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Iglesias-Peón M, Mesa-Jiménez J, Fernández-DE-Las-Peñas C, García Iglesias N, Iglesias Peón CM, Rodrigues-DE-Souza DP, Alburquerque-Sendín F. Test-retest reliability of the isometric contraction test (IC test) of the masticatory muscles in subjects with and without temporomandibular muscle disorders. J Appl Oral Sci 2023; 31:e20230045. [PMID: 37909525 PMCID: PMC10609633 DOI: 10.1590/1678-7757-2023-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/24/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Recently, the DC/TMD has become an essential tool for the diagnosis of temporomandibular disorders (TMD). However, as they fail to include functional activities, new assessment proposals have emerged, such as the isometric contraction test (IC test) of the masticatory muscles, which uses muscle contractions to identify muscular TMD. This study aimed to determine the test-retest reliability of the IC test. METHODS A total of 64 participants (40 women and 24 men) completed the IC test administered by two different physical therapists on two non-consecutive days. Cohen's kappa (k), PABAK, and percent agreement (PA) between days were estimated. RESULTS The IC test showed good to excellent test-retest reliability values (k>0.77; PABAK>0.90), both globally and individually for the muscles evaluated, and PA>90%, therefore above the thresholds for clinical applicability. However, the global assessment of myofascial pain and the evaluation of the medial pterygoid muscle showed slightly lower reliability values. CONCLUSION The IC test is reliable for the assessment of subjects with muscular TMD, both in terms of the global assessment and the evaluation of each muscle, which supports its clinical applicability. Care should be taken when assessing myofascial pain globally and when evaluating the medial pterygoid in all types of pain.
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Affiliation(s)
- Marcos Iglesias-Peón
- Osteopatía y Fisioterapia Guadalajara, Guadalajara, España
- Universidad de Córdoba, Programa de Doctorado en Biomedicina, Córdoba, España
| | - Juan Mesa-Jiménez
- Universidad CEU San Pablo, Departamento de Fisioterapia, Madrid, España
| | - César Fernández-DE-Las-Peñas
- Universidad Rey Juan Carlos, Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Alcorcón, Madrid, España
| | | | | | | | - Francisco Alburquerque-Sendín
- Universidad de Córdoba, Facultad de Medicina y Enfermería, Departamento de Enfermería, Farmacología y Fisioterapia, Córdoba, España
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
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Murray GM, Carignan C, Whittle T, Gal JA, Best C. Pterygoid muscle activity in speech: A preliminary investigation. J Oral Rehabil 2022; 49:1135-1143. [PMID: 36165884 PMCID: PMC9828251 DOI: 10.1111/joor.13377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/17/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Speaking depends on refined control of jaw opening and closing movements. The medial pterygoid muscle (MPT), involved in jaw closing, and the lateral pterygoid muscle (LPT), involved in jaw opening, are two key mandibular muscles in mastication and are likely to be recruited for controlled movements in speech. OBJECTIVES Three hypotheses were investigated, that during speech the MPT and LPT: (1) were both active, (2) but exhibited different patterns of activity, (3) which fluctuated with the vowels and consonants in speech. METHODS Intramuscular EMG recordings were made from the right inferior head of the LPT and/or the right MPT in five participants during production of 40 target nonsense words (NWs) consisting of three syllables in the form /V1 C1 V2 C2 ə/ (V = vowel; C = consonant; ə = unstressed, reduced vowel), spoken by each participant 10 times per NW; analysis focussed on the target syllable, C1 V2 . RESULTS Both MPT and LPT exhibited robust increases in EMG activity during utterance of most NWs, relative to rest. Peak LPT activation was time-locked to the final part of the target consonant (C1 ) interval when the jaw begins opening for the target vowel (V2 ), whereas peak MPT activation occurred around the temporal midpoint of V2 , when the jaw begins closing for C2 . EMG amplitude peaks differed in magnitude between "high" vowels, i.e., for which the tongue/jaw are high (e.g., in SEEK), and "low" vowels, i.e., for which the tongue/jaw are low (e.g., in SOCK). CONCLUSIONS These novel findings suggest a key role for the LPT and MPT in the fine control of speech production. They imply that speech may impose major synergistic demands on the activities of the MPT and the LPT, and thereby provide insights into the possible interactions between speech activities and orofacial activities (e.g. mastication) and conditions (e.g. Temporomandibular Disorders) that involve the masticatory muscles.
