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Mastication Muscle Fibrosis

Dr. Carolyn J. Agresti, MD - Otolaryngologist (ENT) Dr. Carolyn J. Agresti, MD - Otolaryngologist (ENT)
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Rx Musculoskeletal System (A - Z)

Fibrosis of the masticatory muscles—mastication muscle fibrosis—is a pathological process characterized by the excessive, chronic accumulation of collagenous extracellular matrix (ECM) within the muscles responsible for chewing. This aberrant ECM deposition replaces functional muscle fibers, leading to stiffness, reduced elasticity, and impaired jaw mobility. In skeletal muscle, fibrosis is defined as “an abnormal and unresolvable, chronic increase in extracellular connective tissue that interferes with function” PMC. When this process affects the masseter, temporalis, medial pterygoid, or lateral pterygoid muscles, patients experience trismus (lockjaw), pain, and difficulty with basic oral functions.

Anatomy of the Masticatory Muscles

The four primary muscles of mastication attach the mandible to the skull and generate the movements needed for chewing, grinding, and speech. Below is a breakdown of their key anatomical features and functions:

Muscle Origin Insertion Blood Supply Nerve Supply Primary Actions (6)
Masseter Zygomatic arch (superficial head) & zygomatic process of maxilla (deep) Lateral surface of ramus & angle of mandible Masseteric branches of the maxillary artery Mandibular nerve (V₃) via masseteric branch Elevation, protrusion, retrusion (deep head), ipsilateral excursion, clenching, stabilizing mandible
Temporalis Temporal fossa & temporal fascia Coronoid process & anterior ramus of mandible Deep temporal branches of maxillary artery Mandibular nerve (V₃) via deep temporal branches Elevation, retrusion, lateral deviation (contralateral), maintaining occlusion, stabilizing TMJ, assisting in rapid closure of jaw
Medial Pterygoid Medial surface of lateral pterygoid plate & pyramidal process of palatine bone Medial surface of ramus & angle of mandible Pterygoid branches of maxillary artery Mandibular nerve (V₃) via medial pterygoid nerve Elevation, protrusion, contralateral excursion, rotary chewing, stabilizing mandible, maintaining occlusion
Lateral Pterygoid Infratemporal surface of greater wing of sphenoid (superior head) & lateral pterygoid plate (inferior head) Pterygoid fovea of condylar neck & articular disc of TMJ Pterygoid branches of maxillary artery Mandibular nerve (V₃) via lateral pterygoid nerves Protrusion, depression of mandible, contralateral excursion, stabilizing disc–condyle relationship, coordinating opening, initiating opening phase KenhubNCBI

Types of Mastication Muscle Fibrosis

  1. Myofibrotic Contracture
    A painless shortening of muscle due to fibrosis around remaining contractile fibers, often following trauma or infection, limiting passive stretch and opening Physiopedia.

  2. Radiation-Induced Fibrosis
    Occurs after head and neck radiotherapy; up to 15% of patients develop fibrosis in masticatory muscles, leading to trismus Radiology Key.

  3. Post-Traumatic Fibrosis
    Chronic ECM overproliferation after severe muscle injury disrupts normal healing, resulting in scar tissue that impairs muscle regeneration Frontiers.

  4. Chronic Inflammatory Fibrosis (Myositis-Related)
    Persistent muscle inflammation (e.g., myositis) can trigger fibrotic remodeling when repair processes fail to resolve Physiopedia.

  5. Autoimmune Myositis-Associated Fibrosis
    Immune-mediated attack on masticatory fibers (e.g., type 2M autoantibodies) may culminate in chronic fibrosis and trismus MSPCA-Angell.

  6. Idiopathic Fibrosis
    Fibrosis with no identifiable cause, representing an end-stage, irreversible ECM accumulation interfering with function PMC.

