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Temporal muscle wasting, also known as bitemporal wasting, is a condition where the fullness of the temporalis muscles is lost due to atrophy. It is often indicative of a more serious underlying condition such as cancer, tuberculosis, chronic infection, or malnutrition. The wasting of these muscles can be observed through MRI, which reveals fatty degeneration, or through visual assessment, which has been shown to have moderate agreement in validity for nutritional screening. Ultrasound and CT scans are also used to monitor temporal muscle wasting and its correlation with nutritional status and life expectancy.
| Characteristics | Values |
|---|---|
| Definition | Temporal wasting, in the setting of significant pathology and cachexia, is manifested by temporalis muscle wasting, characterised by the absence of normal fullness of these muscles. |
| Observation | Temporal muscle wasting can be observed by a simple visual assessment, which can indicate a serious diagnosis. |
| Measurement | Ultrasound and CT-based TMT measurements can be used to monitor muscle wasting. |
| Inflammation | Inflammation is a key risk factor for temporal muscle wasting. Inflammation-induced microcirculatory changes have been discussed as a pathophysiologic mechanism of axonal damage. |
| Nutritional Status | The size of the temporal muscle correlates with a person's nutritional status. |
| Cancer | Temporal muscle wasting can be an indicator of metastatic cancer. |
| Life Expectancy | Temporal muscle wasting can be used to predict life expectancy in certain types of cancers. |
| ICU Patients | Quantification of temporal muscle volume can be used as a biomarker for muscle wasting in intensive care unit (ICU) patients with acute brain injury. |
| Cardiac Arrest Survivors | Temporal muscle atrophy occurs rapidly at 2.0% per day in out-of-hospital cardiac arrest survivors, but no significant association with 30-day mortality has been found. |
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What You'll Learn
- Temporal muscle wasting can be evaluated visually and is an important indicator of malnutrition
- Ultrasound-based measurements of temporal muscle thickness are feasible and show good inter-rater reliability
- Magnetic resonance imaging (MRI) can reveal fatty degeneration of the temporalis muscle
- Temporal muscle wasting can be a sign of significant pathology and cachexia
- Quantification of temporal muscle volume can be used as a biomarker for muscle wasting in patients with acute brain injury
Temporal muscle wasting can be evaluated visually and is an important indicator of malnutrition
Temporal muscle wasting, or bitemporal wasting, refers to the atrophy or degeneration of the temporalis muscle, resulting in the loss of its normal fullness. This condition can be observed and diagnosed through simple visual assessment or examination, without the need for advanced imaging techniques. The visual evaluation of temporal muscle wasting plays a crucial role in identifying malnutrition in clinical practice, particularly in older adults.
The temporalis muscle is located in the temple region of the head and is responsible for jaw movement during chewing. When this muscle undergoes wasting, the underlying zygomatic bone, zygomatic arch, and temporal lines become prominently visible. This visual manifestation can be a critical indicator of underlying malnutrition or other significant health conditions.
Visual assessment of temporal muscle wasting has been found to have moderate agreement and validity for nutritional screening. It can help identify individuals with severe or mild temporal wasting, who often exhibit lower levels of arm muscle circumference and calf circumferences compared to those without wasting. However, visual evaluation alone may not be sufficient to determine the detailed degree of muscle wasting.
The correlation between temporal muscle wasting and malnutrition has been supported by various studies. For example, Hasegawa et al. found that the decline in temporal muscle thickness was significantly associated with inadequate energy intake in bedridden older adults. Additionally, in patients with metastatic cancer, a correlation was established between temporal muscle thickness and lumbar skeletal muscle cross-sectional area, a marker of sarcopenia.
The evaluation of temporal muscle wasting through visual observation or ultrasound measurements can provide valuable insights into an individual's nutritional status and overall health. It serves as a simple yet effective tool for healthcare professionals to identify potential malnutrition or other underlying pathologies, such as cancer, tuberculosis, or chronic infections, and facilitate timely interventions.
