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BACK GROUND: A common pedicled facial technique in head and neck reconstruction is the TMF It can be utilised to replace missing tissues in a variety of conditions, including oral deformities of the hard and soft palate. AIM: Aim of the study was to document the utility and outcomes with the reconstruction of the palate using TM flaps following Maxillectomy For maxillary sinus malignancies. METHODOLOGY: The study included 24 patients who were operated on for cancer maxilla and eligible for maxillectomy and reconstruction of the Palate using temporalis flap. Follow-up was planned for at least 12 months postoperative. Postoperative physical and speech therapy are initiated to help improve speech and swallow outcomes and to prevent trismus. RESULTS: The current study included 24 cases with Maxillary sinus cancer with a mean age of 42.34 ± 4.67. The mean operative time was 5.4 ± 1.22 h with no reported intraoperative bleeding or injury of important structures. No cases of facial palsy or trismus were reported while partial flap loss was reported in one case where oronasal fistula was evident. The donor site complications were minimal where seroma occurred in two patients and alopecia, wound infection and dehiscence were reported in one case each. The donor site depression was evident in 25 % of cases. CONCLUSION: TMF is an excellent option for the reconstruction of many craniofacial defects, it is easy to be harvested with good blood supply with minimal postoperative complications.

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BACKGROUND: Sarcopenia, defined as the loss of skeletal muscle mass, has been associated with a worse functional outcome after stroke. Measurement of temporal muscle thickness (TMT) has been introduced as an easily obtainable surrogate marker to identify patients with sarcopenia. Our study aims to investigate the correlation between pre-stroke sarcopenia, measured by TMT assessment, and functional outcome in patients treated with revascularization procedures for acute ischemic stroke. METHODS: We included consecutive adult patients who underwent thrombolysis, endovascular thrombectomy or both for acute ischemic stroke at our Centre from January 2020 to June 2022. Besides collecting baseline clinical and neuroradiological features, TMT was measured on brain computed tomography scans according to a standardized protocol. Modified Rankin Scale (mRS) scores at 3 months represented the main endpoint of functional outcome. RESULTS: A total of 261 patients were available for the analysis. In univariate models, patients with excellent outcomes (mRS = 0-1) were younger, had higher TMT values and lower pre-event disability and stroke severity. In multivariate models higher TMT values resulted independently associated with reduced mortality (Odds Ratio 0.708, 95% Confidence Interval 0.538-0.930, p = 0.013). Age, diabetes, brain bleeding events and stroke severity were found to be predictors of mortality, too. CONCLUSIONS: Our retrospective analysis shows that in patients who underwent revascularization treatments for ischemic stroke TMT is as an independent predictor of survival easily obtainable from the baseline CT scan. Further investigation is required to confirm the role of sarcopenia assessment and TMT measurement in the prognostication toolkit of this disease.

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Background This study aimed to determine if individuals with skeletal Class II and skeletal Class III malocclusions had different levels of masticatory muscle activity. Materials and methods This cross-sectional study, conducted at the University of Damascus, investigated the myoelectric activity of perioral muscles in patients with Class II and III malocclusions. The sample size of 60 patients was determined according to a prior sample size calculation. Patients were selected based on specific inclusion and exclusion criteria and divided into Class II and III groups. Electromyography was used to monitor the activity of various muscles, including the temporalis, masseter, orbicularis oris, buccinator, mentalis, and digastric muscles. Results The study found similar muscle activity within the same group in the temporalis, masseter, buccinator, digastric, and orbicularis oris muscles. No significant differences were observed between the Class II and III groups for several oral and perioral muscles (P > 0.05). However, the mean activity of the digastric muscle was significantly greater in the Class II group (P < 0.05), whereas the mean activity of the mentalis muscle was smaller in the Class II group (P < 0.05). Conclusions Perioral muscles influence facial complex development and jaw relationship, affecting orthodontic treatment. Digastric muscle activity is greater in Class II patients, while mental muscle activity is smaller in Class III patients. Further studies are needed for older age groups and other skeletal malocclusion types.

