The Coronoid Anatomical Variation of the Masseter Muscle: A Case Report.

INTRODUCTION: Masseter muscle is considered to consist of two layers: the superficial and the deep parts. However, in the literature a few cases have been reported of a third layer of the masseter muscle, which is called the coronoid part. The aim of this study is to present such a rare case of the coronoid part of the masseter muscle. MATERIAL AND METHODS: In our study, a case report is presented and enhanced by searching the existing literature in PubMed for other similar cases that recorded the coronoid part of the masseter muscle. RESULTS: The coronoid part of the masseter muscle was found in a male cadaver of Greek origin that was dissected in the Department of Anatomy, Medical School Athens, Greece. CONCLUSIONS: Good knowledge of anatomy and variations of the masseter muscle are of paramount importance due to their clinical and functional applications as well as during surgical procedures in this anatomical region.

The relationship of masseter muscle thickness with face morphology and parafunctional habits: an ultrasound study.

OBJECTIVE: The aim of this study was to determine the normal range of masseter muscle thickness by ultrasonographic measurement in individuals over 15 years of age, and to evaluate its relationship with age, gender, facial morphology, body mass index and parafunctional habits. METHODS: The study was conducted on 115 volunteers whose lateral cephalometric radiography was performed within the indication in Gazi University Faculty of Dentistry, Department of Dentomaxillofacial Radiology. The participants in the study were asked questions about their parafunctional habits, age, height and weight. Individuals were grouped as hypodivergent (n = 28), normdivergent (n = 55), or hyperdivergent (n = 32) according to vertical face morphology by making measurements on lateral cephalometric films. Right and left masseter muscle thicknesses of individuals were measured by ultrasonography while at rest and in contraction. RESULTS: The mean value of masseter muscle thickness was found to be 13.57 ± 2.57 mm. The rest and contracted muscle thicknesses were significantly higher in males than in females for the right and left masseter muscles (p < 0.05). When the masseter muscle was at rest and contracted, its thickness was higher in individuals with hypodivergent facial morphology, than in the other groups. No statistically significant difference was found in terms of masseter muscle thickness between individuals having parafunctional habits and those who did not have parafunctional habits (p > 0.05). CONCLUSION: Although masseter muscle thickness varied according to vertical facial morphology, this was not the case for parafunctional habits.

Masseter muscle thickness and vertical cephalometric characteristics in children with Class II malocclusion.

BACKGROUND: Masseter muscle thickness and its relationship with vertical craniofacial morphology have been extensively studied in adults, but data on children are lacking. OBJECTIVE: To examine the association between masseter muscle thickness and vertical cephalometric parameters in a group of Class II malocclusion growing children. METHODS: The current study design was retrospective and cross-sectional, looking at a sample of 211 growing children with Class II malocclusion between the ages of 6 and 15 derived from two centers. Ultrasonographic masseter muscle thickness measurements and vertical cephalometric variables, including the gonial angle, were evaluated before any orthodontic treatment had been carried out. Multiple linear regression analysis was used to examine the association between masseter muscle thickness and vertical cephalometric measurements, including age and patient origin as independent variables in the analysis. RESULTS: In the present sample, masseter muscle thickness was found to be independent of sex, but correlated with age, with older children presenting thicker masseter muscles. In the total patient sample, using multiple regression analyses, children with thicker masseter muscles had significantly smaller intermaxillary and gonial angles. No other cephalometric vertical characteristics showed associations with masseter muscle thickness. CONCLUSION: In growing children with Class II malocclusion, those with thicker masseter muscles are more likely to display smaller intermaxillary and gonial angles respectively.

The significance and classification of the layered structures of the human masseter and temporalis.

A report published in the Annals of Anatomy recently stated that the coronoid part of the masseter was a newly described layer. However, there have been numerous discussions regarding the layered structures in the masseter and temporalis. In this review, we show that the muscle bundle stated as a newly described layer could be similar to the zygomaticomandibularis that was previously reported. Knowledge of various muscle bundles with different fiber directions is essential to understanding the stabilization and closing functions of the jaw. Therefore, the layered structure of the masseter and temporalis should be considered more for clinical and functional applications.

