Standardization of the ultrasound examination of the masseter muscle with size-independent calculation of records

Abstract

Background. As ultrasonography provides objective parameters and values, it is a reliable method of examining the structure and dimensions of the masseter muscle. Although the method is well known, there is no standardization in clinical examination and data analysis yet. Objectives. The study aimed to measure masseter muscle thickness in designated areas to establish the most repeatable and clinically applicable method of ultrasound examination, and to assess differences in measurements in designated areas for clinical purposes by devising the size-independent parameter. The size-independent parameter may potentially be more clinically applicable than distance records, which are affected by the size of the subject. Materials and methods. An ultrasound examination of 124 masseter muscles was performed. Axial examination in 3 horizontal regions (lower, middle and upper) and coronal examination in 2 vertical regions (proximal and distal) was carried out. Masseter muscle thickness was measured in every designated area when relaxed (muscle at rest (RMT)) and with clenched teeth (contracted muscle (CMT)). A morphological independent functional index of thickness difference (FITD) was calculated. Results. The study revealed very high statistical differences between RMT and CMT (p < 0.0001) in all designated areas but with location variations. Masseter muscle thickness significantly differed depending on the examined area and transducer projection. Conclusions. The ultrasound study showed that masseter muscle thickness significantly differs depending on the examined area. The authors emphasize the necessity to examine the masseter muscle in specified areas with both coronal and axial projections to achieve objective and repeatable examination. Notable clinical value is assigned to FITD, which is independent from the morphological dimensions of the muscle.