TEMPORO

MANDIBULAR JOINT
Dr.dr.Zaenal M. Sofro, AIFM, Sport &
Circ. Med.
Bag.Ilmu Faal Fak.Kedokternn UGM

Condyle: The condyle is the oval- or kidney-shaped

structure found on the end of the condyloid process.

Palpation of the patient during movements of

both TMJs.

Copyright 2009, 2006 by Saunders, an imprint of Elsevier Inc. All rights

How Do We Eat?

Safe

Social Engagement

Ventral

Vagal

Fight, Flight,
Freeze

Immobility

16

Sympathetic

Nervous
System

Dorsal
Vagal
System

Danger

Life Threatening

Pusat vagus bermielin dan yang tidak bermielin

di medulla oblongata. Sumber: Porges (2011)
Gambar 17

Stress at Work

Cardiovascular
system

Autonomic
Autonomic
Nervous
Nervous
System
System

Immune
system

Urogenital
tract

Homeostasis

Gastrointestinal tract

FIT Formula for

Lifestyle Physical
Activity

Most days of
the week

Equal to brisk
walking
About 150
kcal
3-5 METS

Accumulate
30 minutes

- John Hughlings Jackson (1835-1911)

Father of English Neurology
Quoted by Stephen Porges 11/01

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Temporomandibular Joint (TMJ)

A complex giniglymoarthrodial (hinge and glide)
articulation with limited capability of
diarthrosis (free movement)

24

Temporomandibular Joint (TMJ)

Composed of
Condyle
Mandibular fossa
Articular capsule
Synovial tissue
Articular disc
Ligaments

25

Mandibular Condyle

Modified barrel shape approx.

20 x 10 mm (ML x AP)

Perpendicular to the
ascending ramus of mandible

Dense cortical bone covered

with dense fibrous
connective tissue with
irregular cartilage like cell

26

Mandibular Fossa

Dense cortical bony surface

of temporal bone

Posterior to articular
eminence

Posterior nonarticular fossa

is formed by tempanic plate

Thin at the roof of the fossa

and tympanic plate

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Articular Capsule and Disk

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Articular Capsule
Ligamentous capsule
surrounds the joint

Attached to the neck of the

condyle and around the
border of the articular surface
of the temporal bone

anterolateral aspect of the

capsule may thicken form the
Temporomandibular ligament
function as stabilising
structure

29

Synovial tissue

Synovial cell and connective tissue

covering the lower and upper-joint
spaces

Synovial fluid, a proteoglycanhyaluronic acid complex acts as a

lubricant and may participated in
nutritional and metabolic interchange
for central part.
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Articular Disk (Meniscus)

Biconcave oval structure

interposed between the
condyle and the temporal
bone

1 mm in the middle and 2-3

mm at periphery

Dense collagenous
connective tissue

Centre area is a vascular,

hyaine and devoid of nerve
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Articular Disk (Meniscus)

Fuse to a strong ligament
at lateral side connect to
the neck of the condyle

The other borders are

attached to capsule
ligaments or synovial
membranes separate
between two joint
spaces.

32

TMJ Ligaments

33

Ligaments

Temporomandibular
ligament
extend from base of
zygomatic process of the
temporal bone downward
and oblique to the neck of
the condyle

34

Ligaments

Stylomandibular
ligament
From styloid process and
runs downward and
forward to attach broadly
on the inner aspect of the
angle of mandible

35

Ligaments

Sphenomandibular
ligament
arising from the angular
spine of sphenoid bone
and petrotympanic
fissure, ending at lingula
of mandible

36

Functions of Ligaments

Accessory ligaments may limit border

movements of the mandible

Fibrous capsule and TM ligament may

limit of extreme lateral movements in
wide opening of mandible

37

Masticatory Muscles

Masseter muscle

Temporalis muscle

Medial pterygoid muscle

Lateral pterygoid muscle

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Masster muscle

Superficial layer
O : lower border of malar
bone, Zygomatic arch &
zygomatic process of maxilla
R : Downward and
Backward
I : Angle of mandible and
inferior half of the lateral
side of mandible
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Masster muscle

Deep layer
O : Internal surface of
zygomatic arch
R : Downward (vertical)
I : Ramus of mandible and
base of coronoid process
50 degree between 2 layers

