Randomized clinical trial of the effects of azithromycin use in the treatment of peri-implantitis

BACKGROUND

The aim of this clinical trial was to establish a proof of concept that the adjunctive use of systemic azithromycin (AZM) in conjunction with mechanical debridement has an increased benefit in reducing soft tissue inflammation in the treatment of peri-implantitis.

METHODS

In a randomized, double-blind, clinical trial, the treatment group (nine patients) received AZM as well as mechanical debridement in a single course of treatment, whereas the control group (eight patients) received a placebo and mechanical debridement. The primary outcome variables studied were bleeding on probing, suppuration, pocket probing depth and gingival recession. The secondary variables studied were gingival index, plaque index, microbiological and interleukin-1β status. The observation period was 6 months.

RESULTS

Over the 6 months' observation period, the treatment patients showed a consistently greater reduction of gingival inflammation and an improvement in soft tissue healing than the control patients.

CONCLUSIONS

The adjunctive use of a single course of systemic azithromycin can assist in the control of peri-implant mucositis in the treatment of peri-implantitis.

The medial pterygoid muscle: a stabiliser of horizontal jaw movement

There is limited information of the normal function of the human medial pterygoid muscle (MPt). The aims were to determine whether (i) the MPt is active throughout horizontal jaw movements with the teeth apart and (ii) whether single motor units (SMUs) are active during horizontal and opening-closing jaw movements. Intramuscular electrodes were placed in the right MPt of 18 participants who performed five teeth-apart tasks: (i) postural position, (ii) ipsilateral (i.e. right) jaw movement, (iii) contralateral movement, (iv) protrusive movement and (v) opening-closing movement. Movement tasks were guided by a target and were divided into BEFORE, OUT, HOLDING, RETURN and AFTER phases according to the movement trajectories recorded by a jaw tracking system. Increased EMG activity was consistently found in the OUT, HOLDING and RETURN phases of the contralateral and protrusive movement tasks. An increased RETURN phase activity in the ipsilateral task indicates an important role for the MPt in the contralateral force vector. Of the 14 SMUs active in the opening-closing task, 64% were also active in at least one horizontal task. There were tonically active SMUs at the postural jaw position in 44% of participants. These new data point to an important role for the MPt in the fine control of low forces as required for stabilisation of vertical mandibular position not only to maintain postural position, but also throughout horizontal jaw movements with the teeth apart. These findings provide baseline information for future investigations of the possible role of this muscle in oro-facial pain conditions.

Functional Activity of Superior Head of Human Lateral Pterygoid Muscle during Isometric Force

There is controversy as to the jaw tasks for which the superior head of the human lateral pterygoid muscle (SHLP) becomes active. The aim was to describe the functional activities of SHLP single motor units (SMUs) during horizontal isometric force tasks. In 11 subjects, 48 SMUs were recorded from computer-tomography-verified SHLP sites during generation of horizontal isometric force in the contralateral (CL), protrusive (P), and ipsilateral (IL) directions and intermediate directions (CL-P, IL-P). In eight subjects, SHLP SMUs were active in CL, CL-P, and P. Qualitatively, SHLP EMG activity increased with increased isometric force. Forty-two SMUs were active in directions other than IL; 6 exhibited activity at IL and other directions. The similarity of these data to previous human lateral pterygoid (IHLP) data supports the notion that SHLP and IHLP should be regarded as a single muscle, with activities shaded according to the biomechanical demands of the task.

Effect of experimental anterior temporalis muscle pain on jaw movements

To test the hypotheses that experimental noxious stimulation of the anterior temporalis muscle results in significant decreases in jaw movement amplitude and velocity, and there are significant correlations between scores of mood or pain-related cognitions and amplitude and velocity. The jaw movements of 14 asymptomatic participants were recorded during standardised open/close jaw movements and free and standardised chewing tasks. Tonic infusion of hypertonic saline into the right anterior temporalis muscle maintained pain intensity between 40 and 60 mm on a 100-mm visual analogue scale. Tasks were performed in a single session in the following sequence: baseline condition, test 1 condition (during hypertonic or isotonic saline infusion), test 2 condition (during saline infusion) (10-min rest between conditions). Participants completed the Depression, Anxiety and Stress Scale (DASS-21) and the Pain Catastrophizing Scale (PCS). Amplitude and velocity of opening and closing were compared between conditions with a repeated-measures analysis of variance (anova), and Spearman's rank correlation coefficient explored correlations; statistical significance: P < 0·05. For any of the three tasks, there were no significant differences in kinematic variables between any condition and no significant correlations between DASS-21 or PCS scores and kinematic variables during hypertonic saline infusion. The absence of a significant reduction in velocity or amplitude of open/close or chewing jaw movements during experimental temporalis muscle pain is not consistent with the Pain Adaptation Model proposing decreases in kinematic measures in pain. The lack of significant correlations between psychological variables and measures of jaw movement may reflect the low scores reported by our study sample.

