• The Korean Journal of Pain
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• v.30 no.4
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• pp.304-307
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• 2017

A 19-year-old male patient presented with facial hemi-atrophy with unilateral spasms of the masseter and temporalis muscles. Ultrasound therapy and Transcutaneous Electric Nerve Stimulation therapy, known as combination therapy, were given on alternate days for 2 weeks. At the end of 2 weeks of combination therapy the patient reported a drastic reduction in the number of episodes of muscle spasm. The visual analog scale score for tenderness of the masseter and temporalis was also markedly reduced. No one has previously used combination therapy for the treatment of facial hemi-atrophy with hemi-facial spasms. The encouraging results of the combination therapy has prompted us to document this study.

• Journal of Oral Medicine and Pain
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• v.30 no.2
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• pp.247-255
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• 2005

The purpose of this study is to evaluate the effect of botulinum toxin type A on masseter muscle atrophy and the extent of masseter muscle affected from the injection site in relation to injection dose, with and without occlusal splint therapy through computed tomographic measurement. 32 volunteers were divided into four groups - group 25U (injection dose of 25 unit), group 25Us (injection dose of 25 unit with occlusal splint), group 35U (injection dose of 35 unit), group 35Us (injection dose of 35 unit with occlusal splint). Each group consisted of 8 people. 3 positions (position 1, 2, 3 - 10mm, 20mm and 40mm from the inferior border of the mandible, respectively) were selected for the evaluation of the masseter muscle change. The following results were obtained. 1. The thickness and the cross-sectional area of the masseter muscle had reduced in all groups except for the right side thickness at position 3 of group 25U and group 25Us, and the right side thickness as well as the left side cross-sectional area at position 3 of group 35Us. In group 35Us, the thickness and the cross-sectional area of the masseter muscle had reduced significantly in all positions (P < 0.05). 2. There was no significant difference in the masseter muscle change between the injection dose of 25unit and that of 35unit. 3. The groups with occlusal splint showed greater reduction of the masseter muscle thickness than the other groups (P < 0.05). From the above results, botulinum toxin type A injection together with occlusal splint therapy in the treatment of masseter muscle hypertrophy would be clinically effective.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.2
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• pp.247-251
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• 2011

Botulinum toxin type A (BoNT-A) is used for treating bilateral masseter hypertrophy since 1994. Recently there have been more clinical studies in this area, with some authors reporting that BoNT-A can reduce the size of the masseter muscle, as documented by photography, ultrasonography, computed tomography, and 3D(three dimensional) laser scan. However, earlier studies were only for bilateral masseter hypertrophy cases, not for unilateral masseter hypertrophy cases. The aim of this study was to use 3D laser scanning to evaluate changes in the external facial contour induced by unilateral BoNT-A injection. BoNT-A was injected into hypertrophic masseter muscle unilaterally in 10 patients with asymmetric masseter hypertrophy. The clinical effects of unilaterally injected BoNT-A were evaluated before the injection and 4, 8, and 12weeks after the injection using 3D laser scan. And the mean values of both sides (injection and non-injection sides) were compared with. At injection side, mean values of the volume and the bulkiest height at each time point diminished significantly between pre-injection and 4, 8, and 12weeks post-injection. At non-injection side, in contrast, mean values of the volume and the bulkiest height diminished also but less than that of injected side, and there was no statistical significance. In this limited study, we concluded that the unilaterally BoNT-A injection side showed greater mean values of the reduction of muscle volume than non-injection side at 4, 8, and 12 weeks after the injection.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.654-659
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• 2009

Purpose: A botulinum toxin type A (BoNT - A) injection has been used as a noninvasive management for lower face contouring since 2000. The aim of this study was to compare reduction rate of lower face width for a longtime according to repeated Botox$^{(R)}$ injections on masseter muscles for lower face contouring procedure. Methods: Forty - five patients were analyzed for single session of Botox$^{(R)}$ injection and 13 patients were evaluated for repeated Botox$^{(R)}$ injections for over two years. Single injection group was tracked regular intervals at 1, 3, 6, 10, 12 months after injection, and repeated injection group was measured at every injection time. Twenty - five to thirty units of Botox$^{(R)}$ was injected into each masseteric muscle at five to six points at the prominent portions of the mandibular angle. Standardized frontal view of digital photographs were analyzed by Adobe Photoshop$^{(R)}$ (version CS3) to measure an reduction rate of lower face width. Results: Reduction rate was 3.7%, 6.9%, 6.2%, 4%, 4% at 1, 3, 6, 10, 12 months post injection each other in single injection group. However, more than 8% reduction rate was found in repeated injection group persistently for more than two years. Conclusion: This study shows that effective duration of Botox$^{(R)}$ injection for lower face contouring is expected to continue over one year clinically. Moreover, repeated injections maintained lower reduction rate consistently for a long time. Therefore, repeated injections on masseter muscles at regular intervals are most effective procedure for lower face contouring.

