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Muscle Name: Masseter

Muscle Group: Face & Throat

Symptoms and Referred Pain:  
The masseter is divided into two layers, a superficial layer and a deep layer.

The superficial layer refers pain to the lower jaw, teeth, gums, and sometimes into the maxilla.

Trigger points in other areas of this layer of the masseter will refer pain to the upper molar teeth, gums, and maxilla. Pain may also be referred in an arc shape above the eyebrow and may appear in the lower jaw.

Trigger points in the masseter, or temporalis, may cause tooth hypersensitivities to heat, cold, percussion, or occlusal pressure.

The deep layer may refer diffuse pain to the mid-cheek area and sometimes to the area of the temporomandibular joint (TMJ). Pain may be referred deep into the ear as well as tinnitus (ear ringing). The tinnitus is usually described as being “low roaring”.

A person with TrPs in the masseter, particularly the superficial layer, will most likely complain of restriction of jaw opening. Most are unaware that their jaws do not open sufficiently, especially if eating food is not difficult. Pain is very common and usually occurs as described above in the “pain pattern” section.

Unilateral tinnitus may be associated with the upper portion of the deep masseter as well as earache of unexplained origin.

Muscle Description: The masseter functions to elevate (close) and retract the jaw.

Self Treatment:
  • If teeth grinding is a problem, take steps to stop retrusive bruxism (teeth grinding) and restore breathing through the nose, instead of the mouth.
  • Head forward posture should be corrected to reduce masseter activity.
  • Find solutions for emotional stress and anxiety.
  • Other myofascial trigger points must be deactivated if they exist in other muscles, such as the sternocleidomastoid (SCM), trapezius, and any other muscles that refer to the area of the masseter.
  • Intermittent breaks should be taken during long dental procedures

How You May Have Injured This Muscle:
  • Excessive head forward posture
  • Chronic mouth breathing, such as through a surgical mask, or nasal obstruction
  • Crushing ice or nuts with the teeth
  • Teeth clenching or bruxism (teeth grinding)
  • Gum chewing, nail biting, or clamping the teeth on a tobacco pipe
  • Emotional tension or anxiety that causes clenching of the teeth
  • Prolonged over stretching as with a dental procedure
  • Direct trauma to the masseter
  • Whiplash type injuries, as experienced in a motor vehicle accident

Activities to Avoid: By avoiding the listed of activities, you will decrease the stress placed on this muscle and allow it to heal faster.

In general, you should be pain free for 2 weeks before slowly introducing these activities again. If you have any questions, please consult a licensed health care provider.

  • Avoid crushing ice or nuts with the teeth
  • Avoid chewing gum

Other Possible Disorders: This is a partial list of common medical conditions that may cause similar pain to what you are experiencing. It is important have a health care professional rule out these conditions prior to treating only this muscle group.
  • Tinnitus of neurological origin
  • Pulpitis
  • Apical inflammation of the periodontal ligament
  • Anteriorly displaced discs of the TMJs
  • Trismus

References : 
Simons DG, Travell JG, Simons LS, Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1, 2nd Ed. Baltimore: Williams and Wilkins, 1999.
Travell JG, Simons DG, Myofascial Pain and Dysfunction, vol 2. Baltimore: Williams & Wilkins, 1992.