The Anatomy Study of Temporal Region based on Ultrasound Investigation: A Spatial Structure Study.

BACKGROUND: With the growing popularity of rejuvenation, people are giving more concerns on their temporal depression which makes them look older and wishing to improve it by injection. The complex structure of the temporal region leads to a higher risk of failed injection. The temporal region is well understood based on cadaver anatomy, but few studies have described its spatial structure. The purpose of this study was to improve the efficacy and safety of temporal injection by studying the spatial structure of the soft tissues and major blood vessels in each layer of the temporal region. METHODS: A total of 30 volunteers (24 men and 6 women, 60 temporal regions) were investigated. Color Doppler ultrasound was used to measure the thickness of the temporal layers at the selected measurement points (A, B, C, D, E, and F). The maximum thickness of the temporal fat pads was also measured, and the layers, depths and diameters of the major temporal vessels (frontal branch of superficial temporal artery and vein, middle temporal vein and deep temporal artery) were measured. RESULTS: At the various measurement points, the thickness and position of the skin, subcutaneous fat superficial fascia, and temporalis muscle did not differ significantly, whereas the superficial temporal fat pad and deep temporal fat pad differed significantly. The diameter and depth of the superficial temporal artery, superficial temporal vein, and deep temporal artery did not differ significantly, whereas the diameter of the middle temporal vein differed slightly, whereas the depth differed more obviously. CONCLUSIONS: The temporal structure is very complex, and understanding the spatial position of each layer of tissue plays an important role in improving the efficacy and safety of temporal filler injection. Ultrasound can help us to understand this information and assist in therapy. LEVEL OF EVIDENCE: Level II.

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.

Safe Zones for Temporal Muscle Hook Retraction: A Technical Note.

BACKGROUND: The temporal muscle (TM) needs to be dissected and reflected downward in some anterolateral cranial approaches, and failing to preserve its integrity could have severe functional and cosmetic consequences. Most articles focus on techniques to prevent vascular injury during retrograde dissection or techniques to preserve the facial nerve; however, information on how to take care of the muscle during hook retraction is limited. We presented an anatomic study of vascularization of the TM, and we established safe areas for muscular hook retraction. METHODS: We dissected 16 TMs in 8 cadaveric heads. The TM was reflected downward, and we measured the distance between the anterior branch of the posterior deep temporal artery (PDTA) and the frontozygomatic suture and the distance between the posterior branch of the PDTA and the external auditory meatus projection. RESULTS: The average distance between the anterior branch of the PDTA and the frontozygomatic suture was 19.5 mm (range, 14-26 mm). The average distance between the posterior branch of the PDTA and the external auditory canal was 37.1 mm (range, 31-43 mm). We established 2 safe zones for hook placement: an anterior safe zone 14 mm posterior to the frontozygomatic suture and a posterior safe zone 30 mm anterior to the external auditory meatus. CONCLUSIONS: We delimited 2 safe zones for hook placement during TM retraction aiming to avoid direct vascular damage in anterolateral cranial approaches.

Muscle architecture dynamics modulate performance of the superficial anterior temporalis muscle during chewing in capuchins.

Jaw-muscle architecture is a key determinant of jaw movements and bite force. While static length-force and force-velocity relationships are well documented in mammals, architecture dynamics of the chewing muscles and their impact on muscle performance are largely unknown. We provide novel data on how fiber architecture of the superficial anterior temporalis (SAT) varies dynamically during naturalistic feeding in tufted capuchins (Sapajus apella). We collected data on architecture dynamics (changes in muscle shape or the architectural gear ratio) during the gape cycle while subjects fed on foods of different mechanical properties. Architecture of the SAT varied with phases of the gape cycle, but gape distance accounted for the majority of dynamic changes in architecture. In addition, lower gear ratios (low muscle velocity relative to fascicle velocity) were observed when animals chewed on more mechanically resistant foods. At lower gear ratios, fibers rotated less during shortening resulting in smaller pinnation angles, a configuration that favors increased force production. Our results suggest that architectural dynamics may influence jaw-muscle performance by enabling the production of higher bite forces during the occlusal phase of the gape cycle and while processing mechanically challenging foods.

Location of the split line of the deep temporal fascia when reducing a zygomatic arch fracture.

