Does suprahyoid muscle complex pull cause relapse following genial advancement by distraction osteogenesis? An electromyographic study


      Active pull of the suprahyoid muscle complex (SMC) was thought to be the main contributor of relapse in mandibular or chin advancement, but literature evidence lacks human studies that assess the role of the SMC following genial advancement (GeA). This study therefore aimed to analyse the influence of SMC pull on relapse following GeA by distraction osteogenesis based on electromyographic (EMG) changes. EMG was recorded and analysed preoperatively (T0), at four months (T1), and at one-year follow up (T2) at three submental regions during two different activities. The outcome variables were EMG changes of the SMC, and hard and soft tissue relapse. Assessment was carried out by comparison of EMG and lateral cephalograms taken at T0, T1, and T2. Ten patients (7 male and 3 female; median (SD) age 21.2 (3.99) years, range 18-28) were included. The EMG values revealed a statistically significant reduction between T0 and T1. T2 values were not higher than T0 during any activity. The results of Pearson’s correlation demonstrated no significant relation between the amount of relapse and change in EMG values. This study concluded that active pull of the SMC is not the actual reason for skeletal relapse in chin or mandibular advancement. Passive biomechanics such as adnexial or muscular connective tissue, and paramandibular periosteum pull with native bone remodelling might be the prime reasons for relapse. However, further large sample studies are warranted to find the actual causes of relapse.


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        • Ellis III, E.
        • Dechow P.C.
        • McNamara Jr, J.A.
        • et al.
        Advancement genioplasty with and without soft tissue pedicle: an experimental investigation.
        J Oral Maxillofac Surg. 1984; 42: 637-645
        • Wittbjer J.
        • Rune B.
        Changes of the profile after advancement genioplasty.
        Scand J Plast Reconstr Surg Hand Surg. 1989; 23: 65-70
        • Schendel S.A.
        • Epker B.N.
        Results after mandibular advancement surgery: an analysis of 87 cases.
        J Oral Surg. 1980; 38: 265-282
        • Epker B.N.
        • Wolford L.M.
        • Fish L.C.
        Mandibular deficiency syndrome. II. Surgical considerations for mandibular advancement.
        Oral Surg Oral Med Oral Pathol. 1978; 45: 349-363
        • McNeill R.W.
        • Hooley J.R.
        • Sundberg R.J.
        Skeletal relapse during intermaxillary fixation.
        J Oral Surg. 1973; 31: 212-227
        • Steinhauser E.W.
        Advancement of the mandible by sagittal ramus split and suprahyoid myotomy.
        J Oral Surg. 1973; 31: 516-521
        • Poulton D.R.
        • Ware W.H.
        Surgical-orthodontic treatment of severe mandibular retrusion.
        Am J Orthod. 1971; 59: 244-265
        • Wessberg G.A.
        • Schendel S.A.
        • Epker B.N.
        The role of suprahyoid myotomy in surgical advancement of the mandible via sagittal split ramus osteotomies.
        J Oral Maxillofac Surg. 1982; 40: 273-277
        • Ellis III, E.
        • Carlson D.S.
        Stability two years after mandibular advancement with and without suprahyoid myotomy: an experimental study.
        J Oral Maxillofac Surg. 1983; 41: 426-437
        • Carlson D.S.
        • Ellis III, E.
        • Dechow P.C.
        Adaptation of the suprahyoid muscle complex to mandibular advancement surgery.
        Am J Orthod Dentofacial Orthop. 1987; 92: 134-143
        • Reynolds S.T.
        • Ellis III, E.
        • Carlson D.S.
        Adaptation of the suprahyoid muscle complex to large mandibular advancements.
        J Oral Maxillofac Surg. 1988; 46: 1077-1085
        • Carlson D.S.
        • Ellis III, E.
        • Dechow P.C.
        • et al.
        Short-term stability and muscle adaptation after mandibular advancement surgery with and without suprahyoid myotomy in juvenile Macaca mulatta.