Jaw shape and mechanical advantage are indicative of diet in Mesozoic mammals.

Jaw morphology is closely linked to both diet and biomechanical performance, and jaws are one of the most common Mesozoic mammal fossil elements. Knowledge of the dietary and functional diversity of early mammals informs on the ecological structure of palaeocommunities throughout the longest era of mammalian evolution: the Mesozoic. Here, we analyse how jaw shape and mechanical advantage of the masseter (MAM) and temporalis (MAT) muscles relate to diet in 70 extant and 45 extinct mammals spanning the Late Triassic-Late Cretaceous. In extant mammals, jaw shape discriminates well between dietary groups: insectivores have long jaws, carnivores intermediate to short jaws, and herbivores have short jaws. Insectivores have low MAM and MAT, carnivores have low MAM and high MAT, and herbivores have high MAM and MAT. These traits are also informative of diet among Mesozoic mammals (based on previous independent determinations of diet) and set the basis for future ecomorphological studies.

Functional morphology and fiber types of the masseter muscles of two caviomorph rodents with contrasting lifestyles, Ctenomys talarum (Ctenomyidae) and Cavia aperea (Caviidae).

The aim of this work is the analysis of histochemical and morphometric properties of the masseter muscles of Ctenomys talarum and Cavia aperea. The former belongs to a subterranean rodent clade, Ctenomyidae, which has evolved a robust masticatory apparatus adapted to chisel-tooth digging and processing of abrasive grasses; C. aperea belongs to the family Caviidae, with relatively graceful jaws and mandibular musculatures, consistent with less mechanically challenging diets. Adult males were captured, immediately transported to the laboratory, and euthanized in a CO2 chamber. The musculus masseter superficialis and musculus masseter profundus on the left side of the animals were used to analyze the histochemical composition of the fiber types treated with myosin adenosine triphosphatase, succinate dehydrogenase and periodic acid Schiff. The mean fiber diameters, relative areas, and frequencies of each muscle fiber type were calculated. The mm. masseter superficialis and masseter profundus on the right side were used to measure the physiological cross-sectional area (PCSA). Based on this measurement, the internal force (F) was estimated. In the m. masseter profundus of both species and in the m. masseter superficialis of C. aperea intermediate fast oxidative-glycolytic fibers (FOGi) predominated. In the mm. masseter superficialis and masseter profundus of C. talarum the relative area of fast glycolytic (FG) fibers was greater than that of the muscles of C. aperea, whose main muscle fiber component is FOGi fibers. When corrected for body mass differences, PCSA was higher for the mm. masseter superficialis of C. talarum. This and the larger relative area of FG fibers, probably contributes to the exertion of large bite forces in C. talarum, as measured in previous studies.

Ultrasonographic Considerations for Safe and Efficient Botulinum Neurotoxin Injection in Masseteric Hypertrophy.

There are still concerns about masseteric bulging due to a lack of knowledge about the internal architecture of the masseter muscle. Further investigations are therefore required of the most-effective botulinum neurotoxin (BoNT) injection points and strategies for managing masseteric bulging. The purpose of this study was to identify safer and more effective botulinum neurotoxin injection points and strategies by using ultrasonography to determine the structural patterns of the deep inferior tendon. We also measured the precise depths and locations of the deep inferior tendon of the masseter muscle. Thirty-two healthy volunteers participated in this study, and ultrasonography was used to scan the masseter muscle both longitudinally and transversely. Three structural patterns of the deep inferior tendon were identified: in type A, the deep inferior tendon covered the anterior two-thirds of the masseter muscle (21.8%); in type B, the deep inferior tendon covered the posterior two-thirds of the masseter muscle (9.4%); and in type C, the deep inferior tendon covered most of the inferior part of the masseter muscle (68.8%). Depending on the ultrasonography scanning site, the depth from the skin surface to the mandible in the masseteric region ranged from 15 to 25 mm. The deep inferior tendon was typically located 2 to 5 mm deep from the mandible. Ultrasonography can be used to observe the internal structure of the masseter muscle including the deep inferior tendon in individual patients. This will help to reduce the side effects of masseteric bulging when applying retrograde or dual-plane injection methods depending on the structural pattern of the deep inferior tendon.