• The korean journal of orthodontics
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• v.22 no.2 s.37
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• pp.389-412
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• 1992

Along with form and function relationship of craniofacial growth comes a concern for the masticatory muscles with postnormal occlusion. It is the aim of this study to grope the certain differences upon the electromyographic activities of the masticatory muscles between normal occlusion and class II malocclusion during the varieties of oral functions. 26 persons of normal occlusion whose mean age were 18.9-25.6 years and another 26 persons of class II malocclusion whose mean age were 19.0-28.9 years served for this study. The electromyographic recordings processed by $Medelec^{\circledR}$ MS 25 EMG apparatus were taken from the anterior and posterior temporal, and anterior and posterior masseter muscles of both sides, and suprahyoid muscles as well. Analyses of the data toward such specific activities as mandibular rest, maximal biting, chewing gums and swallowing peanuts turned out the following summary and conclusions. 1. The maximal mean amplitude of the posterior temporalis showed significant augmentation in class II malocclusion, however the anterior temporalis, posterior masseter, and suprahyoid muscles manifested meaningful diminutions. 2. Stronger posterior temporalis and weaker anterior masseter and suprahyoid muscles were arranged in maximal biting with parameters of maximal mean amplitude. 3. The anterior temporalis of working side expressed smaller maximal mean amplitude in class II malocclusion. Significant swelling in duration were shown at anterior and posterior temporalis of working side, and posterior temporalis of balancing side in class II malocclusion, and marked reduction at anterior masseter of balancing side and posterior masseter of working side as well. The lessened latency were expressed at anterior masseter of working side, and anterior and posterior masseter of balancing side. Class II malocclusion group had significant prolongation of silent period duration. Mean silent period duration of 10.75 msec in normal occlusion and 24.37 msec in class II malocclusion were calculated. 4. Significant augmentations of maximal mean amplitude while swallowing peanuts were yielded at right anterior temporalis and posterior temporalis of both sides, however left anterior masseter and right posterior masseter showed diminution. No significant differences in duration showed at every muscle examined in class II malocclusion group.5. Weaker masseter and stronger temporalis were suggested as characteristics of class II malocclusion.

• The Journal of the Korean dental association
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• v.58 no.2
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• pp.114-122
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• 2020

Aesthetic facial profile is mainly determined by cultural background. In some countries, prominent mandibular angle is considered as characteristics, whereas it is considered as unattractive in East Asian countries. Therefore, reduction surgery for prominent mandibular angle is one of the popular cosmetic surgery in theses countries. The anatomical component of the mandibular angle consists of masseter muscle and the angular part of the mandibular ramus. Thus, the mandibular angle reduction can be performed by myotomy or bone reduction or both.

• The Korean Journal of Pain
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• v.29 no.1
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• pp.12-17
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• 2016

Background: The study aimed to determine if ultrasonography of masseter can be used to evaluate the outcome of transcutaneous electrical nerve stimulation (TENS) in subjects with temporomandibular disorders (TMDs) such as myositis and myofascial pain. Methods: Fifteen TMD subjects with myofascial pain/myositis who satisfied the RDC/McNeil criteria were included in the study. All the subjects were administered TENS therapy for a period of 6 days (30 minutes per session). The mouth opening (in millimeters) and severity of pain (visual analogue scale score) and ultrasonographic thickness of the masseter (in millimeters) in the region of trigger/tender areas was assessed in all the subjects both prior and post TENS therapy. A comparison of the pre-treatment and post-treatment values of the VAS score, mouth opening and masseter thickness was done with the help of a t-test. Results: There was a significant reduction in the thickness of masseter muscle (P = 0.028) and VAS scores (P < 0.001) post TENS therapy. There was also a significant improvement in the mouth opening (P = 0.011) post TENS therapy. Conclusions: In the present study, ultrasonography was found to be an effective measuring tool in the assessment of TENS therapy in subjects with myositis and myofascial pain.

