Muscles of

Mastication
n
Facial Expression

INTRODUCTION
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.

Influence of these muscles in prosthetic

dentistry.
2
Defines the borders & peripheral extensions.

DEFINITIONS
GPT 8
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

the process of chewing food in preparation

for swallowing and digestion.
3

Masticatory muscle

muscles that elevate the mandible to

close the mouth.
Mainly four pairs of muscles in the

mandible make chewing movements

possible.
These muscles along with accessory

ones together are termed as MUSCLES

OF MASTICATION.
4

These muscles can be divided into:

BASIC MUSCLES

TEMPORALIS
MASSETER
MEDIAL PTERYGOID
LATERAL PTERYGOID

ACCESSORY MUSCLES
Muscles of tongue, lip &
cheek

Suprahyoid muscles :
Mylohyoid
geniohyoid
stylohyoid
digastric (anterior belly)
Infrahyoid muscles:
Sternothyroid
Thyrohyoid
Omohyoid
Sternohyoid

DEVELOPMENT
The basic muscles of mastication develop

from the mesoderm of the first phyaryngeal

arch.

The muscular system develops from

intra embryonic mesoderm.

Muscle tissues develop from
embryonic cells called myoblast.
Muscular component of Branchial
arch form many striated muscles in
the head and neck region.

10

So they receive all their innervations from

the mandibular branch of the trigeminal

nerve, all from the anterior division except
the medial pterygoid which gets its nerve
supply from the main trunk.

11

12

MOVEMENTS OF MANDIBLE
Movements that the mandible can undergo are:

a)Depression:opening the mouth.

b)Elevation:closing the mouth.
c)Protraction:Horizontal movement of the
mandible anteriorly.
d)Retraction:Horizontal movement of the
mandible posteriorly.
e)Rotation:The anterior tip of the mandible is
slewed from side to side.
13

These movements of mandible are performed

by various muscles involved in it. So,

functionally, the muscles of mastication are
classified as:
Jaw elevators

Masseter
Temporalis
Medial pterygoid
Jaw depressors

Lateral pterygoid
Anterior digastric
Geniohyoid
Mylohyoid

14

MUSCLES OF
MASTICATION

15

TEMPORALIS

16

TEMPORALIS

It is the largest among all the mastication

muscles and is a fan shape muscle.

Pennate type.

It has been divided into 2 heads:

Deep head (anterior, middle and posterior
fibers)
Superficial head (much smaller)

17

Origin:

From the

inferior temporal
line , floor of the
temporal fossa and
from the overlying
temporal fascia of
the side of the skull.

Insertion:

Superior border and

medial tip of the
coroniod process.
18

Action:
Elevation

(anterior fibers)
Retraction
(posterior fibers)

Nerve supply:
Anterior division

of the mandibular
nerve
(by two deep
temporal nerves)
19

20

Blood & nerve supply

Deep
temporal
br of
mandibul
ar.n
&
Temporal
br of
maxillary.
a

21

Its Action is done by

The anterior fibers during function act

vertically and elevate the mandible.

The posterior fibers diverge and become

horizontal and retract the mandible.

22

The middle fibers run obliquely forward as

they pass downward -elevate and retrude

the mandible

23

ELEVATION OF
MANDIBLE

24

POSTERIOR FIBERS DRAW

MANDIBLE BACKWARDS

25

Blood supply: From the maxillary artery (one of two

termination of external carotid artery).
26

27

PALPATION

The muscle is divided into three functional

areas and therefore each area is independently
palpated.

The anterior region is palpated above the

zygomatic arch and anterior to the TMJ .

28

The middle region is palpated directly

above the TMJ and superior to the
zygomatic arch .

29

The posterior region is palpated above and

behind the ear.

If uncertainity arises regarding the proper
finger placement. The patient is asked to
clench the teeth together so that the
temporal muscle contracts and the fibers
should be felt beneath the finger tips.

30

Clinical significance
Recording Coronoid process
area
The patient is instructed to close and

move his mandible from side to side and

then immediately asked to open wide.
The side to side motion records the

activity of the coronoid process in a closed

position whereas opening causes the
coronoid to sweep past the denture
periphery
31

LITERATURE REVIEW
Antje Tallgren, Dr.Odont, et al. studied jaw muscle

activity in complete denture wearers A

longitudinal electromyographic study. J Prosthet
Dent August 1980 Vol 44 (2) Pg 123-32.
Tallgren studied the patterns of activity of some
masticatory muscles in partially edentulous
subjects & fully edentulous.
The study indicated that loss of posterior teeth
causes imbalance in muscular patterns
concerning masseter , anterior temporal muscle
and digastrics muscle and wearing immediate
complete upper and lower dentures revealed
inactivity of the jaw closing muscles during the
32
biting actions.

 Bengt Ingervall, Dr Odont et al. did an

electromyographic study of masticatory and lip

function in patient with complete dentures J
Prosthet Dent March 1980 Vol 43(3) pg 266-71
Two groups of patients having new and old
dentures were studied.
The results showed muscle activity during
maximal biting was markedly lower in patients
with new denture than in patients using the old
ones
No difference in chewing activity was seen with
old and new dentures
33

MASSETER

34

MASSETER

It consist of three overlapping layers:

The origin of the whole muscle is mainly from

the zygomatic process which consists of :

The superficial layer
The middle layer
The deep layer

35

SUPERFICIAL LAYER

It is the largest component that arises from the

anterior two thirds of the lower border of the
zygomatic arch.
Its fibers run downwards and backwards and
inserts into lower half of the ramus including
angle of the mandible.