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Ultrasound-based measurements of temporal muscle thickness are feasible and show good inter-rater reliability
Temporal muscle wasting is the absence of the normal fullness of the temporalis muscles, which can be observed through the prominence of the zygomatic bone, zygomatic arch, and temporal lines. This wasting is indicative of some significant underlying condition, such as cancer, tuberculosis, chronic infection, or malnutrition.
Ultrasound-based measurements of temporal muscle thickness have been explored as a potential tool for monitoring muscle wasting, particularly in neurocritical care settings. The feasibility and reliability of these ultrasound measurements have been evaluated in several studies.
One study by Hasegawa et al. introduced longitudinal temporal muscle ultrasound measurements in bedridden elderly individuals. They found a significant correlation between temporal muscle thickness decline and inadequate energy intake in this population. However, Anand et al. questioned the usefulness of these measurements in sepsis patients, as they did not find a significant correlation between muscle thickness and muscle wasting in this cohort.
Further studies have demonstrated the feasibility and good inter-rater reliability of ultrasound-based temporal muscle thickness (TMT) measurements. These studies have shown that ultrasound can accurately capture sarcopenia as a prognostic marker and that it is less susceptible to inter-rater variability compared to other methods. Ultrasound measurements have also been found to be highly correlated with rectus femoris muscle thickness (RFT) measurements, which are used as a marker of muscle wasting.
In a single-center observational study, ultrasound-based TMT measurements exhibited diagnostic utility for monitoring muscle wasting in neurocritical care patients. These measurements demonstrated comparable results to sequential CT-based measurements and showed high inter-rater reliability up to 20 days. Additionally, ultrasound-based measurements were robust to potential confounders such as BMI, muscle echogenicity, agitation, and changes in fluid balance.
In conclusion, ultrasound-based measurements of temporal muscle thickness have been shown to be feasible and reliable in the context of monitoring muscle wasting, particularly in neurocritical care settings. These measurements offer a valuable tool for assessing nutritional status and predicting outcomes in certain types of cancers and other critical illnesses.
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Magnetic resonance imaging (MRI) can reveal fatty degeneration of the temporalis muscle
Temporal muscle wasting, also known as bitemporal wasting, is a physical exam finding that can be observed by the loss of fullness of the temporalis muscles. This loss of fullness causes the zygomatic bone, zygomatic arch, and temporal lines to become more prominent.
Bitemporal wasting can be indicative of an ongoing significant condition, such as cancer, tuberculosis, chronic infection, or malnutrition. Other conditions such as congestive heart failure, COPD, chronic kidney disease, Crohn's disease, mercury poisoning, or trypanosomiasis may also manifest bitemporal wasting.
Magnetic resonance imaging (MRI) is a diagnostic procedure that uses a combination of a large magnet, radio frequencies, and a computer to produce detailed images of organs and structures within the body. MRI does not use ionizing radiation, unlike X-rays or computed tomography (CT) scans. MRI is particularly useful for examining soft tissues and telling the difference between normal and abnormal soft tissue.
In the context of temporal muscle wasting, MRI can reveal fatty degeneration of the temporalis muscle. This degeneration can be observed and measured accurately with ultrasound as well. The size of the temporal muscle is correlated with a person's nutritional status and can even help predict life expectancy in certain types of cancers. Thus, MRI is a valuable tool for assessing and diagnosing temporal muscle wasting and its potential underlying causes.
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Temporal muscle wasting can be a sign of significant pathology and cachexia
Temporal muscle wasting, also known as bitemporal wasting, refers to the atrophy or degeneration of the temporalis muscle, resulting in the loss of its normal fullness. This condition can be observed through physical examination, particularly the prominence of the zygomatic bone, zygomatic arch, and temporal lines due to muscle atrophy.
Temporal muscle wasting is often indicative of significant underlying pathology and cachexia. Cachexia refers to the progressive loss of muscle mass and weight, typically seen in the context of chronic illnesses such as cancer, tuberculosis, chronic infections, or connective tissue diseases. In such cases, temporal muscle wasting serves as a visual marker of muscle depletion and malnutrition.
