G

O O D

M O R N

N G

MUSCLES OF MASTICATION

SUBMITTED BY: DR. DEV ANAND GUPTA 2 ST YEAR PG 1 DEPT OF P.H.D

CONTENTS
Introduction 2. Definitions 3. Classification 4. Embryology 5. Primary Muscles of Mastication 6. Accessory Muscles of Mastication 7. Applied Significance 8. Movements of Mandible 9. Conclusion 10. Reference
1.

INTRODUCTION

 Moves

the mandible during mastication and speech. in deglutition & speech

Helpful

Elevate

and depress the mandible to open/ close the mouth.

INTRODUCTION CONT
Mastication

is a harmonious and skillful activity, requires the presence and co ordination of not only the muscles of mastication but also the supra &infrahyoid muscles, and the facial muscles.

IMPORTANCE AND NEED OF THE TOPIC

Being

a dentist this topic is fore most important for us so that we can know the normal functioning and pathology of oro facial region regarding muscles of mastication and orofacial structures.

Seminar

on muscles of mastication is very much needed for us so that we can brush up our knowledge regarding the anatomy, function & clinical significance of muscles of mastication which may be helpful to us to diagnose the day to day patients in clinics and camps.

DEFINITIONS

Muscle:- A type of tissue composed of contractile cells or fibers that effects movement of an organ or part of the body.
(Tabers Cyclopedic Medical Dictionary)
10

Origin:- In any case, the muscle attachment site which remains relatively stationary when the muscle contracts is known as the Origin.
Insertion:- The muscle attachment site having the greater movement during the contraction 11 is called the insertion.

 Action:-

A description of the movement which take place as a result of muscle contraction is called the action.

12

FUNCTIONS OF MASTICATION:.Enables

the bolus to be easily swallowed.

Mixes food with saliva - Activates Salivary Amylase. Enhances the digestibility. Prevents irritation of gastrointestinal system by large food masses. 13

Primary muscles of mastication

CLASSIFICATION
Accessory muscles of mastication

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PRIMARY MUSCLES OF MASTICATION

Masseter

Muscle Temporalis Muscle Medial Pterygoid Muscle Lateral Pterygoid Muscle

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ACCESSORY MUSCLES OF MASTICATION

Suprahyoid Muscles

Digastrics Muscle o Geniohyoid Muscle o Mylohyoid Muscle o Stylohyoid Muscle

o
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EMBRYOLOGY OF MUSCLES OF MASTICATION

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 Develops

from Mesoderm of 1st Branchial/ Pharyngeal arch. by the Mandibular Nerve (Nerve of

Supplied 1st arch).

Pharyngeal

arches appears in 4th & 5th weeks of development.

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In 42 days old embryo - 5 mesenchymal prominence can be recognized (5th arch disappears later)

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i) The Mandibular Prominence (1st pharyngeal arch) ii) The Maxillary Prominence (dorsal portion of pharyngeal arch
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 Accessory

muscles( Digastric- posterior belly, Stylohyoid) develop from 2nd branchial arch (Hyoid Arch) and supplied by FACIAL NERVE ( Nerve of 2nd arch). Each arch consists of: i) Muscular Component (have their own Cranial nerve) ii) Nerve Component iii) Artery Component Whenever muscle cells migrate they carry their 22 nerve component with them.

ANATOMY

Of PRIMARY MUSCLES OF MASTICATION

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MASSETER MUSCLE

- Has 3 layers: * Superficial Layer * Middle Layer * Deep Layer

MASSETER MUSCLE
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ORIGIN :-

INSERTION :-

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26

ARTERY SUPPLY

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NERVE SUPPLY

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RELATIONS
-

Superficial: Skin , Platysma , Risorius, Zygomaticus major, & Parotid gland. - Deep: Temporalis, Mandibular Ramus. - Posterior Margin: Overlapped by Parotid Gland. - Anterior Margin: Projects over Buccinator & crossed below by Facial Vein.