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Affiliation(s)
- Greg M. Murray
- Sydney Dental School, Faculty of Medicine and HealthUniversity of SydneyWestmeadNew South WalesAustralia
| | | | - Terry Whittle
- Sydney Dental School, Faculty of Medicine and HealthUniversity of SydneyWestmeadNew South WalesAustralia
| | - John A. Gal
- School of Engineering, Design and Built EnvironmentWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Catherine Best
- MARCS Auditory LaboratoriesWestern Sydney UniversityPenrithNew South WalesAustralia
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Nozad Mojaver Y, Tawadros P, Moura Ferreira P, Whittle T, Murray GM. Threshold variations of medial pterygoid single motor units during vertical or horizontal force tasks. J Oral Rehabil 2021; 48:1314-1326. [PMID: 34510487 DOI: 10.1111/joor.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To test the hypotheses that (a) the force thresholds at onset of medial pterygoid muscle single motor unit (SMU) activity do not decrease with an increase in the rate of force generation in standardised vertical or horizontal jaw-force tasks, and (b) there is evidence for functional heterogeneity within the medial pterygoid muscle. METHODS In 14 healthy participants, electromyographic recordings of the right medial pterygoid muscle were performed with intramuscular fine-wire electrodes during four isometric force tasks: vertical, horizontal contralateral, horizontal protrusion and horizontal ipsilateral, performed at two rates of force development (slow ramp, fast ramp). Computer tomography scans confirmed electrode location within the muscle, which was divided into medial and lateral parts. Force thresholds of onset of discriminated SMUs were compared between rates in each task; significance accepted at p < 0.05. RESULTS Of 45 SMU force thresholds studied in one or more tasks, there was no significant difference between slow and fast ramp within each force task, except slow ramp thresholds from the lateral part during the vertical force task were significantly higher than fast ramp thresholds. Reversals of recruitment order between tasks provided evidence for functional heterogeneity within the muscle. Force thresholds of the vertical tasks (range: 1-292.6 N) were mostly higher than for the horizontal tasks (range: 0.1-12.5 N). CONCLUSION The data are consistent with the proposal that the medial pterygoid muscle stabilises the jaw in the vertical plane during isometric force generation in the jaw closing, as well as horizontal directions.
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Affiliation(s)
- Yalda Nozad Mojaver
- Faculty of Medicine and Health, Sydney Dental School, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, Australia
| | - Paul Tawadros
- Faculty of Medicine and Health, Sydney Dental School, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, Australia
| | - Polyana Moura Ferreira
- Faculty of Medicine and Health, Sydney Dental School, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, Australia
| | - Terry Whittle
- Faculty of Medicine and Health, Sydney Dental School, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, Australia
| | - Greg M Murray
- Faculty of Medicine and Health, Sydney Dental School, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, Australia
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Duanmu Z, Liu L, Deng Q, Ren Y, Wang M. Development of a biomechanical model for dynamic occlusal stress analysis. Int J Oral Sci 2021; 13:29. [PMID: 34493701 PMCID: PMC8423745 DOI: 10.1038/s41368-021-00133-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/06/2021] [Indexed: 02/08/2023] Open
Abstract
The use of traditional finite element method (FEM) in occlusal stress analysis is limited due to the complexity of musculature simulation. The present purpose was to develop a displacement boundary condition (DBC)-FEM, which evaded the muscle factor, to predict the dynamic occlusal stress. The geometry of the DBC-FEM was developed based on the scanned plastic casts obtained from a volunteer. The electrognathographic and video recorded jaw positional messages were adopted to analyze the dynamic occlusal stress. The volunteer exhibited asymmetrical lateral movements, so that the occlusal stress was further analyzed by using the parameters obtained from the right-side eccentric movement, which was 6.9 mm long, in the stress task of the left-side eccentric movement, which was 4.1 mm long. Further, virtual occlusion modification was performed by using the carving tool software aiming to improve the occlusal morphology at the loading sites. T-Scan Occlusal System was used as a control of the in vivo detection for the location and strength of the occlusal contacts. Data obtained from the calculation using the present developed DBC-FEM indicated that the stress distribution on the dental surface changed dynamically with the occlusal contacts. Consistent with the T-Scan recordings, the right-side molars always showed contacts and higher levels of stress. Replacing the left-side eccentric movement trace by the right-side one enhanced the simulated stress on the right-side molars while modification of the right-side molars reduced the simulated stress. The present DBC-FEM offers a creative approach for pragmatic occlusion stress prediction.
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Affiliation(s)
- Zheng Duanmu
- grid.443248.d0000 0004 0467 2584Key Laboratory of the Ministry of Education for Optoelectronic Measurement Technology and Instrument, Beijing Information Science and Technology University, Beijing, China
| | - Lu Liu
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Qi Deng
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Yuanyuan Ren
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
| | - Meiqing Wang
- grid.233520.50000 0004 1761 4404Department of Oral Anatomy and Physiology and TMD, School of Stomatology, Air Force Medical University, Xi’an, China
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MRI-Based Assessment of Masticatory Muscle Changes in TMD Patients after Whiplash Injury. J Clin Med 2021; 10:jcm10071404. [PMID: 33915742 PMCID: PMC8036470 DOI: 10.3390/jcm10071404] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022] Open
Abstract
Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.
