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Muscles of Mastication

1) Introduction





Introduction: Muscle: Tissue of characterized by the aggregation of cells whose primary role is to produce contraction, causing and allowing movements of parts and organs of the body It may also be defined as a band of contractile fibrous tissues, which produces movements in an animal body !uscle cells, which ma"e up the bundles, are long and narrow and one called as #I$%&' ( muscle fibre can be several cm in length and ) 1 mm in diameter the cell

membrane of the muscle fibre is called as '(%*+,&!(-( Mastication: %hythmic opposition and separation of .aws with the involvement of teeth lips, chee"s, tongue for chewing of food in order to prepare it for swallowing and digestion In simple words it is the process of chewing !astication is the first mechanical process to which entry in to alimentary tract The main purpose of mastication is to

reduce the size of food particles to a size that is convenient for swallowing /$olus formation) with the help of saliva The muscles concerned with mandibular movement during mastication and speech are four primary muscles 1) 2) 3) !(''&T&% T&!0+%(,I' !&DI(, 0T&%12+I-


,(T&%(, 0T&%12+I-

(nd some of the suprahyoid group of muscles being used as secondary or supplementary muscles they are 1) 2) 3) Digastric !ylohyoid 2eniohyoid 4ence the four primary muscles, which act upon mandible, are traditionally approved as muscles of mastication The muscles of mastication are primarily responsible for &,&5(TI-2, 0%+T%6DI-2, %&T%6DI-2 +% *(6'I-2 !(-DI$,& T+ !+5& ,(T&%(,,1 !uscles of mastication are powerful muscles have evolved through ages and got adapted to the re7uirement placed before it ( strong layer of fascia, derived from the deep cervical fascia and named the 0(%+TID #('*I(, covers the masseter and is firmly connected with it It is attached to the lower border of the zygomatic arch and invests the parotid gland

Development: The muscles of mastication are developed from the embryonic !&'+D&%! of different pharyngeal arches and are supplied of the nerve of respective arches 1) I ARCH OR MANDIBU AR ARCH !asseter Temporalis !edial pterygoid ,ateral pterygoid !ylohyoid (nterior belly of digastric !upplied "# mandi"ular nerve $) II ARCH 0osterior belly of digastrics 'upplied by facial nerve Ori%in: +rigin of a muscle is the end is the end of the muscle that is attached to the least movable structure Insertion: Insertion of the muscle it the other end of the muscle that is attached to the more movable structure

Action: (ction is the wor" that is accomplished when the muscle fibres contract 2enerally during action, insertion moves towards the origin &#pes: I) MA!!'&'R The masseter muscle is probably the most powerful of the muscles of mastication It is a 8uadrilateral muscle and has three layers i) ii) iii) 'uperficial layer !iddle layer Deep layer

(!uperficial la#er: superficial layer of masseter is largest Ori%in: It arises by a thic" aponeurosis from the zygomatic process of ma9illa and anterior 2:3rd of the lower border of zygomatic arch ; It s fibres passes downward and bac"wards at an angle of 3< and Insertion: Inserted into the angle and lower half of the lateral surface of the ramous of the mandible ( Middle la#er: Ori%in: It arises from the deep surface of the anterior 2:3 rd of the zygomatic arch and lower border of the posterior 1:3rd of the zymatic arch and passes vertically down wards Insertion: is inserted into the middle of the ramus of the mandibles

Deep la#er Ori%in: (rises from the deep surface of the zygomatic arch and its fibres pass vertical downward and Insertion: is inserted into the upper part of the ramus of the mandible and into the coronoid process The middle and deep layers of the masseter together constitute the D&&0 0(%T ;3 layers are separated posterio=inferiorly by an artery and nerve +n the account of its pro9imity to the s"in, the masseter can be palpated when it is thrown into contraction vigorously, as in clenching the teeth Relations !uperficial to t)e muscle (re the integument, platysma, risonius, zygomaticus ma.or and the parotid gland> the parotid duct, branches of facial nerve and the transverse facial cross the muscle Deep surface Mediall#: +verlies the insertion of templralis muscle and the ramus of the mandible,

a mass of fat separates it is front buccinator and the buccal nerve The massetric nerve and artery reach the deep surface of the muscle by passing through the dorsal part of the mandibular inclsure *osterior mar%in: Is overlapped by the parotid gland

