TEMPOROMANDIBULAR JOINT (TMJ) The name is derived from the two bones which form the joint: the

e upper temporal bone which is part of the cranium (skull), and the lower jaw bone called the mandible. It is an example of diarthrosis and its movements are combination of gliding movements and a loose hinge movements. It allows a wide range of motion to the mandible Composed of bones, ligaments, cartilages and synovial membrane. COMPONENTS OF TMJ 1. Osseous- the articulating bony parts Mandibular Fossa of the Temporal Bone/ Glenoid Fossa An oval depression in the temporal bone just anterior to the auditory canal. Condyloid Process/ Condylar Process/ Mandibular Condyle A knob-like bone (wider lateromedially than antero-posteriorly), it is convex on all bearing surfaces although somewhat flattened posteriorly. Articulating Tubercle/ Articular eminence Bony elevation located anterior and posterior to the glenoid fossa or mandibular fossa.
2. Ligaments- tough tissues that connects various structures such as two

bones. Capsular Ligament - A synovial capsule which completely surround the condyle. - Divided into 4 portions: a. Anterior Portion b. Posterior Portion c. Internal Portion d. External Portion/ Temporomandibular Ligament Temporomandibular Ligament - Largest portion

Acts as main suspensory ligament of the mandible during the moderate opening movement (hinge). It has a broad attachment above the zygomatic process of the temporal bone, the anterior fibers attaching forward beyond the articular eminence and is inserted into the outer side and posterior margin of the neck of the condyle.

Sphenomandibular Ligament Round and cordlike at its origin and takes more of a ribbon like form at its insertion. With wider opening of the jaw, the condyle move forward rapidly, relaxing the external lateral ligament as the sphenomandibular ligament become tensed or slightly stretched. Originates from the spinous process of the sphenoid bone and inserts into the lingual of the mandible with some fibers attached below the mandibular foramen. Stylomandibular Ligament Extends from the styloid process of the temporal bone and inserts into the posterior border of the ramus of the mandible. Just before the stylomandibular ligament makes its insertion, it gives off an accessory fiber which continues downward to the posterior border of the hyoid bone, called the stylohyoid ligament. The temporomandibluar ligament and the sphenomandibular ligament acts as suspensory ligaments. The stylomandibular ligament and its accessory stylohyoid ligament acts as checkrein on the mandible and helps prevent excessive anterior drift at the angle during more extreme opening movements.

3. Meniscus- is a fibrous, saddle shaped structure that separates the condyle and the temporal bone. It is the cartilage that controls that acts as cushion between the ends of bones that meet in a joint.It promotes smooth articulation. It is surrounded by synovial membrane which lubricates the cartilage Cavities:

a) Menisco-Temporal Cavity - larger cavity - allows gliding of the condylar head to the articular eminence. b) Menisco-Condylar Cavity - smaller cavity - allows hinge movement of the condylar head. 4. Synovial Membrane- lines the internal surface of the meniscus. The synovial membrane allows diffusion of a plasma filtrate and components of its own to produce synovial fluid that fills both joint compartments. Its shape is altered during functional movement. Synovial Fluid lubricates the articulating parts. The synovial tissue can be divided into three layers: 1. The synovial lining, or intima, is the most intimate with the functional joint surface. 2. The subsynovial tissue, which is similar to the intima but with a more developed connective tissue network. 3. The capsule, which is a relatively acellular layer with thick bands of collegen that forms the outer boundary of the joint. 5. Muscles of Mastication

DEPRESSOR -mouth is opened because mandibular is pulled down. Lateral Pterygoid - Superior head is active during various jaw closing movement - Inferior head is active during jaw upward movement. - The lateral pterygoid (or external pterygoid) is a muscle of mastication with two heads. It lies superiorly to the medial pterygoid. -The upper/superior head originates on the infratemporal surface and infratemporal crest of the greater wing of the sphenoid bone, and the lower/inferior head on the lateral surface of the lateral pterygoid plate. Inferior head inserts onto the neck of condyle of the mandible; upper/superior head inserts onto the articular disc and fibrous capsule of the TMJ.

 The mandibular branch of the fifth cranial nerve, the trigeminal nerve, specifically the V3 branch, innervates the lateral pterygoid muscle.

The primary function of the lateral pterygoid muscle is to pull the head of the condyle out of the mandibular fossa along the articular eminence to protrude the mandible. A concerted effort of the lateral pterygoid muscles acts in helping lower the mandible and open the jaw whereas unilateral action of a lateral pterygoid produces contralateral excursion (a form of mastication), usually performed in concert with the medial pterygoids.