An investigation of risk factors associated with tooth surface loss: a pilot study

Few prospective studies have investigated risk factors associated with severe tooth surface loss. This case-control study assessed the possible association between medical history, diet, psychological profile and salivary pH and flow [Delongis 1982, Johansson 1993] with the incidence of severe tooth surface loss. A total of 80 subjects (40 cases and 40 age- and gender-matched controls) aged 25-85 years were recruited. Cases were subjects with severe tooth surface loss, and controls with mild tooth surface loss. Conditional logistic regression analysis estimated the odds of severe tooth surface loss to be 15·4 times higher for those with cardiovascular disease and 16 times for gastrointestinal disturbances. Most domains of the psychological profile were associated with elevated risk of severe tooth surface loss, particularly the effects of finance and health. Recreational drug use and prescription medications were also associated with severe tooth surface loss. There was no association between salivary flow and severe tooth surface loss. Although not statistically significant, the pH was slightly lower in the severe tooth surface loss group.

Isotonic resistance jaw exercise alters jaw muscle coordination during jaw movements

The aim was to investigate the effects of isotonic resistance exercise on the electro-myographic (EMG) activity of the jaw muscles during standardised jaw movements. In 12 asymptomatic adults surface EMG activity was recorded from the anterior temporalis and masseter muscles bilaterally and the right anterior digastric muscle during right lateral jaw movements that tracked a target. Participants were randomly assigned to a Control group or an Exercise group. Jaw movement and EMG activity were collected (i) at baseline, before the exercise task (pre-exercise); (ii) immediately after the exercise task (isotonic resistance at 60% MVC against right lateral jaw movements); (iii) after 4 weeks of a home-based exercise programme; and, (iv) at 8-weeks follow-up. There were no significant within-subject or between-group differences in the velocity and amplitude of the right lateral jaw movements either within or between data collection sessions (P > 0.05). However, over the 8 weeks of the study, three of the tested EMG variables (EMG Duration, Time to Peak EMG from EMG Onset, and Time to Peak EMG activity relative to Movement Onset) showed significant (P < 0.05) differences in the five tested muscles. Many of the significant changes occurred in the Control group, while the Exercise group tended to maintain the majority of the tested variables at pre-exercise baseline values. The data suggest a level of variability between recording sessions in the recruitment patterns of some of the muscles of mastication for the production of the same right lateral jaw movement and that isotonic resistance exercise may reduce this variability.

Masseter Motor Unit Recruitment is Altered in Experimental Jaw Muscle Pain

Some management strategies for chronic orofacial pain are influenced by models ( e.g., Vicious Cycle Theory, Pain Adaptation Model) proposing either excitation or inhibition within a painful muscle. The aim of this study was to determine if experimental painful stimulation of the masseter muscle resulted in only increases or only decreases in masseter activity. Recordings of single-motor-unit (SMU, basic functional unit of muscle) activity were made from the right masseters of 10 asymptomatic participants during biting trials at the same force level and direction under infusion into the masseter of isotonic saline (no-pain condition), and in another block of biting trials on the same day, with 5% hypertonic saline (pain condition). Of the 36 SMUs studied, 2 SMUs exhibited a significant ( p < 0.05) increase, 5 a significant decrease, and 14 no significant change in firing rate during pain. Five units were present only during the no-pain block and 10 units during the pain block only. The findings suggest that, rather than only excitation or only inhibition within a painful muscle, a re-organization of activity occurs, with increases and decreases occurring within the painful muscle. This suggests the need to re-assess management strategies based on models that propose uniform effects of pain on motor activity.

