Muscles of Mastication: DR Gauri Mulay

Muscles of Mastication
Dr Gauri Mulay
Contents
 Introduction
 Muscles of mastication
 Accessory muscles of mastication
 Anatomy
 Dysfunction of muscles
 Treatment
 Role of electromyography
Muscles involved in mastication
 Masseter
 Temporalis
 Lateral Pterygoid
 Medial Pterygoid
Accessory muscles involved
 Vital for normal chewing, but not
mandibular adductors/protractors
 Diagastric
 Geniohyoid
 Mylohyoid
 Buccinator
Masseter
•Origin:
– Superficial portion – Max process of
zygomatic bone & lower border of ant 2/3
zygomatic arch
– Deep portion – medial surface of
zygomatic arch
• Insertion:
– Lateral surface of ramus, coronoid
process, and angle of mandible
• Function:
– Elevates mandible, clenches
teeth
Innervation of masseter muscle
 Massetric nerve (branch of ant trunk

of mandibular nerve)
 Massetric artery (branch of

maxillary artery)
Relation of masseter
Ant superior part
Multiple areas of
masseter
Post inferior part

Temporalis Muscle
Origin:
– Temporal fossa ( fan shape)
Superior to the inferior
temporal line. Lat attached to
temporal fascia
Ant fibers- vertically
Post fibers- horizontally
• Insertion:
Tendon
– Coronoid process, anterior
border of ramus
Actions of temporalis
Retraction
Function: Elevation
– Elevates and retracts

mandible, helps in lateral
movements.
Innervation of Temporalis
 Deep temporal nerves ( Br of mand nerve)
 Deep temporal arteries

Temporalis muscle
Anterior, middle and

posterior part of
temporalis muscle
Palpation of temporalis
Anterior part of temporalis muscle

Palpation of temporalis
Middle part of temporalis Posterior part of temporalis

Medial Pterygoid muscle.
Origin:
– Deep head-Medial surface of
lateral pterygoid plate
-Superficial head- from max
tuberosity and adjacent pyramidal
process of palatine bone
Insertion:
– Posterior and lower part of medial
surface of ramus,angle of mandible
Innervation of Medial pterygoid
Nerve to medial pterygoid
Function:
– Elevates, assists lateral pterygoid in protruding the
mandible and helps in lateral movements.
Palpation of medial pterygoid
Lateral pterygoid Muscle.
Origin:
– Superior head – infratemporal surface of
greater wing of sphenoid bone
– Inferior head – lateral surface of lateral
pterygoid plate
Triangular shape and fibers are oriented in
horizontal manner
• Insertion:
– Anterior portion of condylar neck into
pterygoid fovea and articular disc of the
capsule of the TMJ
Actions of lateral pterygoid
Condyle rotates and translates Protrusion and depression

Function:
– Protrudes the mandible, pulls
articular disc forward by
contracting, lateral movements
 The combined efforts of the Digastrics and
Lateral Pterygoids provide for natural jaw
opening.

Lateral Pterygoid action
Unilateral pterygoid muscle contraction, because of

its mediolateral direction, produces condylar
translation and an anterior movement of the
mandibular angle on the side of contraction. The chin
is displaced toward the contralateral (opposite) side,
which becomes the working side as that condyle
rotates and moves slightly laterally (the Bennett
shift).
Palpation of ILT
Digital palpation- impossible and misleading

It is nearly impossible to reach the
inferior lateral pterygoid muscle
with the palpating forefinger.
*J Prosthet Dent 2000;83:548-54.

Pterygomasseteric Sling
Anterior view of
pterygoid muscles.
A, Lateral pterygoid
B, medial pterygoid
Posteroinferior view of
pterygoid muscles. A, Medial
pterygoid B, lateral pterygoid C,
mandibular angle; D, hard
palate; E, posterior surface of
mandibular ramus; F, body of
mandible.
Reflection of masseter muscle and Further reflection of masseter muscle. A,
zygomatic arch. A, Masseter muscle; B, Body of mandible; B, masseter muscle; C,
zygomatic arch; C, body of mandible; D, medial pterygoid muscle; D, lateral
medial pterygoid muscle; E, temporalis pterygoid muscle; E, inferior alveolar
tendon; F,temporalis muscle. nerve; F,lingual nerve; G, buccal nerve.
ELEVATION
P
R Masseter
Temporalis R
E Med. Pterygoid O
T
T
R
R
A
A
C Digastric Lat. Pterygoid C
T Geniohyoid T
I
I
O
O
N Myelohyoid N
DEPRESSION
SIDE TO SIDE MOVEMENTS:

