MUSCLES OF

MASTICATION
CONTENTS
• INTRODUCTION
• CLASSIFICATION
• DEVELOPMENT
• MUSCLES IN THE CRANIOFACIAL REGION
• MUSCLES OF MASTICATION
• MUSCLE CHANGES DURING GROWTH
• FORM AND FUNCTION
• MUSCLE FUNCTION AND MALOCCLUSION
• REFLEX CONTROL OF JAW MUSCLES
• MASTICATORY MUSCLE DISORDERS
INTRODUCTION
• Human has 639 muscles, composed of 6 billion muscle fibers.
• Food is the main source of energy, this energy is derived through the
complicated process of digestion.
• 1st step of digestion is mastication.
• Teeth, jaws, muscles of the jaws, tongue and the salivary glands aid in
mastication.
• Muscles of mastication are the group of muscles that help in
movement of the mandible as during chewing and speech.
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
Classification of Muscle

• Morphological classification • Functional classification:

(based on structure)
1. Voluntary
• 1. Striated 2. 2. Involuntary
• 2. Non-striated or smooth
Types of Muscle
• 3 types of muscles in the human body
• Skeletal muscle
• Smooth muscle
• Cardiac muscle
• Smooth muscle:
• striated and involuntary.
• found within the walls of organs and structures such as the
esophagus, stomach, intestines, bronchi, uterus, urethra, bladder,
blood vessels, and even the skin
• Unlike skeletal muscles, smooth muscles are not under conscious
control.
• Cardiac muscle:
• non-striated and involuntary.
• More similar in structure to skeletal muscle, and is found only in the
heart
• Skeletal muscle
• “voluntary muscle”
• anchored by tendons to the bone and is used to affect skeletal
movement such as locomotion and maintaining posture.
• Slow-twitch, or type I
• Fast-twitch, or type II
• Muscles have three major areas:
• 1. A belly or Gaster.
• 2. An origin: a tendinous connection of the muscle to a bone, usually
the bone that is stabilized.
• 3. An insertion: a tendinous connection of the muscle to a bone,
usually the bone to be moved.
Skeletal muscle fibers can generally be
classified into two groups.
• Slow-twitch/ type I fibers (“Red”)
• have more mitochondria
• store oxygen in myoglobin
• rely on aerobic metabolism
• produce ATP more slowly
• Marathon runners tend to have
more type I fibers, generally
through a combination of
genetics and training.
• Fast-twitch, / type II fiber(“White”)
• have fewer mitochondria
• capable of more powerful (but
shorter) contractions
• metabolize ATP more quickly
• Weightlifters and sprinters tend to
have more type II fibers.
• Type II fibers are distinguished by
their primary sub-types
• IIa, IIx, and IIb.
 Histology
• Skeletal muscle is designed as a bundle
within a bundle arrangement
• Individual muscle fibers are surrounded by
endomysium.
• Muscle fibers are bound together by
perimysium into bundles called fascicles
• the bundles are then grouped together to
form muscle, which is enclosed in a sheath
of epimysium.
• At the ends of the muscle, all of the
connective tissue sheaths (epimysium,
perimysium, and endomysium) converge to
form a tendon which will connect the
muscle to its attachment site.
The Muscle Fiber
• (Muscle Cells) Skeletal muscle cells are elongated or tubular.
• The nuclei are located in the peripheral aspect of the cell, just under
the plasma membrane, which vacates the central part of the muscle
fiber
• Each muscle cell contains all the organelles
• The nucleus contains the genetic material of the muscle cell.
• Although these organelles are the same as in other cells they are
given special names.
• Sarcolemma plasma membrane
• cytosol cytoplasm
• sarcoplasmic reticulum endoplasmic reticulum

