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Myofascial pain patterns of the masseter muscle

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Essential (solid red) and spillover (stippled red) referred pain from the 4 primary trigger points (x's) within the masseter refer pain to: (A) the upper molar teeth, adjacent gums and maxilla, with the maxillary pain often described as sinusitis; (B) the lower molars and mandible, which may cause tooth hypersensitivity; (C) from the angle of the mandible, supraorbitally and to the lower jaw; (D) to the lateral cheek and TMJ, and often deep into the ear, causing ipsilateral tinnitus from referred motor unit activity of the stapedius muscle of the tympanic membrane. (From: Travell JG, Simons DG. Myofascial pain and dysfunction, masseter muscle, the trigger point manual. Volume 1. Baltimore: Williams & Wilkins, 1983:220, with permission.)