1

GOOD MORNING

“Nothing is more fundamental to treating

patients than knowing the anatomy”

MUSCLES OF
MASTICATION
Presented by:
Sohail
1st year PGT
 2

 Introduction
 Development / Embryology
 Muscles of mastication (in detail about each)
 Movements of mandible at TMJ

 Physiology of masticatory muscles

 Mastication – Role of masticatory muscles
- Reflexes
 Investigations
 Disorders of muscles
 INTRODUCTION 3

 MUSCULUS – “little mouse”

 Is a soft tissue found in most
animals
 Muscle cells -protein filaments
of actin & myosin -contraction –
changes length & shape of the
cell
 DEVELOPMENT 4
 INTRODUCTION
 Day 17 – 3 germ layers
 Day 19 – mesodermal plate cleaves – diff of somite plate -
somites
 Day 20-21 – 42-44 pairs of somites
 Myocoele, Sclerotome , Dermatome, Myotome

 SKELETAL MUSCLES
 MUSCLES OF MASTICATION
5
6
 7
4th week- the oral pit is surrounded by several
masses of tissue. Pharyngeal arches are also
evident below the pit & on the sides of the
neck

During 5th & 6th weeks - primitive

muscle cells from mesoderm of
mandibular arch begin to
differentiate.

By 7th week - cells migrate into areas

where they will differentiate into
muscles of mastication.

By 10th week - muscle masses become

well organized & 5th cranial nerve
branches are incorporated.
 Skeletal muscle –
8
structure & physiology
 Cylindrical in shape
 Average length – 3cms
 Diameter – 10-100um

Muscle
Tendon BONE
fibre
 Cell membrane – plasma 9
membrane/ sarcolemma

 Sarcoplasm

1. Nuclei
2. Myofibril
3. Golgi apparatus
4. Mitochondria
5. Sarcoplasmic reticulum
6. Ribosomes
7. Glycogen droplets
 MYOFIBRIL 10

 Fine parallel filaments present in the sarcoplam

 Run through the entire length

MICROSCOPIC STRUCTURE
MUSCLES Of 11

MASTICATION
 Rhythmic movement of the jaw is a 12
series of cyclical movements

 Masticatory system includes

1. Temporomandibular joint
2. Mandible
3. Teeth &
4. Muscles of mastication.
 13

 Participate in all jaw movements involved in mastication,

deglutition and other non masticatory movements

 Voluntary muscles

 Originate from the skull, span the TMJ, and insert into the
mandible. On contraction, they act to move the mandible.
 TYPES 14
Dr.Frank Gaillard et al

• MASSETER • SUPRA HYOID MUSCLES

• TEMPORALIS • DIGASTRIC

• MEDIAL PTREYGOID • MYLOHYOID

• LATERAL PTERYGOID • GENIOHYIOD

• INFRAHYOID MUSCLES
(Sternohyoid,Omohyoid
,Thyrohyoid muscles)

PRIMARY SECONDARY
 15

Origin

Insertion
Innervation
Relations
Actions
Vascular supply
Clinical importance
 MASSETER 16

1. SUPERFICIAL LAYER

2. MIDDLE LAYER
3. DEEP LAYER

 The width of the muscle at its origin ranges from 27 to 39mm

in brachycephalic skulls, its anterior border length 51 –
70mm, and its posterior length 40 – 62mm.

 Its physiologic cross section is 2.75 cm square

 About 29.9% of the total masticatory muscle mass.
 PAROTID FASCIA 17

 Strong layer of fascia

 Derived from deep cervical fascia
 Covers the masseter and firmly connected to it
 Attached – lower border of zygomatic arch
 Invests the parotid gland
18
 ORIGIN AND INSERTION
19
Superficial
layer

INSERTION
ORIGIN – -
• Maxillary process
• Angle
of
zygomatic
• Lower post
bone half of
• Ant 2/3rds
lateral of
surface
inferior
of
border of zygomatic
ramus
arch
 ORIGIN AND INSERTION
20
Middle
layer

