COMMONWEALTH OF AUSTRALIA Copyright Regulations 1968 WARNING This material has been reproduced and communicated to you by,

or on behalf of, Griffith University, pursuant to Part VB of The Copyright Act 1968 (The Act; a copy of the Act is available at SCALEPlus, the legal information retrieval system owned by the Australian Attorney Generals Department, at http://scaleplus.law.gov.au). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of Copyright Protection under the Act. Information or excerpts from this material may be used for the purposes of private study, research, criticism or review as permitted under the Act, and may only be reproduced as permitted under the Act. Do not remove this notice

Temporomandibular Joint (TMJ)

Oral Biology

Alex Forrest
Associate Professor of Forensic Odontology Forensic Science Research & Innovation Centre, Griffith University Consultant Forensic Odontologist, Queensland Health Forensic and Scientific Services, 39 Kessels Rd, Coopers Plains, Queensland, Australia 4108

Learning Objective

You should be able to describe the structure of the TMJ and its movements in preparation for understanding the roles of the muscles of mastication in moving the mandible.

Structure

Structure
It consists of parts of the mandible and temporal bones which are covered by cartilage, and surrounded by several ligaments including a joint capsule.

Structure

The Temporomandibular Joint is the site of articulation between the mandible and the cranium. It is a bilateral synovial joint, and serves to open and close the jaws, and to approximate the teeth of each jaw during mastication.

Between the two bones is a fibrous articular disk, breaking the joint into two separate synovial-lined compartments.
http://www.tmj.com/b1_patient.html

Several pairs of muscles attached to the mandible produce movements required to suckle, ingest and masticate food, swallow and yawn, and produce speech. They are called the muscles of mastication and the accessory muscles of mastication.
http://e-ortho.tripod.com/orofacialPain.htm

Alex Forrest 2008

The mandible possesses two articular surfaces, the condyles, which are located on the upper end of each of the bilateral condylar processes.

http://chiropracticresearch.org/NEWS_chiropractic_and_tmj.htm

The condyles, which are characteristically "football-shaped, are directed at an oblique angle, so that if the planes of the long axes were continued they would meet at the front of the foramen magnum.
Modified from: Scott, JH & Dixon, AD. Anatomy for Students of Dentistry. Edinburgh, Churchill Livingstone, 3rd Edition 1972. p. 150.

Each condyle articulates with a meniscus (articular disk) which lies between it and the temporal bone.

The Temporal Bone

Grays Anatomy, 35th Ed, Longman, London 1973, p. 293.

Alex Forrest 2008

The site of articulation on the temporal bone is on the inferior surface of the zygomatic process. It is called the glenoid fossa or the mandibular fossa.

While on the dried skull the mandibular condyle appears to articulate within the glenoid fossa between the bony articular tubercle and the post-glenoid process, in real life it probably articulates about the tubercle.

http://cpmcnet.columbia.edu/dept/dental/Dental_Educational_Software/TMJ/LatTMJ2.gif Modified from: Posselt, U, Physiology of Occlusion and Rehabilitation, Blackwell Scientific, Oxford, 2nd Edition 1973.

The Articular Disk (meniscus) is a compact, dense fibrous connective tissue plate. It is roughly oval in shape and lies between the mandibular condyle and the articular eminence of the temporal bone.

Its inferior surface is concave to fit the convex surface of the condyle. Superiorly, its surface is concavo-convex. The disk is thickest at its periphery and thinnest in the stress-bearing part of the joint.

The coverings of the articular surfaces of the condyle and articular eminence are composed of dense fibrous connective tissue. The heaviest stressbearing areas of the disk are also fibrocartilage, and indeed the whole disk may become fibrocartilaginous in later life.
http://e-ortho.tripod.com/orofacialPain.htm

These fibrocartilaginous structures are all essentially avascular, but they are bathed in synovial fluid which provides nourishment as well as lubrication.

http://e-ortho.tripod.com/orofacialPain.htm

Ligaments

Ligaments

Anatomy textbooks describe several ligaments around the TMJ. They do not always clearly differentiate between the ligaments of the joint (which are true ligaments), and the accessory ligaments, some of which are not true ligaments, but are simply thickenings in sheets of fascia.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The ligaments of the joint comprise the joint capsule, and the medial and lateral ligaments.

