Zygomaticus Trigger Points
Introduction
The zygomaticus muscles are key facial muscles responsible for smiling, facial expressions, and upper lip movement. When trigger points develop in these muscles, they can cause cheek pain, facial tightness, and difficulty smiling, often mimicking TMJ dysfunction, sinus pain, or trigeminal nerve irritation.
Name and Area
Name: Zygomaticus Major and Zygomaticus Minor
Area: Located on the side of the face, running from the zygomatic bone (cheekbone) to the corners of the mouth and upper lip.
Indications
Zygomaticus trigger points may contribute to:
Pain in the Cheeks and Around the Mouth (Mistaken for TMJ Dysfunction or Sinus Pain)
Tightness in the Face That Feels Like a "Stiff" or "Pulled" Sensation
Difficulty Smiling or Expressing Emotions (Can Mimic Facial Nerve Dysfunction or Muscle Weakness)
Pain or Sensitivity in the Cheeks That Worsens with Smiling or Laughing
A Feeling of Heaviness in the Face, Especially After Prolonged Talking or Eating
Pain That Radiates to the Upper Lip and Nose (Can Resemble Trigeminal Neuralgia or Dental Issues)
Pain from these muscles is often mistaken for TMJ dysfunction, sinus pressure, or facial nerve irritation.
Muscle Action
Elevates the Corners of the Mouth: Creates the smiling expression, essential for social interaction and facial movement.
Assists in Facial Expressions: Works with other facial muscles to control upper lip and cheek movement.
The zygomaticus muscles are crucial for smiling, facial expressiveness, and facial muscle coordination.
Signs and Symptoms
Individuals with zygomaticus trigger points often report:
Pain or Tightness in the Cheeks That Feels Like a "Cramping" or "Burning" Sensation
Difficulty Smiling or a Feeling of Facial Fatigue
Tenderness in the Cheeks That Worsens with Talking, Laughing, or Eating
Pain That Radiates to the Upper Lip and Side of the Nose (Can Feel Like Sinus Pressure or Dental Pain)
Tension in the Face That Worsens with Stress or Clenching the Jaw
Increased Sensitivity to Facial Massage or Touch in the Cheekbone Area
Pain worsens with excessive talking, emotional stress, or jaw clenching.
Perpetuating Factors
Common causes of zygomaticus trigger points include:
Chronic Jaw Clenching or Teeth Grinding (Bruxism, Common in Stress and TMJ Disorders)
Frequent Smiling or Facial Strain (Common in Public Speakers, Actors, and Singers)
Forward Head Posture (Puts Excess Strain on the Face and Jaw Muscles)
Sinus Congestion or Facial Tension (Can Cause Overuse of the Zygomaticus Muscles for Facial Movement)
Prolonged Talking or Chewing Gum (Overuse of the Facial Muscles Can Lead to Tension and Trigger Points)
Trigger Point Referral Pattern
Trigger points in the zygomaticus refer pain to:
The cheeks and upper lip (Can Mimic TMJ Dysfunction or Trigeminal Neuralgia)
The side of the nose and under the eyes (Mistaken for Sinus Pain or Nasal Congestion)
The jaw and around the mouth (Can Resemble Dental Pain or Facial Nerve Issues)
Pain from these muscles is often confused with TMJ disorders, sinus pressure, or nerve irritation.
Differential Diagnosis
Zygomaticus trigger points may be mistaken for:
TMJ Dysfunction (Jaw Pain, Clicking, and Limited Movement, Common in Teeth Clenchers and Jaw Tension Sufferers)
Trigeminal Neuralgia (Sharp, Shooting Facial Pain That Can Resemble Nerve Compression)
Sinus Headaches (Pain and Pressure in the Cheeks and Forehead, Often Accompanied by Congestion)
Dental Pain (Tooth or Gum Sensitivity, Can Mimic Upper Jaw and Cheek Pain)
Facial Nerve Dysfunction (Weakness or Loss of Facial Control, Can Resemble Bell’s Palsy or Nerve Compression)
A thorough facial, jaw, and sinus examination is necessary to rule out these conditions.
Associated Trigger Points
Zygomaticus trigger points often co-exist with:
Masseter (Cheek and Jaw Pain, Common in Teeth Clenchers and TMJ Sufferers)
Temporalis (Temple and Head Pain, Can Resemble Tension Headaches or Migraines)
Sternocleidomastoid (SCM) (Neck and Head Pain, Can Mimic Migraines or Sinus Pressure)
Orbicularis Oculi (Eye and Cheek Pain, Can Resemble Sinus Pain or Eye Strain)
Anatomy and Innervation
| Muscle | Origin | Insertion | Innervation |
|---|---|---|---|
| Zygomaticus Major | Zygomatic bone | Corners of the mouth | Facial nerve (CN VII) |
| Zygomaticus Minor | Zygomatic bone | Upper lip | Facial nerve (CN VII) |
The zygomaticus muscles are innervated by the facial nerve (cranial nerve VII), which also controls facial expressions and mouth movement.
Patient Examination
A comprehensive examination should include:
Palpation: Identify tender nodules along the cheekbones and upper lip area.
Facial Movement Testing: Assess pain and tightness when smiling, frowning, or speaking.
TMJ Function Testing: Rule out jaw misalignment, clenching, or restricted jaw movement.
Sinus and Nasal Assessment: Check for pressure sensitivity around the nose and eyes.
Corrective Actions
Dry Needling
Dry needling can release trigger points in the zygomaticus muscles, reducing facial tightness and improving smile function.
Manual Therapy
Trigger Point Release: Apply gentle sustained pressure along the cheekbones and upper lip.
Facial and Scalp Massage: Helps improve circulation and reduce muscle tension in the face and jaw.
Stretching
Facial Relaxation Exercises: Open and close the mouth gently while relaxing the cheek and jaw muscles.
Cheekbone Stretch: Massage and stretch the zygomaticus area using upward and outward strokes.
Strengthening Exercises
Smiling Drills: Helps activate the zygomaticus muscles and reduce muscle tightness.
Jaw Relaxation Techniques: Encourages proper jaw alignment and reduces excessive facial tension.
Postural and Behavioral Adjustments
Avoid Excessive Jaw Clenching or Facial Tension (Use Relaxation Techniques if Needed)
Maintain Good Head and Neck Posture (Reduces Facial Muscle Strain and Jaw Imbalances)
Limit Excessive Talking, Chewing Gum, or Facial Strain (Prevents Overuse of the Zygomaticus Muscles)
Conclusion
The zygomaticus muscles play a crucial role in smiling, facial expressions, and mouth movement, but trigger points in these muscles can cause significant cheek pain, jaw tightness, and difficulty smiling. By incorporating dry needling, manual therapy, stretching, and relaxation techniques, individuals can reduce pain, improve facial mobility, and prevent chronic facial tension.
➡️ Learn more about Trigger Points
➡️ Explore our Trigger Point Index
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.