A working-side change to lateral tooth guidance increases lateral pterygoid muscle activity

The inferior head of lateral pterygoid (IHLP) is thought to play a critical role in the generation and control of lateral jaw movements.

AIM

The aim was to test the hypothesis that a change to the lateral tooth guidance (working-side occlusal alteration, OA) results in a significant change in the electromyographic (EMG) activity of the IHLP during standardised lateral jaw movements (laterotrusion) tracked by a jaw-tracking system.

METHODS

Ten trials of right laterotrusion were repeated under: control 1 (before occlusal alteration), OA (after occlusal alteration placement), and control 2 (after occlusal alteration removal) conditions in 14 subjects while recording left IHLP, bilateral anterior and posterior temporalis, masseter and submandibular muscles.

RESULTS

IHLP activity was significantly (p<0.05) increased with the occlusal alteration during the outgoing (movement from intercuspal position to approximately 5mm right) and return phases of laterotrusion. The other muscles demonstrated no change or a significant decrease in activity.

CONCLUSIONS

These findings suggest that a change to the occlusion on the working-side in the form of a steeper guidance necessitates an increase in IHLP activity to move the mandible down the steeper guidance. It must be emphasised that these data cannot be used as justification for occlusal therapy.

The influence of the leaf gauge and anterior jig on jaw muscle electromyography and condylar head displacement: a pilot study

BACKGROUND

A leaf gauge and an anterior jig may be used to assist the recording of a reproducible jaw position for restorative and prosthodontic treatment. This study investigated possible condylar displacement using an opto-electronic jaw-tracking device and a leaf gauge or anterior jig. The effect of a leaf gauge and anterior jig on jaw muscle electromyography was also examined.

METHODS

Five healthy adults without symptoms of temporomandibular disorders were selected. Condylar displacement during clenching were recorded simultaneously with electromyographic activity of superior and inferior heads of the lateral pterygoid, anterior and posterior temporalis, masseter, and suprahyoid muscles. Subjects were trained to bite at maximum and half-maximum bite-force using an anterior jig incorporating a force transducer.

RESULTS

No consistent condylar displacement was observed in x, y and z axes between different bite-forces although there was a trend towards superior displacement. Comparison of maximum intercuspal clench and maximum clench on a leaf gauge and an anterior jig produced significant decrease in anterior temporalis activity (p < 0.05), whilst an anterior jig with maximum clench significantly decreased posterior temporalis muscle activity.

CONCLUSION

Within the limits of this pilot study, no consistent change in condylar position was identified with these appliances.

Ipsilateral interferences and working-side condylar movements

There is limited knowledge of the effects of the occlusion on temporomandibular joint function.

AIM

The aim was to investigate the influence of a working-side occlusal alteration (OA, i.e. interference) on trajectories of working-side condylar points during standardized lateral jaw movements (laterotrusion) tracked by a jaw-tracking system.

METHODS

Ten trials of right laterotrusion were repeated under: control 1 (before OA), OA (immediately after placement of a working-side interference) and control 2 (immediately after removal of OA) conditions.

RESULTS

During right jaw movement, the paths of the working-side condylar points under OA were significantly more inferior and anterior to those under control at the same amount of mid-incisor-point displacement from the intercuspal position. The OA significantly reduced the rotation of the mandible about the antero-posterior and supero-inferior axes and significantly increased the opening angle. Controls 1 and 2 were not significantly different.

CONCLUSIONS

A working-side interference has an immediate, significant effect on working-side condylar movement.

Activity of inferior head of human lateral pterygoid muscle during standardized lateral jaw movements

OBJECTIVE

(a) To describe the changes in electromyographic (EMG) activity from selected jaw muscles during a standardized lateral jaw movement with the teeth together, and (b) to investigate the effects on jaw muscle activity of changes in both the rate of lateral jaw movement and the relative magnitude of jaw-closing force.

DESIGN

In 16 healthy volunteers, recordings were made using a jaw-tracking system, of mid-incisor point (MIPT) movements, as well as EMG activity from the contralateral inferior head of the lateral pterygoid muscle (IHLP), and bilateral anterior and posterior temporalis, masseter and submandibular muscles, during lateral jaw movement tasks at two speeds and two closing force levels with the teeth together.

