The temporalis muscle converges to a broad, thick tendon that descends deep to the zygomatic arch, passing through the infratemporal fossa, and inserts on the medial surface and anterior border of the coronoid process and the anterior ramus of the mandible. The tendon is fan-shaped and palpable just superior to the mandibular notch between the condyle and coronoid. The deep temporal nerves supply the temporalis through its tendon zone.
The temporalis tendon and its coronoid insertion are involved in several clinical scenarios: temporalis myofascial pain produces temporal headache and radiates to the upper teeth; coronoid hyperplasia elongates the coronoid and its tendon, causing trismus from arch impingement; and temporalis tendon transfer is used in facial reanimation surgery to restore smile animation in chronic facial palsy by detaching the coronoid and rerouting the tendon to the oral commissure.
In long-standing facial palsy, the temporalis tendon is detached from the coronoid process and rerouted through a subcutaneous tunnel to the corner of the mouth, using voluntary biting or clenching movements to animate the smile, with or without lengthening the tendon with a fascial strip to reduce the required bite force.
Trigger points within the temporalis muscle belly and its tendon zone produce a characteristic temporal headache that refers to the upper teeth and lateral orbital region, mimicking dental pain and requiring differentiation by trigger point injection and manual therapy targeted at the temporalis.
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