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ORIGINAL ARTICLE

Magnetic resonance spectroscopy of the
masseter muscle in different facial
morphological patterns
Emadedeen T. Al-Farra, BDS, MSc,* Krista Vandenborne, PhD, PT, Alex Swift, BS, and Joseph Ghafari, DMD
Philadelphia, Pa
The aims of this study were (1) to develop a reliable noninvasive method to evaluate the masseter muscle
metabolism, by using 31P-magnetic resonance spectroscopy, and (2) to evaluate the metabolic profile of the
masseter muscle in subjects with various facial patterns. The maxillary-mandibular relationship, which varied
from hypodivergent to hyperdivergent, was measured on lateral cephalograms of 20 adults, 22 to 35 years of
age. 31P-spectra were acquired from the masseter muscle at rest with a custom-made, single-turn, doubletuned, 3 × 5-cm oblong surface coil. The inorganic phosphate to phosphocreatine (Pi/PCr) ratios were
measured and compared in relation to vertical and sagittal cephalometric measurements. A statistically
significant (R2 = 0.65, r = 0.81, P = .001) relationship was found between Pi/PCr ratio and the palatal-tomandibular plane angle. As the maxillary-to-mandibular divergence increased, the Pi/PCr ratio decreased.
This correlation suggests that muscles with a higher Pi/PCr ratio have a higher resting metabolic activity than
those with a lower Pi/PCr ratio. Consequently, these muscles may keep bone under more tension and
influence its growth in a more horizontal direction. Another possible explanation of the results is that the fiber
type composition of the masseter muscle varies with facial morphology. (Am J Orthod Dentofacial Orthop
2001;120:427-34)

T

he facial skeletal muscle has been shown to
influence facial growth and morphology,1,2 but
the nature of this interaction is not well known.
Most investigations of this relationship in humans have
relied on electromyography3-5 and measurements of
bite force.6,7 High electromyographic amplitudes and
strong bite forces have been associated with parallel
jaws and increased posterior face height.3,8 In contrast,
weaker-than-normal occlusal forces have been reported
in patients with long-face syndrome,7 and low electromyographic activity has been recorded in subjects
with anterior open bite.5 More recently, van Spronsen
et al9 used magnetic resonance imaging to compare the
cross-sectional area of several facial muscles, including
the masseter, in adults with long-face syndrome and
normal adults. They reported smaller muscle crosssectional areas in the long-face group.
Metabolic studies of facial muscles have been previously limited because of the invasiveness of muscle biop-

From the University of Pennsylvania.
Supported by NIH Grants RR-02305 and R29-HD33738.
*Recipient of Special Merit Award from the American Association of Orthodontists.
Reprint requests to: Joseph Ghafari, DMD, Professor of Orthodontics, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania,
4001 Spruce St, Philadelphia, PA 19104; e-mail, josephgi@pobox.upenn.edu.
Submitted, October 2000; revised and accepted, February 2001.
Copyright © 2001 by the American Association of Orthodontists.
0889-5406/2001/$35.00 + 0 8/1/117910
doi:10.1067/mod.2001.117910

sies, the conventional means of metabolic evaluation.
Magnetic resonance spectroscopy (MRS), a noninvasive
biochemical sampling technique, is a viable alternative
for the metabolic study of the masseter muscle. MRS can
be performed on a large number of nuclei, but phosphorus 31 (31P) has been the nucleus of choice, in part
because phosphorylated metabolites are intimately
related to the function of muscle as a chemomechanical
converter. The energy for muscle contraction is provided
by adenosine triphosphate (ATP), which converts to
adenosine diphosphate (ADP) or monophosphate
(AMP), and inorganic phosphate (Pi).10 The amount of
ATP available in a muscle is small (8.2 mmol/L) and
must constantly be restored to maintain the energy
needed for continuous or repetitive muscle contraction.
The replenishment occurs through the breakdown of
phosphocreatine (PCr); glycogeneolysis/glycolysis; and
the oxidation of carbohydrates, free fatty acids, and,
rarely, amino acids. 31P is also the only naturally occurring isotope of phosphorus; thus, no isotopic enrichment
is necessary. Although the sensitivity of 31P-nuclear magnetic resonance (NMR) is only one-fifteenth that of 1H,
31P is still one of the most sensitive nuclei. As a result, the
phosphate compounds are relatively easy to detect.
