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Good Morning: Muscles of Mastication
Good Morning: Muscles of Mastication
GOOD MORNING
MUSCLES OF
MASTICATION
Presented by:
Sohail
1st year PGT
2
Introduction
Development / Embryology
Muscles of mastication (in detail about each)
Movements of mandible at TMJ
SKELETAL MUSCLES
MUSCLES OF MASTICATION
5
6
7
4th week- the oral pit is surrounded by several
masses of tissue. Pharyngeal arches are also
evident below the pit & on the sides of the
neck
Muscle
Tendon BONE
fibre
Cell membrane – plasma 9
membrane/ sarcolemma
Sarcoplasm
1. Nuclei
2. Myofibril
3. Golgi apparatus
4. Mitochondria
5. Sarcoplasmic reticulum
6. Ribosomes
7. Glycogen droplets
MYOFIBRIL 10
MICROSCOPIC STRUCTURE
MUSCLES Of 11
MASTICATION
Rhythmic movement of the jaw is a 12
series of cyclical movements
1. Temporomandibular joint
2. Mandible
3. Teeth &
4. Muscles of mastication.
13
Voluntary muscles
Originate from the skull, span the TMJ, and insert into the
mandible. On contraction, they act to move the mandible.
TYPES 14
Dr.Frank Gaillard et al
• TEMPORALIS • DIGASTRIC
PRIMARY SECONDARY
15
Origin
Insertion
Innervation
Relations
Actions
Vascular supply
Clinical importance
MASSETER 16
1. SUPERFICIAL LAYER
2. MIDDLE LAYER
3. DEEP LAYER
INSERTION
ORIGIN – -
• Maxillary process
• Angle
of
zygomatic
• Lower post
bone half of
• Ant 2/3rds
lateral of
surface
inferior
of
border of zygomatic
ramus
arch
ORIGIN AND INSERTION
20
Middle
layer
ORIGIN -
• Medial aspect of ant
INSERTION -
2/3rds of zygomatic
Central part of ramus of
arch
mandible
• Lower border of post
3rd of this arch
ORIGIN AND INSERTION
Deep 21
layer
Elevates the
mandible
• Side to side
movement
• Protraction
• Retraction
25
26
CLINICAL
IMPORTANCE
27
• Whole part of
temporal
fossa
• Deep surface
of temporal
fascia
INSERTION
32
i) Medial surface,
Apex, Ant & post
borders
Coronoid process
1. Elevates the
mandible
2. Side to side
grinding
movements
3. Posterior fibres –
retract the
protruded
mandible
37
CLINICAL IMPORTANCE
38
The most anterior tendon insertion may extend very close to the
third molar
1.Elevation : (bilateral)
2.Protrusion : (bilateral)
3.Contralateral excursion: (unilateral)
CLINICAL IMPORTANCE 45
IANB
LATERAL PTERYGOID
ORIGIN AND INSERTION
47
Relations 48
SUPERFICIAL
Ramus of the mandible
Maxillary artery
Tendon of temporalis and masseter
DEEP SURFACE
Upper part of the medial pterygoid
Sphenomandibular ligament
Middle meningeal artery
Mandibular nerve
UPPER BORDER
Temporal and massetric branches
of the mandibular nerve
LOWER BORDER
Lingual and inferior alveolar nerve
BLOOD SUPPLY 49
Nerve supply
50
Protrusion (bilateral):
The inferior lateral pterygoids are the 2 prime protractors of the
mandible.
Depression (bilateral):
Contraction of both the lateral pterygoids not only pull the condyles
forward but also along with the suprahyoid & the infrahyoid muscles
help in the depression of the mandible.
The Superior head are particularly active when the teeth ,upon
closure, encounter resistance such as a bolus of food.
Palpate by pressing in a
superior, medial, & posterior
direction.
CLINICAL IMPORTANCE 54
ACCESSORY MUSCLES
of mastication
DIGASTRIC 58
Origin – anterior belly from digastric fossa
of mandible , posterior belly from
mastoid notch of temporal bone.
INSERTION
The posterior fibers run steeply
downwards medially and forward n gets
attached to body of the hyoid bone.
FUNCTION:
Anterior fibers elevate the floor of the oral cavity there by acts
as elevator of the tongue.
