Oro-facial muscles: internal structure, function and ageing

Electrical stimulation of the lower eyelid orbicularis oculi muscle improves periocular dark circles

BACKGROUND

We developed and tested the safety and efficacy of a cosmetic device to improve dark circles using electrical muscle stimulation of the orbicularis oculi muscle.

METHODS

Overall, 18 participants (36 eyes) were studied. The following five items were evaluated before and after the intervention:(1) the Clinical Dark Circle Score using clinical findings and photographs, (2) transcutaneous oxygen partial pressure (TcPO2) on the lower eyelid, (3) thermography, (4) two-dimensional laser blood flowmetry, and (5) spectrophotometry.

RESULTS

The mean score at baseline was 2.0 ± 0.90 (mean ± standard deviation), and that at the end of the study was 1.2 ± 1.0 (Wilcoxon signed-rank sum test, p < 0.0001), indicating a significant reduction. The spectrophotometer showed a significant decrease in a* and L* values before and after use (Wilcoxon signed-rank sum test, p < 0.0001). There was also a weak negative correlation between the change in score and the change in blood flow and TcPO2 measured using a laser perfusion device (Spearman's rank correlation coefficient, r = -0.32 and -0.39, respectively). Stratified analysis of the baseline score showed a strong negative correlation between the change in score and the change in spectrophotometric a* in the subjects/group with mild periocular dark circles (Spearman's rank correlation coefficient, r = -0.46). Contrastingly, no correlation was observed for any of the measurements in the subjects/group with severe periocular dark circles. After 1 month, no device-related ophthalmic adverse events were observed in any of the participants.

CONCLUSION

Electrical muscle stimulation could improve periocular dark circles, especially in the subjects/group with mild periocular dark circles, and was safe.

Lip and tongue pressure and the functionality of oro-facial structures in healthy individuals

BACKGROUND

With the ageing process changes in the musculature of oro-facial structures take place, consequently there is a reduction in the strength and mobility of the lips, tongue and cheeks.

OBJECTIVE

The aim of this study was to correlate oro-facial structures and chewing and swallowing functions among a group of senior citizens and young adults and check the influence of lip and tongue pressure of these functions.

METHODS

This is an observational, cross-sectional and analytical study. Thirty seniors with an average age of 67.13 years and 30 young adults with an average age of 22.03 years participated in the study. The Oro-facial Myofunctional Assessment Protocol with Scores for the Elderly and the Oro-facial Myofunctional Assessment Protocol with Expanded Scores were also used. The evaluation of the force of pressure of the lips and tip and dorsum of the tongue was carried out using the Biofeedback device Pró-Fono: Lip and Tongue Pressure.

RESULTS

Young adults had a higher evaluation score for the aspect/posture of the face, cheeks, lips, mentalis muscle, tongue, mobility of lips, tongue, jaw and cheeks, chewing and swallowing functions, total time and chewing strokes, and tip pressure and dorsum of tongue. According to the Structural Equation Modelling, a direct relationship was found between the tongue dorsum pressure force and the swallowing function.

CONCLUSION

With healthy ageing changes occurring in the appearance, posture and mobility of the lips, tongue, jaw and cheeks, with the seniors and reduced performance of chewing and swallowing functions.

Trigeminal Sensory Supply Is Essential for Motor Recovery after Facial Nerve Injury

Recovery of mimic function after facial nerve transection is poor. The successful regrowth of regenerating motor nerve fibers to reinnervate their targets is compromised by (i) poor axonal navigation and excessive collateral branching, (ii) abnormal exchange of nerve impulses between adjacent regrowing axons, namely axonal crosstalk, and (iii) insufficient synaptic input to the axotomized facial motoneurons. As a result, axotomized motoneurons become hyperexcitable but unable to discharge. We review our findings, which have addressed the poor return of mimic function after facial nerve injuries, by testing the hypothesized detrimental component, and we propose that intensifying the trigeminal sensory input to axotomized and electrophysiologically silent facial motoneurons improves the specificity of the reinnervation of appropriate targets. We compared behavioral, functional, and morphological parameters after single reconstructive surgery of the facial nerve (or its buccal branch) with those obtained after identical facial nerve surgery, but combined with direct or indirect stimulation of the ipsilateral infraorbital nerve. We found that both methods of trigeminal sensory stimulation, i.e., stimulation of the vibrissal hairs and manual stimulation of the whisker pad, were beneficial for the outcome through improvement of the quality of target reinnervation and recovery of vibrissal motor performance.

Quantitative volume and area assessment of masticatory muscles through magnetic resonance imaging in patients with temporomandibular joint disorders

OBJECTIVE

To compare volume and surface area measurements of the lateral pterygoid (LPM), medial pterygoid (MPM), and masseter muscles (MM) as calculated on magnetic resonance imaging (MRI) based on the position of the temporomandibular joint disk, mouth position, and patient sex, and to calculate the correlations of the measurements among the muscles.

STUDY DESIGN

Measurements of muscle volume and area were performed on the MRIs of 51 patients. Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests were used to calculate the significance of differences in measurements. The Spearman correlation coefficient calculated the correlation of measurements among the muscles. The significance of difference was established at P < .05.