RESULTS

The IHLP was the only muscle to show a consistent increase in activity in association with the outgoing phase of the task and a decrease during the return phase. Under high closing force at slow speed, the EMG activities of the IHLP and bilateral anterior temporalis and masseter muscles were significantly (p < 0.05) higher than those under a low closing force, while there was no significant change (p > 0.05) in bilateral posterior temporalis and submandibular muscles. The change from slow to fast lateral movement at low force did not significantly (p > 0.05) alter the mean activity except for the IHLP (increase in activity) and the contralateral anterior temporalis (decrease in activity).

CONCLUSIONS

The data suggest that the IHLP is one of the principal jaw muscles involved in a lateral jaw movement with the teeth together while the other jaw muscles may play a contributory or facilitatory role.

The human lateral pterygoid muscle: A review of some experimental aspects and possible clinical relevance

The clinical notion that some disturbance to the activity of the lateral pterygoid muscle plays a role in the aetiology of temporomandibular disorders (TMD) is still widely accepted and influences management strategies. However, there is no rigorous scientific evidence to support this clinical notion and the role of the lateral pterygoid muscle in normal function is still controversial. The classically defined functions of each head of the muscle are that the superior head is active on closing, retrusion, and ipsilateral jaw movements, while the inferior head is active on opening, protrusion and contralateral jaw movements. However, recent data indicate that these concepts are too simplistic. For example, recent evidence suggests that parts of the superior head may also be active on opening, protrusion and contralateral jaw movements, and that the superior head may consist of three mediolaterally arranged functional zones. Given these complexities, the proposal that clicking and/or locking conditions arise in the temporomandibular joint through some form of lack of co-ordination between the two heads of the muscle needs re-evaluation. Despite earlier reports to the contrary, both heads of the lateral pterygoid muscle appear to be electrically silent at the postural or resting jaw position, and therefore appear to play no role in the anteroposterior positioning of the jaw at the postural position. An important role has also been demonstrated electromyographically for progressive changes in activity in the inferior head as the direction of horizontal jaw force shifts from one side to the other. This suggests an important role for the lateral pterygoid muscle in the generation of side-to-side and protrusive jaw forces. The lateral pterygoid muscle is likely therefore to play an important role in parafunctional excursive jaw movements and also possibly a role in influencing jaw position in patients where the maxillomandibular relationship records change from session to session. The above data provide new insights into the normal function of the lateral pterygoid muscle. The proposal that the lateral pterygoid muscle plays some role in the aetiology of TMD needs now to be rigorously tested.

Minimal tonic firing rates of human lateral pterygoid single motor units

OBJECTIVE

The minimal tonic firing rates (the lowest firing rates at which motor units fire regularly; MTFR) of single motor units (SMUs) within the lateral pterygoid muscle have not been widely investigated. The aims of this study were (a) to identify MTFR of SMUs within the inferior head (IHLP) and superior head (SHLP) of the lateral pterygoid muscle during horizontal jaw movements, and (b) to determine whether these MTFR vary with movement direction.

METHODS

Twenty subjects moved the jaw to maintain SMU firing at the lowest continuous firing rate. SMU activity was recorded from computer-tomography-verified sites within the IHLP or SHLP.

RESULTS

In the IHLP, the mean (+/-SD) MTFR for contralateral movement (15.6+/-2.3 imp/s; n=22 SMUs) were not significantly different from those during protrusion (16.3+/-3.4 imp/s; n=19). In the SHLP, the mean (+/-SD) MTFR for contralateral, ipsilateral movement, and protrusion were 14.7+/-2.5 imp/s (n=10), 13.2+/-2.1 imp/s (n=8), and 16.2+/-3.7 imp/s (n=2), respectively.

CONCLUSIONS

Lateral pterygoid SMUs have greater MTFR than previously reported in the masseter and IHLP, namely 5-8 and 8-10 imp/s, respectively. The MTFR did not vary with the task within each muscle head.

SIGNIFICANCE

Some physiological properties of lateral pterygoid SMUs may be different from those in other jaw muscles.