A typical 31P-spectrum of skeletal muscle displays
5 major peaks (Fig 1). The most prominent peak at rest
is from PCr, which buffers rapid increases in metabolic
demand. The 4 smaller resonances are Pi, and the 3
427

29° ± 6°)13 defines the vertical relationship between the jaws. 2. Area under peaks is function of concentration.11. 22 to 35 years of age. ATP peaks are gamma. The experiments were performed in a 1-m. muscular disease. All cephalographs were traced by 1 investigator (E.428 Al-Farra et al American Journal of Orthodontics and Dentofacial Orthopedics October 2001 Fig 1. varies in subjects with differing facial skeletal divergence. fructose-6-P. Each phosphate compound is observed at a very specific frequency. The ratio Pi/PCr is proportional to the free ADP concentration and hence provides information on the phosphorylation potential and the metabolic activity.2 in (13 cm) from the midfacial plane. spectra of good quality are relatively difficult to acquire from these muscles.A-F). 31P magnetic resonance spectrum of skeletal muscle in vivo has 5 characteristic resonances: Pi. Before any procedure. γ-ATP. and their consent was obtained. PCr. and beta. A lateral cephalograph was taken with the subject standing and biting on the posterior teeth. and the angle between the palatal plane (drawn from anterior to posterior nasal spines) and the mandibular plane (gnathion to gonion) (PP/MP). and contraindications to radiography and MRS. craniofacial anomalies. and interincisal angle. In the vertical plane. Carteret. not depicted in this figure but can be observed between Pi and PCr). alpha. maxillary incisor to NA. the relatively small size of facial muscles. The basic premise of this research was that under resting conditions the metabolic activity of the masseter muscle. such as the masseter.12 Although MRS has obvious advantages over muscle biopsy. the measurements included lower face height relative to total face height.0-T superconducting magnet (Oxford Superconducting Technology. Present in lower amounts. Consequently. The following angular measurements were made in the sagittal plane: SNA. The film was placed at a distance of 5. the goals of this study were (1) to develop a reliable method to study the masseter muscle metabolism noninvasively by using 31P-MRS and (2) to measure the basal energy-rich phosphate content of the masseter muscle in subjects with normal and extreme divergence between the jaws. mandibular incisor to NB. ANB. The PP/MP angle of divergence (mean. NJ) interfaced with a home-built spec- Radiography . including metal implants and fixed orthodontic appliances. α-ATP. Therefore. and β-ATP. and AMP) and phosphodiesters (membrane and bone phospholipids). inosine monophosphate [IMP]. MATERIAL AND METHODS MRS: acquisition and analysis of spectra We recruited 23 healthy volunteers. and their proximity to bone present 2 major problems. The exclusion criteria were signs and symptoms of temporomandibular joint dysfunction. SNB. the purpose and the process of the investigation were explained to them. Other compounds that can be identified are phosphomonoesters (PME) and phosphodiesters (PDE. as measured by the basal Pi/PCr ratio. posterior face height relative to anterior face height. other compounds that can be identified are phosphomonoesters (glucose-6-P.T.