RESULTS

Volume and area of the left MPM in patients with disk displacement without reduction (DDWOR) were larger than in patients with normal disk position (P ≤ .040). MM volumes were smaller with DDWOR than with DD with reduction bilaterally (P ≤ .031). The volume and area of LPM and MM were significantly different between closed and open mouth positions (P < .001). Differences in volume and area between females and males were significant for all muscles in volume (P ≤ .021) and for MPM and MM in area (P ≤ .021). Significant positive correlations were found among all muscles for volume and area.

CONCLUSION

Volume and area measurements of the masticatory muscles varied according to disk and mouth position and patient sex and exhibited significant positive correlations.

Assessments of Muscle Thickness and Tonicity of the Masseter and Sternocleidomastoid Muscles and Maximum Mouth Opening in Patients with Temporomandibular Disorder

The purpose of this study was to compare the muscle thickness and tone of the masseter and sternocleidomastoid (SCM) muscles and maximum mouth opening (MMO) in subjects with and without temporomandibular disorders (TMD), and perform a correlation comparison on the results of the TMD group. Sixty patients were allocated to the TMD group (n = 30) or the non-TMD group (n = 30). Ultrasound imaging, myotonometer, and vernier calipers were used to determine the related changes in muscle thickness and muscle tone in masseter and SCM, and MMO, respectively. The TMD group revealed a significant decrease than the non-TMD group in the muscle thickness of masseter and SCM, respectively (p < 0.001), with a significant increase in frequency (p < 0.001) and stiffness (p < 0.001) in the masseter muscle tone, with a significant increase in frequency (p < 0.001) and stiffness (p = 0.005) in the SCM muscle tone, a significant decrease in the MMO (p < 0.001). There was a moderate negative correlation between the relaxed state of masseter muscle thickness and stiffness of SCM muscle tone (r = −0.40, p = 0.002), and a moderate negative correlation between the relaxed state of SCM muscle thickness and frequency of SCM muscle tone (r = −0.42, p = 0.001). There was a moderate negative correlation between the clenching state of SCM muscle thickness and the frequency of SCM muscle tone (r = −0.47, p < 0.001). In addition, a moderate negative correlation between MMO and frequency of SCM muscle tone (r = −0.44, p < 0.001). The muscle thickness was decreased, and the muscle tone was increased in the masseter and SCM muscle, respectively. Additionally, MMO was decreased in patients with TMD compared with non-TMD.

Motor unit firing rates during constant isometric contraction: establishing and comparing an age-related pattern among muscles

Motor unit (MU) firing rates (FRs) are lower in aged adults, compared with young, at relative voluntary contraction intensities. However, from a variety of independent studies of disparate muscles, the age-related degree of difference in FR among muscles is unclear. Using a standardized statistical approach with data derived from primary studies, we quantified differences in FRs across several muscles between younger and older adults. The data set included 12 different muscles in young (18-35 yr) and older adults (62-93 yr) from 18 published and one unpublished study. Experiments recorded single MU activity from intramuscular electromyography during constant isometric contraction at different (step-like) voluntary intensities. For each muscle, FR ranges and FR variance explained by voluntary contraction intensity were determined using bootstrapping. Dissimilarity of FR variance among muscles was calculated by Euclidean distances. There were threefold differences in the absolute frequency of FR ranges across muscles in the young (soleus 8-16 and superior trapezius 20-49 Hz), but in the old, FR ranges were more similar and lower for nine out of 12 muscles. In contrast, the explained FR variance from voluntary contraction intensity in the older group had 1.6-fold greater dissimilarity among muscles than the young (P < 0.001), with FR variance differences being muscle dependent. Therefore, differences between muscle FR ranges were not explained by how FRs scale to changes in voluntary contraction intensity within each muscle. Instead, FRs were muscle dependent but were more dissimilar among muscles in the older group in their responsiveness to voluntary contraction intensity.NEW & NOTEWORTHY The mean frequency of motor unit firing rates were compared systematically among several muscles and between young and older adults from new and published data sets. Firing rates among muscles were lower and more similar during voluntary isometric contraction in older than younger adults. Firing rate responses from voluntary contraction intensity were muscle dependent and more dissimilar among muscles in the older than young adults.

Influence of botulinum toxin A on craniofacial morphology after injection into the right masseter muscle of dystrophin deficient (mdx-) mice

BACKGROUND

Severe craniofacial and dental abnormalities, typical for patients with progressive Duchenne muscular dystrophy (DMD), are an exellcent demonstration of Melvin L. Moss "functional matrix theory", highlighting the influence of muscle tissue on craniofacial growth and morphology. However, the currently best approved animal model for investigation of this interplay is the mdx-mouse, which offers only a limited time window for research, due to the ability of muscle regeneration, in contrast to the human course of the disease. The aim of this study was to evaluate craniofacial morphology after BTX-A induced muscle paralysis in C57Bl- and mdx-mice, to prove the suitability of BTX-A intervention to inhibit muscle regeneration in mdx-mice and thus, mimicking the human course of the DMD disease.

METHODS

Paralysis of the right masseter muscle was induced in 100 days old C57Bl- and mdx-mice by a single specific intramuscular BTX-A injection. Mice skulls were obtained at 21 days and 42 days after BTX-A injection and 3D radiological evaluation was performed in order to measure various craniofacial dimensions in the sagittal, transversal and vertical plane. Statstical analysis were performed using SigmaStat®Version 3.5. In case of normal distribution, unpaired t-test and otherwise the Mann-Whitney-U test was applied. A statistical significance was given in case of p ≤ 0.05.

