Cadaveric and in vivo validation of needle placement in the medial pterygoid muscle

Abstract

BackgroundEvidence suggests that medial pterygoid muscle plays an important role in temporomandibular pain. Therapeutic approaches targeting this muscle are needed. ObjectiveTo determine if a solid needle accurately penetrates the medial pterygoid muscle during the application of dry needling. DesignA cadaveric and human descriptive study. MethodsNeedling insertion of the medial pterygoid was conducted in 5 fresh cadaver and 5 subjects with temporomandibular pain. Needling insertion was performed using a 40 mm needle inserted at the inferior angle of the mandibular bone. The needle was advanced from an inferior to superior direction into the medial pterygoid to a maximum depth of 30 mm. In cadavers, medial pterygoid placement was assessed by observation after resecting the superficial overlying tissues. In patients, medial pterygoid placement was assessed by self-reported pain referral during insertion. ResultsAccurate needle penetration of the medial pterygoid was observed in all fresh cadavers and pain referral was reported by 4/5 patients during needling insertion. ConclusionResults from both cadavers and patients support the assertion that needling of the medial pterygoid can be accurately conducted.