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ACTIONS
Elevation Clenching

Protruding

(superficial

fibers)
Stabilizes

the condyle, when mandible is protruded(deep fibers)

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Palpation:# Palpated bilaterally at its superior & inferior attachments. 1st fingers are placed on each Zygomatic arch (anterior to TMJ)
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Fingers are dropped down slightly to the portion of masseter attached to the zygomatic (anterior to TMJ

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Once deep portion of masseter is palpated fingers drop to inferior attachment on inferior border of ramus.
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Bimannual palpation of masseter muscle

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Interesting fact for masseter muscle

Interesting property of this muscle is that, internally, the muscle has many tendinous septa that greatly increase the area for muscle attachment and so increase its power.
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Temporalis Muscle

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TEMPORALIS MUSCLE
Fan Shaped Muscle

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ORIGIN :-

INSERTION :-

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TEMPORALIS MUSCLE
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BLOOD SUPPLY

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NERVE SUPPLY

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RELATIONS
-

Superficial:
Skin, Auriculares anterior & superior, temporal fascia, Superficial Temporal vessels, auriculotemporal nerve, Temporal Branches of facial Nerve, Zygomaticotemporal nerve, Epicranial apponeurosis, Zygomatic arch & masseter.
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RELATIONS CONT

- Deep: Temporal fossa , Lateral pterygoid, superficial Head of Medial Pterytgoid, Buccinator (small part), Maxillary artery & its deep temporal branches, deep temporal nerves, Buccal nerves & vessels.

Anterior Margin: Separated from zygomatic bone by mass of Fat.

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ACTIONS
Elevation
Retraction (posterior fibers)

Grinding movements

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 Three distinct movements are seen (According to fiber direction) i)Anterior portion(raise mandible vertically on contraction)

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ii) Middle portion (Elevates & retrudes mandible) iii)Posterior portion (Elevation & retrusion of mandible)
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PALPATION

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Palpation of anterior region

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Palpation of middle region

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Palpation of posterior region

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Palpation of tendon of temporalis

LATERAL PTERYGOID MUSCLE: Has

two heads:- Upper head (Superior Lateral Pterygoid) - Lower head (Inferior Lateral Pterygoid)
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TWO HEADS OF LATERAL PTERYGOID

Upper head
Origin- infratemporal surface and greater wing of sphenoid

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Lower head
Origin- Outer surface of lateral pterygoid plate

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NERVE SUPPLY

BLOOD SUPPLY

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RELATIONS:-

Superficial: Mandibular ramus, Maxillary artery, Tendon of temporalis, Masseter.

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Deep: Upper part of Medial Pterygoid, Sphenomandibul ar ligament, Middle meningeal artery, mandibular nerve.
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Upper Border: Temporal & masseteric branch of mandibular nerve.

Lower Border: Lingual & inferior alveolar nerves.
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ACTIONS:* Depression * Protrusion * Lateral movement (Right & Left) * Superior Headactive during power stroke & helps in clenching.

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* Inferior HeadProtrusion (Bilateral contraction) & Mediotrusive movement (unilateral contraction)

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Palpation :-

Palpated by inserting the finger facial to the maxillary teeth & around distal to the Pterygomax illary or Hamular notch.
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MEDIAL PTERYGOID MUSCLE:-

Deep head of Medial Pterygoid

Superficial head of Medial Pterygoid

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MEDIAL PTERYGOID MUSCLE:-

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 Also

called pterygoideus internus (internal pterygoid muscle).

Consists

of two heads Deep head Superficial head

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SUPERFICIAL HEAD
Originates from maxillary tuberosity

 Originates-

DEEP HEAD

medial surface of lateral pterigoid

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plate

NERVE SUPPLY BLOOD SUPPLY

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RELATIONS: Lateral

Surface o Mandibular ramus, o Sphenomandibuar ligament, o Maxillary artery, o Inferior alveolar nerve & vessels, Lingual nerve o Process of parotid gland.
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 Medial

Surface

Tensor veli palatini, o Separated from superior constrictor by styloglossus, stylopharyngeus & some areolar tissue.
o

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ACTIONS
Acts with the LP to protrude the mandible.

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Palpation :-

Palpated by the index finger on the inner surface of the ramus of mandible.
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Palpated by the index finger on the inner surface of the ramus of mandible.
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Accessory muscles of mastication

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DIGASTRIC MUSCLE
Has two bellies, united by intermediate tendon:

a) Anterior Belly Of Digastric (DGA)

b) Posterior Belly Of Digastric (DGP)

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ORIGIN :INSERTION :-

NERVE SUPPLY :-

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RELATIONS:Superficial: Platysma, sternocleidomastoid, part of splenius, Longissimus capitis, Mastoid process, stylohyoid, retromandibular vein, and parotid & submandibular glands.

