Head posture and hyo-mandibular function in m/an

A synchronized electromyographic and videojkorographic study of

the open-close-clench cycle

Anders Winnberg, DDS, PhD,* Hans Pancherz, DDS, PhD,** and

Per-Lennart Westesson, DDS, PhD***
MalmB, Sweden, and Giessen, West Germany

Synchronized electromyography and videofluorography (lateral projection) were used to investigate

the influence of altered head posture on hyo-mandibular movements, suprahyoid muscle length,
suprahyoid working angle, and timing of suprahyoid and masseter muscle activity. Twelve adult male
subjects with normal dentofacial morphology were investigated during the open-close-clench cycle.
Using upright head position (Frankfort horizontal) as reference, several statistically significant
observations were made during forward flexion and backward extension of the head. The results
indicate that head posture is a significant factor in studies of mandibular and hyoid bone movements,
and masseter and suprahyoid muscle function. (AM J ORTHOD DENTOFAC ORTHOP 1988;94:393-404.)

C m-rent research has shown a close rela-

tionship between head posture and craniofacial mor-
phology’-3 in man. Functional studies of the effects of
altered head posture have yielded a significant amount
of experimental data concerning the interrelationships
of head posture and gravity,4 respiratory function,5.6
pressure from oral structures,’ occlusion,8.9 and mas-
ticatory muscle function.‘0-‘4 Altered head posture has
also been found to influence the position of the hyoid
bone,‘5.‘h which takes an active part in the cranial
balance’7-‘9 and serves as a muscle junction and linkage
element to the mandible without bone articulation. Fix-
ation of the hyoid bone by the infrahyoid muscles allows
the anterior suprahyoid muscles to pull the lower jaw
toward the hyoid bone and open the mouth. The position
of the hyoid bone accordingly reflects the instant bio-
mechanical conditions of the supra- and infrahyoid mus-
cles in the hyo-mandibular system.*’ In a recent human
study,*’ using synchronized electromyography and vi-
deofluorography, it was shown that the hyoid bone was
never fixed during jaw movement and that an asyn-
chronous phase relationship existed between mastica-
tory muscle activity and hyo-mandibular movements in
the upright head position.
Study supported by grants from the Faculty of Odontology, University of Lund.
the South Swedish Dental Association, the Swedish Dental Association. and
the Swedish Medical Research Council (project nos. 6751 and 6960).
*Assistant Professor, Department of Orthodontics, University of Lund.
**Professor, Department of Chthodontics, University of Giessen.
***Associate Professor. Department of Oral Radiology, University of Lund.
At present little is known about the influence of
altered head posture on the interaction between mas-
ticatory muscles and hyo-mandibular movements.
The purpose of this investigation was to quan-
tify the effects of altered head posture on the interplay
of masseter and suprahyoid muscle activity, hyo-
mandibular movements, suprahyoid muscle length, and
working angle during the open-close-clench cycle in
persons without craniofacial disorders.
SUBJECTS
Nineteen male dental students*’ were selected for
the investigation; the criteria for their inclusion were
normal occlusion, normal facial profile, and no symp-
toms or signs of dysfunction of the masticatory system.
Five of the 19 subjects showed a uniform suprahyoid
EMG-activity pattern during cyclic jaw movements,
which made analysis of the interaction between the
opening and closing muscle activity impossible. In two
subjects the hyoid bone was not visible on the TV screen
in some of the recordings of maximal opening. These
seven subjects were excluded from the analysis. Thus,
the investigation was based on the remaining 12 sub-
jects (mean age 26 years, range 22 to 31 years).
The craniofacial morphology of the subjects was
determined from profile roentgenograms obtained with
the subject’s head oriented horizontally with the
Frankfort plane. Cephalometric landmarks, angles, and
planes are shown in Fig. 1. The cephalometric values
for the 12 subjects are given in Table 1.
393
394 Winnberg, Pancherz, and Westesson Am. J. Orthod. Dentofac. Orthop.
November 1988

