on the course of the internal carotid artery in the parapharyngeal space, including the impact of the patient characteristics on the distances between the artery and other anatomical structures, as well as symptoms accompanying the aberrations. Pathologies related to the course of ICA in the parapharyngeal space are common (10%-60% in the general population and up to 84.4% in the elderly). In women, the distances in the oropharynx area are shorter than in men. Although the number of morphological studies is growing, providing more information on this topic, the identified studies differ in the methods and results. Knowledge on the variability in the course of ICA can help identify patients at high risk for the ICA trauma during pharyngeal procedures.

Botox Therapy for Hypertrophy of the Masseter Muscle Causes a Compensatory Increase of Stiffness of Other Muscles of Masticatory Apparatus.

Little is known about the nature of masseter muscle hypertrophy. We investigated the masseter muscle stiffness change after a single intra-masseteric session of Botox injections in people with benign bilateral masseter hypertrophy and the effect of the treatment on the stiffness of the temporalis muscle. Stiffness of the muscles was measured with shear-wave elastography at baseline and 3 weeks after Botox injections in 22 otherwise healthy people. Before the treatment, the stiffness of the masseter was lower than of the temporalis muscle (10.18 ± 1.67 kPa vs. 11.59 ± 1.54 kPa; p = 0.002). After the treatment, this difference increased (6.38 ± 1.34 vs. 13.10 ± 1.92; p < 0.0001). The drop in the stiffness of the masseter muscle was symmetrical (left side by 3.78 kPa; right side by 3.83 kPa). No differences between the left and right sides of the face in terms of muscle stiffness were observed. The study shows that Botox injections reduce stiffness of the masticatory muscles which, in turn, increases the stiffness of the temporalis muscles. Due to the knock-on effect of the change in the masseter function on the other masticatory muscles, simultaneous evaluation and treatment of the temporalis muscle may be required to ensure the desired functional and cosmetic effect.

Determination of Reference Values of the Masseter Muscle Stiffness in Healthy Adults Using Shear Wave Elastography.

Shear wave elastography (SWE) is an objective and reliable method for the assessment of muscles and internal organs. Every organ exhibits its own stiffness characteristics and hence requires individual reference values. We aimed to determine the reference values of stiffness of the masseter muscle in healthy adult individuals using SWE. We analyzed the data of 140 participants (74 men, 66 women) with a median age of 50 years. The overall mean elasticity was 10.67 ± 1.77 kPa. The average values were lower by 2.25 kPa (9.15%) in women compared to men (9.48 ± 1.47 kPa vs. 11.73 ± 1.27 kPa; p < 0.0001). The values of stiffness increased with age, with a correlation coefficient of about 0.35 and a p < 0.0001. Age was a significant influencing factor of masseter muscle stiffness. The left and right masseters had similar stiffness. We conclude that stiffness values are significantly lower in women than in men with a difference of 9%. Age significantly influences the stiffness of masseter muscle, and the values of stiffness increase significantly with age, particularly in men. However, further studies are required to determine the precise ranges of stiffness accounting for age and sex in healthy subjects and people with disorders and conditions of the masticatory system.

Analysis of alveolar ridge width in an area of central lower incisor using cone-beam computed tomography in vivo.

BACKGROUND: Planning a comprehensive dental treatment should include assessment and classification of the condition of the alveolar ridge. Existing classifications are insufficient. This study aimed to investigate the frequency of bone deficiencies in the anterior mandible and to develop an extension of one of the alveolar bone dehiscence classification. METHODS: Cone-beam computed tomography scans of 100 adults with the mean age of 36.75 ±â€¯11.77 years were analyzed. Measurements were taken from the 31. tooth. RESULTS: The presence of any bone defect was found in 91 (91%) of cases. Fenestrations were detected in 9% of study images, and dehiscence were detected in 90% of study images. A thin alveolar plate of below 0.2 mm independent from the side was found in 37 (37%) of cases. The mean height of buccal fenestration was 3.10 ±â€¯1.09 mm, and the mean height of lingual fenestration was 2.73 ±â€¯0.91 mm. The mean height of buccal dehiscence was 4.39 ±â€¯1.82 mm, and the mean height of lingual dehiscence was 4.27 ±â€¯2.49 mm. CONCLUSIONS: An attempt to restore the correct morphology of the alveolar process after improper treatment constitutes a therapeutic challenge. The frequent occurrence of bone deficiency prompts establishing safe treatment planning strategies, including careful assessment of the alveolar process supported by the comprehensive classification of bone defects.