Causes

  1. Radiation Therapy for head and neck cancers Radiology Key

  2. Severe Trauma (contusion, laceration) to masticatory muscles Frontiers

  3. Surgical Scarring post-oral or TMJ surgery Wikipedia

  4. Infection-Related Fibrosis (e.g., peritonsillar abscess) Wikipedia

  5. Tetanus-induced sustained muscle spasm Wikipedia

  6. Oral Submucous Fibrosis from areca nut chewing Pocket Dentistry

  7. Myofibrotic Contracture post-infection or trauma Physiopedia

  8. Chronic Myositis (e.g., inflammatory myopathies) Physiopedia

  9. TMJ Ankylosis (fibrous or bony) AAFP

  10. Coronoid Hyperplasia causing mechanical restriction Wikipedia

  11. Poor-Positioned Dental Injections injuring medial pterygoid Wikipedia

  12. Mandibular Fractures with malunion and fibrosis Wikipedia

  13. Neoplastic Infiltration of masticatory muscles Wikipedia

  14. Systemic Sclerosis involving facial muscles Wikipedia

  15. Chemotherapy-Induced Fibrosis in oral mucosa Wikipedia

  16. Repeated Bruxism leading to microtrauma Physiopedia

  17. Chronic TMJ Disorders causing muscle overload AAFP

  18. Volumetric Muscle Loss in battlefield injuries Frontiers

  19. Idiopathic (unknown) PMC

  20. Genetic Syndromes (e.g., trismus-pseudocamptodactyly) Wikipedia

Symptoms

  1. Limited Mouth Opening (Trismus) Physiopedia

  2. Jaw Stiffness Radiology Key

  3. Pain on Chewing Physiopedia

  4. Facial Pain AAFP

  5. Ear Pain (Otalgia) AAFP

  6. Headache AAFP

  7. Difficulty Eating Physiopedia

  8. Speech Difficulties Physiopedia

  9. Swallowing Problems Physiopedia

  10. Drooling Physiopedia

  11. Weight Loss/Malnutrition Lippincott Journals

  12. Jaw Deviation on opening Physiopedia

  13. Muscle Spasms Physiopedia

  14. Tenderness on Palpation Physiopedia

  15. Facial Asymmetry Lippincott Journals

  16. Jaw Fatigue Physiopedia

  17. Clicking/Crepitus (secondary TMJ involvement) AAFP

  18. Oral Hygiene Difficulty Physiopedia

  19. Sleep Disturbance Physiopedia

  20. Social Withdrawal due to eating/speaking challenges Physiopedia

Diagnostic Tests

  1. Maximal Interincisal Opening Measurement NCBI

  2. Clinical Palpation Exam AAFP

  3. Jaw Function Questionnaires AAFP

  4. Magnetic Resonance Imaging (MRI) Radiology Key

  5. Computed Tomography (CT) Scan Radiology Key

  6. Ultrasonography AAFP

  7. Electromyography (EMG) MSPCA-Angell

  8. Muscle Biopsy with Histology (Masson Trichrome) PMC

  9. Hydroxyproline Collagen Assay PMC

  10. Inflammatory Marker Panels (e.g., CRP) Frontiers

  11. Autoantibody Screening (e.g., anti-Type 2M) MSPCA-Angell

  12. TMJ Arthroscopy AAFP

  13. Arthrography AAFP

  14. Jaw Tracking Devices AAFP

  15. Cephalometric Radiographs AAFP

  16. Bone Scintigraphy AAFP

  17. Ultrasound Elastography AJR American Journal of Roentgenology

  18. Nutritional Assessment Lippincott Journals

  19. Speech and Swallowing Evaluation Physiopedia

  20. Differential Diagnosis Exclusion Tests (e.g., dental, ENT workup) Wikipedia

Non-Pharmacological Treatments

  1. Moist heat packs to masticatory muscles NCBI

  2. Jaw-stretching exercises NCBI

  3. Physical therapy (mobility training) NCBI

  4. Manual massage of masseter and temporalis NCBI

  5. Sugar-free chewing gum NCBI

  6. Soft or blenderized diet NCBI

  7. Transcutaneous electrical nerve stimulation (TENS) NCBI

  8. Therapeutic ultrasound NCBI

  9. Stretching to adaptively increase collagen alignment Frontiers

  10. Cognitive behavior therapy AAFP

  11. Biofeedback for muscle relaxation AAFP

  12. Low-level laser therapy AAFP

  13. Acupuncture AAFP

  14. Occlusal splints (stabilization splints) AAFP

  15. Jaw-opening devices (e.g., Therabite™) NCBI

  16. Myofascial release techniques Physiopedia

  17. Stress-management practices (e.g., relaxation) AAFP

  18. Trigger-point injection with saline (diagnostic aid) Physiopedia

  19. Ergonomic posture correction AAFP

  20. Moist hot towel applications NCBI

  21. Jaw mobilization under anesthesia (therapeutic) PMC

  22. Splint-assisted exercises AAFP

  23. Prosthetic adjustments to prevent microtrauma Wikipedia

  24. Thermal biofeedback AAFP

  25. Photobiomodulation (light therapy) AAFP

  26. Manual stretching with finger support Physiopedia

  27. Progressive resistive mouth opening NCBI

  28. Tele-rehabilitation guidance NCBI

  29. Yoga-based jaw relaxation exercises AAFP

  30. Interprofessional care coordination (dentist, physio, surgeon) AAFP

 Drugs

  1. Ibuprofen (NSAID) AAFP

  2. Naproxen (NSAID) AAFP

  3. Diclofenac (NSAID) AAFP

  4. Cyclobenzaprine (muscle relaxant) AAFP