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 Medial

to DGA:- Mylohyoid

Medial

to DGP:- Superior oblique, rectus capitis lateralis, transverse process of atlas vertebra, accessory nerve, internal jugular vein, occipital artey, hypoglossal nerve, ICA & ECA , facial & lingual arteries & hyoglossus.
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ACTIONS:a) Anterior belly Depresses mandible when mouth is open widely or against resistance (secondary to LP)

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b) Posterior belly elevates hyoid bone.

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GENIOHYOID MUSCLE
Short & narrow Muscle

ORIGIN :INSERTION :NERVE SUPPLY :81

ACTIONS
- Elevates Hyoid Bone - May depress mandible when hyoid is fixed.

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MYLOHYOID MUSCLE
-Flat,triangular muscle. -Two mylohyoid muscle form floor of mouth cavity, deep to digastric muscle.
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ORIGININSERTIONACTIONS:- Helps in depression of mandible. - Elevation of hyoid bone

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STYLOHYOID MUSCLE
- Small Muscle. - Lies on Upper border of DGP.

ORIGIN :INSERTION :NERVE SUPPLY :85

Stylohyoid Muscle

ACTIONS
- With other muscles help in Depression of mandible. - Fixes Hyoid bone.

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APPLIED SIGNIFICANCE

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MUSCLE HYPERTROPHY
esults R

from increase number of action & Myosin filaments

Significant

hypertrophy in 6-10 weeks

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CAUSES:
evelopmental D

defects unctional disturbances F Inflammations & Infections Metabolic changes Neoplasm Over loading the muscle
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TRISMUS
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Trismus ( tonic spasm of masseter causes this)

Motor Disturbance Of The Trigeminal Nerve, Especially Spasm Of The Muscles Of Mastication With Difficulty In Opening The Mouth.

Causes:
Trauma

To Muscle / Blood Vessels Hemorrhages Infections

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Causes cont..
Contaminated

LA Excessive Volume Of LA Trauma Profound Muscle Spasm, Tenderness & Trismus.

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MUSCLE ATROPHY
AGING AND CACHEXIA. DENERVATION MUSCULAR DYSTROPHIES NEUROLOGICAL DISTURBANCES NUTRITIONAL DISTURBANCES INFECTIONS AND TOXINS MUSCULAR HYPOTONIAS METABOLIC DISTURBANCES VASCULAR CHANGES

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Myofunctional Pain Dysfunction Syndrome (MPDS)

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 Muscular

Disorders (Myofacial Pain Disorders) are the most common cause of TMJ pain associated with masticatory muscles.

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Common

aetiologies include: 1.Patient with high stress level. 2. Poor habits including gum chewing, bruxism, hard candy chewing. 3. Poor dentition.
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TREATMENT
Its

treatment includes 4 phases of therapy which includes muscle exercises and drugs involving NSAIDs and muscle relaxants. A bite appliance is also worn by the patient in the further stages to splint the muscle movement.
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Myositis Ossificans
It

is a condition wherein fibrous tissue and heterotropic bone forms within the interstitial tissue of muscle, as well as in associated tendons or ligaments. It is of two types: localized generalized
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Localized myositis ossificans

The

affected site remains swollen and tender, and the overlying skin may be red and inflamed. There may present a difficulty in the opening of the mouth Etiology Trauma or heavy muscular strains or by metaplasia of pluripotential intermuscular connective tissue.

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 Management

Give sufficient rest to the muscle OR excision of the involved muscle after the process has stopped.

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Generalized myositis ossificans

Formation

of bone in tendons and fascia occurs along with subsequent replacement of muscle mass by the bony tissue. The masseter muscle is the most frequently involved. Mostly occurs in children less than 6 years of age

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Gradual increase in stiffness Limitation in the motion of masticatory muscles Entire muscle may get transformed into bone No movement
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Management: There

is no specific treatment. The muscles involved are to be excised.

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MASSETERIC INFECTION

Limited opening due to Submass eteric infection( now k/n as Masseter ic infection)
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Temporalis :- Some TMJ diseases lead to TEMPORAL TENDONITIS. (create pain in muscle & referred pain- behind adjacent eye.)
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LATERAL PTERYGOID :- Pain Radiating in all direction from TMJ due to spasm of LP.

- Inferior Belly of LP influences degree of Retrusion of condyle.

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MEDIAL PTERYGOID :- Pain in it may be due to hematoma following Inferior alveolar nerve block.

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GENIOHYOID :

In cases of extreme resorption of residual alveolar ridge, it can cause unseating of the denture.