36

MIDDLE LAYER

The middle layer takes its orgin from the medial

surface of the anterior two-thirds and the lower
border of posterior one third of the arch.
The fibers run more directly downwards to be
inserted into lateral surface of the middle part of
the ramus.
37

The deep layer arises from the whole length of

medial surface of the zygomatic arch.
The fibers pass downwards to attach to the
upper part of the mandible ramus.

DEEP HEAD
38

39

Action of masseter is mainly to elevate

the mandible (antigravity action) and

also helps in retrusive movement.

It is the main powerful muscle involved

in the elevation of the mandible

40

Elevation(bilateral):masseter elevates the

mandible to occlude the teeth in

mastication.
Ipsilateral excursion(unilateral): as the

origin of the masseter muscle is slightly

lateral to its insertion , a single masseter
muscle can move the mandible to the same
side.
Retrusion: (bilateral): when the mandible is

in a protruded position the deep fibers are

41

Nerve supply: By the mandibular branch of

the trigeminal nerve, from the anterior

division(massetric nerve).

42

Blood supply is from the Maxillary

artery which is a terminal branch from

external carotid artery.
One of the interesting property of this

muscle is that, internally, the muscle

has many tendinous septa that
greatly increase the area for muscle
attachment and so increase its power.

43

Blood & Nerve

Supply

Maxillary
artery
&
Massertic
nerve

44

PALPATION
The patient is asked to clench their teeth

and, using both hands, the practitioner

palpates the masseter muscles on both
sides extraorally, making sure that the
patient continues to clench during the
procedure.
Palpate the origin of the masseter

bilaterally along the zygomatic arch and

continue to palpate down the body of the
mandible where the masseter is attached.
45

D-Palpation of the
masseter muscles

E-Bimanual
palpation of
the masseter
muscles
46

Clinical Significance

MASSETRIC NOTCH
On Denture border :
An active masseter muscle will create a
concavity in the outline of the
distobuccal border and a less active
muscle may result in a convex border.
In this area the buccal flange must

converge medially to avoid displacement

due to contraction of the masseter
muscle because the muscle fibers in that
area are vertical and oblique .
47

Effect of masseter muscle on the distobuccal

border
A. Moderate activity will create a straight line
B. An active muscle will create a concavity.
C. An inactive muscle will create a convexity .
48

Activation of Masseteric notch and distal

areas.
Instruct the patient to open wide and then

to close against the resting force of your

fingers.

49

Opening wide activates the muscles of

pterygomandibular raphe by stretching,
which thereby defines the most distal
extension.
Instructing the patient to close against
your fingers on the tray handle causes
masseter muscle to contract and push
against the medially situated
buccinator muscle.
50

Muscle dysfunction

Facial asymmetry in a eleven yr old boy whose

masseter muscle was missing on left side
51

Tempromandibular joint
dysfunction.
The masseter is most often tender along

the central fibers of at its insertion.

Masseter hypertonicity is found in patients

who have premature contacts on the

nonworking side.
Parafunctions such as bruxism and

clenching also give rise to masseter pain

that is frequently associated with pain in
the temporalis muscle.
52

LITERATURE REVIEW
According to Garrett NR, Kaurich M et. al a cross-

sectional study on Masseter muscle activity in

denture wearers with superior and poor
masticatory performance was done.J Prosthet
Dent 1995 Dec vol 74 (6) 628-36.

The results indicated that application of more

equivalent force by the right and left masseter
muscles during unilateral chewing is consistent
with improved chewing ability in denture wearers.
53

 Jacob R, Van Steenberghe et al. studied on

Masseter muscle fatigue before and after

rehabilitation with implant-supported prostheses.
J Prosthet Dent. 1995 Mar Vol 73(3):284-9.

Study was performed in two groups of edentulous

patients
One group consisted of patients who were
rehabilitated by means of an implant overdenture and
another with an implant-supported fixed prostheses
A decrease in the biting force and clenching with
implant-supported overdentures was noted. The
absence of a spectral shift expressed a fear of biting
too hard and fracturing the prosthesis when
compared with implant fixed prostheses.
54

Belser UC and Hannam AG studied the

contribution of the deep fibers of the

masseter muscle to selected tooth-clenching
and chewing tasks. J Prosthet Dent. 1986
Nov; Vol 56(5):629-35
The purpose of this study was to describe
functional behaviour in the deep fibers of the
masseter muscle and to define any differences in
its behaviour from that of the superficial fibers.
During chewing, activity in the deep fibers of
masseter muscle was distributed evenly
bilaterally, whereas that in the superficial fibers
of the masseter muscle was biased significantly
toward the chewing side.

55

Antje Tallgren, Dr.Odont, et al. studied jaw muscle

activity in complete denture wearers A

longitudinal electromyographic study. J Prosthet
Dent August 1980 Vol 44 (2) Pg 123-32.
Tallgren studied the patterns of activity of some
masticatory muscles in partially edentulous subjects &
fully edentulous.
The study indicated that loss of posterior teeth causes
imbalance in muscular patterns concerning masseter ,
anterior temporal muscle and digastrics muscle and
wearing immediate complete upper and lower
dentures revealed inactivity of the jaw closing
muscles during the biting actions.
56

MEDIAL PTERYGOID

57

MEDIAL PTERYGOID
It is also called as the Pterygoideus internus

(Internal pterygoid muscle).