Table I. Cephalometric values in 12 subjects

with normal occlusion and a normal facial
profile
Variables Mean SD Range

S-ll-SS 84.0 3.2 79.5-90.0

s-n-sm 83.2 3.3 75.5-85.0
ILsiNL 114.3 7.1 102.5-131.5
ILi/ML 98.3 6.0 90.0-107.5
NSLIML 24.1 5.6 12.5-29.5
NSLiNL 7.9 3.6 2.5-12.5
NSLiBA 129.0 5.0 120.0-137.0
Lower lip/E -3.8 2.4 -0.5-8.3
(mm)*
Upper lip/E -5.1 2.5 - 1.3--8.3
@no*
Head balance 87.7 3.6 82.0-93.0
angle**
n-sp’ (mm)* 57.0 4.2 45.0-63.0
sp’-gn (mm)* 62.2 8.2 60.0-81.0
Profile angle 140.7 4.1 133.0-148.0
Fig. 1. Cephalometric tracing showing reference points, lines,
NFL/NCL
and angles used in this study. (For definitions, see Bjork’ and
Gonion angle 118.8 6.2 109.0-127.0
Sarnas and SOIOW.~) The tracing is oriented horizontally with
cd-pg (mm)* 130.3 6.5 121.5-145.0
the sella-nasion line. FL, Foramen line: A tangent to the lower
contour of the anterior and posterior borders of the foramen
*Corrected for enlargement factor.
magnum. HBA, Head balance axis: A perpendicular to the fo-
**Head balance axis (HeA) to N-S line.
ramen line. Head balance: The angle between the head balance
axis (MA) and the nasion-sella line (ML).
tained by means of an x-ray tube and an image inten-
sifier with a TV camera (Fig. 3). Every effort was made
The methods used in this investigation have been to protect the subjects from unnecessary radiation. Dur-
described previously*’ and therefore only a brief de- ing exposure the subjects were seated erect (Frankfort
scription is given here. horizontal) with the head immobilized in a cephalostat.
The distance between the focal spot and the image in-
Electromyography tensifier was 1600 mm. The distance from the midsag-
Direct and integrated EMG recordings were ob- ittal plane of the head to the image intensifier was
tained from the left suprahyoid muscle group and the 210 mm, resulting in a geometric magnification factor
left masseter muscle by means of bipolar pregelled of 1.15. An acrylic reference template furnished with
silver/silver chloride disposable surface electrodes* vertical and horizontal rows of steel balls (1.5 mm in
and a Mingograph 8OO.t The interelectrode distance diameter and at lo-mm interball distance) was placed
was 20 mm (center-center) and the electrodes were po- 35 mm in front of the image intensifier. The images of
sitioned along the muscle fiber direction according to the steel balls were used for assessing enlargement and
placement shown in Fig. 2. The skin was cleansed with distortion, and as a reference when studying head pos-
alcohol and thoroughly dried before the electrodes were ture and hyo-mandibular movements.
applied. The action potentials were recorded and am- The roentgenographic images were recorded on
plified on the Mingograph. The amplification was 200 videotape. The TV system operated’ with 50 TV
p.V/cm and the paper speed was 100 mm/second. The fields/second. Each TV field could be visualized sep-
frequency range of the galvanometers was 0 to 700 arately on the screen. ‘In each subject approximately
cycles I second. 600 fields were recorded during four open-close-clench
cycles.
Videofluorogrsphy
Lateral roentgenographic registrations of the max- Synchronization of EMG and videofluorography
illary, mandibular, and hyoid bone regions were ob- The TV fields were numbered by means of a
TV-field counter and the EMG recordings were simul-
taneously labeled by means of a pulse generator. In this
*Harco Electronics Ltd., Winnipeg, Canada. way the roentgenographic images could be related to
tSiemens-Elema, Stockholm, Sweden. the corresponding EMG recordings (Fig. 4).
Volume 94
Head posture and hyo-mandibular function in man 395
Number 5

\ a-b 20mm I a-b

b-c
20mm
20mm

Fig. 2. A, Electrode placement on the masseter muscle. 6, Electrode placement on the suprahyoid
muscle group. (From Winnberg A, Pancherz H. Eur J Orthod 1983;5:209-17.)

CEPHALOSTAT

Fig. 3. The setup for synchronized electromyography and videofluorography. (From Pancherz H,
Winnberg A, Westesson P-L. AM J ORTHOD1986;89:122-30.)

Head posture
The upright head position (Frankfort horizontal)
was used as reference; the head was flexed 15” forward
and extended 15” backward. The head position was
adjusted and measured with the aid of a protractor as
the angle between the Frankfort horizontal and a vertical
plane on the cephalostat. The accuracy of positioning
the head was later checked by measuring the angle
between the row of steel balls on the reference template
and the occlusal plane (OL) on the tracings of the roent-
genographic images. The mean forward flexion was
15.0” (SD = 5.0) and the mean backward extension
was 18.0” (SD = 4.5).
Suprahyoid muscle length and worklng angle
The length of the suprahyoid muscle group (h-rgn)
( Fig. 5) (anterior digastric , mylohyoid, and geniohyoid
396 Winnberg, Pancherz, and Westesson Am. .I. Orthod. Dentofac. Orthop.
November 1988

4 16 16 12 4

Opening Open Closing

movement position movement 1 ~L%Z? 1
I I
s&t start El;d St.&t
opening closing closing opening

Fig. 4. Diagram demonstrating the method used to relate suprahyoid and masseter EMG activity to
different phases of the mandibular open-close-clench cycle. The stroke signals (shown at the top of
the illustration) from the pulse generator were used for identification of the TV fields. The distance
between two strokes corresponds to two fields (1 field = 20 ms). The magnitudes of the errors of the
method of defining the start and end of EMG activity and locating the mandibular positions are given
in milliseconds. (From Pancherz H, Winnberg A, Westesson P-L. AM J ORTHOD 1988;89:122-30.)

