ELECTROMYOGRAPHIC EVIDENCE SUPPORTING THE

MANDIBULAR HINGE AXIS THEORY

JULIAN B. WOELFEL, D.D.S.,* JI:DSON C. HICKEY, D.D.S., M.S.,** aXD

LLOYD RINEAR, B.A.***

College of Dentistry, Ohio State University, Columbus, Ohio

HE PRINCIPLE O F H I N G E A X I S opening of the temporomandibular

T joint has been the subject of controversy,1-" and the functions of the external
pterygoid muscles have been discussed in relation to this principle. ''~ The existence
of a mandibular hinge axis opening is becoming more generally accepted by anat-
omists, physiologists, and prosthodontists. The extent of hinge opening without
translation is claimed by some to be small. Kurth and Feinstein ° stated that the
average individual has one half to three quarters of an inch of this type of opening,
and reported one subject with one and one-half inches of opening without
translation.
Most studies of the external pterygoid muscles have been limited to those of
cadavers and to those of living patients with unilateral or bilateral condylectomy.''~
Electromyographic interpretation of the normal functions of the external pterygoid
muscles ~ has been limited; primarily by the difficult accessibility of the muscles to
needle electrodes, and by the pain accompanying the insertion of the needles.
In this investigation, the functions of the external pterygoid muscles during
mandibular hinge axis openings were studied by means of electromyography.

METIIODS AND PROCEDURES

Records were made on a Grass Model III-D electroencephalograph as previ-

ously described. ~ Muscle filter controls were on for all recordings. The recording
paper speed was 6 cm. per second. Straight and curved needle electrodes (1.5 inch
suture needles) and surface electrodes were used to register the electrical activity
from the various muscles.
The curved suture needles were insulated with a plastic spray, except for 1.5
ram., at their entering ends. One was inserted intraorally into the lower head of
the right external pterygoid muscle near its origin, while the other was inserted
extraorally into this same nmscle near its insertion. The wire lead from the in-
traoral electrode was ligated to the upper right first molar with dental floss to mini-
mize movement of the needle.
The straight needle electrodes were insulated as described above. They were
inserted extraorally into both right and left external pterygoid nmscles to permit
simultaneous recordings from these muscles.
R e e e i v e c l f o r p u b l i c a t i o n Dee. 14, 1956.
*Assistant Professor, Division of Prosthodontics.
* * I n s t r u c t o r , D i v i s i o n of P r o s t h o d o n t i e s .
***E:lectroeneephalograph Specialist, Columbus Receiving Hospital and State Institute of
Psychiatry, Columbus, Ohio.
,361
362 "WOELFELj HICKEY, AND RINEAR J. Pros. Den.
May, 1957

The surface electrodes used to record from the digastric muscles were 9 ram.
concave discs, which were attached to the skin by means of adhesive tape. Electrode
salt paste jelly was used to make intimate contact between the disc and the skin.
The interelectrode resistance, by this method of attachment, varied between 5,000
and 11,000 ohms.

Fig. 1.--An electromyogram made during a forward protrusive movement of the mandible.
Note the increased electrical activity of the external pterygoid muscles during the movement.

F i g . 2 . - - A n e l e c t r o m y o g r a m m a d e d u r i n g a l e f t l a t e r a l m o v e m e n t of t h e m a n d i b l e , A r r o w s
indicate the beginning of movement. N o t e t h e i n c r e a s e d e l e c t r i c a l a c t i v i t y ( m a x i m a l ) of t h e
right external pterygoid muscle during this movement.
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ELECTROMYOGRAM IN .~IANDIBULAR HINGE AXIS THEORY 363

The basic wave form recorded from all electrodes showed some irregularity
on the electromyograms, at times coincidental with mandibular movements. This
irregularity or artifact was due to movement of the needle and of the lead wire
from it in the case of the needle electrodes, and to nlovement of the lead wires in
the case of the surface electrodes.
The authors served as subjects for the recordings of these controlled hinge
openings of the mandible and the other jaw movements performed. The sub-
jects were comfortably seated upright in an armchair with the eyes closed. The
following jaw movements were executed: regular (uncontrolled) opening, hinge
opening, retrusion, protrusion, and right and left lateral movements. Right and
left lateral movements and the forward protrusion of the mandible were used so
that correct interpretation of maximal and minimal electrical activity, as recorded
on the electromyogram from the external pterygoid muscles, could be determined.
These movements were also used to make certain that the electrodes were properly
placed. Recordings were made with the mandible in rest position for comparison.

F i g . 3 . - - A n e l e c t r o m y o g r a m m a d e d u r i n g r i g h t l a t e r a l m o v e m e n t of t h e m a n d i b l e ( e l e c t r o d e
p o s i t i o n s w e r e t h e s a m e as f o r r e c o r d s in F i g . 2). A r r o w s i n d i c a t e t h e b e g i n n i n g of m o v e m e n t .
N o t e t h e m i n i m u m of e l e c t r i c a l a c t i v i t y of t h e r i g h t e x t e r n a l p t e r y g o i d m u s c l e d u r i n g this m o v e -
ment.

