REVIEW

Australian Dental Journal 2004;49:(1):2-8

The human lateral pterygoid muscle: A review of some

experimental aspects and possible clinical relevance
GM Murray,* I Phanachet, S Uchida, T Whittle*

Abstract
The clinical notion that some disturbance to the
activity of the lateral pterygoid muscle plays a role in
the aetiology of temporomandibular disorders
(TMD) is still widely accepted and influences
management strategies. However, there is no
rigorous scientific evidence to support this clinical
notion and the role of the lateral pterygoid muscle in
normal function is still controversial. The classically
defined functions of each head of the muscle are that
the superior head is active on closing, retrusion, and
ipsilateral jaw movements, while the inferior head is
active on opening, protrusion and contralateral jaw
movements. However, recent data indicate that these
concepts are too simplistic. For example, recent
evidence suggests that parts of the superior head
may also be active on opening, protrusion and
contralateral jaw movements, and that the superior
head may consist of three mediolaterally arranged
functional zones. Given these complexities, the
proposal that clicking and/or locking conditions
arise in the temporomandibular joint through some
form of lack of co-ordination between the two heads
of the muscle needs re-evaluation. Despite earlier
reports to the contrary, both heads of the lateral
pterygoid muscle appear to be electrically silent at
the postural or resting jaw position, and therefore
appear to play no role in the anteroposterior
positioning of the jaw at the postural position. An
important role has also been demonstrated
electromyographically for progressive changes in
activity in the inferior head as the direction of
horizontal jaw force shifts from one side to the other.
This suggests an important role for the lateral
pterygoid muscle in the generation of side-to-side
and protrusive jaw forces. The lateral pterygoid
muscle is likely therefore to play an important role
in parafunctional excursive jaw movements and also
possibly a role in influencing jaw position in patients
where the maxillomandibular relationship records
change from session to session. The above data

*Jaw Function and Orofacial Pain Research Unit, Faculty of

Dentistry, The University of Sydney; Westmead Centre for Oral
Health, Westmead Hospital, Westmead, New South Wales.
PhD student, Jaw Function and Orofacial Pain Research Unit,
Faculty of Dentistry, The University of Sydney.
Visiting research scholar, Jaw Function and Orofacial Pain Research
Unit, Faculty of Dentistry, The University of Sydney.
2

provide new insights into the normal function of the

lateral pterygoid muscle. The proposal that the
lateral pterygoid muscle plays some role in the
aetiology of TMD needs now to be rigorously tested.
Key words: Electromyography, temporomandibular
disorders, computer tomography, functional heterogeneity,
jaw movement.
(Accepted for publication 9 September 2003.)

INTRODUCTION
Studies of the anatomy and function of the lateral
pterygoid muscle have had an important influence on
aspects of dental clinical practice. For example, the
clinical opinion that a disturbance to the activity of the
lateral pterygoid muscle plays an important role in the
aetiology of temporomandibular disorders (TMD) is
still widely accepted.1,2 Patients with TMD complain of
pain in and about the temporomandibular joint and/or
the jaw muscles, and patients may also experience
limitation of jaw movements and/or joint sounds. In
TMD patients, the lateral pterygoid muscle is thought
to become hyperactive, or there is thought to be a lack
of co-ordination between the upper and lower heads of
the muscle, or there is thought to be a disturbance to
the normal postulated role for the muscle in the control
or stabilization of the temporomandibular joint. The
opinion that the lateral pterygoid muscle plays an
important role in TMD at least partly underpins a
number of management philosophies for TMD.
However, a close examination of the available literature
reveals that there is no rigorous scientific evidence that
the lateral pterygoid muscles of TMD patients are
functionally disturbed. Further, the role of the lateral
pterygoid muscle in normal function is still
controversial. Therefore, our present knowledge of the
lateral pterygoid provides little scientific basis for
current treatment recommendations. Given these
uncertainties, together with the clinical significance that
has been attributed to this muscle, it is timely to review
our latest understanding of its normal function and to
update its possible clinical significance. Our purpose
here is to demonstrate that some concepts about the
Australian Dental Journal 2004;49:1.

