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Medial Pterygoid

Muscles

The medial pterygoid is the deep counterpart of the masseter, forming a muscular sling with it around the mandibular ramus to elevate the jaw. Its trigger points refer to the ear, throat, and TMJ, producing symptoms that mimic ear infection and pharyngeal conditions.

Origin, Insertion, Action, Innervation

  • Origin:
  • Deep head (larger): Medial surface of the lateral pterygoid plate of the sphenoid bone, pyramidal process of the palatine bone
  • Superficial head (smaller): Tuberosity of the maxilla
  • Insertion: Medial surface of the mandibular ramus and angle of the mandible (the internal mirror of the masseter's external attachment)
  • Action:
  • Primary: Elevation of the mandible (closing the jaw)
  • Protraction (protrusion) of the mandible
  • Contralateral excursion of the mandible (unilateral contraction)
  • Innervation: Medial pterygoid nerve — a branch of the mandibular division of the trigeminal nerve (CN V3)

Palpation Guide

  • Client position: Supine or seated.
  • Landmark sequence:
  1. The medial pterygoid is largely inaccessible from outside the mouth. It lies on the medial (internal) surface of the mandibular ramus.
  2. External approximation: Palpate at the angle of the mandible on its medial (internal) aspect — hook your fingertips around the inferior border of the mandibular angle and press superiorly along the medial surface of the ramus. This accesses the inferior portion of the medial pterygoid.
  3. Intraoral approach: With a gloved hand, place your index finger inside the mouth along the lingual (tongue-side) surface of the mandible. Slide posteriorly along the internal surface of the ramus. The medial pterygoid lies against this surface, deep to the oral mucosa.
  • Tissue feel: Firm and thick when palpated externally at the mandibular angle — it mirrors the masseter on the opposite side of the ramus. Intraorally, it feels like a dense muscle mass along the internal ramus, often tender to palpation.
  • Confirmation test: Ask the client to clench the jaw. The medial pterygoid contracts along with the masseter. Externally, you may feel increased tension at the mandibular angle on its medial surface.
  • Common errors:
  • Confusing the medial pterygoid with submandibular gland tissue — the submandibular gland lies inferior to the mandibular angle and feels softer and more lobulated.
  • Assuming the masseter is the medial pterygoid — the masseter is on the lateral (external) surface of the ramus; the medial pterygoid is on the medial (internal) surface.
  • Applying excessive pressure intraorally — the area is sensitive and the lingual nerve passes nearby.

Trigger Point Referral

  • Common TrP locations: The primary TrP is in the mid-belly, accessible from the medial surface of the mandibular angle. A secondary TrP may be found near the pterygoid plate attachment (accessible only intraorally).
  • Referral pattern: Refers deep into the ear (similar to deep masseter TrPs), to the TMJ region, and to the posterior throat/pharyngeal area. May also refer to the tongue and hard palate.
  • Clinical significance: Throat and ear referral from medial pterygoid TrPs mimics otitis media and pharyngitis. If a client reports chronic sore throat or ear pain with no infection, and masseter TrPs have been ruled out, check the medial pterygoid — it is the next most likely muscular source of deep ear pain.

Trigger point referral diagram — coming soon

Image coming soon. For visual reference, see [Medial Pterygoid at TriggerPoints.net](http://www.triggerpoints.net/muscle/medial-pterygoid).