ORIGIN -
• Medial aspect of ant
INSERTION -
2/3rds of zygomatic
Central part of ramus of
arch
mandible
• Lower border of post
3rd of this arch
 ORIGIN AND INSERTION
Deep 21
layer

ORIGIN - Deep surface of

zygomatic arch

INSERTION – Upper part

of
• Mandibular ramus
• Coronoid process
 RELATIONS 22

Superficial : Platysma , Risorius ,Zygomaticus

major, Parotid gland, Parotid
duct, Branches of the facial nerve

Deep Surface: Overlies the insertion of

Temporalis &Ramus of the
mandible.
VASCULAR SUPPLY AND 23
INNERVATION
 ACTIONS 24

Elevates the
mandible

• Side to side
movement
• Protraction
• Retraction
25
 26

CLINICAL
IMPORTANCE
 27

Massetric hypertrophy Submassetric space infections

 28
 Variations :-

 Deep masseter fibers may be fused with fibers

of the temporalis muscle
 A connection with the buccinator muscle was observed
by Haller (1978)
 Rare anomaly-phocomelia, the muscle is absent.
 Some fibres may circle around the mandibular angle and
join the medial pterygoid muscle – forming a powerful
sling
 29
TEMPORALIS

Accounts for 37.5 % of the total masticatory muscle mass with a

crosssectional diameter of 4.1 cm 2

- Mc Donald & Andrews 1953

Zenker 1955 ; Schumacher &
Shinker 1960
TEMPORAL FASCIA 30
ORIGIN
31

• Whole part of
temporal
fossa
• Deep surface
of temporal
fascia
INSERTION
32

i) Medial surface,
Apex, Ant & post
borders

Coronoid process

ii) Ant border of

ramus of
mandible upto
the last molar
tooth
 Relations 33

 Superficial – Skin, temporal fascia, superficial temporal

vessels, Auriculotemporal nerve, zygomatic arch , masseter,

 Anterior border – separated from zygomatic bone by a

mass of fat
 Posterior border – Above – temporal fossa
Below – major components of
Infra temporal fossa
VASCULAR SUPPLY 34
NERVE SUPPLY 35
 ACTIONS 36

1. Elevates the
mandible
2. Side to side
grinding
movements
3. Posterior fibres –
retract the
protruded
mandible
37
 CLINICAL IMPORTANCE
38

 When lower dentures are fitted, they should not

extend into the retromolar fossa to prevent trauma
of the mucosa due to the contraction of the
temporalis muscle.

 A plane exists between the temporal fascia which is

attached to the superior surface of zygomatic arch & the
muscle beneath the arch…
 Elevator is introduced into this plane beneath a fractured
zygomatic arch/bone in order to reduce the fracture 
Gillies approach
 Variations 39

 Variations in the thickness and surface areas of temporalis

muscle are relatively common.

 Occasionally the muscle is placed far superiorly and closely

approaches the sagittal suture.

 The most anterior tendon insertion may extend very close to the
third molar

 Henke (1884) applied the term “lesser temporalis” to a bundle

that arises from the articular disc of the TMJ lateral to the lateral
pterygoid muscle and fuses with the posterior border of the
temporalis in the deep layer of the masseter muscle.
MEDIAL PTERYGOID 40
ORIGIN AND INSERTION 41
 Relations 42
Upper part of muscle is
separated from the lateral
pterygoid muscle by
a) lateral pterygoid plate
b) lingual nerve
c) inferior alveolar nerve

Inferiorly the muscle is

separated from ramus of
mandible by nerves,the
maxillary artery and
sphenomandibular ligament.
Medial surface – tensor palatine
& superior constrictor
Lateral surface - Ramus
Vascular and nerve supply 43
 Actions 44

1.Elevation : (bilateral)
2.Protrusion : (bilateral)
3.Contralateral excursion: (unilateral)
 CLINICAL IMPORTANCE 45

