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The Insertional Attachment of the Superior Head of the Lateral Pterygoid Muscle to the Temporomandibular Joint Components in Humans: an Anatomic Investigation

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The Insertional Attachment of the Superior Head of the Lateral Pterygoid Muscle to the Temporomandibular Joint Components in Humans: an Anatomic Investigation Loyola University Chicago Loyola eCommons Master's Theses Theses and Dissertations 1994 The Insertional Attachment of the Superior Head of the Lateral Pterygoid Muscle to the Temporomandibular Joint Components in Humans: An Anatomic Investigation Thomas Otto Dusek Follow this and additional works at: https://ecommons.luc.edu/luc_theses Part of the Orthodontics and Orthodontology Commons This Thesis is brought to you for free and open access by the Theses and Dissertations at Loyola eCommons. It has been accepted for inclusion in Master's Theses by an authorized administrator of Loyola eCommons. For more information, please contact [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. Copyright © 1994 Thomas Otto Dusek THE INSERTIONAL ATTACHMENT OF THE SUPERIOR HEAD OF THE LATERAL PTERYGOID MUSCLE TO THE TEMPOROMANDIBULAR JOINT COMPONENTS IN HUMANS: AN ANATOMIC INVESTIGATION by Thomas Otto Dusek A Thesis Submitted to the Faculty of the Graduate School of Loyola University of Chicago in Partial Fulfillment of the Requirements for the Degree of Master of Science January 1994 Copyright by Thomas Otto Dusek 1993 All Rights Reserved DEDICATION AND ACKNOWLEDGEMENTS This thesis is dedicated to my mother, Violet Anne Dusek, and father, Otto William Dusek, who always gave for their children before they took for themselves. May their childhood teaching of 'hard work and persistence' be reflected in the substance of this study. To my beloved wife, Kimberly Ann, who for fourteen years has patiently supported my endeavours. May her personal sacrifices be remembered by the contents of this work. I want to thank all of my teachers, professors and counsellors, who throughout my education passed on their wisdom, guidance, and direction. The support and guidance I received from my advisor, Dr. Michael Kiely and other committee members, Dr. Joe Gowgiel and Dr. Lewis Klapper is greatly appreciated. Without their knowledge, guidance and patient understanding, this study could not have been possible. I want to express my gratitude to Mr. Bob Martinez and the staff in the histotechnic lab for their assistance in tissue and slide preparation. I especially want to thank Ms. Sandra Cello for her skillful artistic renderings and Mr. Al Spradlin for his expertise in preparing and mounting the photographic material. I am extremely grateful to Ms. Sally Ford who has been very supportive in preparing the layout and typing of this manuscript. Thank you to all those who in some small, but special way assisted me in the collection and ii DEDICATION AND ACKNOWLEDGEMENTS CONTINUED preparation of the material, methods and thoughts behind this work. May no one go unrecognized. VITA The author, Thomas o. Dusek, is the first of four children of Otto William Dusek and Violet Ann (Cierny) Dusek. He was born July 6, 1949 in Chicago, Illinois and became married to Kimberly Ann Cilc on July 1, 1978. His elementary education was obtained at the Mark Twain elementary, public school of Chicago, Illinois. His secondary education was completed in 1967 at the Harold L. Richards High School in Oak Lawn, Illinois. In August, 1967, the author entered Western Illinois University in Macomb, Illinois, where he majored in zoology and minored in chemistry. He received the degree of Bachelor of Science in zoology in June of 1971. While attending Western Illinois University, he was inducted into the Tri-Beta Biological Honor Society. In August of 1971, he entered the Loyola University, School of Dentistry in Maywood, Illinois. He graduated with the Doctor of Dental Surgery degree in June 1975. Dr. Dusek was accepted to the Air Force General Practice residency program during his senior year at the dental school. He entered residency in July 1975 at the USAF Medical Center, at Scott AFB, Illinois. He completed his one year rotation in July 1976 with a certificate of proficiency. Following his Air Force residency, Dr. Dusek served two additional years active duty with the Air Force Air Defense Command until July 1978, attaining the rank of Captain. iii Following his active duty Air Force term, Dr. Dusek transferred to the U.S. Public Health Service where he became detailed to the U.S. Coast Guard as a general dental officer. He served six years active duty from July 1978 thru July 1984 attaining the rank of Lieutenant Commander. In August 1984, Dr. Dusek returned to post-graduate studies in Orthodontics at Loyola University in Maywood, Illinois. He received the certificate of specialty in Orthodontics from Loyola University School of Dentistry in May 1986. While attending Loyola for his specialty studies in orthodontics, Dr. Dusek entered the Oral Biology graduate program. He also received an assistantship in the department of Anatomy which enabled him to instruct and do research on the present topic. During the compilation of the data for this research, Dr. Dusek was recalled to active duty by the U.S.Air Force in support of Operation Desert storm. Dr. Dusek now maintains a private practice of orthodontics in Chesapeake, Virginia. TABLE OF CONTENTS Page DEDICATION AND ACKNOWLEDGEMENTS ii VITA iii TABLE OF CONTENTS iv LIST OF TABLES v LIST OF ILLUSTRATIONS vi Chapter I. INTRODUCTION 1 II. PURPOSE 3 III. REVIEW OF RELATED LITERATURE 4 Dual Insertion Theory....................... 