Beyond two heads: An imaging-based analysis of the lateral pterygoid muscle's heads

The lateral pterygoid muscle (LPM) is crucial for masticatory function but exhibits significant anatomical variability that challenges traditional anatomical views. Advanced imaging techniques have revealed these variations, necessitating a reevaluation of the LPM's structure.

To categorize variations in the number of LPM heads and their relationship with the maxillary artery, aiming to improve the understanding of orofacial anatomy and move beyond simplified anatomical models.

Cone-beam computed tomography (CBCT) coronal sections of the LPMs were examined to identify five muscle types, ranging from the typical two-headed configuration to variants with extra or single large heads. Additionally, computed tomography angiograms (CTAs) were analyzed to classify the maxillary artery's relation to the LPM into three patterns: superficial, deep, or coursing through the LPM.

A total of 271 CBCT scans were bilaterally assessed (542 sides). Variations in the number of LPM heads were observed in 36.9 % of cases. Similarly, 170 CTAs (340 sides) were analyzed. Among these, deviations in the typical superficial path of the maxillary artery were observed in 36.76 % of cases. Notably, the artery either passed deep to the LPM or, in rare instances (1.47 %), traversed through the LPM.

The study challenges conventional anatomical dogmas by highlighting significant variability in LPM anatomy and its association with the maxillary artery. These findings highlight the necessity of adopting imaging-driven, personalized anatomical insights to improve clinical decision-making and outcomes, advocating for a paradigm shift in understanding human anatomy.