 IANB

 Intraorally ,to palpate the medial

pterygoid muscle slide the index finger a
little posterior to the insertion site of
inferior alveolar nerve block, to where
the muscle is felt & press laterally.
 46

LATERAL PTERYGOID
ORIGIN AND INSERTION
47
 Relations 48
SUPERFICIAL
Ramus of the mandible
Maxillary artery
Tendon of temporalis and masseter

DEEP SURFACE
Upper part of the medial pterygoid
Sphenomandibular ligament
Middle meningeal artery
Mandibular nerve

UPPER BORDER
Temporal and massetric branches
of the mandibular nerve

LOWER BORDER
Lingual and inferior alveolar nerve
BLOOD SUPPLY 49
Nerve supply
50

i) 1 for each head –

anterior trunk of
mandibular nerve

ii) A) Upper head ,lateral

part of lower head
– buccal nerve
B) Medial part of lower
head – branch from
the anterior trunk
ACTIONS :
51
Actions by the inferior Head

 Protrusion (bilateral):
The inferior lateral pterygoids are the 2 prime protractors of the
mandible.

 Depression (bilateral):
Contraction of both the lateral pterygoids not only pull the condyles
forward but also along with the suprahyoid & the infrahyoid muscles
help in the depression of the mandible.

 Contralateral Excursion (unilateral):

The insertion of the lateral pterygoids is lateral to its origin & thus
the lateral pterygoid muscle acting singly moves the mandible to
the opposite side.
 52
ACTIONS BY THE Superior Head:

 The superior lateral pterygoids are inactive during opening.

 They are active during the mandibular elevation or closing

along with Temporalis , Masseter & the Medial pterygoid
muscles.

 The Superior head are particularly active when the teeth ,upon
closure, encounter resistance such as a bolus of food.

 Closure on resistance & the Superior lateral pterygoid play an

active role in this.
 53
 Slide the fifth finger along the
lateral side of the maxillary
alveolar ridge to the most
posterior region of the
vestibule
( location for PSA nerve block) .

 Palpate by pressing in a
superior, medial, & posterior
direction.
 CLINICAL IMPORTANCE 54

 TMJ joint dysfunction –

PTERYGOID SIGN
Together Medial and Lateral 55
Pterygoid muscle

Move the mandible to left side

 Left Lateral Pterygoid
 Right Medial Pterygoid

Move the mandible to right side

 Right Lateral Pterygoid
 Left Medial Pterygoid
Sphenomandibularis-5th
56
muscle
 Recently discovered.
 Previously thought to be a part of
temporalis.
Origin-
 From infratemporal surface of greater wing
of sphenoid bone.
Insertion-
 Mandible.
Blood supply-
 Maxillary artery, from vessels of medial
pterygoid.
Nerve supply-
 Not yet determined.
 57

ACCESSORY MUSCLES
of mastication
 DIGASTRIC 58
Origin – anterior belly from digastric fossa
of mandible , posterior belly from
mastoid notch of temporal bone.

Insertion – intermediate tendon

Innervation - anterior belly by mylohyoid

nerve , posterior belly by facial nerve.

Action – Depresses the mandible ,

elevates the hyoid bone
 MYLOHYOID 59

 Forms anatomically and

functionally floor of the
oral cavity.

 The right and left muscles are united in the

midline between the mandible and the hyoid bone
by a tendinous strip-the mylohyoid raphae.
ORIGIN
 Mylohyoid line on the inner surface of
the mandible. 60

 Anterior fibers originate from lower

border of the mandible.

 Its most posterior fibers take their origin

from the alveolus of the third molar.

INSERTION
 The posterior fibers run steeply
downwards medially and forward n gets
attached to body of the hyoid bone.

 Majority of fibers however join those of

the contralateral muscles in the
mylohyoid raphae.
NERVE & VASCULAR SUPPLY: 61
 Mylohyoid nerve of the mandibular nerve.

