Muscles of Mastication

MUSCLES OF MASTICATION
CONTENTS
• Introduction
• Definitions
• Types of muscles
• Mechanism of muscle contraction
• Embryological development
• Muscles of mastication
• Mandibular movements
• Masticatory muscle disorders and Treatment
• Form and function
• The Importance of Masticatory Muscle Function in
Dentofacial Growth
• Conclusion
• References
INTRODUCTION
 To propel the skeleton, man has 639 muscles, composed of 6
billion muscle fibers. Each fiber has 1000 fibrils, which means
there are 6000 billion fibrils at work at one time or another.
 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.
 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.
 Muscles of mastication are the group of muscles that help in
movement of the mandible as during chewing and speech. We need
to study these muscles as they control the opening & closing the
mouth & their role in the equilibrium created within the mouth.
They also play a role in the configuration of face.
 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”
 A good knowledge of masticatory system and functional efficiency
is basic requirement for good Orthodontist
DEFINITIONS
 MUSCLE: An organ that by contraction produces movements
of an animal; a tissue composed of contractile cells or fibers
that effect movement of an organ or part of the body.
 MASTICATION Is defined as the process of chewing food in

preparation for swallowing and digestion.
CLASSIFICATION OF MUSCLE
Muscle tissue can be classified as
 Morphological classification:-
 Striated
 Non- Striated or smooth
 Functional classification:-
 Voluntary
 Involuntary
TYPES OF MUSCLES
There are generally three types of muscles in the human body:
 Skeletal muscle: This is striated and voluntary. Skeletal

muscle or “voluntary muscle” is anchored by tendons to the
bone and is used to affect skeletal movement such as
locomotion and maintaining posture. Though this postural
control is generally maintained as a subconscious reflex, the
muscles responsible also react to conscious control like non-
postural muscles.
 Smooth muscle: This is striated and involuntary. Smooth
muscles or “involuntary muscles” are found within the walls
of organs and structures such as the esophagus, stomach,
intestines, bronchi, uterus, urethra, bladder, blood vessels, and
even the skin (in which it controls erection of body hair).
Unlike skeletal muscles, smooth muscles are not under
conscious control.
 Cardiac muscle: This is non-striated and involuntary. Cardiac

muscle is also an “involuntary muscle” but is more akin in
structure to skeletal muscle, and is found only in the heart.
THE ULTRA STRUCTURE OF
SKELETAL MUSCLE
ACTIN AND MYOSIN FILAMENTS
GENERAL MECHANISM OF MUSCLE
CONTRACTION
SLIDING FILAMENT MECHANISM.

 Caused by interaction of cross bridges from myosin filament
with the actin filament.

 Action potential causes sarcoplasmic reticulum to causes
release of calcium ion.

 Calcium ion combines with troponin c of troponin
tropomyosin complex causing a conformational change. And it

moves deeper between two actin strands.
 This uncovers the active sites of actin allowing these to the
myosin head and cause contraction to proceed.

EMBRYOLOGICAL DEVELOPMENT
 The muscular system develops from intra embryonic mesoderm

from embryonic cells called myoblast.
 Muscles of mastication are derived from first brachial arch that
is mandibular arch.
5th- 6th week

 Primitive cells form and
differentiate
 Get oriented to site of origin
and insertion
Textbook of Human Embryology- by Inderbir Singh, 8 th edition, 2007

7th week
 Mandibular arch mass enlarges
 Cell migrate to areas of formation of 4 major muscles of
mastication
 Cell differentiation occurs before formation of facial arch
10th week
 Muscle mass well organized
 Nerve masses get incorporated
MUSCLE HYPERTROPHY ATROPHY
AND HYPERPLASIA
 HYPERTROPHY: when total mass of muscle enlarges,
increase in actin and myosin filament in response to maximal
force causing enlargement of muscle fiber.
 HYPERPLASIA: Under rare condition of extreme muscle

force generation actual no of muscle fiber have been observed
to increase
 ATROPHY: When total mass of muscle decreases.

