Академический Документы
Профессиональный Документы
Культура Документы
PRESENTED BY:
DR.MURALI P.S
DEPARTMENT OF ORTHODONTICS AND
DENTOFACIAL ORTHOPAEDICS
MUSCLES OF
MASTICATION
CONTENT
Introduction
Development of muscle of mastication
Anatomy of Muscles of mastication
Physiology of muscles of mastication
Characteristic of muscles of jaw
Palpation of muscles of mastication
Significance in relation to orthodontics
Masticatory muscle disorder
pathological diseases of muscles of mastiction
Conclusion
INTRODUCTION
Orthodontist aim is to achieve
FUNCTIONAL EFFICIENCY
STRUCTURAL BALANCE
ESTHETIC HARMONY
to achieve this balance not only our concepts regarding
occlusion has to be clear,,,,,,,,,,,
It is also important that we realize and study the action of
various muscle of expression, mastication, deglutition,
speech and breathing.
INTRODUCTION
Orthodontist aim is to achieve
FUNCTIONAL EFFICIENCY
STRUCTURAL BALANCE
ESTHETIC HARMONY
to achieve this balance not only our concepts regarding
occlusion has to be clear,,,,,,,,,,,
It is also important that we realize and study the action of
various muscle of expression, mastication, deglutition,
speech and breathing
DEVELOPMENT
Muscles of mastication develops from the
Temporalis :
Begins lateral development in the 8th week ,
Masseter:
Begins attachment to the zygomatic arch as it
undergoes lateral growth, providing space for
muscle development.
Pterygoid muscle:
Differentiate in the 7th week.
It is related to the cartilage of the cranial
ANATOMY
ORIGIN
INSERTION
BLOOD AND NERVE SUPPLY
ACTION
MASETTER
This
is
quadrilateral
muscle.
which covers the lateral
surface of the ramus of
mandible
Its fibres has 3 layers
Superficial
Middle
Deep layers
Origin:
superficial
layer
INSERTION:
RELATIONS:
Superficial relations:
Skin, Platysma Risorious, Zygomaticus Major and
Parotid Gland.
Muscle is crossed by the parotid duct, branches of
facial nerve and transverse facial vessels.
Deep relations :
Temporalis and mandibular ramus.
A mass of fat separates it in front of the buccinator and
the buccal nerve.
Masseteric nerve and artery reach the deep surface of
the muscle.
Nerve supply:
Supplied by masseteric nerve a
branch of anterior division of
mandibular nerve
Blood supply:
Supplied by masseteric artery
branch of maxillary artery and
venous
supply
through
masseteric vein
Action:
Elevation(bilateral):masseter elevates the
TEMPORALIS MUSCLE
Large, fan shaped
muscle.
The muscle is
covered by a strong
membranous sheet of
fascia, which attaches
superiorly to superior
temporal line.
Origin:
originates from the temporal fossa and
Insertion:
It's
Relations:
Superficial :
Skin, temporal fascia, superficial temporal vessels,
auriculotemporal nerve, zygomatico temporal
nerve zygomatic arch and Masseter muscle.
Deep Relation :
Temporal fossa lateral pterygoid, superficial head
of the medial pterygoid and maxillary artery.
Nerve Supply :
Deep temporal branches of the anterior trunk of
the mandibular nerve.
ACTIONS :
i.Elevation(bilateral): Temporalis elevates the
mandible to close mouth and approximate the
teeth, this movement requires the both the upward
pull of the anterior fibres and backward pull of the
posterior fibres.
Retrusion(bilateral): the posterior fibers of
temporalis lie in an almost horizontal plane and
therefore are in a good position to pull the
protruded mandible to a centric position.
MEDIAL PTERIGOID
Deep head:
Origin: Medial surface
of the Lateral plate of
Pterygoid process and
Pyramidal process of
Palatine bone.
Insertion : Medial
Superficial head:
Orgin:Tuberosity of the
Action :
Elevation (bilateral) : the medial pterygoid
Lateral pterygoid
Upper head:
Origin : It arises from
the infratemporal
surface and crest of the
grater wing of the
sphenoid bone.