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Temporalis muscle

3 bundles
Anterior bundle (vertical fibre)
Action: Mandible elevator (Close
jaws), crushing and chewing at
C.O.
Inaction: Mandible depression
(except Max. Opening and Opening
against resistance)

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Temporalis muscle
Posterior bundle (Horizontal
bundle)
Action: Mand. retraction and
positioner
Inaction: Mand. depression and
protrusion

Intermediate bundle
Action: Protrisive movement

Nerve supply

Ant. and Post. deep

temporal nerve
42

Med. Pterygoid muscle

Rectangular shape at medial surface of ramus,
synergistic with masseter muscle
O : Pterygoid fossa and medial
surf. of the lateral pterygoid
plate
I : Inf. + Post. border of ramus
and angle of mand.
R : Downward and Backward
N : Medial Pterygoid nerve

43

Lat. Pterygoid muscle

Superior head
O: Wing of sphenoid and
infratemporal crest
R: Downward and Backward

Inferior head
O: Lateral surf. of lateral
pterygoid plate
R: Upward and backward

44

Lat. Pterygoid muscle

Insertion of superior and inferior
heads
Ant. portion of the condylar neck
(pterygoid fovea)
Ant. surface of the articular
capsule
Ant. Border of the disk
Function
Open the jaws, protrude and
lateral movement with moving disk
forward
45

Lat. Pterygoid muscle

Superior head
Synergistic with elevator
group of muscle for closing
and clenching

Inferior head
Synergistic with suprahyoid
group of muscle for opening
jaw

Nerve supply
Lateral pterygoid nerve
46

Non Masticatory Muscle

Digastric muscle

Mylohyoid muscle

Geniohyoid muscle

Orbicularis Oris

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Non Masticatory Muscle

48

Types of Mandibular
Movement

Rotational movement
Horizontal axis of rotation
Frontal (vertical) axis of rotation
Sagittal axis of rotation

Translational movement

49

Rotational Movement

Around the horizontal axis (hinge axis)

50

Rotational Movement

Around the frontal (vertical) axis

51

Rotational Movement

Around the sagittal axis

52

Translational movement

53

Sagittal Plane Border

Movement

54

Sagittal Plane Border

Movement

Posterior open border

Anterior open border
Superior contact border
Functional movements

55

Horizontal Plane Border

Movement
Left lateral border
Continued left lateral border

with protrusion
Right lateral border
Continued right lateral border
with protrusion
Functional movements

56

Horizontal Plane Border

Movement
Continued right lateral border with protrusion

57

Horizontal Plane Border

Movement
Functional movements

58

Frontal (Vertical) Border and

Functional Movement

59

Frontal (Vertical) Border and

Functional Movement

Left lateral superior border

60

Frontal (Vertical) Border and

Functional Movement

Right lateral opening border

61

Frontal (Vertical) Border and

Functional Movement

Functional movements

62

Internal Derangements
General orthopedic term implying a

mechanical fault that interferes with the

smooth action of a joint
The most common internal derangement is
disc displacement
Clinical Features
Clicking sounds from joint(s)
Restricted or normal mouth opening capacity
Deviation on opening
Pain

Internal Derangements
Imaging Features
Anterior disc displacement: posterior
band of the disc located anterior to the
superior portion of the condyle at
closed mouth on oblique sagittal images
Disc may have normal (biconcave) or
deformed morphology
In opened mouth position disc may be
in a normal position (with reduction)
or continue to be displaced (without
reduction)

Osteoarthritis
Definition
Non-inflammatory focal degenerative disorder
of synovial joints, primarily affecting articular
cartilage and sub-condylar bone; initiated by
deterioration of articular soft-tissue cover and
exposure of bone.
Clinical Features
Crepitation sounds from joint(s)
Restricted or normal mouth opening capacity
Pain or no pain from joint areas and/or of
mastication muscles
Occasionally, joints may show inflammatory
signs
Women more frequent than men

Arthritides
Definition
Inflammation of synovial membrane
characterized by edema, cellular accumulation,
and synovial proliferation (villous formation).
Clinical Features
Swelling of joint area, not frequently seen in TMJ
Pain (in active disease) from joints
Restricted mouth opening capacity
Morning stiffness, in particular stiff neck
Dental occlusion problems; my bite doesnt fit
Crepitation due to secondary osteoarthritis

Thank
you