Muscles of Mastication

1
DEPT OF ORAL MEDICINE, DIAGNOSIS &

RADIOLOGY
12th JULY 2011 09:30 Hrs

RADIOLOGY
12th JULY 2011 09:30 Hrs
:PRESENTED BY
Dr LALIT SINGH NEGI
PG STUDENT
3
: GUIDED BY
Dr NAGESH BINJOO
Dr PUNEET BHARGAVA
Dr CHANDNI SHEKHAWAT
Dr ROOPIKA HANDA

RADIOLOGY
12th JULY 2011 09:30 Hrs
CONTENTS
INTRODUCTION
TMJ MOVEMENTS
CHIEF MUSCLES OF MASTICATION
ACCESSORY MUSCLES OF MASTICATION
CLINICAL EXAMINATION
MEDICAL & SURGICAL CONSIDERATIONS
CLINICAL APPLIED
CONCLUSION
BIBLIOGRAPHY

RADIOLOGY
12th JULY 2011 09:30 Hrs
MUSCLES
DEFINITION :
Muscle (from Latin musculus, diminutive of mus

"mouse") is a contractile tissue of animals and
is derived from the mesodermal layer of
embryonic germ cells. Muscle cells contain
contractile filaments that move past each other
and change the size of the cell. They are
classified as skeletal, cardiac, or smooth
muscles. Their function is to produce force and
cause motion. Muscles can cause either
locomotion of the organism itself or movement
of internal organs.
5

RADIOLOGY
12th JULY 2011 09:30 Hrs
MUSCLES OF
MASTICATION
During mastication ie chewing of food, four
muscles of mastication are responsible for

adduction and lateral movements of the mandible
which is the only moving jaw.
The four muscles of mastication are :
The Masseter
The Temporalis
The Lateral Pterygoid
The Medial Pterygoid
Each of these primary muscles of mastication is
paired, with each side of the mandible possessing
one of the four.
6

RADIOLOGY
12th JULY 2011 09:30 Hrs
Introduction to the TMJ

movements

RADIOLOGY
12th JULY 2011 09:30 Hrs
MOVEMENTS
1. Depression of mandible
(mouth opening)
3 muscle groups
1- lateral pterygoid
2- Suprahyoid. 3- Infrahyoid.
* Main mover is Gravity

2. Elevation of mandible
(mouth closing)
3 muscles
1- Masseter.
2- Medial
pterygoid.
3- Anterior half of temporalis muscle.

RADIOLOGY
12th JULY 2011 09:30 Hrs
3. Protrusion of mandible
(forwards)
3 muscles 1- Lateral pterygoid. 2- Masseter.
3- Medial pterygoid.
main one
is Lateral pterygoid.
4. Retrusion/Retraction of
mandible
(backwards)
by 1- Posterior half of temporalis
2- Deep part of masseter
5. Lat. Movement to the sides:

by 1- Lateral and Medial pterygoid of the
opposite side
2- Temporalis of the same side.
9

RADIOLOGY
12th JULY 2011 09:30 Hrs
10

RADIOLOGY
12th JULY 2011 09:30 Hrs
CHIEF MUSCLES OF MASTICATION
Masseter muscle
Temporalis muscle
Medial pterygoid muscle
Lateral pterygoid muscle
11

RADIOLOGY
12th JULY 2011 09:30 Hrs
THE MASSETER
Thick,
somewhat
quadrilateral
muscle
It has two
Deep part
heads:
superficial andSuperficial
part
deep
12

RADIOLOGY
12th JULY 2011 09:30 Hrs
The superficial part of

Masseter
The largest of the two heads
Origin: It arises by a thick, tendinous
aponeurosis from the zygomatic

process of the maxilla, and from the
anterior two-thirds of the lower border
of the zygomatic arch.
Insertion: Its fibers pass downward and
backward, to be inserted into the angle

and lower half of the lateral surface of
the ramus of the mandible.
13

RADIOLOGY
12th JULY 2011 09:30 Hrs
14

RADIOLOGY
12th JULY 2011 09:30 Hrs
The deep part of Masseter

muscle
Much smaller, but more muscular in texture
Origin: arises from posterior third of the lower
border and whole of the medial surface of the
zygomatic arch.
Insertion: its fibers pass downward and forward,
to be inserted into the upper half of the ramus
The deep portion of the muscle is related
Ant.: the superficial portion

