Pain in the masticatory muscle

The muscle muscle (Musculus masseter) is considered one of the strongest muscles of the human body for its strength, despite its rather small size. It is able to develop an effort of up to 70-75 kilograms, taking part in the actual chewing of food, swallowing, articulation, yawning, and also in mimic expressions of emotions. Pain in the chewing muscle is its dysfunction caused by various causes, the most important of which is a constant, almost round-the-clock load, which results in the development of pathological muscle hypotrophy or spasm.

[1], [2], [3],

Causes of pain in the masticatory muscle

Recently, doctors have begun to pay well-deserved attention to muscle diseases in general, including a very active study of myalgia of the face, as well as pain in the masticatory muscle within the myofascial pain syndrome of the face or myofascial prozopalgia.

The first detailed description of the pain in the face as a symptom complex, including joint and muscle manifestations, was given back in the 30s of the last century by American doctors Goodfried and Costen. A little later, the concept of "bruxism" was introduced, which was the starting point for explaining the causes of pain in the masticatory muscle.

Despite almost half a century of history, the etiology of the facial muscular syndrome is not fully understood, an example of this is the contradiction in diverse terms and the absence of a unified classification of causes. Pain in chewing muscles can be called myofascial prozopalgia, craniomandibular dysfunction, muscle-tonic face syndrome, and so on.

At present, all previous studies are subjected to a more thorough revision, it is noteworthy that the hypothesis of the myofascial cause of the pain symptom in the masticatory muscle is less promising. Although until now many doctors consider the cause of pain in Musculus masseter (chewing muscle) the collective concept of TMJ is a syndrome (temporomandibular joint syndrome). There are other, no less reasoned researches, confirmed by the results of diagnostic examinations in the field of mental disorders, in the category of ENT pathologies, vertebrogenic dysfunctions.

Sometimes the pain symptom in the chewing apparatus can have a very simple explanation. If a person is pessimistic in character, constantly frowns, gets angry, he unconsciously squeezes his jaws and it becomes a habit. It would seem that this feature of nature is not associated with muscle disease, but quite often psychological reasons are the basis for many diseases in principle, including in person.

Also, professional activity, especially sports, can cause stress. Divers, scuba divers, forced to squeeze the mouthpiece, weightlifting weightlifters, lifting in the weight of the fish are at risk of damage to the TMJ and pain in the masticatory muscle.

Possible factors, the causes that cause pain in the area of chewing muscles, are very diverse and can be: 

• Dental treatment, manipulation.
• Violation of the occlusion (occlusion, closing of the teeth).
• Dysfunction, degenerative process in the temporomandibular joint, TMJ syndrome, Kosten's syndrome.
• Maxillofacial trauma.
• Osteochondrosis of the cervicothoracic spine.
• Anatomical abnormalities in the structure of the spine, asymmetry of the shoulder girdle, uneven length of the legs (shortening).
• Stressful situations.
• Psychogenic factor, hysteria.

Practitioners say that the leading cause of hypertonia of the masticatory muscle is a violation of occlusion, closing of the teeth, which in turn is provoked by such factors: 

• Poor-quality prosthetics, orthodontic therapy.
• Chronic psychoemotional stress, especially in people working in responsible positions.
• Neurotic diseases.

Occlusal dysfunctions lead to a reflex hypertonic muscle of the face, the most sensitive part is the chewing muscle. If the bite is not corrected in time, and in 75-80% this is the case, the secondary syndrome develops-myofascial, the function of the TMJ, mimic muscles is disrupted, and a persistent psychovegetative symptom complex is gradually formed. The patient can go for a long time to the doctors, presenting purely neurological complaints, the treatment is unsuccessful, because the symptoms of pain in the face, in the chewing muscle have not been determined with proper accuracy.

