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Anastasi MR, Rizzo G, Nicita F, Bramanti A, Milardi D, Macchi V, Brunetto D, Cascone P, Arco A, Nicita A, Anastasi G, Favaloro A. Microscopic reconstruction and immunohistochemical analysis of discomalleolar ligament. Heliyon 2020; 6:e04651. [PMID: 32817892 PMCID: PMC7424222 DOI: 10.1016/j.heliyon.2020.e04651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 07/22/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
Discomalleolar ligament represents the vestiges of the primitive lateral pterygoid muscle which penetrates in the caudal end of Meckel's cartilage; during the development of newborn, the petrotympanic fissure close almost completely leaving inside the discomalleolar ligament. After entering in tympanic cavity, some fibers of the discomalleolar ligament insert to walls of cavity, other fibers continue with the lateral margin of the anterior ligament and insert in the neck of malleus; in contrast, other Authors demonstrated that discomalleolar ligament is an independent structure inserted in proximity of the neck of the malleus. Although the discomalleolar ligament can be considered as a structure of clinical importance, it is not described by anatomy textbooks. Moreover, it is likely that important correlations between temporomandibular diseases and otological symptoms exist. We have studied discomalleolar ligament submitting the specimens to the 3D volume rendering technique, light microscopy, reconstructing a wide light microscopic fields to analyze the real connection between retrodiscal connective tissue and middle ear, and immunofluorescence methods in order to analyze the consistence of ligament. We have shown two types of connections between TMJ and ear: first, with external acoustic meatus and, second, with middle ear through discomalleolar ligament. The different insertion represents a strong support in order to demonstrate that the TMJ disorders can determine variations of tension that are transmitted on the tympanic membrane provoking tinnitus in according to clinical features. Then, we propose that it is necessary to mention, also in anatomy textbook, the discomalleolar ligament as ligament distance of TMJ.
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Affiliation(s)
- Michele Runci Anastasi
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.,Department of Maxillo-Facial Surgery, "Sapienza" Università di Roma, Via del Policlinico, Roma, Italy
| | - Giuseppina Rizzo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
| | - Fabiana Nicita
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
| | | | - Demetrio Milardi
- IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy.,Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Neurosciences, University of Padova, Italy
| | - Dario Brunetto
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
| | - Piero Cascone
- Department of Maxillo-Facial Surgery, "Sapienza" Università di Roma, Via del Policlinico, Roma, Italy
| | - Alba Arco
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
| | - Arianna Nicita
- Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Giuseppe Anastasi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
| | - Angelo Favaloro
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria, 1, Messina, Italy
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Evaluation of the human petrotympanic fissure using anatomized cadaveric specimens and multi-detector CT imaging. Surg Radiol Anat 2020; 42:337-346. [DOI: 10.1007/s00276-019-02346-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 09/14/2019] [Indexed: 10/26/2022]
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Runci Anastasi M, Macchi V, Vellone V, Nastro Siniscalchi E, Anastasi G, Morra A, Porzionato A, De Caro R, De Ponte FS, Cascone P. The discomallear ligament: anatomical, microscopical, and radiologic analysis. Surg Radiol Anat 2020; 42:559-565. [PMID: 31982932 DOI: 10.1007/s00276-020-02419-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 01/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several anatomic relationships between the ear and the temporo-mandibular joint have been proposed to account for the presence of tinnitus during temporo-mandibular disorders. Among the otomandibular structures, the discomallear ligament (DML) is interposed between the malleus and the retrodiscal capsular complex. The aim of present paper was to study through dissection the frequency and morphology of DML, to characterize its type of collagen, and to evaluate the DML on routine computed tomography (CT). METHODS AND RESULTS The study has been conducted on five un-embalmed adult cadavers, and in all cases, the DML was present (100%). It was constituted mainly by fibers of collagen I, with abundant elastic fibers. On CT exams of 40 patients with no reported pathology of the ear, on axial images, a dense structure, going from the upper end of the petrotympanic fissure to the neck of the malleus, was present in all the cases. In 90%, it showed a triangular shape, in 5% a rectangular shape, and in 5% a curved course. The mean length of the antero-medial side was 2 ± 0.6 mm and that of the antero-lateral side was 1.63 ± 0.5, and the mean area was 1.29 ± 0.83 mm2. CONCLUSION The DML could represent an anatomical structure that joining the temporo-mandibular joint and the malleus may play a role in the otologic symptoms during temporo-mandibular disorders.