muscles) was measured from the hyoidale (h) (the most
superoanterior point of the corpus of the hyoid bone)
to the retrognathion (rgn) (the most inferoposterior point
on the mandibular symphysis).
The suprahyoid working angle (ML/h-rgn) (Fig. 5)
was defined as the angle between the mandibular plane
(ML) and a line through the hyoidale (h) and the
retrognathion (rgn) .
Recording and analyzing procedures
All EMG and roentgenographic recordings were
performed on one occasion with a fixed test setup. Four
open-close-clench cycles were recorded for each subject
in each of three head positions. The speed of the open-
close-clench cycle was monitored by means of a met-
ronome to 90 cycles/minute.
The subjects were instructed to open the mandible
about 20 mm during the opening phase of the open-
close-clench cycle. The mean mandibular opening
(is-rgn) at end opening as measured from the tracings
of the roentgenographic images was ‘found to be 17.5
mm (SD = 4.2) in the upright head position, 14.4 mm
(SD = 5.4) during forward flexion of the head, and
17.5 mm (SD = 4.4) during backward extension of
the head.
The start and end of EMG activity were visually
determined from direct inspection of the EMGs
(Fig. 4). The start was defined as an obvious increase
in EMG amplitude of 1 mm above the ground activity
level. The end was defined as an obvious decrease in
EMG amplitude of 1 mm back to ground activity level.
The following four mandibular positions were identified
on the TV screen by running the videotape forward and
backward from stills to 50 fields/second:
Start of mandibular opening (SO)--The field before onset of
motion from intercuspal position
Endof mandibular opening (EO)-The field after termination
of motion
Start of mandibular closing (SC)-The field before onset of
motion
End of mandibular closing (EC)-The field after termination
of motion with the teeth in the intercuspal position
On the basis of the mandibular positions, the open-
close-clench cycle was divided into four phases: open-
ing movement, open position, closing movement, and
occlusal position (Fig. 6).
Statistical methods
The arithmetic mean (M) and standard deviation
(SD) were calculated and the t test for paired samples
was used to compare the different head positions with
the upright position. The ievels of significance used
were P < 0.001 (***), P < 0.01 (**), and P < 0.05
(*). The errors of the different methods used in this
study have been calculated in a previous study.” The
error (milliseconds) in defining the start and end of the
 Head posture and hyo-mandibular function in man 397

suprahyoid and masseter EMG activity and error in OLP

locating the mandibular positions are given in Fig. 4.
The combined error in locating, superimposing, and
tracing the slide images and in the measuring procedure
was 1.O mm for both sagittal and vertical hyoid bone
positions.

RESULTS
The speed of the open-close-clench cycle was paced
by a metronome and accordingly the duration of the
whole cycle (Fig. 6) did not vary with changes of head
posture (upright-mean 662 ms; forward flexion-
mean 661 ms; backward extension-mean 654 ms).
However, the duration of the different phases within
the open-close-clench cycle was influenced by altered
head posture (Table II). Only suprahyoid EMG activity
was recruited during the opening movement phase and
only masseter activity during the closing movement
phase, irrespective of head position. In one subject,
however, suprahyoid EMG activity was also registered
during the first part of the closing movement when the
head was flexed forward.
With the upright head position as reference (Frank-
Fig. 5. Composite tracing of the roentgenographic image of the
fort horizontal) (Figs. 6 and 8). the following statisti- test area showing reference points, lines, and angles used for
cally significant observations were made: the cephalometric evaluation of the roentgenographic image.
Separate slide images are superimposed on occlusal line (Ol)
Forward jkxion
at incision (is) of the mandibular positions, at the start of opening
-The duration of the occlusal phase was longer and the
(SO), end of opening (EO), start of closing (SC). and end of
closing phase was shorter (Table II). closing (EC), with the corresponding hyoid bone positions. OL,
-The masseter EMG activity continued a longer time after Occlusal line: A line through (m) and (is). The line was used as
closing (Fig. 7. D). reference for vertical measurements of the hyoid bone position.
-The suprahyoid muscles were shorter during the whole OLP, Occlusal line perpendiculare: A line perpendicular to OL
cycle (Table V). through is. The line was used as reference for sagittal mea-
-The suprahyoid working angle was smaller during open surements of the hyoid bone position. h-rgn, Suprahyoid muscle
phase (Table VI). length. h-rgnlML, Suprahyoid working angle.
-The downward movement of the hyoid bone (Fig. 9) was
shorter during the opening phase and the upward movement
of the hyoid bone was shorter during the closing phase. DISCUSSION
Backwrd e.uension
-The duration of the opening phase was shorter (Table II). The cephalometric values of our subjects were sim-
-The masseter EMG activity started earlier, before the start ilar to those described for normal subjects by Bjiirk’ in
of closing (Table IV, Fig. 7. C). 1955 (including normal cranial base angle and head
-The suprahyoid EMG activity continued a shorter time after balance axis), and by Sam& and Solow” in 1980. This
the end of the opening movement (Table III. Fig. 7. B). is a prerequisite for studies of EMG since an association
-The suprahyoid muscles were longer during the whole cycle between dentofacial morphology and muscle function
(Table V). has been demonstrated both for persons with normal
-The suprahyoid working angle (Table VI) was larger during occlusion23.24and for those with malocclu$ons.‘5 The
the open position phase. cephalometric definition of the working angle and mus-
-The forward-upward movement of the hyoid bone
cle length of the suprahyoid muscle group’” in this study
(Fig. 10. B) was shorter during the occlusal phase and the
involved an approximation since the fibrous sling or
backward movement was longer during the opening phase
(Fig. 10. A). pulley through which the intermediate tendon of the
-The downward movement of the hyoid bone was shorter digastric muscle passes is situated superior to the hyoid
(Fig. 10. C) during the open phase. bone. This should not influence our results, however.
-The upward movement of the hyoid bone was longer during because we made comparisons between different head
the closing phase (Fig. 10. ‘4). positions in the same subjects.
 Am. J. Orthod. Denrofac. Orthop.
398 Winnberg, Pancherz, and Westesson
November 1988