Clinical Notes

Innervation significance:
  • Shares CN V3 innervation with all muscles of mastication. The medial pterygoid and masseter form an anatomical and functional pair — they act as a sling around the mandibular ramus for jaw elevation, and they typically become hypertonic together.
Common conditions:
  • Contributes to conditions/tmj-dysfunction as part of the jaw-closing group. Along with the masseter, it is chronically overworked in bruxism and clenching.
  • Medial pterygoid TrPs can produce referred pain to the throat that creates a persistent sense of "something stuck in the throat" (globus sensation). This is an underrecognized muscular contribution to a symptom that is often attributed to reflux or psychological factors.
  • Deep ear pain from medial pterygoid TrPs is difficult to distinguish from masseter deep layer referral — both must be assessed in clients with chronic ear pain and no infection.
What you'll typically find:
  • The medial pterygoid is rarely the primary complaint muscle in TMJ dysfunction — the masseter and temporalis are more accessible and symptomatic. However, it is frequently a contributing factor that maintains the dysfunction when the more superficial muscles have been treated.
  • Tenderness at the mandibular angle (medial surface) is a common finding. Ask the client to report if palpation here reproduces their ear or throat symptoms.
  • Because it is a protractor along with the lateral pterygoid, medial pterygoid hypertonicity can contribute to anterior mandibular posture.
Treatment effects:
  • External technique: fingertip compression at the mandibular angle, hooking around the inferior border to press superiorly into the medial pterygoid. Hold for 30–60 seconds. The client may report ear or throat referral.
  • Intraoral technique is more effective but requires informed consent and gloved hands. Compress the muscle between the intraoral finger (on the medial surface of the ramus) and the external thumb (on the lateral surface).
  • Post-treatment, clients often report reduced ear fullness and throat tension.
Cautions:
  • The lingual nerve (a branch of CN V3) runs along the medial surface of the mandible in close proximity to the medial pterygoid. Deep pressure here can compress the nerve, causing tongue numbness or pain.
  • The inferior alveolar nerve enters the mandibular foramen on the medial surface of the ramus — avoid direct pressure on the mandibular foramen.
  • The area is highly vascular — the maxillary artery branches pass through the infratemporal fossa near the medial pterygoid.
Clinical pearl:
  • The medial pterygoid and masseter form a "mandibular sling" — one on each side of the ramus. If you treat the masseter without treating the medial pterygoid, you have only addressed half the sling. In persistent TMJ dysfunction where masseter release does not resolve symptoms, the medial pterygoid is the most likely untreated contributor.

Assessment

Manual muscle testing:
  • Jaw elevation: Same as masseter — resisted jaw closure tests all elevators simultaneously. The medial pterygoid cannot be isolated from the masseter by manual testing.
Stretch test:
  • Mandibular depression (jaw opening): Same as masseter. Restricted opening suggests the entire elevator group, including medial pterygoid.
Related special orthopedic tests:
  • TMJ palpation — note clicking, crepitus, or deviation
  • Jaw deviation on opening — unilateral medial pterygoid tightness may contribute to contralateral deviation

Muscle Groups

Muscles of mastication (anatomical): Jaw elevators (closers) (functional): Mandibular protractors (functional): Trigeminal nerve — mandibular division (CN V3) group (innervation):

Related Muscles

Synergists for jaw elevation: Antagonists: Clinically related:

Key Takeaways

  • Forms a "mandibular sling" with the masseter — treating one without the other addresses only half the TMJ elevation dysfunction.
  • Throat referral produces globus sensation ("something stuck in the throat") — an underrecognized muscular contribution.
  • Deep ear pain referral mimics otitis media — check medial pterygoid in chronic ear pain with no infection.

Related

Sources

  • Travell, J. G., & Simons, D. G. (1999). Myofascial pain and dysfunction: The trigger point manual (Vol. 1, 2nd ed.). Williams & Wilkins. (pp. 371–394)
  • Biel, A. (2014). Trail guide to the body (5th ed.). Books of Discovery.
  • Vizniak, N. A. (2010). Muscle manual. Professional Health Systems.
  • Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2023). Clinically oriented anatomy (9th ed.). Wolters Kluwer. (Ch. 7: Head)
  • Rattray, F., & Ludwig, L. (2000). Clinical massage therapy: Understanding, assessing and treating over 70 conditions. Talus Incorporated.
  • Magee, D. J., & Manske, R. C. (2021). Orthopedic physical assessment (7th ed.). Elsevier.
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