RESULTS

The nmximal electrical activity of the right external pterygoid muscle was ob-
served in a protrusion or left lateral movement of the mandible (Figs. 1,2). A
similarity of the rest pattern for the external pterygoid muscle and the digastric
muscle with different types of electrodes is evident on the electromyogram. No
significant change was noted on the recording of the basic wave form, frequency,
or amplitude from either area of the right external pterygoid muscle during a right
lateral movement of the mandible (Fig. 3).
 364 \VOELFEL~ H I C K E Y ~ A N D R I N E A R J. Pros. Den.
May, 1957

Uncontrolled openings were executed from mandibular physiologic rest posi-

tions. Typical uncontrolled openings are shown in Figs. 4 and 5. Increased
electrical activity from both digastric muscles and the external pterygoid nmscles
occurs within the same tenth of a second. On retruded hinge mandibular openings
(Figs. 6,7), an instantaneous increase in electrical activity from both digastric

' ~ J= ~ i I ~ ! )i ~

F i g . 4 . - - A n e l e c t r o m y o g r a m m a d e d u r i n g a n u n c o n t r o l l e d ( r e g u l a r ) o p e n i n g of t h e m a n d i b l e .
T h e a r r o w i n d i c a t e s a n a r t i f a c t w h i c h w a s p r o d u c e d b y m o v e m e n t of t h e n e e d l e e l e c t r o d e a t
t h e b e g i n n i n g of t h e o p e n i n g . N o t e t h e i n c r e a s e d e l e c t r i c a l a c t i v i t y r e c o r d e d f r o m t h e e x t e r n a l
pterygoid muscle from both intraoral and extraoral needle electrodes.

F i g . 5 . - - A n e l e c t r o m y o g r a m m a d e d u r i n g a n u n c o n t r o l l e d ( r e g u l a r ) o p e n i n g of t h e m a n d i b l e .
T h e a r r o w i n d i c a t e s a n a r t i f a c t w h i c h w a s p r o d u c e d b y m o v e m e n t of the nee:tie e l e c t r o d e as
t h e j a w w a s closecl. N o t e t h e i n c r e a s e d e l e c t r i c a l a c t i v i t y f r o m b o t h t h e r i g h t a n d left e x t e r n a l
p t e r y g o i d m u s c l e s d u r i n g th;s m o v e m e n t .
Volume 7 ELECTROMYOGR,AM I N MANDIBULAR HINGE AXIS THEO2.Y 365
Number 3

F i g . 6 , - - A n e l e c t r o m y o g r a m m a d e d u r i n g a h i n g e o r r e t r u d e d o p e n i n g of t h e m a n d i b l e .
T h i s r e c o r d w a s m a d e a t t h e s a m e s i t t i n g as t h a t f o r F i g . 4, a n d t h e e l e c t r o d e p o s i t i o n w a s un-
c h a n g e d . T h e first a r r o w i n d i c a t e s t h e b e g i n n i n g of r e t r u s i o n of t h e m a n d i b l e p r i o r to o p e n -
ing. TLhe s e c o n d a r r o w i n d i c a t e s t h e b e g i n n i n g of t h e h i n g e o p e n i n g m o v e m e n t . Note the
l a c k of i n c r e a s e of e l e c t r i c a l a c t i v i t y f r o m t h e e x t e r n a l p t e r y g o i d m u s c l e o v e r t h a t of its r e s t -
ing potential. C o m p a r e this with the increased electrical activity f r o m this muscle d u r i n g
the uncontrolled opening (Fig, 4).

F i g . 7 . - - A n e l e c t r o m y o g r a m m a d e d u r i n g a r e t r u d e d h i n g e o p e n i n g of t h e m a n d i b l e .
T h i s r e c o r d w a s m a d e a t t h e s a m e s i t t i n g as t h a t f o r F i g . 5, a n d t h e e l e c t r o d e p o s i t i o n s w e r e
unchanged. T h e a r r o w s i n d i c a t e t h e b e g i n n i n g of t h e h i n g e o p e n i n g m o v e m e n t . Compare
t h e l a c k of i n c r e a s e of e l e c t r i c a l a c t i v i t y of t h e e x t e r n a l p t e r y g o i d m u s c l e s s e e n in t h i s h i n g e
o p e n i n g w i t h t h e i n c r e a s e f r o m t h e s e s a m e m u s c l e s d u r i n g t h e r e g u l a r o p e n i n g s e e n in Fig. 5.
366 WOELFEL~ HICKEY, AND RINEAR J. Pros. Den.
May, 1957

muscles is noted. However, the external pterygoid muscles exhibit no significant

change or increase of electrical activity from their rest pattern as recorded on the
electromyogram. This lack of electrical activity from the external pterygoid muscles
during the hinge movement is similar to the rest pattern shown on Figs. 1 and 2.
Electrical activity from the external pterygoid muscles was observed at the instant
the maximal hinge opening was exceeded (Fig. 8).
The amount of hinge opening beyond mandibular physiologic rest position
consisted of a separation in the incisor region of at least 12 mm. Comparative
measurements were taken between the cervical gingivae of the upper and lower
right central incisors with the mandible first in rest position, and then at its maximal
hinge opening (before an increase of electrical activity from the external pterygoid
muscles was noted). The average opening for the subjects was not computed, but
the fact that they were able to execute at least 12 mm. of the hinge opening was
considered significant.

