Research Article| Volume 31, ISSUE 1, 106173, January 2022

Bite Force, Thickness, and Thermographic Patterns of Masticatory Muscles Post-Hemorrhagic Stroke



      Stroke is a neurological deficit of cerebrovascular origin, considered a 21st-century epidemic that causes functional changes in the human body. This study aimed to evaluate the stomatognathic system of patients after hemorrhagic stroke through the bite force, thickness, and skin temperature in the region of the masseter and temporalis muscles.

      Material and Methods

      Twenty-four subjects were divided into groups: post-hemorrhagic stroke; with right side of the affected body (n = 12) and without the neurological disorder (n = 12). Maximum molar bite force was verified using a digital dynamometer. Muscle thickness was measured using ultrasound images obtained at rest and during maximal voluntary contraction of the masseter and temporalis muscles. Thermographic camera was used to record the thermographic patterns of the masseter and temporalis muscles. Data were subjected to Student's t-test (P < .05).


      The maximum molar bite force showed significant differences in the right (P = .04) and left (P = .03) sides, with a reduction in force in the post-hemorrhagic stroke group on the affected and unaffected sides. There was a significant difference (P < .05) in the thickness of the left temporal muscle at mandibular rest (P = .01) between groups. The post-hemorrhagic stroke group clinically presented greater muscle thickness in almost 100% of the muscles evaluated in both clinical conditions. There were no significant differences in skin temperature in the masseter and temporal muscles between the groups.


      Our results suggest functional changes in the stomatognathic system of subjects after a hemorrhagic stroke, especially concerning molar bite force and masticatory muscle thickness in the temporal muscle (unaffected side).