Dentists can provide reliable shear wave elastography measurements of the stiffness of masseter muscles: A possible scenario for a faster diagnostic process.

BACKGROUND: Masseter muscle pathologies include hypertrophy and the experience of pain, which clinically manifest with increased stiffness and tension. Assessment of muscle stiffness has been gaining importance among physicians dealing with temporomandibular disorders (TMD). Currently, shear wave elastography (SWE) is still often performed by radiologists, while dentists diagnose, treat and monitor TMD. OBJECTIVES: In this cohort study, we investigated whether dentists trained to use SWE can obtain reliable measurements of masseter muscle stiffness following participation in a short training program and hands-on workshop. MATERIAL AND METHODS: A group of healthy volunteers was examined by an experienced radiologist and a novice dentist before and after the training. RESULTS: The mean values of stiffness obtained by the operators were consistent and ranged from 10.20 kPa to 10.84 kPa. Intraobserver agreement was excellent for measurements of the radiologist (intraclass correlation coefficient (ICC) 0.92 and 0.93, respectively). The training improved the agreement between measurements made by the dentist from poor before the training (ICC = 0.46) to good after the training (ICC = 0.89). Also, the operator agreement between the radiologist and dentist increased from poor (ICC = 0.48) before the training to good (ICC = 0.84) after the training. CONCLUSIONS: The diagnostic accuracy of measuring masseter muscle stiffness was acceptable among dentists after the training. For this reason, the patient can be diagnosed by a single TMD specialist. This can shorten the diagnostic process and reduce treatment costs.

Stiffness of the Masseter Muscle in Children-Establishing the Reference Values in the Pediatric Population Using Shear-Wave Elastography.

In children, the quality and muscle function are altered in many pathologic conditions, including temporomandibular disorders. Although several methods have been used to evaluate muscle tonus, none became a golden standard. Moreover, the masseter muscle characteristics in children have not been investigated to date. This study aimed to measure the stiffness of the masseter muscle using shear-wave elastography in healthy children. We enrolled 30 healthy children (mean age 10.87 ± 3.38 years). The stiffness of masseter muscles was measured with shear wave elastography. Stiffness for the total sample was 6.37 ± 0.77 kPa. A comparison of the measurements did not show significant differences between the right and the left masseter muscles (left-6.47 ± 0.78 kPa; right-6.24 ± 0.76 kPa; p = 0.3546). A significant difference was seen between boys and girls (boys-5.94 ± 0.50 kPa; girls-6.63 ± 0.80; p = 0.0006). Shear-wave elastography is a promising diagnostic tool. It may help to detect changes in the stiffness of the masseter muscle and draw attention to pathological processes within the jaw muscles. Directions for further research shall include determining stiffness values in pathological conditions and the impact of biological and functional factors on the stiffness of the masseter muscle.

Monitoring of Changes in Masticatory Muscle Stiffness after Gum Chewing Using Shear Wave Elastography.

This study aimed to investigate if intensive exercise affects the stiffness of the masticatory muscles measured with shear-wave elastography. The study included a cohort of healthy adults (n = 40) aged 40 ± 11 years. In each individual, the stiffness of both the masseter and temporalis muscle was examined three times: at baseline, after 10 min of intensive exercise (chewing gum), and after 10 min of relaxation. Stiffness values (median (IQR)) of both the masseter and temporalis muscle were the lowest at the baseline (11.35 (9.7-12.65) and 10.1 (9.1-10.95)), increased significantly after the exercise (12.5 (11.1-13.25) and 10.3 (10.2-10.52)) and then dropped significantly after 10 min of relaxing (11.75 (9.95-12.6) and 10.2 (9.65-11.9)). The stiffness of the temporalis muscle was significantly lower than that of the masseter muscle. The values of the stiffness of the masseters correlated significantly with the values of the stiffness of the temporalis muscles. Shear wave elastography proved to be a sensitive method for showing changes in the stiffness of the muscles involved in the mastication occurring as a response to the effort, which increased the muscle stiffness. Further research is needed to broaden knowledge on the impact of eating habits and the occurrence of parafunctions on the development of temporomandibular disorders and the condition of masticatory muscles.

Great potential of ultrasound elastography for the assessment of the masseter muscle in patients with temporomandibular disorders. A systematic review.

