TEMPOROMANDIBULAR

JOINT DISORDERS
BY
Prof. Dr. Ragia Mohamed Mounir
Professor of Oral Surgery Department
Faculty of Oral and Dental Medicine
Cairo University
 Definition

Anatomically the TMJ is a diarthrodial

joint which is a discontinuous articulation
of two bones permitting freedom of
movement that is dictated by associated
muscles and limited by ligaments.
Components of T.M.J ( Functional anatomy )
1- Mandibular condyle:

 The shape of the condyle varies greatly from one

individual to another, superior surface may be flattened,
convex, angle, rounded
2- Articular fossa and eminence:
 The receptable of the condyle is the articular fossa
which is a part of the squamous temporal bone. The
squamous temporal bone forms both the concave
articular fossa and the convex articular eminence. The
articular fossa (glenoid fossa) is bounded medially,
laterally, and posteriorly by bony ridges which limit
gross displacment of the condyles in these directions.
 The proper articular surface of the glenoid fossa is
covered by thin layer of non-vascularized non-
innervated dense fibrous tissue.
 This layer thickens remarkably over the posterior
slope of the articular eminence indicating the areas
best suited to sustain maximum pressure which is
upward and forward
3- The Disc ( Meniscus )
 Pear shape fibrous tissue
band that suits the
articulating bone surfaces.
The apex of the disc (pear)
projects anteriorly, the
posterior part is rounded and
encloses the articular surface
of the condyle, the anterior
part of the disc extends
forward in front of the
condyle in relation to the
articular eminence.
 The disc is functionally adapted to the high mobility of
the joint. The disc can be divided into a large central
part which is dense and hard, and peripheral loose and
soft part which emerges with the surrounding capsule.
 The central dense part of the disc is avascular and
thinnest in the middle, about 1 mm and thicker
anteriorly and posteriorly 2.00 and 2.8 mm.
respectively
 The disc normalizes changes in the intra-articular space
during chewing, promotes lubrication, energy
absorption and joint range of motion.
 The postrior part of the disc is known as bilaminar zone,
it consists of upper stratum which is attached to the
posterior wall of the glenoid fossa and the
squamotympaic suture.
 The lower stratum is attached to the back of the
manidibular condyle.
 The articular disc is attached to the medial and lateral
poles of the mandibular condyles by a non-elastic C.T.
ligaments known as collateral ligaments, it do not
stretch but permit only slight lateral movement of the
disc against the condyle.
 During opening movement, the condylar head moves
forward, the meniscus does so too but at approximately half
the speed. This is because the disc rotates posteriorly on
the condyle as the disc-condyle complex moves forward in
relation to the articular eminence. The posterior rotation of
the disc over the condyle on opening is established in order
to maintain contact between the disc and the articular
eminence the maneuver causes bodily forward movment of
the disc to a considerably less than that of the condyle.
4- T. M. Joint capsules

 The fibrous capsule of the mandibular joint is

attached to the articular surface of the glenoid fossa
and eminence superiorly, and to the neck of the
mandible inferiorly. It encloses the articular surfaces
of the temporal component and the condyle. The
T.M.J capsule maintains proximity of the joint parts
during function.
 The fibrous capsule is well vascularized and
innervated, it is lined with synovial membrane which
secretes the synovial fiuid into the joint cavities. The
vascular supply of the capsule is chiefiy from
superficial temporal artery and masseteric artery. Nerve
supply of posterior part of the capsule from
auriculotemporal nerve. Which the anterior part of the
capsular ligament takes innervation from masseteric
and temporal nerves.
5- Temporomandibular joint ligament
1- Functional ligaments:
A. Lateral fan shape layer, originates from lateral
inferior surface of zygomatic arch outer surface of
articular tubercle, it converge obliquely downwards
and backwards and insert at the back of the
mandibular neck.
B. Medial fibres, it arises on the crest of the articular
tubercle and runs horizontally backward and
attached to the disc on the lateral pole of the
condyle. It prevents backward displacement of the
condyle.
2- Accessory ligaments:

A. Sphenomandibular ligament: Arises from spine of

sphenoid bone and is directed downward and inserted
at mandibular lingula at the lower border of mandibular
foramen. It is a suspensory ligament, it limits the jaw
movement at maximum opening.
B. Stylomandibular ligament : It extends from the styloid
process of the temoral bone and insets on the posterior
border of the mandibular. It prevents excessive anterior
shift protrusion of the mandible during extreme
opening.
6- Synovial lining