Anterior mar%in: 0ro.ects over the buccinator and is crossed below by the facial vein Nerve suppl#: !(''&T%I* -&%5&, a branch of anterior division of mandibular nerve /which is the 3rd part of 5 cranial nerve= trigeminal nerve) Blood suppl#: !a9illary artery, which is a branch of e9ternal carotid artery Actions: &levates the mandible to close the mouth and to occlude the teeth in mastication Its activity in the resting position is minimal It has a small effect in side=to=side movement, protraction and retraction (lthough anatomically, there are 2 components of muscles that can be readily distinguished but in functional terms, this muscle is divided into 3 components namely Deep anterior Deep posterior 'uperficial anterior 'uperficial posterior

$) &'M*ORA I! Temporal facial covers the temporalis It is strong fibrous investment covered,

laterally, by the auriculars anteriorly and epicranial opoveurosis and orbicularies oculi superiorly 'uperficial temporal vessels and auriculo=tempotal nerve ascends over it (bove, it is a single layer, attached to the whole of the superior temporal line> below it has two layers one attached to the lateral and the other to the medial margin of the upper border of zygomatic arch ( small amount of fat ?ygomatic branch of the superficial temporal artery and ?ygomatic temporal branch of ma9illary nerve Deep surface of the fascia affords attachment to the superficial fibers of the temporalis &emporalis@ is a fan shaped muscle It has a very wide origin from the entire temnporal fossa and fascia covering the muscle It is a $ipennate muscle


(rises from the whole of the temporal fossa concept the part formed by the zygomatic bone) and from the deep coverage and descend into a tendon which passes through the gap between the zygomatic arch and the side of the s"ull, and> IN!'R&ION: Inserted to the medial surface, ape9, anterior and posterior border of the coronoid process of the mandible and the anterior border of the ramus of the mandible nearly as far as possible to the last molar R' A&ION!: !uperficial to t)e muscle are '"in Temporal fascia 'uperficial temporal vessels (uriculo temporal nerve Temporal branches of ficial nerve ?ygomatico temporal nerve, The galea aponeurotica The zygomatic arch !asseter D''* !UR,AC' Temporal fossa ,ateral pterygoid

'uperficial head of medial pterygoid 'mall pant of buccinator !a9illary artery and its deep temporal branches Deep temporal nerves $uccal vessels and nerves AN&'RIOR BORD'R (nterior border is separated from the zygomatic bone by a mass of fat *O!&'RIOR BORD'R !assetric nerves and arteries B OOD !U** Deep temporal part of ma9illary artery N'R.' !U** Temporalis is supplied by the deep temporal branches of the anterior trun" of mandibular nerve AC&ION! Temporalis elevates the mandible and so closer the mouth and appro9imates the teeth this movements re7uires both the upward pull of anterior fibres and the bac"wards pull of the posterior border, bAcoz the head of the mandible rests on the articular eminence when mouth is open The posterior fibres draw the mandible bac"ward after it has been protuded

It also contributes to side to side grinding movements +wing to the strength of the temporal fascia, the muscle is not easy to palpate, but its contraction is easy to feel Its upper limit can be made out along the inferior

temporal bone, when the teeth are formerly clenched 3) M'DIA *&'R-+OID Is a thoc" 86(D%I,(T&%(, !6'*,& It has two heads ( small superficial head ( larger deep head ORI+IN !U*'R,ICIA H'AD +riginates from ma9illary tuberosity .ust behind the third molar and #rom the lateral surfaces of the pyramidal process of the palatine bone D''* H'AD / AR+') +riginates fro the medial surface of the ,(T&%(, 0T&%12+ID 0,(T& and The grooved surface of the 01%(!I+(, 0%+*&'' +# T4& 0(,(TI-& $+-& Its fibres runs downward, laterally and bac"ward and are attached, by a strong tendinous lamina IN!'R&'O

Inserted into the posterior inferior part of the medial surfaces of the ramus and angle of the mandible, as high as mandibular foramen and nearly as far forward as the mylohyoid groove Thus, area is often rugged, due to tendinous fascicule in this attachment This is .ust opposite the masseter insertion on the lateral side