SHLP

Lateral
oterygoid
plate

Disc

Condyle

IHLP

Anterior

Fig 1. Diagram of lateral pterygoid muscle and relations. Stylized

lateral view of left temporomandibular joint, superior head (SHLP)
and inferior head (IHLP) of the lateral pterygoid muscle, and lateral
pterygoid plate (partly obscured).

function of the human lateral pterygoid muscle are

either erroneous or too simplistic. We believe that this
demonstration will undermine the scientific basis of
those clinical philosophies reliant on such concepts, for
example some management strategies for TMD.
Role of the lateral pterygoid muscle in jaw movement
The lateral pterygoid consists of two bellies or heads,
a superior head (SHLP) and an inferior head (IHLP)
(Fig 1). It has a close association with the
temporomandibular joint and is thought to play a
major role in the control of jaw and
temporomandibular
joint
function.
Many
electromyographic studies support the classical view
that there are reciprocal patterns of activity between
the two heads such that the IHLP is active on opening,
protrusion and contralateral jaw movements, while the
SHLP is active on closing, retrusion and ipsilateral jaw
movements.3-11 On the other hand, other studies have
suggested synchronous activity in both heads during
certain jaw movements.12-15
We believe that a major reason for the differing
conclusions as to the function of the lateral pterygoid
muscle is that almost all previous electromyographic
studies in the human have not verified that the
electromyographic recording electrodes were correctly
located within the muscle. Therefore, there is the very
real possibility that some of these recordings may have
been from other adjacent jaw muscles, such as the
medial pterygoid or the temporalis muscle, or may have
been from the lateral pterygoid but incorrectly
attributed to a particular head of the muscle.
With the use of computer tomography we have
developed a technique for verification of electrode
recording sites within the lateral pterygoid muscle.14-16
An example of verification of electrode placement
within IHLP by imaging with computer tomography is
shown in Fig 2. The black arrows label the electrode
tips within the IHLP.
Refined single-motor-unit recordings, taken at sites
within the IHLP that have been verified by computer
tomography, have recently confirmed the classical view
that the IHLP is involved in opening, protrusion and
contralateral jaw movements (a single-motor-unit is
the basic functional unit of a muscle and consists of a
Australian Dental Journal 2004;49:1.

Fig 2. Verification of electrode placement within IHLP by computer

tomography imaging. (A) horizontal slice (1mm thick) showing finewire electrode tips (black arrow) within IHLP in one participant.
Reformatted images in (B) and (C) were taken through the tips of
the wires (black arrows) in the IHLP in the plane of section
indicated at the bottom. (B) was reformatted in the coronal plane
and (C) represents an oblique plane parallel to the long axis of the
lateral pterygoid muscle. Calibration bars: 10mm per division.

group of muscle fibres (a few hundred) that are all

activated simultaneously by one alpha-motoneurone
during a muscle contraction. Single motor units are
recorded through needle electrodes inserted into the
muscle).17,18 We have extended this basic knowledge by
providing evidence of complexity in these basic
functions. The superomedial part of the IHLP appears
to be important in initiating contralateral jaw
movements while the inferomedial part appears to play
a role in fine control once the movement has
commenced.17,18
In the SHLP, the patterns of activity have recently
been shown to be more complex than previously
thought. Thus, in contrast to the classical view that the
SHLP is active only during closing, retrusion and
ipsilateral jaw movements, most of the SHLP does
3

Condyle

SHLP
Medial
Middle
Lateral

Lateral

Anterior

Fig 3. Tentative division of superior head into three functional

zones. Stylized view of SHLP divided into proposed three functional
zones. The view is of the left condyle, anterior ramus, and a lower
molar tooth from the anterior, and from a slightly superior and
medial aspect.

appear to be at least active during opening, protrusion

and contralateral jaw movements. Further, the activity
pattern in SHLP varies with the location within the
muscle and we have tentatively divided the SHLP into
three functional zones (Fig 3).19 The medial zone
exhibits patterns of activity similar to those identified
in the IHLP. The lateral zone can be active also on
closing, ipsilateral movements and retrusion, while the
middle zone exhibits an intermediate range of patterns.
These new functional data have clinical implications in
understanding the role of the lateral pterygoid in TMD
(see below).
Is the lateral ptergyoid one or two muscles?
There has been much discussion as to whether the
lateral pterygoid should be regarded as one muscle or
two or more muscles on the basis of the number of
heads. In light of the recent findings summarized above,
we believe the best way to view the muscle is as
proposed by Hannam and McMillan13 that both heads
of the lateral pterygoid constitute a system of fibers
acting as one muscle, with varying amounts of evenly
graded activity throughout its entire range, with the
distribution shaded according to the biomechanical
demands of the task (see also Widmalm et al20).
Therefore, the muscle is functionally analogous to the
fan-shaped temporalis muscle which is one muscle with
a continuous range of functional properties from
posterior to anterior. We believe that the lateral
pterygoid muscle has a continuous range of properties
from superior to inferior and from medial to lateral. In
this context, the concept of a specific pattern of coordination between superior and inferior heads has
little meaning. Motor units within the lateral pterygoid
will be recruited as determined by the biomechanical
demands of the task to be performed.
4