• Mitochondria are sites of energy production (ATP synthesis) in the

muscle cell as in all other cells of the body.
• The sarcomere is the functional or contractile unit of muscle
Physiology of Muscle Contraction
• Muscles contract when they receive a motor impulse from a motor
nerve.
• The muscle fibers served by a single motor neuron, make up a
structure known as a motor unit.
• Motor units allow for selective contraction of muscle fibers so that we
may control the strength and extent of muscle contraction.
• The unit between two consecutive
Z-lines is defined as the sarcomere
• it is the basic contractile unit of
the myofibril.
• The thick filaments of myosin
form the A band which is visible as
the striations.
• The thin filaments are
predominantly composed of actin
polymer
• The main theory of muscle contraction used today is based upon Huxley's sliding
filament theory.
• key principle : overlapping of the actin and myosin filaments
• This leads to the shortening or closing up of the sarcomere thus leading to a
muscular contraction.
• The thin actin filaments are surrounded by two substances, troponin and
tropomyosin.
• Troponin is a globular protein complex that at rest holds the tropomyosin in
place and blocks the myosin binding sites upon the actin filaments.
• Tropomyosin is more of a thin wire like strand which has troponin attached to it
at regular intervals
DEVELOPMENT

5th- 6th week -

Primitive cells Cell migrate to
areas of formation Cell differentiation
form and 7th week 10th week Muscle
of 4 major occurs before Nerve masses get
differentiate, Get Mandibular arch mass well
muscles of formation of facial incorporated
oriented to site of mass enlarges organized
mastication arch.
origin and
insertion
Prenatal
• increase in size and amount of fibrous tissue and by cell division.
• Striped muscle differentiation - 7th week of intrauterine life
• typical muscle fibers seen - 22nd week.
• Normal muscular activity begins - end of the 7th month
• Muscles of mastication at first develop in relation to Meckel's cartilage but are
independent of the insertions and are attached only to the forming mandible.
• Increase in bulk of a muscle activity.
• Disuse Atrophy
• infancy and childhood, gain in muscle tissue hypertrophy.
• 4th fetal month To birth muscular system increases by 50 fold.
• birth To middle of the 3rd decade of postnatal life increases 40 fold
• Postnatal
• Muscle growth is rapid in infancy and childhood,
• slower and regular in the middle of childhood
• and again more rapid preceding and during adolescence.
• The muscles of the head show the smallest relative increment of growth.
• The weight of the facial musculature increases 4-fold between birth and
age 20 years
• while that of the mandible alone increases almost 7-fold by age 20 years.
SKELETAL MUSCLES IN THE
CRANIOFACIAL REGION
Facial Muscles
• The primary function expression of emotions.
• Coleman contends that the average human is capable of 7000 possible facial
expressions
• these muscles are important in the maintenance of posture of facial
structures.
• The facial muscles also contribute to stabilization of the mandible during
infantile swallowing and in chewing and swallowing in the edentulous and
occlusally compromised adult.
• postural alternations in the facial muscles may contribute to structural
changes in the jaws.
• Form also dictates function: patients with short upper lips or excessively
proclined maxillary incisors compensate by the elevation of the lower lip
through the action of the mentalis muscle establish anterior seal
• Facial muscles also play an important role in both visual and spoken
communication.
• Lips and cheeks are essential for bolus control in mastication as well.
• According to Proffit, the lip and buccinator muscles opposed by the
tongue contribute to a postural equilibrium of the teeth.
• Frankel has speculated that the buccinator muscles exert a constraining
force on the maxillary alveolar process as well as the teeth.
Muscles of Mastication
1.MASTICATION :

• Rhythmic opposition and separation of jaws with the involvement of

teeth ,lips ,cheeks and tongue for chewing of food in order to prepare it
for swallowing and digestion.
• Main purpose of mastication is to reduce the size of food particles to a
size that is convenient for swallowing (bolus formation) with the help of
saliva
 • The muscles which are required for mastication are known as the
muscles of mastication
• Four pairs of the muscles in the mandible make chewing movement
possible.
• These muscles along with accessory ones together are termed as
“MUSCLES OF MASTICATION”
 MUSCLES OF
MASTICATION