LAT & MED PTERYGOID MUSCLES OF OPP SIDE ALTERNATELY
Muscle tone
 Muscle tone- imp in edentulous patients

 House’s classification of muscle tone-
1 Class 1- Normal tension and tone
2 Class 2- Normal muscle function & slight
decrease in tone
3 Class 3- Decreased tone and function
Temporomandibular Disorders
 – Muscles of Mastication
 – Temporomandibular joints
 – Both
Muscle pain in TMD
Myalgia (Myofacial pain)

Symptoms
 Pain in localized area of one masticatory muscle
(usually masseter or temporalis)
 Fatigue with chewing
Signs
 Tender muscles upon palpation
 Sometimes limited active vertical range of
mandibular motion
Masseter muscle dysfunction
Masseter Muscle Rigidity

Often precedes MH
 Many degrees of rigidity
 –Slight stiffness
 –Open mouth with difficulty
 –Unable to open mouth
Treatment- Conservative approach
 – Stop the case
Masseter muscle
hypertrophy
*Braz. Dent. J. vol.17 no.4

 Differential diagnosis
 –Myotonic syndrome
 –TMJ dysfunction
 - Dental infection
Masseter Muscle Myositis
 Immune-mediated
 Acute, painful Muscle
 Pain on opening mouth
 Muscle swelling
 Chronic, atrophy with fibrosis
Muscle trismus
 Inflammation of one of the muscles’ of
mastication
 Following surgical removal of 3rd molar- Acute
 Needle injuries while giving anaesthesia
 Patients with severe bruxism – Slowly
Treatment
 Usually recovers in 10-15 days
 NSAIDs and muscle relaxants
 Heat application
 Physiotherapy
Pterygoid dysfunction
Interference in Lateral excursion

Effect of deviation
Interocclusal splints help in treating deviation

Effect of clenching
The lateral pterygoid is responsible for the strain and load that can be
exerted to the temporomandibular joint complex during parafunctional
acts. If the teeth are not in contact, there is no resistance to lateral
pterygoid contractions, therefore there is negligible strain to the TMJ.
Effect of stress on dysfunction
Stress or psychosomatic disorders can increase

muscle activity leading to myofacial pain and
tenderness in the muscles
*Journal of Dental Research, Vol 58, 1866-1871

Neurological disorders
 Parkinson’s disease – Degenerative disorder of

CNS
 Hemiplegia – Paralysis of half the pt’s body
 Myasthenia gravis – Weekness of muscles

associated with decreased function and strength
Electromyography
 Electromyography (EMG) is a technique for

evaluating and recording physiologic properties
of muscles at rest and while contracting. EMG is
performed using an instrument called an
electromyograph, to produce a record called an
electromyogram. An electromyograph detects
the electrical potential generated by muscle cells
when these cells contract, and also when the
cells are at rest.
 Intra/ Extra muscular myography
Electromyographic activity of the masticatory
muscles on resistance to opening.
Electrode Position of masticatory muscles
All muscles increased their activity

when the resistance to the jaw
opening movement was applied.
*Journal of Oral Rehabilitation 34; 184–194
Method for lateral pterygoid
electromyographic electrode placement
*J Prosthet Dent 2007;98:224-231
Insertion needle electrode parallel

to line joining lateral pole of
condyle and center of external
auditory meatus.
Effect of ant bite stop in EMA of
muscles of mastication
Anterior bite stop
* J Prosthet Dent 1999;82:22-6.

EMA of muscles
EMA before and after placement of ant bite stop

Use of occlusal splint
*J PROSTHET DENT 1995;73:316-8.

Splint in mobile mand incisors
*J PROSTHET DENT 1995;73:316-8.

