MUSCLE OF

MASTICATION

Presented by:-
Dr. Shaifali
MDS PG 1st year
CONTENTS:-

 Introduction
 Embryology of muscle of mastication
 Types: Muscles of mastication (Primary and accessory)
 Anatomy
 Disorders of the Masticatory Muscle
 Conclusion
 References
 INTRODUCTION
MUSCLE : Muscle is a contractile tissue of the
body and is derived from the mesodermal layer of
embryonic germ cells.
Muscle cells contain contractile filaments that move
past each other and change the size of the cell.
MUSCLE OF MASTICATION :
The muscles of mastication move the mandible during
mastication and speech.
EMBRYOLOGY OF MUSCLE OF MASTICATION
 They develop from the mesoderm of the first branchial
arch, and are supplied by the mandibular nerve which is the
nerve of that arch.
 Posterior belly of digastric muscle develops from second
branchial arch and is supplied by facial nerve.
 PRIMARY MUSCLE OF MASTICATION

 Masseter

 Temporalis

 Lateral pterygoid

 Medial pterygoid
 Accessory Muscles Of Mastication

 Buccinator

 Suprahyoid muscles (Digastric muscle,

Mylohyoid muscle, and Geniohyoid muscle)
 MASSETER
 Quadrilateral in shape.
 Covers the lateral aspect of the ramus
and the coronoid process of the
mandible.
 It has three layers :
Superficial ,
Middle , and
Deep
ORIGIN :

A. SUPERFICIAL LAYER (largest) : from anterior 2/3 of lower border of

zygomatic arch and adjoining zygomatic process of maxilla.

B. MIDDLE LAYER : from anterior 2/3

of deep surface and posterior 1/3 of
lower border of zygomatic arch.

C. DEEP LAYER : from deep surface of

zygomatic arch.
INSERTION :

A. Superficial layer : into lower part of lateral surface of ramus of

mandible.

B. Middle layer : into middle part of ramus.

C. Deep layer : into upper part of ramus and coronoid process of

mandible.
FIBRES:

A. Superficial fibres pass downwards and backwards at 45 degrees

B. Middle and Deep fibres pass vertically downwards.

 Three layers are separated posteroinferiorly by an artery and a

nerve.
NERVE SUPPLY :

Masseteric Nerve (A branch of anterior division of mandibular

nerve)

ACTIONS :
Elevates mandible to close the mouth to bite.
VASCULAR SUPPLY
TEMPORALIS

 Fan shaped muscle.

 Bipennate muscle.
 Fills the temporal fossa.

FIBRES:
Converge and pass through gap deep to
zygomatic arch.
TEMPORAL FASCIA:

 The temporal fascia is a thick aponeurotic

sheet that roofs over the temporal fossa and
covers the temporalis muscle.

 Superiorly, the fascia is single layered and is

attached to the superior temporal line.
Inferiorly, it splits into two layers which are
attached to the inner and outer lips of the
upper border of the zygomatic arch .

 The deep surface of the temporal fascia gives origin to some fibres of the
temporalis muscle.
ORIGIN:

A. Temporal fossa, excluding zygomatic bone.

B. Temporal Fascia.

INSERTION:
C. Margins and deep surface of
coronoid process
B. Anterior border of ramus of
mandible.
NERVE SUPPLY :

 Two deep temporal branches from anterior

division of mandibular
nerve.
VASCULAR SUPPLY

Deep temporal part of maxillary artery.

ACTIONS:

A. Elevates mandible.
B. Posterior fibres retract the protruded mandible.
C. Helps in side to side grinding
movement.
LATERAL PTERYGOID

 Short, conical.
 Has upper and lower heads.
ORIGIN:
A. Upper head (small) : originates from infratemporal surface and crest of
greater wing of sphenoid bone.
B. Lower head (larger) : originates from lateral surface of lateral pterygoid
plate.
 INSERTION:
A. Pterygoid fovea on the anterior surface
of neck of mandible.