Insertion: The upper
head passes posteriorly
and lateraly to insert
into the articular
capsule and the
articular disc.
Lower head:
Origin :It arises from the
Action :
Action of 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).
RELATIONS:
Superficial :
Ramus of mandible, maxillary artery and the
tendon of temporalis
Deep :
Upper part of the medial pterygoid,
sphenomandibular ligament, middle meningeal artery
and mandibular nerve.
Upper border : It is related to the temporal and
Masseteric branch of mandibular nerve.
Lower border : It is related to the lingual and inferior
alveolar nerve.
The buccal nerve and maxillary artery pass
between two heads.
Digastric
Posterior belly:
Ori : Mastoid process
of Temporal bone
Anterior belly:
Ori : Body of Mandible
Ins : Intermediate
Nerve supply :
Facial Nerve (post belly)
nerve to mylohyoid (ant belly)
Action :
Depresses Mandible or elevates Hyoid
bone
Stylohyoid:
Ori : Styloid process
Ins : Body of Hyoid
bone
Nerve supply : Facial
nerve
Action : Elevates
hyoid bone
Mylohyoid:
Ori : Myloid line of
body of Mandible
Ins : Body of Hyoid
bone and fibrous raphe
Nerve supply : Inferior
Alveolar nerve
Action : Elevates floor
of mouth and hyoid
bone or depresses
mandible
Buccinator
Is thin quadrilateral muscle,
occupying the interval between
the maxilla and the mandible
.
cerebral cortex
basal ganglia
peripheral influences
(e.g. peridontium, muscles )
Mandibular Closing :
Mandible is elevated slowly without
occlusal contact, is brought about by the
contraction of the masseter and medial
pterygoid muscle.
Mandible is elevated against resistance, it
is brought about by the contraction of the
temporalis, masseter and medial pterygoid
muscles.
MANDIBULAR OPENING :
PROTUSION :
The lateral and medial
pterygoid muscles contract
together, in conjunction with
controlled stabilizing
relaxation of opening muscle
RETRUSION :
Voluntary mandibular retrusion
with occlusion is brought about by
contraction of the posterior fibers of
the Temporalis muscle and by the
suprahyoid and infrahyoid muscles.
Retraction of the mandible from
protrusion and without occlusal
contact is effected by the
contraction of the posterior and
middle fibers of the Temporalis
muscles.
PHYSIOLOGY OF MUSCLES OF
MASTICATION
It is skeletal muscle.
Types of muscle fiber:
Slow muscles fibers (type I)
Fast muscles fibers (type II)
Lateral movement:
Lateral movement of the mandible to the
right side without occlusal contact is
achieved by ipsilateral contraction of
primarily the posterior fibers of the
Temporalis muscle.
Movement to the left side without
occlusal contact is brought about by the
contralateral contraction of the medial
pterygoid and masseter muscles.
Movement to the right side with
occlusal contact is achieved by ipsilateral
contraction of the Temporalis muscle.
Movement to the left with occlusal
contact is brought about by contralateral
contraction of the medial pterygoid and
masseter muscles.
45
fibers
Acc. To burke et .al 1973 type can be subdivided
into fibers which fatigue easily [type IIB] and the
other one which are resistant to fatigue [type II A].
Type IIA is found in 30 % only in digastric
muscle.
Type IIB is found in 45 % in the superior
temporalis, posterior medial pterygoid, and
anterior digastric muscle. [Acc to Eriksson]
Myotactic reflex
47
contract.
Myotactic reflex
50
This
52
Characteristics of the jaw muscles: The mandible being maintained against the
56
independently palpated.
Anterior region: - Palpated above the zygomatic
arch and anterior to the TMJ.
Middle region: - Directly above TMJ and superior
ear.
Otherwise, the patient is asked to clench the teeth so
that the temporalis contracts and this is felt with
hands.
