LIMITINGFACTORS POSTERIOR IN MOVEMENTS OF MANDIBULAR CONDYLES

LOUISJ. BOUCHER, D.D.S."

Marquette University, School of Dentistry, Milwaukee, Wis.

found that angle human A cadavers with the joints intactthe symphysealmusclescould be traced onfindings but with the removed. These
PRILE AND SAIZAR~

indicate that the muscles are not responsible for limiting the posterior movements of the mandible. Page2 stated that the temporomandibular ligament controls the amount of posterior movement of the mandible. Steinhardts agreed with Arstad4 that the capsular ligaments of the temporomandibular joint limit the posterior movements of the mandible. Various opinions are held by different investigators as to the functional importance of the anatomic structures involved in limiting retrusive movements of the mandible.5 The purpose of this article is to determine if the ligaments are responsible for limiting posterior movements of the mandible. The effects of severing the temporomandibular ligaments in unembalmed human cadavers and living human patients were observed.
MATERIALS AND METHODS

Gothic arch (needle point) tracings were made on a fresh human cadaver specimen both before and after severing the temporomandibular and capsular ligaments. Impressions were made of the relationship of the teeth of the mandible to those of the maxillae while the mandible was forced to the most retruded position both before and after severing the temporomandibular and capsular ligaments. Artificial stone casts were made from the impressions. The fresh, unpreserved specimen was a 62-year-old white man. The tests were performed only a few hours after death, before rigor mortis had set in. Measurements were made of the relationship of the lower to the upper teeth on 27 living patients. The treatment for these pa.tients required severing of the temporomandibular and capsular ligaments. Impressions were made of the teeth of the lower jaw of each patient in relation to the teeth of the upper jaw while the mandible was forced to its most retruded position. After severance of the temporomandibular and capsular ligaments, similar impressions were made at intervals of 1 hour, 2 weeks, 3 months, and in three instances 6 months. Artificial stone casts were made in all of the impressions. --This investigation was supported by Public Health Fellowship DF-8205. This preliminary report will be part of a thesis in partial fulfillment of the requirements for the degree of Doctor of Philosophy in Anatomy, Marquette University Graduate School, *Graduate student, Department of Anatomy, Marquette University Graduate School. 23

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BOUCHER

Fig. l.-Artificial stone casts made while the mandible was forced to its most retruded position, both before and after severing the temporomandlbular and capsular ligaments, show that the relation of the upper and lower teeth is identical.

All patients were women, with an average age of 42 years. All had good alveolar bone structure.
RESULTS

Needle point tracings made on the fresh human specimen before and after severing the temporomandibular and capsular ligament were identical. Measurements of the distance between the lingual incisal edge of the upper teeth and the labial incisal edge of the lower teeth before and after severing the temporomandibular and capsular ligaments and with the mandible forced to its most retruded position were identical. Measurements of the relationship of the casts of the lower teeth to the upper teeth of the 27 living patients made before severing the temporomandibular and capsular ligaments were identical to those made after severing the ligaments. There was no lateral deviation of the mandible to the operated side on any patient (Fig. 1) . This refers to the comparison of the casts made while the mandible was forced to the most retruded position.
DISCUSSION

The results obtained from the fresh human specimen indicate that neither the temporomandibular nor capsular ligaments are responsible for limiting retrusion of the mandible. These results differ from those reported by Aprile and Saizar.1 However, our experiments cannot be considered completely valid. It is possible that the condyles may have been forced back to contact the posterior slope of the articular fossa both before and after severance of the ligaments. The use of roentgenograms would have made the results more valid.

Volume 11 Number 1

POSTERIOR

MOVEMENTS

OF

MANDIBULAR

CONDYLES

25

The temporomandibular ligaments and capsular ligaments were severed unilaterally in the 27 living patients. There would be little change in the posterior direction since only one ligament was severed. However, if the ligaments were responsible for limiting retrusive movements, there should have been a slight lateral deviation of the lower midline to the operated side.
SUMMARY

It appears that neither the temporomandibular nor the capsular ligaments are responsible for limiting posterior border movements of the mandible. Further investigation of this problem is indicated.
Acknowledgment is made to Dr. Walter Zeit, Professor and Chairman of the Department of Anatomy, Marquette University Medical and Dental Schools, and to Dr. R. P. Gingrass, Professor and Chairman of the Department of Oral Surgery, Marquette University, School of Dentistry.
REFERENCES

1. Aprile, 2. 3. 4. 5.

H., and Saizar, P. : Gothic Arch Tracing and Temporomandibular Anatomy, J.A.D.A. 35:256-261: 1947. Page, H. L. : Temporomandibular Joint Physiology and Jaw Synergy, D. Digest 60 :.54-59, 1954. Steinhardt, G. : Anatomy and Physiology of the Temporomandibular Joint: Effect of Function, Internat. D. J. 8:155-156, 1958. Arstad, T.: The Capsular Ligaments of the Temporo-Mandibular Joint and Retrusion Facets of the Dentition in Relationship to Mandibular Movements, Monograph, Oslo, 1954, A. W. Brdggers Boktrykkeri. Boucher, L. : Observations on Arthrodial Types of Temporomandibular Joints, J. PROS. DEN. 10:1086-1091, 1960.
MARQUETTE UNIVERSITY SCHOOL OF DENTIST~~Y 604 NORTH SIXTEENTH ST. MILWAUKEE 3, WIS.