4 Separate Insertion Theory .........••....... 13 Non-Discal Insertion Theory ................ 15 IV. METHODS AND MATERIALS 16 Anatomic Description; Gross Dissection ..... 16 Blunt Dissection of Lateral Pterygoid Muscle and Joint Components ........... 17 Decalcification/Fixation Process ........... 18 Fine Muscle Dissection . 19 Embedding Technique . 2 o Microtome Technique ....•..........•.•...... 21 Method of Muscle Fiber Counting •......••••• 21 V. RESULTS 23 General Anatomic Features .................. 23 Superior Head Insertions (Pterygoid Fovea) .. 25 Superior Head Insertions (Disc-Capsule) ..... 26 Histologic Findings of Superior Head Insertion . 28 Fiber Count Distribution •..•......•........ 29 Tables . 3 O iv TABLE OF CON'l'EN'l'S (CON'l'IHUED) Chapter Page VI. DISCUSSION . 36 General Discussion •••••••••••••••••••••••.• 36 Superior Head in Joint Dynamics •.•••••••.• 39 Pterygoid Proprius Muscle ••••••..••••••••• 44 VII. SUMMARY AND CONCLUSIONS . 46 VIII. APPENDIX . 50 Plates of Gross Dissection Technique ••..••• 51 Plates of Microdissection Results .••••....• 58 Diagrams of Fine Dissection •••••.•••.•••..• 71 Plates of Histologic Results .••••.•...•••.. 77 Plates of Morphometric Analysis Technique .••.••••• 86 Plates of Fiber Count Results •••••..•••.•••. 92 Plates of Pterygoideous Proprius Muscle ...•• 95 REFERENCES . 109 APPROVAL SHEET . 115 LIST OF TABLES Item Page TABLE I EQUATIONS I. Computing Average Number of Muscle Cells within Muscle Area 30 II. Computing Average Number of Muscle Cells Within Total Area of Superior Head 31 III. Computing Percentages 31 TABLE II AVERAGE NUMBER OF MUSCLE CELLS PER TOTAL MUSCLE AREA 32 TABLE III PERCENTAGES 34 LIST OP ILLUSTRATIONS Item Page Plate 1 Whole Gross Specimen ••••••••••••••••••• 52 Plate 2 Sagittally Bisected Specimen: External .. 53 Plate 3 Sagittally Bisected Specimen: Internal •• 54 Plate 4 Outline of Gross Incision ••••••••••.•••• 55 Plate 5 Gross Block Section Removal: External ••• 56 Plate 6 Gross Block Section Removal: Internal ••• 57 Plate 7 Anterior Inferior Capsule ••••••••••••••• 59 Plate 8 Sagittal Cut Thru Medial One Third: Disc on Top ............................... 60 Plate 9 Sagittal Cut Thru Medial One Third: Disc Lifted ............................... 61 Plate 10 Lateral View of Medial One Third: Tendon. 62 Plate 11 Lateral View of Disc-Capsule-Condyle Complex •••••..•••••••••••...•••.•••..• 63 Plate 12 Anterior Inferior View of Disc: Lateral to Medial ............................ 64 Plate 13 Superior Head Fibers Separated ••••••...• 65 Plate 14 Disc Lifted to View Anterior-Inferior Capsule .............................. 66 Plate 15 Central Tendon of Inferior Head ••••••••• 67 Plate 16 Medial Pole of Disc-Capsule-Condyle Complex •••••••••••••...••••••••..••••. 68 Plate 17 Fascia Overlying Superior Head ..••.••••. 69 Plate 18 Grouping of Superior Head Fibers •••••••• 70 Plate 19 Diagram I: Sagittal Section Thru Middle of D-C-C Complex •••••••••.•••••••••... 72 Plate 20 Diagram II: Sagittal Section Thru Medial One Third ............................ 73 Plate 21 Anterior Cranial Diagram of Disc-Condyle Complex: Fascia ...................... 74 Plate 22 Anterior Cranial Diagram of Disc-Condyle Complex: No Fascia ••••••••.•••.•.••.•• 75 Plate 23 Key for Plates 24-29 ••••••••.•••••.•••.. 76 Plate 24 Histosection: Anterior-Inferior Capsule • 78 Plate 25 Histosection: Anterior-Inferior Capsule Disc Interface ....................... 79 Plate 26 Histosection: Foot of Disc {45x) ..••.•.• 80 Plate 27 Histosection: Foot of Disc {lOOx) ..•••.. 81 Plate 28 Histosection: Foot of Disc: Tendon Interface . 82 Plate 29 Histosection: Disc: Tendon Interface (200x) • • • • • • • • • . • • • • • • . • • • • • • • • • • • • • • . 83 vi LXST OP XLLUSTRATXONS CONTXNUED Item Page Plate 30 Sagittal Histosection: Medial One Third of Complex ........................... 84 Plate 31 Sagittal Histosection: Medial One Third ( 4 ox) ••.•••••••••••••••••••••••••••.•• 85 Plate 32 Digitizer and Computer System •••..•••..• 87 Plate 33 Digitizing Morphometry System ••••••••••• 88 Plate 34 Digitizer Handpiece Against Hipad Board • 89 Plate 35 Handpiece Cross-Hairs Under Magnification 90 Plate 36 Muscle
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