R' A&ION! !U*'R,ICIA - C A&'RA -

,ateral pterygoid 'pheno mandibular ligament !a9illary artery Inferior alveolar nerves and vassels ,ingual nerve 0rocess of parotid gland D''* !UR,AC' /M'DIA Tensor vili palatini 'tyloglossus 'tylopharyugeus (realar tissue N'R.' !U** $ranch of the main trun" of the mandibular nerve -)

B OOD !U** 0terygoid branch of 2nd part of ma9illary artery AC&ION! &levates of the mandible Bith lateral pterygoid these muscles helps ion protruding the mandible Bith opsilateral lateral pterygoid muscle, it helps in rotating the opposite condyles along a vertical a9i9 and helps in apposite side movements of the .aw 0) A&'RA *&'R-+OID It is a short, thic" muscle with two parts or heads 6pper head /small) ,ower head /larger) ORI+IN U**'R H'AD 1!MA Infra temporal surface and Infra temporal crest of greater wing of the sphenoid bone O2'R H'AD AR+' ,ateral surface of lateral pterygoid plate /opposite to the origin of the medial pterygoid)

Its fibres pass horizontally bac"ward and laterally and converge for insertion IN!'R&ION 'ome fibres from the superior head penetrate the capsule of T!C and insert into the anterior border of the articular disc of the .oint The remainder fibres from this origin and the fibres from the inferior origin insert into the nec" of the condyle i e 0T&%12+ID #+5&( on the anterior surface of the nec" of mandible R' A&ION! !U*'R,ICIA !UR,AC' / A&'RA -)

%amus of the mandible !a9illary artery Tendond of the temporalis and !asseter D''* !UR,AC' /M'DIA -)

6pper part of the medial pterygoid 'pheno mandibular ligament !iddle meningeal artery and !andibular nerve

U**'R BORD'R /!U*'RIOR -) Temporal and massetric branches of mandibular nerve

O2'R BORD'R /IN,'RIOR -) ,ingual inferior alveolar nerves The buccal nerve and the ma9illary artery past between the parts of the muscle N'R.' !U** The lateral pterygoid is supplied by a branch of anterior division of the mandibular nerve B OOD !U** 0terygoid branch of 2nd part of ma9illary artery AC&ION! 1) The lateral pterygoid assists in opening the mouth by pulling forward the condylar process of the mandible and the articular disc, while the head of the mandible rotates on the articular disc In the reverse movement of closure the bac"ward gliding of the articular disc and condyle of the mandible is controlled by the slow elongation of the lateral pterygoid, while the masseter and temporalis restore the .aw to the occlusal position

2) Bhen the medial and lateral pterygoid of the two sides act together, they protude the mandible so that the lower incisor pro.ect in front of the upper 3) (cting with the medial pterygoid of the same side, the lateral pterygoid advances the condyle of that side so that .aw rotates about a vertical a9is through the opposite condyle Different actions to the two parts of the lateral pterygoid muscle have been described, the upper /superior) head mug, being involved in chewing and lower head in protusion !'CONDAR- MU!C '! &A3IN+ *AR& IN &H' MA!&ICA&ION The 3 primary muscles of mastication are in turn supported or supplemented by few secondary muscles "nown as '60%(41+ID 2%+60 of muscles they are DI2('T%I* !1,+41+ID 2&-I+41+ID 'T1,+41+ID is other suprahyoid muscle, which does not ta"e part in mastication 4) DI+A!&RIC It has two bellies united by an inter=mediate rounded tendon The anterior belly and The posterior belly

It lies below the body of the mandible and e9tends, in an angled form, from the mastoid process of the chin ORI+IN AN&'RIOR B' -

Is attached to the digastric fossa on the base of the mandible close to the medium plane *O!&'RIOR B' -

,onger than the anterior and is attached in the mastoid notch of the temporal bone The fibres of posterior belly pass downwards and forward, and, fibres of anterior belly pass downwards and bac"wards The two bellies meet in an intermediate tendon, which perforates the stylohyoid IN!'R&ION The intermediate tendon in turn is help by a fibrous pulley attached to hyoid bone N'R.' !U** (nterior belly by mandibular nerve 0osterior belly by facila nerve



!astoid process with sternomastoid 'tylohyoid 0arotid gland 'ub mandibulat lymph nodes (ngle of mandible with medial pteygoid D''* Internal and e9ternal carotic artery ,ingual, facial and occipital arteries Internal .ugular vein 5agus, accessory and hypoglossal nerve !U*'RIOR 0osterior arricular artery 'tylohyoid muscle IN,'RIOR +ccipital artery