Unlike the other three muscles of mastication, the lateral pterygoid is the only muscle of mastication that assists in depressing the mandible (opening the jaw). At the beginning of this action it is assisted by the digastric, mylohyoid and geniohyoid muscles.

Origin: Great wing of sphenoid and pterygoid plate Insertion: Condyle of mandible Innervation: The mandibular branch of the CN V, the trigeminal nerve, specifically the V3 branch Artery Supply: pterygoid branches of maxillary artery Function: Depresses mandible Protrude mandible side to side movement of mandible

ELEVATORS

- Mandible is pulled upward and mouth closes

The temporalis, masseter, and medial pterygoid muscles produce biting movements. The lateral pterygoid muscles protrude the mandible with assistance from the medialpterygoid muscles and retrudedlargely by the posterior fibers of the temporalis muscle. Gravity is sufficient to depress the mandible, but if there is resistance, the lateral pterygoid, suprahyoid and infrahyoid, mylohyoid and anterior digastric muscles are activated. DURING THE PROCESS OF ELEVATION, THE MANDIBLE IS PULLED IN AN UPWARD DIRECTION THEREFORE CLOSING THE MOUTH.

Masseter - This muscle is active during the forceful closing of the jaw. The masseter also assists in the protrusion of the mandible itself. - This is a quadrangular muscle that covers the lateral aspect of the ramus and the coronoid process of the mandible. Origin: Medial surface and inferior border of the zygomatic arch Insertion: Lateral Surface of the gonion and ramus of the mandible Innervation: Mandibular branch of the trigeminal nerve Function: Elevates and protrudes the mandible closing the jaw

Temporalis - The temporalis controls the principle positioning of the mandible during its elevation. - Its posterior portion is active during the protrusion of the mandible, whereas the anterior portion is active during chewing.

 This is an extensive fan-shaped muscle that covers the temporal region. It is a powerful masticatory muscle that can easily be seen and felt during closure of the mandible.

Origin: Temporal lines, temporal fossa, and the temporal fascia Insertion: Tip and medial surface of the coronoid process of the mandible Innervation: Mandibular branch of the trigeminal nerve Function: Elevates and retracts the mandible at the temporo- mandibular joint closing the jaw

Medial Pterygoid -The medial pterygoid muscle is involved in the elevation and lateral positioning of the mandible and is active during its protrusion. - Posterior part- active in retruding the mandible - Anterior part- active during chewing This is a thick, quadrilateral muscle that also has two heads or origin. It embraces the inferior head of the lateral pterygoid muscle. It is located deep to the ramus of the mandible. It helps to elevate the mandible and closes the jaws. Acting together, they help to protrude the mandible. Acting alone, it protrudes the side of the jaw. Acting alternately, they produce a grinding motion. Origin: (Superficial Head) Maxillary Tuberosity; (Deep Head)Medial surface of the lateral pterygoidplate and palatine bone Insertion: Medial Surface of the ramus and gonion of the mandible Innervation: Mandibular branch of the trigeminal nerve

Function: Both heads elevate the protract the mandible, however, individually the move the mandible side to side.

ACCESSORY

- Helps elevators and depressor Buccinator Origin: Buccinator ridge of mandible, alveolar process of maxilla, pterygomandibular ligament Insertion: Orbicularm muscle of mouth at angle of mouth Innervation: (Motor) innervation is from the buccal the facial nerve (CN VII). Artery Supply: Buccal artery Function: Compresses cheek and retracts angle of the mouth. Prevent accumulation of excess food in the vestibule of mouth. It is not a primary muscle of mastication - it does not move the jaw - and this is reflected in its motor innervation from the facial nerve. However, proprioceptive fibres are derived from the buccal branch of the mandibular part of the trigeminal nerve (CN V). It moves boluses of food out of the vestibule of the mouth and back towards the molar teeth, tense the cheeks during blowing and whistling and assist with closure of the mouth. 6. Nerves- Sensory innervation of the temporomandibular joint is derived from the auriculotemporal and masseteric branches of V3 (otherwise known as the mandibular branch of the trigeminal nerve). These are only sensory innervation. branch of

