The mandible is the largest, most mobile and the strongest bone in the head.
consists of a condylar, barrel-shaped joint surface for the temporal
DETAILED ANATOMY AND MUSCULATURE
The mental protuberance swells on either side of the original site of the symphysis
mentis, which makes it, resemble the symphysis pubis. The lateral surfaces have the
masseter muscle and 1/8th of the temporalis tendon externally. Internally, they accept
the remaining 7/8th of temporalis tendon and both medial and lateral ptergoids. The
medial ptergoids mimic the external masseter in form and in function. The lateral
ptergoids pronate the jaw. The main muscle that propogates masticatory is the
buccanator which attaches to the mandible superior to the obligue line and by the
pterigomandibular raphe, plays the vital role (with the tongue) of locating and
containing the chewed morsel of food for the teeth to work on.
The internal aspect of the mandibular canal is the entry point of the 5th cranial
nerve. Thirty-eight percent of neurological input to the brain comes from the face,
mouth and TMJ region.
There are 136 muscles above and below the mandible pivot the jaw, moving it forward as
the mouth opens. The total neurological input to the brain from sensory and
proprioceptors nerves during mandibular motion acts as a dominant pattern setter for
the motor cortex. (in other words, mandibular motion sets the pattern for at least 38%
of the motor muscles in the body, particular in the neck, pectoral muscle area of the
chest and pelvic regions. Normalizing mandibular and temporomandibular joint function
is a wise prerequisite to any attempt at normalizing the neuromuscular mechanisms of
the rest of the body. The mandible has 16 muscle group attachments.
Depressor labi inferioris
Superior pharngeal constrictor
Depressor anguli oris
The masseter muscle has the greatest contractile strength per fibre out of ant
muscle in the body. It is the major pattern setter in mandible movements.
The lateral ptergoids are short, stout and tenacious muscle
The posterior fibres of the temporalis are involved in the TMJ conditions. They play a
role in TM joint pain and in muscular contractions headaches, and can contribute to
temporal bone imbalance. These fibres are antagonists of the lateral pterigoid muscle.
The lateral pterigoids protrude the jaw, the posterior fibres of temporalis retrude it.
The mandible is more open to psychological input than
any other bone in the head. These inputs from unexpressed aggression,
determination, or fear of speaking out, cause changes in mandibular motion
that range from subtle to dramatic. For instance, in states of rage the
mandible is so muscularly tense that almost all movement is lost. The
person can barely separate his teeth to speak.
It is amazing how the rest of the body responds to
optimizing of mandibular status. For instance, neck tension and
osteoarthritis, respiratory inhibition such as occurs in asthmatic states,
and low back pain may all be relieved by normalizing the mandible.
The mandible represents both expression and absorption. For over 160,000 generations
the mandible has smiled with pleasure, chattered, trembled in moral anxiety, moved
sideways while perusing problems, pouted, kissed, seduced, and signaled. Many of
these behavior patterns are locked up in our jaws and muscles and play havoc with the
TM joint and temporal bones when we are confronted with on going stresses.
Among the energies held in the
The bone associated with the individuals sense of who he is.
Where we display our readiness to fight prognating the jaw. We lift our upper
eyelids and eyebrows, jut our head forward toward the target, clench our teeth and
raise our shoulders-----like a cat fanning out its fur.
We set our jaws out and start to stroke our chins wisely.
We hang on with our nails and teeth; we clench our teeth; we grin and bare it.
Sexuality and sensual movement in the pelvis is natural but often restricted by
fears and conditioning about sensuality and sexuality. If we can not allow natural
movement in our pelvis, we transfer the need for movement to the mandible and we talk
about our own, or other peoples sexuality. If we can not move either the pelvis or
mandible, we begin to armor our belly and begin to become psychotic: we feel nothing
at all. Some people may manifest sexual inhibition by becoming tight-lipped, or by
pursing their lips. The stiffness of inhibition gets caught as stiffness in the upper
neck and TM joints and is acted out as anger.
We evert our lips to suckle, sing, playing the saxophone, to show pleasure and kissing.
Suppression of Tender Emotion
At age five we are told to grow up and dont cry. The mentalis muscle on the chin,
quivers and oscillates attempting to suppress the emotion. The lower lip rotates to
cry out like a pout, then retracts to a pencil thin line to keep it all in. This
leaves a lasting impression on the mandible, the teeth clenching and the TM joints.
Trauma and Dysfunction
The mandible is frequently traumatized. How many scars do you have on your chin?
How many dental visits left a mark physical or psychic? Who beat you up? Fist fights.