It consist of Two heads which differ in origin:

The superficial head

The deep head
58

SUPERFICIAL HEAD

The superficial head originates from

the maxillary tuberosity.
59

 The muscle inserts into the inner

surface of the angle of the mandible.

Nerve supply of the muscle comes

from the main trunk of the mandibular

nerve.
Blood supply is chiefly from the

maxillary artery.

60

The deep head originates from the medial

surface of lateral pterygoid plate of the
sphenoid bone.

DEEP HEAD

61

Main trunk of
mandibular
nerve.

Pterygoid branch of
2nd part of maxillary
62
artery

 Action:
Elevation (bilateral) : The medial pterygoid

acting along with the masseter muscle are

powerful elevators of the mandible
Protrusion( bilateral): The insertion of the

muscle is posterior to its origin and therefore it

helps in protrusion of mandible
Contralateral excursion: The medial and lateral

pterygoid muscle of two sides contract alternately

to produce Side-to-Side movement of Mandible
63

Medial and lateral pterygoid

act together to protrude the
mandible

64

SIDE TO SIDE GRINDING

MOVEMENT

65

PALPATION
It can be palpated by placing the finger on
the lateral aspect of the pharyngeal wall of
the throat, this palpation is difficult and
sometimes uncomfortable for the patient.

Functional manipulation is done when the

muscle becomes fatigued and
symptomatic.
The muscle contracts as the teeth are
coming in contact
Also stretches when the mouth is open
wide.
66

G- Palpation of the medial pterygoid

muscle
67

CLINICAL SIGNIFICANCE
Mandibular dysfunctions :

The medial pterygoid muscle is not

usually involved in gnathic dysfunctions
but when they are hypertonic, the
patient is usually conscious of a feeling
of fullness in the throat and an
occasionally pain on swallowing.

68

LITERATURE REVIEW
Wodd WW studied the medial pterygoid

muscle activity during chewing and

clenching. J Prosthet Dent. 1986 May;Vol
55(5): 615-21.

Patterns of medial pterygoid muscle activity

were consistent for ipsilateral chewing
Intercuspal clenching initiated less activity
when force was directed posteriorly and more
activity when directed anteriorly
69

LATERAL PTERYGOID

70

LATERAL PTERYGOID
Also called as the Pterygoideus externus

(External pterygoid muscle).

It is a short conical muscle, having 2

heads:
upper and lower.

71

Upper head:
Origin: infra-temporal surface & crest of the

greater wing of sphenoid

72

73

Lower head:
Origin: Lateral surface of the lateral

pterygoid plate

74

Both the heads have the same

insertion
These fibers run backwards and

laterally to be inserted into:

a) Pterygoid fovea of the neck of
the mandible
b) Articular disc
c) Capsule of TMJ (anterior aspect)
75

 Nerve supply is from the anterior

division of the mandibular branch of

trigeminal nerve(nerve to lateral
pterygoid).

Blood supply of lateral pterygoid

muscle is from maxillary artery .

76

Blood & nerve supply

Pterygoid br of maxillary.a
Ant div of mandibular.n
77

 Actions of lateral pterygoid:

1.

Depression of the
mandible .
2
Side to side movement
(lateral
movement) .
3.
Protrusion of the mandible.
.If the Pterygoid muscles of one

side act, the other side of the

mandible is drawn forward
while the same condyle remains
comparatively fixed.

78

Superior Head
active during the power stroke.Power stroke refers

to movement that involves closure of the mandible

against resistent such as in chewing or clenching
the teeth together.
Inferior Head
Depression(bilateral): depresses the mandible along
with suprahyoid and infrahyoid muscles to open the
mouth
Protrusion(bilateral): the lateral pterygoid acting
together are the prime protractors of the mandible.
Contralateral excursion(unilateral): the medial and
lateral pterygoid muscle of the two sides contact
alternately to produce side to side movement of the
mandible(as in chewing
79

IHLP is active on opening,

protrusion and contralateral jaw movements.

SHLP is active on closing, retrusion and
ipsilateral jaw
movements.

80

The combinded efforts of the Digastrics and

Lateral Pterygoids provide for natural jaw
opening.

81

82

SIDE TO SIDE GRINDING

MOVEMENT

83

PALPATION

Silverman ( occlusion in prosthodontics and

natural dentition, ed 1 1962) recommended

the bilateral use of tip of little finger of each
hand in the back of maxillary tuberosity and as
high as possible to compare the degree of pain
on each side as reported by the patient.

Schwartz and Chayes ( Facial pain and

mandibular dysfunction ed 1 1968 ) suggested

the use of the fore finger in much the same
way.
In clinical practice, palpation of the ILP muscle
84
is considered as a useful clinical tool for

F-Palpation of the lateral

pterygoid muscles
85

Jeffery P Okeson ( management of

tempromandibular disorders and occlusion,

ed. 4 1998) recommended palpation by
functional manipulation, where each muscle is
contracted and then stretched.

