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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (3): 571-578. doi: 10.19723/j.issn.1671-167X.2019.03.029

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Application of digital mandibular movement record and masticatory muscle electromyography in the evaluation of stomatognathic function in patients with mandibular tumor

Jing WANG,Jun-peng CHEN,Yang WANG,Xiang-liang XU,Chuan-bin GUO△()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2019-03-18 Online:2019-05-10 Published:2019-06-26
  • Supported by:
    Supported by the Fundamental Research Funds for the Central Universities: Peking University Clinical Scientist Program (BMU2019LCKCJ009) and Youth Fund of Peking University School and Hospital of Stomatology (PKUSS20180202)

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Abstract: Objective: To study the clinical characteristics of mandibular movement and masticatory muscle function in preoperative and postoperative patients with unilateral mandibular tumors in the region of mandibular body and ramus by combining digital mandibular movement records with electromyography, and to preliminarily explore the relationship and mechanism between movement and masticatory muscle function.Methods: Six preoperative patients with tumor in unilateral body and ramus of mandible were included, and three postoperative patients with unilateral segmental resection and reconstruction of mandibular bone were included. The mandibular movement recording system and surface electromyography system were used to collect the movement trajectory of the patients’ mandibular marginal movement and chewing movement, and the surface electromyography of bilateral masseter and temporalis was recorded concurrently. The surface electromyography of bilateral masseter and temporalis was collected when the patients were at relaxation and at maximal voluntary clenching (MVC). The motion trajectory was observed on the digital virtual model, and the motion amplitude and direction of mandibular marginal movements were analyzed. The characteristics of masticatory electromyogram (EMG) activity in affected and unaffected sides at relaxation, MVC and bilateral mastication were analyzed, and the asymmetry indexes and activity indexes were calculated. Results: The preoperative mean maximum opening of the patients was (35.20±6.87) mm. Three patients had mild mouth opening limitation, and all the patients’ mouth opening trajectory was skewed to the affected side. During lateral movements, the mean range of motion of the affected side [(10.34±1.27) mm] and that of the healthy side [(6.94±2.41) mm] were significantly different. The maximum opening of the postoperative patients was (30.65±17.32) mm, and the mandibular marginal movement characteristics were consistent with those of the patients before surgery. During MVC in the preoperative patients, the median EMG activities of the masseter muscle [44.20 (5.70, 197.90) μV] and the temporalis muscle [42.15 (22.90, 155.00) μV] on the affected side were slightly lower than those of the masseter [45.60 (7.50, 235.40) μV] and the temporalis muscle [63.30 (44.10, 126.70) μV] on the healthy side. In the postoperative patients, individualized changes occurred. Some patients suffered from weakened electromyographic activity on the affected side, while some other ones showed hyperelectromyographic activity on the affected side.Conclusion: Both benign and malignant tumors as well as their surgery can cause abnormal mandibular movements and change of electromyographic activity of bilateral masseter and temporalis muscles.

Key words: Mandibular movement, Electromyography, Head and neck tumor, Rehabilitation and reconstruction, Masticatory muscle

CLC Number: 

  • R782.13

Figure 1

Installation of Zebris jaw movement record system"

Figure 2

The virtual visualization model of mandibular movement"

Table 1

Demographic data of preoperative mandibular tumor patients"

No. Gender Age/years Diagnosis Benign/
malignant		 Tumor range Muscle involved
1 F 64 Gingival SCC M Right second premolar to middle ramus Part of temporalis and medial pterygoid
2 F 18 Right mandibular fibrosis B Right second premolar to middle ramus None
3 F 57 AME B Right first molar to upper ramus Part of temporalis
4 F 73 Gingival SCC M Left first premolar to middle ramus Part of masseter and temporalis
5 M 55 AME B Right first molar to sigmoid notch Part of masseter and temporalis
6 F 22 AME B Right first molar to condylar neck Part of masseter and medial pterygoid

Table 2

Demographic data of reconstructed mandibular tumor patients"

No. Gender Age/
years		 Diagnosis Postoperation
time		 Osteotomy range Muscle involved Reconstruction
method
7 M 24 AME 17 months Right lateral incisor to right condylar neck Part of the masseter, temporalis and medial pterygoid, lateral pterygoid Fibula free flap
8 M 33 AME 9 months Right central incisor to right mandibular angle Part of the masseter, medial pterygoid Iliac crest free flap
9 M 38 AME 10 months Left canine to left condylar neck Part of the masseter, temporalis and medial pterygoid Fibula free flap

Figure 3

Trajectory of the incisal point during maximum opening A,coronal view; B, sagittal view; C, axial view; H, head; F, foot; R, right; L, left; Po, posterior; An, anterior; O, initiation point."

Figure 4

Activity index change from relax to maximal voluntary clenching EMG,electromyography; MVC, maximal voluntary clenching."

Figure 5

Electromyography of both masseter muscle and temporalis muscle during chewing gum on the healthy side and the affected side in postoperative patient no. 8 Right mandibular bone of the patient was the affected side. A, EMG of TL; B, EMG of ML; C, EMG of MR; D, EMG of TR; TL, left temporalis; ML, left masseter; MR, right masseter; TR, right temporalis; L, chewing on left side; R, chewing on right side; EMG, electromyography."

Table 3

Analysis of electromyogram of masticatory muscles"

Muscle and kinetics Preoperative/μV, median (min, max) Postoperative/μV, median (min, max)
Relax
UM 3.90 (2.30, 7.60) 8.00 (5.60, 11.00)
AM 4.50 (2.00, 5.70) 5.20 (4.90, 6.00)
UT 8.15 (4.10, 21.80) 5.60 (3.20, 7.80)
AT 9.85 (5.80, 59.20) 5.90 (5.90, 7.00)
MVC
UM 45.60 (7.50, 235.40) 77.80 (53.50, 95.00)
AM 44.20 (5.70, 197.90) 65.20 (13.70, 103.90)
UT 63.30 (44.10, 126.70) 34.90 (28.80, 165.60)
AT 42.15 (22.90, 155.00) 19.90 (13.90, 371.80)

Table 4

Index table of asymmetric muscle activity"

Patients Total asymmetry index Masseter asymmetry index Temporalis asymmetry index Activity index
Relax
1 -0.08 -0.04 -0.10 -0.38
2 -0.61 0.14 -0.75 -0.67
3 -0.18 0.07 -0.20 -0.85
4 -0.15 -0.14 -0.16 -0.18
5 0.13 -0.16 0.24 -0.47
6 -0.14 0.07 -0.31 -0.07
7 0.07 0.14 -0.03 0.10
8 0.14 0.38 -0.30 0.27
9 0.05 0.04 0.05 -0.16
MVC
1 0.15 0.01 0.32 0.11
2 -0.26 0.02 -0.41 -0.31
3 0.32 0.43 0.24 -0.19
4 0.12 0.28 -0.10 0.13
5 -0.12 -0.23 0.17 0.45
6 0.48 0.14 0.51 -0.82
7 0.24 0.19 0.43 0.53
8 0.52 0.70 0.18 0.31
9 -0.37 -0.32 -0.38 -0.55
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