On going stress shocks into bruxism (grinding of the teeth) and the degeneration of
the TM joints. Anxiety, stress and aggression alter the physiology of the jaw
musculature, temporomandibular joints, and upper neck.
The mandible plays a part in sphenoid and temporal status. It may dominate maxillary
function by way of the teeth. It is a principle player in most types of headaches. It
acts as a strong controller and pattern setter for the neck, upper chest, pelvic girdle,
and feet. The position and motility of the mandible is affected by all of the midline
structures of the body - the hyoid, sternum, xiphoid process linea alba and symphysis
The temporals are complex bones that form the most decisive structure of the cranium.
They are composed of diploic bone, which takes several different forms:
A thin flat upper portion called the squama.
A flying buttress formation that joins with the zygomae.
An anvil shaped petrous portion whose cone-shaped extremity articulates with the
A cone shaped mastoid that is formed by traction from the sternocleidomastoid.
The temporals are located posterolateral to the sphenoid, inferior to the parietals
and anterior and lateral to the occiput.
SUTURES & ARTICULATION
The temporals present a highly delicate, ballerina on points suture with the
zygomae; a rolling overlap, or squamous suture with the parietals; a modified and
robust interdigitated suture with the occiput; a harmonic (plain) suture with the
sphenoid; and an open no contact border with the condylar and basilar portions of the
occiput at the cranial base.
The temporals are the most superficial of the four bones that meet the pterion. They
are one of three bones that form the asterion.
Each temporal articulates with a maximum of five bones: sphenoid, occiput, parietal,
zygomae and the fronal.
DETAILED ANATOMY & MUSCULATURE
The temporals hold the organ of hearing and balance in the inner ear. The CN7 (facial
nerve) weaves through the petrous portion, making two right angles. The CN8
(vestibulocochlear nerve) passes through the same foramana, the internal acoustic
Additional temporal landmarks worth noting include the foramen lacerum (shared with
the sphenoid), the jugular foramen (shared with the occiput), the temporomandibular
fossa and its saddle joint architecture, and the styloid process (whose attachments
form a small but important ingredient in temporal motility).
A variety of muscles can affect temporal status. The sternocleidomastoid and
temporalis are the most powerful and important muscles that directly affect the
Muscles that attach to the temporals consists of the:
Each temporal bone rotates around the long axis of the petrous portion.
The temporals are effective governors of the
sphenoid; think of them as inseparable and mischievous twins. Look you the
mandible whenever the temporals are affected and then you have four bones
to consider: temporals, the sphenoid, and the mandible.
Styloid and mastoid ligamentous and muscular attachments add further potentially
disequilibriating forces. The tugs, tears trituration, and traumas of the teeth, and
the action of the muscles of mastication, all affect the temporals. They do this
through the temporomandibular joint, the lateral ptergoids, the retrodiscal ligaments,
the sphenotemporal ligaments, the stylomandibular ligaments, and the most powerful
neck muscles of all, the sternocleidomastoids.
The petrous tip is anchored to the posterolateral corner of the body of the sphenoid by
the petroclinoid ligament. This structure helps to create the axis of rotation and
maintains a pinpoint articulation between the petrous tip and the root of the posterior
The temporals are about the balance of life. The heavy scheduling of modern life can
remove this balance, our organizers serving to over organize our lives. One
symptom of the loss of balance in life is VERTIGO can be seen as the patient saying,
please pick me up. The second symptom is TINNITUS I dont want to hear it
anymore! It is often a symptom with a strong causative emotional component. In
tinnitus and deafness, people cut themselves off from the world; through hearing we
assimulate our environment, or choose not to. The temporals are often involved in
In psychogenic states especially anger, suppressed rage, anxiety, and tension play
an emphatic role in temporal bone balance. These motions are mediated to the temporals
through the temporomandibular joints and SCM and temporalis tension.
TRAUMA & DYSFUNCTION
A person feels quite out of sorts when their temporals are faulted. They may
suffer from disequilibrium or vertigo and short term memory lapses and short term
emotional problems as well. Temporal disequilibrium is a side effect of automobile
Schoolteachers all over the world used to punish children by yanking their ears in an
abrupt and repeated oscillatory fashion. This strange, obviously instinctive ritual
form of punishment (it is probably tens of thousands of years old) may guarantee
feelings of malaise and repentance in the unfortunate child by displacing and altering
the energetic field of his temporal bones.
The open architecture of the jugular and petrous portions makes the cranial base
portion of the temporals susceptible to displacement, especially in low impact
trauma, such as falling onto grass while running, and low speed whiplash injury.