Comparison of Ultrasonic Thickness of Masseter Muscle Between Individuals With and Without Severe Forward Head Posture: A Cross-Sectional Study.

OBJECTIVE: In this cross-sectional descriptive-analytical study, we sought to compare the ultrasonic thickness of the masseter muscle in people with severe forward head posture vs people without forward head posture, and to determine sex differences in muscle thickness. METHODS: Thirty-eight volunteers (19 with normal head postures and 19 with severe forward head postures), aged 18 to 35 years, entered the study. The severity of the forward head posture was measured by a plumb line and the craniovertebral angle drawn on the recorded images. Based on the recorded images, the masseter muscle thickness was also measured by a 7.5-MHz linear transducer using an ultrasound device in the seated position with 3 mouth positions (closed, half open, and fully open). RESULTS: The results showed that the head posture affects masseter thickness significantly (P = .01), with masseter thickness significantly lower in the participants without severe forward head postures compared to those with severe forward head postures in the closed, half-open, and fully open mouth positions (P < .05). Comparing the mean masseter thickness across sexes showed that the masseter muscle is significantly thicker in men compared to women (P = .01). CONCLUSION: Head posture and thickness of the masseter muscle are linked, as the masseter muscle was thicker in all 3 positions in the participants with severe forward head postures.

Effects of Neuromuscular Electrical Stimulation Synchronized with Chewing Exercises on Bite Force and Masseter Muscle Thickness in Community-Dwelling Older Adults in South Korea: A Randomized Controlled Trial.

This study is aimed at investigating the effects of synchronized neuromuscular electrical stimulation (NMES) and chewing exercises on bite force and the masseter muscle thickness in community-dwelling older adults. Material and methods: Forty older adults were enrolled in South Korea and randomly assigned to either an experimental or control group. The experimental group performed chewing exercises using the No-Sick Exerciser equipment synchronized with NMES applied to the bilateral masseter muscles, while the control group performed only chewing exercises. Both groups received interventions for 20 min/day, 5 days/week, for 6 weeks. Bite force was measured using the OCCLUZER device, and masseter muscle thickness was measured using a portable ultrasound. Results: Both groups showed a significant increase in bite force and masseter muscle thickness compared to baseline measurements (p < 0.05). The experimental group showed a significantly higher increase in bite force and masseter muscle thickness than the control group after combined intervention (p < 0.05). Conclusion: This study demonstrates that NMES synchronized with chewing exercises is more efficient in increasing bite force and masseter muscle thickness than chewing exercises alone in community-dwelling older adults.

Comparison of quantity and quality of muscle as clinical prognostic markers in patients undergoing carotid endarterectomy.

OBJECTIVE: The measurement of muscle area is routinely utilised in determining sarcopaenia in clinical research. However, this simple measure fails to factor in age-related morphometric changes in muscle quality such as myosteatosis. The aims of this study were to: firstly investigate the relationship between the masseter area (quantity) and density (quality), and secondly compare the prognostic clinical relevance of each parameter. METHODS: Cross-sectional CT head scans were reviewed for patients undergoing carotid endarterectomy. The masseter was manually delineated and the total masseter area (TMA) and the total masseter density (TMD) calculated. Measurements of the TMA were standardised against the cranial circumference. Observer variability in measurements were assessed using Bland-Altman plots. The relationship between TMA and TMD were evaluated using Pearson's correlation and linear regression analyses. The prognostic value of TMA and TMD were assessed using receiver operator curves and cox-regression analyses. RESULTS: In total, 149 patients who had undergone routine CT scans prior to a carotid endarterectomy were included in this study. No significant observer variations were observed in measuring the TMA, TMD and cranium circumference. There was a significant positive correlation between standardised TMA and TMD (Pearson's correlation 0.426, p < 0.001, adjusted R-squared 17.6%). The area under the curve for standardised TMA in predicting all-cause mortality at 30 days, 1 year and 4 years were higher when compared to TMD. Standardised TMA was only predictive of post-operative overall all-cause mortality (adjusted hazard ratio 0.38, 95% confidence interval 0.15-0.97, p = 0.043). CONCLUSION: We demonstrate a strong relationship between muscle size and density. However, the utilisation of muscle area is likely to be limited in routine clinical care. ADVANCES IN KNOWLEDGE: Our study supports the utilisation of muscle area in clinical sarcopaenia research. We did not observe any additional prognostic advantage in quantifying muscle density.