RESULTS

In contrast to C57Bl-mice, in mdx-mice, three weeks after BTX-A treatment a significant decrease of skull dimensions was noted in most of the measurements followed by a significant increase at the second investigation period.

CONCLUSIONS

BTX-A can induce changes in craniofacial morphology and presumably partially inhibit muscle regeneration in mdx-mice, but cannot completely intensify craniofacial effects elicited by dystrophy. Further research is necessary in order to fully understand muscle-bone interplay after BTX-A injection into dystrophic muscles.

Anatomical Study of the Innervation of the Masseter Muscle and Its Correlation with Myofascial Trigger Points

Background and Purpose

Myofascial pain syndrome (MPS) is widely prevalent in the general population; some reports estimate its prevalence ranges from 9 to 85%. Among the different locations where MPS may arise, pain related to the masseter muscle is referred as masticatory myofascial pain. MPS is characterized by myofascial trigger points (MTPs), which represent tender anatomical areas of a muscle where painful symptoms are elicited whenever stimulated. Previous publications have found MTPs to coincide with neuromuscular junctions at the motor end plate, at the innervation zone (IZ). Our study aimed to describe the innervation of the masseter muscle and relate it to clinically described myofascial trigger points (MTPs).

Materials and Methods

We mapped the nerve fiber distribution into the masseter muscles from 16 cadavers by anatomical dissection. We divided the muscle into six regions, three superior (I–III) and three inferior (IV–VI), and classified the nerve’s branches distribution according to these predetermined areas. Statistical analyses was made by Poisson distribution and logarithm link function followed by Bonferroni multiple comparisons (P<0.05).

Results

All six areas received branches from the masseteric nerve. Areas I and II (upper posterior and upper intermediate, respectively) had a significant higher number of nerve entries as compared to the remaining areas.

Conclusion

The penetration areas of the masseteric nerve have been established and MTPs are found in the innervation zones, clinicians should focus initially on the regions of the penetration points, for diagnostics and therapeutic measures, such as injections, dry needling and soft tissue interventions. Anatomical study of nerve supply to the masseter muscle can provide useful additional knowledge to further understanding masticatory myofascial pain and to direct therapeutic interventions and diagnostic studies of temporomandibular junction dysfunction.

Effects of Chronic and Experimental Acute Masseter Pain on Precision Biting Behavior in Humans

Chronic pain in the orofacial region is common worldwide. Pain seems to affect the jaw motor control. Hence, temporomandibular disorders (TMD) are often accompanied by pain upon chewing, restricted mouth opening and impaired maximal bite forces. However, little is known on the effects of pain, in particular the effects of chronic jaw muscle pain on precision biting. The aim of the study was to investigate the effect of chronic and acute jaw muscle pain on oral motor control during precision biting in humans. Eighteen patients with chronic masseter muscle pain and 18 healthy participants completed the experiment. All participants were examined according to the Diagnostic Criteria for TMD. Experimental acute pain was induced by bilateral, simultaneous sterile hypertonic saline infusions into the healthy masseter muscles. A standardized hold and split biting task was used to assess the precision biting. The data was analyzed with non-parametric statistical tests. The results showed no significant differences in the hold forces, split forces, durations of split or peak split rates within or between the pain and pain-free conditions. The mean split rate increased significantly compared to baseline values both in the chronic patients and the pain-free condition. However, this increase was not evident in the experimental acute pain condition. Further, there were no significant differences in the mean split rates between the conditions. The data suggest that jaw muscle pain does not seem to alter precision biting in humans, however, the possibility that a nociceptive modulation of spindle afferent activity might have occurred but compensated for cannot be ruled out.

Human motor unit characteristics of the superior trapezius muscle with age-related comparisons

Current understanding of human motor unit (MU) control and aging is mostly derived from hand and limb muscles that have spinal motor neuron innervations. The aim here was to characterize and test whether a muscle with a shared innervation supply from brainstem and spinal MU populations would demonstrate similar age-related adaptations as those reported for other muscles. In humans, the superior trapezius (ST) muscle acts to elevate and stabilize the scapula and has primary efferent supply from the spinal accessory nerve (cranial nerve XI) located in the brainstem. We compared electrophysiological properties obtained from intramuscular and surface recordings between 10 young (22-33 yr) and 10 old (77-88 yr) men at a range of voluntary isometric contraction intensities (from 15 to 100% of maximal efforts). The old group was 41% weaker with 43% lower MU discharge frequencies compared with the young (47.2 ± 9.6 Hz young and 26.7 ± 5.8 Hz old, P < 0.05) during maximal efforts. There was no difference in MU number estimation between age groups (228 ± 105 young and 209 ± 89 old, P = 0.33). Furthermore, there were no differences in needle detected near fiber (NF) stability parameters of jitter or jiggle. The old group had lower amplitude and smaller area of the stimulated compound muscle action potential and smaller NF MU potential area with higher NF counts. Thus, despite age-related ST weakness and lower MU discharge rates, there was minimal evidence of MU loss or compensatory reinnervation.NEW & NOTEWORTHY The human superior trapezius (ST) has shared spinal and brainstem motor neuron innervation providing a unique model to explore the impact of aging on motor unit (MU) properties. Although the ST showed higher MU discharge rates compared with most spinally innervated muscles, voluntary strength and mean MU rates were lower in old compared with young at all contraction intensities. There was no age-related difference in MU number estimates with minimal electrophysiological evidence of collateral reinnervation.