86

For Inferior lateral pterygoid :

The patient is asked to protrude the mandible

against resistance & Clench on maximum

87

For Superior lateral pterygoid muscle:

The muscle contracts and stretches on

clenching.
Inorder to differentiate pain arising
from elevator muscle, the patient is
asked to open the jaw wide.

88

CLINICAL
SIGNIFICANCE

Unilateral failure of lateral pterygoid muscle

to contract results in deviation of the
mandible toward the affected side on
opening.

Bilateral failure results in limited opening,

loss of protrusion and loss of full lateral

deviation.
In patients with nonworking side

interferences, the lateral pterygoid muscle on

the opposite of the interference is sometimes
painful
89

B
90

The insertion of the lateral pterygoid in the

articular disc occurs in the medial aspect of

the anterior border of the disc and thus it
plays a role in the T.M.J. diseases especially
internal derangement.

Some of the T.M.J. diseases have been due

to an attributed variation of the function

and attachment of the superior head as an
etiological factor in T.M.J. diseases.

91

LITERATURE REVIEW
R. Johnstone and Mc cormick templeton
studied the feasibility of palpating the lateral
pterygoid muscle ( J Prosthet Dent Vol 44 (3)
Sept 1980 Pg 318-23) and came to a
conclusion through dissections and lateral
head radiographs that it is not possible to
palpate the lateral pterygoid muscle directly
by conventional clinical techniques without
applying pressure through the overlying
superficial head of medial pterygoid muscle.
92

Stratmann U. et al studied the clinical anatomy

and palpability of the inferior lateral pterygoid
muscle ( J Prosthet dent 2000 May VOL 83(5):54854) and came to a conclusion that the inferior
lateral pterygoid muscle palpation technique
should no longer be considered as a standard
clinical procedure because it is nearly impossible
to palpate the muscle anatomically and because
the risk of false-positive findings (by palpation of
the medial pterygoid muscle) is high.

93

ACCESSORY MUSCLES OF
MASTICATION

94

BUCCINATOR

95

BUCCINATOR:

It is an accessory muscle of mastication,

occupying the gap between mandible and

maxilla forming important part of the
cheek.

arises from the posterior part of the

maxilla and mandible opposite the molar

teeth and the pterygomandibular raphe,
which is a tendinous band between the
pterygoid hamulus superiorly and the
mandible inferiorly.
96

Course and insertion :

Upper fibers gets inserted into upper lip,
Lower fibers gets inserted into lower lip,
Middle fibers decussate at the angle of the
mouth, the upper fibers pass to lower lip while
the lower fibers pass to the upper lip .

97

98

Nerve supply is from buccal

branch of facial nerve.

Blood supply is from facial

artery.
The main action of buccinator is

to prevent the accumulation of

food in the vestibule of mouth
and to bring the food on to the
occlusal table during
mastication.
99

CLINICAL SIGNIFICANCE
On Denture border :

For buccal flange area in mandibular

impressions.
The area is moulded by massaging the cheek
in an anterior-posterior direction using
moderate manual pressure against the
compound.
This moves the fibers of the buccinators
muscle and the tissues of the cheek in the
direction of functional action of the
buccinators muscle.
100

In maxillary impressions:

The cheek is manually molded in

anterior-posterior direction using slight

finger pressure against the compound or
the patient is instructed to control the
amount of movement by sucking action.

101

ANTERIOR BELLY OF DIGASTRIC:

Origin:
It arises from the
digastric fossa on
the lower border
of mandible on
both sides of
symphysis menti.

102

Insertion; into the intermediate tendon

which is connected to the hyoid bone

by a fibrous loop.
Nerve supply; is through anterior

division of mandibular branch of

trigeminal nerve.
Action; its main action is to depress the

mandible .
103

ANTERIOR BELLY AND ITS ACTION

104

MYLOHYOID MUSCLE:

It forms the floor of the mouth.

Origin is from mylohyoid line on the

internal aspect of mandible.

Insertion; The fibers slops downwards
and forwards to inter-digitate with the
fibers of the other side to form the
median raphe.
This median raphe insert in the chin
from above and the hyoid bone from
below.
105

 Action:

Elevates hyoid bone,

supports and raises
floor of mouth which
aids in early stage of
swallowing, depress the
mandible.

MYLOHYOID MUSCLE

Nerve supply:

By nerve to
mylohyoid: which is a
branch of Inferior
alveolar branch of
mandibular nerve,
106

Blood supply: by Facial artery

and Lingual artery.

This muscle provides a

separation between the

submandibular and sublingual
salivary glands.

107

CLINICAL SIGNIFICANCE
On denture borders :

Mylohyoid area.
Instruct the patient to place the tip of his
tongue into the upper and lower vestibules
on the right and left side.
The area to be molded is reheated and the
patient and is instructed to swallow two or
three times in rapid succession.
The tongue movements raise the level of
the floor of the mouth through contraction
of the mylohyoid muscle.
108

GENIOHYOID:
Origin:

From inferior genial tubercle (in the

midline of inner surface of mandible).
Insertion: is into the hyoid bone.
Action: depresses the mandible.
Blood supply: is through lingual artery.
Nerve supply: is by hypolossal nerve.
109

GENIOHYOID

110

ORBICULARIS ORIS:
It has two parts: intrinsic and extrinsic part.
Intrinsic part is a very thin sheet and

originates from superior and inferior

incisivus from maxilla & mandible. It inserts
into the angle of mouth.
The extrinsic part is actually formed by

elevator and depressor muscles of the lips

and inserts into the angle of the mouth.
The orbicularis oris functions is to compress

the lips against the teeth and close the oral

orifice

111

ORBICULARIS ORIS

112

Action varying kind of movements of

lips like pouting , pursing , twisting

113

CLINICAL SIGNIFICANCE
For mandibular impressions :

On recording Labial flange and labial frenum

The lip is massaged from side to side to
mold the compound to desired functional
extension.
In order to activate the mentalis muscle the
patient is asked to pout or lick his lower lip.