08 6. The CV is defined as the standard deviation of the estimated peak areas divided by their mean. 0. RESULTS The mean and the standard deviations for the basal phosphate concentration and intracellular pH are listed in Table I.05-0. The estimated CV was 20% for Pi and 3% for PCr. a pulse repetition time of 30 seconds.65 for the ATP peak.Al-Farra et al 429 American Journal of Orthodontics and Dentofacial Orthopedics Volume 120. because preliminary work revealed that these can diminish the quality of the spectra. The amplitude of the noise was varied from 0. and γ-ATP).001) was observed between the Pi/PCr . The estimated error in the Pi and PCr areas at different signal-tonoise levels was determined by calculating the coefficient of variation (CV) from the simulated results at each signal-to-noise ratio level. Monrovia.83 42. Pi.15 Intracellular pH was calculated from the chemical shift of Pi relative to PCr on the basis of the equation pH = 6.00 13. Representative spectra from the masseter muscle of 2 subjects. and the areas of the γ-ATP. Spectra were recorded on the side with the fewest metallic dental restorations.65. Statistical analysis A regression analysis was used to evaluate the relationship between the MRS variables (pH. and PCr peaks were integrated. The subject lay on a manually adjustable platform that allowed the alignment of his or her masseter muscle with the center of the magnet. and the Pi peak was identifiable in the range of 4. Two pieces of adhesive tape (Durapore. The data were analyzed 100 times. Computer simulations were performed to estimate the error in the MRS measurements with our experimental setup. P = . the signal-to-noise ratio was equal to or higher than 9 (PCr peak/peak noise). The average correction factors were 0. where δ equals the chemical shift of Pi in parts per million relative to PCr.11 1. and 0.90-7. PCr.69-δ). 5 × 3-cm surface coil. with 40 noise levels tested. expressed as a percentage.23 pH 7. and the 3 ATP peaks. and Pi/PCr) and the cephalometric measurements. The true peak areas can be assumed to be unvarying. The spectra were acquired with and without NOE in 5 subjects to calculate the NOE enhancement for the individual peaks (Pi. the PCr. we instructed them to separate their teeth and relax their jaws. are shown in Fig 2.75 20. The head was stabilized with a custom-made pillow. the final sample consisted of 20 subjects (12 males and 8 females). The Pi/PCr ratio varied in subjects with different vertical skeletal patterns. Pi. double tuned to both 31P and 1H frequencies.25 because it had a shim of 52 Hz. with normally distributed noise added to the spectra for each repetition.64 for the Pi peak. MRS spectra were considered acceptable only if the shim was below 40 Hz. Before sliding the subjects into the magnet. Number 4 trometer.8 to 5. and 1024 complex data points.00-72. Consequently. The coil was designed to conform to the general shape of the masseter muscle.75 + log(δ-3. Three spectra were rejected: the first Table I.27)/(5. The spectra were phased manually.96 2. the CV is a measure of the precision associated with the Pi and PCr peak areas.5 to 30 (based on PCr peak height). Experimentally observed chemical shifts and line widths were taken into account. and pH levels Mean SD Range Pi/PCr Pi (mmol/L) PCr (mmol/L) 0. Data sets consisted of 1024 data points.81. Each simulated spectrum contained 5 lorentzian peaks representing the Pi.04 0. 4000 complex spectra were computer generated. The spectra were averaged for 15 minutes and were enhanced by using the nuclear Overhauser effect (NOE) to maximize the signal-to-noise ratio and to reduce the time needed for data acquisition. Mean.00-9.17 4. oval. and the third because a broad signal arising from phosphomonoesters overlapped with the Pi peak. The NMR spectral data were filtered with an exponential filter corresponding to a line broadening of 5 Hz.10 0. PCr. The first 3 acquisition points were skipped to remove the broad signal obtained from bone. r = 0.14 The homogeneity of the magnetic field was adjusted by using the muscle proton signal from water. the second because it had a small signal-to-noise ratio (4/1).12 The radiofrequency coil was a single-turn.16 Exclusion criteria were incorporated because of the difficulty in acquiring reliable 31P spectra from the masseter muscle. Therefore. PCr. Calif) were used to secure the coil in place to ensure continuous contact between the coil and the subject’s face during the experiment.2 mmol/L. SD. The NOE was achieved by applying a long. Pi/PCr. one with a hypodivergent and the other a hyperdivergent pattern.73 for the PCr peak. low-power proton pulse as previously described.12 0. All 31P spectra were acquired with a sweep width of 3000 Hz. except for the contributions of the noise. 3M Unitek. and range of Pi.2 ppm from PCr. The peak areas were corrected for the NOE. Absolute concentrations were calculated on the basis of an ATP concentration of 8. Based on the signal-to-noise levels and metabolite concentrations observed in the 20 experimental spectra. The waterline widths were typically 25 to 35 Hz. The surface coil was secured to a custom-made stand and positioned against the skin over the muscle. A strong association (R2 = 0. All spectra were approved (n = 20) or rejected (n = 3) by 2 investigators. The muscle was located by palpating the area while the subject clenched and relaxed the teeth.

