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Temporomandibular Joint

(TMJ)
Oral Biology

Alex Forrest
Associate Professor of Forensic Odontology
Discipline Head, Forensic Science, Griffith University
Senior Forensic Odontologist,
Health Support Queensland Forensic and Scientific Services,
39 Kessels Rd, Coopers Plains, Queensland, Australia 4108

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Learning Objective

You should be able to describe the structure of the TMJ and


its movements in preparation for understanding the roles of
the muscles of mastication in moving the mandible.
Structure

Structure

The Temporomandibular Joint is the site of articulation


between the mandible and the cranium.
It is a bilateral synovial joint, and serves to open and close
the jaws, and to approximate the teeth of each jaw during
mastication.

Structure

It consists of parts of the


mandible and temporal
bones which are covered
by cartilage, and
surrounded by several
ligaments including a
joint capsule.
Between the two bones is
a fibrous articular disk,
breaking the joint into two
separate synovial-lined
compartments.
http://www.tmj.com/b1_patient.html
Several pairs of muscles
attached to the mandible
produce movements
required to suckle, ingest
and masticate food,
swallow and yawn, and
produce speech.
They are called the
muscles of mastication
and the accessory
muscles of mastication.

http://e-ortho.tripod.com/orofacialPain.htm

© Alex Forrest 2008

The mandible possesses two articular surfaces, the


condyles, which are located on the upper end of each of
the bilateral condylar processes.

http://chiropracticresearch.org/NEWS_chiropractic_and_tmj.htm

Each condyle articulates with a meniscus (articular disk)


which lies between it and the temporal bone.
The condyles, which
are characteristically
"football-shaped”, are
directed at an oblique
angle, so that if the
planes of the long
axes were continued
they would meet at
the front of the
foramen magnum.

Modified from: Scott, JH & Dixon, AD. Anatomy for Students


of Dentistry. Edinburgh, Churchill Livingstone, 3rd Edition
1972. p. 150.

The Temporal Bone

Grays Anatomy,
35th Ed, Longman,
London 1973, p.
293.

The site of articulation on the temporal bone is on the inferior


surface of the zygomatic process. It is called the glenoid fossa
or the mandibular fossa.

© Alex Forrest 2008

While on the dried skull the mandibular condyle appears to


articulate within the glenoid fossa between the bony articular
tubercle and the post-glenoid process, in real life it probably
articulates about the tubercle.
http://cpmcnet.columbia.edu/dept/dental/Dental_Educational_Software/TMJ/LatTMJ2.gif

The Articular Disk (meniscus) is a compact, dense fibrous


connective tissue plate.
It is roughly oval in shape and lies between the mandibular
condyle and the articular eminence of the temporal bone.

Modified from: Posselt, U, Physiology of Occlusion and Rehabilitation, Blackwell


Scientific, Oxford, 2nd Edition 1973.

Its inferior surface is concave to fit the convex surface of


the condyle. Superiorly, its surface is concavo-convex.
The disk is thickest at its periphery and thinnest in the
stress-bearing part of the joint.

The coverings of the


articular surfaces of the
condyle and articular
eminence are composed of
dense fibrous connective
tissue.
The heaviest stress-
bearing areas of the disk
are also fibrocartilage, and
indeed the whole disk may
become fibrocartilaginous
in later life.

http://e-ortho.tripod.com/orofacialPain.htm
These fibrocartilaginous
structures are all
essentially avascular, but
they are bathed in
synovial fluid which
provides nourishment as
well as lubrication.

http://e-ortho.tripod.com/orofacialPain.htm

Ligaments

Ligaments

Anatomy textbooks describe several ligaments around the


TMJ.
They do not always clearly differentiate between the
ligaments of the joint (which are true ligaments), and the
accessory ligaments, some of which are not true
ligaments, but are simply thickenings in sheets of fascia.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The ligaments of the joint comprise the joint capsule, and the
medial and lateral ligaments.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The capsule is reinforced along its medial and lateral margins


by bundles of collagenous fibres. Its lateral part is strongly
reinforced, and this strengthened fibres are known as the
lateral ligament or temporomandibular ligament.