AC&ION! 1) The muscle has secondary role in mastication as a depressor muscle adding to the action of lateral pterygoid muscle when mouth is to be opened against resistance 2) &levation of hyoid bone 5) M- OH-OID It is a flat, triangular muscle for lying superior or deep to the anterior belly of digastric and both right and left muscle together form the floor of the mouth this is attached to the whole length of the mylohyoid line of the mandible ORI+IN It has 3 fibres= posterior, middle and anterior, which originates from the mylohyoid line of the mandible IN!'R&ION 0osterior fibres pass medially and slightly downwards and are inserted into the body of the hyoid bone (nterior and middle fibres from each side interest in a medium fibrous rouphe that unites right and left muscles of form floor of the mouth 'ometimes it is futed with the anterior belly of digastric

N'R.' !U** !ylohyoid nerve a branch of mandibular nerve branch of inferior also nerve AC&ION 1) The secondary role of this muscle is evidnent as a depressor seen in action when mouth is to be opened against resistance 2) It elevates the floor of mouth to help in deglutition R' A&ION! IN,'RIOR OR !U*'R,ICIA !UR,AC' Is related to platysma, anterior belly of digastric, superficial part of the sub mandibular gland, facial and sub mental vassals and mylohyoid nerves and vessels !U*'RIOR O, IN&'RNA !UR,AC' I in relation with geniohyoid, part of hyoglossus and styloglossus, hypoglossal and lingual nerves, sublingual gland, sub mandibular ganglion, sub mandibular duct, lingual and sublingual vessels, *O!&'RIOR Bith mucous membrane of mouth


+riginates from inferior general tubercle on the lingual surface of anterior part of the mandible IN!'R&ION #ibres run bac"ward and downward and inserted into the anterior surface of body of the hyoid bone N'R.' !U** #irst cervical spinal nerve through the hypoglossal nerve AC&ION 2eniohyoid elevates the hyoid bone and draws it forward, thus acting as a partial antagonist to stylohyoid Bhen the hyoid bone is fi9ed, it depresses the mandible MU!C ' *RO&'IN! *+-T%(TI,& 0%+T&I-'= (*TI+- /T4I-) (-D !1+'I %&26,(T+%1 0%+T&I-'= T%+0+-I- T%+0!1+'I('

&RO*OM-O*!IN 'trand li"e and covers acting molecular &RO*ONIN present along with tropomyosin, has 3 component 1) Troponin *= has affinity for *a DD

2) Tropnin has strong affinity for acting and does not allow it to combine with myosin 3) Troponin E combines with tropomyosin *H-!IO O+-: -&6%+=!6'*6,(% +F&-'&-= oral surgery T%(-'!I''I+- /-!T) The function of masticatory system is comple9 ( highly refined neurologic

control system regulates and co=ordinates the activities of the entire masticatory system system The basic component of neuro=muscular system is the motor unit,, which consists of muscle fibres that are innervated by one motor neuron each neuron .oins the muscle fibres at the motor end plats which has thic" soorcolema There are folds of end plate are called as G'6$ -&6%(, #+,D'G, which increases the surface area of end plate region *ell membrane of nerve terminal or H0%&=C6-*TI+-(, !&!$%(-&G and muscle fibre /end) plated is H0+'T C6*TI+-(, !&!$%(-&G The space b:w the pre and post .unctional membrane is called as H-&6%+=!6'*6,(% *,&#TG This cleft It consists primary of nerves and muscler, hence the term neuro=muscular

contains choline esterase enzyme /which destroys acetyl choline) !otor nerve terminal contains abundant mitochondria and vesicles containing (ch /(cetylcholine) %eceptors of (ch are present in post .unctional membrane /motor and plate) !'6U'NC' O, '.'N&! IN NM&

-=! transmission is chemical Bhen the neuron is activated, there is a opining up of *a DD channels> *a the nerve terminals



There is fusion of (ch vesicles with pre=.unctional membrane, by &I+*1T+'I' vesicles enters neuromuscular cleft (ch reach the post=.unctional membrane and bind with the receptors present there

