Surgical Intervention for Masticatory Muscle Tendon-Aponeurosis Hyperplasia Based on the Diagnosis Using the Four-Dimensional Muscle Model.
Surgical Intervention for Masticatory Muscle Tendon-Aponeurosis Hyperplasia Based on the Diagnosis Using the Four-Dimensional Muscle Model.
复制标题
DOI：
10.1097/scs.0000000000001932
复制
发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Ogawa T
中科院分区：
文献类型：
--
作者：
Nakaoka K;Hamada Y;Nakatani H;Shigeta Y;Hirai S;Ikawa T;Mishima A;Ogawa T
咀嚼肌腱-腱膜增生症（MMTAH）的手术靶点是咬肌或颞肌。在我们的临床中，四维肌肉模型（4DMM）已被用来决定我们是否应该接近咬肌或颞肌。本研究的目的是根据手术结果验证4DMM的临床有效性。4DMM由患者的3D-CT数字数据和4维下颌运动数据构建。使我们能够直观地观察咀嚼肌在最大张口时的扩张率与其在闭口位时的长度相比。15例患者术前应用4DMM，2例健康志愿者作为对照组。患者组颞肌最大张口度扩张率明显小于对照组（P <0.05）。 另一方面，所有患者的咬肌扩张与对照组相同。因此，张口受限的主要原因被认为是颞肌挛缩。因此，我们在所有患者中成功地进行了双侧冠状突切除术，而没有对咬肌进行手术干预。目前的4DMM将是有价值的模式，以确定目标肌肉的手术治疗的MMTAH患者。颞肌挛缩似乎是导致张口受限的主要原因。
The surgical target of Masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) is the masseter or temporal muscle. In our clinic, the 4-dimentional muscle model (4DMM) has been used to decide if we should approach to the masseter or temporal muscle. The aim of this study is validate the clinical usefulness of 4DMM on the basis of the surgical results. The 4DMM was constructed from the digital data of 3D-CT and 4-dimentional mandibular movements of the patients. It made us to able to visually observe the expansion rate of masticatory muscles at maximum mouth opening comparing to their length at closed mouth position. Fifteen patients were applied the 4DMM before the surgical treatment and 2 healthy volunteers were enrolled as control group. The expansion rate of temporal muscle at the maximum mouth opening in the patient group was significantly less than that in the control group (P < 0.05). On the other hand, the masseter muscles of all patients were expanded as same as the control group. Therefore the main cause of limitation of mouth-opening was suggested to be a contracture of the temporal muscle. Consequently, we performed successful bilateral coronoidectomy with no surgical intervention to the masseter muscles in all patients. The present 4DMM would be valuable modality to decide the target muscle of surgical treatment for patients with MMTAH. In this pathology, contracture of the temporal muscle seems to be main cause of limited mouth opening.