IMPORTANT FACTS ABOUT
MASTICATION
 There are about 15 chews in a series from the time of food entry
until swallowing
 Average jaw opening during chewing is between 16-20mm
 Average lateral displacement on chewing is between 3 and 5mm
 Duration of masticatory cycle varies between 0.6 and 1 sec
 Men chew faster and have a shorter occlusal phase than women, it
also depends on the type of food
Masticatory forces: The aver maximum sustainable biting force
is 756N{170 pounds}.
 Molar region: Biting force range 400-890N
 Premolar region: Biting force range 222-445N
 Canine region: Biting force range 133-334N
 Incisor region: Biting force range 89-111N

CLASSIFICATION
MUSCLES OF MATICATION
PRIMARY MUSCLES ACCESSORY MUSCLES

 Masseter Digastric
 Temporalis Stylohyoid
 Lateral pterygoid Mylohyoid
 Medial pterygoid Geniohyoid
B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

FUNCTIONAL CLASSIFICATION
JAW ELEVATORS :
 Masseter
 Temporalis
 Medial pterygoid
 Upper head of lateral pterygoid
JAW DEPRESSORS :
 Lower head of lateral pterygoid
 Anterior digatric
 Geniohyoid
 Myolohyoid

MASSETER MUSCLE
The Masseter is a quadrilateral muscle placed superficial to ramus
of the mandible.
Its consists of three layers :
 Superficial
 Middle
 Deep

SUPERFICIAL LAYER
ORIGIN: From Anterior 2/3rd of lower border of zygomatic arch

and adjoining zygomatic process of maxilla
INSERTION: Into Lower part of lateral surface of ramus of
mandible
B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

MIDDLE LAYER
ORIGIN: From Anterior 2/3rd of deep surface and post. 1/3rd of

lower border of zygomatic arch
INSERTION: Middle part of ramus

DEEP LAYER
ORIGIN: From deep surface of zygomatic arch

INSERTION: Into rest of the ramus of mandible

NERVE SUPPLY
 Supplied by masseteric nerve branch of the anterior trunk of the
mandibular nerve.

ACTIONS
 Elevates the mandible to close the mouth and occlude the teeth in
mastication.
 Masseter has small effect in side to side movements, protraction

and retraction.

Palpation of Masseter muscle
 Patient is asked to clench and the superficial masseter is palpated
at three sites:
1. The origin along the inferior border of the zygomatic arch.
2. The insertion along the lateral aspect of the ramus.
3. The body of the muscle.
Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition. 2008

 It is best examined using a bi-digital approach of one index
finger extra orally and the other index finger intra orally,
adjacent of extra oral finger.
 The deep masseter is palpated extraorally at their superior
attachment to zygomatic arch.
 The superficial masseter is palpated near the lower border of
mandible.
Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition 2008

TEMPORALIS
It is a Fan shaped muscle fills the infratemporal fossa.
ORIGIN:
Temporal
 fossa, excluding zygomatic bone
Temporal
 fascia
INSERTION:
Margins
 and deep surface of coronoid
process
Anterior
 border of ramus of mandible

ACTIONS
It can be divided into 3 distinct areas according to fiber direction
and function
The Anterior fibers are directed almost vertically – Elevation of
mandible.
 The Middle fibers run obliquely forward as they pass downward –
Elevate and retrude the mandible
The Posterior fibers are aligned almost horizontally – Retrusion of
mandible

NERVE SUPPLY
Supplied by deep temporal branches from Anterior Division of

Mandibular nerve

BLOOD SUPPLY
 Middle temporal artery branch of superficial temporal artery
 Deep temporal artery branch of maxillary artery.

Palpation of the Temporalis Muscle
 The temporalis muscle is palpated at three sites as it is a fan-shaped
muscle.
 The anterior temporalis muscle is palpated posterior to the orbit in
an area that is slightly depressed.