A Mini Review of Using the Oralift Appliance and a Pilot Study to See if 3D Imaging Techniques Could Improve Outcomes

Background:

Occlusal appliances of various designs have been described in the literature. They usually have to be worn for substantial periods including night time to have the desired effect for which they are designed. The Oralift® appliance has been designed to address the signs of facial ageing and to help stop parafunctional habits. The appliance is based on the principles of the pivot appliance and is worn for very short periods, never at night and not even every day. The maximum usage recommended is two hours every third day.

Objective:

This is a review of five patients who have been treated with Oralift® with the aim of assessing whether the visual changes seen by wearing the appliance can be quantified by changes in volume as measured by 3D Imaging, and if this quantification could be useful in improving the outcomes for each patient.

Methods:

The patients were fitted with the appliances in general practice, and 2D images were taken before, during and after treatment. Afterwards, the patient attended King’s College London, to have 3D imaging.

Results:

3D imaging has been proved far superior to standardized 2D photography in assessing the changes taking place on the face, and helped quantify the volume changes.

Conclusion:

To further improve the outcome for each patient, the 3D imaging should be done before the visit to the practitioner or ideally by the practitioner so that the results could be assessed, and the treatment adjusted accordingly. The implication of the volume changes requires a much larger study.

Local myogenic pulp-derived cell injection enhances craniofacial muscle regeneration in vivo

OBJECTIVES

To enhance myogenic differentiation in pulp cells isolated from extracted premolars by epigenetic modification using a DNA demethylation agent, 5-aza-2'-deoxycytidine (5-Aza), and to evaluate the potent stimulatory effect of 5-Aza-treated pulp cell injection for craniofacial muscle regeneration in vivo.

SETTING AND SAMPLE POPULATION

Pulp cells were isolated from premolars extracted for orthodontic purposes from four adults (age range, 18-22.1 years).

MATERIAL AND METHODS

Levels of myogenic differentiation and functional contraction response in vitro were compared between pulp cells with or without pre-treatment of 5-Aza. Changes in muscle regeneration in response to green fluorescent protein (GFP)-labelled myogenic pulp cell injection in vivo were evaluated using a cardiotoxin (CTX)-induced muscle injury model of the gastrocnemius as well as the masseter muscle in mice.

RESULTS

Pre-treatment of 5-Aza in pulp cells stimulated myotube formation, myogenic differentiation in terms of desmin and myogenin expression, and the level of collagen gel contraction. The local injection of 5-Aza pre-treated myogenic pulp cells was engrafted into the host tissue and indicated signs of enhanced muscle regeneration in both the gastrocnemius and the masseter muscles.

CONCLUSION

The epigenetic modification of pulp cells from extracted premolars and the local injection of myogenic pulp cells may stimulate craniofacial muscles regeneration in vivo.

[The third dimension of the face aging, improvement of its understanding]

OBJECTIVES

Over the past 30 years, surface imaging has made tremendous progress. Surgical management has also been subject of numerous technical and strategic developments. For a better understanding of the curative strategies of face aging, the authors have put into perspective the three-dimensional data acquired up to date.

METHOD

A review of the literature focused on the three-dimensional study of facial aging was carried out.

RESULTS

Thanks to the precision of new surface acquisition systems and larger patient cohorts, our understanding of surfaces and volumes is now much more accurate. 3D, particularly highlights the major impact of aging on the perioral area, which was up to now neglected compared to other facial areas.

CONCLUSION

A technical discussion is needed to identify the best techniques to correct the defects and provide a natural result for those anatomical areas that are heavily impacted by aging but not corrected in the final.

Coupling dynamics in speech gestures: amplitude and rate influences

Speech is a complex oral motor function that involves multiple articulators that need to be coordinated in space and time at relatively high movement speeds. How this is accomplished remains an important and largely unresolved empirical question. From a coordination dynamics perspective, coordination involves the assembly of coordinative units that are characterized by inherently stable coupling patterns that act as attractor states for task-specific actions. In the motor control literature, one particular model formulated by Haken et al. (Biol Cybern 51(5):347-356, 1985) or HKB has received considerable attention in the way it can account for changes in the nature and stability of specific coordination patterns between limbs or between limbs and external stimuli. In this model (and related versions), movement amplitude is considered a critical factor in the formation of these patterns. Several studies have demonstrated its role for bimanual coordination and similar types of tasks, but for speech motor control such studies are lacking. The current study describes a systematic approach to evaluate the impact of movement amplitude and movement duration on coordination stability in the production of bilabial and tongue body gestures for specific vowel-consonant-vowel strings. The vowel combinations that were used induced a natural contrast in movement amplitude at three speaking rate conditions (slow, habitual, fast). Data were collected on ten young adults using electromagnetic articulography, recording movement data from lips and tongue with high temporal and spatial precision. The results showed that with small movement amplitudes there is a decrease in coordination stability, independent from movement duration. These findings were found to be robust across all individuals and are interpreted as further evidence that principles of coupling dynamics operate in the oral motor control system similar to other motor systems and can be explained in terms of coupling mechanisms between neural oscillators (organized in networks) and effector systems. The relevance of these findings for understanding motor control issues in people with speech disorders is discussed as well.

