PALPATION OF THE LATERAL PTERYGOID

There is little doubt regarding the importance of the LPM

in TMJ function.

For a long time, it has been assumed that the inferior

Figure 2: Palpation technique
intended for the lateral
pterygoid muscle.
pressure in a posterior, superior, and medial direction behind the maxillary tuberosity (Figure
2).
belly of this muscle can be accessed near its origin
through digital probing, and, thus, its palpation has
traditionally been included in study protocols and clinical
examinations of the masticatory system.2 In fact, intra-
oral palpation of this structure is still included in the
Research Diagnostic Criteria for Temporomandibular
Disorders (RDC/TMD).6 Attempted palpation of what has
been thought to be this structure is commonly done by
placing the forefinger, or the little finger, over the buccal
area of the maxillary third molar region and exerting

However, as early as 1980, literature such as Johnstone and Templetons influential article
questioned the ability of a practitioner to palpate this structure.7 Since then, many
anatomical and clinical studies have demonstrated the inability to digitally contact the LPM
due to its location and surrounding tissues.2

One such study, conducted by Stratmann et al. in 2000, found that . . . even after maximal
impression of the buccal mucosa, a considerable residual distance remains between the ILP
muscle and the buccinators fascia indented by the tip of the palpating forefinger.8 A
systematic review carried out by Turp and Minagi (2001) also concluded that: in the
overwhelming majority of cases, palpation of the inferior lateral pterygoid muscle is
impossible due to anatomical reasons.2 The study notes that these reasons include:

restricted space that does not allow access of the finger (a portion of this potential
space is narrowed by the deep tendon of the temporal muscle)
resistance by the tendinous origin of the buccinator muscle (pterygomandibular
raphe)
resilience of the buccal mucosa due to its close connection to the alveolar gingival
that is firmly attached to the maxillary alveolar process
an obstructing deep origin of the medial pterygoid, which rests on the inferior face of
the inferior head of the ILPM.

Figure 3: Medial view of the

mastication system. Note the
distance between the third This may come as a surprise to practitioners dealing with
molar and the lateral pterygoid TMDs in their practice, considering that epidemiological
muscle. Diagram also shows the studies have shown that patients with these disorders
buccinator muscle, frequently report the most tenderness to palpation of
pterygomandibular raphe, and what was thought to be the lateral pterygoid muscles in
the medial pterygoid muscle. this region. However, one must also consider that the
same studies have shown that among individuals not
suffering from orofacial pain, the lateral pterygoid area
is also considerably more tender than other masticatory muscles. If the LPM cannot be
implicated for this tenderness, then, one must wonder what the actual cause of the pain on
palpation is, if this muscle is, in fact, not accessible.

Various potential structures and mechanisms have been cited to explain this, including:

stretching of the overlying buccal mucosa

compression of the buccinators muscle
palpation of the insertion of the deep tendon of the temporal muscle on the medial
surface of the coronoid process
pressure on fibres of the superficial head of the medial pterygoid

TRADUCCION

No hay duda sobre la importancia de la LPM en funcin de la ATM.

Durante mucho tiempo, se ha supuesto que el vientre inferior de este msculo se

puede acceder a travs de cerca de su origen digital de sondeo, y, por lo tanto, su
palpacin tradicionalmente ha sido incluida en protocolos de estudio y los exmenes
clnicos de la masticatorio sistema.2 De hecho , intra-oral palpacin de esta estructura
todava se incluye en los criterios diagnsticos para los trastornos
temporomandibulares (RDC / TMD) .6 palpacin Intento de lo que se cree que esta
estructura se hace comnmente colocando el dedo ndice o el dedo meique, sobre la
zona bucal del maxilar tercera regin molar y la presin que ejerce en una direccin
posterior, superior y medial detrs de la tuberosidad maxilar (Figura 2).

Sin embargo, ya en 1980, la literatura, tales como Johnstone y el artculo

influyente de Templeton en duda la capacidad de un profesional para palpar
esta structure.7 Desde entonces, anatmicos y muchos estudios clnicos han
demostrado la imposibilidad de contactar digitalmente el LPM debido a su
ubicacin y sus alrededores tissues.2

Un tal estudio, llevado a cabo por Stratmann et al. en 2000, encontr que ". . .
incluso despus de impresin mxima de la mucosa bucal, una distancia
residual sigue siendo considerable entre el msculo y la fascia ILP buccinators
sangrado por la punta del dedo ndice palpa "8 Una revisin sistemtica
realizada por Turp y Minagi (2001) tambin lleg a la conclusin de que:". en la
inmensa mayora de los casos, la palpacin del msculo pterigoideo lateral
inferior es imposible debido a razones anatmicas "2 el estudio seala que
estas razones incluyen.:
 espacio restringido que no permite el acceso del dedo (una parte de este
espacio potencial se estrecha por el tendn profundo del msculo temporal)
resistencia por el origen tendinoso del msculo buccinador (pterigomandibular
rafe)
resistencia de la mucosa bucal debido a su estrecha relacin con la enca
alveolar que est firmemente unido al proceso alveolar maxilar
un origen obstruir profundo de la pterigoideo interno, que descansa sobre la
cara inferior de la cabeza inferior de la ILPM.

Esto puede venir como una sorpresa para los profesionales que se ocupan de
TTM en su prctica, teniendo en cuenta que los estudios epidemiolgicos han
demostrado que los pacientes con estos trastornos frecuentemente reportan las
ms dolor a la palpacin de lo que se cree que son los "laterales" msculos
pterigoideos en esta regin. Sin embargo, tambin hay que considerar que los
mismos estudios han demostrado que entre las personas que no sufren de
dolor orofacial, el "pterigoideo lateral" zona tambin es considerablemente ms
sensible que otros msculos de la masticacin. Si la LPM no puede ser
implicado por esta ternura, entonces, uno se pregunta cul es la causa real del
dolor a la palpacin es, si este msculo es, de hecho, no es accesible.
Diversas estructuras y mecanismos posibles se han citado para explicar esto,
incluyendo:
estiramiento de la mucosa bucal suprayacente
compresin del msculo buccinators
palpacin de la insercin del tendn profundo del msculo temporal en la superficie
medial de la apfisis coronoides
presin sobre las fibras de la cabeza superficial del msculo pterigoideo medial