 The mid or deep temporalis is palpated directly above the
zygomatic arch on a vertical line with the TMJ.
 The posterior temporalis is palpated directly over the tops of the

ears.
Management of Temporomandibular
. disorders and Occlusion by Jeffery P. Okeson 6 th edition. 2008
LATERAL PTERYGOID
 Lateral Pterygoid is also known as key muscle.
 It is a short, thick muscle with two heads :
a)Upper head
b)Lower head

UPPER HEAD :
ORIGIN: FromInfratemporal surface and crest of greater wing of
sphenoid bone.
INSERTION: Into Pterygoid fovea on the anterior surface of the neck
of mandible
LOWER HEAD :
ORIGIN: Lateral surface of lateral pterygoid plate.
INSERTION: Anterior margin of articular disc capsule of TMJ

NERVE SUPPLY
Lateral pterygoid nerve branch of the anterior division of mandibular

nerve

BLOOD SUPPLY
Pterygoid branch of second part of maxillary artery

ACTIONS
 Depresses mandible to open mouth
 Side to side movements
 Protrusion of mandible with medial pterygoid acting

simultaneously

Palpation of the lateral pterygoid muscle
 The index finger is inserted facial to the maxillary teeth and around
distal to the ptergomaxillary, or hamular notch to palpate the lateral
pterygoid muscle.
 Pain projection area is palpated in close proximity to the neck of
condyle and joint capsule, cranially behind the maxillary tuberosity.

MEDIAL PTERYGOID MUSCLE
 It is a quadrilateral muscle.
 It has a small superficial head and a large deep head which forms of
the major part of the muscle.

SUPERFICIAL HEAD :
ORIGIN: From Tuberosity of the maxilla and adjoining bone
INSERTION: Into Roughened area on the medial surface of the angle
and adjoining ramus of mandible
DEEP HEAD :
ORIGIN: From Medial surface of lateral Pterygoid plate and
adjoining process of palatine bone
INSERTION: Into below and behind mandibular foramen and
mylohyoid groove

NERVE SUPPLY
Nerve supply of the muscle comes from the main trunk of the
mandibular nerve.

BLOOD SUPPLY
Pterygoid branch of second part of maxillary artery

ACTIONS
 Elevates mandible
 Protrusion of mandible
 Side to side movements with lateral pterygoid

Palpation of medial pterygoid muscle

ACCESSORY MUSCLES
DIGASTRIC MUSCLE
ORIGIN: The anterior belly of the digastric muscle is found at
the digastric fossa of mandible, while the posterior belly of
the digastric muscle has its origin at the mastoid notch of temporal
bone.

INSERTION: A tendon is between anterior and posterior digastric
muscle that is attached by a loop like strip of fascia to the hyoid
bone.
ACTION: Its main action is to depress the mandible secondary to

lateral pterygoid.

NERVE SUPPLY
 A mylohyoid branch of inferior alveolar nerve innervates the
anterior digastric muscle.
 The digastric branch of the facial nerve innervates the posterior
digastric muscle.

BLOOD SUPPLY
 Anterior belly of digastric supplied by submental artery branch of

facial artery
 Posterior belly of digastric supplied by occipital artery branch of
external carotid artery

MYLOHYOID
 The mylohyoid muscle is a paired muscle running from
the mandible to the hyoid bone, forming the floor of the oral
cavity of the mouth
ORIGIN :
The two mylohyoid muscles arise from the mandible at
the mylohyoid line, which extends from the mandibular symphysis in
front to the last molar tooth behind

INSERTION :
 The posterior fibers pass inferomedially and insert at anterior
surface of the hyoid bone.
 The medial fibers of the two mylohyoid muscles unite in a
midline raphe (where the two muscles intermesh).

NERVE SUPPLY :
The myolohyoid nerve branches from inferior alveolar nerve which
is a branch of mandibular nerve
BLOOD SUPPLY:
The myolohyoid artery branch of inferior alveolar artery

ACTIONS
 The mylohyoid elevates the hyoid and the tongue.
 This is particularly important during swallowing and speaking.
 Alternatively, if other muscles are used to keep the position of

the hyoid fixed, then the mylohyoid depresses the mandible.
 It also functions as reinforcing the floor of the mouth.