EMG-coordination during the open-close-&h cycle

Upright
.

Opening Open ’ Closing Occlusal ’

gwg$lm 1 position I fmsition
g&
law :I& 1% %k

Fig. 6. Suprahyoid and masseter EMG activity, and mandibular movement (is-rgn) related to the
different phases of the open-close-clench cycle. Recordings in milliseconds and millimeters (M and
SD) in 12 subjects with the head in upright position.

Onset of suprahyoid
EMG-activity prior to
start opening Suprahyoid EMG-activity
during open position

Upright

50 msec
+

0
Occlusal
A positlon
$$ing Opening
m
V
Opening $&ing Open
positon
.

Onset of masseter
EMG-activity prior to
start closing Masseter EMG-activity
during occlusion

Upright
P(O.05 I 78%
Forward
281%pm05 Backward
1
msec
-
50
b - ‘rd.
50 IllWC
b

Open ~~&g Closing Closing

0C position m
v
CoS’ng Occlusion

Fig. 7, A through D. Suprahyoid and masseter EMG activity (ms) in relation to the stat-l and end of
the four mandibular movement phases during the open-close-clench cycle. Values (M and SD) are
given with respect to head position in 12 subjects.

In 1957, Wood” studied the working angle of the included subjects with different dentofacial morphol-
suprahyoid muscle group (h-gn / ML) for different head ogy, whereas our study was based solely on subjects
positions. His mean values are comparable with our with normal dentofacial morphology.
observations, but he found a considerably greater vari- EMG recording under dynamic conditions involves
ation. This difference was probably caused by the dif- many variables to control. Alterations in muscle func-
ferent samples in the two studies. Thus, his materiai tion and EMG activity may accordingly be caused by
 Volume 94
Number 5 Head
OLP
mm 137 135 133 131 129 127
4 OL
98
100
t mm
Fig. 8. Hyoid bone position with the head upright. Mean values
(M) are given in millimeters for hyoid position at the start of
opening (SO), end of opening (EO), start of closing (SC), and
end of closing (EC) (n = 12 subjects). (Enlargement factor, 2.2.)
lateral excursions of the mandible,2h which are not de-
tectable by videofluorography in a lateral projection.
To avoid such mandibular movements, the simple open-
close-clench cycle was applied in this study. In an
unpublished methodologic study, we used an electro-
gnathograph*’ (Sirognathograph”) for simultaneous re-
cording of mandibular movements in the lateral and
frontal planes to study possible lateral excursions during
a 20-mm open-close-clench cycle. We found that the
lateral excursions were less than 2 mm. It is therefore
reasonable to assume that lateral movements did not
influence our results.
The mean open-close-clench cycle frequency was
not affected by variations in head posture since the
movement cycle was standardized by means of a met-
ronome. Despite the attempts to standardize the opening
to 20 mm, a smaller opening was found during forward
flexion compared to the upright head position and to
backward extension. This was basically in agreement
with previous findings9.‘7.‘8.29 and seems difficult to
avoid.
The accuracy in orientation of the head was later
controlled by measuring the angle between the occlusal
plane (OL) and a horizontal plane on the reference
template. The standard deviation found was larger than
expected and larger also in comparison with findings
for registration of natural head posture.30 The precision
*Siemens. Bensheim. West Germany
posture and hyo-mandibular ,functicm in man 399
OLP
mm 120 118 118 114
4 OL
. 92
.. 94
., 98
.. 98
., 100
t mm
Fig. 9. Hyoid bone position with the head flexed forward 15”.
Mean values (M) are given in millimeters for the hyoid positions
at the start of opening (SO), end of opening (EO), start of closing
(SC), and end of closing (EC) (n = 12 subjects). (Enlargement
factor, 2.2.)
may be increased with a more accurate orientation tech-
nique.5.8 A natural upright head posture2.3,3’.32would be
preferable as a reference both in studies of normal den-
tofacial morphology and in studies of dentofacial de-
formities. However, it was not possible to achieve a
natural head posture in this experimental setup.
In this study five subjects showed a uniform supra-
hyoid cocontraction during mandibular closing. Similar
observations have been made previously for the upright
head position.33-” This was possibly caused by poor
relaxation in the mylohyoid muscle36 functioning as an
“oral diaphragm.” In 1956, Carl~66~~pointed out that
if the closing movement occurred in a path somewhat
anterior to the habitual one, great activity was recorded
in the digastric muscle throughout the course of the
movement to occlusion. This uniform suprahyoid mus-
cle activity made analysis of the interaction between
jaw and muscle functions impossible. The results of
this study are therefore valid only for those subjects
with a distinctly cyclic EMG pattern.
Closing movements were performed without antag-
onistic muscle control in all but one of the 12 subjects
in this study in whom we recorded cocontraction from
depressor muscles during forward tlexion of the head.
Cocontraction from the depressor muscles33.37has pre-
viously been observed and interpreted as a means of
providing smoothness and stability to the closing move-
ment. Irrespective of head posture. EMG activity was
400 Winnberg, Pancherz, and Westesson Am. J. Orthod. Dentofac. Orthop.
November 1988