Post.: the parotid gland.
15
*The fibers of the two portions are continuous at

DEPT OF
ORAL MEDICINE, DIAGNOSIS &
their
insertion.
12th JULY 2011 09:30 Hrs
RADIOLOGY
ACTIONS OF MASSETER
elevates and protrudes the
mandible thus closing the mouth;

deep fibers retrudes it.
Swings the chin from one side to
another producing a grinding

movement
16

RADIOLOGY
12th JULY 2011 09:30 Hrs
Innervation:
Mandibular division
of trigeminal nerve
through masseteric
nerve which passes
through the
mandibular notch to
enter its deep
surface.
17

RADIOLOGY
12th JULY 2011 09:30 Hrs
Blood supply:
masseteric artery
from the 2nd part of
maxillary artery
18

RADIOLOGY
12th JULY 2011 09:30 Hrs
THE TEMPORALIS MUSCLE

is a broad, radiating muscle,
situated at the side of the

head.
ORIGIN: It arises from the

whole of the temporal fossa
and the deep surface of
temporal fascia
INSERTION : Its fibers
converge as they descend, and
end in a tendon, which passes
deep to the zygomatic arch and
is inserted into the medial
surface, apex, and anterior
border of the coronoid process,
and the ant. Border of
19mandibular ramus
RADIOLOGY
12th JULY 2011 09:30 Hrs
Action:
its anterior and

middle fibers elevate
the mandible thus
closing the mouth;
its posterior fibers
retrudes it.
20

RADIOLOGY
12th JULY 2011 09:30 Hrs
Innervation:
Deep temporal
branches of
mandibular nerve.
21

RADIOLOGY
12th JULY 2011 09:30 Hrs
Blood supply:
Deep temporal
branches of
maxillary artery.
22

RADIOLOGY
12th JULY 2011 09:30 Hrs
THE LATERAL PTERYGOID MUSCLE

Has two heads: superior
and inferior
Origin : the superior

head arises from greater
wing of sphenoid bone
while the inferior head
arises from the lateral
surface of the lateral
pterygoid plate
Insertion: fibers pass
23
backward to be inserted
into the neck of mandible
OF ORAL MEDICINE, DIAGNOSIS &
and DEPT
articular
disc of TMJ.
RADIOLOGY
12th JULY 2011 09:30 Hrs
Innervation:
Ant. division of
mandibular
nerve through
lateral
pterygoid nerve
24

RADIOLOGY
12th JULY 2011 09:30 Hrs
Blood supply:
maxillary artery
through the pterygoid

branch.
From the 2nd part
25

RADIOLOGY
12th JULY 2011 09:30 Hrs
Action:
acting together they
protrude and depress the
mandible;
acting alone and
alternatively they produce
side to side movements of the
mandible.
(rotates the mandible to

the opposite side)
26

RADIOLOGY
12th JULY 2011 09:30 Hrs
THE MEDIAL PTERYGOID

MUSCLE
It has two heads:
superficial and deep
Origin: the superficial

head arises from the
maxillary tuberosity. The
deep head arises from
medial surface of the
lateral pterygoid plate
Insertion: fibers run

downward, backward and
laterally and are inserted
into the medial surface of
27 the angle of the mandible
RADIOLOGY
12th JULY 2011 09:30 Hrs
Innervation:
main trunk of
mandibular nerve
through nerve to
medial pterygoid
it also innervates
Tensor veli
palatini & Tensor
tympani.
28

RADIOLOGY
12th JULY 2011 09:30 Hrs
Blood supply:
Maxillary artery
through the medial
pterygoid artery
From the 2nd part
29

RADIOLOGY
12th JULY 2011 09:30 Hrs
Action:
assets in elevating
and protrusion of
the mandible
acts together with
lat. Pterygoid of the
same side in
rotating the
mandible
30

RADIOLOGY
12th JULY 2011 09:30 Hrs
31

RADIOLOGY
12th JULY 2011 09:30 Hrs
ACCESSORY MUSCLES
OF MASTICATION
32
Accessory muscles of
mastication are those muscles
which assist the main muscles
of mastication to move the
mandible during mastication
.and speech
These are mylohyoid,
geniohyoid and diagastric
.muscles
RADIOLOGY
12th JULY 2011 09:30 Hrs
THE DIAGASTRIC MUSCLE

This muscle is so called because it has two bellies.
The bellies are united by an intermediate tendon.