Fig 4. Activity within IHLP in association with contralaterally

directed force in the horizontal plane. Semi-diagrammatic superior
view of IHLP on each side taken from a computer tomography
scan, together with outline of part of the mandible. As the subject
exerts a larger force in the contralateral direction (A through E), the
magnitude of the electromyographic activity within the IHLP
progressively increases. This increase is indicated in the inset
histogram at the top left. Data derived from Uchida et al. 2001.22

Is the lateral pterygoid muscle active at the postural

jaw position?
Some single motor units in the jaw-closing muscles
are tonically active while the jaw is at resting jaw
posture. This information has clinical relevance in that,
one of the methods of assessment of occlusal vertical
dimension is based on the assessment of the postural or
resting jaw position. However, there is conflict in the
literature as to whether the SHLP and/or the IHLP are
tonically active with the jaw is at the postural jaw
position.1,4,9,14,21 The presence of tonic activity in the
lateral pterygoid muscle at resting jaw posture might
also be of clinical significance in that variations in the
level of lateral pterygoid muscle activity could influence
the horizontal positioning of the condyle in relation to
the disc and eminence, as well as the horizontal
positioning of the jaw at postural position. Under these
circumstances closure from postural position may
result in premature occlusal contacts and possibly the
perception by the patient that the bite is not even.
Recent single-motor-unit studies at computertomography-verified sites in 31 asymptomatic young
adults with nearly full complements of teeth, showed
that the SHLP and IHLP were inactive when the jaw
was in the clinically determined postural jaw
position.14,17,19 Therefore, the lateral pterygoid muscle
does not appear to play a role in maintaining the
condyle in close apposition with the disc and articular
eminence when the jaw is at the postural jaw position,
nor does it appear to play a role in determining the
anterior-posterior positioning of the jaw at the postural
jaw position.
Role of the lateral pterygoid muscle in force
production
Experimental aspects
The lateral pterygoid muscle appears to play an
important role in the generation of horizontal forces as
required in mastication and parafunctional activities.6,20
Recent data support this role by showing progressive
Australian Dental Journal 2004;49:1.

increases in IHLP activity as subjects increased the size

of their jaw effort (i.e., force) to the opposite (i.e.,
contralateral) side in the horizontal direction.22 Figure 4
22
shows diagrammatically (based on previous findings ),
progressive increases in the activity of the left IHLP as
the magnitude of horizontally directed jaw force is
progressively increased to the right side. Further, the
magnitude of IHLP activity also changes with the
direction of applied force in the horizontal plane.
Figure 5 shows diagrammatically progressive decreases
in IHLP activity as the direction of horizontally
directed jaw effort progressively shifts from the
contralateral direction (e.g., direction 1 for left lateral
pterygoid) towards the ipsilateral direction (e.g.,
direction 5 for left lateral pterygoid23). Recent data
suggest that the pattern of activity in the SHLP during
similar force tasks may not be comparable to the IHLP
(S Ruangsri, personal communication, December 2003).
There have been reports of activity in the SHLP, and
also IHLP, during jaw closing and with clenching at
intercuspal position or at excursive tooth contact
positions (Miller10 has reviewed this). Although recent
single-motor-unit recordings at verified sites do not
support IHLP activity during intercuspal clenching,17
some parts of SHLP do appear to be active during
intercuspal clenching.19 The role of this activity is
unclear. However, it has been proposed that during
clenching, SHLP and IHLP can act to prevent the
condyle from being displaced posteriorly and thereby
exerting pressure on sensitive postcondylar
structures.20 Another equally possible role for activity
in the SHLP during closing or clenching may be in
setting the required level of tension in the intraarticular disc for optimal condylar movement. The
deep temporalis and masseter fibres that appear to
insert into the disc may also play a role here (Dr A
Flatau, personal communication, January 2003).
Clinical aspects
Many parafunctional jaw movements are
characterized by protrusion and/or side-to-side
movements of the jaw. These movements are usually
associated with large jaw-closing muscle activity1 that
necessitates large horizontal force vectors to overcome
the frictional resistance between the teeth. The above
experimental force data suggest that the IHLP, and
possibly also the SHLP, would play an important role in
the generation of these horizontal forces. Is it possible
that excessive demands on the lateral pterygoid muscle
for heavy masticatory and parafunctional activities may
be a factor in the generation of localized lateral
pterygoid muscle tenderness in patients with some
forms of orofacial pain? Although the cause of the
muscle tenderness in TMD is not clear, both central and
peripheral mechanisms of sensitization appear to play a
role.24,25 For example, in peripheral sensitization, a
range of chemical mediators (e.g., bradykinin,
histamine) released by damaged tissues are thought to
sensitize nociceptive primary afferents and make them
Australian Dental Journal 2004;49:1.