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BACKGROUND: This study aimed to elucidate the effects of botulinum toxin A (BoNT-A) treatment for patients diagnosed with masseter hypertrophy on the temporalis muscle, with a particular focus on assessing alterations in muscle thickness, electromyographic (EMG) activity, and the development of muscle pain. METHODS: The present randomized triple-blinded clinical trial enrolled 26 female participants aged between 25 and 50 years complaining about masseter hypertrophy. Participants received 75U of BoNT-A (abobotulinumtoxinA) in both masseter muscles and after three months were randomized to receive a second treatment session of saline solution (S-BoNT-A) or BoNT-A (M-BoNT-A). Longitudinal assessments included temporalis muscle thickness through ultrasound, EMG activity, subjective pain, and masseter prominence severity after one, three, and six months of the first injection session. Muscle thickness, EMG, and subjective pain were analysed using two-way ANOVA with repeated measures and post hoc Sidak test, and for masseter prominence severity, Friedman and Mann-Whitney tests were used. RESULTS: Regarding inter-group comparisons, a higher muscle thickness (p < 0.02) and a higher EMG activity (p < 0.01) were found in the M-BoNT-A group at the 6-month follow-up. For subjective pain assessments, inter-group comparisons showed a higher prevalence of painful regions in M-BoNT-A group at the 6-month follow-up (p < 0.02). No significant differences were found in masseter prominence severity at the 6 months assessment between groups. CONCLUSION: BoNT-A treatment for masseter hypertrophy lead to structural and functional changes in the temporalis muscle, presenting higher changes after multiple injections of this treatment. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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This study used ultrasonography to compare the thickness and cross-sectional area of the masticatory muscles in patients with temporomandibular joint arthralgia and investigated the differences according to sex and the co-occurrence of headache attributed to temporomandibular disorders (HATMD). The observational study comprised 100 consecutive patients with TMJ arthralgia (71 females and 29 males; mean age, 40.01 ± 17.67 years) divided into two groups: Group 1, including 86 patients with arthralgia alone (60 females; 41.15 ± 17.65 years); and Group 2, including 14 patients with concurrent arthralgia and HATMD (11 females; 33.00 ± 16.72 years). The diagnosis of TMJ arthralgia was based on the diagnostic criteria for temporomandibular disorders. The parameters of the masticatory muscles examined by ultrasonography were subjected to statistical analysis. The pain area (2.23 ± 1.75 vs. 5.79 ± 2.39, p-value = 0.002) and visual analog scale (VAS) score (3.41 ± 1.82 vs. 5.57 ± 12.14, p-value = 0.002) were significantly higher in Group 2 than in Group 1. Muscle thickness (12.58 ± 4.24 mm) and cross-sectional area (4.46 ± 2.57 cm2) were larger in the masseter muscle than in the other three masticatory muscles (p-value < 0.001). When examining sex-based differences, the thickness and area of the masseter and lower temporalis muscles were significantly larger in males (all p-value < 0.05). The area of the masseter muscle (4.67 ± 2.69 vs. 3.18 ± 0.92, p-value = 0.004) and lower temporalis muscle (3.76 ± 0.95 vs. 3.21 ± 1.02, p-value = 0.049) was significantly smaller in Group 2 than in Group 1. An increase in VAS was significantly negatively correlated with the thickness of the masseter (r = - 0.268) and lower temporalis (r = - 0.215), and the cross-sectional area of the masseter (r = - 0.329) and lower temporalis (r = - 0.293). The masseter and lower temporalis muscles were significantly thinner in females than in males, and their volumes were smaller in patients with TMJ arthralgia and HATMD than in those with TMJ arthralgia alone. HATMD and decreased masseter and lower temporalis muscle volume were associated with increased pain intensity.

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BACKGROUND: Data from patients with post-ablative dural defects reconstructed using a free temporalis muscle fascia graft (FTFG) after resection of anterior or central skull base tumors were retrospectively analyzed. METHODS: The primary predictor and outcome variables were the reconstructive methods for dural repair and postoperative cerebrospinal fluid (CSF) leakage rate, respectively. RESULTS: Eighty patients were included, and 94 postoperative dural reconstructions were performed using FTFG. The postoperative CSF leakage rate was 3.19%. The postoperative CSF leakage rates did not significantly differ between open and endonasal endoscopic surgeries (1.92% vs. 4.88%; p > 0.05). In cases completed using the endonasal endoscopic approach, the postoperative CSF leakage rate was significantly associated with the intraoperative CSF leak flow (p < 0.05). CONCLUSIONS: Post-ablative dural defect reconstruction using FTFG resulted in low postoperative CSF leakage and complication rates comparable to those of free fascia lata graft from available literature.