Table II. Duration (ms) of different phases of the mandibular open-close-clench cycle-mean (M) and
standard deviation (SD) in 12 subjects with the head in different positions
Mandibular movement phases

Occlusal Opening Open Closing

Head
positions M SD M SD M SD M SD

Forward 177 53 189 28 113 65 182 26

* **
Upright 130 58 199 31 127 61 206 36
*
Backward 170 47 177 23 97 44 210 34

*P < 0.05.
**p < 0.01.

Table Ill. Duration (ms) of EMG activity in the suprahyoid muscle group during different phases of the
mandibular open-close-clench cycle-Mean (M) and standard deviation (SD) in 12 subjects with the head
in different positions
Mandibular movement phases

Occlusal Opening Open Closing

Head
positions M SD M SD M SD M SD

Forward 72 26 185 23 86 63 0 0
Upright 58 32 198 31 79 61 0 0
**
Backward 48 31 168 32 29 51 0 0

**p < 0.01.

Table IV. Duration (ms) of EMG activity in the masseter muscle during different phases of the
mandibular open-close-clench cycle-Mean (M) and standard deviation (SD) in 12 subjects with the head
in different positions
Mandibular movement phases

Occlusal Opening Open Closing

Head
positions M SD M SD M SD M SD

Forward 87 52 0 0 14 30 178 24
**
Upright 49 40 0 0 11 26 206 37
*
Backward 89 59 0 0 42 26 210 33

*P < 0.05.
**p < 0.01.

found to precede the mechanical response and also to ment phases, and onset and cessation of EMG activity
persist after the movement had stopped, which is in found may be explained by the fact that the initial mus-
agreement with previous findings.38-20 The altered co- cle length at the time of stimulation may have influenced
ordination of the start and end of the mandibular move- the contractile response.38 Furthermore, action poten-
Volume 94
Number 5

f
OFF I mm
mm 150 143 140 144 142 140 138 t
4: : II -0L

1.0

$
SO
It
..
88

90

92

94
-OS-

L”‘. Ec .. 90

,/
.. 96
/
,,4 . . 100

‘“/ OLP
/ SC
* mm Fig. 10 (Cont’d). 8, Hyoid bone movement during the occlusal
phase, from end of closing (EC) to start of opening (SO), during
Fig. 10. A, Hyoid bone position with the head extended back- the open-close-clench cycle. Recordings in millimeters (M and
ward 15”. Mean values (M) are given in millimeters for the hyoid SD) with the head extended backward 15” (n = 12 subjects).
position at the start of opening (SO), end of opening (EO), and (Enlargement factor, 2.2.)
end of closing (EC) (n = 12 subjects). (Enlargement factor, 2.2.)

tials may have been initiated differently by altered

stretching of the muscles. Thus, tension receptors, such
as muscle spindles in the masseter and the anterior
digastric muscles,4’ are sensitive to altered stretching.“’
The recruitment of masseter EMG activity was ob-
served before the start of closing in all head positions.
This is in agreement with previous findings during rapid
masticatory movements39 and in the upright head po- OL l
sition in which action potentials appeared before, or 0.5 1.0 mm
simultaneously with. the initiation of the closing move-
ment. On the other hand, AhlgrerP demonstrated that SC
the masseter muscle was inactive during the first part 0.5
of the closing phase, possibly indicating that passive
elastic tension in stretched elevator muscles39 is in-
volved in propelling cyclic” movements. In a subse-
quent study, Ahlgren39 concluded that the exact time 1.0
when action potentials appeared during the closing
phase was dependent on the load, speed, and shape of
the masticatory movements.
The hyoid bone showed a more vertical movement 1.5
pattern during backward extension of the head com-
pared with forward flexion, which is in agreement with mm I
earlier findings.‘0.‘6 We observed a small upward-
forward movement of the hyoid bone before the start Fig. 10 (Cont’d). C, Hyoid bone movement during the open
position phase, from end of opening (EO) to start of closing
of opening in all head positions. This movement was (SC), during the open-close-clench cycle. Recordings in milli-
less pronounced during backward extension than in the meters (M and SD) with the head extended backward 15”
upright position and during forward flexion: however. (n = 12 subjects). (Enlargement factor, 2.2.)
402 Winnberg, Pancherz, and Westesson Am. J. Orthod. Dentofac. Orthop.
November 1988