BACKGROUND: The deep temporal fascia (DTF) is known to separate into two layers that descend to attach to the zygomatic arch. When surgeons reduce an isolated fracture of the zygomatic arch through a temporal approach, the temporal incision site needs to be superior to the split line of the DTF. MATERIALS AND METHODS: Sixty-seven hemifacial cadavers were investigated after removing the skin, subcutaneous tissue, and superficial temporal fascia. The superficial layer of the DTF was exposed. We cut the superficial layer along the line along, which it adhered to the deep layer inseparably. The heights of the split line of the DTF from the superior border of the zygomatic arch and from the top of the helix were measured at three points: at the jugale, zygion, and 3 cm from the tragus. RESULTS: In all cases there were thick identifiable deep layers of the DTF. The mean heights of the split line of the DTF from the superior border of the zygomatic arch were 49.8, 46.7, and 42.6 mm at the jugale, zygion, and 3 cm from the tragus, respectively; the corresponding mean heights of the split line from the top of the helix were 19.1, 15.6, and 11.4 mm. CONCLUSIONS: Knowledge of the mean height of the split line of the DTF will be helpful for surgeons to determine the temporal incision site for ensuring the safe reduction of a zygomatic arch fracture.

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.

Intraoral Endoscopic Ligation of Maxillary Artery in the Infratemporal Fossa.

Ligation of the sphenopalatine and posterior nasal arteries is indicated for posterior epistaxis as initial treatment or when conservative measures fail. In some patients, a transnasal approach or its alternative transantral approach are not possible due to tumor filling the nasal corridor, pterygopalatine fossa, or maxillary sinus. Aim of this study was to evaluate feasibility of endoscopically assisted transoral approach for the ligation of the maxillary artery (MA). Six fresh cadaver specimens (12 sides), previously prepared with intravascular injections of colored latex, were dissected. A combined transnasal and transoral approach exposed the MA from the deep belly of the temporalis muscle laterally to its terminal branches medially. Anatomical relationships of the MA with the deep belly of the temporalis muscle and the lower head of the lateral pterygoid muscle, and feasibility of access to the MA via a transoral approach were assessed. In all specimens, the MA was found at the point where horizontal fibers of the lower head of the lateral pterygoid muscle cross the vertical fibers of the deep belly of the temporalis muscle. In 5 specimens, the artery ran anteriorly and laterally to lower head of the lateral pterygoid muscle, and in 1 specimen, it ran posteriorly and medially to this muscle, diving between its fibers. The modified endoscopically assisted transoral approach is feasible to ligate the MA. It can be used for proximal vascular control in cases when transnasal and transantral approaches are not viable.

Ontogenetic changes to muscle architectural properties within the jaw-adductor musculature of Macaca fascicularis.

OBJECTIVES: Changes to soft- and hard-tissue components of the masticatory complex during development can impact functional performance by altering muscle excursion potential, maximum muscle forces, and the efficiency of force transfer to specific bitepoints. Within Macaca fascicularis, older individuals exploit larger, more mechanically resistant food items and more frequently utilize wide-gape jaw postures. We therefore predict that key architectural and biomechanical variables will scale during ontogeny to maximize bite force and gape potential within older, larger-bodied individuals. MATERIALS AND METHODS: We analyzed 26 specimens of M. fascicularis, representing a full developmental spectrum. The temporalis, superficial masseter, and deep masseter were dissected to determine muscle mass, fiber length, and physiologic cross-sectional area (PCSA). Lever-arm lengths were also measured for each muscle, alongside the height of the temporomandibular joint (TMJ) and basicranial length. These variables were scaled against two biomechanical variables (jaw length and condyle-molar length) to determine relative developmental changes within these parameters. RESULTS: During ontogeny, muscle mass, fiber length, and PCSA scaled with positive allometry relative to jaw length and condyle-molar length within all muscles. TMJ height also scaled with positive allometry, while muscle lever arms scaled with isometry relative to jaw length and with positive allometry (temporalis) or isometry (superficial and deep masseter) relative to condyle-molar length. CONCLUSION: Larger individuals demonstrate adaptations during development towards maximizing gape potential and bite force potential at both an anterior and posterior bitepoint. These data provide anatomical evidence to support field observations of dietary and behavioral differences between juvenile and adult M. fascicularis.

