Masseter muscle rigidity is a known complication of drugs such as succinylcholine and volatile agents. However, muscle rigidity is an uncommon complication of propofol. We report the case of a 56-year-old ASA-PS class I woman refereeing for colonoscopy due to chronic constipation under deep intravenous sedation. She suffered masseter spasm after the injection of propofol. Masseter spasm should not be considered limited to special drug groups. In any case of difficult mouth opening, masseter spasm should be kept in mind and deepening of anesthesia or complete blockade of neuromuscular junction should be considered by the use of non-depolarizing muscle relaxants.

Objective: Infantile spasm (IS) is a convulsive disease characterized by brief, symmetric axial muscle contraction (neck, trunk, and/or extremities). IS is a type of seizure that was first described by West in 1841, who witnessed the seizure in his own son. West’s syndrome refers to the classic triad of spasms, characteristic EEG, and neurodevelopmental regression. Most cases involve flexors and extensors, but either of the types may be involved independently.IS, as its name implies, most often occurs during the first year of life with an incidence of approximately 1 per 2000-4000 live births. Most, but not all, patients with this disorder have severe EEG abnormalities; this pattern was originally referred to as hypsarrhythmia by Gibbs and Gibbs. Cases with known etiology or signs of brain damage are considered as symptomatic. The Overall prognosis of the disease is poor. Peak onset age of the epileptic syndrome is 3 to 7 months, which mainly occurs before 2 years of age in 93% of patients. Hypsarrhythmia is the EEG hallmark of IS, which comprised a chaotic, bilaterally asynchronous high-voltage polyspike, and slow wave discharges interspersed with multifocal spikes and slow waves.Etiological classification is as follows: 1) Symptomatic: with identifiable prenatal, perinatal, and postnatal causes with developmental delay at the presentation time; 2) Cryptogenic: unknown underlying cause, normal development at the onset of spasms, normal neurological exam and neuroimaging, and no abnormality in the metabolic evaluation; 3) Idiopathic: pure functional cerebral dysfunction with complete recovery, no residual dysfunction, normal neuroimaging and normal etiologic evaluation, and normal neurodevelopment.

A 40-year-old male patient referred with a chief complaint of swelling in the right cheek for 5 years. The swelling showed a gradual increase in size for over 6 months. No other relevant history in terms of habit, medication or systemic disease was given by the patient. On extra-oral examination (Figure 1a), mild swelling was observed in the cheek region that extended posteriorly towards the angle of the mandible. The skin over the swelling was normal and no other abnormalities were noted.

Introduction & objective: One of the most important drawbacks of radial artery is its tendency toward spasm and one of the rare etiologies of that is recurrent blood sampling of the artery. Other causes are injection of drugs in artery in spite of vein, or using radial artery in cardiopulmonary bypass. Papaverine is a useful drug in vasospasm, but it must be used with special caution to avoid it's complications such as arrhythmia.Case: The patient was a 72 year old man with intestinal gangrene and peritonitis whom was operated in Al-Zahra hospital in 2008. During Laparatomy surgery, because of severe acidosis, blood sampling was done 3 times for blood gas analysis. After being taken to the recovery ward, no radial pulse was detectable in the patient's right hand and severe cyanosis in the same hand was seen. After inserting the arterial catheter in brachial artery, treatment with Papaverine, indications of recovery were seen. Conclusion: Despite the rarity of radial artery spasm during anesthesia, it is very dangerous situation, and anesthesiologist must try to prohibit and be able to manage this problem and have suitable drugs in the operation room. 