Influence of Botulinumtoxin A on the Expression of Adult MyHC Isoforms in the Masticatory Muscles in Dystrophin-Deficient Mice (Mdx-Mice)

The most widespread animal model to investigate Duchenne muscular dystrophy is the mdx-mouse. In contrast to humans, phases of muscle degeneration are replaced by regeneration processes; hence there is only a restricted time slot for research. The aim of the study was to investigate if an intramuscular injection of BTX-A is able to break down muscle regeneration and has direct implications on the gene expression of myosin heavy chains in the corresponding treated and untreated muscles. Therefore, paralysis of the right masseter muscle was induced in adult healthy and dystrophic mice by a specific intramuscular injection of BTX-A. After 21 days the mRNA expression and protein content of MyHC isoforms of the right and left masseter, temporal, and the tongue muscle were determined using quantitative RT-PCR and Western blot technique. MyHC-IIa and MyHC-I-mRNA expression significantly increased in the paralyzed masseter muscle of control-mice, whereas MyHC-IIb and MyHC-IIx/d-mRNA were decreased. In dystrophic muscles no effect of BTX-A could be detected at the level of MyHC. This study suggests that BTX-A injection is a suitable method to simulate DMD-pathogenesis in healthy mice but further investigations are necessary to fully analyse the BTX-A effect and to generate sustained muscular atrophy in mdx-mice.

Remodeling of Neuromuscular Junctions in Aged Rat Genioglossus Muscle

Speech and swallowing disorders represent a large clinical problem in elderly persons. Poor lingual control is associated with both speech and swallowing impairment. Studies of limb and laryngeal muscles suggest that age-related musculoskeletal changes may be characterized by remodeling of muscles, nerves, and their connections at neuromuscular junctions (NMJs). To evaluate dynamic remodeling of NMJ structure in the tongue as a function of aging, we studied tongues from 10 aged and 10 young rats. A fluorescent, triple-labeled, immunohistochemical technique was used with genioglossus (GG) muscle samples to allow confocal microscopic visualization of receptor clusters, nerve terminals, axons, and synaptic vesicles. Normal axon terminals and receptor clusters were easily identified in young rat GG muscles, whereas aging induced a significantly higher degree of receptor dispersal. These results suggest that NMJ remodeling is found in aged GG muscles and may underlie the progressive neuromuscular changes observed in the elderly.

Effects of tongue pressing effortful swallow in older healthy individuals

INTRODUCTION

The risk of swallowing disorders is increased for older individuals due to weak tongue and pharyngeal muscle strength. This study was appraised the value of a preventative approach by developing the tongue pressing effortful swallow (TPES) applied using a home-based and self-administered procedure. The TPES was developed by combining two swallowing exercises: tongue strengthening exercise and the effortful swallow. The purpose of this study was to examine the effects of the TPES on maximum tongue pressure and peak amplitude of submental muscle activity in older individuals.

MATERIAL AND METHODS

27 older individuals (mean 73 years) performed a 4-week TPES. The exercise program was adapted to a home-based and self-administered procedure. The maximum tongue pressure was measured by the Iowa Oral Performance Instrument and peak amplitude of submental muscle activity by surface electromyography (sEMG). Statistical comparisons were made by a matched pairs t-test (p<0.05).

RESULTS

The results of this study showed that the TPES had statistically significant and positive effects on increasing maximum tongue pressure, but the peak amplitude of the submental sEMG did not differ between before and after exercises.

CONCLUSIONS

The TPES had a positive impact in older individuals. The TPES, a combining exercise, was possible because two exercises had common physiological events. The TPES was a more innovative and efficient approach than the tongue strengthening exercise alone. In addition, older individuals were able to perform the swallowing exercise at home and by themselves with little assistance. Future research needs to refine the TPES and apply it to patients with dysphagia.

Potentials and limitations of peripheral nerve injury models in rodents with particular reference to the femoral nerve

Restoration of function after peripheral nerve repair in humans is unsatisfactory. Various causes of poor recovery have been proposed. Still, we do not understand which of these potential factors are indeed detrimental and do not know how to manipulate them experimentally in a clinically feasible way. Future success largely depends on methodological improvement in rodent models. An example of recent progress is the introduction of new functional and anatomical outcome measures in the facial nerve injury paradigm which led to novel insights into facial nerve regeneration and a new therapeutic concept. Less success can be ascribed to the use of the classical spinal nerve model, the sciatic nerve paradigm, not least because of its anatomical and functional complexity making assessment of recovery challenging. A simpler alternative to the sciatic nerve is the femoral nerve model. It offers, alongside with its known usefulness for studies on precision of motor reinnervation, the possibility of reliable functional assessments and a straightforward search of anatomical substrates of dysfunction. The structure-function approach in the femoral nerve paradigm has been useful for testing of novel therapeutic means and analyses of regeneration in mutant mice. The potential of the method has still not been really exploited and its more extensive use may contribute to better understanding of nerve regeneration.

Tongue pressure and submental surface electromyography measures during noneffortful and effortful saliva swallows in healthy women

PURPOSE

The effortful swallow, a compensatory technique frequently employed by speech-language pathologists for their patients with dysphagia, is still not fully understood in terms of how it modifies the swallow. In particular, although age-related changes are known to reduce maximum isometric tongue pressure, it is not known whether age affects people's ability to perform the effortful swallow. In this study, differences were explored between younger and older healthy women in execution of the effortful swallowing maneuver through a comparative analysis of effortful and noneffortful swallows.

