Logan Steele
The masseter muscle is one of the muscles that must be checked during a TMJ exam. Palpation of the masseter muscle can be done extra-orally and intra-orally. The masseter muscle doesn't usually contract unless the posterior teeth touch, so it can be helpful to ask the patient to open wide, close, and clench their teeth to determine when the muscles contract and if they are simultaneous. The masseter muscle refers pain to the upper and lower posterior teeth, the mandible, above the eye, and in front of the ear. Palpation of the masseter muscle can be used to detect the existence of functional jaw pain possibly associated with TMD and to score pain intensity associated with TMD in younger patients.
| Characteristics | Values |
|---|---|
| Palpation type | Flat palpation, pincer palpation, snapping palpation |
| Palpation location | Superficial masseter, deep masseter, medial pterygoid (inside and outside), anterior temporalis, posterior temporalis, SCM (Sternocleidomastoid), temporalis muscle tendon |
| Palpation technique | Slide the overlying skin back and forth across the muscle, apply firm pressure, ask the patient to report the tender point, compress the point for 5 seconds with 2 kg of pressure |
| Patient action | Open wide, close, and clench teeth |
| Pain referral | Upper and lower posterior teeth, mandible, above the eye, in front of the ear |
| Tenderness assessment | None, mild, moderate, or severe |
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What You'll Learn
Palpating the superficial masseter
To begin, it is important to locate the correct area for palpating the superficial masseter. The masseter muscle is located on the cheek, just below the zygomatic arch (cheekbone) and in front of the ear. It is attached to the jawbone (mandible) and helps to raise the lower jaw during activities such as chewing and speaking.
When palpating the superficial masseter, the examiner should use their fingers to gently press and feel the muscle. They should slide the overlying skin back and forth across the muscle to identify any taut bands, which are areas of muscle tension or tightness. These taut bands can be a source of pain and discomfort for the individual.
Once a taut band is identified, the examiner should move their fingers up and down the band, applying firm pressure. They should ask the patient to report any tender points or areas of increased sensitivity within the band. This information helps to identify specific trigger points that may be contributing to the patient's symptoms.
Additionally, the examiner can perform a relative tenderness assessment for the superficial masseter. This involves palpating the muscle and asking the patient to rate the level of tenderness or pain on a scale, such as none, mild, moderate, or severe. This assessment provides valuable information about the patient's pain perception and can guide further treatment decisions.
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Palpating the deep masseter
Step 1: Patient Positioning and Preparation
Ensure the patient is comfortably seated or lying down. Explain the procedure to the patient to alleviate any anxiety and obtain their informed consent. Ask the patient about their history of trauma, pain, headaches, and joint sounds to gain a comprehensive understanding of their symptoms.
Step 2: Locating the Deep Masseter
The deep masseter muscle is located beneath the zygomatic arch, angled back towards the angle of the mandible. To locate it, identify the insertion and origin on a dry skull: anterior and inferior to the lateral condyle pole, posterior to the posterior edge of the superficial masseter, and beneath the zygomatic arch.
Step 3: Palpation Technique
Using your fingers, palpate the deep masseter muscle by sliding the overlying skin back and forth across it. Apply firm pressure and move up and down to identify any taut bands, which are areas of muscle tension. Ask the patient to report the level of tenderness on a scale from none to severe as you palpate.
Step 4: Identifying Trigger Points
Once you identify a taut band, focus on that area and move your fingers up and down to locate the most tender point within the band. This point is known as the trigger point. Apply compression to this point for approximately 5 seconds with 2 kg of pressure to assess if the pain radiates or refers to other areas.
Step 5: Extra-Oral and Intra-Oral Examination
The masseter muscle can be palpated both extra-orally (outside the mouth) and intra-orally (inside the mouth). Ask the patient to open wide, close, and clench their teeth during the examination to determine when the muscles contract. The masseter muscle typically refers pain to the upper and lower posterior teeth, the mandible, above the eye, and in front of the ear.