The capsule is reinforced along its medial and lateral margins by bundles of collagenous fibres.

Accessory Ligaments
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The medial part is a slight thickening of the capsular ligament and the lateral part, which is more strongly reinforced, is known as the lateral ligament or temporomandibular ligament.

Accessory Ligaments
The sphenomandibular ligament is a derivative of Meckel's cartilage, and runs between the spine of the sphenoid bone and the lingula of the mandible. It is clinically important because if local anaesthetic solution is deposited anterior to it during an inferior dental block injection, it will prevent the diffusion of the solution posteriorly and result in a failed block.

The accessory ligaments are basically thickenings in sheets of fascia. They are not ligaments in the true sense, and they definitely are not strong enough to fulfil the "suspensory" role sometimes assigned to them in textbooks. Instead, they have stretch receptors which feed into reflex control loops and thus prevent excessive opening and protrusion of the mandible.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

Innervation

The stylomandibular ligament is a thickening of the deep cervical fascia, and extends from the styloid process of the temporal bone to the posterior border of the angle of the mandible.

The joint capsule is sensitive, and is heavily endowed with sensory endings from the mandibular division of the trigeminal nerve, primarily through its auriculotemporal branch. Additional fibres to the joint are derived from the masseteric branch of the mandibular nerve.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

Blood Supply

Blood supply is via the maxillary artery and by branches of the superficial temporal artery. Venous drainage is via the pterygoid plexus, and lymphatic drainage is via the buccal and submandibular lymph nodes.

Movements of the TMJ

Movements

During its movements, the mandible swings on its elevator muscles, and on the other tissues which suspend it from the cranium. The mandible may be depressed, elevated, protruded, retruded, moved laterally, and returned to its resting position. It may be rotated around an axis passing roughly through both condyles. Chewing is a combination of all of these movements.

Movements

Movements

Jaw Opening is a combination of protrusion, depression, and rotation about the intercondylar axis. Jaw Closing is a combination of retrusion, elevation and rotation. Protrusion cannot occur without depression to disocclude the teeth.

When the mandible is swung to one side, the contralateral condyle is pulled forwards, downwards and medially. The ipsilateral condyle remains in its fossa, undergoing only slight movement, being slightly depressed, swung slightly laterally, and rotated around a vertical axis. This is sometimes known as "Bennett Movement".

Ligaments and Function

Ligaments act to limit the range of a movement in a joint.

Ligaments & Function

The limiting function of TMJ ligaments should not be regarded as purely mechanical. Ligaments contain receptors that are sensitive to tension generated within the ligament. Afferents from these nerve endings probably instigate the appropriate reflex control on opposing muscle groups.

The Lateral Ligament of T.M.J. limits the movement of the condyle to an arc, the radius of which is determined by the ligament. It may also play a part in limiting the movement of the mandible when it is swung towards the contralateral side.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The Medial Ligament of T.M.J. is more vertically aligned than the lateral ligament. It probably limits depression of the mandible.

From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The Sphenomandibular Ligament limits depression of the mandible and prevents dislocation of the joint. The Pterygoid Fascia is continuous with the sphenomandibular ligament, and should therefore serve a similar function.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

The Stylomandibular Ligament is suitably aligned to limit the movement of the mandible towards the ipsilateral side. During such movement, the angle of the mandible swings away from the midline.
From Grays Anatomy, 35th Ed, Longman, London 1973, p. 408

Ligaments and Function

The meniscus may also be regarded as a ligament. Its strong attachment to the anterior margin of the articular eminence (on the one hand), and to the posterior surface and both poles of the condyle (on the other hand) enable it to restrain the amount of retrusion of the mandible.
http://e-ortho.tripod.com/orofacialPain.htm

The mandible may be forcibly retruded up to 1.5 mm. posterior to its normal maximum intercuspal position, and the amount of retrusion possible represents the amount of "slack" in the meniscus and lateral ligaments.

Learning Objective

You should be able to describe the structure of the TMJ and its movements in preparation for understanding the roles of the muscles of mastication in moving the mandible.

The End