TEMPOROMANDIBULAR ARTICULATION A. Definition: o This is a ginglymo-arthrodial joint A hinge joint (ginglymus) is a bone joint in which the articular surfaces are molded to each other in such a manner as to permit motion only in one plane. A plane joint (arthrodial joint, gliding joint, plane articulation) is a synovial joint which, under physiological conditions, allows only gliding movement. o Articulation of the condyle with the temporal bone of mandibular fossa

B. Function o permits the lower jaw to move o helps on opening and closing of the mouth o important for chewing, swallowing and talking o C. Two Major Bone
Lateral View of the mandible

Pointed part: Zygomatic process of temporal bone

 Temporal Bone (zygomatic process) long, arched process projecting from the lower part of the squamous portion of the temporal bone o articulates with the zygomatic bone
o

1. Glenoid Fossa (articular fossa, mandibular fossa) - depression in the temporal bone that articulates with the mandibular condyle - plays an essential part in joining the temporal bone with the lower jaw bone 2. Osseous - for support, protection, assisting of movements of the TMJ - provides points of attachment for muscles 2.1 head of condyle occupies an oval surface with a fibrocartliage covering for articulation at the mandibular fossa with the temporal bone. 2.2 glenoid fossa - part of the temporal bone which mates to the upper surface of the articular disk 2.3 anterior articular eminence - anterior to the mandibular fossa - allows opening and closing of the jaw - controls forward movement of the condylar head 2.4 posterior glenoid fossa - controls backward movement of condylar head

Actions of Two Major Bones during Closing and Opening of the Mouth

 Mandibular bone bone forming the skull with the cranium o the largest and strongest bone of the face o serves for the reception of the lower teeth
o

Articulating Parts 1. Condylar Process - part of the mandible and is thicker than the coronoid - convex from before backward and from side to side - knob like bone 1.1 ligament - hold the skeleton together - act as passive restraining devices to limit and restrict joint movement 1.2 articular disc - thin, oval plate of fibrocartilage present in several joints which separates synovial cavities - permits a more even distribution of forces - increases the stability of the joint 1.3 condyle - articulates with the temporal bone in the mandibular fossa - anchors muscle ligaments

1.4 lateral pterygoid muscle - its contraction pulls the disc and condyle forward - serves to open the mouth 1.5 articular fossa - part of the temporal bone which mates to the upper surface of the articular disk - lacks depth and shallowness

Articulating Parts of TMJ

D. Articulating Disc

o The unique feature of the TMJs is the articular disc. The disc is composed of fibrocartilagenous tissue which is positioned between the two bones that form the joint. o The disc divides each joint into two: a. The lower joint compartment formed by the mandible and the articular disc is involved in rotational movement-this is the initial movement of the jaw when the mouth opens. b. The upper joint compartment formed by the articular disc and the temporal bone is involved in translational movements-this is the secondary gliding motion of the jaw as it is opened widely. E. Articular Fossa
o

A deep hollow in the squamous portion of the temporal bone at the root of the zygoma, in which rests the condyle of the mandible.

MANDIBULAR POSITIONS AND MOVEMENTS Basic positions of the mandible : 1. Rest position (postural position or rest relation). 2. Centric occlusion (intercuspal position). 3. Centric relation (retruded position). Rest Position : It is defined as the position of the mandible when the elevator and depressor muscles of the mandible are in a state of equiribrium, and the condyles are in neutral, unstrained position. Centric Occlusion : Centric Occlusion It is the relation of opposing occlusal surfaces which provides the maximum planned contact and/or intercuspation. Centric Relation : Centric Relation It is the most retruded relation of the mandible to the maxillae when the condyles are in the most posterior unstrained position in the glenoid fossa from which lateral movement can be made, at any given degree of jaw separation.