Table V. Suprahyoid muscle length (h-rgn) in millimeters at different mandibular positions of the
mandibular open-close-clench cycle-Mean (M) and standard deviation (SD) in 12 subjects with the head
in different positions
Mandibular positions

Start opetiing End opening Start closing End closing

Head
positions M SD A4 SD M SD M SD

Forward 40.4 6.2 36.0 6.3 35.9 6.0 40.7 6.3

*** ** ** ***
Upright 47.4 5.3 40.5 5.2 40.2 5.1 47.5 5.5
*** ** ** ***
Backward 52.7 5.4 45.6 4.3 45.2 2.0 52.8 4.9

**lJ < 0.01.

***p < 0.001.

Table Vi. Suprahyoid working angle (ML/h-rgn) in degrees at different mandibular positions of the
mandibular open-close-clench cycle-Mean (M) and standard deviation (SD) in 12 subjects with the head
in different positions
Mandibular positions

Start, opening End, opening Start, closing End, closing

Head
positions M SD M SD M SD M SD

Forward 17.6 10.5 7.0 11.5 6.9 11.4 18.3 10.5

* *
Upright 17.3 8.8 11.1 10.2 10.7 10.9 18.1 8.9
** **
Backward 18.9 7.3 16.5 11.3 16.3 11.4 19.1 7.3

*P < 0.05.
**P < 0.01.

similar hyoid movements have been reported during
slow opening in experimental studies in animals.44.45In
these studies additional EMG recordings of the infra-
hyoid muscles showed that these muscles were silent
during slow opening. This suggests that the infrahyoid
muscles might have been inactive in our subjects during
the occlusal phase. The hyoid bone thereby was not
stabilized from below during the occlusal phase. The
asynchronous upward-forward movement of the hyoid
bone before the start of mandibular opening may be
explained’by a time lag between the synergistic con-
traction of the suprahyoid muscles (particularly the di-
gastric opening of ‘the mandible) and the infrahyoid
muscles (stabilizing the hyoid bone).
A downward-forward movement of the hyoid bone
was observed during the open phase just before the’start
of mandibular closure when the head was extended
backward. This movement of the hyoid bone was pos-
sibly caused by decreased activity and passive stretch-
ing from the suprahyoid muscles while the infrahyoid
muscles were still active, an assumption partly sup-
ported by the observation that this downward-forward
movement of the hyoid bone was not observed in the
upright and forward flexed head positions.
Our findings on the backward extended head po-
sition (increased suprahyoid muscle length and working
angle) indicated a more favorable lever mechanism than
in the upright and forward flexed head positions. Fur-
thermore, soft-tissue stretching46 may have caused a
compensatory decrease in the contraction time of the
suprahyoid muscle group resulting from increased trac-
tion on the mandibular symphysis’7~‘9,20in an infero-
posterior direction. Our findings concerning the shorter
period of suprahyoid EMG activity before opening and
the longer period of masseter EMG activity before clos-
ing may therefore be explained by the soft-tissue
stretching.
The smaller suprahyoid working angle during for-
 Volume 94 Head posture and hyo-mandibular function in man 403
Number 5