Anatomical Considerations When Treating Compensatory Hypertrophy of the Upper Part of the Masseter after Long-Term Botulinum Neurotoxin Type A Injections.

The masseter is the most targeted muscle when treating hypertrophy to produce a smooth face shape. Compensatory hypertrophy is a well known clinical sequela that occurs in botulinum neurotoxin (BoNT) treatments and is limited to the lower part of the masseter. Based on the masseteric hypertrophy procedure, which targets a confined area, we predicted the possibility of compensatory hypertrophy occurring in the upper part of the masseter. If the patient complains about an unexpected result, additional injections must be performed, but the involved anatomical structures have not been revealed yet. The aim of this study was to identify the morphological patterns of the masseter. Deep tendons were observed in most specimens of the upper part of the masseter and mostly appeared in a continuous pattern (69.7%). The superficial and deep tendons could be classified into a simply connected form and forms surrounding part of the muscle. In 45.5% of cases there were tendon capsules that completely enclosed the muscle, which can interfere with how the injected toxin spreads. Interdigitation patterns in which the tendons could be identified independently between the muscles were present in 9.1% of cases. The present findings provide anatomical knowledge for use when injecting BoNT into the masseter.

Applicability of the masseter muscle as a nutritional biomarker.

Nutritional assessment is feasible with computed tomography anthropometry. The abdominal muscle at the L3 vertebra is a well-known nutritional biomarker for predicting the prognosis of various diseases, especially sarcopenia. However, studies on nutritional assessment of the brain using computed tomography are still scarce. This study aimed to investigate the applicability of the masseter muscle as a nutritional biomarker.Patients who underwent simultaneous brain and abdominopelvic computed tomography in the emergency department was retrospectively analyzed. We assessed their masseter muscle 2 cm below the zygomatic arch and abdominal muscle at L3 via computed tomography anthropometry. The skeletal muscle index, prognostic nutritional index, and other nutritional biomarkers were assessed for sarcopenia using the receiver operating characteristic curve analysis.A total of 314 patients (240 men and 72 women) were analyzed (mean age, 50.24 years; mean areas of the masseter and abdominal muscles, 1039.6 and 13478.3 mm, respectively). Masseter muscle areas significantly differed in sarcopenic, obese, and geriatric patients (P < .001). The areas under the curve of the masseter muscle in sarcopenic, geriatric, and obese patients were 0.663, 0.686, and 0.602, respectively. Multivariable linear regression analysis showed a correlation with the abdominal muscle area, weight, and age.The masseter muscle, analyzed via computed tomography anthropometry, showed a statistically significant association with systemic nutritional biomarkers, and its use as a nutritional biomarker would be feasible.

Histological features of masticatory muscles after botulinum toxin A injection into the right masseter muscle of dystrophin deficient (mdx-) mice.