 Submental artery, Facial artery

FUNCTION:

 Posterior fibers run vertically from the mandible to the hyoid; if

mandible is fixed, they lift the hyoid bone, and if the hyoid is in
place they depress the mandible.

 Anterior fibers elevate the floor of the oral cavity there by acts
as elevator of the tongue.
 GENIOHYOID 62
 ORIGIN
 It arises above the
anterior end of the
mylohyoid line from the
inner surface of
mandible

 including inferior mental

spines by a short and
strong tendon.

 INSERTION
 attached to the upper half
of the hyoid body.
 63
TMJ MOVEMENTS

Side to side
movements –
temporalis
(same side),
pterygoids
(opp side),
masseter
Summary of the anatomy 64
 65
PHYSIOLOGY OF
MASTICATORY
MUSCLES

“You cannot successfully treat dysfunction

unless you understand function”
 66

Mastication Deglutition Speech

 67
MASTICATION

 Human masticatory motor system –

remarkable machine
 Chewing, swallowing, speech
 Extreme force

1. High force activities

2. Extremely precise movements (speech)
CONTROL OF MASTICATION 68
 Voluntary
 Reflex
 Cyclical
 During closing movement – jaw closing muscles on both
sides are activated at the same time
 Opening – only jaw openers are active
 Chewing stroke – activity of left masseter is less than right
masseter because most of the work is being done by the
muscles on the right hand side
 Highly coordinated activity of masticatory, tongue & cheek
muscles
Mechanisms that modulate muscle69
activity during chewing

Muscle spindle receptors

Mechanoreceptors in the PDL

Tendon organ reflexes

Joint reflexes
 Forces of Mastication 70

 Males – 53-65kg
 Females – 36-45 kg

 Increases with age upto adolescence

 Role of individual muscles in 71
chewing
 Major jaw closing muscles – masseter & temporalis
 Direction in which the fibres run – indicates the direction in which
they apply force
 Temporalis – most post fibres- pull posteriorly
- most ant fibres- pull upwards & anteriorly
 Lateral pterygoid – imp role in several phases of chewing cycle
( pulls the mandible forward during jaw opening, controls the rate
at which the condyle should return to its fossa during closing)

 Jaw opening muscles – not normally required to exert much force

during chewing

 In jaw opening – contraction of digastric

 INVESTIGATIONS 72
ELECTRO MYOGRAPHY

 Specialised technique that is used to

measure the activity of individual muscles

Experimental analysis of
masticatory system To analyse patterns of
masticatory activity with
abnormal masticatory function
73
 74
ETIOLOGY OF
FUNCTIONAL
DISTURBANCES IN THE
MASTICATORY SYSTEM

“The clinician who looks only at occlusion is

missing as the clinician who never looks at
occlusion”
 Events interrupting normal muscle
function 75
Local factors–
 Restoration in supraocclusion/improperly occluding crown
 Fracture of a tooth
 Secondary to Trauma involving local tissues (post
injection response following L.A, wide opening of
mouth{long dental procedure, yawning}, unaccustomed
use{bruxism, biting on hard object, gum chewing})
 Deep pain input
Systemic factors-
 Emotional stress
 Acute illness or viral infections
 Constitutional patient factors( immunologic resistance)-
affected by age, gender, diet
Activities of masticatory system
76

• Speaking
Functional
• Chewing
• Swallowing
Parafunctional/ • Clenching/grinding of

Nonfunctional teeth
• Oral habits
Parafunctional activities +
Muscle hyperactivity general increase in level of
muscle tone
 BRUXISM IN CHILDREN 77

If masticatory function –
 common finding
problem, evaluate the child in
 rarely associated with symptoms
dental office
-Explain parents the benign
nature
 Self limiting phenomenon
- Monitor any complaints of child If frequent & significant
 Not related to increased risk – TMD examination
headaches
also indicated – to rule out
masticatory dysfunction as a
possible cause
 78
SIGNS AND
SYMPTOMS OF
DISODERS OF
MUSCLES
“You can never diagnose something
you have never heard about”
 79