Functional manipulation
Three
muscles that are basic to jaw movements
.
but impossible or nearly impossible to palpate are
(1) the inferior lateral pterygoid,
(2) superior lateral pterygoid,
(3) medial pterygoid.
Stretching:
The inferior lateral pterygoid stretches
when the teeth are in maximum
intercuspation. Therefore if it is the
source of pain when the teeth are
clenched, the pain will increase.
When a tongue blade is placed
between the posterior teeth, the
intercuspal position (ICP) cannot be
reached; therefore the inferior lateral
pterygoid
does
not
stretch.
Consequently, biting on a separator
does not increase the pain but may
even decrease or eliminate it.
lateral pterygoid.
These observations are exactly the same as for the elevator muscles.
Stretching is needed to enable superior lateral pterygoid pain to be
distinguished from elevator pain.
Stretching:
-As
Functional
pterygoid
manipulation
of
the
medial
Stretching.:
The
medial
pterygoid
also
Role of masticatory
muscle in orthodontics
70
73
. According
Brachyfacial
88
SPLINTING):
CLINICAL CHARACTERISTICS
Structural dysfunction: decreased range of
DEFINITIVE TREATMENT;
Treatment should be directed toward the reason for the
co- contraction. When co- contraction results from
trauma, definitive treatment is not indicated because the
cause is no longer present.
When co-contraction results from the introduction of a
poorly fitting restoration, definitive treatment consists of
altering the restoration to harmonize with the existing
occlusion. Altering the occlusal condition to eliminate cocontraction is directed only at the offending restoration
and not the entire dentition. Once the offending
restoration has been eliminated, the occlusal condition is
returned to its preexisting state, which resolves the
symptoms.
SUPPORTIVE THERAPY:
It begins with instructing the patient to restrict use
CLINICAL CHARACTERISTICS
Structural dysfunction: marked decrease in the
velocity and range of mandibular movement (full
range of movement cannot be achieved by patient)
Minimum pain at rest
Pain increased with function
Actual muscle weakness present
Local tenderness when the involved muscles are
palpated
DEFINITIVE TREATMENT
or other).
CLINICAL CHARACTERISTICS
Structural dysfunction: marked restriction in
DEFINITIVE TREATMENT:
CLINICAL CHARACTERISTICS
Structural dysfunction:
The heterotopic pain is felt even at rest.
Pain may increase with function.
When provoked,the trigger points increase the heterotopic pain.
DEFINITIVE TREATMENT
Eliminate any source of ongoing deep pain input in an
appropriate manner according to the cause.
Reduce the local and systemic factors that contribute to
myofascial pain.
If a sleep disorder is suspected, low dosages of a tricyclic
antidepressant, such as 10 to 20 mg of amitriptyline
before bedtime, can be helpful
Clinical charecteristic:
structural dysfunction.
Significant pain at rest
Pain increased with function
Generalized feeling of muscle tightness
Significant pain to muscle palpation
As chronic centrally mediated myalgia becomes protracted, it
DEFINITIVE TREATMENT
of mastication
MYASTHENIA GRAVIS
It is a chronic disease with progressive weakness of
skeletal muscles
Caused by destruction of acetyl choline receptors at
neuromuscular junction
This is autoimmune condition
Muscles of mastication are involved before any other
muscle group
Difficulty in mastication ,deglutition and dropping of
jaw is seen
Treatment
Drug of choice is physostigmine and anticholinisterase
administered intramuscularly(im) ,which improves the
strength of muscles in minutes
TRISMUS
There is stiffness of muscles of mastication
Etiology
Local infection pericoronitis,dentoalveolar abscess
Direct trauma to muscles of mastication
Cns tetanus, rabies
Local infection
Pressure is on med.Pterygoid and masseter leading
to irritation and consequent spasm
Tetany
Infection is caused by clostridium tetanus which
releases powerful exotoxin thus destroying the
spinal inhibition causing uncontrolled muscle spasm
In muscles of mastication it causes lock jaw
Conclusion:
It is crucial responsibility of orthodontist to
REFERENCES
Thank you