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The temporalis muscle is one of the four primary muscles used for chewing food. It is a fan-shaped muscle that spans from the temporal fossa to the inferior temporal line of the lateral skull. Palpation of the temporalis muscle is a common technique used to assess orofacial pain and identify any tenderness or taut bands in the muscle. This can be done by feeling for tenderness at the coronoid process, just beneath the zygomatic process, with the patient's mouth open. The pressure applied during palpation should be standardised at 2 kg of pressure with one finger for 2 seconds, and the patient should rate the pressure as none, mild, moderate, or severe.
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What You'll Learn
Palpating the anterior temporalis muscle
To begin the palpation, the patient's chin is grasped firmly between the examiner's thumb and index finger, while the other hand is placed on top of the patient's head for stability. The anterior temporalis muscle itself is best palpated at the hairline and opposite the eyebrow. This site is just above the pinna (the ear), and its direction is posterior from the coronoid process.
When palpating, use a standard pressure level of 2 kg of pressure with one finger for 2 seconds. Ask the patient to rate the pressure as none, mild, moderate, or severe. It is important to calibrate your pressure periodically with a pressure algometer to ensure consistency across both hands.
The palpation of the anterior temporalis muscle is part of a broader cranial nerve examination, assessing the tenderness of various muscles in the head and neck region.
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Palpating the posterior temporalis muscle
To begin the palpation, the patient's chin is grasped firmly between the examiner's thumb and index finger, while the other hand is placed on top of the patient's head for stability. This position allows for control during the assessment. The posterior temporalis muscle is then palpated for tenderness using a standard scale of none, mild, moderate, or severe. It is important to calibrate the pressure periodically with a pressure algometer to ensure accurate palpation with the correct pressure on both hands. The recommended pressure is 2 kg of pressure with one finger for 2 seconds.
The posterior temporalis muscle is located just above the ear, with its direction being posterior from the coronoid process. It is important to note that the temporalis muscle tendon is situated at the coronoid process, just beneath the zygomatic process, and is accessed by having the patient open their mouth. Palpation of this muscle can help identify any taut bands, which may indicate the presence of myofascial pain.
Additionally, the patient can be asked to protrude their jaw to assess the function of the lateral pterygoid muscle, as it cannot be palpated directly. This comprehensive approach to palpating the posterior temporalis muscle aids in the evaluation of orofacial pain and provides valuable information for diagnosis and treatment planning.
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Using a relative tenderness assessment
The temporalis muscle tendon is at the coronoid process just beneath the zygomatic process and is accessed by having the patient's mouth open. Palpate the temporalis muscle tendon for tenderness using the scale mentioned above. The anterior temporalis muscle is best palpated at the hairline and opposite the eyebrow. Palpate the anterior temporalis for tenderness using the same scale. This site is just above the pinna or the ear and its direction is posterior from the coronoid process. Palpate the posterior temporalis for tenderness using the same scale.
Tenderness of the masseters and temporalis can be considered a relevant tool for diagnosing myo-type craniofacial pain disorders. However, a limit of pain score systems is that they are based on subjective pain perception. Surface electromyography (sEMG) is a noninvasive and reliable tool for recording muscle activity. A study on fifty adult volunteer patients with painful temporomandibular disorder (TMD) and concurrent tension-type headache (TTH) found an overall moderate correlation between muscle tenderness and sEMG values.
To make the scores comparable, the mean value of the two recordings for the temporal and masseter muscles was used, and the reference population tenderness score with 95% confidence intervals was adjusted according to the tender spots investigated in the study.
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Palpating the temporalis muscle tendon
To begin the palpation, the patient's chin is grasped firmly between the examiner's thumb and index finger, while the other hand is placed on top of the patient's head for stability. The temporalis muscle tendon is located at the coronoid process, just beneath the zygomatic process, and is accessed by asking the patient to open their mouth. The examiner should then palpate the temporalis muscle tendon, assessing its tenderness on a scale of none, mild, moderate, or severe. This is done by applying 2 kg of pressure with one finger for 2 seconds. It is important for the examiner to calibrate their pressure periodically with a pressure algometer to ensure consistent palpation pressure with both hands.
The anterior temporalis muscle is best palpated at the hairline and opposite the eyebrow. This site is just above the pinna (outer ear) and its direction is posterior from the coronoid process. Tenderness in this area can be assessed using the same scale as before—none, mild, moderate, or severe. Moving on to the posterior temporalis, this area is palpated for tenderness using the same scale.
In addition to assessing tenderness, the examiner should also palpate across the muscle with their fingers to identify any taut bands. This is done by sliding the fingers across the muscle fibres and feeling for any areas of increased tension or tightness. Taut bands can indicate the presence of trigger points, which are hypersensitive spots within a taut muscle that can refer pain to other areas.
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The role of the examiner
To begin the palpation, the examiner should instruct the patient to open their mouth. This provides access to the temporalis muscle tendon, which sits just beneath the zygomatic process at the coronoid process. With the patient's mouth open, the examiner can then begin to palpate the tendon for tenderness.
It is important for the examiner to use the correct amount of pressure during palpation. The standard pressure level is achieved by applying 2 kg of pressure with one finger for 2 seconds. While palpating, the examiner should ask the patient to rate the pressure as none, mild, moderate, or severe. Regular calibration with a pressure algometer ensures that the examiner palpates with the appropriate pressure on both hands.
In addition to assessing tenderness, the examiner should also palpate across the muscle to identify any taut bands. This involves moving the fingers across the muscle to detect any areas of increased tension or tightness. By carefully feeling the muscle and assessing its texture, the examiner can identify any abnormalities or areas of concern.
Overall, the examiner plays a crucial role in the palpation of the temporal muscle. Through their skilled application of manual techniques and patient assessment, they can gather valuable information about the muscle's condition, tenderness, and presence of any taut bands, contributing to an accurate evaluation of the patient's orofacial pain and overall health.
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Frequently asked questions
The temporalis muscle is one of the four primary muscles used for mastication (chewing food).
There are two methods for palpating the temporalis muscle. The first is the relative tenderness assessment, which is done by applying standard pressure (2kg of pressure with one finger for 2 seconds) to a standard anatomic location and asking the patient to rate the pressure as none, mild, moderate, or severe. The second method involves palpating across the muscle with your fingers to identify any taut bands.
The temporalis muscle tendon is located at the coronoid process just beneath the zygomatic process and is accessed by having the patient's mouth open. The anterior temporalis muscle is best palpated at the hairline and opposite the eyebrow.
The standard pressure used for palpation is 2kg of pressure with one finger for 2 seconds. It is important to calibrate yourself periodically with a pressure algometer to ensure accurate palpation.
Palpating the temporalis muscle is often done as part of a muscle tenderness exam to identify and assess orofacial pain.