Morphological and morphometric characterization of the "sphenoidal tubercle" / Caracterización morfológica y morfométrica del tubérculo esfenoidal

The sphenoidal tubercle is a bone elevation located in the anterior edge of the infratemporal crest of the sphenoid greater wing, where the temporal and lateral pterygoid muscles have their origin. This bone accident presents varied morphology so its description and denomination are a topic of discussion. 60 dry skulls obtained from the morphology laboratory of the Biomedical Basic Sciences Department of the University of Talca were used for a morphological and morphometric analysis of the sphenoidal tubercle including its morphology, diameters (anteroposterior, transverse and vertical) and the distance to the grooves for the maxillary artery and maxillary nerve. Sphenoidal tubercle had a prevalence of 98.4 % of all dry skulls analyzed with a bilateral presentation in the 76.6 % of the cases. According to its different forms of presentation established by Cáceres et al., (2016) the pyramidal form was the most frequent with a 25.7 %. The average diameters were of 4.12 mm anteroposterior, 5.50 mm transverse and 3.89 mm vertical. The average distance to the grooves of the maxillary artery and maxillary nerve were 9.04 mm and 7.6 mm, respectively. Sphenoidal tubercle is a constant bone accident with a variated morphology and measures. Due to its anatomical relations with important neurovascular elements such as the maxillary artery and the maxillary nerve, it may be used as a reference point for surgical access to the infratemporal fossa. From this analysis we establish that the denomination of "infratemporal process" is more accurate, because the development of this bone accident is from muscular traction performed by the lateral pterygoid muscle and the deep portion of the temporal muscle causing great variations in its morphology, probably due to external and functional parameters or even influenced by the biotype.

El tubérculo esfenoidal es una elevación ósea ubicada en el extremo anterior de la cresta infratemporal del ala mayor del hueso esfenoides, donde presta inserción al músculo temporal y pterigoideo lateral. Presenta morfología variada, por lo que su descripción y denominación resultan motivo de discusión. 60 cráneos secos obtenidos del Laboratorio de Morfología del Departamento de Ciencias Básicas Biomédicas de la Universidad de Talca, fueron utilizados para realizar un análisis morfológico y morfométrico del tubérculo esfenoidal evaluando forma, diámetros (anteroposterior, laterolateral y vertical) y distancia con el surco de la arteria y nervio maxilar. El tubérculo esfenoidal tuvo una prevalencia del 98,4 % del total de cráneos analizados, presentándose bilateralmente en el 76,6 % de los casos. De acuerdo a las diferentes formas de presentación establecidas por Cáceres et al (2016) la forma piramidal fue la más frecuente con un 25,7 %. Los diámetros promedio fueron de 4,12 mm anteroposterior, 5,50 mm laterolateral y 3,89 mm vertical. Las distancias promedio con el surco de la arteria y nervio maxilar fueron de 9,04 mm y 7,6mm, respectivamente. El tubérculo esfenoidal es un accidente óseo constante de morfología y dimensiones variadas. Debido a sus relaciones con elementos vasculares de importancia, tales como la arteria y nervio maxilar, podría ser utilizado como elemento de referencia para el acceso quirúrgico a la fosa infratemporal. A partir de su análisis planteamos que su denominación como "proceso infratemporal" sería más apropiado, debido a que se desarrollaría a partir de la tracción muscular ejercida por el musculo pterigoideo lateral y la porción profunda del músculo temporal, ocasionando variaciones notables en su morfología, probablemente debido a factores externos y funcionales o incluso influenciada por el biotipo.

One skull to rule them all? Descriptive and comparative anatomy of the masticatory apparatus in five mouse species.

Murine rodents display a unique cranial morphology and masticatory musculature. Yet detailed myological descriptions are scarce, especially considering the great diversity of the subfamily and the use of the house mouse and brown rat as model organisms. The masticatory musculature in these two species has been thoroughly described, which allows comparisons with other wild species. Description and comparison of a wide range of species constitutes a necessary step to fully understand how ecological factors may influence the morphology and myology of the skull in the Murinae and vice versa. In this study, we describe the masticatory musculature of five mouse species: Mus caroli, Mus cervicolor, Mus pahari, Mus fragilicauda, and Mus minutoides. For each species, one to five specimens were dissected, and their muscle weights and volumes calculated. One specimen was selected for iodine-enhanced CT-scanning, which allowed us to digitally reconstruct the musculature. We then compared the different masticatory arrangements between these species, as well as with the previous descriptions of the house mouse and brown rat. We show that interspecific differences especially involved the temporalis muscle and zygomatico-mandibularis muscular groups, although some differences were also seen in the pterygoid muscle and masseter muscle groups. We then propose some ecological interpretations for these differences, by interpreting them in terms of functional differences.