Fig 5. Activity within IHLP in association with different directions

of horizontally directed force. Semi-diagrammatic superior view of
IHLP on each side taken from a computer tomography scan,
together with outline of part of the mandible. As the direction of
exerted force shifts from direction 1 through to direction 5, the
magnitude of the electromyographic activity within the left IHLP
progressively decreases while that in the right IHLP progressively
increases. Protrusion is associated with similar levels of activity in
both IHLP muscles. Different directions of horizontal jaw
movement are generated by different relative levels of activity
within the two muscles. Data derived from Uchida et al. 2002.23

respond to non-noxious stimuli. This is one possible

way whereby muscles may be painful at rest and during
normal functional movements.
It is not uncommon to observe clinically that patients
who have full dentures with worn occlusal surfaces
posture their jaws forward or to the side. From
appointment to appointment, not only the
anteroposterior positioning of the centric relation
record but also the side-to-side positioning can change.
This can make it difficult to register a reliable centric
relation record. One reason for this could be that, in
attempting to achieve a reasonable bite with poor
dentures, the patient actively maintains the jaw forwards
or to the side while at resting jaw posture. Given the
above recent findings, it is most likely that not only the
IHLP but also the SHLP are playing an important role in
maintaining the jaw at this new position. Variations in
the levels of activity between the two muscles on each
side would determine the side-to-side and
anteroposterior positioning of the jaw (see Fig 5). In
order for the condyle to completely seat under the disc
in the anterosuperior position, it is likely that the lateral
pterygoid muscle should be silent, and indeed our data
suggest that it is so, at least in young healthy adults.
Role of the lateral pterygoid muscle in clicking/locking
It has been proposed that clicking and/or locking
conditions arise in the temporomandibular joint
5

example, indicate at least two possible directions along

which force can be applied to the condyle. This
suggestion of the possibility that those SHLP fibers
inserting into the disc could activate independently of
other SHLP fibres, should not be taken to imply that we
may rejuvenate the old theory of lack of co-ordination
between the SHLP and IHLP as the cause of clicking
and locking. Rather, we take the new findings to point
to the need to re-evaluate some proposed mechanisms
of the aetiology of internal derangement.

Fig 6. Superior view of SHLP and proposing different directions of

force. Superior view of SHLP (taken from Troiano;33 with
permission of Elsevier Science) showing three bands or groups of
muscle fibres: a superficial slip or group, a deep slip, and a medial
head or group. With selective activation of these different groups of
muscle fibres, the possibility arises for different directions of force
application to the condyle and disc/capsule complex.

through some form of lack of co-ordination between

the SHLP and IHLP. This lack of co-ordination is said
to lead to a disturbance in the horizontal positioning of
the intra-articular disc in relation to the condyle.1,26,27
However, the nature of this normal pattern of coordination between the two heads needs re-thinking
given the complexities that we have demonstrated
within the SHLP (see above).19 Further, this view of a
lack of co-ordination between the two heads of the
muscle necessitates an important role for the SHLP in
horizontal disc position, an idea that was based on the
erroneous view that the SHLP inserts entirely into the
disc. Despite the persistence of these notions in the minds
of some,9 a role for SHLP in horizontal disc position is
unlikely given the convincing evidence now that the
SHLPs principal insertion is into the condyle.28-32 Manual
traction on the SHLP in cadavers has been reported to
bring both disc and condyle forward together.20,28,29,31
Figure 1 shows diagrammatically the current view
where most SHLP muscle fibres insert into the condyle.
These latter observations seemed to rule out the
possibility that a lack of co-ordination between the
SHLP and the IHLP could lead to clicking or locking
via a disturbance in the horizontal positioning of the
intra-articular disc in relation to the condyle. However,
recent evidence points to the possibility that those
SHLP fibers inserting into the disc could activate
independently of other SHLP fibres and could possibly
exert forces on the disc that are not directed
simultaneously to the condyle. The possibility that
selective activation within SHLP might occur comes
from data suggesting that the SHLP is functionally
heterogeneous (see above).14,19 Figure 6 shows a
hypothetical proposal as to how this might apply to the
SHLP. Troiano33 described anatomically discrete bands
or slips of muscle fibres within the SHLP; these are
labelled in Fig 6 (drawn from his Fig 3). In light of our
EMG data,19 we propose that these bands are capable of
selective activation by the brain. The dotted lines, for
6