1.MASSETER ACCESSORY
2.TEMPORALIS MUSCLES
3.LATERAL 1.DIGASTRIC
PTERYGOID 2.MYLOHYOID
4.MEDIAL 3.GENIOHYOID
PTERYGOID 4.STYLOHYOID
Temporalis Muscle
• fan-shaped muscle that covers
the temporal region.
• powerful masticatory muscle
that can easily be seen and felt
during closure of the mandible.
• It extends like a fan from most
of the temporal fossa , and from
the deep surface of the temporal
fascia.
• Origin: floor of temporal fossa
and deep surface of temporal
fascia.
• Insertion: tip and medial surface
of coronoid process and anterior
border of ramus of mandible.
• Fibres: The anterior fibers run
vertically
• middle obliquely
• posterior fibers are almost
horizontal.
• Action: Anterior Fibers -
Elevates the mandible , closes
the jaws
• Posterior Horizontal Fibers -
Retracts the mandible
• Vascular Supply:Supplied by
deep temporal branches from
second part of maxillary artery
• Nerve Supply : deep temporal
branches of mandibular nerve
(CN V3)
Masseter Muscle
• This is a quadrangular muscle
that covers the lateral aspect of
the ramus and the coronoid
process of the mandible.
• consisting of two parts,
superficial and deep.
• Buccal pad of fat separates the
muscle from buccinator.
• Origin:
• SUPERFICIAL LAYER Anterior
2/3rd of lower border of
zygomatic arch and adjoining
zygomatic process of maxilla
• DEEP LAYER:From deep surface
of zygomtic arch
• Insertion:
• SUPERFICIAL LAYER lower part of
lateral surface of ramus of
mandible
• DEEP LAYER into rest of the
ramus of mandible
• Innervation: mandibular nerve
via masseteric nerve that enters
its deep surface.
• Vascular Supply :masseteric
artery
• Action: It elevates and protrudes
the mandible
• closes the jaws and the deep
fibres retrude
Lateral Pterygoid Muscle
• This is a short, thick muscle that
has two heads or origin.
• It is a conical muscle with its
apex pointing posteriorly.
• two parts or head
• Its fibers pass backwards and
laterally
• Origin:
• superior head—infratemporal
surface and infratemporal crest
of the greater wing of the
sphenoid bone
• inferior head—lateral surface of
lateral pterygoid plate.
• Insertion: neck of mandible,
articular disc, and capsule of
temporomandibular joint.
• Innervation: mandibular nerve
via lateral pterygoid nerve from
anterior trunk, which enters it
deep surface.

• Vascular Supply :Pterygoid

branches from the maxillary
artery.
• Action: acting together, these
muscles protrude the mandible
and depress the chin.
• Acting alone and alternately,
they produce side-to side
movements of the mandible.
Medial Pterygoid Muscle
• This is a thick, quadrilateral
muscle -has two heads or origin.
• embraces the inferior head of
the lateral pterygoid muscle.
• located deep to the ramus of the
mandible.
• Origin:
• superficial head—tuberosity of
maxilla.
• deep head—medial surface of
lateral pterygoid plate and
pyramidal process of palatine
bone
• Insertion: medial surface of
ramus of mandible, inferior to
mandibular foramen
• Innervation: mandibular nerve
via medial pterygoid nerve. It
helps to elevate the mandible
and closes the jaws

• Vascular Supply :Pterygoid

branches from the maxillary
artery.
• Action: acting together, they
help to protrude the mandible.
• Acting alone, it protrudes the
side of the jaw.
• Acting alternately, they produce
a grinding motion.
Movements of mandible and muscle producing them

ELEVATORS DEPRESSORS PROTRUSION RETRACTION

MEDIAL
1.LATERAL PTERYGOID
1.MASSETER LATERAL POSTERIOR
PTERYGOID
2.TEMPORALIS 2.DIGASTRIC PTREYGOID FIBERS OF
3.MEDIAL PTERYGOID 3.MYLOHYOID TEMPORALIS
SUPERFICIAL
4..GENIOHYOID FIBERS OF
MASSETER
• the 4 primary muscles of mastication are in turn supported by few
secondary muscles -SUPRAHYOID GROUP of muscles

