title: Electrical stimulation to the trigeminal proprioceptive fibres that innervate the mechanoreceptors in Müller's muscle induces involuntary reflex contraction of the frontalis muscles.
abstract: The levator and frontalis muscles lack interior muscle spindles, despite consisting of slow-twitch fibres that involuntarily sustain eyelid-opening and eyebrow-raising against gravity. To compensate for this anatomical defect, this study hypothetically proposes that initial voluntary contraction of the levator fast-twitch muscle fibres stretches the mechanoreceptors in Müller's muscle and evokes proprioception, which continuously induces reflex contraction of slow-twitch fibres of the levator and frontalis muscles. This study sought to determine whether unilateral transcutaneous electrical stimulation to the trigeminal proprioceptive fibres that innervate the mechanoreceptors in Müller's muscle could induce electromyographic responses in the frontalis muscles, with monitoring responses in the orbicularis oculi muscles. The study population included 27 normal subjects and 23 subjects with aponeurotic blepharoptosis, who displayed persistently raised eyebrows on primary gaze and light eyelid closure. The stimulation induced a short-latency response in the ipsilateral frontalis muscle of all subjects and long-latency responses in the bilateral frontalis muscles of normal subjects. However, it did not induce long-latency responses in the bilateral frontalis muscles of subjects with aponeurotic blepharoptosis. The orbicularis oculi muscles showed R1 and/or R2 responses. The stimulation might reach not only the proprioceptive fibres, but also other sensory fibres related to the blink or corneal reflex. The experimental system can provoke a monosynaptic short-latency response in the ipsilateral frontalis muscle, probably through the mesencephalic trigeminal proprioceptive neuron and the frontalis motor neuron, and polysynaptic long-latency responses in the bilateral frontalis muscles through an unknown pathway. The latter neural circuit appeared to be engaged by the circumstances of aponeurotic blepharoptosis.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan. kmatsuo@shinshu-u.ac.jp
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Osada
authors.forename: Ryokuya
authors.initials: R
authors.lastname: Ban
mesh_terms: D000328:Adult; D001763:Blepharoptosis / Q000175:diagnosis / Q000628:therapy*; D001767:Blinking / Q000502:physiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D004558:Electric Stimulation / Q000379:methods*; D004576:Electromyography / Q000379:methods; D005143:Eyelids / Q000294:innervation / Q000502:physiology; D005152:Facial Muscles / Q000294:innervation* / Q000502:physiology; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008465:Mechanoreceptors / Q000502:physiology; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D018657:Muscle Fibers, Slow-Twitch / Q000502:physiology; D009412:Nerve Fibers / Q000502:physiology*; D009431:Neural Conduction / Q000502:physiology*; D009801:Oculomotor Muscles / Q000294:innervation / Q000502:physiology; D011434:Proprioception / Q000502:physiology; D012016:Reference Values; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014276:Trigeminal Nerve