GENIOHYOID MUSCLE
 The geniohyoid muscle lies superior to the mylohyoid muscle and
adjacent to midline .
ORIGIN: From the mental spine on the posterior aspect of symphysis

menti of mandible
INSERTION: on the anterior surface of the hyoid bone

NERVE SUPPLY:
The geniohyoid muscle is innervated by fibers from first cervical nerve
travelling along the hypoglossal nerve. These fibers are called ansa cervicalis
BLOOD SUPPLY:
The lingual artery branch of external carotid artery

ACTIONS
 Depresses the mandible
 Elevates the hyoid bone

MOVEMENTS OF THE MANDIBLE:
SUMMARY
MUSCLE ORIGIN DESCRIPTION
INSERTION
Masseter Zygomatic arch Mandible Closes jaw; flat

(external surface) thick muscle
Temporalis Temporal bone Coronoid process Closes jaw;

at the anterior fan -shaped
boder of the
ramus
Medial pterygoid Sphenoid, Inner surface of Closes jaw;
palatine ,& the ramus parallels
maxillary bones masseter muscle
Lateral pterygoid Sphenoid bone Anterior surface Open jaw;
of mandibular Allows grinding
condyle action side to
side
SUMMARY
MUSCLE ORIGIN INSERTION DESCRIPTION
Digastic Anterior belly Both the heads meet at Depression of jaw
•Digastric fossa the intermediate tendon Elevation of hyoid
Posterior Belly which is held by a
•Mastoid notch fibrous pulley to hyoid
bone
Mylohoid Mylohoid line Body of hyoid Elevates

floor of mouth ,
depression of mandible,
elevation of hyoid bone
Geniohyid Genial Tubercle Anterior surface of the Elevates

body of hyoid Hyoid
Buccinator Maxilla 3rd molar Fibers Aids in mastication

region, run forward and
pterygomandibular continuous with the
raphe, mandible Orbicularis oris.
below molar teeth.
Masticatory muscle disorders
INTRODUCTION :
 Muscle disorders involving masticatory muscles have been

considered analogous to skeletal muscle disorders throughout the
body.
 Mechanisms behind masticatory mucle 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.
Disorders of the Masticatory Muscles Scott S. Rossi, DMDa,b,c,*, Ilanit Stern, DMDa,
Thomas P. Sollecito, DMDd
CLASSIFICATION
 Local myalgia
 Centrally mediated myalgia
 Myofascial pain
 Myospasm
 Myositis
 Myofibrotic contracture
 Masticatory muscle neoplasia
LOCAL MYALGIA
 Sore muscles of mastictation with pain in cheeks and temples