• DIGASTRIC
• MYLOHYOID
• GENIOHYOID
• STYLOHYOID
DIAGASTRIC MUSCLE
• Two bellies united by tendon
• The muscle has secondary role in
mastication as a depressor
muscle ,adding to the action of
lateral pterygoid muscle when
mouth is to be opened against
resistance.
MYLOHYOID MUSLE
• Flat triangular
• The secondary role of this
muscle is evident as a depressor
seen in action when mouth is to be
opened against resistance.
• It elevates the floor of mouth to
help in deglutition.
GENIOHYOID
• Short and narrow musle lies
above mylohyoid
• When the hyoid bone is fixed, it
depresses the mandible
STYLOHYOID

• Small muscle,lies on upper

border of digastric
• Pulls hyoid bone upwards and
backwards
• With other hyoid muscels,it fixes
the hyoid bone
MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION

DIGASTRIC ANTERIOR BELLY: from the Into common tendon Mylohyoid nerve Elevates hyoid
digastric fossa near the lower
border of mandible near
symphysis menti
POSTERIOR BELLY: from the Common tendon Branch from facial Depress mandible
mastoid notch of the which is bound to nerve
temporal bone hyoid by a sling

MYLOHYOID From the mylohyoid line on Posterior fibers Mylohyoid nerve Elevates hyoid
the inner surface of inserted to front of the Elevates tongue
mandible body of the hyoid
bone

GENIOHYOID From the anterior end to the Upper half of the body Branches of C1,C2 Pulse the hyoid upward and
mylohyoid line on the inner of the hyoid bone through hypoglossal forward and exerts a
surface of mandible and nerve downward and backward pull
from inferior genial tubercles on the mandible

STYLOHYOID From the lateral and inferior Greater horn of the Branch from facial Elevation and retraction of
surface of the stylohyoid hyoid bone nerve hyoid bone
process
Muscle changes during growth
• Continued adjustments in muscle attachments occur during skeletal
growth.
• Muscles can be divided into two groups with respect to their
attachments.
• Periosteal: Muscles attached to the fibrous layer of the periosteum.
• Tendinous: Muscles attached by means of tendon which cannot be
removed from the bones without some destruction of the surface of
the bone
Periosteal
• Muscle can shift its attachments by
growth changes of the periosteum.
• Different rates of lengthening at
different regions allow the
periosteum to shift relative to the
bone
• carries the muscle attachments
with it
• maintaining the constant spatial
relationship of the muscles.
Tendinous
• This type of muscle attachments -
mechanism exists to break down
or alter the attachment
• so that the muscles may shift.
• the change is made by bone
resorption and apposition- carrying
the tendinous attachments with it.
• Eg; The insertion of the suprahyoid
and external pterygoid muscles
into the mandible
• bone resorption found in relation to the tendinous attachment of a
muscle resorption frees the muscle from the bone.
• Muscles become temporarily periosteal in attachment and can shift
relative to bone growth, maintaining their normal position.
• This is particularly true of muscles attached at the growing ends of the
mandible.
• When bone resorption ceases, the muscles become reattached
directly to the bone by tendinous fibers.
 The attachment of
internal pterygoid
The tendinous shifts during the
Growth at the insertion of the growth of the
anterior end of temporal muscle is mandible and
each half of the gradually fixed expands as the
mandible until the from the bone of ramus increases in
symphyseal suture the anterior size by bone
is obliterated in border of the deposition along
the latter part of ramus of the its posterior
the first year mandible border.

tends to separate which is resorbed

the anterior belly to make room for
of the digastric and eruption of
the geniohyoid permanent molar
muscles. and the
development of
the alveolar
process around
these teeth.
FORM AND FUNCTION

• Skeletal growth is influenced by muscular growth-the parts of bones

to which muscles attach develop in conjunction with the muscle

• functional matrix theory of Melvin Moss explained the mechanism by

which the soft tissue envelope could direct/divert the skeletal growth.
• Sassouni (1969) outlined the concept that the vertical alignment (and
subsequent force) of jaw-closing muscles direct skeletal growth
toward a shallow mandibular plane angle, an acute gonial angle, and
deep bite, whereas obliquely aligned jaw-closing muscles (with
subsequent diminished force) permit a steep mandibular plane, an
obtuse gonial angle, and open bite.

