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Fully automated 3D volumetric analysis of masticatory muscles in a pediatric population: A CT-based normative
Özlem Kanber Uzun1, Canan Ertemoğlu Öksüz1, Şahi Nur Kalkişim1
1Department of Anatomy, Vocational School of Health Services, Karadeniz Technical University, Trabzon, Türkiye.
Insights
This study provides crucial normative volumetric data for pediatric masticatory muscles, revealing age- and sex-specific growth patterns essential for craniofacial development and clinical applications.
Area of Science:
- Craniofacial Biology
- Pediatric Radiology
- Biomedical Engineering
Background:
- Masticatory muscles are vital for craniofacial growth, but normative volumetric data across pediatric ages are lacking.
- Understanding these muscles' development is key for diagnosing and treating craniofacial abnormalities.
Purpose of the Study:
- To establish age- and sex-specific normative reference values for pediatric masticatory muscle volumes.
- To analyze volumetric development patterns using automated 3D segmentation.
Main Methods:
- Retrospective, cross-sectional study of 258 pediatric individuals (0-17 years).
- Automated 3D segmentation using TotalSegmentator in 3D Slicer.
- Statistical analysis (ANOVA, Bonferroni) to assess age and sex differences.
Main Results:
- All masticatory muscles showed significant volume increases with age, with the masseter growing most (199%).
- Sex-specific differences emerged from 6-9 years, with pterygoid muscles showing the largest effect sizes.
- Bilateral asymmetry was observed, with muscle-specific lateralization patterns.
Conclusions:
- This study provides a comprehensive CT-based normative reference for pediatric masticatory muscles.
- Findings highlight muscle-specific volumetric patterns and variable sex differentiation crucial for clinical decision-making.
- Normative ranges support dentistry, craniofacial surgery, and pediatric radiology practices.
Abstract:
The masticatory muscles play a fundamental role in craniofacial growth and development, yet normative volumetric data encompassing all four muscles across the full pediatric age range remain poorly characterized. The aim of this study was to establish age- and sex-specific normative reference values for the volumetric development of masticatory muscles in a normal pediatric population (0-17 years) using a fully automated 3D segmentation method. This retrospective, cross-sectional study included 258 normal pediatric individuals stratified into four age groups based on biomechanical milestones (0-5, 6-9, 10-13, and 14-17 years). Bilateral volumes of the masticatory muscles were automatically calculated using TotalSegmentator in the 3D Slicer environment. Two-way analysis of variance and Bonferroni post-hoc tests were applied. All muscles showed significant volume increases with age (p < 0.001), with the masseter demonstrating the greatest increase (199%). No sex differences were observed in 0-5 years; significant male-favoring differentiation began from 6 to 9 years. The temporalis muscle exhibited a biphasic sex differentiation pattern, with no significant difference at 10-13 years despite significance at 6-9 and 14-17 years. The highest sex-related effect sizes were observed in the pterygoid muscles (medial pterygoid ηp² = 0.176; lateral pterygoid ηp² = 0.160). Bilateral asymmetry analyses revealed left-sided favoring in the masseter, a lateralization trend in the temporalis (exploratory), right-sided favoring in the medial pterygoid, and sex-specific lateralization in the lateral pterygoid. These findings provide a large-scale CT-based normative reference for pediatric masticatory muscles, demonstrating muscle-specific volumetric patterns and variable sex differentiation, with normative ranges supporting clinical decision-making in dentistry, craniofacial surgery, and pediatric radiology.