Does the Deep Layer of the Deep Temporalis Fascia Really Exist?

PURPOSE: It has been widely accepted that a split of the deep temporal fascia occurs approximately 2 to 3 cm above the zygomatic arch and extends into the superficial and deep layers. The deep layer of the deep temporal fascia is between the superficial temporal fat pad and the temporal muscle. However, during procedures, the authors noted the absence of the deep layer of the deep temporal fascia between the superficial temporal fat pad and the temporal muscle. This prospective study was conducted to clarify the presence or absence of a deep layer of the deep temporal fascia. MATERIALS AND METHODS: Anatomic layers of the soft tissues of the temporal region, with reference to the deep temporal fascia, were investigated in 130 cases operated on for zygomaticofacial fractures using the supratemporal approach from June 2013 to June 2017. RESULTS: Of 130 surgeries, the authors found the absence of a thick, obviously identifiable, fascial layer between the superficial temporal fat pad and the temporal muscle. In fact, the authors found nothing above the temporal muscle in most cases. In a few cases, the authors observed only a small amount of scattered loose connective tissue between the superficial temporal fat pad and the temporal muscle. CONCLUSIONS: This clinical study showed the absence of a thick, obviously identifiable, fascial layer between the superficial temporal fat pad and the temporal muscle, which suggests that a "deep layer of the deep temporal fascia" might not exist.

Dietary Correlates of Primate Masticatory Muscle Fiber Architecture.

Analyses of masticatory muscle architecture-specifically fascicle length (FL; a correlate of muscle stretch and contraction speed) and physiological cross-sectional area (PCSA; a correlate of force)-reveal soft-tissue dietary adaptations. For instance, consumers of large, soft foods are expected to have relatively long FL, while consumers of obdurate foods are expected to have relatively high PCSA. Unfortunately, only a few studies have analyzed these variables across large primate samples-an order of particular interest because it is our own. Previous studies found that, in strepsirrhines, force variables (PCSA and muscle masses; MM) scale with isometry or slight positive allometry, while the body size corrected FL residuals correlate with food sizes. However, a study of platyrrhines using different methods (in which the authors physically cut muscles between fascicles) found very different trends: negative allometry for both the stretch and force variables. Here, we apply the methods used in the strepsirrhine study (chemical dissection of fascicles to ensure full length measurements) to reevaluate these trends in platyrrhines and extend this research to include catarrhines. Our results conform to the previous strepsirrhine trends: there is no evidence of negative allometry in platyrrhines. Rather, in primates broadly and catarrhines specifically, MM and PCSA scale with isometry or positive allometry. When examining size-adjusted variables, it is clear that fascicle lengths (especially those of the temporalis muscle) correlate with diet: species that consume soft, larger, foods have longer masticatory fiber lengths which would allow them to open their jaws to wider gape angles. Anat Rec, 301:311-324, 2018. © 2018 Wiley Periodicals, Inc.

Anatomical connections between the buccinator and the tendons of the temporalis.

The aim of this study was to clarify the anatomical relationship between the buccinator and the temporalis in order to improve understanding of the precise and coordinated movements of the mouth and the mandible. The buccinator and the temporalis were investigated in 72 hemifaces from Korean cadavers. Removing the buccal fat pad from the buccinator revealed that the fascia encircled the space between the superficial and deep tendons of the temporalis laterally, and the external surface of the buccinator medially in all specimens (100%). The fascia was located between the buccinator and the tendons of the temporalis, thereby connecting these two muscles. The fascial space was filled with connective tissue, and the buccal nerve and artery passed through this space. The inferior fibers of the buccinator arose from the anterior portion of the deep tendon of the temporalis in all specimens (100%). The anterior portion of the deep tendon of the temporalis extended forward obliquely between the ramus and body of the mandible. Thus, both the anterior portion of the deep tendon of the temporalis and its attaching inferior muscle fibers of the buccinator coursed obliquely. The above observations indicate that the connecting fascia between the buccinator and tendons of the temporalis and the inferior fibers of the buccinator that were attached to the deep tendon of the temporalis could assist in coordinatation of the movements of the mandibular region and the mouth angle in the timing and strength of contraction of the muscles during mastication, facial expression, and speech.

