The Temporomandibular Joint

Prof . Rita Khounganian

CLASSIFICATION OF JOINTS
1. Fibrous joints: joints:
- cranial sutures - tooth socket

2. Cartilaginous joints: joints:

Permit little if any movement between the bones involved Primary cartilaginous: cartilaginous: costochondral joint Secondary cartilaginous: cartilaginous: pubic symphisis 3. Synovial joint: TMJ joint:

Anatomy of the TMJ

BASIC COMPONENTS OF TMJ

The right and left condylar heads of the mandible The articulating surfaces of the temporal bone (glenoid fossa and articular eminence ) The articulating disc (meniscus) The articulating capsule, synovial membrane and supportive ligaments

ANTERIOR

The Articular Space is divided into 2 Compartments

The 2 compartments differ in Action

UPPER COMPARTMENT : (TEMPORODISCAL) Translatory Gliding action being the larger between disc and temporal bone LOWER COMPARTMENT : (CONDYLODISCAL) Rotational Hinge action between under surface of the disc and the rotating surface of the head of the condyle

Histology of The TMJ

Disk

CONDYLAR STRUCTURE
Articular [fibrous tissue] zone

Proliferation zone

Hyaline cartilage zone

Calcified cartilage zone

Cortical bone zone

Young Condyle

Glenoid Fossa and Articular Tubercle

Disc

Condylar Head

HISTOLOGY OF ADULT CONDYLE

Very thin cortex

Anterior

Medullary trabeculae
Condyle

Marrow tissue
[hematopoietic even in adults]

Large marrow spaces are found in the cancellous bone but decrease by age due to marked thickening of the trabeculae

The red marrow is cellular then later replaced by fatty marrow in old individuals

Covering of the Bones of the Joint

Dense avascular fibrous CT Consisting largely of bundles of collagen fibers Very occasional elastic fibres interspersed through the collagen Fibroblasts are situated between the fiber bundles

Histology of the Articular Disc

It is composed of: of:
Fibrous tissue arranged in 3 layers - Upper layer the fibers run parallel - Lower layer to the surface - Middle layer : The fibers are interlacing Few elastic fibers Fibroblasts Chondroid cells

ARTICULAR DISC
Central thin portion of the disc is avascular whereas the peripheral disc is highly vascular

Central Portion
Posterior Boundaries

TMJ Capsule

1. LAYERS a) Cellular intima b) Vascular subintima

2. INTIMA - CELL TYPES a) type A - macrophage like light cells b) Type B - fibroblast like dark cells

Function of Synovial Fluid

Provides liquid environment for the joint surfaces Provides lubrication to increase efficiency and reduce erosion Provides nutrition for TMJ debatable

Movement at the Joint

Translatory Movement (Gliding ) In the superior portion of the joint The disk and the condyle traverse anterioly along the inclines of the articular tubercle to provide an anterior and inferior movement of the mandibular head Hinge Movement (rotational movement) In the inferior portion of the joint Permits opening of the jaws

During Rest and Slight Jaw Opening

(Hinge action)

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Closed Jaw and Wide Jaw opening

(Hinge and Glide action)

TMJ ANATOMY
during Opening and Closure

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Muscles of Mastication

Muscles Moving The Joint

DepressionDepression- lateral pterygoid Elevation- temporalis, masseter, Elevation- temporalis, masseter, and medial pterygoid ProtrusionProtrusion- lateral and medial pterygoid Lateral motion- medial and lateral motionpterygoid, acting alternatively

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Ligaments Associated with Joint Support

Ligaments along with the muscles provide stability for synovial joint 3 ligaments are associated with TMJ: TMJ: Temporomandibular ligament: laterally ligament: Sphenomandibular ligament: medially ligament: Stylomandibular ligament: posteriorly ligament:
SPHENOMANDIBULAR

TEMPOROMANDIBULAR

STYLOMANDIBULAR

Only Temporomandibular ligament has only functional significance, the other two have significance, only a causal relationship to the joint

Lateral pterygoid muscle: anteriorly muscle:

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The sensations of pain and pressure are found to

be important symptoms in TMJ disorders: disorders: Changes in occlusion displacement of condyle - disc to disc-fossa relationship discirritate nerve receptors Inflammation in synovial fluid produces pressure irritate nerve ending in the synovial folds Muscle tension

Dislocation (luxation & subluxation) (luxation

It occurs when the head of the condyle is displaced anteriorly over the articular eminence and cannot be returned voluntarily to its normal position

It is characterized by sudden locking and immobilization of the jaws when the mouth is open, accompanied by prolonged spasmodic contraction of the temporalis, medial pterygoid and temporalis, masseter muscles with protrusion of the jaw

It may occur following condylar fracture, or in overstretching, usually at the attachment point of the lateral pterygoid into the capsule

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TRAUMA AND DISLOCATION OF THE TMJ

May take place without the impact of an external force The dislocation is usually bilateral with an anterior displacement

E.g.:
Mouth opened unusually wide during yawning and the head of the mandible may slip forward into the infratemporal fossa causing articular dislocation of the joint

Ankylosis of TMJ
Debilitating condition involving immobility of jaw Trauma and infection are the most common causes May be of 2 types: types: 1. In intra-articular ankylosis progressive intradestruction of meniscus, flattening of fossa, thickening of condyle, and shrinkage of capsule partial or complete abolition of the joint 2. After infection, extra-articular Ankylosis leads to extrasplinting of the joint by a fibrous or a bony mass external to the joint proper

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Trauma to the TMJ

Injury to the Articular Disc

May result from inflammation commonly, malocclusion and more

Malocclusion usually results from abnormal patterns of mandibular excursion during mastication excessive movements capsule is overstretched prevents too great an anterior condyle movement loss of adaptation of the disc to the condyle degeneration of the disc

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Aging of the TMJ

Condyle appears flattened in outline Remnant of condylar cartilage sometimes is present in aged joints Fibrous covering of the condyle is thicker and may show chondroid changes Osteoporosis of underlying bone of the condyle Articular disc becomes thinner and exhibits hyalinization and chondroid changes and tear appears in small areas. Similar changes are areas. found in CT capsule Synovial folds appear fibrotic wall of blood vessels are thickened Nerves appear decreased in number in the capsule and peripheral portion of the disc

TMJ - INNERVATION Four types of nerve endings:

Have a variety of functions Proprioception nociception (pain) mechanoreception.

TYPES: TYPES:
1. Free nerve endings - Pain (peripheral region of disc). disc).
2. Ruffini corpuscles - Posture (dynamic/static) (Capsule). (Capsule). 3. Meissners corpuscles - Static mechanoreception (Ligaments) 4. Pacinian corpuscles - Dynamic mechanoreception (Capsule)

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