Pterygoids

Medial & Lateral · See Scenario 1: TMD

Pterygoid muscles anatomy, view 1 — Anatomy — Visible Body. © Cengage Learning, Inc.

Pterygoid muscles anatomy, view 2 — Anatomy — Visible Body. © Cengage Learning, Inc.

Medial pterygoid trigger point referral pattern — Medial pterygoid referral — triggerpoints.net, after Travell & Simons

Lateral pterygoid trigger point referral pattern, view 1 — Lateral pterygoid referral — triggerpoints.net, after Travell & Simons

Lateral pterygoid trigger point referral pattern, view 2 — Lateral pterygoid referral — triggerpoints.net, after Travell & Simons

Origin

Medial: deep head — medial surface of lateral pterygoid plate; superficial head — maxillary tuberosity and pyramidal process of palatine bone · Lateral: superior head — infratemporal surface of sphenoid; inferior head — lateral surface of lateral pterygoid plate

Insertion

Medial: medial surface of mandibular ramus and angle (pterygoid tuberosity) · Lateral: superior head — articular disc and TMJ capsule; inferior head — condylar neck of mandible

Action

Medial: elevates mandible, assists protrusion and contralateral excursion; works with masseter as the pterygoid-masseter sling · Lateral: inferior head opens jaw and protrudes; superior head regulates disc tension during closing

Innervation

Medial and lateral pterygoid nerves — both branches of CN V3

Temporalis · Masseter · Digastric · SCM

Clinical context The lateral pterygoid is the only jaw muscle that actively opens the jaw. Spasm or hypertonicity here is strongly associated with jaw deviation on opening, disc displacement, and TMJ clicking. Because its superior head attaches directly to the articular disc, chronic hypertonicity can contribute to disc displacement mechanics — this is the muscle that explains why treating only the jaw closers sometimes gives incomplete results. The medial pterygoid works with the masseter to form the pterygoid-masseter sling and is frequently hypertonic in bruxers. Both muscles require intraoral access for thorough palpation and treatment.

Medial pterygoid	Pain inside the mouth, throat, and below the ear — can mimic ear pain, throat pain, or a sense of fullness in the ear
Lateral pterygoid	Deep pain in the TMJ region and cheek; can refer into the maxillary sinus area — can mimic sinusitis

Group note All four jaw muscles — Temporalis, Masseters, Medial and Lateral Pterygoids — can be hyperactive in bruxism and clenching. In practice, you rarely find one without finding at least two others involved. The pterygoids are often the missing piece when masseter and temporalis treatment alone gives partial relief.

Client position: Supine, head in neutral. Pillow removed or flat. Therapist seated at head of table.

Client communication: “I’m going to work inside your mouth with a gloved finger. You’ll feel pressure, and it may be quite tender, especially on the side that’s been giving you trouble. Breathe slowly through your nose. If the pressure becomes too strong, raise your hand and I’ll ease off straight away.”

Medial pterygoid

Locate & confirm: Glove on. Slide your index finger along the inner surface of the lower molars to the retromolar fossa — just behind the last molar. Press laterally against the medial surface of the ramus.

What to feel for: Significant tenderness, often disproportionate to the pressure used. Reproduction of deep jaw ache, throat pain, or ear fullness confirms the trigger point.

Lateral pterygoid

Locate & confirm: Glove on. Slide your index finger along the inner surface of the upper molars to the upper retromolar area — past the last molar. Angle the finger superiorly and medially into the infratemporal space. Ask the client to perform a small jaw protrusion — the inferior head contracts, confirming placement.

What to feel for: Deep, sharp tenderness. Reproduction of TMJ pain or cheek pain confirms involvement. This area is frequently exquisitely tender in clients with disc displacement or deviation on opening.

FMT

Active — intraoral

Medial: Gloved index finger contacts the medial pterygoid at the retromolar fossa, pressing laterally against the ramus. Ask the client to open the jaw slowly and fully, then return to neutral. Repeat 4–6 cycles. Adjust pin location between sets to cover the full belly.

Lateral: Gloved index finger contacts the lateral pterygoid in the infratemporal space, superior to the last upper molar. Ask the client to deviate the jaw slowly to the ipsilateral side (same side as the pin), then return to neutral. Repeat 4–6 cycles.

TPT

Intraoral

Medial: Sustained pressure to the identified trigger point at the retromolar fossa, pressing laterally against the ramus. Hold 60–90 seconds or until referred pain reduces. Client breathes through the nose throughout.

Lateral: Sustained pressure in the infratemporal space. Hold 60–90 seconds. Do not increase pressure if strong referred pain is present — maintain and wait for release. Client breathes through the nose.

MET

PIR (medial) · Resisted opening (lateral)

Medial — PIR: Client supine. Cupped hand placed under the chin. Ask client to close the jaw against gentle upward resistance (10–20% effort). Hold 5–7 seconds. Relax — jaw drops open passively, do not force it. Repeat 3–5 times.

Lateral — resisted opening: Hand placed lightly at the chin. Ask client to open the jaw, or deviate laterally to the ipsilateral side, against gentle resistance. Hold 5–7 seconds. On release, mobility improves passively. Repeat 3–5 times. PIR is not applicable here — the lateral pterygoid opens the jaw, so resisted opening is the correct approach.

Frictions

Technique not indicated for either muscle. Intraoral and deep external access make effective cross-fibre friction delivery impractical. Sustained TPT pressure is the appropriate alternative.

Key safety notes

Intraoral consent: Any intraoral technique requires explicit informed consent before every session — not just on intake. Some clients will decline; this must be respected without pressure. Never proceed without clear agreement. Gloves required for all intraoral contact. Fingernails trimmed short.

Sensitive structures — medial pterygoid: Lingual nerve and inferior alveolar nerve run adjacent to the medial pterygoid intraorally. Avoid aggressive probing. Check for dental work, crowns, or sensitivity before intraoral contact. Any shooting sensation to the lower teeth or lip — adjust position immediately.

Sensitive structures — lateral pterygoid: Middle meningeal artery and maxillary artery branches are present in the infratemporal fossa. Approach is always controlled, steady pressure — never probing. Do not attempt direct external palpation as a primary method for the lateral pterygoid.

Technique limit: If symptoms worsen, joint noise increases, or the client reports sharp catching during treatment — stop and reassess. Do not push through sharp joint-adjacent pain.

Relevant to these conditions

Scenario 1: TMD

Headaches — Cervicogenic & Tension

Lateral pterygoid trigger points refer to the TMJ region and cheek; medial pterygoid referral overlaps with masseter deep layer around the ear. Both contribute to headache patterns in complex TMD presentations. This scenario page is still being built.