Effect of osseointegrated implants on the
EMA of masticatory muscles
 Patients with multiple implants

 No significant clinical difference.
 No significant difference in the EMA of
muscles

The effect of age on the function of the
masticatory system : EMG study
 Elderly show hyperactivity of masticatory

musculature during posture maintenance and a
slight hypoactivity of this musculature during
chewing when analyzed side by side with
young individuals.
*Gerodontology 2006; 23; 177–182

Electromyography for determining
rest position
 Determination of a correct vertical dimension
of occlusion is a critical step.
 Clinical rest position and electromyographic
rest positions were compared
 EMG and clinical rest position recordings
did not reveal significant differences
 Jaw posture with a few millimeters of
interocclusal distance involves a great
reduction of masticatory muscle activity.
*J Prosthet Dent 1997;78:48- 53.
Effects of a functional appliance on
masticatory muscles
The appliance and a schematic representation of the FGB-D in

place. (1) anterior metallic bite planes; (2) posterior metallic
bite plane.
May be useful in muscle-related TMD patients
requiring orthodontic treatment for dental deep bite
correction by reducing muscle activity..
*Journal of Oral Rehabilitation 31; 2004
Masticatory pattern in men and women
 Men have significantly shorter chewing cycles

with faster velocities than women.
 Men have significantly greater
chewing/masticatory force than women.

Summary:
Causes of muscular dysfunction
1 Clenching/Bruxism
2 Occlusal interferences
3 Mal-occlusion
4 Psychosomatic disorders
5 Deviation in mandibular movements
6 Muscle trismus
7 Neurological disorders eg Parkinsonism.
Summary:
Sreening Questions
Pain in jaw/temples/ears
• Fatigue/stiffness in jaw
• Difficulty opening
• Locking open/closed
• TMJ noise
• Trauma to jaw/face
• Change in occlusion
• Oral habits
Summary:
Screening Examination
Summary: Treatment of muscular
dysfunction
 Night guards in patients with bruxism
 Remove the cause such as occlusal interferences or
stress related issues
 Relief can be obtained by passive occlusal or
interocclusal splints or anterior bite stops.
 Orthodontic treatment in patients with dysfunction
related to mal occlusion
 Muscle relaxants for immediate relief.
 Physiotherapy
 Understanding functional anatomy of TMJ
 Medical treatment - neurological disorders
Conclusion
 Thus the knowledge of anatomy and physiology

of these muscles help in diagnosing many of the
problems like orofacial pain, joint disorders and
treating them in a correct manner.
 In such patients meticulous palpation of each
muscle should be carried out.
 EMG is of a great help before prosthetic
treatment planning.
Thank you!

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Muscles of Mastication

 Massetric nerve (branch of ant trunk

 Massetric artery (branch of

Post inferior part

– Elevates and retracts

 Deep temporal nerves ( Br of mand nerve)

 Deep temporal arteries

Anterior, middle and

Anterior part of temporalis muscle

Middle part of temporalis Posterior part of temporalis

Nerve to medial pterygoid

Condyle rotates and translates Protrusion and depression

Unilateral pterygoid muscle contraction, because of

Digital palpation- impossible and misleading

*J Prosthet Dent 2000;83:548-54.

SIDE TO SIDE MOVEMENTS:

 Muscle tone- imp in edentulous patients

Myalgia (Myofacial pain)

Masseter Muscle Rigidity

*Braz. Dent. J. vol.17 no.4

Interference in Lateral excursion

Interocclusal splints help in treating deviation

Stress or psychosomatic disorders can increase

*Journal of Dental Research, Vol 58, 1866-1871

 Parkinson’s disease – Degenerative disorder of

 Hemiplegia – Paralysis of half the pt’s body

 Myasthenia gravis – Weekness of muscles

 Electromyography (EMG) is a technique for

All muscles increased their activity

Insertion needle electrode parallel

Anterior bite stop

* J Prosthet Dent 1999;82:22-6.

EMA before and after placement of ant bite stop

*J PROSTHET DENT 1995;73:316-8.

*J PROSTHET DENT 1995;73:316-8.

 Patients with multiple implants

*J Prosthet Dent 2000;84:185-93.

 Elderly show hyperactivity of masticatory

*Gerodontology 2006; 23; 177–182

The appliance and a schematic representation of the FGB-D in

 Men have significantly shorter chewing cycles

*J Prosthet Dent 1997;78:179-86.

 Thus the knowledge of anatomy and physiology

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