• He classified the skeletal facial types into short face syndrome and
long face syndrome.
Short Face Syndrome
• clinically recognizable facial type
with reduced lower facial height as
the common denominator.
• reduced eruption of posterior
teeth
• increased posterior facial height,
• flat mandibular plane angle.
• Two subgroups were distinguished
in the short face syndrome group.
Factors leading to increased horizontal
growth of the facial skeleton
Long Face Syndrome
• excessive eruption of posterior
teeth
• normal or excessive eruption of
anterior teeth
• short posterior facial height
• and a steep mandibular plane
angle.
• The primary cause of long face
syndrome is an unfavorable
growth pattern
• Sassouni and Prahl-Anderson et al, showed that a retruded mandible
combined with characteristics of long face syndrome results in poor
facial esthetics.
• McNamara showed that more than 60 percent of patients with class
II malocclusions exhibit one or more symptoms of long face
syndrome.
Factors leading to increased vertical growth
of facial skeleton
Muscles function and bone development
➤ Muscle function begins in prenatal life itself.
➤ Muscle function influences the internal arrangement of bones and
also induces the changes on the surface of the bones.
➤ Osteogenesis proceeds in the opposite direction to muscular
stresses.
➤ Between 6 and 10 years of age, there is a steady rate of muscle
development.
Development of muscles is rapid during the replacement of deciduous
teeth by permanent teeth.
➤ Child acquires coordinated activity of the voluntary muscles gradually.
The balance of voluntary muscles is easily upset by habits. Muscles of facial
expression, mimetic and vocal muscles are easily influenced by habits.
➤ There are two types of muscle contraction:
(i) isotonic – contraction seen with shortening of muscle
(ii) isometric contraction – no change in size of muscles.
➤ The degree of muscle function determines the quantity, quality,
structure and form of the face.
➤ Masseter and temporalis muscles show strong developmental
increase in size.
➤ Because of the muscle functions, maxillary tuberosities become well
developed, mandible shows everted border, and bigonial width
increases.
FACTORS CONTROLLING FACIAL
GROWTH
• Masticatory Muscle Thickness
• Bite Force
• Spatial Orientation of Muscles
• Muscle Activity
• Muscle Fiber Type
• Buccinator Mechanism
Role of Masticatory Muscle Thickness
• masticatory muscle thickness increases with age.
• Males have thicker masticatory muscles when compared to females.
• The thicker the muscles, the more tension generated by them.
• Thicker masseter muscle is found to significantly correlate with
reduced gonial and mandibular plane angles and increased ramus
height implying its role in the more horizontal development of face.
• The thicker masseter also leads to a broader maxillary arch and a
broader face in general.
Role of Bite Force
• higher bite force short lower anterior facial heigh
• Masseter muscle is the most important contributor to the bite force.
High bite forces are related to decrease in anterior facial height,
gonial angle and mandibular plane angle
• Bite force magnitude is related to jaw muscle thickness, fiber type
composition, sarcomere length, jaw muscle activation level, direction
of bite, age, sex and occlusal contact measures
• humans typically use a bite fork which has a force transducer which is
placed between the teeth and used to record the bite force
Role of Spatial Orientation of Muscles
• The dento-skeletal morphology is related to masticatory muscle orientation in
children
• Short face types have more vertically placed masticatory muscles whereas long face
types have more horizontally placed muscles.
• Therefore, there is a variation in the direction of bite force between long face and
normal adults.
• the variation of spatial orientation of the human jaw closing muscles is
predominantly associated with variation of mandibular morphology (expressed by
the gonial angle) and the posterior face height.
• research showed that the variation of the spatial orientation of the jaw muscles is
small and does not significantly contribute to the explanation of the different molar
bite-force levels of long face and normal subjects
Role of Muscle Activity
• decreased activity in all jaw muscles in long-faced persons.
• Masseter and digastric activities are shown to have significant negative
correlation with vertical craniofacial morphology.
• Mouth breathing is found to be associated with reduced EMG activity of
masseter and could be responsible for the long face seen in such patients.
• High correlation between bite force and EMG activity of masseter is also
observed.
• Short face types have high bite force levels and increase the EMG activity of
masseter.
• Decreased jaw muscle activity has been demonstrated in long face subjects.
( Animal studies have supported EMG studies).
Role of Muscle Fiber Type
• type I fibers with slow shortening velocities less force per unit area
(than type II fibers with rapid shortening velocities.)
• Hence, muscles with a high percentage of type I fibers are less powerful
than muscles with predominantly type II fibers
• The thick skeletal muscles can generate more muscular tension leading to
a more horizontal rotation of mandible in turn leading to short face
• The muscles in the facial region contract most while chewing food.
• The consistency of the food also regulates the facial growth changes in a
child as more force is required to chew raw food than refined food.
• The increased effort also causes the muscle hypertrophy.
Buccinator Mechanism
• Muscles are a potential force whether they are at rest or in active
function.
• Teeth and supporting structure of the jaw are under the control of
the adjacent muscles.
• The balance between the muscles is responsible for the integrity of
the dental arches and the relation of teeth to the arches.
• Buccinator mechanism refers to a phenomenon in which a
continuous band of muscles that encircle the dentition and is firmly
anchored at the pharyngeal tubercle of the occipital bone.
Buccinator mechanism starts with the decussating
fibers of the orbicularis oris