114

For maxillary impressions in labial flange

and labial frenum area.

Manually mold the compound by
externally moving the lip side to side,
simultaneously applying finger pressure
to control the width of the border
Lift the patients upper lip and vertically
place the frenum into the softened
compound and mold with your fingers
using a side to side external motion

115

STYLOHYOID
Orgin :

It arises from the posterior and lateral

surface of the styloid process of the temporal
bone.
Insertion :

Is inserted into the body of the hyoid

bone, at its junction with the greater cornu,
and just superior the omohyoid muscle.
Action : draws the hyoid bone upward,

backward and elongates the floor of the mouth

116

STYLOHYOID

117

INFRAHYOID MUSCLES:

The origin and insertion of this group of

muscles have no particular significance in
complete denture prosthodontics insofar
having any influence in denture borders.
The action of these muscles is important to
the prosthodontist, for they are a part of
kinetic chain of mandibular movement. Their
action is to fix or depress the hyoid bone so
that the suprahyoid muscles can act.
118

SUMMARY OF THE ANATOMY AND FUNCTION

119

CHEWING
Two separate acts are recognized in the

chewing process.
First is a combination of prehension and

incision in which the food is secured by

the lips and bitten by the front teeth.
The second is mastication, the major

activity during which the food is mashed

between the back teeth.
120

The total chewing cycle occurs

through three phases:

1. The opening stroke during which the

mandible is lowered.
2. The beginning closing stroke during

which the mandible is rapidly raised

until the entrapped food is felt and
3. The power stroke in which the food

is compressed, punctured, crushed

121

CHEWING MOVEMENTS AND MECHANICS

122

The chewing process generally acts as a

2nd order lever system resulting in

compression at TMJ.
The turning moment generated along

mandibular body and ramus creates a

sheer at Tempromandibular joint.

123

Chewing in humans is actually asymmetrical and

unilateral.
At the working side:
. It possesses the greatest adductor force, but

articular emminence is less substantially

loaded.
At the balancing side:
. It possesses the less adductor force and the

articular emminence is substantially loaded.

. At the initial action, contraction of inferior

head of lateral pterygoid muscle occurs to

124
initiate mandibular deviation to working side.

Chewing strokes in different

occlusions

125

MASTICATORY MUSCLE DISORDERS

Some of the common masticatory muscle

disorders involve:
Trismus
Bruxism
Tetanus
Congenital hyperplasia/ hypoplasia
Hypermobility/ hypomobility of the muscle
Muscle pains
MPDS
Myositis ossificans etc.
Temporal Tendonitis
126

Trismus

Due to prolonged tetanic spasm of the jaw

muscles by which normal opening of the mouth
is restricted.
Restricted jaw movements regardless of the
etiology.
Causes:
Intracapsular: Arthritis
Condylar fracture
Pericapsular: Irradiation
Dislocation
Infection & inflammation
Muscular:
Tmj dysfunction syndrome
Tetanus
127
Other:
Oral submucous fibrosis

Problems:
Eating issues
Oral hygiene issues
Swallowing issues
Joint immobilization

Treatment:
Removal of the cause
Heat therapy
Warm saline rinses
NSAIDS
Passive muscle stretching exercises

128

Bruxism
Bruxism is the clenching or grinding of the teeth when the
individual is not chewing or swallowing
It can occur as a brief rhythmic strong contractions of the

jaw muscles during eccentric lateral jaw movements,or in

maximum intercuspation,which is called clenching.

Causes:

1) Associated with stressful events

2)Non stress related or hereditary

Bruxism may lead to

-tooth wear
-fracture of the teeth or restoration
-muscle hypertrophy
129

Increased muscle tension is directly

related to stress activity during the

day.

Treatment:
Coronoplasty
Maxillary stabilisation appliance
130

Each of the graphics below

displays identical degree of
lateral pterygoid "hyperactivity :

131

Tetanus (Lock Jaw)

Tetanus is a disease of the nervous system

characterized by intense activity of motor neuron

and resulting in severe muscle spasm
Caused by exotoxins of gram positive bacillus,
Clostridium tetani.

CLINICAL FEATURES :
Pain and stiffness in the jaws and neck muscles

,with muscle rigidity producing trismus and

dysphagia
Rigidity of facial muscles
Sometimes whole body becomes
affected.

132

TREATMENT
All patients should receive

antimicrobial drugs
Active and passive immunization.
Surgical wound care
Anticonvulsant if indicated

133

CONGENITAL HYPOPLASIA/
HYPERPLASIA
It occurs very rarely, and is more common

in masseter and orbicularis oris.

