Chances are that if you do cranial osteopathic treatment, you probably do not pay much attention to the mandible. Most of the treatments for the mandible have simply focused on treating the temporomandibular joints (TMJ). In this blog, I want to explain why as a practitioner of osteopathic manipulative medicine (OMM), you should pay more attention to the mandible even beyond the TMJ, such as intraosseous strains during your osteopathic manipulative treatments (OMT) . Releasing tension at the mandible can give profound pain relief throughout the body. This is done because of the mandible’s influence on the dura.
The mandible can have a strong indirect influence on dura. The mandible is not directly connected to dura but there are many ways that it can have an effect on dural membranes. The sensory innervation of the jaw is through the mandibular branch of the trigeminal nerve, cranial nerve V (CN V). Therefore strains in the mandible, including intraosseous strains, can facilitate the mandibular branch of the trigeminal nerve. The trigeminal nerve is an abundant innervator of the dura mater. It is plausible then, that facilitation of the trigeminal nerve could then influence the dura mater and that has been my observation.
Furthermore, the mandible is also tied to the trigeminal nerve because of the two most powerful muscles in the body. These are the masseter muscle and the temporalis muscle. They are the muscles that are involved with closing the mouth during chewing. The innervation of the masseter and temporalis muscles is through branches of the trigeminal nerve. Tenderness in these muscles can also facilitate the trigeminal nerve and indirectly influencing the trigeminal nerve. The masseter originates on the zygomatic process and maxilla and the temporalis muscle originates on the parietal bones. Dysfunction of the masseter and temporalis can cause dysfunctions in the temporal, zygomatic, maxillary, and parietal bones directly. These muscles, the trigeminal nerve, and dura are also influenced by emotions such as stress, anger, and irritation.
An intraosseous strain of the mandible can alter the shape of the mandible. In doing so, the symmetries of the condyloid process of the mandible can become affected. So if the condyloid processes are no longer symmetrical, then the temporal bones may have to adjust their position on the skull to account for the asymmetry. The tentorium cerebelli, a dural membrane in the head, is attached to the petrous portion of the temporal bones. By changing the position of the temporal bones, the tentorium cerebelli may become strained. Once again, this would be an indirect influence on the dura mater by a mandibular strain.
Lastly, fascia is strongly bound to bone via Sharpey’s fibers. There is a superficial and deep layer of fascia in the face that have attachments to the mandible itself. They are continuous down the neck and eventually down to the feet. An intraosseous strain of the mandible places tension on this fascia, which affects proper venous and lymphatic drainage from the face and neck. Two recent cases come to mind that reinforced the importance of this.
One patient, a young woman in her early 30’s, had severe cystic acne that was worse along her chin. She had so much inflammation in her chin, the skin was stretched out and tight from the congestion. A few minutes after releasing her mandibular intraosseous strain, the congestion in her face had drained. Her skin no longer looked so inflamed and she reported feeling the front of her neck feeling like it was “draining.” After a few more treatments, her acne cleared up considerably and continues to improve to this day without any other specific acne products. It has only been a few weeks so I do not yet know what the final outcome will be.
Another patient, also a young woman in her 30’s, lost her voice 10 days prior to coming to my office as a result of an upper respiratory infection. On evaluation, I also noted an intraosseous strain of her mandible and felt congestion in the tissues of her neck. In a scratchy voice, the patient was telling me the story of losing her voice while I was releasing her mandible. She was telling me of the exact moment and place when she went from having a normal voice to losing it completely in “mid-sentence.”
After I finished the release, I noticed the congestion in her face and neck draining. So, while she was telling me the story of losing her voice, I could hear her voice improving. By the time she was done telling the story, her voice was back to normal. I noted the improvement and moved on with my treatment. Because I did not want to disrupt the patient from the story, I did not tell her. It was not until later when she spoke again, that she noticed. “Wait a minute. When did my voice come back?” asked the patient. Astonished, she called her friend who she spoke to prior to the visit as proof that her voice was suddenly returned.
The sphenoid bone is considered a very important bone in the cranial concept. The sphenoid can be directly affected by the mandible via the sphenomandibular ligament. The sphenomandibular ligament attaches to the sphenoid at the spina angularis and then attaches to the mandible at the mandibular foramen. The sphenomandibular ligament becomes taut with opening the mouth. An intraosseous strain of the mandible could potentially have an effect on the ligament influencing the sphenoid bone.
Treating the TMJ and intraosseous strains of the mandible can have a profound effect on the head and the rest of the body via its effects on the trigeminal nerve and dura. Considering this in your treatments may help make progress with patients. In addition, I have added a video of a home exercise for patients to reinforce the treatment when appropriate that goes well in another post or with the “How To Relieve Tension In The TMJ” video.