the Pi/PCr ratio decreased (Fig 3).5 and from the study of muscular cross-sectional areas.9 in which muscular characteristics were different in persons with parallel jaws (hypodivergence) and long-face syndrome (hyperdivergence). Because of the greater variability in the γ-ATP peak. As the angle between the palate and mandible increased. the Pi concentration was more variable than was the Pi/PCr ratio. Significant associations were also observed between the basal phosphate content and other vertical cephalometric measures. brachyfacial pattern). This conclusion supports but further qualifies previous reports from electromyographic data3.12 Muscles with a higher Pi/PCr ratio have a higher resting metabolic activity than those with a lower Pi/PCr ratio and. Both the basal Pi/PCr ratio and the Pi concentration have been shown to be good indicators of the metabolic activity of skeletal muscle. fatiguable [IIa] or fatigue resistant [IIb]).12. Statistically significant correlation coefficients (0. This difference in phosphorylation potential could be the result of varying levels of resting muscle tension. but not between the basal PCr levels and the cephalometric parameters.8. In both human and animal studies.17-24 In animal studies.23 and the form of the sigmoid bone was associated with the temporalis muscle.65. consequently. No statistical relationship was found between the cephalometric measures and the intracellular pH of the masseter muscle. this conclusion is consistent with the premise that muscles affect the shape of associated bones. r = 0. P = .66. Fig 2. Further analysis showed that the variation in the Pi/PCr ratio was related to a difference in the basal Pi concentration and not to the PCr concentration. Also. Spectra from 2 subjects with high (top) and low (bottom) maxillary-mandibular divergence. particularly those involving lower face height (Table II). several authors have reported that fibers of the masseter and other jaw muscles are more fatigue resistant than those of other skeletal mus- .11.430 Al-Farra et al American Journal of Orthodontics and Dentofacial Orthopedics October 2001 Fig 3.25 Moreover.2. the Pi/PCr ratio and Pi content decreased. As the maxillary/mandibular divergence increased. ratio and the PP/MP relationship.81. Note apparent Pi peak differences.24 The relationship between basal phosphate content and facial form also may be associated with a variance in fiber type composition.47 to 0. DISCUSSION The basal phosphate content of the masseter muscle was related to facial form.003X. Table II) were observed between the basal Pi concentration and the vertical cephalometric measures. the existence and the shape of the gonial angle were directly related to the level of insertion and the function of the masseter and medial pterygoid muscles.11.001). which is used to calculate absolute concentrations. investigators have shown that muscles composed of predominantly type I fibers (slow twitch. y = 0. fatigue resistant) have a higher basal Pi content and Pi/PCr ratio than muscles primarily composed of type II fibers (fast twitch. Inorganic phosphate/phosphocreatine (Pi/PCr) versus palatal plane to mandibular plane (PP/MP) angle (degrees) (R2 = 0. may keep the bone under more tension and influence its growth in a more horizontal direction (hypodivergent.185-0.

