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Is there a relationship between masseteric muscle spasm and malignant hyperpyrexia?

A S Christian1, F R Ellis, P J Halsall

  • 1University Department of Anaesthesia, St James's University Hospital, Leeds.

British Journal of Anaesthesia
|May 1, 1989
PubMed
Summary

Masseteric muscle spasm (MMS) is less common in children than previously thought and may not indicate malignant hyperpyremia (MH). However, MMS can still be an early warning sign for MH, especially with elevated creatine kinase.

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Area of Science:

  • Anesthesiology
  • Pediatric Medicine
  • Neuromuscular Disorders

Background:

  • Masseteric muscle spasm (MMS) in children is often presumed to be frequent and linked to malignant hyperpyrexia (MH).
  • Previous assumptions may overestimate the incidence and diagnostic significance of MMS in pediatric populations.

Purpose of the Study:

  • To investigate the actual incidence of masseteric muscle spasm (MMS) in children.
  • To evaluate the association between MMS and malignant hyperpyrexia (MH) in pediatric patients.
  • To clarify the clinical features supporting an MH diagnosis.

Main Methods:

  • Retrospective analysis of pediatric cases involving masseteric muscle spasm.
  • Clinical data review, including serum creatine kinase (CK) levels and myoglobinuria.

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  • Assessment of patient responses to suxamethonium.

    • Main Results:

    • A lower incidence of MMS was observed in children than previously reported.
    • Fifty percent of children experiencing MMS showed no underlying muscle abnormality.
    • High serum CK concentration and myoglobinuria were identified as key indicators for MH diagnosis.
    • Suxamethonium was noted to increase jaw tone in both adults and children, potentially mimicking MMS.

    Conclusions:

    • Masseteric muscle spasm (MMS) occurs less frequently in children than presumed and is not always indicative of malignant hyperpyrexia (MH).
    • Clinical indicators like elevated serum CK and myoglobinuria are crucial for diagnosing MH.
    • While an exaggerated jaw tone response to suxamethonium might be mistaken for MMS, MMS should still be considered a potential early warning sign for MH.