B. Anterior margin of articular disc and

capsule of TMJ. Insertion is posterolateral
and at a slightly higher level than origin.

FIBRES:
Fibres run backwards and laterally and
converge for insertion.
NERVE SUPPLY:

 A branch from anterior division of mandibular nerve.

ACTIONS:

A. Depress mandible to open mouth with suprahyoid muscles.

B. Lateral and medial pterygoid protrude mandible.
C. Left lateral pterygoid and right medial pterygoid turn the chin to
left side as part of grinding movements.
VASCULAR SUPPLY

 Pterygoid branch of 2nd part of maxillary artery

MEDIAL PTERYGOID
 Quadrilateral.
 Has a small superficial and a large deep head.
ORIGIN:

A. Superficial Head (small slip) : from tuberosity of maxilla and

adjoining bone.
B. Deep Head (quite large) : from medial surface of lateral pterygoid
plate and adjoining process of palatine bone.

INSERTION:
Roughened area on the medial surface of
Angle & adjoining ramus of mandible,
below & behind the mandibular foramen &
mylohyoid groove.
FIBRES:

Fibres run downwards, backwards and laterally.

NERVE SUPPLY:

 Nerve to medial pterygoid, branch of the main trunk of mandibular

nerve.
 VASCULAR SUPPLY
 Pterygoid branch of 2nd part of maxillary artery
ACTIONS:

A. Elevates mandible.
B. Helps protrude mandible.
C. Right medial pterygoid with left lateral pterygoid turn
the chin to left side.
Accessory Muscles Of Mastication
BUCCINATOR
 Is thin quadrilateral facial muscle.

ORIGIN:
A. Upper fibres, from maxilla opposite molar teeth.
B. Lower fibres, from mandible, opposite
molar teeth.
C. Middle fibres, from pterygomandibular
raphae
INSERTION:
A. Upper fibres, straight to the upper lip.
B. Lower fibres, straight to the lower lip.
C. Middle fibres decussate before passing to the lips.

ACTION:

D. Flattens cheek against gums and teeth; prevents accumulation of

food in the vestibule.
E. This is the whistling muscle.
DIGASTRIC MUSCLE
 Suprahyoid muscle.
 Has two bellies united by an intermediate tendon.
ORIGIN:

A. Anterior belly (DGA) : from digastric fossa of mandible.

B. Posterior belly (DGA) : from mastoid notch of temporal bone.

INSERTION:

Both ends meet at the intermediate tendon

which perforates stylohyoid and is held by a fibrous
pulley to the hyoid bone.
FIBRES:

A. Anterior belly runs downwards and backwards.

B. Posterior belly runs downwards and forwards.

NERVE SUPPLY:
C. Anterior belly by nerve to mylohyoid.
D. Posterior belly by facial nerve.
ACTIONS:

A. Depresses mandible when mouth is opened widely or against

resistance; it is secondary to lateral pterygoid.
B. Elevates hyoid bone.
MYLOHYOID

 Flat triangular
 Two mylohyoids form floor of the oral cavity.
ORIGIN:

 Mylohyoid line of mandible.

INSERTION:
 Posterior fibers : body of the hyoid bone.
 Middle and anterior fibers : median raphae, between mandible
and hyoid bone.
FIBRES:
 Runs medially and slightly downwards.

NERVE SUPPLY:
Mylohyoid Nerve .

ACTIONS:
A. Elevates floor of mouth in first stage of deglutition.
B. Helps in depression of mandible, and elevation of hyoid bone.
GENIOHYOID
 Short and narrow muscle, lies above medial part of mylohyoid.

ORIGIN:
Inferior mental spine (genial tubercle)

INSERTION:
Anterior surface of body of hyoid
bone.
FIBRES:

 Runs backwards and downwards.

ACTIONS:

A. Elevates hyoid bone

B. May depress mandible when hyoid is fixed.
 Disorders of the Masticatory Muscle

 Masticatory muscle disorders are a group of musculoskeletal conditions that

are the major cause of nonodontogenic pain in the orofacial region.

