TEMPORO

MANDIBULAR
JOINT
JAHANVI GAMIT
840
INTRODUCTION
The name TMJ derived from the two
bones that form the joint
 *TEMPORAL BONE
 *MANDIBLE

*Type of joint- synovial joint of

condylar variety.
ARTICULAR SURFACES

 UPPER SURFACE IS FORMED BY

 *Articular tubercle
 *Anterior part of mandibular fossa
 *posterior non-articular part-Tympanic plate
 LOWER SURFACE FORMED BY
 *Head of mandible
 THE JOINT CAVITY IS DIVIDED INTO UPPER and LOWER
PARTS BY INTRA-ARTICULAR DISC.
LIGAMENTS

*Fibrous capsule
*Lateral temporomandibular ligament
*Sphenomandibular ligament
*Stylomandibular ligament
*Pterygomandibular ligament
[Link] CAPSULE

 Attached
 Above - articular tubercle
 Front- circumference of mandibular fossa
 Behind- squamotympanic fissure
 Below - neck of the mandible.
 The capsule is loose above the intra-auricular disc and
tight below it.
 The synovial membrane lines the fibrous capsule and neck
of the mandible.
2. LATERAL TEMPOROMANDIBULAR
LIGAMENT
 Reinforcesand strengthen the lateral part
of capsular ligament.
 Fibers runs downwards and backwards.
 Attachment:

Above: articular tubercle

Below: posterolateral aspect of neck of the
mandible.
[Link] LIGAMENT

 Accessary ligament.
 Lieson a deep plane away from the fibrous
capsule.
 Attachment:

Superiorly: spine of the sphenoid.

Inferiorly: lingula of the mandibular foramen.
 Remnant of dorsal part of Meckel’s cartilage.
RELATIONS
 Lateral

a)lateral pterygoid muscle
b)auriculotemporal nerve
c)maxillary artery
 Medial
 a)Chorda tympani nerve
b)Wall of pharynx
At the lower end it’s pierced by the mylohyoid nerve and vessels.
[Link] LIGAMENT-
accessory ligament
 Accessary ligament.
 it’s thickened part of deep cervical fascia,
saparete parotid and submandibular salivary
gland.
 Attachment:

Above: lateral surface of styloid process.

Below: angle and adjacent part of posterior
border of ramus of mandible.
[Link] LIGAMENT

Attachment:

Above: pterygoid Hamulus at lower end

of medial pterygoid plate.
Below: to the inner aspect of mandible
just behind 3rd molar.
ARTICULAR DISC

 Articular disc is oval predominantly fibrous plate.

 Divides the joint into,
 1)Upper compartment – meniscotemporal compartment
 (provide gliding movement)
 2)Lower compartment – maniscomandibular compartment
 (provide gliding and rotatory
movement)
 Concavoconvex superior surface.
 Concave inferior surface.
The disc is composed

Anterior region
 Anterior thick band
 Intermediate region
 Posterior thick band
 Bilaminar region containing venous
plexus.
 Disc represent the degenerated primitive insertion
of lateral pterygoid muscle.
FUNCTION OF DISC

 Acts as a cushion and helps in shock absorption.

 Stabilizes
the condyle by filling up the space
between articulating surface.
 The proprioceptive fibers present in the disc helps
to regulate movements of the joint.
 Helps in distribution of weigh across the TMJ by
increasing the area of contact.
SYNOVIUM: The capsule of TMJ is lined by synovium
and synovial fluid fills the joint cavity
Synovial fluid is filtrate of plasma with additional
proteins and mucins.
Its main content is hyaluronic acid. Synovial tissue
is vascular connective tissue lining the fibrous
capsule.
 It extends till the boundaries of articular surfaces.
 Lining of fluid on the articulating surface
HISTOLOGY

 Condyle: composed of cancellous bone Covered by thin layer of

compact bone.
 Red bone marrow: cellular or myeloid.
 fossaRoof of the mandibular : thine plate of compact bone.
 Articular tubercle: cancellous bone covered by compact bone.
 Articular disc: comprised of dense fibrous tissue with few elastic
fibers.
 Synovial membrane lining the capsule folds to form synovial villi into
joint spaces.
 Comprises internal cells like fibroblast and macrophages and
subintimal connective tissue layer.
 Lateral:
1. Parotid gland
2. Temporal branches of facial nerve
3. Skin and fasciae

