09-11-2024

TEMPEROMANDIBULAR
JOINT

Introduction
• TMJ is a unique in both structure and function.
• Structurally the mandible is a horseshoe shaped bone that articulates
with temporal bone at each posterior superior end.
• Each TMJ contains a disc that separates the joints into upper and lower
articulations
• The temporomandibular joint (TMJ) is a synovial joint that is made up
of the articulating surface of the temporal bone and the head of the
mandible.
• The joint itself is also associated with a number of important functions
including eating, speaking, breathing and sleeping.

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Joint Structure
It has four articular surfaces:

 Mandible condyle
 Temporal fossa
 Inferior and superior surfaces of the articular disc
 The superior surface faces the temporal fossa

• The inferior surface is in contact with the mandible condyle

• The situation of the condyle inside the joint is a controversial subject. The so-
called “central position” is a theoretical concept. The jaw is suspended,
supported by the muscles and other stabilising elements, such as ligaments
and the articular capsule.

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ARTICULAR STRUCTURE
Proximal segment- temporal bone
Distal segments- condyles of mandible
Fibrocartilage- present in areas, intended to withstand repeated and
high level stress.

• The incongruence of the TM joint is addressed by a unique articular disc.

• A disc located within each TM joint separates the articulation into distinct
superior and inferior joints with slightly different functions.
• Thus, mandibular motion involves the simultaneous movement of four
divergent joints.
• The inferior TM joint is formed by the mandibular condyle and the inferior
surface of the disc and functions as a simple hinge joint.
• The superior TM joint is larger than the inferior joint and is formed by the
articular eminence of the temporal bone and the superior surface of the
disc; it functions as a gliding joint.

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• The purpose of the disc is to allow the convex surfaces of the articular eminence
and the mandibular condyle to remain congruent throughout the range of motion
of the TM joint in all planes.
• It increases stability, minimizes loss of mobility, reduces friction, and decreases
biomechanical stress on the TM joint.
• The disc within each TM joint has a comp set of attachments. The disc is firmly
attached to the medial and lateral poles of the condyle or the mandible, but it is
not attached to the TM joint capsule medially or laterally.
• These attachments allow the condyle to rotate freely on the disc in an
anteroposterior direction. The disc is attached to the joint capsule anteriorly, as
well as to the tendon of the lateral pterygoid muscle.
• The anterior attachments restrict posterior translation of the disc. Posteriorly, the
disc is attached to a complex structure, collectively called the bilaminar retro
discal pad.

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• The two bands (or laminae) of the bilami retrodiscal pad are both attached to
the disc.The superior lamina is attached posteriorly to the tympanic plate (at
the posterior mandibular fossa).
• The superior lamina consists of elastic fibers that allow the superior band to
stretch.
• The superior lamina allows the disc to translate anteriorly along the articular
eminence during mandibular depression; its elastic properties assist in
repositioning the disc posteriorly during mandibular closing.
• The inferior lamina is attached to the neck the condyle and is inelastic. The
inferior lamina serves as a tether on the disc, limiting forward translation, but
does not assist with repositioning the disc during mandibular closing.
• Neither of the laminae of the retrodiscal pad is under tension when the TM
joint is at rest.
• Loose areolar connective tissue rich in arterial and neural supply is located
between the two laminae

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CAPSULE AND LIGAMENT

• The elasticity of the joint capsule and ligaments determines the available motion at the TM
joint in all planes. can be enhanced or restricted
• Motion depending on the flexibility of these structures. The portion of the capsule
superior to the disc is quite lax, whereas the portion of the capsule inferior to the disc is
taut.
• Consequently, the disc is mor firmly attached to the condyle below and freer to move in
the articular eminence above.
• The capsule is thin and loose in its anter medial, and posterior aspects, but the lateral
aspect is stronger and reinforced with long fibers (temporal bone to condyle).
• The lack of strength of the capsule anteriorly and the incongruence of the bony articular
surfaces predisposes the joint to anterior dislocation of the mandibular condyle.
• The capsule is highly vascularized and innervated, which allows it to provide a great deal of
information about position and movement of the TM joint.

• The primary ligaments of the TM joint are TM ligament, the

stylomandibular ligament, and the sphenomandibular ligament.
• The TM ligament bis a strong ligament composed of two parts, an
outer oblique element and an inner horizontal element.
• The outer oblique element attaches to the neck of the condyle and
the articular eminence. It serves as a suspensory ligament and limits
downward and posterior motion of the mandible, as well as limiting
rotation of the condyle during mandibular depression.

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Ligaments
• Oblique portion of Tempero
mandibular ligament- checks excessive
post movement of mandible.
• Stylomandibular- from styloid process
to superiorly over the angle of the
mouth. It checks excessive anterior
movementt of mandible.
• Spnemandibular ligament – checks ant
movementt n inferior of mandible.

• The stylomandibular ligament is the weakest the three ligaments and

is considered a thickened part of the parotid sheath joining the styloid
process to the angle of the mandible
• The sphenomandibular ligament is described as the "strong" ligament
that is the "swinging hinge" from which the mandible is suspended.
• The sphenomandibular ligament attaches to the spine of the
sphenoid bone and to the middle surface of the ramus of the
mandible.

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MUSCLES
Primary muscles
• The muscles acting on the TM joint are divided into primary and
secondary muscle groups.
• The primary muscles include the temporalis, masseter, lateral pterygoid,
and medial pterygoid.

• The temporalis is a flat, fan-shaped

muscle that is wide at the proximal
portion and narrow at the inferior
portion.
• The temporalis fills the concavity of
the temporal fossa and can be
palpated easily over the temporal
bone.

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• The masseter is a thick, powerful

muscle with its superior attachments
on the zygomatic arch and zygomatic
bone and its inferior attachment on
the external surface of the ramus of
the mandible.

