TEMPORO

MANDIBULAR
JOINT
 CONTENTS
 1. INTRODUCTION
 2. ANATOMY
 3. EMBRYOLOGY
 4. HISTOLOGY
 5. MUSCULATURE
 6. MOVEMENTS
 7. FUNCTIONS
 8. AGE CHANGES
 9. CLINICAL EVALUATION
 10. RADIOLOGICAL EVALUATION
 11. APPLIED ASPECTS
 INTRODUCTION
 The temporomandibular joint (TMJ), also known as the
craniomandibular joint/articulation is peculiar to mammals.

 It is the articulation between the squamous part of the temporal

bone and the head of the mandibular condyle

 The TMJ articulation consists of a mandibular or glenoid fossa, an

articular eminence or tubercle, a condyle, a separating disc, a
joint fibrous capsule and an extra capsular check ligament.
 ANATOMY
ARTICULATORY SYSTEM
 The articulatory system comprises of
the following:
a. Temporomandibular joint (TMJ)
b. Masticatory and accessory muscles.
c. Occlusion of the teeth
 MANDIBULAR (GLENOID) FOSSA
(CRANIAL COMPONENT)

 Limits Anteriorly, the articular eminence or

tubercle, and posteriorly, a small conical
postglenoid tubercle.
 Articular eminence
 Postglenoid tubercle
 Glenoid fossa
Mandibular Component :
Mandibular Condyle

 The articular part of the mandible is an

ovoid condylar process (head) with
narrow mandibular neck

 Mediolateral dimension varies

between 13 to 25 mm

 Anteroposterior width varies between

5.5 to 16 mm
The majority of human condyles
 58% are slightly convex.
 25% are flat superiorly
 Approx 12 % are pointed or angular
 3 % are bulbous or rounded in shape
 Articular Disc or Meniscus

 The TMJ is a diarthroidial synovial paired joint. This means that there are
two joint movements, which occur in separate compartments of this
synovial joint and that one joint cannot operate without the other.

 Two parts:
1. The lower or inferior compartment
2. The upper (temporodiscal)
or superior compartment.
SYNOVIAL TISSUE
 Is a connective tissue membrane, which lines the joint
cavities or spaces and secretes synovial fluid for
lubrication of the joint.

 The upper and lower joint spaces are bathed in a viscous

synovial fluid.

 Function of the synovium : nutrition, phagocytosis and

immunological response (Synovitis—proliferation of the
synovial cells with the concomitant release of
prostaglandins and large quantity of collagenase—pain).
TMJ Capsule
 TMJ capsule is a thin sleeve of fibrous tissue
investing the joint completely.

 It is a funnel-shaped capsule, which blends with the

periosteum of the mandibular neck and it envelops
the meniscus.
 anteriorly - to the anterior border of the articular
eminence
 Posteriorly - to the lip of the squamotympanic
fissure
 lateral as well as on the medial aspect -
circumference of the cranial articulating surface
and below to the neck of the condyle
Ligaments
Lateral or Temporomandibular Ligament :

 TMJ capsule is reinforced by this main stabilizing ligament

Accessory Ligaments

 Sphenomandibular ligament
 stylomandibular ligament
EMBRYOLOGY OF TMJ

 TEMPORAL BLASTEMA:

 CONDYLAR BLASTEMA:
 PHASES IN DEVELOPMENT OF TMJ

STAGES EVENTS

Blastematic stage (7-8weeks) Corresponds with the onset of the organization

of condyle and the articular disc and capsule.
During week 8, intramembranous ossification of
temporal squamous bone begins.

Cavitation stage (9-11 weeks) Corresponding to the initial formation of inferior

joint cavity (week 9) and the start condylar
chondrogenesis. Week 11 marks the initiation of
organization of superior joint cavity.

Maturation stage After week 12 of development.

HISTOLOGY:
 Blood Supply

 Nerve Supply
Blood Supply

 Lateral aspect is supplied by superficial temporal

branch of the external carotid artery.
 retrodiscal capsular part by deep auricular,
posterior auricular and masseteric branches of the
internal maxillary artery.
 To the head of the condyle by penetration of
numerous nutrient foramina vessels.
 The venous pattern is more diffuse, forming a
plentiful plexus all around the capsule.
Nerve Supply
 The mandibular nerve, the third division of the
fifth cranial nerve innervates the jaw joint. Three
branches from the mandibular nerve send
terminals to the joint capsule.
 1. The largest is the auriculotemporal nerve
which supplies the posterior,medial and lateral
parts of the joint.
 2. Masseteric nerve, and
 3. A branch from the posterior deep temporal
nerve, supply the anterior parts of the joint.
MUSCULATURE

 Muscles of Mastication

1. Masseter

2. Temporalis

3. Pterygoid
 ACCESORY MUSCLES:

 The digastric muscle

 The mylohyoid and geniohyoid muscles
 infrahyoid muscles
 The buccinator
MOVEMENTS :
MUSCLE FUNCTION
 Jaw opening (depression)

 Jaw closure (elevation)

 Protrusive movement

 Retrusion

 Lateral movements
AGE CHANGES IN TMJ

 ARTICULAR LAYER

 ARTICULAR DISC

 After 20 yrs, superior and anterior part of

condyle and posteroinferior part of eminence
retain the condylar cartilage
CLINICAL EXAMINATION