ward flexion probably indicated a less efficient lever to bite opening in adult males. AM J ORTHOD 1982;82:157-60.
mechanism and an increased hyo-mandibular soft-tissue 9. Mohl N. Head posture and its role in occlusion. NY State
Dent J 1976;42: 17-23.
compression. This mechanical disadvantage may have
10. Halbert R. Electromyographic study of head position. J Can Dent
required a compensatory adjustment in the contraction Asso; 1958;24:11-23.
time of the suprahyoid muscles. The observation of a 11. Meller E. Lund P, Nishiyama T. Swallowing in upright inclined
longer period of suprahyoid EMG activity before the and supine positions: action of the temporal, lateral pterygoid,
start of opening and in the open position supports the and digastric muscles. Stand J Dent Res 1971;79:483-7.
12. Lund P, Nishiyama T, Moller E. Postural activity in the muscles
assumption of a mechanical disadvantage. The shorter
of mastication with the subject upright, inclined, and supine.
period of masseter EMG activity that preceded the start Stand J Dent Res 1978;78:417-24.
of closing may have been an effect of suprahyoid soft- 13. Winnberg A, Pancherz H. Head posture and masticatory muscle
tissue decompression, which was a decompression function. An EMG investigation. Eur J Orthod 1983;5:209-17.
that preceded masseter recruitment before mandibular 14. Forsberg CM. Hellsing E, Linder-Aronson S, Sheikholeslam A.
Postural muscle activity of the neck muscles in relation to ex-
closing.
tension and flexion of the head. Eur J Orthod 1985;7:177-84.
Our findings are restricted to neuromuscular con- 15. Wood B An electromyographic radiographic investigation of the
ditions during the open-close-clench cycle in subjects positional changes of the hyoid bone in relation to head postures
with normal dentofacial morphology. Head posture may [Thesis]. Chicago: Northwestern University, 1957.
influence hyo-mandibular relationships differently in 16. Gustavsson U, Hansson G, Holmquist A, Lundberg M. Hyoid
bone position in relation to head posture. Swed Dent J
persons with vertical dysplasia because of extreme
1972:65:423-30.
differences in morphology of the hyo-mandibular 17. Schwarz AM. Positions of the head and malrelations of the jaws.
complex. ‘720 Int J Orthod Oral Surg Radiogr 1928;14:56-68.
By monitoring the interplay between hyo-mandib- 18. Smith JA. Cephalometric radiographic study of the position
ular form and function with synchronized polygraphic of the hyoid bone in relation to the mandible in certain
functional positions [Thesis]. Chicago: Northwestern University,
methods, the role of abnormal suprahyoid function on
1956.
occlusion and vertical growth mechanisms’7~‘0449 may 19. Talmant J, Duchateaux C. Maxillomandibular relationship and
be further elucidated. head skeleton balance. Trans Eur Orthod Sot 1977:85-92.
In conclusion, the variations found in EMG pattern 20. Thurow RC. Atlas of orthodontic principles. St. Louis: The CV
caused by altered head posture may be ascribed to a Mosby Company, 1976:26-43.
21. Pancherz H, Win&erg A. Westesson P-L. Masticatory muscle
changed suprahyoid muscle length and working angle.
activity and hyoid bone behavior during cyclic jaw movements
and to differences in movement pattern of the mandible in man. AM J ORTHOD 1986:89:122-30.
and hyoid bone. 22. Sam& K-V, Solow B. Early adult changes In the skeletal and
soft-tissue profile. Eur J Orthod 1980;2:1-12.
We wish to expressour gratitude to ResearchEngineer 23. Moller E. The chewing apparatus. An electromyographic study
Alvar Svensson,Odont. D. (h.c.), and to Mr. Rolf SchiiSner of the action of the muscles of mastication and its correlation to
facial morphology [Thesis]. Acta Physiol Stand 1966;69(suppl
for their technical assistance.We also wish to thank Dr. Klas
280).
Elmqvist, DDS (Syddata, Lund), for developing the computer
24. Ingervall B. Thilander B. Relation between facial morphology
program. and activity of the masticatory muscles. An electromyographic
and radiographic cephalometric investigation. J Oral Rehabil
REFERENCES 1974:1:131-47.
1. Bjark A. Cranial base development. A follow-up x-ray study of 25. Moyers RE. Temporomandibular muscle contraction pattern in
the individual variation in growth occurring between the ages of Angle Class II. Division 1 malocclusion. An electromyographic
12 and 20 years and its relation to brain case and face devel- analysis. AM J ORTHOD 1949;35:837-57.
opment. AM J ORTHOD 1955:41:198-225. 26. Ahlgren J. Mechanism of mastication. A quantitative cinema-
2. Solow B, Tallgren A. Head posture and craniofacial morphology. tographic and electromyographic study of masticatory move-
Am J Phys Anthropol 1976;44:417-36. ments in children, with special reference to occlusion of the teeth
3. Solow B, Tallgren A. Dentoalveolar morphology in relation to [Thesis]. Acta Odontol Stand 1966;24(suppl).
craniocervical posture. Angle Orthod 1977;47:157-63. 21. Jankelsson B, Swain CW. Crane PF, Radke JC. Kinesiometric
4. Vig P. Rink J, Showfety K. Adaptation of head posture in re- instrumentation: a new technology. Am J Dent Assoc 1975;
sponse to relocating the center of mass: a pilot study. AM J 90:834-40.
ORTHOD 1983;83:138-42. 28. Brill N. Lammie GA, Osborne J, Perry HT. Mandibular positions
5. Vig PS, Showfety KJ, Philips C. Experimental manipulation of and mandibular movements. Br Dent J 1959;106:391-400.
head posture. AM J ORTHO~ 1980;77:258-68. 29. McLean LF. Brenman HS, Friedman MGF. Effects of changing
6. Solow B, Siersbaek-Nielsen S, Grewe E. Airway adequacy, head body position on dental occlusion. J Dent Res 1973;52:1041-5.
posture, and craniofacial morphology. AM J ORTHOD 1984; 30. Siersbaek-Nielson S, Solow B. Intra- and interexaminer vari-
86:214-23. ability in head posture recorded by dental auxiliaries. AM J
7. Archer SY, Vig PS. Effects of head position on intraoral pres- ORTHOD 1982;82:50-7.
sures in Class I and Class II adults. AM J ORTHOD 1985;87: 31. Bjerin R. A comparison between the Frankfort horizontal and
311-8. the sella turcica-nasion as reference planes in cephalometric anal-
8. Daly P, Preston CB. Evans WG. Postural response of the head ysis. Acta Odontol Stand 1957;15:1-12.
 Am. J. Orthod. Dentofac. Onhop.
404 Winnberg, Pancherz, and Westesson
November 1988