OBJECTIVE/BACKGROUND: The most frequently used animal model for human DMD (Duchenne muscular dystrophy) research is the mdx mouse. In both species, characteristic histological changes like inflammation, muscle fiber degeneration and fibrosis are the same, but in contrast to humans, in mdx mice, phases of muscle fiber degeneration are compensated by regeneration processes. AIM: Therefore, the interest of this study was to evaluate histological features in masticatory muscles after BTX-A injection into the right masseter muscle of wild type and dystrophic (mdx) mice, illustrating de- and regeneration processes induced by this substance. MATERIAL AND METHODS: The right masseter muscle of 100 days old healthy and mdx mice were selectively paralyzed by a single intramuscular BTX-A injection. Masseter as well as temporal muscle of injection and non-injection side were carefully dissected 21 days and 42 days after injection, respectively, and fiber diameter, cell nuclei position, necrosis and collagen content were analyzed histomorphologically in order to evaluate de- and regeneration processes in these muscles. Statistical analysis was performed using SigmaStat Software and Mann Whitney U-test (significance level: p < 0.05). RESULTS: At both investigation periods and in both mouse strains fiber diameter was significantly reduced and collagen content was significantly increased in the right injected masseter muscle whereas fiber diameters in mdx mice were much smaller, and these differences were even more apparent at the second investigation period. Necrosis and central located nuclei could generally be found in all mdx mice muscles investigated with an amount of centronucleation exceeding 60%, and a significant increase of necrosis six weeks after injection. In wild type mice central located nuclei could primarily be found in the treated masseter muscle with a portion of 2.7%, and this portion decreased after six weeks, whereas in mdx mice a decrease could also be seen in the non-injected muscles. In contrast, in wild type mice necrosis was not apparent at any time and in all muscles investigated. CONCLUSION: From our results it can be concluded that in mdx mice masticatory muscles de- and regeneration processes were extended, triggered by a selective BTX-A injection, or mdx mice at this age, independently of BTX-A treatment, went through another cycle of de- and regeneration as a characteristic of this disease.

Dry versus wet and gross: Comparisons between the dry skull method and gross dissection in estimations of jaw muscle cross-sectional area and bite forces in sea otters.

Bite force is a measure of feeding performance used to elucidate links between animal morphology, ecology, and fitness. Obtaining live individuals for in vivo bite-force measurements or freshly deceased specimens for bite force modeling is challenging for many species. Thomason's dry skull method for mammals relies solely on osteological specimens and, therefore, presents an advantageous approach that enables researchers to estimate and compare bite forces across extant and even extinct species. However, how accurately the dry skull method estimates physiological cross-sectional area (PCSA) of the jaw adductor muscles and theoretical bite force has rarely been tested. Here, we use an ontogenetic series of southern sea otters (Enhydra lutris nereis) to test the hypothesis that skeletomuscular traits estimated from the dry skull method accurately predicts test traits derived from dissection-based biomechanical modeling. Although variables from these two methods exhibited strong positive relationships across ontogeny, we found that the dry skull method overestimates PCSA of the masseter and underestimates PCSA of the temporalis. Jaw adductor in-levers for both jaw muscles and overall bite force are overestimated. Surprisingly, we reveal that sexual dimorphism in craniomandibular shape affects temporalis PCSA estimations; the dry skull method predicted female temporalis PCSA well but underestimates male temporalis PCSA across ontogeny. These results highlight the importance of accounting for sexual dimorphism and other intraspecific variation when using the dry skull method. Together, we found the dry skull method provides an underestimation of bite force over ontogeny and that the underlying anatomical components driving bite force may be misrepresented.

Sciuromorphy outside rodents reveals an ecomorphological convergence between squirrels and extinct South American ungulates.

Notoungulates were a diverse group of South American ungulates that included the rodent-like typotherians. However, they are typically compared with other ungulates and interpreted as grazers. Here we present the first detailed reconstruction of the masticatory muscles of the pachyrukhine typotherians Paedotherium and Tremacyllus. An outstanding feature is the presence of a true sciuromorph condition, defined by an anterior portion of the deep masseter muscle originating from a wide zygomatic plate that reaches the rostrum, a trait traceable since the Oligocene pachyrukhines. Consequently, pachyrukhines are the first case of sciuromorph non-rodent mammals. This morphology would have allowed them to explore ecological niches unavailable for the exclusively hystricomorph coexisting rodents. This innovative acquisition seems to be synchronous in Pachyrukhinae and sciuromorph rodents and related to hard-food consumption. We postulate the expansion of nut and cone trees during the major environmental changes at Eocene-Oligocene transition as a potential trigger for this convergence.

A phylogenomic rodent tree reveals the repeated evolution of masseter architectures.

