Intraoral TMJ Treatment: Lateral Pterygoid Release (RMT Clinical Review)

In this video for Registered Massage Therapists, we review the intraoral approach to treating the Lateral Pterygoid—a primary muscle involved in TMJ dysfunction, anterior disc displacement, and jaw clicking.

We demonstrate:

Landmarking: How to safely navigate past the maxilla to the pterygoid pocket.

Technique: The specific vector of pressure (superior/posterior) required to access the muscle belly.

Communication: Establishing non-verbal safety signals with the patient before beginning internal work.

Technique Highlight: The lateral pterygoid is often the "missing link" in unresolved jaw pain. Because it attaches directly to the intra-articular disc, releasing hypertonicity here can help restore proper disc mechanics and reduce "clicking."

⚠️ Professional Disclaimer: This content is for educational review for Registered Massage Therapists. It is not medical advice. Ensure you have appropriate certification and follow your college’s Infection Prevention and Control (IPAC) guidelines for intraoral treatment.
Rattray & Ludwig "Backup" Notes: TMJ & Lateral Pterygoid

Clinical context based on standard RMT texts (Rattray, Ludwig, etc.) regarding Temporomandibular Joint Dysfunction.
1. Anatomy & Indication

Action: The lateral pterygoid is the only muscle of mastication that opens the jaw (depression). It also performs protrusion and contralateral deviation.

Why treat it?

It inserts into the TMJ capsule and articular disc.

Hypertonicity (shortening) pulls the disc anteriorly, often causing the "click" or "pop" heard upon opening.

Trigger Point Referral: Pain is referred deep into the TMJ joint itself and the maxillary sinus (cheek) area.

2. The Intraoral Technique (Protocol)

Preparation:

Gloves are mandatory (nitrile/non-latex preferred).

Hand Signal: Establish a "stop" signal (e.g., patient raises their hand) since they cannot speak.

Access:

Stand on the contralateral side or at the head.

Slide your gloved index finger along the upper gum line (buccal side of the maxilla) all the way to the back of the mouth, past the last molar.

You will find a small "pocket" between the upper teeth and the cheek.

Palpation & Release:

Direction of Pressure: Press Posteriorly, Medially, and slightly Superiorly toward the lateral pterygoid plate.

Sensation: This area is often exquisitely tender. Use a pain scale (1-10) and ask the patient to stay below a 7.

Modification: If the gag reflex is triggered, you are likely too far medial (touching the soft palate) or too far posterior. Move slightly buccal (lateral).

Duration: Hold ischemic compression or perform slow stripping for 30–60 seconds.

3. Home Care (Self-Care)

Rattray suggests teaching the patient self-release if they are comfortable:

Intraoral: The patient uses their own clean finger to find the pocket behind the upper back molars and applies gentle pressure.

Exercise: "Rocabado's 6x6" or simple tongue-on-roof-of-mouth opening exercises to re-educate the jaw muscles to open without excessive protrusion.

4. Safety & Contraindications

Acute Inflammation: Do not work deeply if the joint is acutely inflamed or swollen.

Infection: Contraindicated if the patient has any active oral infection (herpes simplex/cold sore, gum disease, abscess).

Hygiene: Always wash hands before gloving and after removing gloves. Never touch the outside of the face with "intraoral" gloves.