OBJECTIVE: To summarize the available evidence on the use of elastography in the assessment of the masseter muscle in healthy individuals and patients with masseter muscle disorders. METHODS: Systematic literature review has been performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: 16 of 142 studies identified were analyzed. Elastography was used in seven studies. Heterogeneity was observed in terms of study protocols, devices, patients, units of measure, and results. Elasticity values showed a correlation between the left and right masseter muscle side in healthy people, but not in patients with temporomandibular disorders (TMDs). Elasticity values increased in TMD and were correlated with the severity of TMD symptoms. Phantom studies proved the high reliability of elastography. CONCLUSION: Elastography is a promising tool for the assessment of the masseter muscle elasticity, but the evidence is insufficient. Studies on larger groups are needed to determine the accuracy of elastography to characterize masticatory muscle disorders.

Potential of Using Shear Wave Elastography in the Clinical Evaluation and Monitoring of Changes in Masseter Muscle Stiffness.

The study aimed to evaluate masseter muscle stiffness in adult healthy volunteers referred to a massage treatment and also to investigate whether shear-wave elastography can be used to monitor the effect of massage on the masseter muscle. The study included 21 healthy volunteers, who were subjected to a 30-minute massage of the masseter muscle. Muscle stiffness was measured by shear-wave elastography before and directly after the massage. Pain during the massage was assessed using the visual analogue scale (VAS). The data of 20 patients (one excluded due to severe pain) with a median age of 34.5 years were analysed. The stiffness values were 11.46 ± 1.55 kPa before and 8.97 ± 0.96 kPa after the massage (p < 0.0001). The mean drop was 2.49 ± 1.09 kPa. The greatest decrease was observed in people with higher elasticity values before the massage (r = 0.79; p < 0.0001). The median intensity of pain was 7.2 (range: 6-9.5). We concluded that shear-wave elastography is a sensitive tool to monitor changes in the stiffness of the masseter muscle.

Hounsfield units and fractal dimension (test HUFRA) for determining PET positive/negative lymph nodes in pediatric Hodgkin's lymphoma patients.

OBJECTIVES: We had developed a method that can help detect and identify lymph nodes affected by the neoplastic process. Our group evaluated the fractal dimension (FD) and X-ray attenuation (XRA) of lymph nodes in HL and compared to their metabolic activity as measured by 18F-FDG-PET examination. METHODS: The training set included 72 lymph nodes from 31 consecutive patients, and the tested set of 71 lymph nodes from next 19 patients. The measurement of FD of each lymph node was performed before the start of therapy using original software. X-ray attenuation (XRA) expressed in HU (Hounsfield Units) from CT scans was compared with the metabolic activity of the lymphatic nodes, measured by 18F-FDG-PET examination. RESULTS: Significant differences were observed between XRAmax and FDmax values in assessing the PET(+) and PET(-) nodes. All nodes were scored from 0 to 2. The HUFRA test properly qualified 95% with a score of 2 and 0 points as PET(+) or PET(-). CONCLUSION: The HUFRA test can differentiate about 70-80% of lymph nodes as PET(+) or PET(-) based solely on the CT examination. It can be useful in patients who were not subjected to 18FFDG-PET/CT examination before the treatment, or who had an unreliable result of 18F-FDG-PET/CT with further research requirements.

Modifications of Polymeric Membranes Used in Guided Tissue and Bone Regeneration.

Guided tissue/bone regeneration (GTR/GBR) is a widely used procedure in contemporary dentistry. To achieve the required results of tissue regeneration, soft tissues that reproduce quickly are separated from the slow-growing bone tissue by membranes. Many types of membranes are currently in use, but none of them fulfil all of the desired features. To address this issue, further research on developing new membranes with better separation characteristics, such as membrane modification, is needed. Many of the current innovative modified materials are still in the phase of in vitro and experimental studies. A collective review on new trends in membrane modification to GTR/GBR is needed due to the widespread use of polymeric membranes and the constant development in the field of dentistry. Therefore, the aim of this review was to present an overview of polymeric membrane modifications to the GTR/GBR reported in the literature. The authors searched databases, including PubMed, SCOPUS, Web of Science, and OVID, for relevant studies that were published during 1999-2019. The following keywords were used: guided tissue regeneration, membranes, coating, and modification. A total of 17 papers were included in this review. Furthermore, the articles were divided into three groups that were based on the type of membrane modification: antibiotic coating, ion-use modifications, and others modifications, thus providing an overview of current existing knowledge in the field and encouraging further research. The results of included studies on modified barrier membranes seem to be promising, both in terms of safety and benefits for patients. However, modifications result in a large spectrum of effects. Further clinical studies are needed on a large group of patients to clearly confirm the effects that were observed in animal and in vitro studies.