[4], [5], [6]

Symptoms of pain in the masticatory muscle

It should be noted that the chewing muscles, as well as the other facial muscles, are characterized by the fact that they do not have fasciae, perhaps it causes the atypical nature of pain - it is intolerable, very intense and causes a lot of suffering to a person. In addition, the pain can be reflected in an atypical place - in the nape of the neck, upper neck, near the ear. Therefore, it is extremely important to identify the exact characteristics that the symptoms of pain in the masticatory muscle possess.

Myofascial pain syndrome in the face develops according to a certain pattern: 

• The provoking factor causes stress, a reduction in the masticatory muscle, if the factor is not eliminated, the hypertonus acquires a permanent character.
• Chronic muscle tension goes into the stage of spasm, often it manifests itself clinically as trismus.
• The constant pain sensation, spasmodic exhausts the muscle, it becomes weak, its tone is significantly reduced.
• Against the background of hypotonia, weakness of the affected chewing muscle on the opposite side, a new muscle tension develops as a compensatory functional phenomenon. The muscle involved in the myofascial process does not hurt at first.

The most typical signs of the pain syndrome of the masticatory muscle can be called such manifestations: 

• Pain in the area of the masticatory muscle, which increases with any movement of the lower jaw.
• Limitation of the volume of the movement of the lower jaw to 10-20 millimeters between the teeth.
• Sensation and sound of a click in the joint, crepitus.
• A typical zigzagging deviation of the jaw (in the form of the letter S) is forward or sideways.
• Bruxism (gnashing of teeth), especially at night.
• Pain during palpation of the muscle.
• Tension, hypertrophy of the muscle, determined by palpation.
• Possible asymmetry of the face.

Symptoms of pain in the chewing muscle can be felt in the upper jaw, in the region of the brow ridges, in the sinuses of the nose, and also in the ear, often in the form of a pesky, constant "ringing".

Diagnosis of pain in the masticatory muscle

Chewing muscles of the face are the only group of muscle tissue in this area that can manifest all the typical, reliable from a diagnostic point of view, myofascial pain. This is due to the fact that the chewing muscle carries an extremely intense static and kinetic load, which in turn creates all the conditions for the formation of characteristic myofascial painful bundles-trigger zones. Nevertheless, the diagnosis of pain in the masticatory muscle may be difficult, since the patient can be treated for a long time from a neurologist, therapist, ENT doctor, the symptomatology is smoothed, often the clinical picture is significantly distorted until the development of such a complex syndrome as the oromandibular dystonia of the face (focal muscular dystonia). Therefore, a very important and predominant method after the initial survey and examination is the palpation of the facial muscles. In the clinical sense, the following may be considered the signs determining myofascial syndrome: 

• The position of the patient and the position of the head.
• Amplitude of neck movements.
• Facial expressions, expression (facial muscles, symmetry).
• Condition of muscles during conversation.
• A swallowing reflex and a condition of muscles at a swallowing.
• The presence or absence of blepharospasm.
• Reflex closure of the eyes (corneal reflex).
• Condition of muscles with clenching of teeth, closing of jaw.
• Activity of movement, volume of movements of the lower jaw.
• Distance between teeth (incisors) with open mouth.
• Trajectory of the movement of the lower jaw in relation to the upper (S-symptom).
• Bechterew's reflex (mandibular reflex).
• Mimic activity of the superciliary arches.
• Condition of the facial nerve (symptom of Khvostek).
• Determination of possible biomechanical disorder of the spine, which manifests itself visually - scoliosis, asymmetry of the shoulder girdle, other deformities.

The main diagnostic method, palpation, detects local tension areas, often in the form of trimester. The characteristic features of triggered myofascial points are reflected pain sensations within the spasmodic zone, a symptom of a "jump", when the palpation of the muscle causes the patient to tremble. Palpation is carried out from the outside of the face, also inside, from the side of the mucosa, the gold standard of palpation has been considered for many years a three-phalangeal method.

Voltage points when examining the chewing muscles give reflected pain downward, into the jaw, into the teeth, less often upwards - into the forehead, into the zone of the superciliary arches, into the upper gum, into the temple. If the muscle is toned in the deep layers, the symptom can appear in the ear, the legs are not in the form of pain, but by sound, noise.