Role of the lateral pterygoid muscle in

temporomandibular disorders (TMD)
There has been much speculation on the role of the
lateral pterygoid muscle in TMD.1,2,26,34 However, most
of the theories have been based on erroneous
anatomical detail and a limited understanding of the
functional behaviour of the muscle. Hypotheses of
lateral pterygoid muscle dysfunction in TMD have
included muscle hyperactivity, muscle hypoactivity,
poor co-ordination between the two heads of the
muscle, and/or a disturbance to the normal role of the
muscle in the control or stabilization of the
temporomandibular joint.1,4,5,9,26,34-41 It has been
proposed for example, that hyperactivity of the lateral
pterygoid muscle, resulting from myalgic pain
according to the Vicious Cycle Theory, can cause an
articular disc to be displaced (for review, see Lund).2
These ideas of the functional disturbance of the
lateral pterygoid muscle have formed part of the basis
for unproven reversible and irreversible therapies that
aim to reduce muscle activity either directly or
indirectly and/or improve muscle co-ordination. These
therapies include occlusal adjustments, occlusal splints,
local
anaesthetic/botulinum
toxin
injections,
physiotherapy, repositioning appliances, jaw exercises,
prosthetic reconstruction, myotomy, orthodontics, or
joint and orthognathic surgery.42-46 The occlusal splint,
for example, is thought to reduce muscle activity,
improve muscle co-ordination, reposition and/or
unload the temporomandibular joints, reduce bruxism
in relation to TMD, or simply may have a placebo
affect.47
Clinically, pain in the region of the lateral pterygoid
muscle can be elicited by jaw movements in TMD
patients, and palpation behind the tuberosity region in
TMD patients often elicits pain.48 This symptom and
sign are frequently taken as evidence of a painful lateral
pterygoid muscle. However, pain is frequently referred
in chronic pain patients.48 Further, the close proximity
of other, potentially tender muscles (medial pterygoid,
temporalis), compromises the certainty with which the
tenderness following palpation behind the tuberosity
region in TMD patients can be attributed to a painful
lateral pterygoid muscle. Therefore, there is at present
no rigorous scientific evidence that anything at all is
wrong with the function of the lateral pterygoid muscle
in TMD patients.2 In addition, the notion that
hyperactivity of the lateral pterygoid muscle results
Australian Dental Journal 2004;49:1.

from myalgic pain according to the Vicious Cycle

Theory, is not supported by current evidence.2 Detailed
controlled studies of the activity of this muscle in TMD
patients in comparison with the activity in control
asymptomatic individuals are clearly needed.
ACKNOWLEDGEMENTS
Some of the studies in this paper were supported in
part by grants to GM Murray from the National
Health and Medical Research Council of Australia
(Grant #990460), the Australian Research Council
Small Grants Scheme, the Australian Dental Research
Foundation Inc, and the Dental Board of NSW. Some of
the data presented in this paper were part of a PhD
thesis by Dr I Phanachet who was a Royal Thai
Government sponsored scholar. Dr Uchida was a
Visiting Research Scholar from Osaka Dental
University. We also acknowledge the photographic and
art services of Westmead Hospital, and the Department
of Radiology, Westmead Hospital for the computer
tomography scans. We thank Drs S Ruangsri, Daraporn
Sae-Lee, Manish Bhutada and Anastasia Peppes for
their critical comments on the manuscript. All human
subjects involved in the authors experimental studies
reported in this paper gave informed consent and all
experimental procedures were approved by the Western
Sydney Area Health Service Ethics Committee and the
Human Ethics Committee, University of Sydney. The
ethics guidelines established by the National Health
and Medical Research Council of Australia have been
applied in the authors studies reported in this paper.
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Address for correspondence/reprints:

Associate Professor Greg Murray
Level 3, Professorial Unit
Westmead Centre for Oral Health
Westmead Hospital
Westmead, New South Wales 2145
Email: gregm@usyd.edu.au

Australian Dental Journal 2004;49:1.