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Intra-oral and extra-oral palpation
To begin the intra-oral and extra-oral palpation, it is helpful to ask the patient to open wide, close, and clench their teeth. This will help determine when the muscles contract and if they are simultaneous. The masseter muscle doesn't usually contract unless the posterior teeth touch. This muscle refers pain to the upper and lower posterior teeth, the mandible, above the eye, and in front of the ear.
During the extra-oral exam, palpations are performed on individual muscles, including the masseter. The clinician will massage the neck and head region, evaluating the muscles and jaw joints for any tension or discomfort. It is important to note that many of these muscles refer pain to other locations, which may occur during palpation.
The medial pterygoid muscle, which is located on the inner surface of the pterygoid plate behind the maxilla, can be palpated intraorally and extraorally. The intraoral palpation of the medial pterygoid muscle can trigger a gag response in the patient.
The palpation assessment involves sliding the overlying skin back and forth across the muscle to identify any taut bands. Once a band is found, the clinician moves up and down the band, applying firm pressure while asking the patient to report the tender point. This point is then compressed for 5 seconds (with 2 kg of pressure) to determine if the pain radiates or refers.
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Trigger point assessment
When conducting a trigger point assessment of the masseter muscle, it is important to palpate both the superficial and deep parts of the muscle. The superficial masseter muscle is palpated by pointing out the insertion and origin on a dry skull. The deep masseter muscle is located anterior and inferior to the lateral condyle pole, posterior to the posterior edge of the superficial masseter, and beneath the zygomatic arch.
The masseter muscle can be palpated extra-orally and intra-orally. To determine when the muscles contract, it is helpful to encourage the patient to open wide, close, and clench their teeth. The masseter muscle refers pain to the upper and lower posterior teeth, the mandible, above the eye, and in front of the ear.
In addition to palpating the masseter muscle, a comprehensive trigger point assessment of the masticatory muscles should also include palpation of the posterior temporal, medial, and anterior muscles, lateral pterygoid, sternocleidomastoid, superior trapezius, suboccipital, and posterior neck muscles.
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Flat, pincer and snapping palpation techniques
To palpate the masseter muscle, you need to locate its insertion and origin on a dry skull. The deep masseter is located anterior and inferior to the lateral condyle pole, posterior to the posterior edge of the superficial masseter, and beneath the zygomatic arch. The superficial masseter is beneath the zygomatic arch, with the muscle angled back towards the angle of the mandible.
Now, moving on to the palpation techniques:
Flat Palpation
Using the padded aspect of the fingers or thumb, proceed at a right angle across the muscle fibres while pressing them against the underlying tissue or bone. When trigger points exist, taut bands, focal tenderness, and a twitch response will be detected. This technique involves sliding the overlying skin back and forth across the muscle.
Pincer Palpation
The muscle is gently squeezed between the thumb and fingers with a back-and-forth motion to locate taut bands. This technique is used to detect exquisite, focal tenderness (trigger points) and to elicit local twitch responses.
Snapping Palpation
Locate a taut band of muscle and place the fingertip at a right angle. Begin moving your fingers back and forth to roll the underlying fibres under your finger, similar to plucking a guitar string while maintaining contact with the surface. The purpose of this method is to elicit a local twitch response and is most effective near or on the trigger point with the muscle at a neutral length or slightly lengthened.
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Frequently asked questions
Palpation is the process of examining a muscle by touching and feeling it.
The masseter muscle is one of the muscles that controls the jaw. It is located inside the cheek, in front of the ear.
Palpating the masseter muscle can be done extra-orally and intra-orally. To palpate the muscle, the patient should be encouraged to open wide, close, and clench their teeth to determine when the muscles contract and if they are simultaneous.
Masseter muscle palpation is often done to determine the existence of functional jaw pain possibly associated with temporomandibular disorder (TMD) and to score pain intensity associated with TMD.
Before the exam, it is helpful to get a history from the patient concerning headaches, joint sounds, or pain.