002 0.8%).26. because of their lack of mobility.14 Facial divergence varied over a range of about 40o (Fig 3). total face height. this discussion underscores the need for focused investigation of fiber composition and physiological properties of jaw muscles in subjects with various facial structures. The masseter muscle yielded higher Pi/PCr ratios in hypodivergent faces than it did in hyperdivergent facial forms.66 0. which has not been evaluated previously. such as mouth breathing. a possibility that should be investigated because it may suggest the association of hyperdivergence more with environmental than genetic factors. Eriksson and Thornell28 found that although type I fibers were prevalent in the masseter muscle (61.004 0. LFH/TFH.14 0.30 0. anterior face height.233 0. PFH/AFH).29 The variation regarding histochemical definition of muscle fibers is compounded by the finding of Nordstrom and Miles30 that the human masseter muscle was composed predominantly of fast-twitch motor units with a broad spectrum of fatigability.190 0.782 0.08 0.17 0.03 0. Number 4 Table II. and 1% to 35% intermediate type.47 0.8%).09 0.10 0.20 0. Upper face height.081 0. Ringqvist suggested that the intermediate fibers may be transforming to type I or type II.546 0.034 0. In addition. cles. In our study. and the association between hyperdivergence and a low Pi/PCr ratio may reflect a higher population (although not necessarily predominance) of type II fibers.001 0.437 0. accounting for alterations in the Pi/PCr ratio. The strong correlation between Pi/PCr ratio and facial form raises the question whether the craniofacial morphology itself affects the MRS spectra.8%) and the anterior part of the deep portion (71. however.55 0.62 0.81 0. Although Pi content is independent of muscle mass.66 0. phosphate compounds are not detectable in bone with NMR. in which the muscle presumably is less massive and inserts over narrower areas of mandibular bone.03 0. specifically the vertical relationship between the jaws.69 0. Relations with statistical significance observed for vertical measures (PP/MP. The basal phosphate content of the masseter muscle has not been investigated in other studies in subjects with various facial forms.44 0.004 0. Therefore.39 0. wide variations have been noted.901 0.14 0.388 0.001 0. TFH.02 0. some authors have used 31P-MRS to study the physiology of this muscle. PFH. Ringqvist29 studied biopsies of 10 healthy subjects with mandibular prognathism and also reported a range of variation in fiber composition: 9% to 55% type I.001 0. Studies of muscle biopsy or autopsy have also indicated the predominance of type I fatigue-resistant fibers in jaw-closing muscles.38 0.15 0. posterior face height.02 0. the association of hypodivergence with a high Pi/PCr ratio indicated the predominance of type I fibers.31-35 A comparison shows that the mean basal .808 0. The variation noted in the literature may be associated with variations in facial morphology.220 UPH.14 0.06 0. However. This premise cannot be supported because the Pi levels were internally normalized using ATP as the internal standard and also normalized to PCr levels.65 0. in which hyperdivergence was the least represented. a significant difference in their frequency was observed between the posterior superficial portion (46.549 0.05 0.27 Van Steenberghe et al26 suggested that better fatigue resistance could result from a difference in fiber composition and better oxygenation through a rich blood flow.47 0.013 0. LFH. Pi content is independent of parameters such as muscle mass or coil position.02 0.29 0.Al-Farra et al 431 American Journal of Orthodontics and Dentofacial Orthopedics Volume 120. 28% to 89% type II.04 0.002 0. suggesting that the histochemical appearance of fibers and the physiological properties of the motor units may not be rigidly correlated.6%-71.44 0. R2 and correlation coefficients between cephalometric and MRS measures Pi/PCr PP/MP LFH LFH/TFH PFH/AFH SNA SNB ANB 1/1 1/NA 1/NB Pi R2 r p R2 r p 0. Research targeting the response of the masseter muscle under exercise conditions should help in exploring these possibilities.003 0.08 0.715 0.01 0.547 0. The variation in lower facial height may influence the position of the coil relative to the underlying bones.22 0. AFH. this result may reflect the tendency in hyperdivergent faces toward angular notching of the mandible or muscular compensation for functional demands that favor increased vertical growth. This apparent lack of normal distribution of vertical facial pattern may reflect the predominance of normal and hypodivergent faces in the general population as well.28 However. such as limb muscles.28 0.30 0.