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Introduction: Sarcopenia is associated with worsened outcomes in solid cancers. Temporalis muscle thickness (TMT) has emerged as a measure of sarcopenia. Hence, this study aims to evaluate the relationship between TMT and outcome measures in patients with malignant intra-axial neoplasms. Method: We searched Medline, Embase, Scopus and Cochrane databases for relevant studies. Event ratios with 95% confidence intervals (CI) were analysed using the RevMan 5.4 software. Where meta-analysis was impossible, vote counting was used to determine the effect of TMT on outcomes. The GRADE framework was used to determine the certainty of the evidence. Results: Four outcomes were reported for three conditions across 17 studies involving 4430 patients. Glioblastoma: thicker TMT was protective for overall survival (OS) (HR 0.59; 95% CI 0.46-0.76) (GRADE low), progression free survival (PFS) (HR 0.40; 95% CI 0.26-0.62) (GRADE high), and early discontinuation of treatment (OR 0.408; 95% CI 0.168-0.989) (GRADE high); no association with complications (HR 0.82; 95% CI 0.60-1.10) (GRADE low). Brain Metastases: thicker TMT was protective for OS (HR 0.73; 95% CI 0.67-0.78) (GRADE moderate); no association with PFS (GRADE low). Primary CNS Lymphoma: TMT was protective for overall survival (HR 0.34; 95% CI 0.19-0.60) (GRADE moderate) and progression free survival (HR 0.23; 95% CI 0.09-0.56) (GRADE high). Conclusion: TMT has significant prognostic potential in intra-axial malignant neoplasms, showing a moderate to high certainty for its association with outcomes following GRADE evaluation. This will enable shared decision making between patients and clinicians.

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To compare masticatory muscle thickness in patients with temporomandibular disorders (TMDs) during rest and clenching, and by body position, using ultrasonography. This prospective study included 96 patients with TMD (67 females, 29 males; mean age: 40.41 ± 17.88 years): group 1, comprising 66 patients with TMD without bruxism (TMD_nonbruxer), and group 2, comprising 30 patients with concurrent TMD and bruxism (TMD_bruxer). In patients with TMD, bruxism was correlated with the presence of tinnitus, muscle stiffness, sleep problems, psychological stress, and restricted mouth opening. The masseter muscle significantly thickened during clenching (11.16 ± 3.03 mm vs 14.04 ± 3.47 mm, p < 0.001), whereas the temporalis muscle showed no significant increase in thickness from resting to clenching in an upright position (7.91 ± 1.98 vs 8.39 ± 2.08, p = 0.103). Similarly, during clenching in the supine position, the masseter muscle was significantly thicker compared with rest (11.24 ± 2.42 vs 13.49 ± 3.09, p < 0.001), but no significant difference was observed in temporal muscle thickness (8.21 ± 2.16 vs 8.43 ± 1.94, p = 0.464). In comparison between two groups, the average thickness of the masseter muscle was greater among TMD_bruxers than among TMD_nonbruxers in both the upright and supine positions (all p < 0.05). In the generalized lineal model, female sex (B = - 1.018, 95% confidence interval [CI] - 1.855 to - 0.181, p = 0.017) and bruxism (B = 0.868, 95% CI 0.567 to 1.169, p = 0.048) significantly predicted changes in masseter muscle thickness. Female sex (B = - 0.201, 95% CI - 0.299 to - 0.103, p = 0.011), increased age (B = - 0.003, 95% CI - 0.005 to 0.000, p = 0.038), and muscle stiffness (B = - 1.373, 95% CI - 2.369 to - 0.376, p = 0.007) were linked to decreased temporal muscle thickness. Comparing TMD nonbruxer and bruxer muscle thicknesses in upright and supine positions revealed significant increased thickness in the masseter muscle during clenching but not in the temporalis muscle. Masseter muscle thickness varied significantly by sex, body position, and resting/clenching, notably influenced by bruxism. These findings emphasize the relevance of these factors in clinical examinations of patients with TMD.

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We report the case of a 35-year-old male patient who presented with a right zygomaticomaxillary complex fracture, which was five months old. It was associated with ectropion over the right eye. Diagnosis was made by clinical examination and confirmed by computed tomography, which included a three-dimensional reconstruction view. The patient was concerned about a projecting deformity over the right side of his face and blurring of vision. Surgical rationale of treatment was to easily access the surgical site for the correction of deformity and to achieve the desired facial contour and ectropion correction with uneventful postoperative healing. Deformity at the right zygomatic arch was exposed by a hemicoronal incision. Ectropion over the lower eyelid was addressed by performing Z-plasty. Outcomes were esthetically pleasing with no loss of motor and sensory functions loss. The patient was followed up for six months.