Its oral symptoms include enlargement or

decreased size of the affected muscle,

which may show an asymmetric facial
pattern and stiffness in the temporomandibular joint.
It may or may not be associated with

hypermobility/ hypomobility of the muscles.

134

MUSCLE HYPERMOBILITY/
HYPOMOBILITY
This disorder involves extreme or diminished

activity of the masticatory muscles.

Its etiology includes various factors such as:
Decreased/ increased threshold potential of

neural activity.
Parkinsonism
Facial paralysis
Nerve decompression
Secondary involvement of systemic diseases.
135

MUSCLE PAINS
It usually occurs as a result of reflex protective

mechanism and myofacial triggers.

It is usually felt as a non-pulsatile variable aching

sensation, with a boring quality. It may also present

with tightness, weakness, swelling or tenderness.
It includes 3 types:

1. local muscle soreness:

it is a primary hyperalgesia with lowered pain
threshold due to local factors such as stress, injury,
infection etc.
136

This may be due to:

1. distortion of blood vessels within the muscle or

2. forceful or sustained contraction repeatedly.
2. Muscle splinting pain:
it is defined as rigidity of the muscle occuring as a
means of avoiding pain caused by movement of
the part.
it is a reflex protective mechanism.
Splinting of masticatory muscle may occur as a
protective mechanism in conditions such as
toothache, overstressed teeth, effect of local
anaesthetics, trauma etc.
137

3. Non-spastic myofacial pains:

There is no spasm and pain is the only
complaint and this is generally referred
to structures outside the muscle proper.
it may be due to atrophied muscle mass
because of inactivity, illness or
nutritional deficiency.

138

ZONES OF REFFERED PAIN

The masseter muscle pain refers to the ear,

TMJ and the mandibular teeth.

The temporalis refers to the temple, orbit

and maxillary teeth.

The medial pterygoid refers to the infra-

auricular and post-mandibular area.

The lateral pterygoid always refers its pain to

the TMJ.
139

MYOFACIAL PAIN DYSFUNCTION

SYNDROME (MPDS)
Muscular Disorders (Myofacial Pain

Disorders) are the most common cause

of TMJ pain associated with masticatory
muscles.
Common etiologies include:

1. Many patient with high stress level

2. Poor habits including gum chewing,
bruxism, hard candy chewing
3. Poor dentition
140

Its treatment includes 4 phases of

therapy which includes muscle exercises

and drugs involving NSAIDs and muscle
relaxants.
A bite appliance is also worn by the

patient in the furthur stages to splint

the muscle movement.

141

MYOSITIS OSSIFICANS
It is a condition wherein fibrous tissue and

heterotropic bone forms within the

interstitial tissue of muscle, as well as in
associated tendons or ligaments.
It is of two types: localized and generalized.

A. Localized myositis ossificans:

It is caused by trauma or heavy muscular
strains or by metaplasia of pluripotential
intermuscular cnnective tissue.
142

The affected site remains swollen and

tender, and the overlying skin may be

red and inflamed.
There may present a difficulty in the

opening of the mouth.

management is done by giving sufficient

rest to the muscle and excision of the

involved muscle after the process has
stopped.

143

B. Generalized myositis ossificans:

In this, formation of bone in tendons and fascia
occurs alongwith subsequent replacement of
muscle mass by the bony tissue.
The masseter muscle is the most frequently

involved.
It usually occurs in children less than 6 years of

age.
It shows an evidence of dense osseous

structures in the greater part or whole of the

muscle.
144

There is a gradual increase in stiffness

and limitation in the motion of

masticatory muscles. Ultimately, the
entire muscle may get transformed into
bone resulting in no movement.
Management: there is no specific

treatment. The muscles involved are to

be excised.

145

Temporal Tendonitis
Chronic strain from temporalis muscle

pulling on tendon that attaches to

mandible
Causes sharp headaches in temple just
to side of the eyes

146

Normal function versus

parafunction

147

The image is demonstrating normal

reciprocal functioning of the Lateral

Pterygoids and Masseters/ Medial Pteygoids/
Temporalis'.
The Lateral Pterygoids advance the condyles,
thereby opening the mouth (depressing the
mandible), with the assistance of the
Digastric
The oblique orientation of the Masseters and
Medial Pterygoids create a sling. The nonworking side Medial Pterygoid contacts
simultaneously with the opposite side
working Masseter.
It is this oblique orientation of the Medial
Pterygoids and Masseters that create the
functional "shift" of the mandible, not an
unilateral contraction of a Lateral Pterygoid.

