Quantitative evaluation of masseter muscle stiffness in patients with temporomandibular disorders using shear wave elastography

Abstract

Purpose: The aim of this study was to quantify masseter muscle stiffness in patients with masticatory myofascial pain.

Methods: Stiffness was measured using shear wave elastography, which expresses stiffness as shear wave velocity (Vs). A phantom study was conducted to confirm the reliability of the measuring device. The study participants were 26 females with bilateral masseter muscle pain who were classified into either Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) group Ia (myofascial pain; n=13) or RDC/TMD group Ib (myofascial pain with limited opening; n=13). Healthy controls consisted of 24 female volunteers with normal teeth and jaws, who were not classified into groups I/II/III by RDC/TMD.

Results: Muscle stiffness was 1.96m/s (12.5kPa) in 13 patients in group Ia, 2.00m/s (13.0kPa) in 13 patients in group Ib and 1.27m/s (5.25kPa) in 24 control subjects. Vs was significantly greater in groups Ia and Ib than in the control group (p<0.05). Characteristic pain intensity (CPI) became clear as an independent factor impacting Vs (partial regression coefficient=0.714; multiple regression analysis , p<0.05). Masseter muscle stiffness was positively correlated with CPI (p< 0.05) and negatively correlated with maximum assisted mouth opening (p<0.05) and painless mouth opening (p<0.05).

Conclusion: Shear wave elastography is useful to quantify masticatory muscle stiffness. Masseter muscle stiffness of females measured using shear wave elastography was about two-fold greater in group Ia and Ib than in the healthy control group.

Keywords: Masseter muscle; Masticatory myofascial pain; Shear wave elastography; Stiffness; Temporomandibular disorders.