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INTRODUCTION: Temporomandibular Joint (TMJ) reankylosis is one of TMJ arthroplasty complications that can interfere masticatory function and aesthetics. This case report aimed to describe a TMJ reankylosis in growing age patient that occurred 5 years after interpositional arthroplasty using gold foil. Interpositional arthroplasty using temporalis fascia and costochondral graft followed by unilateral coronoidectomy could be a treatment option. CASE PRESENTATION: A 17-year-old female came with inability to open her mouth 5 years after first interpositional arthroplasty using gold foil due to traumatic TMJ ankylosis. Patient was diagnosed type IV left TMJ reankylosis with left coronoid process hyperplasia. Patient was treated with interpositional arthroplasty using temporalis fascia as an interposition material for articular disc substitution, costochondral graft for ramus condyle unit (RCU) reconstruction and followed by unilateral coronoidectomy. Postoperative mouth opening was ±26 mm. One year evaluation showed stable mouth opening and no recurrency occured. DISCUSSION: Age at growing period, insufficient gap width, surgical technique and the effects of previous surgery may generate TMJ reankylosis. Temporalis fascia widely used for interposision material and act as a lubricant that makes movement frictionless. Costochondral graft can be used for RCU reconstruction to prevent decreasing mandibular ramus height and openbite. CONCLUSION: Growing age increases the risk of TMJ reankylosis. Interpositional arthroplasty, which used temporalis fascia and a costochondral graft, has resulted in a sufficient mouth opening and an improvement in masticatory function. Recurrence was not found in the 1-year postoperative evaluation.

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Masticatory muscle activation and temporomandibular joint (TMJ) load generated during asymmetrically loaded jaw closing are largely unknown. Two different strategies were developed to explain how the central nervous system (CNS) generates muscle activation patterns during motion: minimization of joint load (MJL) vs. minimization of muscle effort (MME). The aim of the present study was to investigate, experimentally, the neuromuscular strategy selected by the CNS to coordinate jaw closing in reaction to the application of an external asymmetric load. Masticatory muscle activation was measured with electromyography (EMG) and the minimum intra-articular distance (MID) was assessed by dynamic stereometry to infer joint loading. Ten healthy subjects performed jaw-closing movements against an asymmetric mandibular load set from 0.0 to 2.0 kg in 0.5-kg steps. Recordings were analyzed by exploratory and graphical statistical tools. Moreover, the observed differences in MID and EMG among the various mandibular loads were tested using non-parametric tests for repeated measures data. The ipsilateral-contralateral differences in MID and EMG of the anterior temporalis showed a significant increase (p < 0.001, p = 0.01) with increasing asymmetrical load with both joints being most heavily loaded at 1 kg. EMG signals of the masseter did not change significantly with increasing load. This study is the first to have analyzed the changes in the TMJ intra-articular space during asymmetrically loaded jaw-closing movements, not only three dimensionally and dynamically, but also combined with EMG. Asymmetrical load affected the TMJ space and masticatory muscle activation patterns, primarily resulting in an increased activation of the anterior temporalis muscle. This might suggest the involvement of a control mechanism to protect the joints from overloading. However, the results do not fully support the hypothesis of MJL nor the MME strategy.

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Many techniques have been proposed to restore facial symmetry in facial nerve palsies. This study presents our surgical approach called Endoscopic Temporalis Tendon Extension (ETTE). After nasotracheal intubation, a 4 cm skin incision is made at the nasolabial fold. Under endoscopic view, the medial face of the masseter muscle is detached from the mandibular ramus. The coronoid process is then sectioned by Piezosurgery®. Finally, a fascia lata graft is suspended between the temporalis tendon and the orbicularis oris. ETTE is a mixed technique, with a static suspension component and a dynamic contraction one. The preservation of the temporalis muscle insertion in temporal fossa allows for an optimal contraction. A fascia lata graft is necessary for reasons of length. The scar produced by the nasolabial incision allows to recreate the missing nasolabial fold. The endoscopic assistance provides greater precision during the procedure and entails a shorter learning curve.

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In this case report we present a very rare case of intramuscular cavernous hemangioma in the temporalis muscle which was successfully managed with surgical excision with no evidence of recurrence in follow-up.