Functional heterogeneity in the superior head of the human lateral pterygoid

The activity of the superior head of the human lateral pterygoid muscle (SHLP) is controversial. Given the non-parallel alignment of some SHLP fibers, the SHLP may be capable of differential activation. The aims were to clarify SHLP activity patterns in relation to location within SHLP. In 18 subjects, SHLP single motor units were intramuscularly recorded at computer-tomography-verified sites during horizontal (e.g., protrusion) and vertical (e.g., opening) jaw tasks (recorded by a jaw-tracking device) and at resting postural jaw position. None of 92 units was active at the resting postural position. Medially located units (21) showed activity during contralateral movement, protrusion, and opening; 5 were also active on jaw closing. There was a significant association between unit location and the number of units active during vertical tasks (i.e., jaw closing and clenching). Analysis of the data suggests differential activation within SHLP and raises the possibility of functional heterogeneity within SHLP.

The role of the human lateral pterygoid muscle in the control of horizontal jaw movements

There is a limited understanding of the normal function of the lateral pterygoid muscle (LP) and the role that this muscle plays in temporomandibular disorders. This article addresses the hypothesis that a major function of the LP is in the control of horizontal jaw movements. The range of fiber alignments suited to generating a major horizontal force vector (magnitude and direction), together with the likelihood of independent activation of subcompartments (that is, functionally heterogeneous zones) within each head, provide the possibility of a finely graded range of force vectors on the condyle to effect the fine control of horizontal jaw movements. This level of control does not appear to extend to the control of resting jaw posture, as recent single motor unit (SMU) data indicate that the LP is inactive with the jaw in the postural jaw position. Available electromyographic data demonstrate graded changes in multiunit and SMU activity with small horizontal jaw displacements at low force levels, a single preferred direction of the SMU firing rate during horizontal isometric jaw tasks, and graded changes in the SMU firing rate with horizontal force magnitude and direction. The evidence suggests that a major function of the LP is in the generation and fine control of the horizontal component of jaw movement by the graded activation of a subset of SMUs within the LP. The data also suggest that the LP is involved in the generation of horizontal force vectors, as required in parafunctional activities and heavy mastication.

Activity in the inferior head of the human lateral pterygoid muscle with different directions of isometric force

The aim was to test the hypothesis that this head of the muscle plays a part in the generation and fine control of horizontal mandibular forces in a range of directions. Electromyographic activity was recorded from the inferior head of the lateral pterygoid of eight individuals during the generation such forces to a target in contralateral, ipsilateral and protrusive directions, and in two intermediate directions (contralateral-protrusive, ipsilateral-protrusive). The mean electromyographic activity and the mean firing rates of 21 single-motor units were significantly affected by direction, with the highest activity being contralateral, and graded decreases occurring as the direction shifted to the ipsilateral. Firing rates were significantly correlated with force magnitude. The data suggest that the inferior head of the human lateral pterygoid is involved in the creation and fine control of mandibular forces in different horizontal directions.

Functional properties of single motor units in the inferior head of human lateral pterygoid muscle: task firing rates

The precise function of the inferior head of the human lateral pterygoid muscle (IHLP) is unclear. The aim of this study was to clarify the normal function of the IHLP. The hypothesis was that an important function of the IHLP is the generation and fine control of horizontal (i.e., anteroposterior and mediolateral) jaw movements. The activities of 50 single motor units (SMUs) were recorded from IHLP (14 subjects) during two- or three-step contralateral movement (n = 36) and/or protrusion (n = 33). Most recording sites were identified by computer tomography. There was a statistically significant overall increase in firing rate as the magnitude of jaw displacement increased between the holding phases (range of increments: 0.3-1.6 mm). The firing rates during the dynamic phases for each unit were significantly greater than those during the previous holding phases but less than those during the subsequent holding phases. For the contralateral step task at the intermediate rate, the cross-correlation coefficients between jaw displacement in the mediolateral axis and the mean firing rate of each unit ranged from r = 0.29 to 0.77; mean +/- SD; r = 0.49 +/- 0.13 (protrusive step task: r = 0.12-0.74, r = 0.44 +/- 0.14 for correlation with anterior-posterior axis). The correlation coefficients at the fast rate during the contralateral step task and the protrusive step task were significantly higher than those at the slow rate. The firing rate change of the SMUs per unit displacement between holding phases was significantly greater for the lower-threshold than for the higher-threshold units during contralateral movement and protrusion. After dividing IHLP into four regions, the SMUs recorded in the superior part exhibited significantly greater mean firing rate changes per unit displacement during protrusion than for the SMUs recorded in the inferior part. Significantly fewer units were related to the protrusive task in the superior-medial part. These data support previously proposed notions of functional heterogeneity within IHLP. The present findings provide further evidence for an involvement of the IHLP in the generation and fine control of horizontal jaw movements.