        Oral Surg Oral Med Oral Pathol. 1989; 68: 135-149
        • Ellis III, E.
        • Dechow P.C.
        • Carlson D.S.
        • et al.
        Electromyography of the suprahyoid musculature following mandibular advancement with and without rigid fixation.
        J Oral Maxillofac Surg. 1990; 48: 49-53
        • Widmalm S.E.
        • Lillie J.H.
        • Ash Jr., M.M.
        Anatomical and electromyographic studies of the digastric muscle.
        J Oral Rehabil. 1988; 15: 3-21
        • Lehr R.P.
        • Blanton P.L.
        • Biggs N.L.
        An electromyographic study of the mylohyoid muscle.
        Anat Rec. 1971; 169: 651-659
        • Munro R.R.
        Activity of the digastric muscle in swallowing and chewing.
        J Dent Res. 1974; 53: 530-537
        • Ashida I.
        • Iwamori H.
        • Kawakami S.-Y.
        • et al.
        Analysis of the pattern of suprahyoid muscle activity during pharyngeal swallowing of foods by healthy young subjects.
        J Med Eng Technol. 2010; 34: 268-273
        • Ahlgren J.
        • Lipke D.P.
        Electromyographic activity in digastric muscles and opening force of mandible during static and dynamic conditions.
        Scand J Dent Res. 1977; 85: 152-154
        • Perlman A.L.
        • Schulze-Delrieu K.
        Deglutition and its disorders: anatomy, physiology, clinical diagnosis and management.
        Singular Publishing Group, 1996
        • Hermens H.J.
        • Boon K.L.
        • Zilvold G.
        The clinical use of surface EMG.
        Electromyogr Clin Neurophysiol. 1984; 24: 243-265
        • Tüz H.H.
        • Kisnisci R.S.
        • Günhan O.
        Histomorphometric evaluation of short-term changes in masseter muscle after lengthening the rabbit mandible by distraction osteogenesis.
        J Oral Maxillofac Surg. 2003; 61: 615-620
        • Mackool R.J.
        • Hopper R.A.
        • Grayson B.H.
        • et al.
        Volumetric change of the medial pterygoid following distraction osteogenesis of the mandible: an example of the associated soft-tissue changes.
        Plast Reconstr Surg. 2003; 111: 1804-1807
        • Castaño F.J.
        • Troulis M.J.
        • Glowacki J.
        • et al.
        Proliferation of masseter myocytes after distraction osteogenesis of the porcine mandible.
        J Oral Maxillofac Surg. 2001; 59: 302-307
        • Sato M.
        • Maruoka Y.
        • Kunimori K.
        • et al.
        Morphological and immunohistochemical changes in muscle tissue in association with mandibular distraction osteogenesis.
        J Oral Maxillofac Surg. 2007; 65: 1517-1525
        • Troulis M.J.
        • Kearns G.J.
        • Perrott D.H.
        • et al.
        Extended genioplasty: long-term cephalometric, morphometric and sensory results.
        Int J Oral Maxillofac Surg. 2000; 29: 167-175
        • Dmytruk R.J.
        Neuromuscular spindles and depressor masticatory muscles of monkey.
        Am J Anat. 1974; 141: 147-153
        • Solow B.
        • Kreiborg S.
        Soft-tissue stretching: a possible control factor in craniofacial morphogenesis.
        Scand J Dent Res. 1977; 85: 505-507
        • Goldspink G.
        The adaptation of muscle to a new functional length.
        in: Anderson D.J. Matthews B. Mastication: proceedings of a symposium on the clinical and physiological aspects of mastication held at the Medical School, University of Bristol on 14–16 April 1975. Wright, 1976: 90-99
        • Mücke T.
        • Löffel A.
        • Kanatas A.
        • et al.
        Botulinum toxin as a therapeutic agent to prevent relapse in deep bite patients.
        J Craniomaxillofac Surg. 2016; 44: 584-589