on chewing, wide opening, and often on waking
 Bilateral
 Described as stiff, sore, aching, spasm, tightness, or cramping
 Sensation of muscle stiffness, weakness, fatigue
 Possible reduced mandibular range of motion
 Regional dull aching pain during function
 No or minimal pain at rest
 Local muscle tenderness on palpation
 Absence of trigger points and pain referral
CENTRALLY MEDIATED MYALGIA
 Prolonged and continuous muscle pain
 Trigger points present and pain referral on palpation
 Sensation of muscle stiffness, weakness and/ or fatigue
 Otologic symptoms including tinnitus, vertigo, and pain
 Decreased range of motion
 Hyperalgesia
 No response to treatment directed at painful muscle tissue
 Regional dull, aching pain at rest
 Pain is aggravated on function of affected muscles
MYOFASCIAL PAIN
 Regional dull, aching muscle pain at rest
 Pain aggravated by function of affected muscles
 Trigger points present and pain refferal on palaption with or
without autonomic symptoms
 Referred pain often felt as headache
 Otologic symptoms including tinnitus, vertigo and pain
 Headache or Toothache
 Decreased range of motion
 Hyperalgesia in region of referred pain
MYOSPASM
 Sudden and involuntary muscle contraction
 Acute malocclusion ( dependent on muscles involved)
 Markedly Decreased range of motion due to continuous
involuntary muscle contraction
 Acute onset of pain on function and at rest
 Pain aggravated by function of affected muscles
 Increased electromyographic activity higher than at rest
 Sensation of muscle tightness, cramping or stiffness
 Relatively rare disorder in orofacial pain
MYOSITIS
 History of trauma to muscle or source of infection
 Often continuous pain affecting entire affected muscle
 Diffuse tenderness over entire muscle
 Pain aggravated on function
 Moderate to severe limited range of motion due to pain and
swelling
MYOFIBROTIC CONTRACTURE
 Not usually painful unless involved muscle is forced to
lengthen
 Often follows long period of limited range of motion or disuse
 History of trauma or infection is common
 Firmness on passive stretch
NEOPLASIA
 Pain may or may not be present
 Tumors may ben in muscles or masticatory spaces
 Swelling, trismus, paresthesias, and pain referred to teeth
 Positive findings on imaging or biopsy
TREATMENT
 Education
 Self care
 Physical therapy
 Intra oral appliance therapy
 Pharmaco therapy
 Behavioural/ relaxation techniques
EDUCATION
 Explanation of diagnosis and treatment
 Reassurance about the generally good prognosis for recovery
and natural course
 Explanation of patient’s and doctor’s role in therapy
 Information to enable patient to perform self-care
SELF CARE
 Avoidance of clenching by reproducing a rest position where
the patient lips are closed but teeth are slightly seperated
 Avoidance of poor head and neck posture
 Avoiding of testing the jaw or jaw joint clickimg
 Elimination of oral habits such as nail biting, lip biting, gum
chewing eand so forth
 Modifying diet : softer foods and avoid foods that cause pain
and require wide opening of mouth, biting off with front teeth,
or foods that are chewy and sticky and that require excessive
movements
 Heat and cold application
 Stretch therapy – Passive stretching
PHYSICAL THERAPY
TECHNIQUES:
 Posture training
 Exercise
 Mobilization
PHYSICAL AGENTS AND MODALITIES :

 Electrotherapy and Transcutaneous electrical nerve stimulations (TENS)
 Ultrasound
 Iontophoresis
 Vapocoolant spray
 Trigger point injections with local anesthetic
 Acupuncture
 Laser treatment
INTRA ORAL APPLIANCE THERAPY
 Bite guards
 Night guards
 Splints
 Orthotics
 Orthopedic appliances
PHARMACOTHERAPY
 NSAIDS
 Muscle relaxants
 Anti anxiety agents
 Tricyclic antidepressants
BRUXISM
Bruxism is defined as “diurnal or nocturnal parafunctional activity including clenching, bracing, gnashing, and grinding of the teeth.”
It is generally for nonfunctional purposes in response to an increased tonus of the muscles of mastication.
Bruxismcan be classified as awake or sleep bruxism. Patients with sleep bruxism are more likely to experience jaw pain and limitation of movement, than people
who do not experience sleep bruxism.
There is no single factor that is responsible for bruxism. Faulty occlusion is one of the most common causes of bruxism that further leads to temporomandibular
joint pain.
Bruxism: A Literature Review Reddy SV, Kumar MP, Sravanthi D et al., J Int Oral Health. 2014 Nov –
Dec; 6(6) 105 – 109.
MANAGEMENT OF BRUXISM
 Treatment of occlusal related disorders is often a challenge for
both the dentist and the patient. As the presenting symptoms of
these conditions are usually, variable, they are difficult to
diagnose.
 Currently, no specific treatment exists that can stop sleep
bruxism. But, treatments based on behavior modification such as a
habit awareness, habit reversal therapy, relaxation techniques may
eliminate awake bruxism.
 The most common method is by use of different interocclusal
appliances such as occlusal splints, night guards, etc.,
 If the treatment does not seem to treat the condition, at least the
adverse effects have to be controlled or minimized.
Bruxism: A Literature Review Reddy SV, Kumar MP, Sravanthi D et al., J Int Oral Health. 2014 Nov –
Dec; 6(6) 105 – 109.
FORM AND FUNCTION
 Embryologically, the bones that make up the maxillofacial region
are membranous bones and are more susceptible to the
environmental factors such as the stimulating influence of muscles
and the extra functional force.
 Skeletal growth to a considerable extent is influenced by muscular
growth, particularly the parts of bone to which muscles attach,
develop in conjunction with the muscle.
Textbook of Craniofacial Growth, Sridhar Premkumar,2011, Jaypee Brothers Medical Publishers