 There are several types of disorders of the masticatory muscles, each of

which may have a complex etiology, clinical course, and response to
therapy.

 Mechanisms behind masticatory muscle pain include overuse of a normally

perfused muscle or ischemia of a normally working muscle, sympathetic
reflexes that produce changes in vascular supply and muscle tone, and
changes in psychological and emotional states.
 MUSCLE HYPERTROPHY

 Hypertrophy refers to an enlargement caused by an

increase in the size, but not in the number of cells.

 Generalized masticatory muscle hypertrophy may affect the temporalis, masseter,

and medial pterygoid muscles in a variety of combination.

 Masseter muscle hypertrophy in itself has been postulated to be associated with

awake and sleep bruxism as a possible result of prolonged tooth clenching
(Manfredini et al. 2013a; Castroflorio et al. 2015b).

 Masseteric hypertrophy may present as either unilateral or bilateral painless swelling

of unknown origin in the region of angle of mandible.
MUSCLE HYPERPLASIA

 Muscle hyperplasia results in an

increase in the number of fibers
within a muscle.

 However masticatory muscle hyperplasia is very rare, with the exception

of the Masticatory muscle tendon-aponeurosis hyperplasia
(MMTAH) (Sato and Yoda 2016).

 MMTAH is a condition in which the tendon and aponeurosis of the

bilateral masticatory muscles exhibit hyperplasia, thus restricting muscle
extension.
 Etiology -- still remains unclear, although parafunctional habits are
often associated with it. A hard cord-like structure found along the
anterior border of the masseter muscle on intraoral palpation can help in
clinical diagnosis, although MRI can help visualize tendons and
aponeuroses.

 Symptom -- limited mouth opening.

 The definitive diagnosis between masticatory muscle hypertrophy and

masticatory muscle hyperplasia can only be established by histology.

 Treatment -- Aponeurectomy combined with coronoidectomy is the

treatment of choice for a better prognosis.
MYALGIA

 According to DC/TMD, masticatory muscle pain or myalgia can be defined as a

pain of muscle origin that is affected by jaw movement, function, or
parafunction, and replication of this pain occurs with provocation testing of the
masticatory muscles.

Features of Local Myalgia

a) Sore MOM with pain in cheeks and temples on chewing, wide opening, and often on
waking (eg, nocturnal bruxism)
b) Bilateral
c) Described as stiff, sore, aching, spasm, tightness, or cramping
d) Sensation of muscle stiffness, weakness, fatigue
e) Possible reduced mandibular range of motion
Myalgia is further subdivided into three mutually exclusive subtypes :
 Myofascial pain syndrome (MPS)
 Myofascial pain syndrome (MPS) is described as the sensory, motor, and autonomic symptoms
caused by myofascial Trigger points. The best available evidence supports that TrPs develop
after muscle overuse.

 Myofascial TrPs, are described as hyperirritable spots in the fascia surrounding skeletal muscle.

 Unexplained pain frequently radiates from these points of local tenderness to broader
areas, sometimes distant from the TrP itself.

 The treatment of MPS focuses on analgesics and anti-inflammatory therapy, followed by

physiotherapy, occlusal splint therapy, transcutaneous electric nerve stimulation (TENS), laser
therapy, acupuncture, and biofeedback (Pal et al. 2014).
MYOSITIS

 Myositis is a primary inflammation of muscle resulting from infection such as

viruses, including the common cold, flu, and human immunodeficiency virus
(HIV) or trauma.

 It is characterized by constant acute pain and is usually accompanied by

swelling, redness of the overlying skin, and increased temperature over the
affected muscle (Greene and Laskin 2013).

 Myositis can be differentiated from other forms of myalgia by its acute

presentation and constant nature of the reported pain, its associated sequelae
such as the patient’s acute and unambiguous responses to muscle palpation, and
a history of recent trauma or infection (Lundberg and Vencovsky 2017).
Myositis ossificans (MO)

 Myositis ossificans (MO) is the most common described myositis of the

masticatory muscles. It is a rare disease involving heterotopic ossification
in the muscle.

