Medical Terminology Daily - Est. 2012

Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

William S. Halsted, MD

William S. Halsted, MD
(1852 – 1922)

American anatomist, teacher, and surgeon, William Stewart Halsted was born in New York City, USA to a wealthy family of English origin. His father was involved in charitable work and Governor and trustee to a city hospital. Not a brilliant student initially, Halsted took an undergraduate in Liberal Arts in Yale, CT., after which he entered the Medical College of Physicians at the Columbia College, where he excelled.

As a second-year medical student Halsted applied and obtained a position in surgery at a local hospital. In here he learned about Lister’s antiseptic technique and became an adamant proponent of it to reduce infection. In 1877 Halsted obtained his MD. After a short time as House Physician at the New York Hospital, Halsted traveled to Europe to further his education studying for two years at the Universities of Vienna, Leipzig, and W?rzburg.

Besides being at the forefront of surgical and antiseptic techniques (introducing the use of rubber gloves in surgery), Halsted was extremely concerned with the way medical students were taught in the US. He pioneered bedside clinical round discussions with the medical students after two years of basic sciences studies. Halsted developed the idea of a patient chart; he also developed the residency program for medical students in use today.

Halsted is probably the most influential researcher and surgeon at the turn of the century. He dedicated time to the study of intestinal anastomoses and the use of silk as a suture material. His experimental work in 1887 proved that the inclusion of the submucosa layer in an anastomosis was mandatory, as well that a single layered anastomosis was enough to attain closure. Perhaps Halsted’s most important contribution was the application and use of the scientific method to surgical questions. Halsted’s principles set the standards used today in surgical suturing and surgical stapling.

He also pioneered the development and surgical techniques for radical mastectomy as a treatment for breast cancer.

As a side effect of this studied in anesthesia and the use of cocaine for anesthesia, Halsted became addicted to this substance, a problem that followed him through the years. Without impairing his capacity as a researcher and a surgeon, Halsted eventually recovered. He died in Baltimore in 1922 as a complication to surgery.

Sources:
1. Dubay, A. D., & Franz, G. M. (2003). Acute Wound Healing: The Biology of Acute Wound Failure. Surg Clin NA, 83, 463-481.
2. Halsted, W. S. (1887). Circular Suture of the Intestine - An Experimental Study. Am J Med Sci, 436-461.
3. “William Stewart Halsted: his life and contributions to surgery” Osborne, P. Lancet Oncol 2007; 8: 256–65
4. “William Stewart Halsted: Surgical pioneer” Burress, P Endoc Today (2010), 8: (2) 22
5. “William Stewart Halsted (1852–1922) Neurological stamp” Haas, LF J Neurol Neurosurg Psych 2000;69:641
Original image courtesy of "Images from the History of Medicine" at  www.nih.gov


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Temporalis muscle
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The temporal muscle (Lat:Temporalis) is a bilateral muscle located on the side of the head. It belongs to a subgroup of head muscles called Masticatory Muscles, named after their function elevating the mandible to produce the mandible movements (1,2). Masticatory muscles are four per side: Temporalis, Masseter, Pterygoideus medialis and Pterygoideus lateralis (1,2).

The temporalis muscle is a fan-shaped muscle which occupies the temporal fossa from which its fascicles (fibers) converge to the coronoid process of the mandible. Classic description for this muscle recognizes three main muscular bodies (anterior, midle, and posterior) originated from the temporal fossa up to the lower temporalis line and the temporalis fascia, fascicles which descend through the inner part de the zygomatic arch converging to be inserted on the coronoid process of the mandible, its temporalis crest and anterior margin of the mandibular branch through thick tendons (1,2).

Temporalis muscle
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In 1996 Dunn et al. (3) reported the discovery of a so far unknown masticatory muscle called the “sphenomandibularis”, originated from the greater wing of the sphenoid bone medial to the temporalis muscle and descends on an oblique (lateral and slightly posterior) fashion reaching distally the coronoid process of the mandible. This muscular portion has been recognized as the “deep belly of the temporalis muscle” and has been described by several authors since then (4,5,6,8). The importance that has been given to this particular bundle lies on the fact that its medial insertion can reach a close relationship to the foramen rotundum, place of emergency from the cranium of the maxillary nerve, which has been hypothesized, could lead to eventual alteration of this nerve if it got trapped by this part of the muscle (6, 7).

The temporalis muscle receives innervation fundamentally from branches of the mandibular nerve: Deep temporal nerve (N. temporalis profundus)through its anterior middle and posterior branches.

The temporalis muscle is covered by a thick fascia layer: the temporalis fascia.

Article written by: Maria F. Cortés, DDS, MSc.

Images from:
Fig 1. Public domain, by Henry Vandyke Carter, MD - Gray's Anatomy, 1918
Fig 2. Geers C, Nyssen-Behets C, Cosnard G, Lengelé B. The deep belly of the temporalis muscle: an anatomical, histological and MRI study. Surg Radiol Anat. 2005 Aug;27(3):184-91. Epub 2005 Apr 9

Sources:
1. “Anatomía humana” V.2. Latarjet- Ruiz Liard, 4ª ed. 6ª reimp. 2008 Médica Panamericana, Buenos Aires, Argentina.
2. “Anatomía humana: descriptiva, topográfica y funcional. Tomo 1. Cabeza y Cuello, Rouviere H – Delmas A, 11° ed. 2005 MASSON, S.A., Barcelona, Spain.
3. Dunn GF, Hack GD, Robinson WL, Koritzer RT. Anatomical observation of a craniomandibular muscle originating from the skull base: the sphenomandibularis. Cranio. 1996 Apr;14(2):97-103; discussion 104-5.
4. Shimokawa T, Akita K, Soma K, Sato T. Innervation analysis of the small muscle bundles attached to the temporalis: truly new muscles or merely derivatives of the temporalis? Surg Radiol Anat. 1998;20(5):329-34.
5. Akita K, Shimokawa T, Sato T. Aberrant muscle between the temporalis and the lateral pterygoid muscles: M. pterygoideus proprius (Henle). Clin Anat. 2001 Jul;14(4):288-91.
6. Schön Ybarra MA, Bauer B. Medial portion of M. Temporalis and its potential involvement in facial pain. Clin Anat. 2001;14(1):25-30.
7. Fuentes E, Llanos S, Gómez R, Llanos P, Llanos F, Cortés-Sylvester MF, Solaria P, Melian A, Asfura J, Santos M, Zamorano E. Discovery of deep temporalis muscle belly close to maxillary nerve in a patient with trigeminal neuralgia: hypothesis of muscular compression and case report treated by Botox® Onabotulinum toxin tipe-A. Chirurgia 2016 June;29(3):99-102
8. Geers C, Nyssen-Behets C, Cosnard G, Lengelé B. The deep belly of the temporalis muscle: an anatomical, histological and MRI study. Surg Radiol Anat. 2005 Aug;27(3):184-91. Epub 2005 Apr 9.