148

In the event the

Temporalis' do not cease

their active contractions,
varying degrees of
parafunctions result. The
Lateral Pterygoids
encounter resistance to
their attempts at condylar
advancement, thereby
increasing their intensity
of contraction and strain
on their origins and
insertions: the pterygoid
plates, sphenoid bone,
and the condylar neck and
disc.
149

The degree of frequency,

duration and intensity of

the contractions of a
Lateral Pterygoid is a
function of the resistance
provided by the
parafunctioning ipsilateral
and/or contralateral
Temporalis. For example,
as a Lateral Pterygoid
attempts to translate its
condyle, it is met with
resistance provided by the
contralateral Temporalis,
thereby causing the
Lateral Pterygoid to pull
its condyle in a medial
direction toward the
contralateral contact
150

In normal chewing

function, the mandible

opens, and then, while
initiating closing, there
is a shift slightly to the
side of the bolus, due to
theorientation of the
masseter and medial
pterygoid. There is no
"canine rise during
normal chewing
function. Canine rise is
mechanism to combat
parafunction
151

MUSCLES OF FACIAL
EXPRESSION

152

Develop from 2nd

pharyngeal arch.
Innervated by
branches of facial
nerve.
They are in
superficial
fascia,with origin
either from bone or
fascia and insertion
into the skin.
153

They are divided into 3

groups:1.Orbital group
2.Nasal group
3.Oral group

154

155

Orbital group of facial

muscles

1.Orbicularis oculi
It has 2 parts:
a.Palpebral part
Origin
-Medial palpebral ligament.
Insertion
-lateral palpebral raphe.
Function
-closes the eyelids gently.

palpebral part- gently closes eyelids

Innervation
-facial nerve
156

b.Orbital part
Origin
-nasal part of frontal bone,frontal pocess
of maxilla,medial palpebral ligament.
Insertion
-fibers from an uninterrupted ellipse
around orbit.
Function
-closes the eyelids forcefully.
Innervation
-facial nerve
157

2.Corrugator supercilli
Origin
-medial end of the superciliary arch.
Insertion
-skin of the medial half of the eyebrow.
Function
-draws the eyebrows medially and
downwards.
Innervation
-facial nerve.
Action
- with oculi muscle shield the eye, involved
in frowning , vertical wrinkles on the
forehead.
158

FROWN

159

160

Nasal group of facial muscles

1.Nasalis
It has 2 parts:
a.Transverse part
Origin
-maxilla just lateral to nose
Insertion
-aponeurosis across dorsum of nose with
muscle fibers from the other side.
Function
-compresses nasal aperture
Innervation

-facial nerve.
161

b.Alar part
Origin
-maxilla over lateral incisor
Insertion
-alar cartilage of nose.
Function
-draws cartilage downward and laterally
opening nostrils
Innervation
-facial nerve

162

2.Procerus
Origin
-nasal bone and upper part of lateral nasal
cartilage.
Insertion
-skin of lower forehead between eyebrows.
Function
-draws down medial angle of eyebrows
producing transverse wrinkles over bridge of
nose and help to reduce the glare of bright

light.
Innervation

-facial nerve
163

164

3.Depressor septi
Origin
-maxilla above medial incisor.
Insertion
-mobile part of the nasal septum.
Function
- pulls the nasal septum downwards ,
with nasalis widens the nasal aperture.
Innervation

-facial nerve.
165

166

3.Oral group
Oral depressors/Muscles of lower lip
a.Depressor anguli oris
Origin
-oblique line of mandible below canine,premolar
and first molar teeth.
Insertion
-skin at the corner of the mouth and blending
with orbicularis oris.
Function
- draws the angle of mouth downwards and
laterally in opening mouth ,expressing
sadness
Innervation
-facial nerve.
167

sadness

168

b.Depressor labii inferioris

Origin
-anterior part of oblique line.
Insertion
-lower lip at midline,blends with muscle
from opposite side.
Function
- draws the lower lip downwards and little
laterally and assist in eversion of lower
lip
Innervation
-facial nerve.
Expression irony , sorrow , doubt.
169

c.Mentalis
Origin
-mandible inferior to incisor teeth.
Insertion
-skin of chin
Function
- raises the lower lip , wrinkling the skin of
the chin, helps in drinking
Innervation
-facial nerve.
Expression doubt

170

171

Oral levators/muscles of upper lip

a.Risorius
Origin
-fascia over masseter muscle.
Insertion
-skin at the corner of the mouth.
Function
-pulls the corner of the mouth
laterally,grinning and laughing
Innervation
-facial nerve

172

GRINNING

b.Zygomaticus major
Origin
-posterior part of lateral surface of
zygomatic bone.
Insertion
-skin at the corner of the mouth.
Function
-draws the angle of the
mouth upwards and laterally
as in laughing
Innervation

-facial nerve.
174

LAUGH

c.Zygomaticus minor
Origin
-anterior part of lateral surface of
zygomatic bone.
Insertion
-upper lip just medial to corner of mouth.
Function
- elevates the upper lip, exposing the max
teeth , deepening and elevating
nasolabial furrow, curl the upper lip in
smiling, contempt.
Innervation
-facial nerve.
176

d.Levator labii superioris

Origin
-infra orbital margin of maxilla.
Insertion
-skin of upper lateral half of upper lip.
Function
- elevates and everts the upper lip, modifies
the nasolabial furrow.
Innervation

-facial nerve

177

e.Levator labii superioris alaeque nasi

Origin
-frontal process of maxilla
Insertion
-alar cartilage of nose and upper lip.
Function
- raises and everts the upper lip,

increases the curvature of top of

nasolabial furrow , dilates the
nostrils.
Innervation

-facial nerve
178

f.Levator anguli oris

Origin
-maxilla below infraorbital foramen.
Insertion
-skin at corner of the mouth.
Function
-raises the angle of the mouth
In smiling, depth and contour of
nasolabial furrow
Innervation