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Affiliation(s)
- Michele Runci Anastasi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy.
| | - Valentino Vellone
- Department of Maxillo-Facial Surgery, University of Roma La Sapienza, Rome, Italy
| | - Enrico Nastro Siniscalchi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giuseppe Anastasi
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Aldo Morra
- Section of Radiology, Euganea Medica Center, Padova, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy
| | - Francesco S De Ponte
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Piero Cascone
- Department of Maxillo-Facial Surgery, University of Roma La Sapienza, Rome, Italy
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Stevens-Sparks C, Strain GM. The canine jaw-ear connection: The malleomandibular and tympanomandibular ligaments. Anat Rec (Hoboken) 2014; 297:876-91. [PMID: 24488755 DOI: 10.1002/ar.22882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/20/2013] [Accepted: 12/19/2013] [Indexed: 11/06/2022]
Abstract
In the human, two ligaments derived from the first embryonic pharyngeal (branchial) arch that unite the mandible and temporomandibular joint (TMJ) with the middle ear have been identified as the discomalleolar ligament (DML) and sphenomandibular ligament (SML), also known as the malleomandibular ligament (MML), anterior ligament of the malleus (AML), and tympanomandibular ligament (TML). Neither of these structures has been previously described in the dog. The homologue of the human sphenomandibular ligament (SML) exists in the dog and is represented as a fibrous remnant of Meckel's cartilage. In the newborn puppy, the ligament is a true malleomandibular ligament (MML), extending from the medial mandible to the rostral process of the malleus with no intermittent attachments. In the adult dog, the ligament is entrapped within a bony passageway, likely due to the development and ossification of the tympanic bulla, making it difficult to grossly view the complete course of the ligament. The majority of the ligamentous fibers attach near the tympanic bulla in the adult dog, thus this portion of the ligament has been named the tympanomandibular ligament (TML). Those fibers of the ligament not attaching near the tympanic bulla appear to continue through a canal, located between the tympanic annulus and the surrounding tympanic bone, to become continuous with a connective tissue sheet within the cavity of the middle ear that has attachments to the malleus and incus. Tension on the adult canine TML did not result in movement of the malleus.
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Affiliation(s)
- Cathryn Stevens-Sparks
- Department of Comparative Biomedical Sciences, Louisiana State University School of Veterinary Medicine, Skip Bertman Dr., Baton Rouge, Los Angeles
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Arai H, Sato I. Anatomical study of the human discomallear ligament using cone beam computed tomography imaging and morphological observations. Okajimas Folia Anat Jpn 2012; 88:89-101. [PMID: 22519068 DOI: 10.2535/ofaj.88.89] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In the present study, the human discomallear ligament (DML) was observed in structures at both macroscopic and cone beam computed tomography levels. Assessments were made regarding the distribution of calcitonin-gene-related peptide (CGRP), protein gene-product (PGP) 9.5, and substance P (SP) of the DML based on immunohistochemical analyses of the anatomical properties of jaw movements using 27 Japanese human cadavers (mean, 79.3 +/- 8.6 years; male, 74.9 +/- 8.0; female, 82.8 +/- 7.5). The DML of the anterior region was connected to the TMJ disc. The DML of the posterior region was attached to both the head and the anterior process of the malleus through the petrotympanic fissure, which formed a narrow channel. The structure of the petrotympanic fissure through the DML was attached to the malleus, and this structure was associated with the mobility of the malleus. In the anterior and posterior parts of the disc-associated connective tissue of the DML, CGRP-, PGP9.5- and SP-positive nerve fibers were located around numerous blood vessels, a condition which may be correlated with chronic pain syndrines disorders and the auditory system.