 Sassouni in 1969 outlined that the vertical alignment 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 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
Characteristic features:-
 Reduced lower facial height
 Reduced eruption of posterior teeth
 Increased posterior facial height
 Flat mandibular plane angle
Short face syndrome
Subgroups:-
SFS1 SFS2
Long ramus Short ramus
Sharply reduced SN:MP Slightly reduced SN:MP

angle angle
Slightly reduced posterior Sharply reduced posterior

maxillary height maxillary height
Factors leading to increased horizontal growth of
the facial skeleton
High muscle activity SHORT FACE SYNDROME
Decreased anterior facial height
High bite force Increased posterior facial height
Low mandibular plane angle
Low gonial angle
Increased masticatory muscle fibre more vertically placed
Muscle thickness type fast masticatory muscles

And volume

LONG FACE SYNDROME
Characteristic features :-
 Excessive eruption of posterior teeth
 Normal or Excessive eruption of anterior teeth
 Short posterior facial height
 Steep mandibular plane angle
Primary Cause
 Unfavourable growth pattern
Factors leading to increased vertical growth of the
facial skeleton
Low muscle activity LONG FACE SYNDROME
Increased anterior facial height
Low bite force Decreased posterior facial height
High mandibular plane angle
High gonial angle
Decreased masticatory Muscle fibre Obliquely placed

Muscle thickness type slow masticatory muscles
And volume

ROLE OF MASTICATORY MUSCLE THICKNESS
 The thickness of the masticatory muscle can be measured
using MRI, CT and ultrasonography.
 The 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.
 Therefore the high bite force leads to reduced gonial angles
and mandibular plane angles.

ROLE OF BITE FORCE
 Masseter muscle is the most important contributor to the bite
force.
 High bite force are related to decrease in anterior facial height,
gonial angle and mandibular plane angle.
 Bite forces alter the region which affects the occlusal loading
thus inducing a change in the direction of growth.

ROLE OF MUSCLE ACTIVITY
 Craniofacial morphology is determined by the activity of the
jaw muscles.
 Electromyographic studies showed decreased activity in all jaw
muscles in long faced persons.
 High correlation between the 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.

THE IMPORTANCE OF MASTICATORY MUSCLE
FUNCTION IN DENTOFACIAL GROWTH
 The elevator muscles of mandible influence transverse and
vertical facial dimensions.
 Increased loading of jaws associated with masticatory muscle

function increases sutural growth and stimulates bone
apposition, resulting in greater tansverse growth of the maxilla
and broader bone bases for the dental arches.
 An increase in masticatory muscle function is often associated

with an anterior growth rotation pattern and well developed
angular, coronoid and condylar processes in the mandible
The Importance of Masticatory Muscle Function in Dentofacial Growth

Stavros Kiliaridis
Individuals with strong masticatory muscles have a more
homogenous facial morphology, in contrast to individuals with
weak masticatory muscles who show a great interindividual
variation in their vertical facial dimensions.
Thus,
individuals with strong masticatory muscles uaually have a
hypodivergent facial type, although not all individuals with
hypodivergent facial form have strong masticatory muscles.
A certainof masticatory muscle strength may be sufficient for

normal vertical craniofacial growth, though it is not a
prerequisite.
The Importance of Masticatory Muscle Function in Dentofacial Growth