The quantification of temporal muscle volume can be achieved through various imaging techniques, including computed tomography (CT) scans, magnetic resonance imaging (MRI), and ultrasound. These tools play a crucial role in assessing muscle wasting, particularly in critically ill or neurocritical care patients. Ultrasound measurements, for example, have demonstrated a correlation between temporal muscle thickness and nutritional status, even predicting life expectancy in certain cancers.
The presence of inflammation, marked by increased interleukin-6 levels, is a significant risk factor for muscle wasting. Inflammation induces microcirculatory changes, leading to axonal damage and contributing to muscle volume loss and neuromuscular dysfunction. Additionally, the severity of the disease often correlates with a reduced level of consciousness, promoting muscle disuse and prolonged immobility, further exacerbating muscle wasting.
The visual assessment of temporal muscle wasting, as a simple observation, can provide valuable insights into a patient's overall health and potential underlying pathologies. However, it is important to note that while visual evaluation can be useful for nutritional screening, it may not be sufficient to determine the detailed degree of muscle wasting.
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Quantification of temporal muscle volume can be used as a biomarker for muscle wasting in patients with acute brain injury
Temporal muscle wasting, also known as bitemporal wasting, is characterised by the absence of the normal fullness of the temporalis muscles. This muscle atrophy can be observed through the prominence of the zygomatic bone, zygomatic arch, and temporal lines. It is often indicative of an ongoing significant condition, such as cancer, tuberculosis, chronic infection, or malnutrition.
In the context of acute brain injury, quantification of temporal muscle volume has emerged as a potential biomarker for muscle wasting. This is particularly relevant in intensive care settings, where muscle wasting is a major concern. Sequential ultrasound and computed tomography (CT)-based measurements of temporal muscle thickness (TMT) have been explored as monitoring tools for muscle wasting. Ultrasound measurements offer portability and the ability to correlate with nutritional status, while CT scans provide easily reproducible measurements that are frequently performed in neurocritical care patients.
The advantage of measuring temporal muscle volume lies in its accessibility on routine head CT scans. This volume progressively decreases during intensive care unit (ICU) stays, particularly after spontaneous subarachnoid hemorrhage. The loss of temporal muscle volume is associated with disease severity and functional outcome, making it a promising biomarker for muscle wasting and outcome prognostication.
Several studies have supported the use of CT-based quantification of temporal muscle volume as a biomarker for overall muscle loss in patients with head injuries. This is further validated by its correlation with other muscle groups, such as the psoas CSA in trauma patients and lumbar skeletal muscle CSA in metastatic cancer patients. The ease of identification on routine CT scans, which are commonly performed in neurocritical care, makes it a practical tool for monitoring muscle wasting in patients with acute brain injuries.
However, the diagnostic utility of TMT measurements in intensive care settings is still uncertain. While some studies have demonstrated the effectiveness of ultrasound-based TMT measurements in bedridden elderly individuals, others have questioned its usefulness in sepsis patients. Further research is needed to establish the optimal diagnostic modality for TMT measurements and improve comparability across studies.
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Frequently asked questions
Temporal muscle wasting, or bitemporal wasting, is the loss of fullness in the temporalis muscles, which are located in the temples. This can be caused by nerve damage from trauma or surgery, or it can be a sign of an ongoing significant condition such as cancer, tuberculosis, chronic infection, or malnutrition.
Temporal muscle wasting can be diagnosed through observation, either by visual assessment or by using medical imaging technologies such as magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound.
Temporal muscle wasting can be indicative of malnutrition or a more serious underlying condition. It has also been associated with poor outcomes in patients with subarachnoid hemorrhage and out-of-hospital cardiac arrest.
Treatment for temporal muscle wasting depends on the underlying cause. In cases of malnutrition, addressing nutritional deficiencies and improving energy intake may help slow or reverse the muscle wasting. For other conditions, treating the underlying disease or disorder may help manage the temporal muscle wasting.