The seventh cranial nerve CN7 (facial nerve) makes two right angles as it weaves
through the petrous portion of the temporals. If the temporal bones displace (due to
ongoing stress mediated to them through posture or muscular tension) or lose their
inherent mobility, the nerve can be faulted. If the nerve is compressed or put under
tension, acute peripheral facial paralysis or Bells Palsy can result. This serious
condition takes three to nine months to heal; with 70 to 90 percent of suffers
recovering to a cosmetically acceptable level. However 16 percent are left with major
defects. The highest incidence of Bells Palsy occurs in the third trimester, which
may be due to altered mediastinal influences upon the cranial base, or increased
tension in the sternocleidomastiod muscles or both.
The very short auditory tubes in infants quite readily allow bacterial infections to
spread from the nasopharnyx into the inner ears or mastoid air cells. (Breast-feeding
can help to reduce ear infections in the newborn by up to 50 percent.) Craniosacral
work with children in these cases focuses on draining the space between the ramus of
the mandible and the mastoid process of the temporal bone.
Possible treatments in craniosacral work would encompass normalization of the atlanto
occipital joint and gentle upper neck decompression and unwinding to optimize the
position and motion of the atlas.
The temporals are functionally wedded by the sphenoid and mandible.
The temporal bones connection to the tentorium is immediate and extensive. Temporal
faulting always involves the tentorium, which therefore tends to implicate the other
bones that attach to the tentorium sphenoid, occiput, and the other temporal bone.
The core link means that the sacrum and ilia may also be affected or be affecting
Temporal status and motility seem to echo the other main lateral joints of the body,
the shoulders and hips. The mastoid processes have an energetic connection to the
Please respect that the above literature has been taken from The Heart of
Listening by Dr. Hugh Milne
TMJ is the most complex joint of the body. It comprises of two temporal bones and our
mandible. The mandibular condyle of the mandible fits into the temporal bone. There
are three postural muscles that attach to the mastoid of the temporal bone.
TMJ problems are not just an isolated phenomenon of this joint, it ha to do with out
posture, how we move, the condition of our teeth and how we chew. It is necessary to
have a total health approach. Your dentist should be the head of the team, but your
therapist should also work in conjunction with the dentist to normalize the pull of
muscles so that this joint can be normalized into its position into the skull.
There is a test you can do. If you have a problem in the joint that you did not know
you have yet because the pain is not there but you maybe slowly and insidiously be
wearing down the joint and destroying the disc of the joint.
Place the pad of your index fingers in both ear canals. Right underneath the hole is the
TM joint. Listen to the joint for 1) crepitus and grinding. 2) Popping when the
opening the jaw and if one of the 3) condyles seeds into the joint at a different time
than the other side.
When we open and close our jaw, it should be like a hinge. It moves forward over the
eminence. As the jaw opens it translates over the eminence and when we close the jaw
it should go back to translate over that eminence and seed into the joint.
If your jaw opens and does not move, the jaw is fixed in that joint. This is not good.
The TM joint is bilateral, which means what happens on one side equally happens to the
PATTERNS OF OPENING AND CLOSING
This due to imbalances of the muscles.
First pattern is a C opening. This is when you open the mouth on one side and close
on the same side.
The second pattern is you open the mouth on one side and close on the other side.
You should open and close the mandible simultaneously. If you have pain or popping,
grinding or crepitus, your joint is under distress. Notice how much you hear it and
how clearly you hear it when you put you fingers in your ears and press slightly down
you open and close the mandible.
ROLE OF TRIGGER POINTS PLAY IN MUSCLES
How muscles play a vital role in causing tension in other muscles.
A trigger point is an area of high neurological activity (an area that is sending out
high intensity impulses in a muscle). It is sending out these impulses to other
muscles which in turn tighten those other muscles. (See TMJ chart).
Lets take a look at the muscles of the skull. They respond to our head going forward.
(posterior suboccipital muscles) Bring you head forward and you can feel a tightening
at the base of you skull. This is one of the postural influences. If your head is in
front of your shoulders (and it should be in alignment with our shoulder) you are
going to get chronic tightness and headache patterns at the base of the skull. These
muscles rotate our head backwards when our head moves forward and they can develop
trigger points in these muscles.
In these TMJ charts (scroll down), you will see the letter T which means Trigger
points and this is the pain referral area which these trigger points at the base of
the skull fire into the temporal area to the temporalis muscle and tightens that muscle.
