CONTENTS

-Introduction
-Muscle anatomy
-Muscles of mastication
-Accessory muscles of mastication
-Muscle physiology
-Regulation of muscle activity
-Applied aspects
-References
You cannot successfully treat dysfunction
unless you understand function
 The functions of masticatory system is complex.
Discriminatory contraction of various head and neck muscle
is necessary to move the mandible precisely and allow effective
functioning. A highly refined neurologic control system regulates
and co-ordinates the activities of entire masticatory system. It con-
sists primarily of nerves and muscles; hence the term Neuromuscu-
lar system.
A basic understanding of anatomy and functions of neuro-
muscular system is essential to understand the influence that tooth
contact and other conditions have on mandibular movement.
Muscle Anatomy
MUSCLES OF MASTICATION
# masseter
# temporalis
# medial pterygoid
# lateral pterygoid
ACCESSARY MUSCLES OF MASTICATION
# buccinator
# mylohyoid
# orbicularis oris
# genioglossus
# modiolus
 THE MASSETER

• This is a quadrilateral muscle which covers the lateral

surface of the ramus of the mandible. Its fibres are
arranged in three layers.
• Origin
• Superficial layer from anterior 2/3 of the lower border
of the zygomatic arch and from the zygomatic
process of the maxilla.
• Middle layer : from the anterior 2/3 of the deep sur-
face and posterior 1/3 of the lower border of zygo-
matic arch.
• Deep layer: from the deep surface of zygomatic arch.
Insertion
• The superficial fibres pass downwards and
backwards at the angle of 45 degree. They are
inserted into the lower part of the lateral surface
of the ramus of mandible.
• The middle and the deep fibres, pass vertically
downwards. The middle fibres are inserted into
the middle part of the ramus, the deep fibres into
the upper part of the ramus and into coronoid
process.
Nerve Supply
• Masseteric nerve, a branch of anterior di-
vision of mandibular nerve.
Action
• Muscle elevates the mandible to close the
mouth and clench the teeth.
Masseter
 TEMPORALIS
• This muscle fills the temporal fossa.

• Origin
• Temporal fossa excluding the zygomatic bone
• Temporal fascia

• Insertion
• The fibres of the muscle pass through the gap deep to
the zygomatic arch. They are inserted into
• The margin and deep surface of the coronoid process.
• The anterior border of the ramus of mandible.
• Nerve Supply
• Deep temporal branch from anterior divi-
sion of mandibular nerve.
• Action
• Elevates the mandible.
• Posterior fibres retract the protruded
mandible
Temporalis
MEDIAL PTERYGOID MUSCLE
• This is quadrilateral muscle having small super-
ficial head and large deep head which forms ma-
jor part of the muscle.

• Origin
• Superficial head: from tuberosity of the maxilla
and adjoining bone.
• Deep head from medial surface of lateral ptery-
goid plate and adjoining part of palatine bone.
Insertion

The fibres run downwards, back-

wards and laterally to be inserted into the
roughened area on medial surface of angle and
adjoining part of the ramus of the mandible, be-
low and behind mandibular foramen and mylo-
hyoid groove.
• Nerve supply
Nerve to medial pterygoid which is a branch of main
trunk of mandibular nerve
• Actions
- elevates the mandible
- helps to protrude the mandible
- the lateral and medial pterygoid muscle of both side
act together to protrude the mandible.
- the medial and lateral pterygoid on both side contract
alternately to produce side to side movement of
mandible (chewing).
 THE LATERAL PTERYGOID
• This muscle has upper and lower heads.
• Origin
• Both heads arise from sphenoid bone.
• The upper head is small. It arises from infratemporal sur-
face and crest of greater wing of sphenoid bone.
• The lower head is large. It arises from lateral pterygoid
plate.
• Insertion
• The fibres run backwards and laterally and insert into
• Pterygoid fovea on the anterior surface of the neck of the
mandible
• Anterior margin of articular disc and capsule of the tem-
poromandibular joint.
 Nerve Supply
• A branch from the anterior division of
mandibular nerve.
Actions
• Depress the mandible to open the mouth
• The lateral and medial pterygoid muscle of both
side act together to protrude the mandible.
• The medial and lateral pterygoid on both side
contract alternately to produce side to side
movement of mandible (chewing).
ACCESSORY MUSCLES OF
MASTICATION
 BUCCINATOR
Origin:-
• upper fibers from maxilla opposite to molar teeth
• lower fibers from mandible opposite to molar teeth
• middle fibers from pterygomandibular raphe: three
sets of fibers.
 Insertion:--
• Upper fibers, straight to the upper lip.
• Lower fibers, straight to the lower lip.
• Middle fibers :--- middle fibers of the middle group end at the angle of
the mouth.
# The upper middle fibers cross over to continue on
into the lower lip.
# The lower middle fibers cross beneath
the former into the upper lip.
ROLE:-