-facial nerve
179

180

Orbicularis oris
Origin

-from muscles in area;mailla and mandible

in midline.
Insertion
-forms ellipse around mouth.
Function
- varying kind of movements of lips like

pouting , pursing , twisting

Innervation

-facial nerve

181

PURSING OF THE LIPS

182

183

Buccinator
Origin

. arises from the posterior part of the maxilla and

mandible opposite the molar teeth and the

pterygomandibular raphe, which is a tendinous
band between the pterygoid hamulus superiorly
and the mandible inferiorly.
Insertion
-The fibers of the buccinator pass towards the
corner of the mouth to insert into the lips.
-Central fibers of the buccinator cross so that
lower fibers enter the upper lip and upper fibers
enter the lower lip.
-The highest and lowest fibers of the buccinator do
not cross and enter the upper and lower lips,
respectively.
184

Function

-Contraction of the buccinator presses

the cheek against the teeth. This

keeps the cheek taut and aids in
mastication by preventing food from
accumulating between the teeth and
the cheek.
-It also assists in the forceful expulsion
of air from the cheeks.
Innervation
-facial nerve.
185

Large thin sheet of

o Other muscles

1.Platysma

muscle in superficial
fascia of neck.
Arises below the
clavicle in upper part
of thorax and ascend
through neck of
mandible.
The more medial fibres
insert in
mandible,while lateral
fibers join with the
muscle around the
mouth.
It tenses the skin.
186

ACTION:releases pressure of skin on the

subjacent veins;depresses mandible,

pulls the angle of the mouth downwards
as in horror or surprise.

187

2.Auricular

muscles

1.Superior elevates
the ear.
2.Anterior pulls the
ear upward and
forward.
3.posterior-retracts
and elevates the
ear.
188

3.Occipitofrontalis
muscle

1.Frontal belly-covers
forehead and attached to
eyebrows.

Acting from above raise

the eyebrows and skin

over the root of the nose.
Acting from below draw

the scalp forward ,

throwing the forehead
into transverse wrinkles.
189

2.Occipital bellycovers posterior

aspect of skull and
is smaller.
-move the scalp
backward and
forward.
- wrinkle the
forehead.

190

SMILING MUSCLES
MUSCLES
Orbicularis Oculi: close

eyelid
Nasalis: compress/dilate
nasal openings
Levator Labii Superioris:
raise upper lip
Levator Anguli Superioris:
raise angle of mouth
upward
Zygomaticus: draw angle
of mouth upward
Risorius: draw angle of
mouth laterally

FROWNING
Frontalis: elevate

eyebrows
Orbicularis Oris: closes
mouth
Depressor Anguli Oris:
draw angle of mouth
downward
Depressor Labii
Inferioris: lowers lower
lip
Mentalis: draws chin up
Platysma: draws lower
lip down & back
191

Muscles of Facial Expression

Anger- Dilator naris &

Depressor septi
Frowning- Corrugator supercilli

Laughing& smiling-

Grinning- Risorius

Zygomaticus major

Sadness- Depressor anguli oris

Whistling- Buccinator

192

MODIOLUS
The modiolus is a chiasma of facial

muscles held together by fibrous tissue,

located lateral and slightly superior to each
angle of the mouth. It is important in
moving the mouth, facial expression and in
dentistry.
It derives its motor nerve supply from the
facial nerve, and its blood supply from labial
branches of the facial artery.
193

Formed by two

types of muscles:
1.Transverse
musles
-orbicularis oris
-buccinator
-risorius
-levator labii
suerioris
-depressor labii
inferioris

194

2.Cruciate muscles
-zygomaticus major
-depressor anguli oris(triangularis)
-levator anguli oris(caninus)
-platysma
Function of modiolus
Prevents food from being spilled out of the

mouth by constricting the corner of the

mouth close to the premolars during
chewing.
Helps in biting,chewing,swallowing,speaking
and various facial expressions.
Palpation
Bidigital.
195

CONCLUSION

The masticatory muscles include a vital part

of the orofacial structure and are important

both functionally and structurally.
It can be influenced by a variety of factors
many of which are controlled by the
practicing prosthodontist namely

During functional impression making

Accurate recording of various clinical

parameters like vertical dimension, centric
relation

Morphology of artificial tooth

Maintenance of arch form

196

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.

197

REFERENCES

Human anatomy by B.D. Chaurasia, 3rd ed.

Human anatomy by dental students by

M.K.Anand, 1st ed.

Complete denture prosthodontics by John J
sharry.
Mastering the art of complete denture by
Alexander R Halperin.
Anatomy for dental students by D.R
Johnson and W.J Moore
Burkits oral medicine diagnosis &
treatment 10th edition.
Textbook of Complete dentures by Charles
198
M Heartwell

Management of Tempromandibular disorders

and occlusion by Jeffrey P Okeson 4 rth ed.

Impressions for complete dentures by Bernard
Levin.
Jaw muscle activity in complete denture
wearers by Antje Tallgren, Dr Odont. J Prosthet
dent aug 1980 vol 44(2) 123-32
Feasibility of palpating the lateral pterygoid by
R Johnstone and Mc Cormick templeton J
Prosthet Dent 1980 Vol 44(3) 318-321.
An Electromyographic study of masticatory and
lip muscle functions in patients with complete
dentures by Bengt Ingervall, Dr Odont et al. J
Prosthet Dent March 1980 Vol 43(3) 266-71
199

THANK YOU
200