ORIGIN:
Anterior belly originates from the digastric fossa of the
mandible.
Posterior belly originates from the mastoid notch of the
temporal bone.
INSERTION:
The anterior belly runs downwards and

backwards, and the posterior belly run downwards
and forwards to meet at an intermediate tendon.
The tendon is held by a fibrous pulley attached to
the hyoid bone.
33

RADIOLOGY
12th JULY 2011 09:30 Hrs
NERVE SUPPLY:
Anterior belly is supplied by the
mylohyoid nerve
Posterior belly is supplied by the
facial nerve.
ACTIONS:
Helps to depress the mandible when
the mouth is opened widely or
against resistance. This action is
secondary to that of the lateral
pterygoid.
Elevates the hyoid bone
34

RADIOLOGY
12th JULY 2011 09:30 Hrs
THE MYLOHYOID MUSCLE

This is a flat, triangular muscle lying deep
to the anterior belly of digastric. The right
and left mylohyoid muscles together form
.the floor of the mouth
ORIGIN:
It originates from the mylohyoid line
of the
mandible.
INSERTION:
The fibers run medially and slightly
downwards.
The posterior
fibers are inserted into the body of
the hyoid bone. The middle fibers are
inserted into
median raphae.
35

RADIOLOGY
12th JULY 2011 09:30 Hrs
NERVE SUPPLY:
It is supplied by mylohyoid nerve
ACTIONS:
Elevates the floor of the mouth during
the first stage of deglutition

Helps in depression of the mandible
and in elevation of the hyoid bone.
36

RADIOLOGY
12th JULY 2011 09:30 Hrs
THE GENIOHYOID
MUSCLE
A short and narrow muscle which lies above the medial part of
the mylohyoid.
ORIGIN:
From the inferior mental spine (genial tubercle) of the mandible.
INSERTION:
The fibers run backwards and downwards to be inserted into the
anterior surface of the body of the hyoid bone.
NERVE SUPPLY:
1st cervical nerve. The fibers pass through the hypoglossal nerve.
ACTIONS:
Elevates the hyoid bone.
May depress the mandible when the hyoid bone is fixed
37

RADIOLOGY
12th JULY 2011 09:30 Hrs
CLINICAL
EXAMINATION
The temporalis muscles should be examined
first and this is accomplished via bilateral

finger pressure applied to the muscle along
the anterior, middle, and posterior portions
38

RADIOLOGY
12th JULY 2011 09:30 Hrs
The masseter is divided into superficial
and deep portions that should be

individually palpated
39

RADIOLOGY
12th JULY 2011 09:30 Hrs
Intra-orally, the temporalis insertion, masseter origin,

lateral and medial pterygoids are evaluated
bilaterally. In order to palpate the temporalis insertion,
the patient opens the mouth and a finger is placed on
the anterior border of the ramus of the mandible (just
lateral and distal to the third molar area). The finger is
then moved superiorly until the most superior portion
of the anterior border of the ramus is palpated. This is
the coronoid process where the temporalis muscle
insertion exists.
Immediately after palpating the temporalis insertion
with the finger in the same location, the patient is
asked to move the mandible to the ipsilateral side.
After the patient moves the mandible laterally, the
finger is moved just lateral and superior-distally, and
the lateral pterygoid muscle can be palpated
40

RADIOLOGY
12th JULY 2011 09:30 Hrs
In addition, the masseter origin can be palpated by
next moving the finger from the lateral pterygoid

position in an anterior and superior direction. The
masseter originates as a thick tendon from the
zygomatic process of the maxilla and from the inferior
border of the zygomatic arch.
The medial pterygoid muscle is palpated by having the
patient open the mouth, and the examiner places finger
pressure in the posterior, floor of the mouth (lateral to
the tongue and medial to the mandibular posterior
teeth).
Intra-oral palpation of the lateral and medial pterygoid
muscles is difficult due to limited access. Tenderness
elicited with these two specific muscle groups should be
interpreted with caution, as an unacceptable rate of
false positives can occur.
41

RADIOLOGY
12th JULY 2011 09:30 Hrs
MEDICAL & SURGICAL

CONSIDERATIONS
The muscles of mastication have important clinical
implications as they have important anatomical entities

around them like the arteries, nerves & salivary glands.
The disorders affecting the muscles of mastication can
have manifestations/symptoms on these surrounding
structures and vice versa.
Likewise the medical and surgical treatment of the
muscles of mastication can have an impact on these
relations & vice versa.
The parotid duct runs anteriorly across the masseter, &
hooks medially over the anterior border and can be felt
by rolling it against the muscle with the jaw clenched.
42

RADIOLOGY
12th JULY 2011 09:30 Hrs
The palpation of Stensons duct is important
clinically as in to diagnose sialolithiasis in this duct.