• Archives of Plastic Surgery
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• v.37 no.2
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• pp.161-168
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• 2010

Purpose: Surgical approaches to the condylar neck and subcondyle area can cause some morbidity such as, facial nerve injury, time-consuming nature and external scar etc. So many surgeons hesitate using open reduction and internal fixation for the treatment of subcondylar fractures. We report open reduction and internal fixation of subcondylar fractures in 13 adult patients via transmasseteric approach. Methods: From 2007 to 2009, 13 adults with subcondylar fracture of mandible were treated with open reduction and internal fixation via transmasseteric approach. A preauricular incision was extended downwards in a curvilinear fashion in the cervicomastoid skin crease. Skin flap was elevated above the SMAS layer. Masseter muscle was splitted at the anteroinferior edge of the parotid gland. After the fracture was reduced, fixed with appropriate plates and screws. All operation were performed under general anesthesia. Results: Mean follow-up period was 13.3 months. There were no signs and symptoms of facial nerve injury, difficulty in mouth opening, or malocclusion. Dissection time was roughly within 30 minutes. Conclusion: Transmasseteric open reduction and internal fixation of mandible subcondylar fracture can be performed with excellent visualization, and inconspicuous scar. It also offers swift access to the subcondylar area while substatially reducing the risk to the facial nerve and eliminating the complications associated with transparotid approaches.

• Journal of Oral Medicine and Pain
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• v.48 no.3
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• pp.106-111
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• 2023

Purpose: In this study, we evaluate the potential of the relative ratio of capsular width (RCW) between the affected side (Aff) and non-affected side (Non-aff) in patients with temporomandibular joint (TMJ) arthralgia. We assessed whether RCW may hold greater diagnostic significance than the objective capsular width (CW) reported in previous studies when diagnosing arthralgia using ultrasonography (US). Methods: Forty-nine patients were assessed using US, excluding four patients with bilateral arthralgia. The patients were divided into two groups: 40 with unilateral arthralgia (UA), and nine without arthralgia (NA). We measured CW and masseter muscle thickness using US. Moreover, we employed RCW to analyze the variances between the groups. The numerical rating scale (NRS) and RCW were compared before and after dexamethasone injection in 10 patients who underwent follow-up evaluations. Results: Within the UA group, CW on the Aff was found to be significantly larger compared to the Non-aff (p<0.001). Additionally, RCW in the UA group was greater than that in the NA group (p<0.01). Furthermore, after dexamethasone injection, a reduction in the NRS and RCW values was observed in the 10 patients who were followed up. Conclusions: While previous studies have suggested a link between arthralgia and TMJ effusion, making CW a possible indirect diagnostic indicator for arthralgia, our findings propose that RCW could hold more diagnostic value than objective CW. However, additional studies are required to standardize the protocols for interpreting US results and determining the cutoff value of RCW in diagnosing TMJ arthralgia.

• Journal of Oral Medicine and Pain
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• v.25 no.2
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• pp.191-203
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• 2000

This study was performed to investigate the relationship between vertical dimension during swallowing and speech pattern in patients with temporomandibular disorders. For this study, 33 patients with temporomandibular disorders(TMDs), namely, 17 patients with disc displacement with reduction and 16 patients with disc displacement without reduction, and 30 normal subjects without any signs and symptoms in the masticatory system were selected as the patient group and as the normal group, respectively. Biopak $system^{(R)}$(Bioresearch Inc., Milwaukee, USA) was used for recording of electromyographic(EMG) activity(${\mu}V$) of the anterior temporalis, the superficial masseter, the sternocleidomastoideus and the trapezius insertion muscle during swallowing, and of mandibular positional change with function time(sec.) during swallowing and speech. A sentence of 'Sue is missing her house' was used for observing of speech pattern. Comparison between the two groups and relationship of the mandibular positional change and the function time between during swallowing and during speech were analysed by SPSS windows program. The results of this study were as follows : 1. Mean EMG activity of the trapezius insertion during swallowing was higher in the patient group, and the value was $3.4{\mu}V$ in patients and $2.1{\mu}V$ in normal subjects. 2. Vertica1 dimension(VD) at mandibular rest position before swallowing was slightly higher in the patient group, but VD at swallowing-late stage and at rest position after swallowing were not different between the two groups. 3. Swallowing time were 2.1 sec. in the patient group, and 1.5 sec. in the normal group, and the difference was significant. 4. VD during speech were generally higher in the normal group. In this case, speaking position showing the most difference between the two groups was 'her' position. The distance from habitual intercuspal position to 'her' position was 4.9mm in the patient group, and 6.6mm in the normal group. Speaking time was also longer in the patient group. 5. There were no difference in all observed items between the two categories of the patient group according to reduction of disc displacement. 6. Relationship between the positional changes during swallowing and speech were different between the patient group and the normal group. And in the normal group, VD at rest position before swallowing was negatively correlated with speaking time.