In addition to palpation, the diagnosis of pain in the masticatory muscle includes such stages of examination: 

• The measurement of occlusion is an occlusion.
• Measurement of dynamics and static bite.
• X-ray of the TMJ (temporomandibular joint).
• OPTG is an orthopantomogram or a panoramic snapshot of the jaw.
• Electromyography of the masticatory muscle and other muscles of the chewing apparatus, if necessary - the muscles of the face as a whole.

[7], [8], [9], [10]

Treatment of pain in the masticatory muscle

The treatment of pain in the masticatory muscle, as well as the therapy of any other kind of myofascial syndrome, depends on many factors, but primarily on the results of the diagnosis. Quite often there are cases when the pain in the facial muscles, in the chewing apparatus, has a polyethylene, for example, the violation of occlusion in combination with dysfunction of the TMJ, aggravated by inflammation of the facial nerve. The whole complex is accompanied by a depressive condition, which pathologically provokes new spasms of the masticatory muscles. In addition, the cause or secondary symptom may be spasmodic muscles of the neck and persistent headache - HDN (tension headache).

The doctor faces a difficult task - how to start treatment? Only careful analysis of the etiological factors and determination of their significance in the pathogenesis of myofascial pain can give the right direction of the therapeutic strategy.

Complex treatment can begin with relief of the main pain symptom, but as a whole it includes such actions: 

• Correction of impaired occlusion (occlusion), restoration of normal occlusal height.
• If necessary, dental prosthetics.
• Rejection of any stress-provoking factors - chewing solid foods, chewing gum, habits of gnawing a pencil or pen and others.
• Identified trigger pain points undergo anesthesia blockade (novocaine, dry puncture).
• Postisometric therapy, relaxation of toned muscles.
• Gentle facial massage.
• Physiotherapeutic procedures.
• Acupuncture.
• Compresses with dimexid on the region of the temple, in the area of the masticatory muscle.

Medication of pain in the chewing apparatus may include the appointment of myelorelaxants (midocalam, baclofen, tizanidine), antidepressants, sedatives, tranquilizers. Less commonly, NSAIDs are prescribed - non-steroidal anti-inflammatory drugs, much more effective intake of a complex of vitamins, including the whole group of vitamin B.

How to prevent pain in the chewing muscle?

Obviously, the prevention of pain in the masticatory muscle, based on the main reasons, is to care for the oral cavity and regular dental examinations. An important role in reducing the risk of pain is played by emotional balance, mental health, which in our age of speed and stressful situations is especially important.

Also, the possibility of developing hypertension in the chewing muscle can get rid of banal habits - gnawing pencils, pens, these ordinary actions are completely ignored by people, committed unconsciously and constantly. Chronic load on the chewing apparatus is only exacerbated, in addition, such habits in themselves are signs of neurotic disorders and an occasion to take care of one's own mental balance.

If the pain symptom still evolved, it was persistently treated, in order to prevent and reduce the risk of relapse it is necessary to follow a certain diet that excludes the use of rough, solid food. Each dish should be thoroughly chewed, and to reduce the load on the muscles it is necessary to prepare food in steamed, shredded form. Also a good effect is provided by regular facial massages, especially with nighttime bruxism. Techniques of relaxation with the help of autogenic training, periodic reception of herbal soothing supplies, homeopathy will help to avoid pain, muscle spasms.

Pain in the chewing muscles of the face is a common symptom that is often not diagnosed and not treated in a timely manner. Self-medication, delaying a visit to a doctor, especially if it is a dentist, can lead to chronic headache, depression, aesthetic problems - asymmetry of the face and a decrease in the quality of life in general. Just in order to not give pain to any chance and "save face" in all senses of this expression, you need to monitor the condition of the muscular system, avoid excessive strain of the facial muscles and not be afraid to seek help from a doctor. The earlier the symptom is identified, the faster and more successfully it will be treated.