Today we are going to talk about the physiology of temporal mandibular joint.

There are three types of TMJ: 1) ginglymoid joint 2) arthrodial joint 3) hinge and sliding movement joint (human and pig) Lets first discuss about ginglymoid joint. This ginglymoid joint is found in carnivores (meat eaters). It ONLY allowed hinge movement (like a door opening and closing). This means that the centre of rotation is always the same. Now lets talk about arthrodial joint. This types of joint presence in herbivores. It allowed opening, closing and at the same time lateral movements. For example a camel (herbivore). When it chewing, it moves its mandible to the right and left. This is an arthrodial joint because it allowed hinge movement and also sliding (lateral movement). What about omnivores (animals that eat meats and vegetables)? They have hinge and sliding movement joint. Arthrodial joint also have sliding movement. The difference is the sliding movement of arthrodial joint is greater than hinge and sliding movement joint in omnivores. For example us, if we try to move our mandible right and left we only able to move it for 8mm. this movement depend on the shape of anatomical/morphology of the TMJ.

Lets look at this example (picture above). This is a skull of leopard (carnivore). We can see here (arrow) the part where TMJ make a joint. It look like a groove. This groove has raise margins anteriorly and posteriorly. Because of this groove, the ginglymoid joint is not able to move laterally. It only able to move up and down.

The picture above is a skull of herbivore. We can see here (arrow) the part where TMJ make a joint. Its a flattened piece of bone. Thats why it allow free movement of mandibular condyle(articulating surface) at any direction. This is the reason why herbivore can move its mandible anteriorly, posteriorly, left and right, open and closing because the condyle is located at open piece of bone. Why do herbivores need this type of joint? Now I want you to think about the structure and function. They (herbivores) eat grasses/leaves. This food is very low in calories so, they need a huge amount of this food to produce enough energy. Also they need to cut (grind) this food into a very fine pieces. Thats why they have lateral movement to grind this food so that itll be crushed into very fine pieces. Then they will regurgitate (poured back food to the mouth) chew it again into a very fine pieces and swallow again. Thats why they have more than one stomach. They chew the food and store it in a first stomach, regurgitate and chew again and lastly swallow it back. If you see the teeth of herbivores, well see a flat surface. The molar of the upper jaw come in contact with the molar of the lower jaw when it is close. They need this kind of teeth so that they will have a wide occlusal surfaces. What about carnivores?? Carnivores have molar that do not meet surface to surface. Look at the molar of the leopard (previous page picture). This is because the molar teeth of carnivores do not have occlusal surfaces. The molar teeth between upper and lower jaw slide with each other like a scissor. The only way they can make occlusal contact is through their incisor teeth. Their incisor teeth have occlusal surfaces. Thats why carnivores have 3 incisor teeth per quadrant to provide more occlusal surfaces. Why carnivore dont have so much occlusal surfaces? This is because of the type of food they eat, meat. Meat contain

high amount of calories that can provide high energy. They dont need to cut the meat into very fine pieces. They just have to slice it and swallow. Is this enough? Yes it is, because meat can be digesting easily in the stomach. Lets go back to the herbivores. The occlusal surfaces of herbivores are not smooth; they are rough with slightly elevated and slight depressed part. This roughness makes the grinding process during chewing become more efficient. Because of that, they have 3 hard tissues in their crown, enamel, dentin and cementum. Enamel which is the hardest is very prominent at the outermost side. Dentin which is the less hard than enamel located at the area thats slightly depress than enamel. Cementum which is the least hard among the three is located at the innermost surfaces. Now well talk about the muscle of mastication. Temporalis is the strongest muscle that elevates the mandible. Masseter is also responsible to elevate the mandible. But you need to remember this. Temporalis muscle is responsible for forceful closing of the mouth while masseter is responsible for the closing and opening of the mouth for a long period of time. This is the reason why carnivores have huge amount of temporalis muscle while herbivores have huge amount of masseter muscle.

Now lets take a look at the TMJ of human. Here (arrow) is the upper part of TMJ where it makes a joint. Its called the mandibular fossa where the head of condyle articulate. Its called temporomandibular joint because the temporal provide the mandibular fossa/glenoid fossa(in dentistry) and the mandible provide the head of condyle.

So what are the skeletal components of the TMJ? We have the articular tubercle (in front of fossa) and the anterior portion of the mandibular fossa that make the upper part of skeletal components. The posterior portion of mandibular is not needed in TMJ. The condyloid process of mandible makes the lower part of the skeletal component. What makes this joint special? Reciprocation If we move the right joint, the left is also affected. This is because the right and left joint is connected by a single mandible bone. Articular surface of this joint is covered by fibrocartilage instead of hyaline cartilage This joint have articular disc dividing the joint into upper & lower cavities

**Remember these three specialties because doctor might ask in exam. TMJ is a synovial joint. the temporal compoenent of TMJ: Glenoid fossa Articular eminence Articular surface

150*

Mandibular condyle components of TMJ: Shape - Oval with 2 different diameters. We have mesiolateral diameters and anteroposterior diameters. The mesiolateral diameters are greater than anteroposterior diameters.