• The middle fibers of the buccinator mus-

cle tense anteroposteriorly during mastication
to move a bolus of food inward between the
opposing posterior teeth and then to press
against their buccal surfaces to hold it there
as the jaws close in mastication.
 MYLOHYOID MUSCLE
• Flat triangular muscle lying deep to the anterior belly of
the digastric.
• Right and Left fibers together form floor of the mouth.
ORIGIN:-
• Muscle fibers originate along the active length
of the mylohyoid line from the symphysis to the last mo-
lar region.
INSERTION:-
• The middle and anterior fibers are inserted
into a median raphae with those of the opposite mylohy-
oid muscle. Posterior fibers attach to the front part of the
hyoid bone.
ACTION:- Elevates floor of the mouth during degluti-
tion.
 Orbicularis Oris
• The orbicularis oris to a great extent forms the lips. In
function, as in chewing, smiling, and swallowing, it ex-
ert forces against the teeth which is counteracted by
the tongue.

• The marginal portion of the orbicularis oris muscle ad-

jacent to the oral fissure acts less forcefully against
the labial surface of the anterior teeth than does its
peripheral portion.
MODIOLUS
• The combined actions of these muscles of facial
expression should be kept clearly in mind. The
convergence of all of them into the modiolus
makes it a muscular knot of considerable strength
with a wide versatility of movement up, down, for-
ward and back.
 Hyoid Muscles
• Suprahyoid muscles •Infrahyoid muscles
–Sternothyroid m.
– Digastric m. –Sternohyoid m.
– Mylohyoid m. –Omohyoid m.
– Geniohyoid m. –Thyrohyoid m.
– Stylohyoid m. •Depress hyoid bone
• Assist muscles of
mastication
Suprahyoid
Muscles

mylohyoid
digastric

hyoid bone
 Suprahyoid Musclse

Mylohyoid m. Geniohyoid m.

Inner surface of
mandible
Genial tubercles
Muscles of neck & throat

Stylohyoid muscle

Hyoid bone
Superior belly of
omohyoid m.
Infrahyoid
Muscles

Hyoid bone
Sternohyoid m.

Thyrohyoid m.
Thyroid cartilage

SCM
Sternothyroid m.
 Intrinsic Muscles of the Tongue
• 4 Sets
– Superior longitudinal
– Transverse
– Vertical
– Inferior longitudinal
 Extrinsic Muscles of Tongue

Styloid process

Styloglossus

Genioglossus

Hyoglossus

Hyoid bone
Muscle Physiology
 General and Molecular Mechanism
of Muscle Contraction
• The initiation and execution of muscle con-
traction occurs in the following sequential
steps:
– The decision to contract a muscle is executed by
the CNS in the form of an impulse through an al-
pha motor neuron to the specific muscle.
– An action potential travels along a motor nerve to
its endings on muscle fibers.
Action potential
from the motor
neuron

Reaches the NM Jn

The action potential

is transferred to the
muscle membrane
The action potential depolarizes
the muscle fiber membrane
(sarcolemma) and rapidly
travels deeply within the muscle
fiber.

When the action potential

reaches the cisternae of
the sarcoplasmic reticulum,
the cisternae are
excited.
 Now, the calcium ions
stored in the cisternae
are released into the sar-
coplasm.

The calcium ions from the

sarcoplasm move towards
the actin filaments to pro-
duce the contraction
 Now, the calcium
ions stored in the
cisternae are re-
leased into the
sarcoplasm.

A large number of cal-

cium ions bind with the
troponin C of the actin
filament.