 The synovial layer lines the fibrous capsule, it serves

to form synovial fluid, the upper and lower joint
cavities are bathed in a viscous synovial fluid, it
provides lubrication of the joint components,
nutrition , phagocytosis and immunological capacity
 MUSCLES OF THE MANDIBULE
1- Muscles of Mastication
A. Temporalis Muscle:

 Fan shape muscle arises from the whole temporal

fossa and deep surface of temporal fascia, the fibers
converges as they descend, passing deep to the
zygomatic arch and and inserts into coronoid
process of the mandibule.

 N. Supply temporal branch of mand. N.

 Arterial supply temporal arties

B. Masseter Muscle:

 Rectangular muscle, consist of two portions

superficial and deep portions. The large superficial
portion arises from the lower border of the zygomatic
arch and zygomatic process of maxilla, the fibres
passes inferiorly and posteriroly and inserted onto
the angle and inferior half of lateral surface of ramus
of the mandibule. The smaller deep portion arises
from the posterior third of the inferior border and
medial surface of zygomatic arch and passes
inferiorly to be inserted onto the base of the
coronoid proces.
Action :- Close the jaws

 Deep portion acts as retractor

 N. Supply masseteric branch of mand.n.
 Arterial supply masseteric artery branch of
internal maxillary artery
C. Internal ( medial ) pterygoid Muscles:

 It arises from medial surface of lateral pterygoid plate,

fibres passes posteriorly and inferiorly and insert onto
the medial surface of mandibular angle.

 Action: Elevates the mandible, i.e. closes

 N. Supply: Medial pterygoid n. Branch of mand. N.

 Arterial supply : Branch of internal maxillary (artery).

D. Lateral pterygoid muscle:
 Short thick conical muscle
it has two bellies upper and
lower heads. The small
upper head arises from
lateral surface of greater
wing of sphenold bone and
passes obliquely
backwards and inserts
onto the anterior part of the
meniscus.
 The greater lower head
arises from lateral surface
of the lateral pterygoid
plate and insert on the
neck of the condyle.
 Action : protrusion and opens the jaws.
 n. Supply : n. to lateral pterygoid from mand. Division of
trigeminal.
 Arterial supply : Branch of internal maxillary artery
2- Suprahyoid Muscles

A. Digastric muscle:
 Has two bellies, anterior and posterior connected
by strong belly. The posterior belly arise from
mastoid process, the anterior belly arise from
digastric fossa near middle of front of mandible,
the two bellies descend downward towards the
hyoid two bellies descend downward towards the
hyoid bone and are united by intermediate tendon.

 Action: Pull the mandible back and downwards.

 n. Supply : Post. Belly facial n.

 Ant. Belly mylohyoid branch of inf. Alv. N.

B. Mylohyoid muscle:

 It is the muscle diaphragm of the oral cavity. It isolates

the sublingual tissue from tissues of neck. It arises
from mylohyoid line on lingual aspect of mandible.
The fibres pass downward and fibres meet in a
median raphe, while others attach to hyoid bone.

 Action : Depress the mandible.

 n. supply: mylohyoid branch of facial n.

C. Geniohyoid muscle:

 Is a narrow muscle lies very close to the middle line

above the mylohyoid muscle. It arises from genial
tubercle of the symphysis of mandibule and inserts on
hyoid bone.
 Action depress mand.
 n. Supply hypoglossal n.

D. Stylohyoid muscle:

 Arises from styloid process of temporal bone and in

serts on body of hyoid bone.
 Action: Draws the hyoid bone up and back.
 n. Supply: Branch of facial n.
Classification of temporomandibular Disorders
 Myofascial Pain dysfunction syndrome.
 Subluxation ( Hypermobility ) – Dislocation.
 Disc displacement disorders.
a. Anterior disc displacement with reduction.
b. Anterior disc displacement without reduction.
 Degenerative joint disease ( arthrosis, osteoarthritis ).
 Ankylosis
a. intra capsular Ankylosis.
b. Extra capsular Ankylosis.
 Neoplasia.
 Infections.
 Fracture condyle.