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Garrido LCF, Simonetti G, Saleh SO, Hojaij F, Andrade M, Jacomo AL, Akamatsu FE. Anatomical Bases of the Temporal Muscle Trigger Points. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6641346. [PMID: 38435541 PMCID: PMC10908571 DOI: 10.1155/2024/6641346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 03/05/2024]
Abstract
Method Temporal muscles of 14 adult cadavers were studied. The muscle bellies were divided into six areas, three superior (1.2 and 3) and three inferior areas (4, 5, and 6) lower, according to a Cartesian plane to analyze and describe the entry points of the branches of the deep temporal nerves into the muscle. The branching distribution was analyzed using Poisson log-linear tests with Bonferroni post hoc tests for comparison between groups (sextants) (p < 0.05). Results Deep temporal nerve entry points were found in the temporal muscle in all areas. Most of the branches were observed in areas 2 and 5, which coincide with the muscle fibers responsible for mandible elevation and related to the previously described MTPs. Fewer branches were found in areas 1 and 6, where contraction produces mandible retraction. Conclusion There is an anatomical correlation between the branching pattern of the deep temporal nerve and temporal muscle trigger points. Adequate knowledge of the innervation of the temporal muscle may help elucidate the pathophysiology of myofascial syndromes and provide a rational basis for interventional or conservative approaches and help surgeons avoid iatrogenic lesions to the deep temporal nerve lesion.
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Affiliation(s)
- Luis Carlos Fernandez Garrido
- Department of Surgery, Laboratory of Medical Research—Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Giulianna Simonetti
- Department of Surgery, Laboratory of Medical Research—Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Samir Omar Saleh
- Department of Surgery Medicine, Laboratory of Medical Research, FMUSP, São Paulo, SP, Brazil
| | - Flávio Hojaij
- Department of Surgery Medicine, Laboratory of Medical Research, FMUSP, São Paulo, SP, Brazil
| | - Mauro Andrade
- Department of Surgery, Laboratory of Medical Research—Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Alfredo Luiz Jacomo
- Department of Surgery, Laboratory of Medical Research—Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Flavia Emi Akamatsu
- Department of Surgery, Laboratory of Medical Research—Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, Brazil
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Macionis V. Neurovascular Compression-Induced Intracranial Allodynia May Be the True Nature of Migraine Headache: an Interpretative Review. Curr Pain Headache Rep 2023; 27:775-791. [PMID: 37837483 DOI: 10.1007/s11916-023-01174-7] [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] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE OF REVIEW Surgical deactivation of migraine trigger sites by extracranial neurovascular decompression has produced encouraging results and challenged previous understanding of primary headaches. However, there is a lack of in-depth discussions on the pathophysiological basis of migraine surgery. This narrative review provides interpretation of relevant literature from the perspective of compressive neuropathic etiology, pathogenesis, and pathophysiology of migraine. RECENT FINDINGS Vasodilation, which can be asymptomatic in healthy subjects, may produce compression of cranial nerves in migraineurs at both extracranial and intracranial entrapment-prone sites. This may be predetermined by inherited and acquired anatomical factors and may include double crush-type lesions. Neurovascular compression can lead to sensitization of the trigeminal pathways and resultant cephalic hypersensitivity. While descending (central) trigeminal activation is possible, symptomatic intracranial sensitization can probably only occur in subjects who develop neurovascular entrapment of cranial nerves, which can explain why migraine does not invariably afflict everyone. Nerve compression-induced focal neuroinflammation and sensitization of any cranial nerve may neurogenically spread to other cranial nerves, which can explain the clinical complexity of migraine. Trigger dose-dependent alternating intensity of sensitization and its synchrony with cyclic central neural activities, including asymmetric nasal vasomotor oscillations, may explain the laterality and phasic nature of migraine pain. Intracranial allodynia, i.e., pain sensation upon non-painful stimulation, may better explain migraine pain than merely nociceptive mechanisms, because migraine cannot be associated with considerable intracranial structural changes and consequent painful stimuli. Understanding migraine as an intracranial allodynia could stimulate research aimed at elucidating the possible neuropathic compressive etiology of migraine and other primary headaches.
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Ziembicki T. Nerve entry points - The anatomy beneath trigger points. J Bodyw Mov Ther 2023; 35:121-123. [PMID: 37330756 DOI: 10.1016/j.jbmt.2023.04.083] [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: 08/23/2021] [Revised: 03/12/2023] [Accepted: 04/22/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION Myofascial trigger points (MTrPs) have been the subject of considerable scientific research for almost forty years. In their seminal paper, Travell and Simons described a model based on the presence of highly irritable, palpable nodules within taut bands of muscle. Since then, a significant number of studies have increased our understanding of the phenomenon, which has, in turn, resulted in refutation of the original model. Alternative models have explained certain properties of MTrP but fail to provide an explanation of their spatial distribution. The aim of this paper was to propose a hypothesis connecting MTrPs and distinct points along the course of the nerve called nerve entry points (NEPs). A literature review was performed in order to identify studies to support hypothesis development. METHODS Literature search of digital databases. RESULTS A total of 4631 abstracts were screened; 72 were selected for further review. Four articles made a direct connection between MTrPs and NEPs. Another fifteen articles provided high-quality data regarding the distribution of NEPs, thus strengthening the hypothesis. CONCLUSIONS There is sufficient evidence to hypothesise that NEPs are the anatomical basis for MTrPs. This presented hypothesis addresses one of the crucial issues in diagnosing trigger points, which is the lack of repeatable and reliable diagnostic criteria. By connecting subjective phenomenon of trigger points with objective anatomy, this paper provides a novel and practical foundation for identifying and treating pain conditions associated with MTrPs.
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Procópio Pinheiro R, Gaubeur MA, Itezerote AM, Saleh SO, Hojaij F, Andrade M, Jacomo AL, Akamatsu FE. Anatomical Study of the Innervation of the Masseter Muscle and Its Correlation with Myofascial Trigger Points. J Pain Res 2020; 13:3217-3226. [PMID: 33299345 PMCID: PMC7719441 DOI: 10.2147/jpr.s265717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/21/2020] [Indexed: 01/17/2023] Open
Abstract
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.
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Affiliation(s)
- Roberto Procópio Pinheiro
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Matheus Aquesta Gaubeur
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Ana Maria Itezerote
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Samir Omar Saleh
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Flávio Hojaij
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Mauro Andrade
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Alfredo Luiz Jacomo
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
| | - Flávia Emi Akamatsu
- Department of Surgery, Laboratory of Medical Research-Division of Human Structural Topography, Faculty of Medicine of the University of São Paulo (FMUSP), São Paulo, SP, 01246903, Brazil
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