An instance of isolated unilateral temporalis muscle hypertrophy (reactive masticatory muscle hypertrophy with fiber type 1 predominance) confirmed by muscle biopsy with histochemical fiber typing and image analysis in a 62 year-old man is reported. The patient presented with bruxism and a painful swelling of the temple. Absence of asymmetry or other abnormalities of the craniofacial skeleton was confirmed by magnetic resonance imaging and cephalometric analyses. The patient achieved symptomatic improvement only after undergoing botulinum toxin injections. Muscle biopsy is key in the diagnosis of reactive masticatory muscle hypertrophy and its distinction from masticatory muscle myopathy (hypertrophic branchial myopathy) and other non-reactive causes of painful asymmetric temporalis muscle enlargement.
active ulcers. No active ulcers were recorded in any of our patients. The pseudodiverticula were not ulcer craters because of the absence of rigidity and tenderness and the contractility of the pouches. Moreover, there was no history suggestive of recurrence of the ulcer. I n the absence of cine-radiographic studies the transit time for the barium suspension to traverse the distance between the cardio-oesophageal junction and the duodenojejunal flexure can be a useful guide as to the patency of the gastroduodenal channel, mindful of the fact that it can be modified by the shape and size of the stomach and peristaltic activity. However, the transit time from the cardiooesophageal junction to the duodenojejunal flexure in post-pyloroplasty patients was shorter than in normal subjects (Bohrer, 1969). The configuration of the gastroduodenal channel in group 2 patients is considered to represent an unsuccessful pyloroplasty (Bloch and Wolf, 1965) although a majority of these patients are asymptomatic (Wilkins, 1953).T h e results of vagotomy and pyloroplasty in the treatment of duodenal ulceration in Nigerians have been satisfactory and compare favourably with the findings of other workers (Ellis and others, 1966).T h e incidence of diarrhoea in this series is over 35 per cent, although less than 5 per cent of the patients required treatment. Our results, although only followed to a maximum of 5 years after operation, were generally satisfactory. This procedure appears to be a reasonable form of treatment to offer our patients provided the necessary precautions are taken.
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