joining the right and left fibers of the lip which

constitute the anterior component of the
buccinator mechanism.

It then runs laterally and posteriorly around the

corner of the mouth, joining other fibers of the
buccinator muscle which gets inserted into the
pterygomandibular raphe

Here, it mingles with the fibers of superior

constrictor muscle and runs posteriorly and
medially to get fixed to the pharyngeal tubercle.
• All of these muscles, numbering thirteen with elasticity and contractility
acts like a rubber band tightly encircling the bone system, the mandible.
• The tongue acts opposite to the buccinator mechanism exerting an
outward force.
• The clinical significance of buccinator mechanism is that any imbalance
in buccinator mechanism leads to malocclusion.
• In pernicious oral habits like thumb sucking and tongue thrusting, the
equilibrium between buccinator mechanism and tongue is lost.
• This causes various changes in dentition like constricted maxillary arch,
increased proclination and open bite
Equilibrium theory
• Definition: When an object is subjected to unequal forces, it will be
accelerated and move to a different position in space. For an object to
be in the same position, the forces acting on it should be in equilibrium

• There are four force contributors to dentition:

• 1. Masticatory force
• 2. Soft tissue pressure
• 3. External pressure Habits ,Orthodontics
• 4. Internal pressure Periodontal fibres ,Gingival fibres
• Masticatory forces rarely move
the teeth to new position.
➤ Reason: the duration of force
which is responsible for moving
the teeth.The duration threshold
for tooth movement to occur is
about 6 h.
➤ Masticatory forces, even
though heavy, are transient.
Hence, they do not cause any
change in dentition in normal
condition
• Soft tissue pressures
• ➤ Pressures from lips, cheek and
tongue are of lesser magnitude,
but their duration is more.
• ➤ Since the light pressures from
lips, cheek and tongue are
maintained for a longer
duration, tooth position is
affected by these pressures.
• ➤ resting posture has the
longest duration. Hence posture
of the tongue is an important
contributor of malocclusion.
• External pressures ➤ Prolonged
habits and continuous
orthodontic force are the source
for external pressure.
• ➤ Both can alter the position of
teeth.
• Internal pressures T
• ➤ Gingival trans-septal fibres
cause the lost space to be closed.
• The same trans-septal fibres cause
opening of the space after active
orthodontic treatment because the
fibres pull the tooth to its original
posture.
• Trans-septal fibres have no role in
dental equilibrium. Their role is only
with orthodontic treatment.
• ➤ Periodontal fibres – take part in
active stabilization of tooth.
• Forces act in three dimension–
anteroposterior, vertical and transverse.
• Equilibrium effects on jaw size and shape
• The effect of force equilibrium on the jaw size is not clear. But the
same principles apply.
• It is the duration which plays a vital role rather than the magnitude.
• Intermittent forces have minimal effect on the dentition and jaw.
• Light continuous or long-lasting force has an impact on the position
of dentition and size of jaws.
Muscle Function in Normal Occlusion
• Muscle function is usually normal in cases
of class I malocclusion.
• The teeth are in a state of balance with
environmental forces
• While the actual measurements of tongue
and lip forces show that they are not equal
in any one area during a particular
function, as if we consider morphogenetic
pattern, tooth size, available basal bone,
and character of contiguous tissue,
postural forces, and the various functional
forces.
