TEMPOROMANDIBULAR

JOINT

Dr. Dinesh Kumar Yadav, KDCH

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The TMJ’s relation to body
posture

Imbalanced occlusion  forward head posture !

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Introduction
• The joint between temporal bone and mandible
that allows the movement of the mandible.
 Gross anatomy of the joint
A. Articulation of the joint
Bones for articulation 
glenoid fossa & condylar head

B. Joint capsule
Fibroelastic sac
( posterior and anterior)

C. Intraarticular disc
Fibrous, Biconcave disc
Thin intermediate zone,
Thick anterior and posterior band

D. Two compartments
Superior and inferior joint space 5
 The articulating surfaces
The upper articulating
surface
Formed by the following
parts of the temporal
bone:
• The articular
eminence
• Anterior part of the
mandibular fossa

The inferior articulating surface is formed by condyle

Definition:
The joint formed by the articulation between the
articular eminence and the glenoid fossa of the
squamous part of the temporal bone above and the
condylar head of the mandible below.

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Condylar process of the
Mandible
• akas: Condyle, Mandibular
Condyle

• Head rotates and

glides(translates) within
mandibular fossa and
articular eminence of the
temporal bone

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 Condylar process of the
Mandible
Anterior & superior  Posterior surface
convex (articular surfaces)  broad and flat

L pole
M pole

Size & shape varies

A-P dimension (8-10 mm) = half M-L dimension (20 mm)

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The glenoid fossa (A)

Medially
• Spine of sphenoid

Laterally
• Zygomatic process of the
temporal bone (D) (A)

Anteriorly
• Articular eminence (C)

Posteriorly
• Squamotympanic and petrotympanic fissure (F) (tympanic plate of temporal bone, E)

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 Articular disc
• An oval fibrous plate that
divides the joint into an
upper and a lower
compartment

• It is biconcave in sagittal
section
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Four parts of the Articular Disc
1. Anterior band
2. Intermediate zone
3. Posterior band
4. Retrodiscal Laminae
• Superior laminae
• Inferior laminae

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Functions of articular disc
• Divides joint cavity
1. superior compartment- Translatory movement
2. Inferior compartment- Rotational and translatory

• 1.2 ml
• 0.9 ml

• Acts as shock absorber

• Increases the type and range of movements
• Contributes to stability of the joint 14
 Capsule of the joint
• Fibroelastic sac
Superiorly:
Margins of glenoid fossa

Anteriorly: Posteriorly :
Ascending slope squamotympanic
fissure

Inner surface:
Smooth and
glistening with
Inferiorly: Neck of condyle Synovial
membrane
Fig :Attachments of joint capsule lining 15
 What type of joint is TMJ?
SYNOVIAL- GINGLYMOID - DIARTHRODIAL JOINT
Synovial: Two bones are united and surrounded by a capsule
that thereby creates a joint cavity, filled with synovial fluid
formed by a synovial membrane that lines the nonarticular
surfaces.

Ginglymoid : A uniaxial joint in which a broad, transversely

cylindric convexity on one bone fits into a corresponding
concavity on the other, allowing of motion in one plane only.

Diarthroses - freely movable articulations

 Why is TMJ an unusual joint?
1. Its articular surfaces
are lined by fibro-
cartilage (rather than
hyaline cartilage).
2. Its joint cavity is divided
into two by an articular
disc.
3. Most movement occur
simultaneoulsy at the
right and left TMJ.
Ligaments

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 Major
Ligaments

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Accessory
ligament

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Capsular Ligament
• Aka, joint capsule
• Surrounds the TMJ from neck to temporal bone
• Holds in synovial fluids
• Well innervated
• Has proprioceptive function

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Lateral ligament
• aka- Temporomandibular ligament
• Double headed
• Inner transverse fibres: Protects retrodiscal tissues from
over retraction
• Outer oblique fibres: Limits pure condyle rotation to 25
degree in inferior joint cavity
• Found over the top of the capsular ligament

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Discal Ligament
• Aka-Collateral Ligaments
• Stabilize the Articular Disc

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Sphenomandibuar Ligament
• No significant function
• Limit distension of the mandible in an inferior direction.
• Spine of the sphenoid bone to the lingula of the
mandibular foramen.

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Stylomandubular Ligament
• Limit excessive anterior translation of the
temporomandibular joint

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Biomechanics of the joint

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Muscles of Mastication
• Major muscles:
• Temporalis
• Masseter
• Lateral pterygoid
• Medial pterygoid

• Accessory muscles :
• Suprahyoid muscles: geniohyoid, mylohyoid, digastric
 Muscles Producing Movements
• DEPRESSION
• Lateral pterygoid
• Digastric, geniohyoid and
mylohyoid muscles help
when the mouth is opened
wide or against resistance
Muscles Producing Movements
• ELEVATION
• Massater
• Temporalis
• Medial pterygoid muscles
 Muscles Producing Movements
• PROTUSION
• Lateral and medial
pterygoid