The loading of troponin

C with calcium ions ex-
erts a pull on the
tropomyosin molecule
away from the F actin.
Due to this movement of
tropomyosin, the active
site of F actin becomes
uncovered and immedi-
ately the head of myosin
gets attached to it.
In this way all the actin
filaments of both the
ends of the sarcomere
are pulled, so the actin
filaments of the opposite
side overlap and form ac-
tomyosin complex caus-
ing contraction.
 Regulation of Muscle Activity
• To create a precise mandibular movement, the
CNS must receive input from the various sen-
sory receptors through the afferent fibers. The
brainstem and cortex must assimilate and orga-
nize this input and elicit appropriate motor activi-
ties through the efferent nerve fibers. These mo-
tor activities involve the contraction of some
muscle groups and the inhibition of others. It is
generally thought that the gamma efferent sys-
tem is permanently activated, though it does
 not necessarily set up movement. The gamma
discharge keeps the alpha motor neurons re-
flexly prepared to receive impulses arising from
the cortex or directly from the afferent impulses
of the spindles. Most mandibular movements are
probably controlled by a link between the spindle
afferents, gamma efferents, and the alpha motor
neurons. This combined output produces the re-
quired contraction or inhibition of the muscles
and allows the neuromuscular system to keep a
check on itself.
• Various conditions of the masticatory sys-
tem greatly influence mandibular move-
ment and function. The sensory receptors
in the periodontal ligaments, periosteum,
TMJs, tongue, and other soft tissues of the
mouth continuously feed back information,
which is processed and used to direct
muscle activity. Noxious stimuli are reflexly
avoided, so that movement and function
can occur with minimal injury to the tissues
and structures of the masticatory system
Neuromuscular regulation of mandibular motion

Muscles that move, hold or stabilize the mandible can

do so because they receive impulses from central ner-
vous system.
Impulses that regulate mandibular motion may arise
at consicious level and results in voluntary mandibu-
lar activities. Impulses may also arise from subcon-
cious level as a result of stimulation of oral or muscle
receptors. Subconscious impulse produce involuntary
movement.
• Cell body of motor nerve may influence inhibition
or excitation. When closing movement occurs
then neurons to the closing muscles are excited
and those to that of opening muscles (Antago-
nist muscles) are inhibited.

• Impulses from subconscious level also regulates

the muscle tone which plays the primary role in
physiologic rest position of mandible.
Some receptors in muscle membrane of oral cavity
stimulated by touch, pain, pressure are nociceptors.
And other receptors present in periodontal liga-
ment, mandibular muscles and stylomandibular lig-
ament which provides informations as to the loca-
tion of mandible in space are called as propriocep-
tors.
Nociceptors travels to sensory nucleus and
proprioceptors to mesencephalic nucleus.
Impulses are transmitted in following ways :-

• l) From sensory cortex & motor cortex conscious level

to produce voluntary change in position of mandible.
• 2)By the way of reflex arch to motor nuclei of trigeminal
nerve and directly back to mandibular muscles to cause
involuntary movement of mandible.
• 3)By combination of these to under the influence of sub-
cortical areas, involuntary movement of mandible takes
place.
Neuromuscular regulation in parafunctional activities

Parafunctional habit involving repeated or sustained oc-

clusion of teeth which can be harmful to teeth and other com-
ponent of masticatory system.
The neuromuscular basis and mechanism of bruxism
have been studied and is explained by increase in tonic activity
in jaw muscles. Emotion or neuron tension, pain or discomfort,
stress, occlusal interferences are the factors that increase muscle
tone and lead to nonfunctional gnashing and clenching.
APPLIED ASPECTS
 EXAMINATION OF MASTICA-
TORY MUSCLES
• To perform the muscle and joint palpation, the pa-
tient is first instructed that muscles are going to be
pressed in order to better understand the pain problem.
The procedure may be uncomfortable at times and the
questions about discriminating pressure from pain and
pain intensity of palpation will be asked.
• In epidemiological studies, 0.9 kg for extra oral
muscles and 0.45 kg for intra oral muscles and TMJ.
Time for which pressure is to be held is unknown, but
3-5 secs appears to be reasonable.
 Points to Consider
• Muscles are palpated with the patient sitting upright.
• Operator faces the patient, with weight evenly balanced on both feet
and fore arm parallel to the floor.
• Patient and operator both are to be relaxed.
• Patient is told to respond to any pain or discomfort on either or one
side when unilateral pressure is applied.
• Physiological and psychological factors affect the report of pain on
palpation. They include activation or sensitization of local peripheral
nociceptors, sensitization of second order neurous, and altered pro-
cessing at the ophthalmic level and above, which can include per-
ceptual or neurological mechanisms. Thus evaluation of reported
tenderness needs to include consideration of other factors such as
age, sex, gender,pain duration and disease state.
 Evaluation Of Temporalis