The temporalis muscle has a tendon that comes down and attaches on the cornoid process
so as we close the mouth it tightens. This is one of the three muscles that we use to
close our jaw. As we open and close our jaw, the masseter muscle may become tighten and
develop trigger points that will fire into the temporalis muscle. When you chew, it
activates the masseter muscle. If you were to bite down right now, you would feel the
muscle bulge out in the cheek. If that muscle is too tight, trigger points can fire up
into the temporal area and to the ear. This can leave us with ringing in the ear
To give you an idea of how important it is to have this joint functioning properly and
our jaw aligned properly we have to understand the incredible enervation of nerves. This
means that the nerve supply to the jaw and teeth is greater than any other area of the
body and one of the most sensitive nerves in the body supplying energy to our teeth.
That nerve is called the Trigeminal nerve.
An anatomist has estimated that 70% of the nerve endings or receptors of the body
intermingle with this nerve which means it is incredibly sensitive. In an anatomist book,
we see how heavily enervated the nerve impulses are. In the upper molars, each tooth has
three nerves going into it and most of our teeth have two nerves. How long could you
go having a single raspberry seed stuck in your teeth? A day, 2 days, a week? You would
probably be nuts by the end of a week. The reason why I ask this question to
understand the incredible influences the teeth and mandible has on our overall health.
How calm, irritated or intense we are.
The mandible influences the position of the teeth. That is why it must be normalized.
POSTURE AND PELVIS The pelvis has a lot to do with our posture. When the posture tilts forward, you
automatically develop a swayback and the knees lock back in response for the pelvis
tilting forward. Another thing you will notice is the head will tilt forward in
response to the pelvis tilting forward. So you can see that the position of the
mandible is going to change as the position of the pelvis changes. Not just tilting
forward or backward but also sideways. If the pelvis tilts to one side, you see people
with their shoulders high or low that will influence the position of the mandible.
Notice the (last trigger point chart) Erector Spinae muscle (which means keeping the
spine erect) and where it attaches to the pelvis. The Erector Spinae muscle
automatically contracts as the pelvis tilts forward. The other attachment of the
Erector Spinae muscle is on the mastoid process of the temporal bone. So, the more our
pelvis tilts forward, the more that muscle tightens up to the attachment on the mastoid
process. It has a tremendous pull down. This is the insertion of the muscle so it
actually pulls down. It does two things. It tilts our head back as the pelvis tilts
forward and it causes compression of the temporal plate pulling down on this joint.
When that happens, it can cause tremendous wearing away of the disc and deterioration
of the mandible condyle itself.
The more our pelvis tilts forward, and the more our head goes forward, the more our
sub-occipital muscles shorten. And when they shorten, they cause compression and cause
all the nerves at the base of our skull to become compressed. These are some of the
mechanics that go on when we have our pelvis tilting forward.
Correct posture looking at the Baching chart states the external auditory meatus is in
correct alignment to our shoulders (our ears should be over our shoulders.) Most
people are tilted forward. Gravity is pushing us forward, down and the force of
gravity is 33.5 pounds of pressure per square inch. Just think of it every square
inch of our body is unceasing stress from cradle to grave and is constantly pushing us
down and forward. And as that occurs, it is changing the position of our pelvis.
Again, when your pelvis goes forward, your knees automatically lock back as the head
goes forward. This starts a whole series of muscles tightening, and cervical muscles
contracting in our head and neck. The result is more pressure on this joint.
In my therapy program, I release all muscles of chewing temporalis, masseter,
pterigoids, (medial pterygoid helps close our jaw), and tongue muscles. The tongue
muscle merges into the styloglossus muscle, which attaches on the styloid process of
the temporal bone. Our swallowing muscles, the stylopharyngeus muscle attaches on the
styloid process of the temporal bone as well as the muscles that open our jaw, the
suprahyoid muscles that will pull our jaw down. We must treat the internal and external
muscles that affect that joint.
Again, the Erector Spinae is the most powerful muscle of the body. It attaches to
mastoid process so the more postural distortion we are, the more the muscles at the
base of the skull sub occipitals tighten and the muscles that attach to the mastoid
process tighten. These three muscles can produce a powerful force pulling the cranium
down and when it pulls the cranium down the upper part of the joint (temporal portion)
will be compressed on the mandible.
Another thing we have to understand that has an influence on the joint is gait
As a person thrusts forward, there is a muscle called the lateral pterygoid inside the
mouth that protrudes the jaw. When a person thrusts forward, their jaw will feel a
tightening at the TM joint. This muscle, the lateral pterygoid tightens and displaces
Waddle Gait Pattern
We see people walk like a duck. They waddle to both sides and each time they got to
the right, the muscles are going to shorten and tighten. On the left, the muscles are
going to lengthen and stretch.