PAIN
DYSFUNCTION
 PAIN 80

 Most common complaint

 Central mechanisms
 Slight tenderness – extreme discomfort
 MYALGIA
 Muscle fatigue, tiredness
 Origin – certain allogenic substances Muscle pain
 Severity of muscle pain ∞ functional activity of muscle
 Cyclic muscle spasm
 Headache
 DYSFUNCTION 81

 Common clinical symptom

 Decrease in range of mandibular movement clinically seen

as inability to open mouth widely

 Acute malocclusion
 Protective co- 82

contraction
Local muscle soreness

Masticatory Myofascial pain

muscle
Myospasm
disorders
Chronic centrally
mediated myalgia
Fibromyalgia
Clinical masticatory muscle pain model 83
 Protective co-contraction
84
(Muscle splinting)

 First response of muscles to any event

 CNS response to injury or threat of injury.

 Co - contraction of antagonist muscles (during opening of mouth

increased activity of elevator muscles and vice versa)

 Normal protective or guarding mechanism.

 Not a pathologic condition – prolonged – may lead to muscle

symptoms
 Etiology- Any change in sensory input from associated
structures {High restoration/crown ,deep pain input or 85
emotional stress}

 Clinically - Muscle weakness following an event

 No pain occurs when muscle at rest - Use of muscle increases
pain.
 Limited mouth opening but when slowly opened-full
opening.

 Key factor- immediately follows an event(history)

 If continues (hrs-days) -muscle can become compromised 
local muscle problem
 Treatment –
DEFINITIVE TREATMENT 86
 Directed towards the reason for co-
contraction
 Trauma – no definitive treatment
 Altering the restoration, occlusal condition

SUPPORTIVE TREATMENT
 When cause is tissue injury
 Restrict use of mandible
 Soft diet
 NSAIDS
 Local muscle soreness
87
(Non inflammatory myalgia)
 1st response to prolonged co-contraction.
 Co-contraction- CNS induced muscle response
 Soreness- changes in local environment of muscle tissue
 ( release of bradykinin, substance P)
 Excessive use- ‘delayed onset muscle soreness’ or ‘post exercise
muscle soreness’
 Co-contraction-cyclic event.
 Clinically – muscle –tender on palpation, increased pain on
function, structural dysfunction, limited mouth opening, acute
muscle weakness
 DEFINITIVE TREATMENT
88
 Eliminate ongoing altered sensory input
 Eliminate source of deep pain
 Restrict mandibular use
 Reduce non functional tooth movements
 Decrease emotional stress

 SUPPORTIVE TREATMENT
 Mild analgesic –every 4-6hrs for 5-7 days
 Passive muscle stretching, gentle massage
 Central nervous system effect on 89
muscle pain

1) Secondary to Ongoing deep pain input.

2)Arise from central influences such as upregulation

of the autonomic nervous system {Emotional
stress}

3)Changes in descending inhibitory system.

Clinician should appreciate that muscle pain

now has a central origin
 90
Centrally influenced muscle
pain disorders

Acute Myalgic Chronic myalgic

disorders disorders
Regional Systemic
Myospas myalgic myalgic
m disorders disorders
Chronic
Myofascial centrally Fibromyalg
pain mediated ia
myalgia
Myospasm (Tonic Contraction Myalgia)
91

 Myospam of masticatory muscles –not common.

 Etiology- local muscle conditions (muscle fatigue, changes in
electrolyte balances) ,deep pain input
 Clinically - Structural dysfunction( jaw positional changes
acute malocclusions ), firm muscles on palpation
 Short lived (similar to leg cramps)
 Repeated –DYSTONIA
 Mouth forced open (opening dystonia), or closed(closing
dystonia) or even off to 1 side
 DEFINITIVE TREATMENT 92
Reducing the spasm
 Reducing the pain
 Passively stretching the involved muscle
 Manual massage
 Injection – 2% lignocaine without vasoconstrictor
Elimination of the factor
 Secondary to fatigue –rest

