Quantitative volume and area assessment of masticatory muscles through magnetic resonance imaging in patients with temporomandibular joint disorders

Published:November 10, 2022DOI:


      Objective: To compare volume and surface area measurements of the lateral and medial pterygoid and masseter muscles (LPM, MPM, and MM) as calculated on magnetic resonance imaging (MRI) based on the position of the temporomandibular joint disk, mouth position, and patient sex, and to calculate the correlations of the measurements among the muscles.
      Study Design: Measurements of muscle volume and area were performed on MRIs of 51 patients. Wilcoxon, Kruskal-Wallis, and Mann-Whitney U tests were used to calculate the significance of differences in measurements. The Spearman correlation coefficient calculated correlation of measurements among the muscles. Significance of difference was established at P<0.05.
      Results: Volume and area of the left MPM in patients with disk displacement without reduction (DDWOR) were larger than in patients with normal disk position (P ≤ 0.040). MM volumes were smaller with DDWOR than with DD with reduction bilaterally (P ≤ 0.031). Volume and area of LPM and MM were significantly different between closed and open mouth positions (P < 0.001). Differences in volume and area between females and males were significant for all muscles in volume (P ≤ .021) and for MPM and MM in area (P ≤ .021). Significant positive correlations were found among all muscles for volume and area.
      Conclusion: Volume and area measurements of the masticatory muscles varied according to disk and mouth position and patient sex.


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        • Schiffman E
        • Ohrbach R
        • Truelove E
        • Look J
        • Anderson G
        • Goulet JP
        • et al.
        Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: Recommendations of the international RDC/TMD consortium network and orofacial pain special interest groupy.
        J Oral Facial Pain Headache. 2014; 28: 6-27
        • Muraoka H
        • Kaneda T
        • Kawashima Y
        • Hirahara N
        • Fukuda T.
        • Muramatsu T
        • et al.
        Parotid lymphadenopathy is associated with joint effusion in non-neoplastic temporomandibular disorders.
        J Oral Maxillofac Surg. 2017; 75: 491-497
        • Okeson JP
        • Kanter RJ.
        Temporomandibular disorders in the medical practice.
        J Fam Pract. 1996; 43: 347-356
        • Solberg WK.
        Temporomandibular disorders: background and the clinical problems.
        Br Dent J. 1986; 160: 157-161
        • Murray GM
        • Phanachet I
        • Ushida S
        • Whittle T.
        The human lateral pterygoid muscle: a review of some experimental aspects and possible clinical relevance.
        Aust Dent J. 2004; 49: 2-8
        • Wang MQ
        • Yan CY
        • Yuan YP.
        Is the superior belly of the lateral pterygoid primarily a stabilizer ? An EMG study.
        J Oral Rehabil. 2001; 28: 507-509
      1. Basit H, Tariq MA, Siccardi MA. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Aug 10, 2020. Anatomy, Head and Neck, Mastication Muscles