Muscle function and malocclusion
➤ Muscle function is an important factor in shaping the dental arches and stability
of the teeth subsequent to orthodontic treatment.
➤ Abnormal muscle posture or function can cause malocclusion.
➤ Muscle tone is a continuous state of contraction of the muscle. It is this
property of muscle which permits the teeth and jaw relationship to maintain
changes brought about by orthodontic treatment.
➤ Muscles can adapt to new functional patterns and growth changes.
➤ During retention period, muscles adapt to the new functional pattern brought
by orthodontic treatment.
➤ Insufficient retention causes inability to achieve muscle balance and then
relapse.
• The effect of muscle forces is three-dimensional
• Whenever there is a struggle between muscle and bone, bone yields.
• Muscle function can be adaptive to morphogenetic pattern.
• A change in muscle function can initiate morphologic variation in the normal configuration
of the teeth and supporting bone, or it can enhance an already existing malocclusion.
• In the latter instance, the inherent structural malrelationship calls for compensatory or
adaptive muscle activity to perform the daily functions.
• The structural abnormality is increased by compensatory muscle activity to the extent that a
balance is reached between pattern, environment, and physiology.
• At times it is impossible to assign a specific cause-and effect role to any one factor.
• It is imperative that the orthodontist appraise muscle activity and that he conduct his
orthodontic therapy in such a manner that the finished result reflects a balance between the
structural changes obtained and the functional forces acting on the teeth and investing
tissues at that time.

• Graber TM. The “three M's”: Muscles, malformation, and malocclusion. American Journal of Orthodontics. 1963 Jun 1;49(6):418-50.
REFLEX CONTROL OF JAW MUSCLES
• Reflex is defined as an automatic and often inborn response to a
stimulus that involves a nerve impulse passing inward from a receptor
to a nerve center and hence outward to an effector without reaching
the level of consciousness.
• Reflexes generally involve feedback of a signal, to maintain some
condition in the body relatively constant
• A reflex arc is a chain of neural connections between the receptor and
the effector.
• Its components are: sensory neuron, interneuron(s)—may have more
than one or none, and motor neuron
Classification
• two types the monosynaptic
multisynaptic or polysynaptic reflex.

Neural reflexes may be roughly categorized as

(1) Postural
(2) Protective
(3) Cardiovascular
(4) Respiratory
(5) Digestive
(6) Specialized
(7) Humoral
• Myotatic Reflex It is the tonic
contraction of the muscles in
response to a stretching force,
due to stimulation of muscle
proprioceptors.

• It is also called as Liddell-

Sherrington reflex, muscular
reflex, and stretch reflex.
• Clasp Knife Reflex This reflex is
produced by stretching an
extensor muscle against a
background of increased extensor
muscle tone.
• The result is a relaxation of the
muscle being stretched, i.e. the
muscle now lengthens easily after
initial resistance.
• also called as autogenic inhibition
or inverse myotatic reflex
• Jaw Closing Reflex
• the most basic reflex in the
facial and oropharyngeal area.
• referred to as jaw jerk reflex.
• Jaw Opening Reflex
• first reflex movement to make its
appearance in the orofacial
region of human beings at about
8.5 weeks of intrauterine life.
• known as the linguomandibular
reflex
Masticatory Muscles Disorders
• Myofacial Pain
• Myositis
• Myospasm
• Myalgia
• Myofibrotic Contracture
• Neoplasia
• Centrally mediated chronic muscle pain