-Long axis inclined mesially -Long axes meet at 150 in foramen magnum (refer picture previous page) -Sagittal section Articular surface Muscle insertion -There is lateral pterygoid muscle that responsible to move the mandible forward when contract. This muscle is attached to the neck of the condyle. We also have soft tissue component,capsule,temporal ligament, the disc,and the synovial membrane And remember that we have 3 type of ligament. This ligament is called : stylomandibular ligament (from styloid process to the angle of mandible),sphenomandibular ligament (from sphenoid to lingual of the mandible) and lateral temporalmandibular joint ligament (located laterally).

Why dont we have a lingual temporomandibular ligament (why only laterally)? The answer is because of procasion. Now, if you move this mandible medially,what resist this movement? The lateral temporomandibular ligament. Then, if I want to move this mandible buccally? The lateral ligament of the other side will prevent this movement. So, because of this procasion, you do not need the lingual ligament. (mandible is one single bone, so you just need lateral temporomandibular ligament.) But, if the mandible is two pieces of bone, then you will need the lateral and the medial ligament. The disc is located between the mandibular fossa, the articular eminence and the condyle. Notice that the disc is also attached to the muscle that brings the mandible forward (lateral pterygoid muscle). Why ? because when you move the mandible forward for example, you need the muscle that brings the muscle forward but I also want the same

muscle again to bring the disc as well. So thats why the anterior part of disc is attached to the lateral pterygoid muscle. The joint is divided into two cavities, upper joint cavities is locates above the articular disc and the lower joint cavities is located below the articular disc. The posterior part of the disc divided into upper lamina and lower lamina. That why it is called bilaminar joint.

The bilaminar joint is very rich with blood vessels,nerves and adipose tissue. The function is to allow protrusion and retrusion of the mandible Functions of TMJ is articulation between the mandible & the cranium,reciprocasion and also growth of the mandible : because we have the cartilage in the condyle. We laso have the cartilage at the coronoid process, but this type of cartilage is only active prenatally. Now we will discuss about joint movement : We said that the temporomandibular joint in human is hinge and sliding movement. The first 20 mm of incisor separation, the only movement that takes place is hinge movement. When you move the mandible, it will rotates (the condyle rotates) and the axis of rotation is exactly at the head of the condyle. But, if you want to open further (more than 20 mm), the condyle will not rotate but it will slide forward.

The condyle starts to slide forward against the articular eminence. See this is what happened in the maximum opening. When you open your jaw for the maximum, the condyle is not located in its position ( now it opposes the articular eminence). And,when you put your finger and try to open your mouth, you can feel the condyle is not only rotating (rotates in short distance) but it starts to move forward. It is not the only condyle move forward, but the intra-articular disc as well. The condyle and also the disc, they move together. Normally,this it is what happened. What happened if the disc do not move with the mandible? We have what we called temporomandibular joint dysfunction (TMJ dysfunction).

Normally, the disc is located above the condyle. But in certain occasion, it is anteriorly displaced. So, when you move the mandible for the first 20 mm, nothing will happened, but when the mandible starts slide, it will make contact with the head and this actually make a click (temporomandibular joint clicking). It is common. What produces this click? Normally the disc is above the condyle, so when the condyle moves, the disc must move with it. But in some people, the disc is anteriorly displaced. So, when the condyle starts to move, it rotates without a problem, after that it hits the disc. The hitting of the disc produces a click. Whats happened in this click? Now, the disc will go above the condyle and both of them will move together. When you closed your mandible, the head and the condyle moved back for a short distance and then the condyle continues alone. This also produces another click. That why people who has clicking, they have click on opening and closing. This is called anterior disk displacement with reduction. What is the difference between anterior disk displacement with reduction and anterior disk displacement without reduction? Without reduction occurs when the problem is severe, the disc is permenantly anteriorly displaced in contrast to the condyle. When the mandible move for the first 20 mm, it will starts to slide, hits the disc, but it not bring the disc over it. So,the condyle will not continue moving (the disc prevent the condyle to moving). This is called anterior disk displacement without reduction. These people is unable to open completely (will open is a short time and will feel pain) Why? Because this prevent the joint to continue. When this problem affect only one joint, imagine that the right joint will move, and the left joint is affected. This will lead to rotation of the mandible towards the affected side. If this problem is bilateral, the person will not to open completely. Lastly, why the mandible need to slide? Because we want to protect the vital structure behind the mandible such as common carotid artey, internal jugular vein, vagus nerve. We do not want the mandible compress this vital structure. Thats why we need the mandible to move in hinge movement about 20 mm and slide forward (extension of the ligament).

*Note : Please read nerve and receptors in TMJ in the slide.