 Medial:
1. The tympanic plate separates the joint from the internal carotid artery.
2. Spine of sphenoid with upper end of sphenomandibular ligament
3. Auriculotemporal nerve and chorda tympani nerve
4. Middle meningeal artey.
 Anterior:
1. Lateral pterygoid
2. Masseteric nerve and artery
 Posterior:
1. The parotid gland separates the gland from external
auditory meatus
2. Superficial temporal vessels
3. Auriculotemporal nerve
Superior:
1. Middle cranial fossa
2. Middle meningeal vessels

 Inferior:
1. Maxillary artery and vein
 Blood supply: branches from superficial temporal artery and maxillary
artery.
 Nerve supply: auriculotemporal nerve and masseteric nerve.
MOVEMENTS

 There are five movements:

1. depression(open mouth)
2. Elevation (close mouth)
3. Protrusion (protraction of chin)
4. Retrusion (retraction of chin)
5. Lateral or side to side movements during chewing
or grinding.
 Movements of joint can be palpated by putting finger at
preauricular point or into external auditory meatus.
The movements at the joint can be divided into,
-between the upper articular surface and articular disc
(meniscotemporal compartment)
-between the disc and head of the mandible
(maniscomandibular compartment)
 Most movements occurs simultaneously at the right and
left TMJ.
 Protraction or forward movement:
the articular disc with the head of the mandible
glides forwards over the upper articular surface.
- Movements occurs in meniscotemporal compartment.

 Retraction or backward movement:

the articular disc glides backwards over the
upper articular surface taking the head of the mandible
with it.
 Depression or open mouth:
- In the slight opening of the mouth, the head of the mandible
moves undersurface of the articular disc like a hinge in lower
compartment.
- In the wide opening of the mouth, this hinge like movement
is followed by gliding of the disc and head of the mandible in
upper compartment as in protrusion.
- At the end, head comes to lie under the articular tubercle.
- This all movements are reversed in elevation of the
mandible.
 Lateral or side to side movements:
- In this movement, head of the right side glides
forwards along with the disc in protraction but the
head on the left side merely rotates on the vertical
axis.
- As a result, chin move forward and the left side.
- Alternate movements of this kind on the two sides
results in side to side movements.
 MUSCLE PRODUCING MOVEMENTS

 Depression:
- Mainly by the lateral pterygoid muscle.
- The digastric, geniohyoid and mylohyoid helps in wide
opening of the mouth.
- The origin of the lateral pterygoid is anterior, slightly lower
and medial to its insertion. So during the contraction it
rotates the head of the mandible and open the mouth.
- During the wide opening, it pulls the articular disc forward.
So, movements occurs in both compartments.
 ELEVATION
- masseter, the anterior vertical, middle oblique fibers of
the temporalis and the medial pterygoid muscle of the
both side.
- These are antigravity muscle.

PROTRUSION:
-lateral and medial pterygoid muscle and superficial
oblique fibers of ,masseter.
LATERAL OR SIDE TO SIDE MOVEMENTS:
-chewing from left side produced by, right lateral pterygoid and right medial
pterygoid which push the chin to left side.
-left masseter(deep fibers) and left temporalis (anterior fibers) chew the food.

AGE CHANGES IN TMJ:

- The large marrow spaces decrease in size as age advances.
- Red marrow gets replaced by fatty marrow.
- The trabeculae becomes thick.
- The fibrocartilage covering the articular surface shows calcification.
TMJ DISORDERS

1. Inflammatroy – arthritis
2. Congenital and developmental – hypoplasia,
aplasia and hyperplasia.
3. Related to intra articular disc – disc deplacement,
dislocation and deviation
4. Ankylosis – true/false/fibrous/bony
5. Neoplasia
6. Muscle related – spasm, myofascial pain.
MYOFACIAL PAIN DISFUNCTION
SYNDROME
 Tenderness of muscle of mastication
 Opening of mouth is limited
 Joint sound are produced
 Seen more in females
 May be related stress.
 Occurs due to spasm of muscles of mastication.
 It is treated conservatively.
CLINICAL ANATOMY

 Dislocation of mandible: during excessive opening of the mouth,

the head of the mandible of both or one side may slip anteriorly
into the infratemporal fossa leads to inability to close the mouth.
Reduction is done by depressing the jaw with the thumbd placed
on 1st molar teeth at the same time elevating the chin.
 Derangement of articular disc may result from any injury, like
overclosure or malocclusion. This gives rise to clicking and pain
during movements of jaw.
 In operation of the TMJ, the 7th nerve and auriculotemporal nerve
branch of mandibular nerve of 5th nerve should be preserved with
care.