L . _ 2 j :

Fig. 8.--An electromyogram made during an opening continued beyond the maximal hinge
opening. Arrows indicate the point of maximal hinge opening. Increasing electrical activity
f r o m t h e e x t e r n a l p t e r y g o i d m u s c l e s is s e e n b e y o n d t h i s p o i n t a s t h e t r a n s l a t i n g c o m p o n e n t is
introduced into the movement.

DISCUSSION

It has been shown that there is no protrusive movement of the mandible if the
external pterygoid muscles are missing or are not functioning. There are no other
muscles capable of performing this movement. ''~
The hinge axis theory is based on the assumption that the mandible rotates
around a definite axis during a retruded hinge opening. The amount of this open-
ing that can be made in a hinge fashion varies with the individual. If the condyle
should move forward in the glenoid fossa, during what is thought to be a hinge
movement, then there could be no single axis for this movement. If such forward
movement were to occur, it could only be the result of action of the external
pterygoid muscles, unless a posterior fulcrum below the level of the condyle was
encountered.
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ELECTROMYOGRAM IN MANDIBULAR HINGE AXIS THEORY 367

It has been established that, if a muscle is contracting beyond its resting

activity, one of the phenomena of this increased contraction is increased electrical
activity. 1°'11 This increased electrical activity does not indicate whether the muscle
is acting as a mover of a part, or if it is acting in a holding or stabilizing capacity.
Conversely, if there is no increase in electrical activity in a muscle during a particu-
lar movement, it can safely be assumed that this same muscle is not active during
that specific movement.
It seems evident that the electrical activity of the external pterygoid muscles
does not increase during the hinge opening movement (Figs. 6,7). This indicates
that these nmscles are not actively involved in this movement. Therefore, it be-
comes apparent that other muscles are responsible for this movement. These are
probably the suprahyoid muscles, aided by the posterior fibers of the temporal
muscles in maintaining the retruded position of the mandible.

CONCLUSIONS

I. It has been demonstrated electromyographically that the hinge opening can be

accomplished when a trained subject makes this type of opening, since no in-
crease of electrical activity is recorded from normally functioning external
pterygoid muscles.
2. The results indicate that the neuromuscular system is so arranged that the hinge
movement of the mandible is possible. This does not preclude the possibility of
the bony structures of the temporomandibular joints interfering with a true hinge
movement.
3. When the bony structure of the temporomandibular joint and shape of the
meniscus will permit, the neuromuscular system is such that a significant amount
of hinge movement can be accomplished. However, for most individuals this is
not the normal opening pattern.
We wish to thank Dr. Morgan L. Allison, Chairman, Division of Oral Surgery, College
of Dentistry, Ohio State University, for inserting needle electrodes into the external pterygoid
muscles.
REFERENCES
1. Sloan, R. B.: Recording and Transferring the Mandibular Axis, J. PRos. DEN. 1:327-
332, 1951.
2. Page, H. L. : Hinge Bow, D. Digest 58:534-537, 1952.
3. Clapp, G. W. : There is No Usable Vertical Opening Axis iu the Mandible, J. PROS.
DEN. 2:147-159, 1952.
4. Vaughan, H. C. : The External Pterygoid Mechanism, J. PROS. DEN. 5:80-92, 1955.
5. Sicher, Harry: Functional Anatomy of the Temporomandibular Articulation, Austral.
J. Den. $$:73-85, 1951.
6. Kurth, L. E., and Feinstein, J. K.: The Hinge Axis of the Mandible, J. PROS. DEN. 1:
327-332, 1951.
7. Smith, A. E., and Robinson, Marsh: Mandibular Function After Condylectomy, J.A.D.A.
46:304-321, 1953.
8. Moyers, R. E.: An Electromyographie Analysis of Certain Muscles Involved in Tem-
poromandibular Movement, Am. J. Orthodontics and Oral Surg. 36:481-515, 1950.
9. Hickey, J. C., Woelfel, J. B., and Rinear, L. A. : The Influence of Ove'rlapping Electrical
Fields on the Interpretation of Electromyograms, J. PROS. DEN. 7:273-281, 1957.
10. Fulton, John F. : A Textbook of Physiology, ed. 17, Philadelphia and London, 1955, W. B.
Sanders Company, p. 131.
11. Houssay, Bernardo A. : Human Physiology, ed. 2, New York, 1955, McGraw-Hill Co., Inc.,
p. 793.
OHIO STATE UNIVERSITY
COLUMBUS 10, OHIO