The thyroid hormones have profound effects on the development of neuromuscular system. These hormones exert their influence on both muscle fibers and related motoneurons during development. Masseter is one of the most important muscles for mastication in mammals. Thyroid hormone deficiency 3 weeks after birth, the period in which an alteration from sucking to biting occurs, could influence the developmental pattern of the muscle. Horseradish peroxidase was injected into the masseter (0.5-5 mlit, 40%) of normal and prenatal hypothyroid pups at 1,7,15 and 23 postnatal days. After 24-48 h, the 50µm brainstem sections were processed for TMB histochemical procedure. Labeled motoneurons in Mo5 were counted, measured and on the basis of their tracing intensity classified into heavy (H), intermediate (I) and light (L) groups. In each age group motoneurons were divideded into small, intermediate and large populations. In 1-day old pups, there was no significant difference between the labeling intensity and size of motoneurons in normal and hypothyroid rats. From the day 7, a significant decrease in the number of H motoneurons was observed (P<0.05), I motoneurons remained unchanged,whereas the number of L motoneurons significantly increased in hypothyroid pups (P<0.05). A significant increase in the number of small motoneurons was observed in hypothyroid pups, medium sized neurons showed no change but large motoneurons significantly decreased in hypothyroid pups (P<0.05). These data suggest that at the end of sucking period (day 23), hypothyroid pups show a 6 days delay in their pattern of masseter innervation as compared to its normal development.

Background: Bruxism is a common parafunctional activity that causes destructive effects on the teeth, periodontal tissue, and temporomandibular joint, leading to hypertrophy and myositis of the masseter muscle. This study aimed to evaluate the sonography findings of masseter muscle among women with bruxism and compare them with those among healthy females.Methods: The statistical population of this study consisted of 45 female volunteers, including 23 patients with bruxism and 22 healthy subjects, referring to the Prosthodontics Department. Masseter muscles were evaluated by sonography in each group bilaterally, at rest and maximum contraction positions, and in longitudinal and transverse planes in terms of thickness. It was also examined in terms of the pattern (type I, II, and III), echogenicity (hypo, intermediate, and hyper), internal structure (homogeneous and heterogeneous), and muscle fiber limits (well-defined, poorly-defined, and ill-defined).Results: In the study of three variables of echogenicity, internal structure, and boundaries of muscle in patients with bruxism, less echogenicity (P ≤ 0.011), heterogeneous structure (P ≤ 0.003), and indeterminate boundaries (P = 0.000) were predominant, and there was a significant relationship between the two groups. Moreover, the examination of the difference in muscle thickness between the two groups showed that only the thickness of the left masseter muscle in the longitudinal plane and at rest position was significant between the healthy and bruxism groups (P = 0.040).Conclusion: There were marked sonographic changes in the masseter muscle in women with bruxism, indicating that the bruxism may affect the masseter muscle.

Hemifacial spasm (HFS) is characterized by irregular involuntary tonic or clonic contractions of muscles innervated by the seventh cranial nerve. Patients usually need long-term treatment, as spontaneous remission is infrequent. Repeated botulinum toxin injection has been shown as a safe and successful treatment for symptomatic relief in patients with HFS. 1 Side effects are usually mild and transient. Ptosis has been reported in about 24% of patients with HFS probably due to diffusion of toxin to levator palpebrae superioris muscle. 2 However, the frequency of ptosis in patients with HFS has not been addressed yet, due to causes other than botulinum toxin side effect...

Dobutamine stress echocardiography (DSE) has been widely used as adiagnostic and prognostic modality in the management of stress. DSE isassociated with limited complications and adverse effects on the health ofpatients. In this case report, we described a 42-year-old female patientwith dobutamine-induced coronary artery spasm with history ofexertional dyspnea, which had deteriorated recently. No risk factors ofcoronary artery disease were observed in the patient, and she hadprevious non-diagnostic exercise tolerance test. DSE was performed on thepatient, and at the end of the infusion rate of 30 mcg/min, retrosternalpain was detected. Standard 12-lead electrocardiogram was indicative ofST segment elevation in inferior leads. Moreover, echocardiographicimaging of the patient revealed concomitant akinesia in the right coronaryartery. On the other hand, subsequent coronary angiograms showed onlymild coronary atherosclerosis.