METHOD

Eighty healthy women (40 age 18-35 years and 40 age 60 and older) participated. Peak amplitude measures and the timing of signal onset to peak were measured using concurrent tongue pressure and submental surface electromyography. Result Statistically significant main effects of age group were not observed in the amplitude data, but older participants showed slower rise times to peak anterior tongue-palate pressure.

CONCLUSIONS

Despite the general age-related deterioration of the swallowing musculature due to the phenomenon of sarcopenia, older women can still produce noneffortful and effortful swallows with lingual pressure and submental surface electromyography amplitudes similar to younger women.

Tongue movements during water swallowing in healthy young and older adults

PURPOSE

The purpose of this study was to explore the nature and extent of variability in tongue movement during healthy swallowing as a function of aging and gender. In addition, changes were quantified in healthy tongue movements in response to specific differences in the nature of the swallowing task (discrete vs. sequential swallows).

METHOD

Electromagnetic midsagittal articulography (EMMA) was used to study the swallowing-related movements of markers located in midline on the anterior (blade), middle (body), and posterior (dorsum) tongue in a sample of 34 healthy adults in 2 age groups (under vs. over 50 years of age). Participants performed a series of reiterated water swallows, in either a discrete or a sequential manner.

RESULTS

This study shows that age-related changes in tongue movements during swallowing are restricted to the domain of movement duration. The authors confirm that different tongue regions can be selectively modulated during swallowing tasks and that both functional and anatomical constraints influence the manner in which tongue movement modulation occurs. Sequential swallowing, in comparison to discrete swallowing, elicits simplification or down-scaling of several kinematic parameters.

CONCLUSION

The data illustrate task-specific stereotyped patterns of tongue movement in swallowing, which are robust to the effects of healthy aging in all aspects other than movement duration.

Factors associated with self-assessed oral health in the Japanese independent elderly

OBJECTIVES

The purpose of this research was to analyse the relationship between oral health status, oral motor function, daily life situations and self-assessed oral health.

MATERIALS AND METHODS

A cross-sectional survey was conducted on 190 independent elderly volunteers aged 62-99 years from senior citizen centres in Tokyo, Japan. A questionnaire survey and oral examination were conducted on each participant. For the descriptive analyses, Independent t-test and the chi-squared test were used. Following that, using four latent variables, (oral health, oral function, daily life situations and chronic health condition), a structural equation modelling analysis (SEMA) was undertaken.

RESULTS

In the descriptive analyses, there were no significant differences between self-assessed oral health and oral health status. However, there were significant differences between self-assessed oral health and oral function and daily life situations. Findings from SEMA revealed that daily life situations and oral function have independent effects on self-assessed oral health and that the relationship between self-assessed oral health and oral health status was weak.

CONCLUSIONS

Many factors affect self-assessed oral health status. Dental clinicians and researchers should attempt to understand these factors and incorporate them into effective personal and population-based oral health education and oral health promotion programmes.

The adaptive response of jaw muscles to varying functional demands

Jaw muscles are versatile entities that are able to adapt their anatomical characteristics, such as size, cross-sectional area, and fibre properties, to altered functional demands. The dynamic nature of muscle fibres allows them to change their phenotype to optimize the required contractile function while minimizing energy use. Changes in these anatomical parameters are associated with changes in neuromuscular activity as the pattern of muscle activation by the central nervous system plays an important role in the modulation of muscle properties. This review summarizes the adaptive response of jaw muscles to various stimuli or perturbations in the orofacial system and addresses general changes in muscles as they adapt, specific adaptive changes in jaw muscles under various physiologic and pathologic conditions, and their adaptive response to non-surgical and surgical therapeutic interventions. Although the jaw muscles are used concertedly in the masticatory system, their adaptive changes are not always uniform and vary with the nature, intensity, and duration of the stimulus. In general, stretch, increases neuromuscular activity, and resistance training result in hypertrophy, elicits increases in mitochondrial content and cross-sectional area of the fibres, and may change the fibre-type composition of the muscle towards a larger percentage of slow-type fibres. In contrast, changes in the opposite direction occur when neuromuscular activity is reduced, the muscle is immobilized in a shortened position, or paralysed. The broad range of stimuli that affect the properties of jaw muscles might help explain the large variability in the anatomical and physiological characteristics found among individuals, muscles, and muscle portions.

Dysphagia in the elderly

The capacity to swallow or eat is a basic human need and can be a great pleasure. Older adults look forward to sharing mealtimes and participating in social interactions. The loss of capacity to swallow and dine can have far-reaching implications. With age, the ability to swallow undergoes changes that increase the risk for disordered swallowing, with devastating health implications for older adults. With the growth in the aging population, dysphagia is becoming a national health care burden and concern. Upward of 40% of people in institutionalized settings are dysphagic. There is a need to address dysphagia in ambulatory, acute care, and long-term care settings.

