TEMPOROMANDIBULAR JOINT – TMJ

CONTENT

• Introduction
• Gross anatomy
• Histology
• Blood & nerve supply
• Clinical consideration
• Age changes
• Development of TMJ
INTRODUCTION

• It is a bilateral synovial articulation between temporal bone above & mandible below.
• Is combination of gliding & loose hinge movement.
• So called as “ginglymoarthroidal articulation”.
• TMJS are the bilateral components of a single craniomandibular articulation / joint.
• Articular surfaces are covered by fibrocartilage not by hyline cartilage because
fibrocartilage is less susceptible to degeneration & have greater repair capacity.
 Articular surface
• 1) Mandibular fossa:
• Oval or Oblong depression in temporal bone.
• Relation :
• anterior = articular eminence (eminentia articularis)
• posterior = external auditory canal & tympanic plate of
petrus portion of temporal bone
externally = middle root of zygoma
Superior = articular disc, joint capsule
inferior = Mondibular condyle, synovial membrane
2) Condyloid process
• Convex all direction somewhat flattened.
• knob like form.
• wider lateromedially than anteroposteriorly.
• Development differs individuals by Functional
• design remains Same.
• Condyle is perpendicular to ramus of mandible.
 Articular disc
• Intra articular disc consist of fibrous tissue.
• Anterior & posterior band are thick and central band is thin.
• Disc divide articulating surface into upper (condylodiscal)
lower (temporodiscal)
• Plate is avascular, oval, fibrous, noninnervated.
 Functional role:
• Act as shock absorber, distributingloads during
mastication & Jaw movement.
• facilitate smooth articulation between themandibular
condyle & the temporal bone.
• JOINT CAPSULE:
• TMJ is enclosed in a capsule.
• Attached:
• articulating surfaces of mandibular fossa & eminence of temporal bone to neck of mandible.
• The anterolateral side of capsule may be thickened form a band → temporomandibular ligament.
• Not always so thickened.
• When distinguishable appears to arise on zygomatic arch to pass backward to attach on
lateral/distal surface of neck of mandible.
Capsule → formed by
internal – synovial layer
outer – fibrous layer.
 LIGAMENT
1) Stylomandibular ligament
2) Sphenomandibular ligament
3) Temporomandibular ligament
 HISTOLOGY

Articular fibrous covering

• In the TMJ (temporomandibular joint), unlike typical synovial joints covered by hyaline cartilage, the articular
surface is covered by fibrocartilage due to the mandible’s membranous ossification.

• The condyle and articular eminence are lined by thick fibroelastic tissue with fibroblasts and varying
chondrocytes.

• The mandibular condyle has a fibrous covering with even thickness and a superficial collagen fiber network.

• Chondrocytes increase with age, and the reserve cell zone supports appositional growth. Fibrocartilage, which
resists mechanical stress and does not calcify, covers articulating surfaces with thickness varying by region.
• It has two layers with fibers oriented either
parallel or perpendicular to the bony surface.
• TMJ’s weight-bearing nature is supported by the
absence of cartilage, dense fibrous tissue with
collagen fibers, and chondroitin sulfate (GAG) which
helps withstand compression.
 Articular disc
• In young articular discs, fibroblasts are elongated with clear

cytoplasmic processes.

• With age, cells become rounded and pair up like

chondroid cells.
• True chondrocytes are absent unless there's pathology.

• If present, chondrocyte-like cells with territorial matrix

and basic dye staining are seen, increasing the fibrous tissue’s
resistance and resilience.
 Synovial Membrane
• Articular capsule is lined with synovial mem that folds form → synovial villi.

• During joint movement synovial mem is stretched & flattened.

• Small amount of synovial fluid is found in articular spaces.

• Is a lubricant & a nutrient fluid for avascular tissue of joint. Have good capacity for regeneration.