  5. Diazepam (benzodiazepine) NCBI

  6. Baclofen (GABA-B agonist) AAFP

  7. Amitriptyline (tricyclic antidepressant) AAFP

  8. Prednisone (corticosteroid) AAFP

  9. Triamcinolone injections (intra-articular) AAFP

  10. Botulinum toxin type A AAFP

  11. Losartan (anti-TGF-β agent) Frontiers

  12. Suramin (growth-factor inhibitor) Frontiers

  13. Gamma interferon Frontiers

  14. Decorin (proteoglycan binder) Frontiers

  15. Halofuginone (SMAD3 inhibitor) Frontiers

  16. Recombinant MMP-1 Frontiers

  17. Pirfenidone (antifibrotic) ScienceDirect

  18. Nintedanib (tyrosine-kinase inhibitor) ScienceDirect

  19. Azathioprine (immunosuppressant) MSPCA-Angell

  20. Mycophenolate mofetil (immunosuppressant) MSPCA-Angell

Surgeries

  1. Coronoidectomy PMC

  2. Myotomy of masticatory muscles PMC

  3. Free flap reconstruction (post-release) PMC

  4. Arthroplasty AAFP

  5. Arthroscopy AAFP

  6. Coronoidotomy ResearchGate

  7. Excision of fibrous bands ResearchGate

  8. Mandibular osteotomy for severe restriction PMC

  9. Buccal fat pad graft with coronoidectomy & myotomy Pocket Dentistry

  10. Temporalis muscle myectomy ScienceDirect

Prevention Strategies

  1. Radiation planning to spare masticatory muscles Radiology Key

  2. Intensity-modulated radiotherapy (IMRT) to reduce fibrosis risk Radiology Key

  3. Early mouth-opening exercises after radiation NCBI

  4. Prophylactic losartan post-injury to attenuate TGF-β signaling Frontiers

  5. Avoid prolonged jaw immobilization Wikipedia

  6. MMP-modulating agents experimentally to prevent ECM buildup Frontiers

  7. Atraumatic dental techniques to minimize muscle injury Wikipedia

  8. Prompt infection management to limit inflammation Wikipedia

  9. Immediate anti-inflammatory therapy post-trauma NCBI

  10. Regular TMD screenings in high-risk patients AAFP

When to See a Doctor

You should consult a healthcare provider if you experience:

  • Jaw opening < 30 mm persisting > 2 weeks despite home exercises NCBI

  • Severe pain impairing eating or speaking AAFP

  • Unintended weight loss due to chewing difficulty Lippincott Journals

  • Signs of infection (fever, swelling, redness) Wikipedia

  • Neurological symptoms (facial weakness, numbness) Wikipedia

  • Inability to maintain oral hygiene Physiopedia

FAQs

  1. What is mastication muscle fibrosis?
    Chronic scarring of the jaw muscles where normal fibers are replaced by non-elastic tissue, causing stiffness and lockjaw.

  2. What causes it?
    Common triggers include radiation therapy, trauma, infection, surgery, and chronic inflammation.

  3. What are the main symptoms?
    Difficulty opening the mouth, jaw pain, earaches, headaches, and trouble chewing or speaking.

  4. How is it diagnosed?
    Through clinical exam (measuring mouth opening), imaging (MRI/CT), ultrasound, EMG, and sometimes muscle biopsy.

  5. Can it be prevented?
    Strategies include sparing radiation dosing, early jaw exercises, anti-fibrotic drugs like losartan, and gentle dental techniques.

  6. What non-surgical treatments help?
    Jaw stretching, heat packs, massage, physical therapy, TENS, low-level laser, and splint devices.

  7. What medications are used?
    NSAIDs (ibuprofen), muscle relaxants (cyclobenzaprine), corticosteroids, botulinum toxin, and antifibrotics like losartan.

  8. When is surgery needed?
    For fibrous band release, coronoidectomy, myotomy, arthroplasty, or free flap reconstruction when conservative care fails.

  9. Is the condition reversible?
    Early fibrosis may improve with therapy; long-standing scar tissue often requires surgery.

  10. How long does treatment take?
    Physical therapy spans weeks to months; surgeries have 6- to 12-month rehabilitation.

  11. Are there complications?
    Yes: nutritional deficiency, speech issues, social isolation, and recurrent fibrosis without proper rehab.

  12. Can children get it?
    Yes—congenital fibrosis or post-traumatic cases occur; early intervention is crucial.

  13. Does it affect only one side?
    It can be unilateral or bilateral, depending on the cause.

  14. What specialists manage it?
    Maxillofacial surgeons, oral surgeons, physiotherapists, and pain specialists collaborate for care.

  15. When should I stop home exercises?
    Only if you develop sharp pain, swelling, or infection signs—in which case see your doctor immediately.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team Rxharun and reviewed by the Rx Editorial Board Members

Last Updated: April 24, 2025.

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