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MUSCLE PAINS
It

is usually felt as a non pulsatile variable aching sensation,with a boring quality. It may also present with tightness, weakness, swelling or tenderness. It includes 3 types: 1. local muscle soreness. 2. Muscle splinting pain. 3. Non-spastic myofacial pains

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Local muscle soreness

It

is a primary hyperalgesia with lowered paint hreshold due to local factors such as stress, injury,infection. This may be due to: Distortion of blood vessels within the muscle

OR

Forceful or sustained contraction repeatedly.

11 0

Muscle splinting pain

It

is defined as rigidity of the muscle occuring as a means of avoiding pain caused by movement of the part.

It

is a reflex protective mechanism.

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Splinting of masticatory muscle may occur as a protective mechanism in conditions such as o Toothache, o Overstressed teeth, o Effect of local anaesthetics, o Trauma etc.
o
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Non-spastic myofacial pains

There

is no spasm and pain is the only complaint and this is generally referred to structures outside the muscle proper.
Cause:

It

may be due to atrophied muscle mass because of inactivity & illness.

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Zones of referred pain

The

masseter muscle pain refers to the ear,TMJ and the mandibular teeth. The temporalis muscle pain refers to the temple, orbit and maxillary teeth. The medial pterygoid muscle refers to the infra-auricular and postmandibular area. The lateral pterygoid muscle always refers its pain to the TMJ.

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MOVEMENTS
MANDIBLE

OF
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TYPES
Voluntary movements (closing and opening movements)
Involuntary movements (bruxism and clenching of teeth)
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MOVEMENTS OF MANDIBLE
a) Opening/Depression:

i) Lateral pterygoid
ii) Accessory muscles: Digastric Geniohyoid Mylohyoid
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b) Closing/Elevation i) Temporalis ii) Masseter iii) Medial Pterygoid of both side

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c) Protrusion:
i) Lateral pterygoid

ii) Medial pterygoid

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d) Retrusion :

i) Posterior fibers of temporalis ii) Deep fibers of masseter

iii) Digastric iv) Geniohyoid
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e) Lateral movements :
i) To right - Left lateral &

Right Medial pterygoid

Right Temporalis ii) To left- Right Lateral & Left Medial Pterygoid Left Temporalis

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CONCLUSION

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 The

masticatory muscles include a vital part of the orofacial structure and are important both functionally and structurally. The proper management and periodical self -examination of the muscles may provide a greater chance of catching the disease process at an early stage which may be useful for its better prognosis.

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REFERENCES

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1) Henry Gray Grays Anatomy ; 38th ed.

2) B. D. Chaurasia human anatomy (head & neck) ; 4th ed.

3) Richard R. Snell Clinical anatomy for medical students ; 6th ed.

4) Barry KB Berkovitz & Bernard J Moxham Head & Neck Anatomy (A Clinical Reference)
5) Anne M.R Agur, Arthur F Dalley Grants Atlas of Anatomy 6) T. W Sadler Langmans Medical Embryology ; 10th ed. 7) Carmine D Clemente Anatomy ( A Regional Atlas) ; 5th ed.
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8) Guytons Medical Physiology ; 11th ed.

9) Jeffery P. Okeson Bells Orofacial Pains (The Clinical Management Of Orofacial pain) ; 6th ed.
12) Bouchers Prosthodontic treatment for edentulous patient ; 12th ed. 14) Trismus: Aetiology, Differential Diagnosis and Treatment
P.J. DHANRAJANI AND O. JONAIDEL. Dental update 2002 15) Burkits oral medicine diagnosis & treatment 10 edition.
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JOURNALS
1.

2.

Beatty, C.H.; Basinger, G.M.; Dully, C.C.; and Bocek, R.M.: Comparison of Red and White Voluntary Skeletal Muscles of Several Species of Primates, J Histochem14:590-600, 1966 Estes, R.D.: Predators and Scavengers, Natural History76:38-47, 1967
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3.

4.

5.

Yurkstas, A. : The Masticatory Act: A Review, J Pros Dent15:248-262, 1965.(CrossRef) Dubrul, E.L., and Sicher, H.: The Adaptive Chin, Springfield: Charles C Thomas, 1954 (CrossRef) Luschei, E.S. , and Goodwin, G.M.: Patterns of Mandibular Movement and Jaw Muscle Activity During Mastication in the Monkey, J Neurophys37:954-966, 1974

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