Accessory Ligaments
Accessory Ligaments

The accessory ligaments are basically thickenings in sheets of


fascia. One of them (the stylomandibular ligament) is not really
even a ligament in the true sense, and they definitely are not
strong enough to fulfil the "suspensory" role sometimes
assigned to them in textbooks.
Instead, they have stretch receptors which feed into reflex
control loops and thus prevent excessive opening and
protrusion of the mandible.

The sphenomandibular
ligament, a true ligament,
is a derivative of Meckel's
cartilage, and runs
between the spine of the
sphenoid bone and the
lingula of the mandible.
It is clinically important
because if local
anaesthetic solution is
deposited anterior to it
during an inferior dental
block injection, it will
prevent the diffusion of the
solution posteriorly and
From Grays Anatomy, 35th Ed, Longman, London 1973,
result in a failed block. p. 408

The stylomandibular
ligament is a
thickening of the deep
cervical fascia, and
extends from the
styloid process of the
temporal bone to the
posterior border of the
angle of the mandible.
It is not a true
ligament, but just a
thickening of fascia.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408
Innervation

The joint capsule is sensitive, and is heavily endowed


with sensory endings from the mandibular division of the
trigeminal nerve, primarily through its auriculotemporal
branch.
Additional fibres to the joint are derived from the
masseteric branch of the mandibular nerve.

Blood Supply

Blood supply is via the maxillary artery and by branches of


the superficial temporal artery.
Venous drainage is via the pterygoid plexus, and lymphatic
drainage is via the buccal and submandibular lymph nodes.

Movements of the TMJ


Movements

During its movements, the mandible swings on its elevator


muscles, and on the other tissues which suspend it from
the cranium.
The mandible may be depressed, elevated, protruded,
retruded, moved laterally, and returned to its resting
position. It may be rotated around an axis passing
roughly through both condyles.
Chewing is a combination of all of these movements.

Movements

Jaw Opening is a combination of protrusion, depression,


and rotation about the intercondylar axis.
Jaw Closing is a combination of retrusion, elevation and
rotation.
Protrusion cannot occur without depression to
disocclude the teeth.
Movements

When the mandible is swung to one side, the contralateral


condyle is pulled forwards, downwards and medially.

The ipsilateral condyle remains in its fossa, undergoing only


slight movement, being slightly depressed, swung slightly
laterally, and rotated around a vertical axis.

This is sometimes known as "Bennett Movement".

Ligaments & Function

Ligaments and Function

Ligaments act to limit the range of a movement in a joint.


The limiting function of TMJ ligaments should not be regarded
as purely mechanical.
Ligaments contain receptors that are sensitive to tension
generated within the ligament.
Afferents from these nerve endings probably instigate the
appropriate reflex control on opposing muscle groups.
The Lateral
Ligament of T.M.J.
limits the movement
of the condyle to an
arc, the radius of
which is determined
by the ligament.
It may also play a
part in limiting the
movement of the
mandible when it is
swung towards the
contralateral side.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The “Medial
Ligament” of T.M.J.
is more vertically
aligned than the
lateral ligament. It
probably limits
depression of the
mandible.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The
Sphenomandibular
Ligament limits
depression of the
mandible and
prevents dislocation
of the joint. The
Pterygoid Fascia is
continuous with the
sphenomandibular
ligament, and should
therefore serve a
similar function.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408
The Stylomandibular
Ligament is suitably
aligned to limit the
movement of the
mandible towards the
ipsilateral side.
During such movement,
the angle of the
mandible swings away
from the midline.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The meniscus may also be


regarded as a ligament.
Its strong attachment to the
anterior margin of the
articular eminence (on the
one hand), and to the
posterior surface and both
poles of the condyle (on the
other hand) enable it to
restrain the amount of
retrusion of the mandible.

http://e-ortho.tripod.com/orofacialPain.htm

Ligaments and Function

The mandible may be forcibly retruded up to 1.5 mm.


posterior to its normal maximum intercuspal position, and
the amount of retrusion possible represents the amount of
"slack" in the meniscus and lateral ligaments.
Learning Objective

You should be able to describe the structure of the TMJ and


its movements in preparation for understanding the roles of
the muscles of mastication in moving the mandible.

The End

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