The PDE peak appears 2 ppm away from Pi and does not interfere with the Pi peak. Understanding the role of the musculature in influencing growth. in certain treatments. 31P-MRS is a promising tool to study the interaction of facial musculature during craniofacial growth.06) than in the deep masseter (0. Because the extracellular space constitutes about 10% of the total tissue volume. This design increased the signal-to-noise ratio of the spectra significantly. 31P-spectroscopy studies of the masseter muscle are also hampered by the proximity of the underlying bony structure.33 Plesh et al31 placed a force transducer between the posterior teeth to measure bite force.09). and to monitor muscular changes related to functional appliance therapy.16 ± 0. or inflammation has been shown to result in an increased Pi/PCr ratio. because the increase in Pi/PCr ratio mainly results from changes in the Pi peak. the low levels of extracellular Pi are not observed in 31P spectra of the human masseter.37 which increases the surface area without increasing the depth of the field of view.32-34 and during recording the teeth were kept lightly interdigitated. However. to help in the diagnosis of patients with myofacial pain. a meander coil design. These values are lower than those found in the other studies.35 whose rest condition and data analysis procedure might be comparable with ours.22 ± 0. Finally. yielded an average Pi/PCr ratio of the superficial masseter closer to the ratio we calculated. CONCLUSIONS This study established the ability of MRS as a quantitative noninvasive method to study muscle metabolism in the masseter muscle. This conclusion applies even in hyperphosphatemic patients whose extracellular Pi is relatively high. is not depicted in 31P spectra of skeletal muscle.31-34 leading Kanayama et al to speculate that the differences may have been caused by the use of peak-height versus peak-integral (area under peak) ratios. retention could be planned when the muscular metabolic profile returns to its normal level or to an acceptable range. In our experimental design. these authors concluded that the extracellular Pi content. To optimize the spectral quality. and in relapse may help predict a patient’s disposition to relapse.432 Al-Farra et al American Journal of Orthodontics and Dentofacial Orthopedics October 2001 Pi/PCr ratio in the masseter muscle of our subjects was lower (by a quarter to half) than the mean ratios reported in previous 31P-MRS studies of the masseter muscle but consistent with levels reported in studies of larger skeletal muscles.42. Several authors have shown that the contribution of extracellular Pi to the Pi peak is negligible. we custom built an oblong (3 × 5 cm) surface coil that conformed to the anatomy of the masseter muscle. Kanayama et al35 found a lower Pi/PCr ratio in the superficial (0.14 Accordingly.41 Muscle injury related to intensive exercise. but also Pi in extracellular spaces.38-40 Taylor et al38 reported that the concentration of Pi in the extracellular spaces of muscle is approximately 1 mmol/L. In addition to the small muscle size. Accordingly. disease. may provide a better signal-to-noise ratio. presumably 0. A question arises whether the Pi concentration mea- sured in resting 31P spectra from skeletal muscle represents not only intracellular Pi. The maximum sensitivity for 31P in living tissue (in vitro) is 0. Several authors asked their subjects to exercise before the MRS recording.43 To avoid a potential elevation in this ratio induced by muscle damage.34 this is the first time a clear correlation has been estab- . the increase in the Pi concentration was not an artifact due to contamination from phosphomonoesters (PME) or phosphodiesters (PDE).2 mmol/L. For these reasons. Similar to our interpretation on the change of Pi/PCr ratio with facial form. the quality of the spectra from the masseter was inferior to corresponding spectra from larger skeletal muscles such as the gastrocnemius or the wrist flexor muscles. the best spectra were obtained in subjects with few dental restorations. Also.32 or the mandible was kept in a resting posture.1 mmol/L. even with this improved coil design. The study of Kanayama et al. we included in our study healthy subjects whose facial musculature was not conditioned by exercise before data collection and excluded persons with myofacial pain or muscle disease. when compared with a circular 2. temporomandibular joint dysfunction. crowns generated more noise than amalgam restorations.5-cm-diameter surface coil (data not shown). In vivo measurements of human skeletal muscle have a detectable limit about 1 mmol/L. orthognathic surgery.36 The most plausible reason for the higher basal Pi/PCr ratio in the former 31P-MRS studies is their experimental design. and retention. Kanayama et al postulated that regional differences between deep and superficial parts of the masseter muscle relate to differences in function and fiber type composition. Although the correlation between muscle and form was suggested in muscle biopsy and MRI studies. In an MRS study of the differences between the deep and the superficial parts of the human masseter at rest. the signals depicted were probably more heavily weighted by the contribution of the superficial part of the masseter muscle. The only subject in whom the PME peak overlapped with the Pi peak was excluded. and they separated the teeth with a stent to avoid interference from the transducer during data collection.