Microsurgical Anatomy of the Interfascial Vein. Its Significance in the Interfascial Dissection of the Pterional Approach.

BACKGROUND: The pterional approach (PA), together with its variants, is still one of the most common methods used by surgeons to reach the anterior and middle cranial base. A highly important technical detail during a PA is the preservation of the frontotemporal branch of the facial nerve, which can be achieved through an interfascial dissection. OBJECTIVE: To describe the anatomy of the interfascial vein (IFV), highlighting its recognition as a significant anatomic reference to perform an interfascial dissection (IFD). METHODS: Eight adult cadaveric heads, fixed with formaldehyde and injected with colored silicone, were studied. In 6 heads, an IFD was performed, simulating a PA. In the 2 remaining heads, the IFV was dissected. In addition, an IFD was performed in 10 patients, studying the IFV anatomy. RESULTS: In the 6 cadaveric heads in which the PA with an IFD was performed, and in the 10 patients who underwent a PA with an IFD, the IFV was found. If the interfascial space is divided into thirds, in all cases, the IFV was located within the middle third of the interfascial fat pad. On the 2 cadaveric heads in which the IFV was anatomically dissected, the IFV was also located within the middle third of the interfascial space. CONCLUSION: Recognizing the IFV in the interfascial space is of great help as an anatomic landmark to confirm that one is actually between both layers of the superficial temporal fascia.

Postoperative temporal hollowing: Is there a surgical approach that prevents this complication? A systematic review and anatomic illustration.

BACKGROUND: Temporal hollowing is a common complication following surgical dissection in the temporal region. Our objectives were to: (1) review and clarify the temporal soft tissue relationships - supplemented by cadaveric dissection - to better understand surgical approach variations and elucidate potential etiologies of postoperative hollowing; (2) identify if there is any evidence to support a surgical approach that prevents hollowing through a systematic review. METHODS: Cadaveric dissection was performed on six hemi-heads. A systematic review of the literature was undertaken to identify surgical approaches with a decreased risk of postoperative hollowing. RESULTS: A total of 1212 articles were reviewed; 19 of these met final inclusion criteria. Level I and II evidence supports against the use of a dissection plane beneath the superficial layer of the deep temporal fascia or through the intermediate temporal fat pad. Level II evidence supports preservation of the temporalis muscle origin - no evidence is available to support other temporalis resuspension techniques. For intracranial exposure, refraining from temporal fat pad dissection (Level I Evidence) and use of decreased access approaches such as the minipterional craniotomy (Level I Evidence) appear to minimize temporal soft tissue atrophy. CONCLUSIONS: This study highlights the significance of preservation of the temporal soft tissue components to prevent hollowing. Preserving the temporalis origin and avoiding dissection between the leaflets of the deep temporal fascia or through the intermediate temporal fat pad appear to minimize this complication.

Characterization and morphological comparison of human dura mater, temporalis fascia, and pericranium for the correct selection of an autograft in duraplasty procedures.

PURPOSE: The objective of this study was to characterize and compare the morphological characteristics of the dura mater, the pericranium, and the temporal fascia to ascertain the most adequate tissue to use as a dura graft. METHODS: 20 dura mater, 20 pericranium and 20 temporalis fascia samples were analyzed. Each of the samples was stained with hematoxylin and eosin, orcein, Van Gieson, Masson's trichrome and Verhoeff-Van Gieson (600 slides in total) for a general morphological evaluation, as well as a quantitative, morphometric and densitometric analysis of elastic fibers present in each of the tissues. RESULTS: The micro-densitometric analysis of the tissues indicated that the area occupied by the elastic fibers showed values of 1.766 ± 1.376, 4.580 ± 3.041, and 8.253 ± 4.467 % for the dura mater, the temporalis fascia and the pericranium, respectively (p < 0.05, all pairs). The values observed in the analysis of the density intensity were 3.42E+06 ± 2.57E+06, 1.41E+07 ± 1.28E+07, and 1.63E+07 ± 9.19E+06 for the dura mater, the temporalis fascia and the pericranium, respectively (p < 0.05), dura mater vs. temporalis fascia and dura mater vs. pericranium). CONCLUSIONS: This is the first study to compare the dura mater with tissues for dural autograft and to quantify the elastic component present in these tissues. The results indicate that the temporalis fascia is a better dural graft because of its intrinsic tissue properties.