        • McComas AJ.
        Oro-facial muscles: internal structure, function and ageing.
        Gerodontology. 1998; 15: 3-14
        • Mapelli A
        • Zanandrea Machado BC
        • Giglio LD
        • Sforza C
        • De Felicio CM
        Reorganization of muscle activity in patients with chronic temporomandibular disorders.
        Arch Oral Biol. 2016; 72: 164-171
        • Okeson JP.
        Joint intracapsular disorders: diagnostic and nonsurgical management considerations.
        Dent Clin North Am. 2007; 5: 85-103
        • Reiter S
        • Goldsmith C
        • Emodi-Perlman A
        • Friedman-Rubin P
        • Winocur E.
        Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders (RDC/TMD).
        J Oral Rehabil. 2012; 39: 941-947
        • Stohler CS.
        Muscle-related temporomandibular disorders.
        J Orofac Pain. 1999; 13: 273-284
        • De Leeuw R
        • Klasser GD.
        American Academy of Orofacial Pain. Orofacial Pain: Guidelines for Assessment.
        Diagnosis, and Management. 5th edn. Quintessence Publ, Chicago, Ill2013
        • Al-Baghdadi M
        • Durham J
        • Araujo-Soares V
        • Robalino S
        • Errington L
        • Steele J.
        TMJ Disc Displacement without Reduction Management: A Systematic Review.
        J Dent Res. 2014; 93: 37-51
        • Whyte AM
        • Mcnamara D
        • Rosenberg I
        • Whyte AW.
        Magnetic resonance imaging in the evaluation of temporomandibular joint disc displacement–a review of 144 cases.
        Int J Oral Maxillofac Surg. 2006; 35: 696-697
        • Tasaki MM
        • Westesson PL
        • Isberg AM
        • Ren YF
        • Tallents RH.
        Classification and prevalence of temporomandibular joint disk displacement in patients and symptom-free volunteers.
        Am J Orthod Dentofacial Orthop. 1996; 109: 249-262
        • Larheim TA
        • Westesson P
        • Sano T.
        Temporomandibular joint disk displacement: comparison in asymptomatic volunteers and patients.
        Radiology. 2001; 218: 428-432
        • Jank S
        • Emshoff R
        • Norer B
        • Missmann M
        • Nicasi A
        • Strobl H
        • et al.
        Diagnostic quality of dynamic high-resolution ultrasonography of the TMJ—a pilot study.
        Int J Oral Maxillofac Surg. 2005; 34: 132-137
        • Tomas X
        • Pomes J
        • Berenguer J
        • Quinto L
        • Nicolau C
        • Mercader JM
        • et al.
        MR imaging of temporomandibular joint dysfunction: a pictorial review.
        Radiographics. 2006; 26: 765-781
        • Vogl TJ
        • Abolmaali N.
        MRI of the temporomandibular joint. Technique, results, indications.
        Rofo. 2001; 173: 969-979
        • Çebi AT.
        Ultrasonographic evaluation of masseter muscle thickness in patients with disk displacement with reduction.
        Oral Radiol. 2019; 35: 239-244
        • Schmid-Schwap M
        • Bristela M
        • Kundi M
        • Piehslinger E.
        Sex-specific differences in patients with temporomandibular disorders.
        J Orofac Pain. 2013; 27: 42-50
        • Koo TK
        • Li MY.
        A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research.
        J Chiropr Med. 2016; 15 (Jun): 155-163
        • Westesson PL.
        Reliability and validity of imaging diagnosis of temporomandibular joint disorder.
        Adv Dent Res. 1993; 17: 331-335
        • Schellhas KP.
        MR imaging of muscles of mastication.
        AJR Am J Roentgenol. 1989; 153: 847-855
        • Goto TK
        • Tokumori K
        • Nakamura Y
        • Yahagi M
        • Yuasa K
        • Okamura K
        • et al.
        Volume Changes in Human Masticatory Muscles between Jaw Closing and Opening.
        J Dent Res. 2002; 81: 428-432
        • Goto TK
        • Yahagi M
        • Nakamura Y
        • Tokumori K
        • Langenbach GEJ
        • Yoshiura K.
        In vivo Cross-sectional Area of Human Jaw Muscles Varies with Section Location and Jaw Position.
        J Dent Res. 2005; 84: 570-575
        • Ng HP
        • Ong SH
        • Liu J
        • Huang S
        • Foong KWC
        • Goh PS
        • Nowinski WL.
        3D Segmentation and Quantification of a Masticatory Muscle from MR Data Using Patient-Specific Models and Matching Distributions.
        J Digit Imaging. 2009; 22: 449-462
        • Maizlin ZV
        • Nutia N
        • Dent PB.
        Displacement of temporomandibular joint disc: Correlation between clinical findings and MRI characteristics.
        J Can Dent Assoc. 2010; 76: 1-5
        • LeResche L.
        Epidemiology of temporomandibular disorders: Implications for the investigation of etiologic factors.
        Crit Rev Oral Biol Med. 1997; 8: 291-305
        • Kapila S
        • Xie Y.
        Targeted induction of collagenase and stromelysin by relaxin in unprimed and beta-estradiol-primed diarthrodial joint fibrocartilaginous cells but not in synoviocytes.
        Lab Invest. 1998; 78: 925-938
        • Lin CS
        • Wu CY
        • Wu SY
        • Chuang KH
        • Lin HH
        • Cheng DH
        • Lo WL.
        Age- and sex-related differences in masseter size and its role in oral functions.
        J Am Dent Assoc. 2017; 148: 644-653
        • Ng HP
        • Foong KWC
        • Ong SH
        • Goh PS
        • Huang S
        • Liu J
        • Nowinski WL.
        Quantitative analysis of human masticatory muscles using magnetic resonance imaging.
        Dentomaxillofac Radiol. 2009; 38: 224-231
        • Hannam AG
        • Wood WW.
        Relationships Between the Size and Spatial Morphology of Human Masseter and Medial Pterygoid Muscles, the Craniofacial Skeleton, and Jaw Biomechanics.
        Am J Phys Anthropol. 1989; 80: 429-445
        • Hsu CW
        • Shiau YY
        • Chen CM
        • Chen KC
        • Liu HM.
        Measurement of the size and orientation of human masseter and medial pterygoid muscles.
        Proc Natl Sci Counc Repub China B. 2001; 25: 45-49