Manually-stimulated recovery of motor function after facial nerve injury requires intact sensory input

We have recently shown in rat that daily manual stimulation (MS) of vibrissal muscles promotes recovery of whisking and reduces polyinnervation of muscle fibers following repair of the facial nerve (facial-facial anastomosis, FFA). Here, we examined whether these positive effects were: (1) correlated with alterations of the afferent connections of regenerated facial motoneurons, and (2) whether they were achieved by enhanced sensory input through the intact trigeminal nerve. First, we quantified the extent of total synaptic input to motoneurons in the facial nucleus using synaptophysin immunocytochemistry following FFA with and without subsequent MS. We found that, without MS, this input was reduced compared to intact animals. The number of synaptophysin-positive terminals returned to normal values following MS. Thus, MS appears to counteract the deafferentation of regenerated facial motoneurons. Second, we performed FFA and, in addition, eliminated the trigeminal sensory input to facial motoneurons by extirpation of the ipsilateral infraorbital nerve (IONex). In this paradigm, without MS, vibrissal motor performance and pattern of end-plate reinnervation were as aberrant as after FFA without MS. MS did not influence the reinnervation pattern after IONex and functional recovery was even worse than after IONex without MS. Thus, when the sensory system is intact, MS restores normal vibrissal function and reduces the degree of polyinnervation. When afferent inputs are abolished, these effects are eliminated or even reversed. We conclude that rehabilitation strategies must be carefully designed to take into account the extent of motor and/or sensory damage.

Shortened cortical silent period in facial muscles of patients with migraine

Despite intensive neurophysiological research, evidence is lacking to show whether abnormal cortical excitability in migraine reflects a primary cortical disturbance or reduced control by thalamo-cortical loops. One way to contribute to the scientific discussion on this topic is to deliver transcranial magnetic stimulation (TMS) and test the cortical silent period (SP) recorded in facial muscles. The facial-muscle SP is a purely cortical phenomenon that reflects the excitability of inhibitory interneurons, and can disclose changes in cortical inhibition even in patients without documented primary lesions of the motor cortices. To test the interictal excitability of cortical motor inhibitory interneurons in migraine, we investigated the facial-SP in patients with migraine with and without aura between attacks. In 26 patients and 15 age-matched controls, high-intensity magnetic stimuli were delivered with a round coil centered at the vertex during a maximal muscle contraction. Electromyographic responses were recorded from surface electrodes placed over the subjects' perioral muscles. Facial SPs were significantly shorter in patients than in controls. The SP shortening provides neurophysiological evidence showing hypoexcitability of cortical inhibitory neurons in patients with migraine between attacks. Despite a possible primary deficit of cortical inhibitory interneurons in migraine, we favor the interpretation of a secondary disfacilitation by hypoactive thalamo-cortical loops. Based on this interpretation, the interictal reduced cortical inhibition documented by the shortened SP could be considered the motor counterpart of the reduced preactivation excitability level in the sensory cortices purported to explain why cortical evoked responses habituate poorly in patients with migraine.

Age-related changes in orolingual motor function in F344 vs F344/BN rats

Normal aging is associated with both locomotor and orolingual motor deficits. Preclinical studies of motor function in normal aging, however, have focused primarily on locomotor activity. The purpose of this study was to measure age-related changes in orolingual motor function and compare these changes between two rat strains commonly used in aging studies: Fischer 344 (F344) and Fischer 344/Brown Norway hybrid (F344/BN) rats. Rats (6-, 12-, 18- and 24-months of age) were trained to lick water from an isometric force-sensing operandum so that the number of licks per session, licking rhythm (licks/second) and lick force could be measured. In both strains, the number of licks per session was greatest in the oldest group, while this measure was greater for F344/BN rats at all ages. Peak tongue force increased with age in F344/BN rats, did not change with age in the F344 rats, and was greater for the F344/BN rats at all ages. Both strains exhibited an age-related slowing of licking rhythm beginning with the 18-month-old group. These findings suggest that despite lifespan differences between these two rat strains, diminished tongue motility emerges at the same age.

Differential expression of sarcolipin protein during muscle development and cardiac pathophysiology

Sarcolipin (SLN) is a small molecular weight sarcoplasmic reticulum (SR) membrane protein expressed both in cardiac and skeletal muscle tissues. Recent studies using transgenic mouse models have demonstrated that SLN is an important regulator of cardiac SR Ca2+ ATPase 2a (SERCA2a). However, there is a paucity of information regarding the SLN protein expression in small versus larger mammals and its regulation during development and cardiac pathophysiology. Therefore, the major goal of this study was to generate an SLN specific antibody and perform detailed analyses of SLN protein expression during muscle development and in the diseased myocardium. The important findings of the present study are: (i) in small mammals, SLN expression is predominant in the atria but low in the ventricle and in skeletal muscle tissues, whereas in large mammals, SLN is quite abundant in skeletal muscle tissues than the atria, (ii) SLN and SERCA2a are co-expressed in all striated muscle tissues studied except ventricle and co-ordinately regulated during muscle development and (iii) SLN protein levels are approximately 3 fold upregulated in the atria of heart failure dogs and approximately 30% decreased in the atria of hearts prone to myocardial ischemia. In addition we found that in the phospholamban null atria, SLN protein levels are upregulated.

Morphometric aspects of the human hypoglossal nerve in adults and the elderly

AIM

Perform a morphometric analysis of the myelinic fibers of the right hypoglossal nerve, in two age groups; to verify quantitative changes as a result of the aging process.

STUDY DESIGN

Anatomic.

MATERIAL AND METHOD

A 1 cm fragment of the right hypoglossal nerve was collected from 12 male corpses without any medical history of diseases such as: diabetes, alcoholism, and malignant neoplasia. The sample was divided in two groups: group with six corpses under sixty years old (adult), and another group with six corpses sixty years old or above (elderly). The material was fixed at 2.5% glutaldehyde and 2% paraformaldehyde solution; post-fixed at 2% osmium tetroxide; dehydrated with increasing ethanol concentrations, and included in epoxy resin. Semi-thin sections of 0.3 microm were obtaining, colored in 1% toluidine blue, and evaluated with light microscope combined with image analyzing system. The following morphometric data were quantified: intraperineural transversal section area, number, and diameter of the myelinic fibers.