(s a result of the combination of (ch and receptors, the -a D and *aDD permeability increases, the entry of -a D and *aDD causes end plate potential, i e there is depolarization /which causes muscle to contract) Bhen nerve and plate potential reaches<) !v, (p is hired in end plate region This (p /(ction potential) enters sarcoplasm via T tobule, *a DD from terminal cichern is released into scarcoplasm and *aDD combines with troponin * /strand li"e with covers action) Tropemyosin is shafted thus uncovering binding sites on action / thin filaments of myofibrils) There is formation of cross bridge between myosin head /thic" filament of myofibrils) and action The action filaments are pulled which slides past myosin towards centre of sarcomene thus the muscle contracts The sloding of action filaments even myosin c:a sliding filament theory of wal" along theory /bAcoz action filaments wal" along myosin filaments) &nergy for sliding of filaments obtained by hydrolysis of (T0+ brought about by myostu (T0+ ats enzyme present in myopsin head (s, the masseter has greater number of motor fibre pre motor neuron, which corresponds to its move gross function of providing the face necessary during masseter MU!C ' ,UNC&ION

The motor unit can carry only one action i e contraction or shortening, the entire muscle, however has three potential function A) I!O&ONIC CON&RAC&ION Bhen the muscle shortening and moves a load, the contraction isotonic 4ence the load remains constant and e7ual to the muscle tension throughout the most of the period of contraction It occurs in the masseter, when the mandibular elevated forcing the teeth through a bolus of food B) I!OM'&RIC CON&RAC&ION Bhen a muscle does not shorter and length remains same /iso= same, metry= length), but develops tension, the contraction is isometric 'uch type of contraction

occurs when muscle attempts to move a load that is greater than the tension developed in muscles, this occurs in masseter when an ob.ect is held between the teeth eg 0ipe or pencil

C) CON&RAC&ION R' A7A&ION Bhen stimulation of the motor unit is discontinued the fibres of motor unit rela9 and return to their normal length This is seen in masseler when the mouth opens to

accept new bolus of food during mastication

CH'2IN+ C-C ': consists of 3 phases /(00,I&' +%(, 041'I+,+21= ,&5&,,&) 1) (n opening phase 2) ( closing phase 3) (n occlusal phase During both the opening and beginning of closing phases, the masticatory muscles under go isotonic contraction or rela9ation phases> however, tension builds up in the elevator muscles &levator muscular contraction is strictly isometric only when

the teeth are in contact or when there is a hand unyielding ob.ect b:w them During the chewing, the change from isotonic to isometric contraction is gradual and not abrupt The opening movement appears to be only .ust suffieicnt to clear the

bolus> tooth contact with bolus occurs soon after beginning of closing phase !astication is characterized not only by a simple straight opening and closing of the .aw but also %&T%6'I5&, 0%+T%6'I5& and ,(T&%(, C(B movements chewing cycle lasts appro9imates ) J to 1 ) sec During the closing phase, the temporalis muscle on the wor"ing side is first to become active, followed by masseter and temporalis of the balancing side /non= wor"ing) The masseter and medial pterygoid are first to become active during incisive during both mandibular protension and opening although it is not strictly a mandibular depressor The suprahygoid muscles /digastric, mylohygoid, geniohyoid) become &ach

active during .aw opening

During opening initial phase of isotonic closing from an open position, the depressor muscles are first activated The depressor muscles then gradually rela9 to

allow the mouth to be closed by the passive tension in the elevator muscles and ligament During opening, there is usually a lateral mandibular shift to the wor"ing /.unctional) side The mandible then swings bac" during closure into the intercuspal the intercuspal position During initial phase of opening or terminal phase of closing, tooth contact glodes may occur as apposing teeth contact one another mandibular body move during mastication The wor"ing side condyle moves laterally during the opening phase, whereas, opposing condyle on the balancing side moves medially downwards and forwards The wor"ing side condyle rapidly assumes its position within its fossa early in the closing phase, whereas balancing side condyle moves bac" into its fossa in the latter phase of closing N'URA MA!&ICA&ION R'C'*&OR! Thus, both condylar head and

&ach muscle is innervated by =efferent motor neurous that supply e9trafusal muscle fibres whereas =efferent supply intrafusal muscle fibres of muscle spindles 'ensory receptors in s"eletal muscle generally comprise two basic groups i e