Stavros Kiliaridis
PTERYGOID RESPONSE
 The placement of functional appliances results in an immediate
change in the neuromuscular proprioceptive response.
 Provided all muscle activity is affected, the resulting muscular

changes are very rapid and can be measured in terms of
minutes, hours and days.
 Structural alterations are more gradual and measured in

months, whereby dento-skeletal structures adapt to restore a
functional equilibrium to support the altered position of muscle
balance.
 In comparison, 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.
 This has been described as the “Pterygoid Response”

(McNamara, 1980; Petrovic) or the formation of a “Tension
zone” distal to condyle (Harvold and Woodside)
 Such a response is rarely observed with functional appliances

that are not worn full time.
Cause:-
 The area distal to condyle is described as a tension zone. No
vaccuum is created behind the condyle.
 Rather the response is one of tissue proliferation to fill in the

area behind the condyle.
 Connective tissue and blood vessels apparently proliferate in

the retrodiscal attachment within minutes or hours of fitting
full time functional appliance activated to advance the
mandible.
 The patient experiences discomfort in the condylar region
when the appliance is removed.
 On removal of the appliance the mandible is retracted and the

condyle compresses connective tissue and blood vessels that
have proliferated in the tension zone behind the condyle.
 After a few days it is comfortable to wear the appliance than
to leave it out.
 This change in muscle action has been described as the

Pterygoid response and results from the altered activity of the
superior head of the lateral pterygoid muscle.
THE LATERAL PTERYGOID MUSCLE
HYPOTHESIS
 It suggests that both postural and functional activity in the
masticatory muscles increases after functional appliance
insertion. This increased activity, especially in the superior
head of the lateral pterygoid muscle , then acts as a stimulus to
mandibular growth.
BUCCINATOR MECHANISM
 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
 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

 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
Textbook the bone
of Craniofacial system,
Growth, the mandible.
Sridhar Premkumar,2011, Jaypee Brothers Medical Publishers
Specific aspects of orthodontic treatment with reference
to the mandibular muscles and facial pattern
Extrusive mechanics
 In general, most short face syndrome or brachyfacial patients
require bite-opening mechanics during orthodontic treatment.
 On the other hand, long face syndrome or dolicofacial patients
usually require some limiting of vertical development during
orthodontic treatment to avoid extrusion of posterior teeth.
 As most orthodontic mechanics are extrusive, there is a greater
potential for the undesirable extrusion of molars in dolichofacial
subjects compared to brachyfacials, who have stronger musculature
that tends to resist extrusive forces during orthodontic treatment.
 During treatment, extrusive forces with intermaxillary elastics or
particular headgears should probably be avoided in patients with
long face syndrome.
The mandibular muscles and their importance in orthodontics: A contemporary review
Am J Orthod Dentofacial Orthop 2005;128:774-80
Extraction and timing of treatment
 It has been shown that, if premolars are extracted in dolicofacial
patients, there is still likely to be a slight increase in the vertical
dimensions.
 Whereas in brachyfacial patients, there is likely to be no change or
even a slight decrease.
 Therefore, the recognition of different muscular patterns, growth
rotation of the mandible and profile convexity or concavity will
influence the premolar extraction decision in each patient.
 Pubertal growth is also an important component of orthodontic
management of most brachyfacial patients, whose treatment often
begins in the late mixed dentition.
 On the other hand in dolicocephalic patients, treatment often
begins later.

MUSCULAR ANCHORAGE
 In 1978, Bench et al introduced this concept.
 The teeth would be controlled with natural anchorage in a
brachyfacial pattern, where the musculature is strong, but
there would be less muscular anchorage in dolicofacial
subjects with weak musculature.
 Itseems that weaker musculature would be less able to over
come the molar extruding and bite opening effects of
orthodontic treatment.

