TMJ & muscles of mastication 1st branchial arch derivatives

• LECTURE OUTLINE
• mandible
• embryological origin
• muscles of mastication (& others)
• temporomandibular joint
• innervated by CN V3
• muscles of mastication
• new principle
• innervation – NP7: The nerve that supplies the muscles
– referred pain acting at a joint also supplies tissues of
that joint and the skin over the muscles
and/or the joint. (Hilton’s law)

Temporomandibular joint TMJ structure

• histological classification - synovial
mandibular – articular surfaces
eminence • mandibular fossa & eminence (tubercle)
• mandibular condyle (head)
• lined with fibrocartilage
mandibular
– possible adaptation and remodelling
fossa
– articular disc
• fibrocartilagenous with variable thickness
• biconcave (condyle & eminence are convex)
• attaches to condyle, capsule, retrodiscal tissue
and lateral pterygoid muscle
mandibular • creates superior and inferior joint cavities
condyle
Marieb

TMJ sagittal section Movement

of articular
disk

Hiatt: 13-1A Hiatt: 13-1B & C

 TMJ structure 2 TMJ function
• histological classification - synovial
• two joints must function together
– capsule
• loose attachments above disk (to temporal • classification by shape
bone) • hinge (inferior cavity)
• tight attachments below disk (to mandible) • gliding (superior cavity)
– ligaments • ‘hinge with movable sockets’
• temporomandibular – movements possible
– lateral • elevation & depression
• sphenomandibular • protraction (protrusion) & retraction (retrusion)
– medial • side-to-side (lateral deviation)
• stylomandibular • wide opening of mouth requires protrusion in
– posterior upper cavity and depression in lower cavity
• all prevent separation of articular surfaces – may lead to dislocation anteriorly
– inferior movement of mandible

(A) Protraction
(superior joint
Depression Lateral deviation of the mandible
cavity)
of the
plus
mandible
(B) Depression
(inferior joint
cavity)

Typical dislocation

arc of opening

Manual: I-3 Manual: I-4

Muscles of mastication Primary muscles of mastication

• primary muscles
– attachments • temporalis
• insertion on mandible – origin
• origin on other bones of skull • temporal fossa (radiating fibres)
– temporalis – insertion
• coronoid process of mandible
– masseter
• masseter
– medial and lateral pterygoids
– origin
• accessory muscles • zygomatic arch
– attachments – insertion
• one attachment on mandible • angle and ramus of mandible
– digastric, mylohyoid, geniohyoid
 Temporalis & masseter Pterygoid muscles

M17: Increasing the distance between the axis for

movement and the point of application of a force
producing the movement (i.e., increasing the lever
Hiatt: 12-5
arm) increases the mechanical advantage. Hiatt: 12-4

Actions of primary muscles

Primary muscles of mastication opening closing protrusion retrusion lateral
deviation
• medial pterygoid
– origin temporalis
• medial surface of lateral pterygoid plate ++
– insertion masseter
• medail surface of angle of mandible
• lateral pterygoid
medial
– origin pterygoid
• lateral pterygoid plate ++
– insertion lateral
pterygoid
• condyle of mandible and capsule/articular disk

TMJ – transverse section Accessory muscles

coronoid • assist with depression of mandible
temporalis process (opening of mouth)
– only effective if hyoid fixed
• infrahyoid muscles

masseter head of
mandible
lateral
pterygoid

hyoid bone

Insight: H3 Manual: I-5

 CNV - Trigeminal nerve Trigeminal nerve (CN V)
• distribution of sensory fibres in CN V3
• nerve type: mixed
– cutaneous
– General Somatic
• lower lip, chin
Afferent (GSA)
fibres – sensory to deeper structures
• general sensation • facial expression muscles
to anterior head
• oral cavity
– SVE fibres
• mandible & lower teeth
• muscles of
mastication • TMJ

Marieb: Table 13.2

Referred pain
• new principle
– P17: Pain carried by a particular branch of a
particular nerve arising from pathology in one
organ or region of the body may be perceived by
the brain as coming from another organ or region
of the body supplied by another branch of the
same parent nerve.
• trigeminal nerve has a common ganglion for
all three divisions
– pain may refer from maxillary sinuses or upper
teeth (innervated by CNV2) to TMJ (inn. by CNV3)
– TMJ pain may refer to teeth and jaw