#ree and encapsulated nerve endings #ree nerve endings are generally bellowed to be primarily some may be sensitive to non=no9ions stimulus eg muscle stretch MU!C ' !*IND '! They comprise stretch sensitive, slowing adopting specialized /intrafusal) muscle fibres that are contained within a capsule lying parallel to e9trafusal muscle fibres The spindle generally has a double afferent innervation a) ,arge 12=2) hm diameter b) small 3=12 hm diameter The efferent /motor) supply to the intrafusal fibres is derived from =motor neurous located with in *-' some muscles eg mandibular elevators /masseter, medial pterygoid and temporalis) have large number of facial muscles have few This suggests that these latter muscles have either alternative meane of proprioceptive control eg free nerve endings: or depend on other stretch sensitive afferents eg receptors in T!C The formes i e masseter, temporalis and medial pterygoid muscles contain numerous spindles which relay information to the brain about muscle length The spindle afferents from the masseter, temporalis and medial poterygoid muscles appear uni7ue, in that cell bodies reside with in *-' i e T%I2&!I-(, !&'&-*&04(,I* -6*,&6' There is a concept that the muscles spindles may be involved in correcting small errors between the intended and actual mandibular movements and maintaining a constant posture against the effects of gravity

+O +I &'NDON OR+AN! The golgi tendon organs are receptors primary located at muscle=tendon .unctions /or T!C capsule) diameter) fibres They are innervated byit myclinated afferent /J=12 mm

There is no evidence of such units with in masticatory muscles or

tension receptors afferents in the irigeminal ganglion *'RIODON&A M'CHANOR'C'*&OR! The 0D, contains mechanoreceptors that respond to the teeth They have wide range of properties 'ome of these are e9cited by .ust a few mictons of tooth displacement 'ome are less sensitive that respond only to the much larger forces 'ome e9hibit directional sensitivity, with nerve fibres responding ma9imally to the forces in one particular direction 'ome are slowly adopting and produce continous discharge when a constant stimulus or applied 'ome adopt more rapidly 'ome adopt very rapidly and do not respond unless a very rapid stimulus is applied The cell bodies of some of these are located in the T%I-2&!I-(, /2(''&%I(-) ganglion, while others in the irigeminal mescncephalic ganglion MUCOU! M'MBRAN' R'C'*&OR!

The types of receptors respond to the pressure in the palate, particularly in the region distal to central incisors 8OIN& R'C'*&OR! #ree nerve fibres comprise the predominant receptors in the T!C capsule In

addition a few comple9 receptors have been recorded including %6##I-I, 0(*I-I((-D 2,+2I %&*&0T+%' These last appear to be confined to the lateral aspect of

the .oint capsule and lateral ligament and supplied by a branch of aurioculo=temporal nerve These receptors appear to be associated with .oint location perception !'N!OR- R'C'*&OR! 'pecific sensory receptors provide specific information to the afferent neunous and thus bac" to *-' 'ome of these receptors are specific for DI'*+!#+%T (-D

0(I- These are called as -+*I*&0TI5& %&*&0T+%' +% -+*I*&0T+%' +ther receptors provide information regarding the position and movement of the mandible and associated oral structures These are called as 0%+0%I+*&0T+%' 8A2 R'* '7'! They are of two types 1) 'imple9 refle9es=eg=mandibular depression 2) *omple9 refle9es eg= masticatory activities

8A2 C O!IN+ R', '7 The simple .aw closing refle9 or /Caw=Cer") has a K ms latency period between stimulus and movement There is stretch induced masseter or tempolis spindle activation, with the afferents passing to the trigeminal motor nucleus via trigeminal mesenchepalic nucleus &fferent then effects appropriate muscle contraction Tapping on the chin initiates the .aw .er" refle9 (fter a brief depression of the

mandible, there is refle9 response in the masseter temporalis muscles, following an Jcms latency If the .aw .er" is repeated with the sub.ect voluntarily biting on a hard

ob.ect, ther is mar"ed increase in refle9 masseter muscular activity There is then followed by 'I,&-T perio=dominant during which the masseter does not activity, but passes though a period level of activity, but passes through a period of decreases activity, during which the muscle of totally inactive If the teeth are clenched with nothing between them, the .aw .er" is depressed> although silent period is still present There is no reverse .aw .er" i e there is no detectable response in either the elevator or depressor muscle of a rela9ed sub.ect if the chin is tapped from under health 8A2 O*'NIN+ R', '7