GENIOHYOID 62
ORIGIN
It arises above the
anterior end of the
mylohyoid line from the
inner surface of
mandible
INSERTION
attached to the upper half
of the hyoid body.
63
TMJ MOVEMENTS
Side to side
movements –
temporalis
(same side),
pterygoids
(opp side),
masseter
Summary of the anatomy 64
65
PHYSIOLOGY OF
MASTICATORY
MUSCLES
Joint reflexes
Forces of Mastication 70
Males – 53-65kg
Females – 36-45 kg
Experimental analysis of
masticatory system To analyse patterns of
masticatory activity with
abnormal masticatory function
73
74
ETIOLOGY OF
FUNCTIONAL
DISTURBANCES IN THE
MASTICATORY SYSTEM
• Speaking
Functional
• Chewing
• Swallowing
Parafunctional/ • Clenching/grinding of
Nonfunctional teeth
• Oral habits
Parafunctional activities +
Muscle hyperactivity general increase in level of
muscle tone
BRUXISM IN CHILDREN 77
If masticatory function –
common finding
problem, evaluate the child in
rarely associated with symptoms
dental office
-Explain parents the benign
nature
Self limiting phenomenon
- Monitor any complaints of child If frequent & significant
Not related to increased risk – TMD examination
headaches
also indicated – to rule out
masticatory dysfunction as a
possible cause
78
SIGNS AND
SYMPTOMS OF
DISODERS OF
MUSCLES
“You can never diagnose something
you have never heard about”
79
PAIN
DYSFUNCTION
PAIN 80
Acute malocclusion
Protective co- 82
contraction
Local muscle soreness
SUPPORTIVE TREATMENT
When cause is tissue injury
Restrict use of mandible
Soft diet
NSAIDS
Local muscle soreness
87
(Non inflammatory myalgia)
1st response to prolonged co-contraction.
Co-contraction- CNS induced muscle response
Soreness- changes in local environment of muscle tissue
( release of bradykinin, substance P)
Excessive use- ‘delayed onset muscle soreness’ or ‘post exercise
muscle soreness’
Co-contraction-cyclic event.
Clinically – muscle –tender on palpation, increased pain on
function, structural dysfunction, limited mouth opening, acute
muscle weakness
DEFINITIVE TREATMENT
88
Eliminate ongoing altered sensory input
Eliminate source of deep pain
Restrict mandibular use
Reduce non functional tooth movements
Decrease emotional stress
SUPPORTIVE TREATMENT
Mild analgesic –every 4-6hrs for 5-7 days
Passive muscle stretching, gentle massage
Central nervous system effect on 89
muscle pain
disorders disorders
Regional Systemic
Myospas myalgic myalgic
m disorders disorders
Chronic
Myofascial centrally Fibromyalg
pain mediated ia
myalgia
Myospasm (Tonic Contraction Myalgia)
91
SUPPORTIVE TREATMENT
Physical therapy
Deep massage& passive stretching
Muscle conditioning exercises
Relaxation techniques
Myofacial pain (Trigger point Myalgia)
93
1st described – Travel & Rinzler -1952
Arises from hypersensitive bands of muscle tissue – TRIGGER
POINTS
Felt as taut bands when palpated elicit pain
Source of constant deep pain central excitatory effects
referred pain reported as headache pain
Etiology- trauma,hypovitaminosis, fatigue,viral infections,
emotional stress
Clinically – trigger points, no local muscle sensitivity, mostly
related to central effects (referred pain)
SUPPORTIVE TREATMENT
Physical therapy
Manual techniques(soft tissue immobilization,
muscle exercises)
Muscle relaxants, analgesics
Characteristic sign of MPDS------ 96
LASKIN'S 4 CARDINAL SIGNS
Unilateral pain
Muscle tenderness
Clicking and popping noise in TMJ
Limitation of jaw function or deviation of jaw
SUPPORTIVE TREATMENT
Careful physiotherapy
Moist heat/cold packs
Gentle stretching
Chronic systemic myalgic disorders
100
(Fibromyalgia)
SUPPORTIVE TREATMENT
Physical therapy
Manual techniques(moist heat, gentle massage,
passive stretching, relaxation)
Mild, well controlled exercise
MUSCULAR DYSTROPHIES 102
Progressively weaker
Parafunctional activity
Clenching/grinding of teeth
Tender
Trismus/Lock jaw 108
Inability to open mouth/reduced opening of jaws