• The lateral pterygoid consists of superior

an inferior segments that travel in a
horizontal direction and combine
posteriorly to attach to the neck of the
mandible, the articular disc, and the joint
capsule.
• The medial pterygoid parallels the
masseter in line of force and size. The
superior fibers attach to the medial surface
of the lateral pterygoid plate on the
sphenoid bone, and the inferior
attachment is on the internal surface of the
ramus near the angle of the mandible.

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Secondary Muscles
• The secondary muscles are smaller than the primary muscles and
consist of the suprahyoid and infrahyoid groups.
• The digastric, geniohyoid, mylohyoid, and stylohyoid comprise the
suprahyoid group.
• The infrahyoid group includes the omohyoid, sternohyoid,
sternothyroid, and thyrohyoid muscles.
• The suprahyoid muscles assist with mandibular depression, while the
infrahyoid muscles are responsible for stabilizing the hyoid.

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• Both the suprahyoid and infrahyoid muscle groups are involved in

speech, tongue movements, and swallowing.
• The digastric muscle is predominantly responsible for mandibular
depression. The hyoid bone has to be stabilized for the digastric
muscle to depress the mandible. This stabilization is provided by the
infrahyoid muscles.

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• Mandibular depression occurs from the concentric action of the

bilateral digastric muscles in conjunction with the inferior portion of
the lateral pterygoid muscles.
• Mandibular elevation results from the collective concentric action of
the bilateral masseter, temporalis, and medial pterygoid muscles.
• The bilateral superior lateral pterygoid muscles eccentrically control
the TM discs as the mandibular condyles relocate into the mandibular
fossa with mandibular elevation

• The other mandibular motions of protrusion retrusion, and lateral deviation are
produced the same muscles that elevate and depress the mandible, but in
different sequences.
• Mandibular protrusion is produced by the bilateral action of the masseter, medial
pterygoid, and lateral pterygoid muscles.
• Retrusion is generated through the bilateral action of the posterior fibers of the
temporalis muscles, with assistance from the anterior portion of the digastric
muscle.
• Lateral deviation of the mandible is produced by the unilateral action of a selected
set of these muscles.The medial and lateral pterygoid muscles e deviate the
mandible to the opposite side.
• The temporalis muscle can deviate the mandible to the same side.
• The lateral pterygoid muscle is attached to the medial pole of the condyle and
pulls the condyle forward.
• The temporalis muscle on the ipsilateral side is attached to the coronoid process
and pulls it posteriorly. Together these muscles effectively spin the condyle to
create deviation of the mandible to the left.

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JOINT FUNCTION/ KINEMATICS

• The TM joint is one of the most frequently used and mobile joints in
the body. It is engaged during mastication, swallowing, and speaking.
• Most of the time, the TM joint movements occur without resistance
from chewing or contact between the upper and lower teeth.
• However, as a third-class lever, the TM joint is designed to maintain its
structure in spite of significant forces acting on it.
• As previously noted, the articular surfaces are covered with a
pseudofibro cartilage that has the ability to remodel and repair and
thus is able to tolerate repeated, high-level stress.

• Both osteokinematic and arthrokinematicmovements are required for

normal function of the TM joint.
• Osteokinematic motions include mandibular depression, elevation,
protrusion, retrusion, and left and right lateral excursions.
• Arthrokinematic movements involve rolling, anterior glide,
distraction, and lateral glide

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Jaw opening and

closing

Mandibular Depression and Elevation

• Mandibular depression and elevation are fundamental components
of mastication.
• Under normal circumstances, the motions of mandibular depression
and elevation are relatively symmetrical, with each TM joint following
a similar pattern.
• To accomplish mandibular depression and elevation, the mandibular
condyle must roll and glide.

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• During rotation, the mandibular condyle sp relative to the inferior surface of

the disc in the lower joint.
• During translation, the mandibular condyle and disc glide together as a
condyle-disc complex along the articular eminence. Translation occurs in the
upper joint between the disc and the articular eminence.
• Rolling occurs predominantly during the initial phase of mandibular
depression with as little as 11 mm or as much as 25 mm, resulting from
rotation of the condyle on the disc.
• The remaining motion results primarily from anterior translation of the
condyle-disc complex along the articular eminence.
• The shape of the condylar head and the steepness of the articular eminence
positively correlate with the amount of rotation.
• Both the shape of the condylar head and steepness of the articular eminence
can be asymmetrical from one TM joint to the other, thus affecting the
symmetry of motion

• The mandibular elevators are thought provide eccentric control of

mandibular depression, although their contribution is unclear.
• Mandibular elevation is the reverse of mandibular depression.
• The mandibular condyle rotates posteriorly on the disc in the lower
joint, and the condyle-disc complex translates posteriorly in the upper
joint

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Protursion and retrusion

• Mandibular protrusion and retrusion occur in the upper TM joint.

• The condyle-disc complex translates in an anterior inferior direction,
following the downward slope of the articular eminence, during protrusion
and returns along a posterior superior path.
• Rotation is not present during protrusion and retrusion. The teeth are
separated during these motions.
• Protrusion is an important compon necessary for maximal mandibular
depression.
• Retrusion is an important component of mandibular elevation from a
maximally depressed mandible.
• The degree of retrusion is limited by tension in the TM ligament as well as
by compression of the soft tissue in the retrodiscal area between the
condyle and the posterior glenoid spine.

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Lateral deviations
• Lateral deviation to Right- right rotation at right condyle, forward
translation of left condyle
• The condyles work together to achieve lateral movements of the jaw.
When assessing lateral movement, it is necessary to differentiate one
condyle from the other:
• The "working side" is the side that moves laterally when taking the
chin as a reference
• The "non-working side" is the side that moves towards the midline

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