Rest Position

Centric Occlusion

Centric Relation

Centric Occluding Relation : Centric Occluding Relation It is a term in which the jaws are in centric relation and the teeth or occlusal surfaces in centric occlusion. Movements Of The Mandible : 1. Rotational Movement (lower compartment) - compartment It is a simple hinge movement in which the condyle can rotate in the lower compartment in either the vertical or horizontal plane or in a combination of these * Hinge axis It is the imaginary line running between the condyles on both sides around which the mandible may rotate during a part of the opening movement 2. Translational Movement (upper compartment) - It occurs in either the sagittal plane along the articular eminence (sagittal condylar path) or the coronal plane along the lateral inclines of the mandibular fossa. Basic Mandibular Movements : 1. Opening and closing movements. 2. Forward movement, (protrusion). 3. Backward gliding movement, (retrusion). 4. Lateral gliding movement. Opening and closing movement: may be divided into: 1. The posterior - The posterior opening movement starts with intercondylar axis rotation and is then followed by both translation and rotation of the condyles 2. The anterior - Anterior Border Opening Movement This is the movement made by the incisal point from the protruded contact position till maximal opening position 3. The habitual (automatic) opening and closing movements- These paths are carried out inside the movement space i.e. intra-border movement. *1 and 2 are border movements and 3 are intra-border movements. Mandibular Movement Protrusion The protrusive path in its complete extent starts from the retruded contact position, passes through the intercuspal position and edge-to-edge position, and ends in the most protruded contact position somewhat in front of the edge-to-edge position. Mandibular Movement Retrusion: Starting from the intercuspal position in natural dentition, the mandible can generally move backwards to a slight extent. Mandibular Movement Lateral movement: In lateral movements the side towards which the movement occurs is called the working or chewing side. The opposite side is named the balancing or the non-working side.

* Christensen Phenomenon When the mandible moves forward to an edge-to-edge position a separation occurs distally between the arches. References http://education.yahoo.com/reference/gray/subjects/subject/75 http://www.aaoms.org/tmj.php http://en.wikipedia.org/wiki/Zygomatic_process_of_temporal_bone http://www.ivy-rose.co.uk/HumanBody/Tissue/Tissue_Bone-Tissue.php http://medical-dictionary.thefreedictionary.com/articular+eminence https://docs.google.com/viewer? a=v&q=cache:iezkFsR3OxUJ:images.adls21.multiply.multiplycontent.com/att achment/0/TkXRgooCHcAACgQGmw1/11.%2520TEMPOROMANDIBULAR.pptx?key %3Dadls21:journal:18%26nmid %3D479114810+posterior+glenoid+fossa+controls+backward+movement +of+condylar+head&hl=tl&gl=ph&pid=bl&srcid=ADGEESiUp2NtD2MscvWX GQrpNZxLvFrE3lUbXSlCfhIYb9g9wZApuUo3CbyP3qHjEJeirmklfzE_HOaNZmba BKoAglc0kUvCY7qe4kkVCCrbYXsEw6ikx5jG6faJR2QiSvwijVF9s5s4&sig=AHIEt bT2La-tNafmhVo4ep2t4sG8H264OA http://www.wisegeek.com/what-is-the-mandibular-fossa.htm http://en.wikipedia.org/wiki/Condyloid_process http://www.innerbody.com/image_skel01/skel116_new_skull.html http://www.biopakcentre.co.uk/index.php? option=com_content&view=article&id=32%3Aanatomy-a-pathology-oftmj&catid=11%3Athe-system&Itemid=54&limitstart=8 http://www.tmjnewjersey.com/tmj-tmd-care/what-is-tmj-tmd/ http://en.wikipedia.org/wiki/Temporomandibular_joint http://www.authorstream.com/Presentation/aSGuest42143-363939temporomandibular-joint-medical-dental-physiotherapy-education-pptpowerpoint/ http://en.wikipedia.org/wiki/Hinge_joint http://en.wikipedia.org/wiki/Gliding_joint http://www.mondofacto.com/facts/dictionary? articular+fossa+of+temporal+bone http://uwmsk.org/tmj/anatomy.html

Pictures

http://uwmsk.org/tmj/anatomy.html http://www.aaoms.org/tmj.php http://www.tmjdsupport.co.uk/apps/photos/photo?photoid=136488307 http://en.wikipedia.org/wiki/File:Processuszygomaticusossisfrontalis.PNG http://roentgenrayreader.blogspot.com/2009_08_01_archive.html http://dc129.4shared.com/doc/lr_PxJo1/preview.html http://www.nismat.org/ptcor/tmj/figure2.jpg http://uwmsk.org/tmj/anatomy.html http://www.google.com.ph/imgres? q=articular+disc+of+temporomandibular+joint+upper+joint&hl=tl&gbv=2& biw=1280&bih=671&tbm=isch&tbnid=wkJJYz7FywRbM:&imgrefurl=http://www.merchantcircle.com/blogs/Bone.and.Joint .Wellness.Center.480-990-2663/2009/7/Chomping-at-the-Bit-to-End-my-JawPain/308589&docid=7oE5gt7_BAdZM&imgurl=http://www.nismat.org/ptcor/tmj/figure2.jpg&w=406 &h=268&ei=bw0_T6W_NcyUiQfcuOTvBA&zoom=1