32. Moorrees CFA, Kean MR. Natural head position, a basic con- 44. Crompton AW, Thexton AJ, Parker P, Hiiemae KM. The activity
sideration in the interpretation of cephalometric radiographs. Am of the jaw and hyoid musculature in the Virginian opossum,
J Phys Anthropol 1958;16:213-34. Didelphis virginiana. In: Gilmore D, Stone-House B, eds. Bi-
33. Moyers RE. An electromyographic analysis of certain muscles ology of marsupials. New York: Macmillan, 1977:287-305.
involved in the temporomandibular movement. AM J ORTHOD 45. Hiiemae KM, Thexton A, McGarrick J, Crompton AW. The
1950:36:481-515. movement of the cat hyoid during feeding. Arch Oral Biol 198 1;
34. Griffin CJ, Munro RR. Jaw closing muscles in the open-close- 26:65-81.
clench cycle in man. Arch Oral Biol 1969;14:141-9. 46. Solow B, Kreiborg S. Soft tissue stretching: a possible control
35. Munro RR. Activity of the digastric muscle in swallowing and factor in craniofacial morphogenesis. Stand J Dent Res 1977;
chewing. J Dent Res 1974;53:530-7. 85:505-7.
36. Lehr RP, Blanton PL, Biggs NL. An electromyographic study 47. Haas AJ. A biological approach to diagnosis, mechanics and
of the mylohyoid muscle. Anat Ret 1971;169:651-60. treatment of vertical dysplasia. Angle Orthod 1980;50:279-300.
37. Carlsti S. An electromyographic study of the activity of certain 48. Van Vlierberghe M, Dermaut L, Jansen H. Influence of the
suprahyoid muscles, mainly the anterior belly of digastric muscle digastric muscle aitd occlusion on the sagiftal growth of the
and of the reciprocal innervation of the elevator and depressor mandible. An experimental investigation in minipigs. Eur J
musculature of the mandible. Acta Anat 1956;26:81-93. Orthod 1986;8:1-11.
38. Inman VT, Ralston HJ, Saunders IB de CM, Feinstein B, Wright 49. Finn RA, Tbrockmorton GS, Gonyea WJ, Barker DR. Bell WH.
EW Jr. Relation of human electromyogram to muscular tension. Neuromuscular aspects of vertical maxillary dysplasias. In: Bell
Electroencephalogr Clin Neurophysiol 1952;4:187-94. WH, Proffit WR, White RP, eds. Surgical correction of dento-
39. Ahlgren J. Kinesiology of the mandible. An EMG study. Acta facial deformities. Vol II. Philadelphia: WB Saunders, 1980:
Odontol Stand 1967;25:593-611. 1712-30.
40. Ahlgren J, Gwall B. Muscular activity and chewing force: a
Reprint requests to:
polygraphic study of human mandibular movements. Arch Oral
Dr. Anders Winnberg
Biol 1970;15:271-80.
Department of Orthodontics
41. Lennartsson B. Number and distribution of muscle spindles in
School of Dentistry
the masticatory muscles. A histochemical and electromyographic
University of Lund
study [Thesis]. University of Gothenburg, 1979.
S-214 21
42. Sherrington CS. Reflexes elicitable in the cat from pinna, vi-
Malmo. Sweden
brissae and jaw. J Physiol 1917;51:404-31.
43. Jerge CR. The neurologic mechanisms underlying cyclic jaw
movements. J Prosthet Dent 1964:14:667-81.

BOUND VOLUMES AVAILABLE i0 SiJB&XllBER~

Bound volumes of the AMERICAN JOURNAL OF ORTHODONTICS AND DENTO-
FACIAL
ORTHOPEDICS are available to subscribers (only) for the -1988 issues from
the Publisher, at a cost of $42.00 ($52.00 international) for Vol. 93 (January-June)
and Vol. 94 (July-December). Shipping charges are included. Each bound volume
contains a subject and author index and all advertising is removed. Copies are
shipped within 60 days after publication of the last issue in the volume. The binding
is durable buckram with the journal name, volume number, and year stamped in
gold on the spine. Payment must accompany all orders. Contact The C.V. Mosby
Company, Circulation De@rtment, 11830 Westline Industrial Drive, St. Louis,
Missouri 63146-3318, USA; tejephone (800)325-4177, ext. 351.
Subscriptions must be in force to qualify. Bound volumes are not available
’ in place of a regular Journal subscription.