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Background: This case series report aimed to present three surgical approaches used for the treatment of cerebrospinal fluid (CSF) otorrhea, providing less invasive surgical options for managing this condition. Methods: Clinical data of 26 patients with CSF otorrhea, who underwent treatment using three surgical methods between June 2012 and June 2022, were retrospectively analyzed. The study collected information on patients' basic demographic characteristics, chief complaints, location of the defect, results of otorrhea endoscopic examination, findings from skull base thin-slice computed tomography (CT) examination, and causes of CSF otorrhea. Postoperative outcomes of CSF otorrhea were followed up. Results: Among the 26 cases of CSF otorrhea, there were 13 (50%) males and 13 (50%) females who underwent treatment using the three surgical methods. The etiology of CSF otorrhea included 10 (38%) cases of spontaneous CSF otorrhea, including 2 (8%) cases of congenital inner ear deformity and 8 (31%) cases without obvious inducement. Additionally, there were 5 (19%) cases of trauma, 6 (23%) cases of cholesteatoma complications, 3 (12%) cases of postoperative complications of brain tumor, 1 (4%) case of radiotherapy, and 1 (4%) case of a malignant tumor. A total of 12 (46%) cases of CSF otorrhea were treated by local repair of the defect. Furthermore, 3 (12%) cases underwent local repair of the defect combined with sealing of the tympanic sinus entrance, while 11 (42%) cases underwent local repair of the defect combined with sealing of the eustachian tube and the external auditory canal. No recurrence of CSF otorrhea was observed during the 6-month to 10-year follow-up period after surgery. Conclusion: The three methods for CSF otorrhea, including local defect repair, local defect repair combined with sealing of the tympanic sinus entrance, and sealing of the eustachian tube and the external auditory canal, demonstrated successful outcomes in appropriately selected patients.

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In this study, we aimed to determine the effects of functional mandibular lateral shift (FMLS) on the muscle mass, fiber size, myosin heavy chain fiber type, and related gene expression in masticatory muscles (masseter and temporalis), as well as whether the baseline levels could be recovered after FMLS correction in growing rats. The FMLS appliance was placed to shift the mandible leftward by approximately 2 mm. After FMLS placement for 2 and 4 weeks, the muscles on the left side had significantly lower wet weight, mean cross-sectional area, and proportion of type IIa fibers than those on the right side or in the control groups (p < 0.05), with downregulation and upregulation of IGF-1 and GDF-8 gene expression, respectively (p < 0.05). Following 2 weeks devoted to recovery from FMLS, the muscle parameters in the recovery group were not significantly different to those of the control group, and IGF-1 expression in the left-side muscles was enhanced and GDF-8 expression was simultaneously suppressed. These findings indicate that the masticatory muscle changes induced via FMLS tend to revert to normal conditions if the intervention is eliminated at an early stage. Therefore, appropriate orthodontic treatment for FMLS during the growth period is advisable to prevent asymmetric alterations in masticatory muscles.

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Objetivo: Describir las características craneofaciales, dentoalveolares, de tejido blando, vía aérea y el patrón de actividad muscular determinadas a través de los estudios cefalométricos y electromiográficos de individuos incompetentes labiales y con presencia de anomalías dentomaxilares de 7 a 12 años de edad. Materiales y método: Cuarenta y seis participantes con incompetencia labial fueron sometidos a una toma de radiografía lateral de perfil para el análisis cefalométrico. Para el estudio electromiográfico se consideró el patrón de actividad de los músculos Orbicular superior de los labios, orbicular inferior de los labios y temporal anterior en funciones: reposo, fonoarticulación, deglución, máximo apriete labial. Resultados: Se observó clase II esqueletal y molar, retrusión mandibular, biprotrusión incisal, biprotrusión labial, disminución de vía aérea superior. La mayor actividad muscular fue observada en máximo apriete labial. Conclusión: Los niños y niñas con incompetencia labial y anomalías dentomaxilares presentan alteraciones en las características craneofaciales, dentoalveolares, de tejido blando, vía aérea y actividad muscular determinadas a través de los estudios cefalométricos y electromiográficos.

Objective: To describe craniofacial, dentoalveolar, soft issue and airway features, and the muscular activity, determined through a cephalometric and electromyographic study in individuals with lip incompetence and dentomaxillary anomalies aged 7 to 12 years. Methods: Forty-six participants with lip incompetence underwent lateral profile radiography for cephalometric analysis. For the electromyographic study, the activity of the superior orbicularis oris, inferior orbicularis oris and anterior temporalis muscles was considered in the following functions: rest, speaking, swallowing, and reciprocal compression of the lips. Results: Skeletal and molar class II, mandibular retrusion, labial biprotrusion, incisal biprotrusion, and upper airway dysfunction were found. The highest muscular activity was observed in reciprocal compression of the lips. Conclusion: Children with lip incompetence and dentomaxillary anomalies have alterations in the craniofacial, dentoalveolar, soft issue, and airway features, and in the muscular activity , determined through a cephalometric and electromyographic study.