(Data from de Leeuw R. Orofacial pain: guidelines for assessment, classification, and management. The American
Academy of Orofacial Pain. 4th edition. Chicago: Quintessence Publishing Co, Inc; 2008)
Myofascial pain
Etiology
Chronic regional muscle pain
Diagnostic criteria
Regional dull, aching pain at rest
Pain aggravated by function of affected
muscles
Provocation of trigger points, alters pain
complaint and reveals referral pattern
>50% reduction of pain with
vapocoolant spray or local anesthetic
injection to trigger point followed by
stretch
Myositis 
It is a true inflammation of the
muscle usually due to direct
trauma/or infection.
Diagnostic criteria
Continuous pain localized in muscle
area following injury or infection
Diffuse tenderness over entire
muscle Pain aggravated by function
of affected muscles
Moderate to severe decreased range
of motion due to pain and swelling
Myospasm

Acute involuntary and continuous muscle

contraction
Diagnostic criteria
Acute onset of pain at rest and during function
markedly decreased range of motion due to
continuous involuntary muscle contraction.
Pain aggravated by function of affected
muscles
Increased electromyographic activity higher at
rest
Sensation of muscle tightness, cramping, or
stiffness
Myalgia (local)
Etiology
Acute muscle pain
Protective muscle splinting
Post exercise soreness
Muscle fatigue
Pain from ischemia
Diagnostic criteria
Regional dull, aching pain during
function No or minimal pain at rest
Local muscle tenderness on palpation
Absence of trigger points
Myofibrotic contracture
Etiology
Painless shortening of muscles
Diagnostic criteria
Limited range of motion
Firmness on passive stretch
(hard stop) Little or no pain
unless involved muscle is forced
to lengthen
Neoplasia
Etiology
Benign or malignant
Diagnostic criteria
May or may not be painful
Anatomic and structural changes Imaging and biopsy needed
Acute involuntary and continuous muscle contraction
Acute onset of pain at rest and during function
Centrally mediated chronic muscle pain

Etiology
Chronic generalized muscle pain
Diagnostic criteria
History of prolonged and
continuous muscle pain
Regional dull, aching pain at rest
Pain aggravated by function of
affected muscles
Pain aggravated by palpation
• Trigger points: “trigger points are clinically identified as specified
hypersensitive areas within the muscle tissue’’
• A small,firm,tight band of muscle tissue can be felt

• Referred pain: “active trigger points represent a source of deep pain

and can therefore produce referred pain’’
Treatment modalities
Myofunctional appliance-principle
Lishers theory

“if compensatory adaptive lip and tongue function could exacerbate

excessive overjet in class II type malocclusion and if abnormal
swallowing and prolonged finger sucking habit could create anterior
open bite and narrow maxillary arches, couldnot the same muscles be
used to correct these problems’’
The sagittal changes observed using
myofunctional appliance is
because
• The appliance increase the
activity of protractor and
elevator muscles with
concomitant relaxation and
stretching of the retractors.
• Elimination of abnormal perioral
muscle function by mandibular
protracti
• This change in muscle pattern
thus produce new pattern and
also change in bony structures as
the muscle adapt to new
functional stress.
• The obvious benefit of a
protracted unloaded condyle is
enhancement of condylar growth
increments and more favourable
upward and backward condylar
growth direction
Significance in relation to orthodontics

• The formation of bone at the point of muscle attachments depends on

the activity of muscle
• The musculature is an important part of the total soft tissue Matrix
whose growth normally caries the jaws downwards and Forwards
•If Loss of part of musculature occur in utero due to any birth Injury it
results in underdevelopment of that part of face
•In cerebral palsy – decreased muscle tonicity which leads to increase in
ant. Facial height ,distortion of facial proportion and mandibular
height ,excessive eruption of post teeth and ant open bite.
Clinical significance
• Pterygoid Response

• Within a few days of the fitting of twin block appliances, the position
of muscle balance is altered so greatly that the patient experiences pain
when retracting the mandible

• Due to the formation of a “tension zone” distal to the condyle

REFERENCES
• B.D.CHAURASIA’S- HUMAN ANATOMY
• TEXTBOOK OF CRANIOFACIAL GROWTH-SRIDHAR
PREMKUMAR
• ORTHODONTICS-PREP MANUAL-SRIDHAR PREMKUMAR