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Clinical Trial
. 2014:2014:432635.
doi: 10.1155/2014/432635. Epub 2014 May 18.

A novel method for intraoral access to the superior head of the human lateral pterygoid muscle

Aleli Tôrres Oliveira  1 , Anderson Aparecido Camilo  2 , Paulo Roberto Valle Bahia  3 , Antonio Carlos Pires Carvalho  3 , Marcos Fabio DosSantos  4 , Jorge Vicente Lopes da Silva  2 , André Antonio Monteiro  1
Affiliations
Clinical Trial

A novel method for intraoral access to the superior head of the human lateral pterygoid muscle

Aleli Tôrres Oliveira et al. Biomed Res Int. 2014.

Abstract

Background: The uncoordinated activity of the superior and inferior parts of the lateral pterygoid muscle (LPM) has been suggested to be one of the causes of temporomandibular joint (TMJ) disc displacement. A therapy for this muscle disorder is the injection of botulinum toxin (BTX), of the LPM. However, there is a potential risk of side effects with the injection guide methods currently available. In addition, they do not permit appropriate differentiation between the two bellies of the muscle. Herein, a novel method is presented to provide intraoral access to the superior head of the human LPM with maximal control and minimal hazards.

Methods: Computational tomography along with digital imaging software programs and rapid prototyping techniques were used to create a rapid prototyped guide to orient BTX injections in the superior LPM.

Results: The method proved to be feasible and reliable. Furthermore, when tested in one volunteer it allowed precise access to the upper head of LPM, without producing side effects.

Conclusions: The prototyped guide presented in this paper is a novel tool that provides intraoral access to the superior head of the LPM. Further studies will be necessary to test the efficacy and validate this method in a larger cohort of subjects.

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Figures

Figure 1
Figure 1
Sagittal (a), coronal (b), and axial (c) CT slices when imported into InVesalius. This software generates 3D reconstructions (d) from 2D DICOM CT or MR images.
Figure 2
Figure 2
((a)–(d)) The construction of a 3D virtual copy of the provisional guide (orange). (a) 3D reconstruction of the CT images. Notice that the mandible is slighted opened and deflected to the left side. (b) 3D model of the provisional guide (orange) articulated to the dental arches. (c) Provisional guide extracted. (d) Detailed view of the provisional guide adjusted to the upper and lower teeth.
Figure 3
Figure 3
After the segmentation of the superior LPM (green), osseous tissues, and teeth, a 3D virtual model of the permanent guide (orange) was designed and imported into the image processing software Magics STL 17.0. The region close to the junction between the middle part and the posterior two-thirds of the upper LPM was chosen to be the target area (a) and the 3D model of the definitive guide was adjusted to perfectly fit the dental arches of our subject.
Figure 4
Figure 4
A small tube was virtually built and adapted to the 3D model of the definitive guide to provide access to the superior LPM (a) and a protection was designed in stainless steel, in order to isolate the inner part of this structure (b).
Figure 5
Figure 5
The final project of the upper LPM guide (green) with the virtual needle directed to the upper LPM (green).
Figure 6
Figure 6
The rapid prototyped guide adjusted to the skull prototype.
See this image and copyright information in PMC

References

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