• It is a fan shaped muscle and the posterior fibres

above the ear, anterior fibres in the depression lateral to
the eyebrows and the temporal tendon at the superior
and anterior aspect of the coronoid process, are pal-
pated.
• Thumb is placed anteriorly just behind and above
the eye, the second finger on the middle belly and the
third finger on the posterior belly.
• Patient is asked to clench firmly, it can also be
palpated intraorally into its insertion in the coronoid
process.
 Evaluation Of Masseter
• Ask the patient to do powerful clenching and the superior
belly is clearly visible. Palpate anterior border. The
deep belly is palpable with one finger under the zygo-
matic arch in front of the ear areas of palpation are
• Origin
• Body
• Insertion
• It can also be palpated by bimanual palpation with index
finger of one hand placed intra orally over the muscle
and index finger of other hand extra orally over the mus-
cles, and pressure is applied all over the muscle.
 Evaluation Of Lateral Pterygoid

• It is not possible to palpate the superior

head of the lateral pterygoid directly, but palpa-
tion of lateral poles give indirect information
about it.
• It is done with equal pressure of the finger
on the lateral poles of the condyles as the pa-
tient open and closes the mouth. Palpation of
the inferior head is by running the index finger
sliding back, buccally and behind the tuberosity.
Evaluation Of Medial Pterygoid

It is palpated by sliding the index finger lingually

and by applying pressure the insertion of the
muscles above the corner (angle) the mandible .
1.The number of muscles innervated by one motor
neuron varies greatly according to the function
of the motor unit . The fewer the muscle fibres
per motor neuron , the more precise the move-
ment .
A variation in the number of muscle fibres per
motor neuron is found within the muscles of
mastication . The inferior lateral pterygoid has
a relatively low muscle fibre / motor neuron
ratio; therefore it is capable of the fine ad-
justments in the length needed to adapt to
horizontal changes in the mandibular posi-
tion .
By contrast , the masseter has a greater
number of motor fibres per motor neuron ,
which corresponds to its more gross func-
tion of providing the force needed during
mastication .
2. There is a reciprocal relationship be-
tween different jaw muscles that is facili-
tated by various muscle fiber characteris-
tics .Thus the jaw opening phase of chew-
ing accomplished by the anterior digastric
muscle is more rapid than the closing
phase.
• The thickness of muscle fiber varies
with the degree of nourishment of the
individual. The growth of the muscle,
on systemic exercise, is due to in-
crease in total fiber volume and im-
provement of blood supply and not due
to increase in fiber number.
To summarize……
 Mastication is a complex physiologic phenomenon and is
performed by series of highly coordinated functions involving
various parts of stomatognathic system. Therefore inspite of vo-
lumionous recent work on functions of elemental structures of
stomatognathic system, systematic studies on mechanisms and
effectiveness of mastication as a whole are most essential.
As per this philosophical standpoint periodontist must reaf-
firm importance of mastication and consider the practical applica-
tion of recent physiological concept to dental practice.
 References
• 1) Grays anatomy: Peter L Williams, Roger Warwick, 37th edition

• 2)B.D Chaurasias; Human Anatomy; regional and applied volume three, third
edition

• 3)Tortora Grabowskai :Principals of anatomy and physiology 7 th edition

• 4)Review of medical physiology : William f Ganong 17th edition

• 5)Management of Temperomandibular disorders and occlusion 5th edition ;

Jeffrey p Okeson

• 6)Evaluation diagnosis and treatment plan of occlusal problem 2 nd edition

Peter E Dawson

• 7)Concised medical physiology 2nd edition sujit chaudarii