RESULTS

The intraperineural area of the hypoglossal nerve was similar in both age groups (p=0.8691). The average area in the adult group was 1.697 mm2 and in the elderly group it was 1.649 mm2. The total number of myelinic fibers of the hypoglossal nerve was similar in both age groups (p=0.9018). The adult group presented an average of 10,286 +/- 2,308 myelinic fibers, and the elderly group presented an average of 10,141 +/- 1,590 myelinic fibers. A bimodal distribution of the myelinic fibers was observed, with a significant peak on the 9 microm fibers, and another smaller peak on the 2 microm fibers.

CONCLUSION

The intraperineural area and the total number of myelinic fibers of the right hypoglossal nerve are similar in both age groups.

Fiber-type composition of the human jaw muscles--(part 2) role of hybrid fibers and factors responsible for inter-individual variation

This is the second of two articles about fiber-type composition of the human jaw muscles. It reviews the functional relationship of hybrid fibers and the adaptive properties of jaw-muscle fibers. In addition, to explain inter-individual variation in fiber-type composition, we discuss these adaptive properties in relation to environmental stimuli or perturbations. The fiber-type composition of the human jaw muscles is very different from that of limb and trunk muscles. Apart from the presence of the usual type I, IIA, and IIX myosin heavy-chains (MyHC), human jaw-muscle fibers contain MyHCs that are typical for developing or cardiac muscle. In addition, much more frequently than in limb and trunk muscles, jaw-muscle fibers are hybrid, i.e., they contain more than one type of MyHC isoform. Since these fibers have contractile properties that differ from those of pure fibers, this relatively large quantity of hybrid fibers provides a mechanism that produces a very fine gradation of force and movement. The presence of hybrid fibers might also reflect the adaptive capacity of jaw-muscle fibers. The capacity for adaptation also explains the observed large inter-individual variability in fiber-type composition. Besides local influences, like the amount of muscle activation and/or stretch, more general influences, like aging and gender, also play a role in the composition of fiber types.

Fast force-generation dynamics of human articulatory muscles

To explore the mechanisms of speech articulation, which is one of the most sophisticated human motor skills controlled by the central nervous system, we investigated the force-generation dynamics of the human speech articulator muscles [orbicularis oris superior (OOS) and inferior (OOI) muscles of the lips]. Short-pulse electrical stimulation (300 μs) with approximately three or four times the sensation threshold intensity of each subject induced the muscle response. The responses of these muscles were modeled as second-order dynamics with a time delay (TD), and the model parameters [natural frequency (NF), damping ratio (DR), and TD] were identified with a nonlinear least mean squares method. The OOS (NF: 6.1 Hz, DR: 0.71, TD: 14.5 ms) and OOI (NF: 6.1 Hz, DR: 0.68, TD: 15.6 ms) showed roughly similar characteristics in eight subjects. The dynamics in the tongue (generated by combined muscles) also showed similar characteristics (NF: 6.1 Hz, DR: 0.68, TD: 17.4 ms) in two subjects. The NF was higher, and the DR was lower than results measured for arm muscles (NF: 4.25 Hz, DR: 1.05, TD: 23.8 ms for triceps long head), indicating that articulatory organs adapt for more rapid movement. In contrast, slower response dynamics was estimated when muscle force data by voluntarily contraction task were used for force-generation dynamics modeling. We discuss methodological problems in estimating muscle dynamics when different kinds of muscle contraction methods are used.

Aged Fischer 344 rats exhibit altered orolingual motor function: relationships with nigrostriatal neurochemical measures

The present study utilized a novel behavioral preparation to measure differences in orolingual motor function between young (6 months) and aged (24 months) Fischer 344 (F344) rats. Rats were trained to lick an isometric force-sensing operandum for water reinforcement so that the number of licks per session, licking rhythm and lick force could be compared between the two groups. The aged rats exhibited a greater number of licks per session, but a slowed licking rhythm, compared to the young rats. Lick force did not differ significantly between the groups. The dopamine (DA) uptake inhibitor nomifensine decreased all three measures in both groups. Analyses of whole brain tissue content of DA, 3,4 dihydroxyphenylacetic acid (DOPAC), and homovanillic acid (HVA) in the substantia nigra and dorsal striatum revealed no significant differences between the two age groups. Differences were observed between the two groups with respect to relationships between behavioral and neurochemical tissue measures. Striatal DA content and the number of licks per session were positively correlated for the young rats but not for the aged rats. In the aged rats, but not the young rats, positive correlations were also observed between licking rhythm and the DOPAC+HVA/DA ratio in the substantia nigra. These findings suggest that age-related alterations in orolingual motor function may relate in part to functional changes in DA neuronal circuits.

Alveolar soft-part sarcoma of the cheek

Alveolar soft-part sarcoma is a rare malignant tumour of uncertain histogenesis, the two main sites of which are the lower extremities in adults and the head and neck in children. We know of only three case reports of intraoral locations without tongue involvement. Here, we describe the first case of an alveolar soft-part sarcoma of the cheek which presented in a patient over 30 years old and had an extremely rapid and eventually fatal evolution. We have also reviewed hypotheses about its aetiology.