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Affiliation(s)
- Hiroshi Arai
- Department of Anatomy, School of Dentistry at Tokyo, Nippon Dental University, 1-9-20 Fujimi Chiyoda-ku, Tokyo, 102-8159, Japan
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Şencimen M, Yalçin B, Doğan N, Varol A, Okçu K, Ozan H, Aydintuğ Y. Anatomical and functional aspects of ligaments between the malleus and the temporomandibular joint. Int J Oral Maxillofac Surg 2008; 37:943-7. [DOI: 10.1016/j.ijom.2008.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2007] [Revised: 12/27/2007] [Accepted: 07/11/2008] [Indexed: 11/17/2022]
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Classifications of tunnel-like structure of human petrotympanic fissure by cone beam CT. Surg Radiol Anat 2008; 30:323-6. [PMID: 18288438 DOI: 10.1007/s00276-008-0327-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 02/07/2008] [Indexed: 10/22/2022]
Abstract
The discomallear ligament (DML) runs through a narrow space of bony petrotympanic fissure, which joins the articular disc of the temporomandibular joint (TMJ) and the malleus in the tympanic cavity. Previous report suggest that an anatomical feature gives rise to TMJ pain and dysfunction. Recently, the movement of the malleus caused by hypertension on the discomallear ligament is important to the function of the TMJ. The purpose of this study is to define its morphological features using the cone beam CT (CBCT) and anatomical dissection of Japanese cadavers. Petrotympanic fissure and DML were observed in 14 cadavers (eight males and six females). It is revealed that a wide tunnel-like structure was found on CBCT images in the middle region of the petrotympanic fissure to the malleus in the tympanic cavity consisting of mainly three types: a wide tunnel-shaped structure (29.2%, 7/24, type 1), a tunnel-shaped structure widely open in the entrance of the petrotympanic fissure to the mandibular fossa and gradually thinning out in the tympanic cavity (20.8%, 5/24, type 2), and a tunnel-shaped structure widely open in the entrance of the mandibular fossa, middle region with flat-shaped tunnel structure and narrow exit in the tympanic cavity (41.7%, 10/24, type 3). These structures between the entrance of the petrotympanic fissure and the exit at the tympanic cavity are important to define the limited movement of the malleus. Therefore, morphological feature of the ligaments in malleus may relate to TMJ pain, dysfunction and hearing function.
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Cheng T, Gan RZ. Mechanical properties of anterior malleolar ligament from experimental measurement and material modeling analysis. Biomech Model Mechanobiol 2007; 7:387-94. [PMID: 17710457 PMCID: PMC8040535 DOI: 10.1007/s10237-007-0094-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2007] [Accepted: 07/11/2007] [Indexed: 12/26/2022]
Abstract
In this paper, mechanical properties of the anterior malleolar ligament (AML) of human middle ear were studied through the uniaxial tensile, stress relaxation and failure tests. The digital image correlation (DIC) method was used to assess the boundary effect in experiments and calculate the strain on specimens. The constitutive behavior of the AML was described by a transversely isotropic hyperelastic model which consists of a first-order Ogden model augmented by a I(4)-type reinforcing term. The material parameters of the model were estimated and the viscoelasticity of the AML was illustrated by hysteresis phenomena and stress relaxation function. The mechanical strength of the AML was obtained through the failure test and the mean ultimate stress and stretch ratio were measured as 1.05 MPa and 1.51, respectively. Finally, a linear Young's modulus-stress relationship of the AML was derived based on constitutive equation of the AML within a stress range of 0-0.5 MPa.
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Affiliation(s)
- Tao Cheng
- School of Aerospace and Mechanical Engineering and Bioengineering Center, University of Oklahoma, 865 Asp Avenue, Room 200, Norman, OK 73019, USA
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