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The reciprocal jaw-muscle reflexes elicited by anterior- and back-tooth-contacts-a perspective to explain the control of the masticatory muscles. BDJ Open 2020; 6:27. [PMID: 33335091 PMCID: PMC7746706 DOI: 10.1038/s41405-020-00056-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 11/09/2022] Open
Abstract
AIMS Tooth-contact sensations are considered essential to boost jaw adductor muscles during mastication. However, no previous studies have explained the importance of the inhibitory reflex of human anterior-tooth (ANT)-contacts in mastication. Here I present the "reciprocal reflex-control-hypothesis" of mammalian mastication. SUBJECTS AND SETTING OF THE STUDY I demonstrate the hypothesis with the live kinematics of free jaw-closures as inferred from T-Scan recordings of dental patients. RESULTS The jaw-closures started with negligible force, predominantly with ANT-contacts (the AF-bites). The first ANT-contact inhibited the first kinematic tilt of the mandible, whereas the bites starting from a back-tooth (BAT)-contact (the BF-bites) accelerated the first tilt. The second tilt established a low-force static tripod of the ANT- and bilateral BAT-contacts for a fixed mandible-maxilla relation. Thereafter, semi-static bite force increased rapidly, relatively more in the BAT-area. DISCUSSION AND CONCLUSIONS In the vertical-closure phase of chewing, the primate joint-fulcrum (class 3 lever) conflicts with the food-bolus-fulcrum in the BAT-area (class 1 lever). The resilient class 3 and 1 lever systems are superseded by an almost static mechanically more advantageous class 2 lever with a more rigid fulcrum at the most anterior ANT-contact. For humans, the class 2 levered delivery of force also enables forceful horizontal food grinding to be extended widely to the BAT-area.
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Chen H, Whittle T, Gal J, Klineberg IJ, Murray GM. Functional properties of single motor units in the human medial pterygoid muscle: Thresholds. J Oral Rehabil 2020; 48:132-142. [PMID: 33068481 DOI: 10.1111/joor.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/01/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known regarding the functional properties of single motor units (SMUs) in the medial pterygoid muscle (MPt) during jaw movements. OBJECTIVES The aims are (a) to report the thresholds of onset of MPt SMUs during 4 goal-directed jaw movement tasks, and (b) to determine whether the threshold of onset of SMU activation varies with the velocity of jaw movement and the location within the muscle. METHODS Intra-muscular electrodes were inserted in the right MPt of 18 participants performing ipsilateral (right), contralateral, protrusive and opening-closing jaw movements recorded at 2 velocities. Task phases were as follows: BEFORE, OUT, HOLDING, RETURN and AFTER. SMU onset thresholds were determined from the displacement (mm) of the lower mid-incisor point. Electrode location within 4 arbitrary muscle divisions was determined with computer tomography. Statistical tests: Spearman's correlations, Kruskal-Wallis tests; significance accepted at P < .05. RESULTS A significant inverse relation occurred between velocity and threshold for the RETURN of the ipsilateral movement (n = 62 SMU thresholds), while a significant positive relation occurred for the OUT of the contralateral movement (n = 208); there were no significant associations for the protrusive (n = 131) and opening-closing (n = 58) tasks. Significant threshold differences occurred across the 4 muscle divisions only during the OUT of the contralateral and protrusive movements. Some evidence was provided for gender differences in MPt SMU properties. CONCLUSIONS The absence of a significant inverse relation between velocity and SMU threshold for most recorded movements suggests the MPt acts as a stabilizer of the jaw in horizontal and opening-closing jaw movements.