The muscles of mastication play an important role
in the fracture displacement as they have strong
tendinous attachments.
Osteaoarthritis has an early manifestation in the
form of spasms of muscles of mastication, resulting
in stiffness and locking of the jaw.
Due to a long standing case of TMJ ankylosis there
is atrophy or fibrosis of these muscles.
In dystrophic myotonia there is masseteric atrophy
which produces a narrowing of the lower half of the
face.
43

RADIOLOGY
12th JULY 2011 09:30 Hrs
44

RADIOLOGY
12th JULY 2011 09:30 Hrs
CLINICAL AND APPLIED

ANATOMY
MYOFACIAL PAIN DYSFUNCTION SYODROME:
A functional disorder involving painful self perpetuating
spasm of masticatory muscles.
Begins with stress which causes clenching and grinding of
teeth, which in turn can lead to muscle fatigue and finally
spasm. Results in a self perpetuating cycle of stress-painstress is created.
Muscles most often involved are lateral pterygoids and
masseter muscles.
SYMPTOMS:
Unilateral dull pain in the ear or preauricular region
;commonly worse on awakening.
Tenderness of one or more of the muscles of mastication
Limitation or deviation of the mandible during opening
45

RADIOLOGY
12th JULY 2011 09:30 Hrs
TREATMENT:
To relieve the symptoms of this syndrome, it is
necessary to break the stress-pain-stress cycle and
to treat the emotional and physical components of
the disease.
Other treatment modalities include:
Spray and stretch: fluoromethane refrigerant spray
can be applied to the skin overlying the involved
muscles. This anesthetizes the area and allows the
patient to slowly stretch the muscles in spasm.
Injecting local anesthetic solution without
epinephrine in the involved muscle. Helpful in
breaking the spasm and disrupting the stress-painstress cycle.
46

RADIOLOGY
12th JULY 2011 09:30 Hrs
FACIAL PARALYSIS:
Facial paralysis is a disfiguring condition since it leads to
not only the inactivity of one side of the face during the
active movements of smiling, frowning, but also causes
obliteration of the facial furrows that are very important in
facial expression.
The muscles paralysis manifests itself by the drooping of
the corner of the mouth, from which the saliva may run,
the watering of the eye, and inability to close the eye
which may lead to infection.
The patient has typical mask like appearance.
TREATMENT:
Masseter muscle is best used to give motion to lower half

of the face. Transplantation of temporalis muscle, aided by
a tendon or facial slip is best suited to lend support and
dynamic action to the eyelids
47

RADIOLOGY
12th JULY 2011 09:30 Hrs
CONCLUSION
It is of utmost importance to have a thorough
knowledge of the anatomy, actions and clinical

relevance of the muscles of mastication and its
importance in diagnosis and take maximum advantage
of it in surgical management in various conditions of
orofacial region.
The muscles of mastication play a vital role in chewing
food and speaking hence any anomaly or dis-ease of
these can have serious implications on the nutritional
status and psycho social development of an individual.
Every clinician must invariably examine them for any
signs of tenderness, associated swellings, ulcers or
growths so as to diagnose the disorders pertaining to
them or the related structures.
48

RADIOLOGY
12th JULY 2011 09:30 Hrs
BIBLIOGRAPHY
GRAYS ANATOMY: 38TH EDITION
CUNNIGHAMS MANUAL OF PRACTICAL
ANATOMY VOL. 3 HEAD & NECK

ANATOMY REGIONAL AND APPLIED:
R.J.LAST
HUMAN ANATOMY, REGIONAL AND
APPLIED: B.D.CHAURASIA (VOL-3 HEAD
AND NECK)
BURKETS ORAL MEDICINE: GREENBERG
& GLICK ( 10TH EDITION)
49

RADIOLOGY
12th JULY 2011 09:30 Hrs
50

RADIOLOGY
12th JULY 2011 09:30 Hrs

Muscles of Mastication

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Muscles of Mastication

Uploaded by

Copyright:

Available Formats

1

DEPT OF ORAL MEDICINE, DIAGNOSIS &

12th JULY 2011 09:30 Hrs

DEPT OF ORAL MEDICINE, DIAGNOSIS &

12th JULY 2011 09:30 Hrs

DEPT OF ORAL MEDICINE, DIAGNOSIS &

12th JULY 2011 09:30 Hrs

DEPT OF ORAL MEDICINE, DIAGNOSIS &

12th JULY 2011 09:30 Hrs

Muscle (from Latin musculus, diminutive of mus

DEPT OF ORAL MEDICINE, DIAGNOSIS &

12th JULY 2011 09:30 Hrs