The role of the inferior head of the human lateral pterygoid muscle in the generation and control of horizontal mandibular force

The aim was to test the hypothesis that the inferior head (IH) of the human lateral pterygoid muscle (LP) is involved in the generation and fine control of horizontal isometric mandibular force. Although previous studies provided some evidence for this, they had limitations that necessitate a re-examination. In eight participants, electromyographic (EMG) activity was recorded from the IHLP unilaterally, as well as bilateral surface recordings from the masseter (M) and anterior temporalis (AT), and the submandibular group of muscles (SUBM), during the generation of horizontal isometric mandibular force in a direction contralateral to the side of the IHLP recording. Isometric force at 5-8 mm open from the intercuspal position was exerted on a transducer (attached by a bar to the upper teeth) by a rod attached to the lower teeth. Participants tracked a target on a video screen that required 5-s holding periods at each 100 gwt (0.98 N) between 400 gwt (3.92 N) and 800 gwt (7.84 N). The mean of multi-unit EMG activity from all muscles during the most stable 2-s force-holding periods increased significantly with each force increment (GLM repeated measures: P<0.0001). When normalized, the multi-unit data from the IHLP exhibited the steepest rate of increase. The mean firing rates of 21 IHLP single motor units (SMUs) significantly increased with force (GLM repeated measures: P<0.0001). Two SMUs fired in advance of force onset, which suggests a role in force initiation. There were close associations between fluctuations in force and in IHLP SMU firing rates and multi-unit activity, but a similar correspondence was not as clear for the other recorded jaw muscles. These findings suggest that the IHLP is important in the generation and fine control of contralaterally directed, horizontal jaw forces.

Functional properties of single motor units in inferior head of human lateral pterygoid muscle: task relations and thresholds

The aim of this study was to clarify the normal function of the inferior head of the human lateral pterygoid muscle (IHLP). The hypothesis was that an important function of the IHLP is in the fine control of horizontal jaw movements. The activities of 99 single motor units (SMUs) were recorded from IHLP (22 recordings from 16 subjects). Most recording sites were identified by computer tomography (CT). All 99 SMUs were active during contralateral jaw movements with the teeth apart, and protrusive jaw movements with the teeth apart, and 81% (48 of 59 units studied during all 3 tasks) were active during submaximal jaw-opening movements. None were active on maximal ipsilateral or retrusive jaw movements with the teeth apart nor on jaw closing/clenching in intercuspal position; nor were they spontaneously active when the jaw was at the clinically determined postural jaw position. Thresholds of SMUs ranged from <0.2 mm of contralateral or protrusive horizontal displacements to 61-89% of the maximum contralateral or protrusive displacement, respectively. For the 35 units continuously active during the contralateral task, 23 (66%) were recruited within 2 mm of contralateral displacement [25 (63% of 40 units) for protrusion]. Recruitment thresholds (mm) of some of the units were rate dependent with thresholds significantly decreasing with increasing rate of horizontal jaw movement in protrusion and contralateral movements. At eight recording sites where up to six SMUs were able to be discriminated, the average thresholds of successively recruited SMUs were within a 1-mm increment of horizontal jaw displacement. After dividing IHLP into four regions, the SMUs recorded in the superior-medial zone exhibited significantly lower mean threshold values than for the SMUs recorded in the other zones (no units were recorded in the inferior-lateral zone). This provides suggestive evidence supporting previously proposed notions of functional heterogeneity within IHLP. Taken together, the data suggest that specific regions of the IHLP are capable of selective activation in a finely controlled manner to allow the application of the appropriate force vector (magnitude and direction) to effect the required condylar movement needed for the generation and control of horizontal jaw movements.