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Affiliation(s)
- Hui Chen
- Jaw Function and Orofacial Pain Research Unit, Faculty of Medicine and Health, Sydney Dental School, Level 2, Westmead Hospital Centre for Oral Health, University of Sydney, Sydney, NSW, Australia
| | - Terry Whittle
- Jaw Function and Orofacial Pain Research Unit, Faculty of Medicine and Health, Sydney Dental School, Level 2, Westmead Hospital Centre for Oral Health, University of Sydney, Sydney, NSW, Australia
| | - John Gal
- Jaw Function and Orofacial Pain Research Unit, Faculty of Medicine and Health, Sydney Dental School, Level 2, Westmead Hospital Centre for Oral Health, University of Sydney, Sydney, NSW, Australia
| | - Iven J Klineberg
- Jaw Function and Orofacial Pain Research Unit, Faculty of Medicine and Health, Sydney Dental School, Level 2, Westmead Hospital Centre for Oral Health, University of Sydney, Sydney, NSW, Australia
| | - Greg M Murray
- Jaw Function and Orofacial Pain Research Unit, Faculty of Medicine and Health, Sydney Dental School, Level 2, Westmead Hospital Centre for Oral Health, University of Sydney, Sydney, NSW, Australia
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Mesa-Jiménez JA, Fernández-de-Las-Peñas C, Koppenhaver SL, Sánchez-Gutiérrez J, Arias-Buría JL. Cadaveric and in vivo validation of needle placement in the medial pterygoid muscle. Musculoskelet Sci Pract 2020; 49:102197. [PMID: 32479337 DOI: 10.1016/j.msksp.2020.102197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/10/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Evidence suggests that medial pterygoid muscle plays an important role in temporomandibular pain. Therapeutic approaches targeting this muscle are needed. OBJECTIVE To determine if a solid needle accurately penetrates the medial pterygoid muscle during the application of dry needling. DESIGN A cadaveric and human descriptive study. METHODS Needling insertion of the medial pterygoid was conducted in 5 fresh cadaver and 5 subjects with temporomandibular pain. Needling insertion was performed using a 40 mm needle inserted at the inferior angle of the mandibular bone. The needle was advanced from an inferior to superior direction into the medial pterygoid to a maximum depth of 30 mm. In cadavers, medial pterygoid placement was assessed by observation after resecting the superficial overlying tissues. In patients, medial pterygoid placement was assessed by self-reported pain referral during insertion. RESULTS Accurate needle penetration of the medial pterygoid was observed in all fresh cadavers and pain referral was reported by 4/5 patients during needling insertion. CONCLUSION Results from both cadavers and patients support the assertion that needling of the medial pterygoid can be accurately conducted.
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Affiliation(s)
- Juan A Mesa-Jiménez
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Physical Therapy, Universidad San-Pablo CEU, Madrid, Spain
| | - Cesar Fernández-de-Las-Peñas
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain.
| | | | - Jesús Sánchez-Gutiérrez
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Maxillo-Facial Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | - José L Arias-Buría
- Oficial Máster in Cranio-Mandibular Disorders and Orofacial Pain, Universidad San-Pablo CEU, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), Alcorcón, Madrid, Spain; Baylor University Doctoral Program in Physical Therapy, Waco, TX, USA
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Nozad Mojaver Y, Tawadros PB, Moura Ferreira P, Whittle T, Murray GM. Single motor units from the medial pterygoid muscle can be active during isometric horizontal and vertical forces. J Oral Rehabil 2019; 46:998-1008. [PMID: 31206789 DOI: 10.1111/joor.12831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/30/2019] [Accepted: 06/09/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To determine (a) whether the medial pterygoid muscle is active in an isometric vertical force task and in isometric horizontal force tasks in the contralateral, protrusion and ipsilateral directions; (b) whether the same single motor units (SMUs) could be active across different directions of isometric force generation; and (c) whether different regions of the medial pterygoid muscle exhibit different patterns of SMU activation during the generation of any one direction of isometric force. METHODS Intramuscular electromyographic (EMG) recordings were made from the right medial pterygoid muscle in 15 healthy participants during isometric force tasks: vertical and horizontal contralateral, protrusion and ipsilateral. A computed tomography scan divided the EMG recording site into a medial or lateral part in each participant. Single motor units were discriminated in each task. RESULTS Medial pterygoid SMU activity was recorded in 100% of participants for the vertical biting tasks, 86% of participants for the horizontal contralateral and horizontal protrusion tasks and 57% of the horizontal ipsilateral tasks. Of the 72 SMUs that were discriminated, 36% were active in all tasks; 18% were active only in the vertical tasks and 17% were active in the vertical, horizontal contralateral and horizontal protrusion tasks. The proportion of SMUs that was active in at least 1 horizontal task in the lateral part (33/39) was significantly higher than the proportion (21/33) in the medial part (Chi-Square, P < 0.05). CONCLUSION The data are consistent with a stabilisation role for the medial pterygoid muscle in isometric jaw forces in the vertical and horizontal planes.
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Affiliation(s)
- Yalda Nozad Mojaver
- Jaw Function and Orofacial Pain Research Unit, Sydney Dental School, Faculty of Medicine and Health, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Paul B Tawadros
- Jaw Function and Orofacial Pain Research Unit, Sydney Dental School, Faculty of Medicine and Health, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Polyana Moura Ferreira
- Jaw Function and Orofacial Pain Research Unit, Sydney Dental School, Faculty of Medicine and Health, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Terry Whittle
- Jaw Function and Orofacial Pain Research Unit, Sydney Dental School, Faculty of Medicine and Health, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, New South Wales, Australia
| | - Greg M Murray
- Jaw Function and Orofacial Pain Research Unit, Sydney Dental School, Faculty of Medicine and Health, Westmead Hospital Centre for Oral Health, The University of Sydney, Westmead, New South Wales, Australia
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