 SUPPORTIVE TREATMENT

 Physical therapy
 Deep massage& passive stretching
 Muscle conditioning exercises
 Relaxation techniques
 Myofacial pain (Trigger point Myalgia)
93
 1st described – Travel & Rinzler -1952
 Arises from hypersensitive bands of muscle tissue – TRIGGER
POINTS
 Felt as taut bands when palpated elicit pain
 Source of constant deep pain central excitatory effects 
referred pain reported as headache pain
 Etiology- trauma,hypovitaminosis, fatigue,viral infections,
emotional stress
 Clinically – trigger points, no local muscle sensitivity, mostly
related to central effects (referred pain)

For treatment to be effective, it must be directed

towards the source of pain
 94
 Diagnosis – trigger points (active/latent)

 Activated by various factors (increased use of muscle,

strain on muscle, emotional stress, upper resp. tract
infections )  headache returns

 Other central excitatory effects – secondary hyperalgesia,

co-contraction, local muscle soreness

Clinical symptoms are associated with the central excitatory

effects created by trigger points and not the trigger points
themselves
 DEFINITIVE TREATMENT 95

 Eliminate source of deep pain

 Reduce local & systemic factors
 Proper sleep (TCA)
 Elimination of trigger points (spray & stretch,
pressure & massage, injection & stretch)

 SUPPORTIVE TREATMENT

 Physical therapy
 Manual techniques(soft tissue immobilization,
muscle exercises)
 Muscle relaxants, analgesics
Characteristic sign of MPDS------ 96
LASKIN'S 4 CARDINAL SIGNS
 Unilateral pain
Muscle tenderness
Clicking and popping noise in TMJ
Limitation of jaw function or deviation of jaw

 Laskin also emphasized that other than the above positive

signs,,the following signs must be absent

 There should be absence of clinical,radiographic or

biochemical evidence of organic changes in TMJ
There should be no tenderness on palpation via external
auditory meatus
 Perpetuating factors for Chronic Myalgias
97
LOCAL
1. Protracted cause
2. Recurrent cause
3. Therapeutic mismanagement
SYSTEMIC
1. Continued emotional stress
2. Downregulation of descending inhibitory system
3. Sleep disturbances
4. Learned behavior
5. Secondary gain
6. Depression
 5) Centrally mediated myalgia (Chronic
myositis) 98

 Originating from CNS effects felt peripherally in the muscle

tissues
 Symptoms similar to inflammatory condition - MYOSITIS
 Neurogenic inflammation
 Etiology – Prolonged input of muscle pain + local soreness,
central mechanisms
 Clinically - Continuity of muscle pain ,Constant aching
myogenous pain , Pain present during rest and increases with
function, muscles are tender to palpate, structural dysfunction.
 DEFINITIVE TREATMENT 99

 Recognize condition correctly

 Restrict mandibular movement
 Avoid exercise /injections
 Disengage the teeth
 NSAIDS

 SUPPORTIVE TREATMENT

 Careful physiotherapy
 Moist heat/cold packs
 Gentle stretching
Chronic systemic myalgic disorders
100
(Fibromyalgia)

 Global musculoskeletal pain disorder

 Often confused with acute masticatory muscle disorder

 Tenderness - 11 or more of 18 specific tender point sites

throughout the body.
 Etiology – central mechanism
 DEFINITIVE TREATMENT 101

 When other masticatory muscle disorders-

present –therapy
 Perpetuating factors – properly addressed
 NSAIDS
 Sleep
 Depression – managed

 SUPPORTIVE TREATMENT

 Physical therapy
 Manual techniques(moist heat, gentle massage,
passive stretching, relaxation)
 Mild, well controlled exercise
MUSCULAR DYSTROPHIES 102

 Rare , inherited muscle diseases

 Muscle fibres are abnormal due to a genetic defect

 Progressively weaker

 Replaced by fat and CT

 Deficiency / malfunction of the muscle protein

(dystrophin / dystropin associated proteins)
 Duchenne’s muscular
dystrophy 103

 Most common form of muscular dystrophy

in children
 Young boys
 Muscles of pelvis & limbs – 1st affected
 Masticatory system – involved later