      Key Words

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        • Oliveira F.A.A.
        • Sampaio Rocha-Filho P.A.
        Headaches attributed to ischemic stroke and transient ischemic attack.
        Headache. 2019; 59: 469-476
        • Chen C.W.
        • Cheng T.J.
        • Ho C.H.
        • et al.
        Increased risk of brain cancer incidence in stroke patients: a clinical case series, population-based and longitudinal follow-up study.
        Oncotarget. 2017; 8: 108989-108999
        • Duncan P.W.
        • Bushnell C.
        • Sissine M.
        • et al.
        Comprehensive stroke care and outcomes: time for a paradigm shift.
        Stroke. 2021; 52: 385-393
        • Thrift A.G.
        • Thayabaranathan T.
        • Howard G.
        • et al.
        Global stroke statistics.
        Int J Stroke. 2017; 12: 13-32
        • Guzik A.
        • Bushnell C.
        Stroke epidemiology and risk factor management.
        Continuum (Minneap Minn). 2017; 23 (1, Cerebrovascular Disease): 15-39
        • Koh S.H.
        • Park H.H.
        Neurogenesis in stroke recovery.
        Transl Stroke Res. 2017; 8: 3-13
        • Popa-Wagner A.
        • Dumitrascu D.I.
        • Capitanescu B.
        • et al.
        Dietary habits, lifestyle factors and neurodegenerative diseases.
        Neural Regen Res. 2020; 15: 394-400
        • Schimmel M.
        • Leemann B.
        • Schnider A.
        • et al.
        Changes in oro-facial function and hand-grip strength during a 2-year observation period after stroke.
        Clin Oral Investig. 2013; 17: 867-876
        • Hegedűs B.
        The potential role of thermography in determining the efficacy of stroke rehabilitation.
        J Stroke Cerebrovasc Dis. 2018; 27: 309-314
        • Gedrange T.
        • Kunert-Keil C.
        • Heinemann F.
        • et al.
        Tissue engineering and oral rehabilitation in the stomatognathic system.
        Biomed Res Int. 2017; 20174519568
        • Schimmel M.
        • Voegeli G.
        • Duvernay E.
        • et al.
        Oral tactile sensitivity and masticatory performance are impaired in stroke patients.
        J Oral Rehabil. 2017; 44: 163-171
        • da Cunha D.V.
        • Degan V.V.
        • Vedovello Filho M.
        • et al.
        Real-time three-dimensional jaw tracking in temporomandibular disorders.
        J Oral Rehabil. 2017; 44: 580-588
        • Regalo S.C.
        • Santos C.M.
        • Regalo C.A.
        • et al.
        Evaluation of molar and incisor bite force in indigenous compared with white population in Brazil.
        Arch Oral Biol. 2008; 53: 282-286
        • Palinkas M.
        • Nassar M.S.
        • Cecílio F.A.
        • et al.
        Age and gender influence on maximal bite force and masticatory muscles thickness.
        Arch Oral Biol. 2010; 55: 797-802
        • Bordignon N.A.
        • Regalo S.
        • de Vasconcelos P.B.
        • et al.
        Impact of chronic allergic rhinitis on bite force and electromyographic activity of masseter and temporalis muscles of adult womenJ.
        Clin Exp Dent. 2020; 12: e488-e493
        • Righetti M.A.
        • Taube O.L.S.
        • Palinkas M.
        • et al.
        Osteoarthrosis: analyze of the molar bite force, thickness and masticatory efficiency.
        Prague Med Rep. 2020; 121: 87-95
        • da Silva J.M.
        • Pires C.P.A.B.
        • Rodrigues L.A.M.
        • et al.
        Influence of mandibular tori on stomatognathic system function.
        Cranio. 2017; 35: 30-37
        • Castelo P.M.
        • Gavião M.B.
        • Pereira L.J.
        • et al.
        Masticatory muscle thickness, bite force, and occlusal contacts in young children with unilateral posterior crossbite.
        Eur J Orthod. 2007; 29: 149-156
        • Verri E.D.
        • da Silva G.P.
        • Fioco E.M.
        • et al.
        Effects of Parkinson's disease on molar bite force, electromyographic activity and muscle thickness of the masseter, temporal and sternocleidomastoid muscles: a case-control study.
        J Oral Rehabil. 2019; 46: 912-919
        • Moreira D.G.
        • Costello J.T.
        • Brito C.J.
        • et al.
        Thermographic imaging in sports and exercise medicine: a Delphi study and consensus statement on the measurement of human skin temperature.
        J Therm Biol. 2017; 69: 155-162
        • Morozumi K.
        • Ohsugi H.
        • Morishita K.
        • et al.
        Fundamental research on surface electromyography analysis using discrete wavelet transform-an analysis of the central nervous system factors affecting muscle strength.
        J Phys Ther Sci. 2021; 33: 63-68
        • Wanshi Arnoni V.
        • Batista de Vasconcelos P.
        • Sousa L.G.
        • et al.
        Evaluation of the electromyographic fatigue of the masseter and temporalis muscles in individuals with osteoporosis.
        Cranio. 2019; 37: 254-263
        • Coppens M.J.M.
        • Staring W.H.A.
        • et al.
        Offline effects of transcranial direct current stimulation on reaction times of lower extremity movements in people after stroke: a pilot cross-over study.
        Neuroeng Rehabil. 2019; 16: 136
        • Lindström I.
        • Protto S.
        • Khan N.
        • et al.
        Association of masseter area and radiodensity with three-month survival after proximal anterior circulation occlusion.
        J Neurointerv Surg. 2021; 13: 25-29
        • Sasegbon A.
        • Hamdy S.
        The anatomy and physiology of normal and abnormal swallowing in oropharyngeal dysphagia.
        Neurogastroenterol Motil. 2017; 29: 1-15
        • Park H.S.
        • Oh D.H.
        • Yoon T.
        • et al.
        Effect of effortful swallowing training on tongue strength and oropharyngeal swallowing function in stroke patients with dysphagia: a double-blind, randomized controlled trial.
        Int J Lang Commun Disord. 2019; 54: 479-484
        • Fatehi P.
        • Hesam-Shariati N.
        • Abouzaripour M.
        • et al.
        Acute ischemic and acidente vascular cerebral and COVID-19: case series.
        SN Compr Clin Med. 2020; : 1-6
        • Scherbakov N.
        • von Haehling S.
        • Anker S.D.
        • et al.
        Stroke induced sarcopenia: muscle wasting and disability after stroke.
        Int J Cardiol. 2013; 170: 89-94
        • Li W.
        • Yue T.
        • Liu Y.
        New understanding of the pathogenesis and treatment of stroke-related sarcopenia.
        Biomed Pharmacother. 2020; 131110721
        • Su Y.
        • Yuki M.
        • Otsuki M.
        Prevalence of stroke-related sarcopenia: a systematic review and meta-analysis.
        J Stroke Cerebrovasc Dis. 2020; 29105092
        • Avvantaggiato C.
        • Casale R.
        • Cinone N.
        • et al.
        Localized muscle vibration in the treatment of motor impairment and spasticity in post-stroke patients: a systematic review.
        Eur J Phys Rehabil Med. 2021; 57: 44-60
        • Monjo H.
        • Fukumoto Y.
        • Asai T.
        • et al.
        Muscle thickness and echo intensity of the abdominal and lower extremity muscles in stroke survivors.
        J Clin Neurol. 2018; 14: 549-554
        • Akazawa N.
        • Harada K.
        • Okawa N.
        • et al.
        Muscle mass and intramuscular fat of the quadriceps are related to muscle strength in non-ambulatory chronic stroke survivors: a cross-sectional study.
        PLoS One. 2018; 13e0201789
        • Nakanishi N.
        • Okura K.
        • Okamura M.
        • et al.
        Measuring and monitoring skeletal muscle mass after stroke: a review of current methods and clinical applications.
        J Stroke Cerebrovasc Dis. 2021; 30105736
        • Flores D.V.
        • Mejía Gómez C.
        • et al.
        MR imaging of muscle trauma: anatomy, biomechanics, pathophysiology, and imaging appearance.
        Radiographics. 2018; 38: 124-128
        • Panwar P.
        • Butler G.S.
        • Jamroz A.
        • et al.
        Aging-associated modifications of collagen affect its degradation by matrix metalloproteinases.
        Matrix Biol. 2018; 65: 30-44
        • Li S.
        • Francisco G.E.
        The use of botulinum toxin for treatment of spasticity.
        Handb Exp Pharmacol. 2021; 263: 127-146
        • van de Port I.
        • Punt M.
        • Meijer J.W.
        Walking activity and its determinants in free-living ambulatory people in a chronic phase after stroke: a cross-sectional study.
        Disabil Rehabil. 2020; 42: 636-641
        • Sánchez-Sánchez M.L.
        • Ruescas-Nicolau M.A.
        • Carrasco J.J.
        • et al.
        Cross-sectional study of quadriceps properties and postural stability in patients with chronic stroke and limited vs. non-limited community ambulation.
        Top Stroke Rehabil. 2019; 26: 503-510
        • Seo J.W.
        • Kim S.G.
        • Kim J.I.
        • et al.
        Principal characteristics of affected and unaffected side trunk movement and gait event parameters during hemiplegic stroke gait with IMU sensor.
        Sensors. 2020; 20 (Basel): 7338
        • Liepert J.
        • Stürner J.
        • Büsching I.
        • et al.
        Effects of a single mental chronometry training session in subacute stroke patients - a randomized controlled trial.
        BMC Sports Sci Med Rehabil. 2020; 12: 66