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Masticatory muscle force and facial morphology in man. Yamaguchi T.37:895.62:566-71. Yoshida S. Moerland T. Future applications of this method to other facial muscles must overcome the problems that have delayed its application. Hultman E. Radda G. The authors wish to thank Glenn Walter. Occlusal forces in normal and long-face children. 1996. J Orofac Pain 1995. Chew W. Sassouni V. Facial morphology and activity of temporal and lip muscles during swallowing and chewing. Plesh O. Meyerhoff DJ. 28. Lam EW. Am J Physiol 1985.106:552-8. Regional 31P magnetic resonance spectroscopy of exercising human masseter muscle. Mammalian skeletal muscle fibers distinguished by contents of phosphocreatine. 3rd ed. Ingervall B. Gadian DG. 2. B. J Appl Physiol 1990. Kushmerick M. Mathews P.74:338-44. Mallet JJ. 32. for performing the computer simulations. Arch Oral Biol 1983. Fry A. Lissac M. Contemporary orthodontics.71:1279-85. van Ginkel FC. Williams CHM. Valk J. Cox G. Enlow D. 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Although it is easy to document craniofacial morphology. It is not yet clear how subject stress and other physiological and technical conditions alter the spectra.79:85-9. Leave the subject line blank and type the following as the body of your message: subscribe ajodo_toc You will receive an e-mail to confirm that you have been added to the mailing list. 40. Note that TOC e-mails will be sent out when a new issue is posted to the Web site. Bank WJ. 42. Detre JA. Radda GK. McCully KK.50:677-94. Chance B. 38.2:212-6. McCully K. Taylor DJ. 37.00 + 0 8/1/118055 doi:10. Brown RL. 39. McCully KK.71:729-35.118055 Receive tables of contents by e-mail To receive the tables of contents by e-mail. Vandenborne K.242:C1-11. An additional strong point of the paper is the authors’ use of computer simulation to estimate error. 41. or even caused by. Bevington A. Ann Neurol 1991. J Gen Physiol 1967. Mol Biol Med 1983. Metabolic heterogeneity in human calf muscle during maximal exercise. Boden BP. Kakihira H. Clin Sci 1986. variations in muscle function is of great significance for orthodon- tists. Muscle Nerve 1988. Phosphorus magnetic resonance spectroscopy (31P MRS) in neuromuscular disorders.30:90-7. 88:5714-8. Wash Copyright © 2001 by the American Association of Orthodontists. Kromash M. Ling G. The purpose of this paper. human masseter muscle by two-dimensional 31P-chemical shift imaging. Leigh JS. PhD Seattle. the tools for investigating muscle function are indirect and difficult to use. Bioenergetics of intact human muscle: a 31P nuclear magnetic resonance study. which was to report on the development of a noninvasive method of examining masseter metabolism. Meyer R. J Dent Res 2000. Am J Physiol 1997. Argov Z. Susan W. Bore PJ. it is important not to jump to conclusions and to emphasize the authors’ statement that additional studies must be conducted to confirm the associations found in this investigation.com/ajodo Choose E-mail Notification Simply type your e-mail address in the box and click the Subscribe button Alternatively. Herring.272:C525-34. Kushmerick M. Although the findings of the paper (Pi/PCr decreasing as lower facial height increases) are consistent with current thinking that long-face characteristics result from low muscle activity or force. Vandenborne K. Bank WJ. Brown T. The extracellular space of voluntary muscle tissues. et al.434 Al-Farra et al American Journal of Orthodontics and Dentofacial Orthopedics October 2001 36. 43. Application of 31P-NMR spectroscopy to the study of striated muscle metabolism. Russell RG. 0889-5406/2001/$35. this article represents the first study with different facial types. Argov Z. Detection of muscle injury in humans with 31P magnetic resonance spectroscopy. Bolinger L. Noninvasive measurement of phosphocreatine recovery kinetics in single human muscles. Am J Physiol 1982. you may send an e-mail message to majordomo@mosby. sign up through our Web site at http://www. is potentially quite important. Walter G.mosby. COMMENTARY The notion that certain craniofacial morphologies are associated with. Taylor DJ. Yates AJ. I hope that some day magnetic resonance researchers will also investigate their experimental error by performing repeated procedures on the same patient at different times. Mundy KI. Gadian DG. A study of intracellular orthophosphate concentration in human muscle and erythrocytes by 31P nuclear magnetic resonance spectroscopy and selective chemical assay. Although 31P magnetic resonance spectroscopy has been used on the masseter muscle in a number of studies.com. . et al.1:77-94.1067/mod. Kanis JA. Prammer M. Proc Natl Acad Sci USA 1991.2001. Styles P.