A method for standardizing jaw displacements in the horizontal plane while recording single motor unit activity in the human lateral pterygoid muscle

The normal function of the lateral pterygoid muscle is not well understood although this muscle is thought to play an important role in the control of jaw and jaw-joint function and is implicated in temporomandibular disorders (TMD). The lack of a validated method for standardization of jaw movement in studies of lateral pterygoid function has contributed to the lack of understanding of the normal function of this muscle. An improved understanding of normal function will allow valid comparisons to be made with TMD patients in order to identify whether purported differences in activity actually exist. This paper describes a methodology for standardizing command jaw movements in the horizontal plane, together with reliable recordings of single-motor-unit (SMU) activity. In six human participants, jaw movements were standardized by having participants track a linear bank of light-emitting diodes (LEDs) aligned on a monitor displaying the mid-incisor point (MIPT). In all participants, the MIPT target (i.e. an illuminated LED) could be tracked, according to a pre-determined criterion, during single- and multiple-step displacements at different rates (1.3--6.5 mm/s at MIPT) and magnitudes (0.65--12 mm) of movement. SMU activity from the superior (SHLP) or inferior (IHLP) head of the lateral pterygoid muscle could be reliably discriminated during repeated trials of these defined tasks. This methodology establishes a reliable technique for characterizing the firing properties of SMUs within the lateral pterygoid, and has implications for analogous studies in other jaw muscles.

The effects of chemotherapy on murine wound healing and orocutaneous fistula closure

The effects of cisplatin and 5-fluorouracil on wound breaking strength and the rate of closure of an orocutaneous fistula were studied in 80 male rodents. Treatment rats received a total of 4.6 mg/kg cisplatin and 62 mg/kg 5-fluorouracil in six doses/12 days; control rats received 0.9 per cent saline. After treatment, 30 treatment and 30 control rats received a dorsal skin incision which was closed primarily. Wound breaking strength were tested at one, three and five weeks in ten rats from each group. An 8-mm orocutaneous fistula was made in the remaining ten treatment and ten control rats; the rate of closure was noted weekly. Cisplatin and 5-fluorouracil did not significantly impair wound breaking strength at one, three, or five weeks. The rate of closure of the orocutaneous fistula was not effected by cisplatin/5-fluorouracil. The chemotherapy caused severe facial cellulitis and death in four orocutaneous fistula rats. Combined chemotherapy with cisplatin and 5-fluorouracil should not interfere with planned surgical care of head and neck tumors. Concomitant antibiotic coverage, however, is advocated.

Replication of cauliflower mosaic virus DNA in leaves and suspension culture protoplasts of cotton

Cauliflower mosaic virus (CaMV) replicated in protoplasts and in inoculated leaves of the non-host, cotton (Gossypium hirsutum, L.). Protoplasts prepared from suspension-cultured cotton cells were infected by incubation with liposome-encapsulated CaMV virions. During a 1-week culture period the amount of CaMV nucleic acid as detected by nucleic acid hybridization in the protoplasts increased significantly regardless of whether or not the protoplasts contained vacuoles. In leaves inoculated with CaMV virions or CaMV DNA, viral DNA sequences were found by leaf skeleton hybridization to be located in small circular areas. DNA extracted from ultracentrifugal pellets of homogenates of inoculated leaves contained circular, gapped CaMV DNA only when inocula contained CaMV virions, CaMV DNA, or partial nested dimer CaMV plasmid DNA. When plants had been heavily watered, the CaMV DNA recovered contained degraded CaMV DNA. The results suggest that the host range limitation for CaMV is not due to an inability to replicate or spread locally in inoculated leaves.

Self-emasculation: review of the literature, report of a case and outline of the objectives of management

Self-emasculation is the end result of an unusual psychiatric disorder, which initially requires surgical treatment. Only 51 cases have been reported in the English literature since 1900. No previous attempt to preserve testicular androgen function by reimplantation or grafting has been reported. We describe an unsuccessful attempt to graft the testicles in subcutaneous thigh pockets. Microscopically, the biopsied autografts showed no viable interstitial or germinal testicular tissue. The objectives of the treatment of self-emasculation injury are restoration of anatomical and functional continuity of the urethra as a urinary channel, preservation of the capacity for sustained penile erection, preservation of testicular androgen activity, prompt psychiatric evaluation and treatment of the underlying illness, and restoration of the normal appearance of the scrotum.