Renske I Wadman1, H Willemijn van Bruggen1, Theo D Witkamp1, Stanimira I Sparreboom-Kalaykova1, Marloes Stam1, Leonard H van den Berg1, Michel H Steenks1, W Ludo van der Pol2. 1. From the Department of Neurology and Neurosurgery and Spieren voor Spieren Kindercentrum and Brain Center Rudolf Magnus (R.I.W., M.S., L.H.v.d.B., W.L.v.d.P.), Department of Oromaxillofacial Surgery and Special Dental Care (H.W.v.B.), and Department of Radiology (T.D.W.), University Medical Center Utrecht, the Netherlands; Radboud University Medical Center (H.W.v.B., S.I.S.-K., M.H.S.), Nijmegen, the Netherlands; and Center for Evidence Based Practice (H.W.v.B., S.I.S.-K., M.H.S.), Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Nijmegen, the Netherlands. 2. From the Department of Neurology and Neurosurgery and Spieren voor Spieren Kindercentrum and Brain Center Rudolf Magnus (R.I.W., M.S., L.H.v.d.B., W.L.v.d.P.), Department of Oromaxillofacial Surgery and Special Dental Care (H.W.v.B.), and Department of Radiology (T.D.W.), University Medical Center Utrecht, the Netherlands; Radboud University Medical Center (H.W.v.B., S.I.S.-K., M.H.S.), Nijmegen, the Netherlands; and Center for Evidence Based Practice (H.W.v.B., S.I.S.-K., M.H.S.), Department of Oral Function and Prosthetic Dentistry, College of Dental Sciences, Nijmegen, the Netherlands. W.L.vanderPol@umcutrecht.nl.
Abstract
OBJECTIVE: We performed a study in patients with proximal spinal muscular atrophy (SMA) to determine the prevalence of reduced maximal mouth opening (MMO) and its association with dysphagia as a reflection of bulbar dysfunction and visualized the underlying mechanisms using MRI. METHODS: We performed a cross-sectional study of MMO in 145 patients with SMA types 1-4 and 119 healthy controls and used MRI in 12 patients to visualize mandibular condylar shape and sliding and the anatomy of muscle groups relevant for mouth opening and closing. We analyzed associations of reduced MMO with SMA severity and complaints of dysphagia. RESULTS: Reduced MMO was defined as an interincisal distance ≤ 35 mm and was found in none of the healthy controls and in 100%, 79%, 50%, and 7% of patients with SMA types 1, 2, 3a, and 3b/4, respectively. MRI showed severe fatty degeneration of the lateral pterygoid muscles that mediate mouth opening by allowing mandibular condylar sliding but relatively mild involvement of the mouth closing muscles in patients with reduced MMO. Reduced MMO was associated with SMA type, age, muscle weakness, and dysphagia (p < 0.05). CONCLUSIONS: Reduced MMO is common in SMA types 1-3a and is mainly caused by fatty degeneration of specific mouth opening muscles. Reduced MMO is a sign of bulbar dysfunction in SMA.
OBJECTIVE: We performed a study in patients with proximal spinal muscular atrophy (SMA) to determine the prevalence of reduced maximal mouth opening (MMO) and its association with dysphagia as a reflection of bulbar dysfunction and visualized the underlying mechanisms using MRI. METHODS: We performed a cross-sectional study of MMO in 145 patients with SMA types 1-4 and 119 healthy controls and used MRI in 12 patients to visualize mandibular condylar shape and sliding and the anatomy of muscle groups relevant for mouth opening and closing. We analyzed associations of reduced MMO with SMA severity and complaints of dysphagia. RESULTS: Reduced MMO was defined as an interincisal distance ≤ 35 mm and was found in none of the healthy controls and in 100%, 79%, 50%, and 7% of patients with SMA types 1, 2, 3a, and 3b/4, respectively. MRI showed severe fatty degeneration of the lateral pterygoid muscles that mediate mouth opening by allowing mandibular condylar sliding but relatively mild involvement of the mouth closing muscles in patients with reduced MMO. Reduced MMO was associated with SMA type, age, muscle weakness, and dysphagia (p < 0.05). CONCLUSIONS: Reduced MMO is common in SMA types 1-3a and is mainly caused by fatty degeneration of specific mouth opening muscles. Reduced MMO is a sign of bulbar dysfunction in SMA.
Authors: Tina Duong; Connie Wolford; Michael P McDermott; Chelsea E Macpherson; Amy Pasternak; Allan M Glanzman; William B Martens; Elizabeth Kichula; Basil T Darras; Darryl C De Vivo; Zarazuela Zolkipli-Cunningham; Richard S Finkel; Michael Zeineh; Max Wintermark; Jacinda Sampson; Katharine A Hagerman; Sally Dunaway Young; John W Day Journal: Neurol Clin Pract Date: 2021-06
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