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Objectives: Temporal tenosynovial giant cell tumors (TGCTs) are often large and have invaded the middle skull base. It is difficult to protect the important neurovascular structures around the tumor and perform functional reconstruction on the basis of complete tumor resection. This study aimed at analyzing the surgical techniques and functional reconstruction during the operation of complex TGCT of temporal bone and middle skull base. Methods: Five patients with pathologically confirmed TGCT of different complex types in the temporal bone and middle skull base were treated in our hospital from December 2020 to February 2023. We collected and retrospectively analyzed their medical records, including medical imaging, surgical procedures, and follow-up data. Results: The tumors invaded beyond the temporal bone and destroyed the middle skull base in all cases, involving the intracranial space and other important neurovascular structures. The internal carotid artery, infratemporal fossa, pterygopalatine fossa, and parapharyngeal space were also involved in 1 case. All the patients' tumors were completely removed, and the operations were performed mainly via modified infratemporal fossa approach, or combined with expanded middle cranial fossa approach. All cases with temporal and skull base destruction were repaired using the temporalis muscle flap with no occurrence of intracranial complications. The dura mater, condyle of temporomandibular joint, facial nerve, and internal carotid artery were fully preserved. Normal maxillofacial morphology was also preserved. The air conductive hearing of 2 patients was preserved. Conclusions: We found and summarized some surgical techniques that can help safeguard the important structures around massive TGCTs of temporal bone and middle skull base, and reconstruct the defects after tumor resection. The techniques are effective and feasible.

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(1) Background: Myopia is one of the most common refractive errors in the world. The aim of this study was to evaluate the transverse dimensions of selected masticatory muscles (temporalis muscle and masseter muscle) versus the transverse dimensions of selected extraocular muscles (superior rectus, inferior rectus, medial rectus and lateral rectus) in emmetropic and high myopic subjects. (2) Methods: Twenty-seven individuals were included in the analysis, resulting in 24 eyeballs of patients with high myopia and 30 eyeballs of emmetropic subjects. A 7 Tesla resonance was used to analyze the described muscles. (3) Results: Statistical analysis showed differences in all analyzed extraocular muscles and all analyzed masticatory muscles between emmetropic subjects and high myopic subjects. In the high myopic subject group, statistical analysis showed four correlations. The three negative correlations were between the lateral rectus muscle and an axial length eyeball, refractive error and an axial length eyeball, and the inferior rectus muscle and visual acuity. The positive correlation was between the lateral rectus muscle and the medial rectus muscle. (4) Conclusions: The high myopic subjects are characterized by a larger cross-sectional area of extraocular muscles and masticatory muscles compared to the emmetropic subjects. Correlations were observed between the thickness of the extraocular muscles and the masticatory muscles. The lateral rectus muscle was related to the length of the eyeball. The phenomenon requires further study.

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Sarcopenia has been identified as a prognostic factor among certain types of cancer. However, it is unclear whether there is prognostic value of temporalis muscle thickness (TMT), a potential surrogate for sarcopenia, in adults patients with brain tumors. Therefore, we searched the Medline, Embase, and PubMed to systematically review and meta-analyze the relationship between TMT and overall survival, progression-free survival, and complications in patients with brain tumors and the hazard ratio (HR) or odds ratios (OR), and 95% confidence interval (CI) were evaluated. The quality in prognostic studies (QUIPS) instrument was employed to evaluate study quality. Nineteen studies involving 4570 patients with brain tumors were included for qualitative and quantitative analysis. Meta-analysis revealed thinner TMT was associated with poor overall survival (HR, 1.72; 95% CI, 1.45-2.04; P < 0.01) in patients with brain tumors. Sub-analyses showed that the association existed for both primary brain tumors (HR, 2.02; 95% CI, 1.55-2.63) and brain metastases (HR, 1.39; 95% CI, 1.30-1.49). Moreover, thinner TMT also was the independent predictor of progression-free survival in patients with primary brain tumors (HR, 2.88; 95% CI, 1.85-4.46; P < 0.01). Therefore, to improve clinical decision making it is important to integrate TMT assessment into routine clinical settings in patients with brain tumors.

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