Understanding the number of times a trait has evolved is a necessary foundation for comprehending its potential relationships with selective regimes, developmental constraints and evolutionary diversification. Rodents make up over 40% of extant mammalian species, and their ecological and evolutionary success has been partially attributed to the increase in biting efficiency that resulted from a forward shift of one or two portions of the masseter muscle from the zygomatic arch onto the rostrum. This forward shift has occurred in three discrete ways, but the number of times it has occurred has never been explicitly quantified. We estimated an ultrametric phylogeny, the first to include all rodent families, using thousands of ultraconserved elements. We examined support for evolutionary relationships among the five rodent suborders and then incorporated relevant fossils, fitted models of character evolution, and used stochastic character mapping to determine that a portion of the masseter muscle has moved forward onto the rostrum at least seven times (with one reversal) during the approximately 70 Myr history of rodents. Combined, the repeated evolution of this key innovation, its increasing prevalence through time, and the species diversity of clades with this character underscores the adaptive value of improved biting efficiency and the relative ease with which some advantageous traits arise.

Mandible strength and geometry in relation to bite force: a study in three caviomorph rodents.

The monophyletic group Caviomorpha constitutes the most diverse rodent clade in terms of locomotion, ecology and diet. Caviomorph species show considerable variation in cranio-mandibular morphology that has been linked to the differences in toughness of dietary items and other behaviors, such as chisel-tooth digging. This work assesses the structural strength of the mandible of three caviomorph species that show remarkable differences in ecology, behavior and bite force: Chinchilla lanigera (a surface-dwelling species), Octodon degus (a semi-fossorial species) and Ctenomys talarum (a subterranean species). Finite element (FE) models of the mandibles are used to predict the stresses they withstand during incisor biting; the results are related to in vivo bite forces and interspecific variations in the mandibular geometries. The study concludes that the mandible of C. talarum is better able to withstand strong incisor bites. Its powerful adducting musculature is consistent with the notorious lateral expansion of the angular process and the masseteric crest, and the enhanced cortical bone thickness. Although it has a relatively low bite force, the mandible of O. degus also shows a good performance for mid-to-strong incisor biting, in contrast to that of C. lanigera, which exhibits, from a mechanical point of view, the worst performance. The mandibles of C. talarum and O. degus appear to be better suited to withstand stronger reaction forces from incisor biting, which is consistent with their closer phylogenetic affinity and shared digging behaviors. The contrast between the low in vivo bite force of C. lanigera and the relatively high estimations that result from the models suggests that its adductor musculature could play significant roles in functions other than incisor biting.

Factors associated with masseter muscle quality assessed from ultrasonography in community-dwelling elderly individuals: A cross-sectional study.

BACKGROUND: Associations between masseter muscle thickness(MMT) and limb muscle thickness, and between grip strength and MMT, as well as tooth-loss, have been reported previously. The previous study also showed that masseter muscle mass could be a better marker of sarcopenia than psoas muscle mass. Although the association between MMT and muscle strength is also known, the quality of the masseter muscle were not assessed in detail previously. We examined the relationship of masseter muscle echo intensity (MMEI) with skeletal muscle, physical function, and nutrition status, in order to determine whether MMEI could be a good indicator of these parameters. METHODS: We assessed 139 community-dwelling elderly individuals (men: 65, women: 74). Age, body mass index (BMI), skeletal muscle mass index, grip strength, walking speed, calf circumference, tooth-loss (Eichner classification), occlusal force, MMT, and MMEI were obtained. In multiple regression analysis, MMEI were set as dependent variables. RESULTS: Multiple regression analysis revealed BMI (p < 0.05), grip strength (p < 0.01), walking speed (p < 0.01), and MMT (p < 0.01) as factors with significant association with MMEI. CONCLUSIONS: MMT is related to occlusal force and MMEI. MMEI was related strongly to grip strength and walking speed, but not to tooth-loss. However, MMEI, which is easily determined ultrasonographically, could be a good indicator of grip strength and walking speed, and thus may be predictive of dynapenia.