Weakness in masticatory & facial muscles

Abnormal patterns of force production

Remodelling of facial bones , malocclusions

 Myotonic dystrophy 104
 Muscular dystrophy – affects adults
 5 in 100,00

Abnormalities in ion channels of

muscle membranes
Leads to
Muscle weakness along the with
muscle stiffness

Inability to relax muscle rapidly

after effort
MYOSITIS OSSIFICANS 105
TRAUMATICA
 Masseter muscle – occasionally affected

 Uncommon sequel to TRAUMA (surgery) /

INFLAMMATION OF MUSCLES

 Calcified lesions – X rays/ other scans

 GUILLAIN – BARRE’ 106
SYNDROME
 Generalised neuropathy

 Inflammation of peripheral nerves

 Severe weakness & numbness

 2 in 100,000….increases with age

 Triggered by – stress, viral infection , surgery

 Most people – recover fully

 20% - residual sensory / motor defects

 BRUXISM 107

 Parafunctional activity

 Clenching/grinding of teeth

 1 of the structures involved- Muscles of mastication

 Fatigue to muscles of mastication

 Not giving them time to relax

 Tender
 Trismus/Lock jaw 108
 Inability to open mouth/reduced opening of jaws

 Causes- inflammation of muscles of mastication, needle prick to

medial pterygoid

 Management- Analgesics, muscle relaxants ,

antibiotics,physiotherapy
Mandibular fractures & muscles of 109
mastication

 Main role in unfavourable fractures

 3 muscles exhibit a strong upward pull on the posterior
mandible and act to close the mouth
 Displace posterior segment superiorly

 Fracture of Condyle – Anteromedial – Lateral Pterygoid

 110
Space infections
Masticatory spaces:

 Formed by splitting of investing fascia into superficial &

Pterygomandibular
deeplayers
 Superficial layer – lies along lateral surfaces of masseter &
 Submasseteric
lower half of temporalis muscle
Superficial
 Deeplayer temporal
– passes along medial surface of pterygoid
 Deep temporal
muscles
 111
Submassetric space

 3 layers of masseter fused anteriorly, separated posteriorly

 Space b/n middle & deep heads
 Insertion – loose intermediate tendon
 Easy accumulation of pus
 Submassetric space abscess – pus b/n masseter& ramus
 Lower 3rd molars
 Swelling -
 Pterygomandibular space
112
 Involvement – infected 3rd molars, infection due
to contaminated needle used for IANB, infection
from maxi 3rd molar after PSA

 Established infections- no much swelling on face

 Severe degrees of limitation of mouth opening
 Tenderness – soft tissues medial to ant.border of
ramus
 Dysphagia
 Temporal space 113

 Secondary to initial involvement of

pterygopalatine & infratemporal space (roots of
upper molars)

 Related to temporalis muscle

 Superficial – b/n fascia & muscle

 Deep – deep to muscle

 Pain, trismus, swelling over temporal region

Points to remember….
114

 Submassetric space abscess – pus b/n masseter& ramus

infection from Lower 3rd molars.
 Pterygomandibular space - Infected 3rd molars,
infection due to contaminated needle used for IANB
 REFERENCES 115

 Gray’s Anatomy – the anatomical basis of clinical practice, 40th edition,

Churchill and Livingstone
 James L Hiatt, Lesie P.Gartner - Textbook of head and neck anatomy - 3rd
edition - Wolters company,
 B.D. Chaurasia’s, Human anatomy, vol 3 - 4th edition - CBS publishers –
2004
 T.W. Saddler - Langman’s medical embryology - 9th edition - Wolters
Kluver publishers
 Management of temporomandibular disorders and occlusion- Jeffrey P.
Okeson - 6th edition

 Clinical oral physiology- Timothy S. Miles, Peter Svensson