It is a response to or facial stimuli and involves two or more synapses and e9citation of the motor neurons that supply the digastric and inferior head of lateral pterygoid muscles The interneurones relaying the sensory afferents from the orofacial region to the digastric motor neurons are located in the irigeminal spinal tract muscles and ad.acent reticular formation &lectrical oral stimulation of sub.ect whose elevator and depressor are released results in now .aw muscle activity Bhen the elevator muscles are voluntarily

contracted, there is masseteric inhibition, with two periods of inhibition with latencies of 1< and 3< cms (fter stimulation, a slight opening movement occurs presumably reflecting elevator muscular inhibition These opening could evo"e a stretch refle9 in the elevator muscles &OO&H CON&AC& R', '7'! Bhen the upper and lower teeth snapped together, refle9 changes occur in the elevator muscles, similar to those produced by mechanical single tooth stimulation This transient activation is followed by a silent period associated activity comparable effects on the depressor muscles 8A2 UN OADIN+ R', '7 There are no

Bhen the .aw is suddenly unloaded, a protective refle9 immediately limits further .aw closing muscular activity This sudden reduction and complete cessation of elevator muscle activity is associated with refle9 e9citement of the .aw depressor muscles HORI9ON&A 8A2 R', '7 ,ateral, protrusive and retrucive refle9 mandibular refle9es are important in direly controlled masticatory mandible movements (lthough lateral mandibular movement

refle9es resulting from lateral prerygoid contraction, can be elicited from facile tooth or oral mucosal stimulation these refle9 pathways have bee sub.ected scant en7uiry '7AMINA&ION O, MA!&ICA&OR- MU!C ' To perform the muscle and .oint palpation, the patients is first instructed that contain muscles are going to be pressed in order to help better understand the pain problem, that the procedure may be uncomfortable at times and the 7uestions about discriminating pressure from pain and about pain intensity of palpation will be as"ed In epidemiological studies, ) L "g for e9tra oral muscles and ) 3< "g for intra oral muscles and T!C Time for which pressure is to be held is un"nown but 3=< secs

appears to be reasonable *OIN&! &O CON!ID'R 1) 2) !uscles are palpated with the patient sitting upright +perator faces the patient, with weight evenly balanced on both feet and fore arm parallel to the floor

3) 3)

0atient and operator both are to be rela9ed 0atient is told to respond to any pain or discomfort on either or one side when unilateral pressure is applied


0hysiological and psychological factors affect the report of pain on palpation There include activation or sensitization of local peripheral nociceptors, sensitization of second order neurous, and altered processing at the ophthalmic level and above, which can include perceptual or neunological mechanisms Thus evaluation of reported tenderness needs to include consideration of other factors such as age, vulture, se9, gender, and pain duration and disease states

'.A UA&ION O, &'M*ORA I! It is a fan shaped muscles and the posterior fibres above the ear, anterior fibres in the depression lateral to the eyebrows and the temporally tendon at the superior and anterior aspect of the coronoid process /metraorally), are palpated Thumb is placed anteriorly .ust behind and above the eye, the second finger on the middle belly and the third finger on the posterior belly 0atient is as"ed to clench firmly, it can also be palpated introlarally into its insertion is the coronoid process '.A UA&ION O, MA!!'&'R

(s" the patient to do powerful clenching and the superior belly is clearly visible 0alpate anterior border The deep belly is palpable with one finger under the zygomatic arch in front of the ear areas of palpation are 1) 2) 3) +rigin $ody Insertion

It can also be palpated by $inanual palpation with inde9 finger of one hand placed intra orally over the muscle and inde9 finger of other hand e9tra orally over the muscles, and pressure is applied all over the muscle

'.A UA&ION O, A&'RA *&'R-+OID It is not possible to palpate the superior head of the lateral pterygoid directly, but palpation of lateral poles give indirect information about it It is done with e7ual pressure of the finger on the lateral poles of the condyles as the patient open and closes the mouth 0alpation of the inferior head is by running the inde9 finger sliding bac", buccally and behind the tuberosity '.A UA&ION O, M'DIA *&'R-+OID It is palpated by sliding the finger inde9 lingually and by applying pressure the insertion of the muscles above the corner /angle) the mandible