• Synovial ne membrane → suintimal CT layer (rich in blood capillaries) + internal cells

• With age, amount of synovial fluid decrease & villous projection increase.
 Intimal cell

B cell/S cell A cell Third type

- Fibroblast like - Macrophages - has cellular
cell like morphology
- Rich in RER - Rich golgi between A & B
bodies & type
lysosome
 Bony structure
• Condyle
• composed of cancellous bone, covered by a thin layer of compact bone.
• marrow spaces decrease & thickening of trabeculae with age
• red marrow in condyle → myeloid or cellular type but with age
replaced with fatty marrow.
During growth,
-layer of hyaline cartilage lies underneath the fibrous
covering of the condyle.
- It’s deep surface is replaced by bone.
• Sometimes remnants of cartilage persist into old age.
• . Hyaline cartilage of condyle is not organized, so
called secondary cartilage.
• Glenoid fossa: thin compact layer of bone.
• Articular eminence – spongy bone covered by
compact bone.
 BLOOD & NERVE SUPPLY

• Nerve supply
• All joint tissue except avascular disc are Supplied by auriculotemporal nerve which is branch of ‘V’ cranial
nerve .
• proprioceptor fibers (about position & movement) are carried by masseteric nerve & other muscular
branch Of mandibular nerve.
• Blood Supply
• Maxillary artery & superficial temporal artery.
Veins
• Large venules close to anterior ligament of disc, bilaminar zone & posterior Capsule.
•
 DEVELOPMENT OF TMJ

• *Development of joint*
• At around 10 weeks of fetal development, the temporomandibular joint (TMJ) begins to form between the condylar cartilage of
the mandible and the temporal bone.
• By 12 weeks, two slit like joint cavities and a disc appear, and the fibrous joint capsule starts developing.
• The TMJ forms from two mesenchymal thickenings: the glenoid fossa blastema (from the otic capsule, undergoes
intramembranous ossification) and the condylar blastema (from secondary condylar cartilage, undergoes endochondral
ossification).
• A third thickening between them becomes the intra-articular disc.
• Joint cavities arise from coalescence of spaces in the mesenchyme.
• The lateral pterygoid muscle attaches to the disc, which is connected to the malleus of the middle ear in the fetus. This
connection disappears in adult.
 AGE CHANGES

• Age changes in TMJ:

• -Age related changes usually occur due to osteoarthritis.
• -Other changes excluding osteoarthritis are,
• -due to remodeling of articular surface it may lead to displacement of disc.
• -Retrodiscal tissue (vascular & highly innervated and located posterior to disc) show
decrease in cellularity & vascularity, increase in collagen which result in progressive joint
damage.
 CLINICAL CONSIDERATION

• The thinness of the bone in the articular fossa is responsible for fractures if the
mandibular head is driven into the fossa by a heavy blow. In such cases, injuries of the
dura mater and the brain have been reported.
• The finer structure of the bone and its fibrocartilaginous covering depends on mechanical
influences.
• A change in force or direction of stress, especially after loss of posterior teeth, may cause
structural changes. These changes may include fibrillation (separation between collagen
bundles) of the fibrous covering of the articulating surfaces and of the disc.
• Presence or absence of teeth influences the amount of jaw movement. When all teeth are
absent, the jaw overcloses.
• In approximately 18% of the population, the mandible deviates on opening, and in almost 86%
of this group deviation is to the left.

• In approximately 35% of the population, the TMJ produces sounds during opening movements.

• The joint has palpable irregularities and produces popping and clicking noises. However, use of
a stethoscope reveals that approximately 65% of TMJs produce some kind of sound.
• This feature by itself, especially if not a sign of disease may not require treatment.
• Disorders of TMJ
• Muscular Disorders (Myofascial Pain Disorders) are the most common cause of TMJ pain
• many patient with “high stress level”
• poor habits including gum chewing, bruxism, hard candy chewing -poor dentitio
• It is caused by muscle tension, fatigue, or (rarely) spasm in the masticatory muscles.
• Joint Disorders :
• Joint Disorders are the second most common cause of temporomandibular pai.
• Include internal derangements, degenerative joint disease, developmental anomalies, trauma, arthritis,
ankylosis and neoplasms.
• What is a dislocated jaw?
• You have a dislocated jaw when your jaw joint or temporomandibular joint (TMJ) is out
of place. Your TMJ includes the joints, jaw muscles and ligaments that connect your lower
jaw to your skull. These parts work together so you can open and close your mouth.
• Osteoarthritis is one disorder that can affect the TMJ. This joint connects the jaw to the
skull. People with TMJ osteoarthritis may develop damage to the hard and soft tissues of
one or both sides of the jaw.