•RETRACTION
• Posterior fibres of the
temporalis
Muscles Producing Movements
• LATERAL OR SIDE TO SIDE
• Medial and lateral pterygoids of each side action
alternately
Movements

Chewing
• side to side movemnts of the mandible
• In these movements the head of one side glides
forward along with the disc
• But the head of the opposite side merely rotates on a
vertical axis
• As a result chin moves forwards and to one side
• Alternate movements of this kind on the two sides
result in side to side movements of the jaw
Movements
• In protraction - the articular
disc glides forwards over the
upper articular surface, the
head of the mandible moving
with it
• The reversal of this movement
is called retraction
Movements
•In slight opening of the mouth -
the head of the mandible moves
of the undersurface of the disc
like a hinge
Movements
In wide opening of the
mouth-hinge like movement
is followed by gliding of disc
and the head of the
mandible, as in protracion. At
end of this movement the
head comes to lie under the
articular tubercle
NERVE SUPPLY
• By branches of the auriculotemporal branch of the
mandibular nerve of the fifth cranial or trigeminal
nerve.
BLOOD SUPPLY
• Arteial supply: Branches
of the maxillary and
superficial temporal
arteries

• Large venules are

consistently seen close to
the anterior ligament, the
bilaminar zone, and the
posterior capsule
 Development of TMJ
At 3 months of gestation, TMJ begins to
form.

Appearance of two distinct regions of

mesenchymal condensation, the temporal
and condylar blastemata.

The temporal blastema appears before the

condylar

Initially positioned some distance from

each other.
 Development of TMJ
The condylar blastema grows rapidly to decrease gap.

Ossification begins first in the temporal blastema

Cleft appears immediately above mandibular mesenchymal

condensation which becomes the inferior joint cavity

The condylar blastema differentiates into condylar cartilage

Then a second cleft appears in relation to the temporal ossification

that becomes the upper joint cavity .
 Histology of the joint

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Glenoid fossa (histology)
• Roof = Thin compact layer of bone
• Fibrous layer covers the articulating surface of
temporal bone
• Thin layer over the glenoid fossa
• Thicker over the posterior slope of the articular
eminence
• Articular surface covered by fibrous tissue
• Fibroblasts
• Chondrocytes

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Mandibular condyle (histology)
• Cancellous bone with covering of
thin compact bone
• Trabeculae at right angle to cortex
• Articular surface covered by
fibrous tissue
• Fibroblasts
• Chondrocytes

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 Articular surfaces
• Articular surface covered by fibrous tissue
(Unlike other synovial joints  covered by
hyaline cartilage)
• Fibroblasts
• Chondrocytes

A = hyaline cartilage layer

B =fibrous articulating surface

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Bands of articular disk

Posterior = loose fibres, highly vascular,

Anterior = bundles of fibres,
rich sensory nerve endings
cellular but avascular

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Synovial membrane
• Lines the inner surface of
the capsule
• Folds or villi  into the
joint cavity

• Increase with age

• More prominent in
pathologic process

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 Synovial membrane
1 - 4 layers of cells in
amorphous, fibrous free,
intracellular matrix

Bilayered

Neither junctional complexes

nor a basal lamina

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 Synovial Membrane
• The intimal cells are of
three types:
• The first is rich in rough
endoplasmic reticullum and
is called Fibroblast like, or B
cells
• The second type is rich in
golgi complex, Macrophase
like, or A cell
• The third type has a cellular
morpholgy between cell
types A and B
Synovial Membrane
Subintimal layer
• Loose connective tissue
• Rich in vascular elements
• Scattered fibroblasts,
macrophages, mast cells
and fat cells

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 Synovial fluid
• A small amount of a clear, straw coloured viscous fluid
is found in the articular spaces

• It is a lubricant and also nutrient fluid for the avascular

tissues covering the condyle, the articular eminence
and for the disk
Clinical considerations
Fracture
• Strong ligament
• Mandibular head driven
into the fossa
• Fracture of neck of condyle

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Clinical considerations
Structural changes
• Change in force or direction of stress
• Loss of posterior teeth

Deviation on opening jaw

• Clicking of jaw
• Palpable irregularities
• Not a sign of disease; may not require treatment 51
Clinical considerations
MPDS (Myofascial Pain Dysfunction Syndrome)
•Characterized by
1. Tenderness of muscles of mastication
2. Limited mouth opening
3. Joint sounds
4. Trigger zones in the face
•Anatomical /Stress related
•Conservative treatment
1. Ice packs/ soft food
2. Restricted movement
3. Massage / physical exercises
4. NSAIDS
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Dislocation of TMJ
• Bilateral ; anterior
• Head of condyle may slip
forward into infratemporal
fossa
• Disk derangements

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Clinical considerations
• Ankylosis
• Trauma
• Infection

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Conclusion

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Let’s recall……
1. Shape of articular disc
2. Functions of articular disc
3. Names of compartments
4. Two layers of synovial membrane
5. Ligaments of TMJ
6. Nerve supply
7. Arterial supply
8. Clinical conditions

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