 The likely etiologic mechanism includes osteoblast stimulation as a

consequence of bone or soft tissue damage causing formation of new bone,
dystrophic calcification, or calcified chondroid matrix.

 MO can be divided into two groups:

(1) Progressive MO
(2) Traumatic MO
Progressive myositis ossificans (PMO)

 Progressive myositis ossificans or Munchmeyer’s disease (also called

fibrositis ossificans progressiva or fibrodysplasia ossificans progressiva) is
a hereditary form with autosomal dominant transmission.

 This disease leads to the formation of a second (heterotopic) skeleton.

 It persists throughout childhood and early adult life, and progressively

immobilizes all the joints.

 There is no treatment for Munchmeyer’s disease.

Myositis ossificans traumatica (MOT)

 Myositis ossificans traumatica (MOT) is a more circumscribed form, which involves a

single muscle or muscle groups subjected to violent or repeated trauma (Spinzia et al.
2014)

 The masseter muscle is the most affected, followed by medial and lateral pterygoid
muscles, while the temporalis muscle is the least affected (Schiff and Meara 2013).

 Pain and swelling, jaw dysfunction, particularly limited range of motion and pain on
movement, are characteristic features of MOT.

 Surgical excision of the entire lesion is a reasonable treatment option. Spontaneous

resolution has been reported in about one-third of cases (Schiff and Meara 2013)
 MYOSPASM

 Myospasm, often referred to as a muscle cramp, is an acute but rare condition

resulting from a sudden, involuntary, and continuous tonic contraction of a muscle
or muscles.

 It is characterized by localized acute pain and severely limited range of motion of

the mandible (Gonzales and Mohl 2006).

 Etiology appears to be related to:-

 Continued deep pain input,
 Local metabolic factors within the muscle tissue associated with fatigue or overuse
(e.g., awake and sleep bruxism) (Castroflorio et al. 2012a, b)
 Idiopathic myospasm mechanisms (Okeson 2015).
 Masticatory myospasm can be classified into:
a) jaw closing
b) jaw opening

 Jaw closing type involves masseter and temporalis muscles,

while jaw opening type involves the inferior lateral pterygoid muscles (Fu et al. 2012).

 Masseter and/or temporalis myospasm is characterized by:

a) limited mouth opening, and
b) acute pain

 On the contrary, inferior lateral pterygoid myospasm is characterized by:

a) difficulty in jaw closing after wide opening and
b) involuntary jaw movements (Cao et al. 2012)
Treatment of myospasms includes :

a) Pain reduction by ice (vapocoolant spray) or

injection of local anesthetic (2% lidocaine
without vasoconstrictors) into the muscle in spasm .
b) If myospasms are secondary to fatigue and overuse, the
patient is advised to rest their jaw.

c) If myospasms are chronic or recurrent without

identifiable etiologic factors, the condition may
represent an oromandibular dystonia and further
investigation is necessary.
Myofibrotic Contracture

 Myofibrotic Contracture often occurs as a consequence of an inflammatory process

leading to fibrous changes in the muscle or its sheath.

 It follows an infectious process or traumatic myositis.

 Radiation therapy, incision through a muscle with fibrotic healing, and disuse for long
period (>6 weeks) can result in myofibrotic contracture .

 This condition, although not painful, can result in a limited jaw opening with resistance
to passive stretching.

