Buccinator Trigger Points

Introduction

The buccinator is a deep facial muscle that plays a crucial role in chewing, speaking, and facial expressions. When trigger points develop in this muscle, they can cause jaw pain, cheek tightness, and difficulty chewing, often mimicking TMJ dysfunction, dental pain, or sinus issues.

Name and Area

  • Name: Buccinator

  • Area: Located in the cheeks, running horizontally from the maxilla and mandible to the orbicularis oris (lip muscles).

Indications

Buccinator trigger points may contribute to:

  • Pain in the Cheeks, Jaw, or Near the Molar Teeth (Mistaken for Dental Pain)

  • Difficulty Chewing or Biting (Pain With Eating, Particularly Tough Foods)

  • Tightness or Stiffness in the Cheek Muscles

  • Pain That Extends Toward the Ear, Mimicking Ear Infections or TMJ Disorders

  • Clicking or Popping Sensations in the Jaw

  • Excessive Drooling or Difficulty Keeping Food Inside the Mouth

Pain is often mistaken for TMJ dysfunction, toothaches, or sinus pressure.

Muscle Action

  • Aids in Chewing: Helps compress food against the molars and prevents food from collecting in the cheeks.

  • Facilitates Blowing and Sucking Movements: Essential for whistling, playing wind instruments, and drinking through a straw.

  • Supports Speech and Facial Expressions: Works with the orbicularis oris for articulation and smiling.

The buccinator is crucial for oral function and facial movement, often overlooked in cases of jaw pain.

Signs and Symptoms

Individuals with buccinator trigger points often report:

  • Pain or Aching in the Cheeks (Especially When Eating or Talking)

  • A Sensation of Fullness or Tightness in the Cheeks

  • Pain That Radiates to the Jaw, Teeth, or Temporomandibular Joint (TMJ)

  • Difficulty Whistling or Blowing Air

  • Involuntary Clenching or Increased Muscle Tension in the Face

  • Unilateral Facial Pain That Can Mimic Trigeminal Neuralgia

Pain worsens with repetitive chewing, talking for long periods, or clenching the jaw.

Perpetuating Factors

Common causes of buccinator trigger points include:

  • Teeth Grinding (Bruxism) or Clenching (Common During Stress or Sleep)

  • Chewing Gum or Eating Tough Foods Frequently

  • Overuse in Wind Instrument Players (Trumpet, Saxophone, Flute, etc.)

  • Post-Dental Procedures (Holding the Mouth Open for Long Periods)

  • Jaw Misalignment or TMJ Dysfunction

  • Excessive Whistling, Puckering, or Sucking Movements

Trigger Point Referral Pattern

Trigger points in the buccinator refer pain to:

  • The cheeks, molar teeth, and jawline

  • The TMJ area, mimicking jaw dysfunction

  • The ears, resembling ear infections or sinus pain

Pain from this muscle is often confused with dental issues, sinus infections, or TMJ disorders.

Differential Diagnosis

Buccinator trigger points may be mistaken for:

  • Temporomandibular Joint Dysfunction (TMJ) – Jaw Pain, Clicking, and Limited Movement

  • Dental Pain (Toothaches, Molar Sensitivity, or Cavities)

  • Sinus Pressure (Facial Fullness and Discomfort in the Cheekbones)

  • Trigeminal Neuralgia (Sharp, Stabbing Facial Pain)

  • Inner Ear Problems (Eustachian Tube Dysfunction or Ear Infections)

A thorough jaw, facial, and dental assessment is necessary for proper diagnosis.

Associated Trigger Points

Buccinator trigger points often co-exist with:

  • Masseter (Jaw Pain and Chewing Dysfunction)

  • Temporalis (Forehead and Jaw Pain, Headaches)

  • Orbicularis Oris (Lip and Mouth Tension, Difficulty Puckering or Speaking Clearly)

  • Sternocleidomastoid (SCM) (Neck and Jaw Tightness, TMJ Dysfunction)

Anatomy and Innervation

Muscle Origin Insertion Innervation
Buccinator Maxilla and mandible (lateral alveolar processes) Blends with orbicularis oris Facial nerve (CN VII)

The buccinator is innervated by the facial nerve (cranial nerve VII), which controls facial expressions and mouth movements.

Patient Examination

A comprehensive examination should include:

  • Palpation: Identify tender nodules along the cheeks, near the molars and TMJ.

  • Resisted Cheek Compression Testing: Assess pain or weakness when puffing the cheeks or blowing air.

  • Mastication Function Testing: Evaluate discomfort when chewing tough foods.

  • Facial Expression and Speech Testing: Check for difficulty with smiling, puckering, or speaking clearly.

Corrective Actions

Manual Therapy

  • Trigger Point Release: Apply sustained pressure along the cheek muscles, near the molars and jawline.

  • Myofascial Release: Massage techniques to loosen tight facial muscles.

Stretching

  • Cheek Stretch: Gently pull the cheek outward while pressing the tongue against the inside of the cheek.

  • Facial Mobility Exercises: Exaggerate smiling, puckering, and opening the mouth to improve flexibility.

Strengthening Exercises

  • Cheek Resistance Training: Press the tongue or fingers against the cheeks while maintaining pressure.

  • Speech and Articulation Drills: Practice exaggerated mouth movements to improve muscle coordination.

Postural and Behavioral Adjustments

  • Reduce Gum Chewing or Hard Food Consumption

  • Use a Mouth Guard to Prevent Nighttime Clenching or Grinding

  • Avoid Overuse of Wind Instruments or Excessive Whistling

Field Details
Name & Area Buccinator; Cheeks, extending to lips and jaw
Indications Jaw and cheek pain, difficulty chewing, tightness in the face
Muscle Action Aids in chewing, blowing, sucking, and speech articulation
Signs & Symptoms Pain near the molars, facial tightness, difficulty with puckering or whistling
Perpetuating Factors Teeth grinding, excessive chewing, overuse in wind instrument players, jaw misalignment
Trigger Point Referral Cheeks, jaw, molars, TMJ, ears
Differential Diagnosis TMJ dysfunction, dental pain, sinus pressure, trigeminal neuralgia
Associated Trigger Points Masseter, temporalis, orbicularis oris, sternocleidomastoid (SCM)
Anatomy & Innervation Facial nerve (CN VII)
Corrective Actions Manual therapy, stretching, strengthening, postural changes

Summary Table: Buccinator Trigger Points

Sources:

  • Travell, J. G., & Simons, D. G. (1983). Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins.

  • Simons, D., & Travell, J. (1999). The Trigger Point Manual, Volume 2: The Lower Extremities. Williams & Wilkins.