1. Measuring maximum interincisal opening

2. Palpation of pretragus area ; the lateral aspect of TMJ
3. Intra – auricular palpation ; the posterior aspect of TMJ
4. palpation of masseter muscle
5. Palpation of lateral pterygoid muscle
6. Palpation of medial pterygoid
7. Palpation of temporalis
 Jaw-Opening Reflex

 Jaw Jerk Reflex

 Rest Position

 Centric Relation
RADIOGRAPHIC EVALUATION

 ANATOMY:
CONVENTIONAL RADIOGRAPH

 TRANSCRANIAL VIEW
 TRANSPHARYNGEAL VIEW/Infracranial/McQueen Dell
 TRANSORBITAL (ZIMMER PROJECTION)
 REVERSE TOWNE’S
 TOWNE’S VIEW/ANTEROPOSTERIOR VIEW

 Observe occipital area of skull

 Neck of condylar process
 Panoramic Radiography
 Tomograms
 TEMPOROMANDIBULAR JOINT ARTHROGRAPHY
 COMPUTED TOMOGRAPHY
 MAGNETIC RESONANCE IMAGING
 NUCLEAR IMAGING
APPLIED ASPECTS
TEMPOROMANDIBULAR JOINT (TMJ)
DISORDERS
CLASSIFICATION
 i. Intra-articular origin or intrinsic disorders.
 ii. Extra-articular origin or extrinsic disorders.
 Extrinsic factors are those not directly associated
with the TMJ, whereas intrinsic factors relate to
those conditions existing within the confines of
the capsule of the joint.
Disorders due to Extrinsic Factors
 Masticatory muscle disorders
a. Protective muscle splinting.
b. Masticatory muscle spasm (MPD syndrome).
c. Masticatory muscle inflammation (myositis).
Problems that result from extrinsic trauma
a. Traumatic arthritis
b. Fracture
c. Internal disc derangement
d. Myositis, myospasm
e. Tendonitis
f. Contracture of elevator muscle—myofibrotic
contractures.
Causes of trismus

1. Due to infection Orofacial infections.

2. Trauma Fracture of the zygomatic arch
3. Inflammation Myositis or muscular atrophy.
4. Myositis ossificans
5. Tetany Typical carpopedal spasm
6. Tetanus
7: Neurological
8. Psychosomatic trismus
9. Drug induced trismus
10. Mechanical blockage
11. Extra-articular fibrosis
Disorders due to Intrinsic Factors

 1. Trauma
a. Dislocation, subluxation
b. Haemarthrosis
c. Intracapsular fracture, extracapsular fracture
 2. Internal disc displacement
a. Anterior disc displacement with reduction
b. Anterior disc displacement without reduction
 3. Arthritis
a. Osteoarthrosis (degenerative arthritis,
osteoarthritis)
b. Rheumatoid arthritis
c. Juvenile rheumatoid arthritis
d. Infectious arthritis
 4. Developmental defects
a. Condylar agenesis or aplasia—unilateral/bilateral
b. Bifid condyle
c. Condylar hypoplasia
d. Condylar hyperplasia
 5. Ankylosis
 6. Neoplasms
a. Benign tumours: osteoma, osteochondroma,chondroma
b. Malignant tumours: Chondrosarcoma, fibrosarcoma, synovial
sarcoma.
Masticatory muscle spasm (MPD
syndrome).
Masticatory muscle inflammation
(myositis).
Internal disc displacement
Condylar hyperplasia
Condylar hypoplasia and aplasia:
Bifid Condyle

 A bifid condyle have a vertical

depression,
notch or deep cleft in the center of condylar
head in sagittal plane.
 Radiographic features: ■ A depression or
notch is present on the superior condylar
surface (heart – shaped) with remodling of
condylar fossa.
Goldenhar syndrome

 Oculo-Auriculo-Vertebral (OAV) syndrome

 is a rare congenital defectcharacterized by

incomplete development of the ear, nose, soft
palate, lip, and mandible. It is associated with
anomalous development of the first branchial
arch and second branchial arch
REFERENCES:
 TEXTBOOK OF HUMAN ANATOMY- HEAD & NECK, B.D CHAURASIA
 TEXTBOOK OF ORAL HISTOLOGY- TENCATE
 DENTAL ANATOMY, PHYSIOLOGY AND OCCLUSION- WHEELERS
 MANAGEMENT OF TEMPOROMANDIBULAR DISORDERS AND OCCLUSION-
OKESON
 TEXTBOOK OF ORAL AND MAXILLOFACIAL SURGERY- NEELIMA MALIK
 WHITE & PHAROAH
 ERIC WHAITES
 KARJODKAR
 R. GRAY.RISK MANAGEMENT IN CLINICAL PRACTICE. PART 8.
TEMPOROMANDIBULAR DISORDERS. BRITISH DENTAL JOURNAL 209, 433 -
449 (2010)
 AL-SALEH ET AL. JOURNAL OF OTOLARYNGOLOGY - HEAD AND NECK
SURGERY (2016) 45:30 DOI 10.1186/S40463-016-0144-4
Thank you