Wisp Gait Pattern
If you have a gait pattern where you wisp to one side, (right side) the right side
will chronically shorten and tighten and the left side of the joint will open.
Lateral ligaments and the articular capsule can be stretched. These two ligaments help
hold the mandible into our skull.
If we have a waddling pattern to one side we shorten and tighten the muscles on the
right side.That ligament will stretch, the whole capsule will stretch and will
displace our jaw and it will cause the disc (that absorbs shock) in the jaw to
responds to forces of torquing and abnormal gait patterns. If left, the disc will be
worn away and we can have a grinding bone on bone then we get arthritis. Then the
condyle will actually flatten out and deteriorate and the pain will be awful.
It is important that we understand these influences.
TRIGGER POINT CHARTS
Lets look at three muscles that are inside the mandible.
Medial Pterygoid closes our jaw from inside. The trigger point fires into the inner
ear, up into the masseter and parts of the temporal area.
The Lateral Pterygoid, which is important in TMJ problems because the superior belly
of that muscle attaches to the disc and pulls the disc forward. The trigger points
fire into the face, ear, and joint capsule.
The Digastric muscle is extremely important because it helps pull our jaw backward
if you wanted to retract your jaw instead of protruding it. Trigger points in this
muscle fire into the mastoid process where the SCM (sternocleidomastoid muscle),
Splenius Capitus and Longissimus Capitus (upper portion of Erector Spinae) attach to
the mastoid process (Muscles I talked about before).
PAIN REFERRAL CHART
If we take a look at the pain referral chart, of the trigger points that commonly fire
around the neck, we notice how many muscles there are. That will give you an idea of
how much of a muscular involvement there is in TMJ problems.
If you have teeth that are sheering off your jaw maybe pulling to one side and your
teeth are grinding and sheering. The muscles are doing this.
If you have teeth that are worn away, and you grind your teeth at the right, (bruxism)
the teeth are ground down, muscular tension does that. So the muscles play an extremely vital role.
Looking at the chart where the mandible and pelvis is, we can see how tilting can be
influenced by muscles and tilting of the pelvis. It is a direct relationship by the
position of the pelvis to the position of the mandible.
In the diagram, we see the mandible that sits in the joint. Number 2 is the articular
disc and behind the disc we see the retrodiscal ligament that attaches on the back of
the capsule that helps stabilize the mandible and the disc.
Lets move to the right diagram and we see how the role of the lateral pterygoid
attaches to the front of the disc can contraction this disc forward. Other muscles like
the Temporalis can take our mandible and push it superior and backwards. So what
happens is the disc starts to move off the mandible and our disc starts riding on our
retrodiscal tissues. That can be extremely painful because there are a lot of vascular
tissues that supply blood and oxygen to the capsule. The displacement of the jaw and the disc is a very complex process.
The Neuromuscular Therapist will design a program to release these muscles and
stabilize your pelvis and work in conjunction with your dentist. It is important that
your dentist understands the role these muscles and postural muscles are playing
the role and position of the pelvis.
In dentistry, there is a subsection called Neuromuscular Dentists. These dentists
have been trained to understand the role of position and muscles in TMJD. The book
Neuromuscular Dental Diagnosis and Treatment written by Robert Jakelson is destine
to be a classic in the dentistry field.
These dentists will be making bite splits to take pressure off the joint. It is
important that these bite splints are made with the muscles IN THE RELAXED STATE.
Many bite splints have been made and are being made in with the muscles in the tense
position, and it is that tension in the muscle that has caused the pathology problem.
The most effective way is to release the muscles and build the bite splint so the jaw
can be in a relaxed position.
Your dentist and therapist should be working together to make sure your jaw is in the
most optimum position to relieve your discomfort.
Imbalances of musculature are some of the causes of TMJD but there are others such as:
1) Direct trauma or blow to the jaw.
2) A fracture of the mandible
3) Occlusal malfunctioning
4) Teeth being misshaped
5) Deformities in the jaw itself
6) Arthritis in the jaw.
There can be many causes to this complex problem. That is why I suggest a total health
team approach between the therapist and dentist. There can be psychological problems
also. The health care team will design for you a program especially for you and your
pain pattern. Work together so you can maximize the healing process.
They believe as I believe that part of your healing
process should be an educational process.
Please respect that the above plates are copyrighted by Dr. Frank H. Netter, M.D., Atlas of
Please respect that the above images are copyrighted by The St. John Method of Neuromuscular Massage
This is a Multidisciplinary Clinic
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