 Myofibrotic contracture is irreversible and requires surgical detachment for a patient

whose function is severely impaired (Benzon and Raj 2008)
Movement Disorders

 Movement disorders are defined by clinical sign and symptom patterns

(syndromes) in which normal functional movements are altered.
 Involuntary movement disorders (dyskinesias) can be classified :
a) Hypokinesias
b) Hyperkinesias
 Hypokinesias
Hypokinesia refers to decreased bodily movement, characterized by a partial or
complete loss of muscle movement due to a disruption in the basal ganglia (Van
Hilten et al. 1994)
Eg. Parkinson Disease and Parkinsonian Syndromes
 Hyperkinesias

Hyperkinesia refers to an increase in muscular activity that can result in excessive

abnormal movements, excessive normal movements, or a combination of both
(Anthoney 1994).
Oromandibular Dystonia

 Dystonia is characterized by involuntary sustained muscle

contractions affecting one or more sites of the body, frequently
causing twisting and repetitive movements or abnormal postures.

 Oromandibular Dystonia produces involuntary contractions of

masticatory muscles, the suprahyoid muscles, and/or the intrinsic
tongue muscles.

 The patient exhibits ocular blinking, tooth grinding, and

grimacing. Such involuntary contractions can be rigid and
painful.
BRUXISM

 Bruxism is a repetitive jaw-muscle activity characterized by teeth

clenching or grinding and/or mandible bracing or thrusting
presenting two distinct circadian manifestations: sleep bruxism (SB),
or awake bruxism (AB) (Lobbezoo et al. 2013).

 AB is a semivoluntary “clenching” activity influenced by stress and

anxiety, SB is a stereotyped movement disorder occurring during
sleep.

 Bruxism can result in detrimental effects on the teeth and

restorations chipping and fracture
 The activity of bruxism results in muscle hyperactivity, particularly in
the masseteric sling muscles (masseter and medial pterygoid) and the
lateral pterygoids. Therefore, myalgia can be the result of this activity
(Glaros et al. 2014)

 AB is linked to emotional and psychological stress (Shetty et al. 2010;

Thompson et al. 1994). AB can exacerbate TMD symptoms such as
headaches, muscle and joint pain, and jaw locking (Glaros and Williams
2012; Goldstein and Clark 2017; Kalaykoya et al. 2011).

 SB is related to sleep arousals and has a combination of different motor

activities including tooth grinding.
 Neoplasms

 The masticatory muscles can be sites of benign (e.g., rhabdomyoma) or

malignant (e.g., rhabdomyosarcoma) or metastatic neoplasms.

 Muscle neoplasms can lead to deviation of the mandible and acute

malocclusions.

 Diagnostic imaging and biopsy are essential when a neoplasm is

suspected.
SPLINT THERAPY:
Splints, orthotics, orthopedic appliances, bite guards, nightguards, or bruxing guards are
used in TMD treatment, and often for disorders of masticatory muscles.
PHARMACOLOGIC THERAPY:

 Medications may promote patient comfort and rehabilitation when

used as part of comprehensive treatment.

 NSAIDS, acetaminophen, muscle relaxants, antianxiety agents,

tricyclic antidepressants.
CONCLUSION

 The masticatory muscles include a vital part of the orofacial structure

and are important both functionally and structurally.

 Masticatory muscle disorders represent the second most common

cause of orofacial pain after tooth pain.

 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.
REFERENCES
 B D Chaurasia’s Human Anatomy 5th edition
 Textbook of craniofacial growth, Sridhar Premkumar
 Elsayed N, Shimo T, Harada F, Takeda S, Hiraki D, Abiko Y, Nakayama E,
Nagayasu H. Masticatory muscle tendon-aponeurosis hyperplasia diagnosed as
temporomandibular joint disorder: A case report and review of literature.
International Journal of Surgery Case Reports. 2020 Dec 2.
 Castroflorio T., Bargellini A., Deregibus A., Svensson P. (2019) Masticatory
Muscle Pain and Disorders. In: Farah C., Balasubramaniam R., McCullough M.
(eds) Contemporary Oral Medicine. Springer, Cham.
https://doi.org/10.1007/978-3-319-72303-7_30
 De Rossi SS, Stern I, Sollecito TP. Disorders of the masticatory muscles. Dental
Clinics of North America. 2013 Jul 1;57(3):449-64.