Anatomical recommendations for safe botulinum toxin injection into temporalis muscle: a simplified reproducible approach.

PURPOSE: The objective of this study was to simplify the anatomically safe and reproducible approach for BoNT injection and to generate a detailed topographic map of the important anatomical structures of the temporal region by dividing the temporalis into nine equally sized compartments. METHODS: Nineteen sides of temporalis muscle were used. The topographies of the superficial temporal artery, middle temporal vein, temporalis tendon, and the temporalis muscle were evaluated. Also evaluated was the postural relations among the foregoing anatomical structures in the temporalis muscle, pivoted upon a total of nine compartments. RESULTS: The temporalis above the zygomatic arch exhibited an oblique quadrangular shape with rounded upper right and left corners. The distance between the anterior and posterior margins of the temporalis muscle was equal to the width of the temporalis rectangle, and the distance between the reference line and the superior temporalis margin was equal to its height. The mean ratio of width to height was 5:4. CONCLUSIONS: We recommend compartments Am, Mu, and Pm (coordinates of the rectangular outline) as areas in the temporal region for BoNT injection, because using these sites will avoid large blood vessels and tendons, thus improving the safety and reproducibility of the injection.

Effective Botulinum Toxin Injection Guide for Treatment of Temporal Headache.

This study involved an extensive analysis of published research on the morphology of the temporalis muscle in order to provide an anatomical guideline on how to distinguish the temporalis muscle and temporalis tendon by observing the surface of the patient's face. Twenty-one hemifaces of cadavers were used in this study. The temporalis muscles were dissected clearly for morphological analysis between the temporalis muscle and tendon. The posterior border of the temporalis tendon was classified into three types: in Type I the posterior border of the temporalis tendon is located in front of reference line L2 (4.8%, 1/21), in Type II it is located between reference lines L2 and L3 (85.7%, 18/21), and in Type III it is located between reference lines L3 and L4 (9.5%, 2/21). The vertical distances between the horizontal line passing through the jugale (LH) and the temporalis tendon along each of reference lines L0, L1, L2, L3, and L4 were 29.7 ± 6.8 mm, 45.0 ± 8.8 mm, 37.7 ± 11.1 mm, 42.5 ± 7.5 mm, and 32.1 ± 0.4 mm, respectively. BoNT-A should be injected into the temporalis muscle at least 45 mm vertically above the zygomatic arch. This will ensure that the muscle region is targeted and so produce the greatest clinical effect with the minimum concentration of BoNT-A.

Relationship between electrical activity of the temporal and masseter muscles, bite force, and morphological facial index. / Relações entre potenciais elétricos dos músculos temporais e masseteres, força de mordida e índice morfológico da face.

PURPOSE: To analyze possible correlations between the electrical activity of masseter and temporal muscles, Bite Force (BF), and Morphological Facial Indices (MFI). METHODS: The study involved 43 young adults, both genders, 18 to 37 years old. The individuals were submitted to: face measurement to calculate MFI; Masseter and Temporal Surface Electromyography (sEMG) and BF measurements on right and left premolars and incisors. The following electromyographic tests were conducted: at rest position; Maximal Voluntary Isometrical Contraction (MVIC) and usual chewing of raisins. Statistical analysis was conducted using the coefficient of Spearman correlation with significance level of 5%. RESULTS: The values at rest in the temporal muscles were significantly higher than those in the masseter muscles. A meaningful correlation was found between MFI and sEMG in the MVIC test for the Left Temporal (rs=36, p=0.017). A significant correlation was observed between FMI and sEMG during BF in incisors for temporal muscles and the Right Masseter. During the force tests, it was possible to observe a meaningful correlation between BF in right premolars and the sEMG of the Left Temporal and Masseters. CONCLUSION: No correlation was found between the sEMG of temporal and masseter muscles, BF, and FMI in adult individuals based on the tests performed. The SEMG of temporal and masseter muscles seems to be associated only with BF. As a datum of habitual postural characteristic, the electrical activity of temporal muscles is higher than the activity of masseters, also regardless of MFI.