Evaluation of Biofeedback Usefulness in Masticatory Muscle Activity Management-A Systematic Review.

Temporomandibular disorders (TMD) have multifactorial and complex etiology. Regardless of their etiology, all those conditions may result in centrally mediated chronic muscle pain, myalgia, myofascial pain, myofibrotic contracture, myosistis, myospasm, headache and a variety of neck, shoulder, upper back and lower back pain. Biofeedback (BF) is one of methods that has been used for more than 50 years in rehabilitation to facilitate normal movement patterns after injuries. Some studies suggest that biofeedback may be an effective treatment option for patients with different muscle disorders. The aim of this study was to evaluate the efficiency of biofeedback in masticatory muscle activity management in the light of current medical literature. The authors followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines for this systematic review. The authors searched the MEDLINE, Scopus, Web of Science, CINAHL databases to identify relevant publications. Finally 10 papers were included. Most of the selected studies showed a significant correlation between biofeedback usage and reduction of masticatory muscle activity. By analyzing qualified studies, it can be concluded that biofeedback can be an effective tool in masticatory muscle activity management.

Measurements of signal intensity of globus pallidus and dentate nucleus suggest different deposition characteristics of macrocyclic GBCAs in children.

INTRODUCTION: The safety of using GBCAs to enhance the visibility of body structures is currently discussed due to possible gadolinium retention in brain structures. The aim of the study was to evaluate the effect of multiple exposures to macrocyclic GBCAs in children. MATERIALS AND METHODS: This retrospective, single-center study included data from 43 patients who had received ≥4 injections of macrocyclic GBCAs during MRI examinations over performed over 8 to 84 months. Signal intensity was measured on unenhanced T1-weighted MRI, and globus pallidus to thalamus (GP/Th) and dentate nucleus to pons (DN/P) ratios were calculated. The differences in ratios were tested with the Student's t-test or the Wilcoxon rank sum test. For categorical data, Pearson's chi-squared test was used. Relationships were analyzed with the Spearman's rank correlation coefficient. RESULTS: Patients with the mean age of 7.5 years (SD = 4.2) received 8.19 (SD = 3.63) injections of GBCAs on average. Differences in GP/Th and DN/P ratios between the first and the last measurement were insignificant. Children before the end of myelination process (≤2 years of age) had the first GP/Th ratio values significantly lower than those >2 years of age (p = 0.0284), which than increased at the final scan and reached the level similar to values obtained in the group of >2 years of age. CONCLUSIONS: Maturation of the brain may affect both signal intensity of brain structures and susceptibility to GBCAs; thus, assessment of signal intensity of the brain structures should be conducted taking into account the age of a child.

The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review.

BACKGROUND AND PURPOSE: Gadolinium based contrast agents (GBCAs) are widely used in magnetic resonance imaging, but recently, high signal intensity in the cerebellum structures was reported after repeated administrations of contrast- enhanced magnetic resonance images. The aim of this systematic review was to investigate the association between increased signal intensity in the dentate nucleus and globus pallidus in the brain and repeated administrations of GBCAs. Additionally, we focused on possible short- and long-term consequences of gadolinium use in those patients. METHODS: Systematic review of retrospective investigations in PubMed and Medline was performed in July 2016. Primary outcomes included the presence of increased signal intensity within the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in patients following administrations of GBCAs. Two independent reviewers were responsible for search and data extraction. RESULTS: 25 publications satisfied inclusion criteria (19 magnetic resonance images analyses, 3 case reports; 3 autopsy studies). Magnetic resonance images of 1247 patients with increased signal intensity on unenhanced T1-weighted MR images were analyzed as well as tissue specimens from 27 patients. Signal intensity correlated positively with the exposure to GBCAs and was greater after serial administrations of linear nonionic than cyclic contrast agents. Gadolinium was detected in all tissue examinations. CONCLUSIONS: High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance images were associated with previous administration of GBCAs. Signal intensity correlated negatively with stability of contrast agents. Clinical significance of gadolinium deposition in the brain remains unclear. There is a strong need for further research to identify type of gadolinium deposited in the brain as well as to gather knowledge about long-term consequences.