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Joint(TMJ)
Notes from slides and audio transcription
Aug 19, 2014
Dr !inio
Temporomandibular Joint
"ies belo# t$e orbitomeatal plane
T%pe of a s%no&ial 'oint
(pecificall% a gingl%m%oart$roidal
'oint
(!lassification is based on
anatomical structure and function)
)mportant because it is one of t$e
most $ig$l% used 'oints
)t #or*s e&en if t$e person is asleep
!onsists of a fibrocartilage unli*e
most of t$e ot$er s%no&ial 'oints
#$ic$ are composed of $%aline
cartilage
A capsule en&elopes t$e articular
regions and sometimes it ser&es as
attac$ment of t$e ligaments
Di&ided b% a fibrous Articular disc.
"o#er !$amber+ Allo#s t$e
$inge,li*e depression and
ele&ation function of t$e
mandible
-pper !$amber+ Allo#s t$e
protrusion and e.trusion of
t$e 'oint
**Articular Disc:
Attac$ed around t$e
temporomandibular ligament
/ecei&es part of t$e insertion of t$e
e.ternal 0 lateral pter%goid muscle
"o#er surface is conca&e
-pper surface undulates to fit t$e
fossa and eminence
)t is an important feature of t$e TMJ
T$e *nee 'oint does not $a&e an
articular disc
1roblems ma% arise #$en t$is
mo&es entirel% anterior to t$e $ead
of t$e mandible (dislocation)
**Synovial Joints:
2it$ s%no&ial fluid, surrounded b% a
la. capsule
T$ic*ened on t$e lateral side b% t$e
temporomandibular ligament
3n&elopes bon% articular surface
4urnis$es attac$ment to t$e
interposed cartilage
55(%no&ial 4luid
-suall% clear and stra#,colored
Diffuses out from t$e base capillar%
net#or* of t$e s%no&ial membrane
!ontains $%aluronic acid and cells
usuall% macrop$ages
4unctions as a lubricant and nutrient
!lears t$e tissue debris caused b%
normal #ear and tear of t$e
articulating surface
Structural association of TMJ:
!ond%loid process of mandible or
$ead of mandible
Articular fossa of temporal bone or
mandibular fossa of temporal bone
3minence or tubercle of temporal
bone
55 Mandibular fossa+ 2$ere mandible and
TMJ meet
55 Mandibular cond%le+ Articulating surface
of t$e mandible )t is con&e. in all
directions and #ider lateromediall%
3 MAJOR LIAM!"TS
5ligaments+ stabili6e and protect 'oints
A. Temporomandibular # !$ternal
Lateral li%ament
!losest to t$e TMJ
"ateral to t$e capsule and it
forms part of t$e capsule )t
is a t$ic*ened portion of t$e
capsule
!o&ered b% upper part of t$e
parotid gland
Associated #it$ t$e
superficial temporal &essels
/uns diagonall% bac*#ard
from t$e margin of t$e
articular tubercle to t$e nec*
of t$e mandible
&. Sp'enomandibular li%ament #
Internal lateral li%ament
"ocated medial to t$e TMJ
7n a deeper plane t$an t$e
'oint
/uns from t$e spine of
sp$enoid bone at t$e base of
t$e s*ull to#ards t$e medial
side of t$e mandible,
specificall% near t$e edge
and margins of t$e
mandibular foramen (lingual
on medial surface of t$e
ramus)
(eparated from t$e mandible
b% t$e auriculotemporal
ner&e and e.ternal pter%goid
muscle
(. Stylomandibular li%ament
T$ic*ened part of t$e
cer&ical fascia
/uns from t$e st%loid
processof t$e temporal bone
to#ards t$e posterior
margin and angle of
mandible
(eparates t$e parotid gland
from t$e submandibular
gland #$ic$ also acts to
pre&ents spread of infection
bet#een t$e t#o glands
MO)!M!"TS O* T+! MA"DI&L!
!$e#ing and grinding motion of t$e
TMJ occurs #$en mo&ements of t$e
TMJ on one side are coordinated
#it$ a reciprocal set of mo&ements
at t$e 'oint on t$e ot$er side
Depression, protrusion, ele&ation,
retraction
1 Depression
8enerated b%+ Digastric,
8enio$%oid, M%lo$%oid,
1lat%sma
Assisted b% gra&it%
)n&ol&es for#ard mo&ement
of t$e $ead of t$e mandible
2 3le&ation
Muscles in&ol&ed+
Temporalis, Masseter,
medial pter%goid muscles
Also in&ol&es t$e mo&ement
of t$e $ead of t$e mandible
into t$e mandibular fossa
7nl% t$e pter%goid muscles
reac$ t$e TMJ $o#e&er,t$e
functions of t$ese muscles
are far but t$e% e.ert t$is
mo&ement into t$e TMJ
(audio transcript)
9 1rotraction 0 1rotrusion
Mainl% ac$ie&ed b% t$e
"ateral pter%goid muscle
7t$er muscles in&ol&ed+
Medial pter%goid muscle,
anterior part of t$e
temporalis muscle, Masseter
fibers
4 /etraction
Muscles )n&ol&ed+ 1osterior
and deep fibers of t$e
temporalis, deep fibers of
t$e masseter, genio$%oid
and digastric
"!R)! S,--L.
Auriculotemporal ner&e
Masseteric ner&e
Deep temporal ner&e
All muscles associated #it$ t$e TMJ
are inner&ated b% t$e mandibular
ner&e of t$e trigeminal ner&e (cranial
ner&e :)
3.cept for t$e 8enio$%oid muscle
#$ic$ is inner&ated b% t$e !1 (cer&ical
1) spinal ner&e
&LOOD S,--L.
(uperficial temporal arter%
Deep auricular arter%
Anterior t%mpanic arter%
Ascending p$ar%ngeal arter%
IM-ORTA"T R!LATIO"S O* T+! TMJ
a Anterior+ Mandibular notc$ and
masseteric ner&e and arter%
b 1osterior+ T%mpanic plate of
e.ternal auditor% meatus and
glenoid process of t$e parotid gland
c "ateral+ parotid gland, fascia and
s*in
d Medial+ Ma.illar% arter% from t$e
e.ternal carotid arter%, ma.illar%
&ein, auriculotemporal ner&e
(LI"I(AL SI"I*I(A"(!
"ies immediatel% in front of t$e
e.ternal auditor% meatus
8reat strengt$ of lateral
temporomandibular ligament
pre&ents $ead of mandible from
passing bac*#ard and fracturing t$e
t%mpanic plate #$en se&ere blo#
falls on c$in
Articular disc of TMJ ma% become
partiall% detac$ed from capsule T$is
causes t$e mo&ement to become
nois% #$ere t$ere is an audible clic*
during t$e mo&ements of t$e 'oint
From audio, Basta importante, you should
be able to identify what is the TMJ, what
are the associated structures and of course
the nerve and blood supply Dr. inio