Clinical anatomy and palpability of the inferior lateral pterygoid muscle.
BACKGROUND
The intraoral palpation technique of the inferior belly of the inferior lateral pterygoid (ILP) muscle is a standard diagnostic examination method for temporomandibular joint dysfunction syndrome, although different studies have revealed inconsistent results.


OBJECTIVE
This study assessed the feasibility of the ILP muscle palpation by a simulated clinical setting.


METHODS
Three dentists performed a bilateral palpation of the ILP muscle in 53 fresh and unfixed human cadavers and decided whether the muscle was palpable or unpalpable. In a second step, it was observed through the dissected infratemporal fossa, whether the examiner's finger did or did not touch the ILP muscle by simulating the performed palpation. Palpatory findings were supplemented by 1-dimensional measurements for determination of topographic relations of the ILP muscle within the infratemporal fossa. For statistical analysis, sensitivity, specificity, and negative and positive predictive values of the palpation technique were calculated. Interexaminer agreement was estimated with the kappa value.


RESULTS
In 86 of 106 dissected specimens, a superficial fascicle of the medial pterygoid muscle was found in direct proximity to the ILP muscle. In these cases, a residual distance of 7.8 +/- 3.2 mm remained between the ILP muscle and buccinator fascia indented by the tip of the examiner's finger. In 10 of 20 specimens with an absent superficial fascicle, the finger was able to reach the ILP muscle.


CONCLUSIONS
It is recommended that the ILP muscle palpation technique should no longer be considered as a standard clinical procedure because it is nearly impossible to palpate the ILP muscle anatomically and because the risk of false-positive findings (by palpation of the medial pterygoid muscle) is high.
Stratmann
U
U
Institute of Anatomy, University of Münster, Münster, Germany. stratmu@uni-muenster.de
Mokrys
K
K
Meyer
U
U
Kleinheinz
J
J
Joos
U
U
Dirksen
D
D
Bollmann
F
F
D005157:Facial Pain; D005240:Feasibility Studies; D006801:Humans; D015588:Observer Variation; D010147:Pain Measurement / Q000379:methods; D010173:Palpation; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care; D011626:Pterygoid Muscles / Q000033:anatomy & histology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013706:Temporomandibular Joint Dysfunction Syndrome / Q000175:diagnosis*