Effects of Modified Osteoplastic Pterional Craniotomy on Temporal Muscle Volume and Frontal Muscle Nerve Function

Introduction Pterional craniotomy is a surgical approach frequently used in aneurysm and skull base surgery. Pterional craniotomy may lead to cosmetic and functional problems, such as eyebrow drop due to facial nerve frontal branch damage, temporal muscle atrophy, and temporomandibular joint pain. The aim was to compare the postoperative effects of our modified osteoplastic craniotomy with classical pterional craniotomy in terms of any change in volume of temporal muscle and in the degree of frontal muscle nerve damage. Materials and Methods Aneurysm cases were operated with either modified osteoplastic pterional craniotomy or free bone flap pterional craniotomy according to the surgeon's preference. Outcomes were compared in terms of temporal muscle volume and frontal muscle nerve function 6 months postoperatively. Results Preoperative temporal muscle volume in the modified osteoplastic pterional and free bone flap pterional craniotomy groups were not different (p > 0.05). However, significantly less atrophy was observed in the postoperative temporal muscle volume of the osteoplastic group compared with the classical craniotomy group (p < 0.001). In addition, when comparing frontal muscle nerve function there was less nerve damage in the modified osteoplastic pterional craniotomy group compared with the classical craniotomy group, although this did not reach significance (p > 0.05). Conclusion Modified osteoplastic pterional craniotomy significantly reduced atrophy of temporal muscle and caused proportionally less frontal muscle nerve damage compared with pterional craniotomy, although this latter outcome was not significant. These findings suggest that osteoplastic craniotomy may be a more advantageous intervention in cosmetic and functional terms compared with classical pterional craniotomy.

Role of Electro Acupuncture Therapy on Temporomandibular Joint Pain With Orofacial Myalgia Following Post Healed Unilateral Cervicofacial Burn

Background: Temporomandibular Joint (TJ) pain and orofacial myalgia (OM) are the most significant problems in physiotherapy context to treat in Cervicofacial burn (CB). However, there is a lack of clinical studies in investigating the effects of electro acupuncture therapy on TJ pain with OM following post healed CB patients.<br/> Objective: To investigate the effects of clinical and functional efficacy of electro acupuncture therapy on temporomandibular joint pain with orofacial myalgia following post healed cervicofacial burn patients.<br/> Methods: Through two block random sampling method, the eligible participants were randomized and allocated into active EAT (Active-EAT; n = 15) and placebo EAT (Placebo-EAT; n = 15) groups. The Active-EAT group received electro acupuncture therapy and the Placebo-EAT group received placebo effect with regular physiotherapy care for 4 times in a week for 4 weeks. Primary (pain intensity, pain threshold, pain frequency) and secondary (mouth opening, disability level and quality of life) measures were measured at baseline, after the 4th week, 8th week and 6 month follow up.<br/> Results: Baseline demographic and clinical attributes show homogenous presentation among the study groups (p > 0.05). After 4 weeks of treatment, and at the end of 6 months follow up, the pain intensity, 3.0 (CI 95% 2.83 to 3.16), pain threshold 18.6 (CI 95% -35.0 to -2.1), pain frequency 2.9 (CI 95% 2.54 to 3.25), mouth opening, -13.4 (CI 95% -15.1 to -11.6), disability level 12.4 (CI 95% 12.16 to 12.63), and quality of life -25.8 (CI 95% -31.0 to -20.5) showed more improvement (p < 0.001) in Active-EAT group than Placebo-EAT group.<br/> Conclusion: The reports of this study proved that, 4 weeks active electro acupuncture therapy with regular physiotherapy care has an ideal treatment protocol for temporomandibular joint pain with orofacial myalgia following post healed cervicofacial burn. This study also provided a new knowledge for physiotherapists in the field of TJ rehabilitation.