CONCLUSION
 Treatment planning in orthodontics is not based entirely on
biomechanical considerations, but it also requires an awareness of
the craniofacial muscular environment of each patient.
 The muscles of the maxilla and mandible seem to be of paramount
importance in the etiology and active treatment of malocclusions
and jaw deformities, and also for the stability of such treatment.
 The effects of the mandibular muscles associated with different
types of tooth movements should be considered during orthodontic
treatment planning.
 A clinician must recognize each patients’s muscular environment
and be aware of the problems related with excessive or deficient use
of muscle and their bearing to the dentition.
 The choice of treatment mechanics, the timing of treatment, and any
extraction decision might well be quite different for different
underlying facial patterns, even for the management of similar
occlusions.
 Any one technique or philosophy of treatment in which all patients
are managed similarly, without consideration of the musculature and
facial type, would appear to be inadequate.
 Therefore, the orthodontist should have a thorough understanding of
the craniofacial musculature and its association with the growth and
development of the dentofacial complex.
REFERENCES
 B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010,

CBS publishers and distributors
 Textbook of Human Embryology- by Inderbir Singh, 8th
edition, 2007
 Textbook of Craniofacial Growth, Sridhar Premkumar,2011,
Jaypee Brothers Medical Publishers
 Temporomandibular Disorders, Scrivani SJ, Keith DA,Kaban
BL, N Engl J Med 2008; 359:2693-2705
 The mandibular muscles and their importance in
orthodontics: A contemporary review. Am J Orthod
Dentofacial Orthop 2005;128:774-80
 Management of Temporomandibular disorders and Occlusion
by Jeffery P. Okeson 6th edition. 2008 Elsevier Mosby
 Disorders of the Masticatory Muscles Scott S. Rossi,
DMDa,b,c,*, Ilanit Stern, DMDa, Thomas P. Sollecito,
DMDd
 Bruxism: A Literature Review Reddy SV, Kumar MP,
Sravanthi D et al., J Int Oral Health. 2014 Nov – Dec; 6(6)
105 – 109.
 The Importance of Masticatory Muscle Function in
Dentofacial Growth Stavros Kiliaridis

Muscles of Mastication

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Muscles of Mastication

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MUSCLES OF MASTICATION

 MASTICATION Is defined as the process of chewing food in

 Skeletal muscle: This is striated and voluntary. Skeletal

 Cardiac muscle: This is non-striated and involuntary. Cardiac

SLIDING FILAMENT MECHANISM.

with the actin filament.

release of calcium ion.

tropomyosin complex causing a conformational change. And it

myosin head and cause contraction to proceed.

 The muscular system develops from intra embryonic mesoderm

5th- 6th week

Textbook of Human Embryology- by Inderbir Singh, 8 th edition, 2007

 HYPERPLASIA: Under rare condition of extreme muscle

 ATROPHY: When total mass of muscle decreases.

 Premolar region: Biting force range 222-445N

 Canine region: Biting force range 133-334N

 Incisor region: Biting force range 89-111N

PRIMARY MUSCLES ACCESSORY MUSCLES

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

 Upper head of lateral pterygoid

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

ORIGIN: From Anterior 2/3rd of lower border of zygomatic arch

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

ORIGIN: From Anterior 2/3rd of deep surface and post. 1/3rd of

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

ORIGIN: From deep surface of zygomatic arch

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

 Masseter has small effect in side to side movements, protraction

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition. 2008

Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition 2008

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

Supplied by deep temporal branches from Anterior Division of

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

 Deep temporal artery branch of maxillary artery.

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition. 2008

 The posterior temporalis is palpated directly over the tops of the

 It is a short, thick muscle with two heads :

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

Lateral pterygoid nerve branch of the anterior division of mandibular

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

Pterygoid branch of second part of maxillary artery

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

 Depresses mandible to open mouth

 Side to side movements

 Protrusion of mandible with medial pterygoid acting

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition. 2008

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

Pterygoid branch of second part of maxillary artery

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

 Side to side movements with lateral pterygoid

B.D. Chaurasia, Head and Neck Volume, 5 th Edition, 2010

Management of Temporomandibular disorders and Occlusion by Jeffery P. Okeson 6 th edition. 2008

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010

ACTION: Its main action is to depress the mandible secondary to

B.D. Chaurasia, Head and Neck Volume, 5th Edition, 2010