Sunteți pe pagina 1din 47

T M J Functional Anatomy

Function must be understood before


dysfunction can have any meaning.

12th May 2004 -Seminar


T M J Functional Anatomy
CLASSIFICATION OF JOINTS

• BASED ON ANATOMICAL
CHARACTERISTICS
(Structural classification)

• BASED ON FUNCTIONAL
CLASSIFICATION:
( type of movement)

12th May 2004 -Seminar


T M J Functional Anatomy
STRUCTURAL CLASSIFICATION:
Based on presence or absence of joint cavity:
FIBROUS JOINT:
CARTILAGENOUS JOINT:
SYNOVIAL JOINT

FUNCTIONAL CLASSIFICATION:
SYNARTHROSIS: Immovable joints
AMPHIARTHROSES: Slightly movable joints
DIARTHROSIS: Freely movable joints:

12th May 2004 -Seminar


T M J Functional Anatomy
SYNARTHROSIS: Immovable joints

SUTURE: sutura = seam


Fibrous joint composed of thin layer of dense fibrous
connective tissue that unites bones of the skull

GOMPHOSIS: to bolt together


Cone shaped peg fits into a socket eg tooth into alveolar bone
through periodontal ligament

SYNCHRONDROSIS: syn= together , chondros=cartilage


Cartilaginous joint in which connective material is hyaline
cartilage eg epiphyseal plate

12th May 2004 -Seminar


T M J Functional Anatomy
AMPHIARTHROSES:

SYNDESMOSIS:band /ligament
fibrous joint in which there is considerably more fibrous
connective tissue than in a suture. The fit of the bones is not so
tight. Some amount of flexible movement. EG distal articulation
between fibula and tibia

SYMPHYSIS:growing together
Cartilaginous joint in which connecting material is broad flat disc of
fibro cartilage EG intervertebral discs.pubic symphysis

12th May 2004 -Seminar


T M J Functional Anatomy
DIARTHROSIS: Also known as synovial joints. Presence of
Synovial cavity and articular cartilage a characteristic feature.

Based on types of movement:

GLIDING : eg intercarpal joint


HINGE eg: elbow joint/ ankle
CONDYLOID eg: joint between
radius and carpals
PIVOT eg: joint between atlas and
axis
SADDLE eg : joint between
carpus and thumb
BALL AND SOCKET: eg :
shoulder/ hip joint
12th May 2004 -Seminar
T M J Functional Anatomy
BILATERAL SYNOVIAL
GINGLYMOID (DIARTHRODIAL )
COMPOUND JOINT

12th May 2004 -Seminar


T M J Functional Anatomy SYNOVIAL JOINT:
Specialized endothelial cells form a synovial lining and forms the synovial
fluid which fills both joint cavities and performs two functions:

 Medium for metabolic exchange: as the articular surfaces are avascular


Lubricant during function:

Two mechanisms by which lubrication occurs:

BOUNDARY LUBRICATION:
primary mechanism;synovial fluid forced from one region to
another by movement of the joint itself.

WEEPING LUBRICATION:
The articular surfaces itself absorb some amount of synovial fluid
which due to the pressure during function is forced in and out of the
articular tissues and provided the medium for metabolic exchange. This
occurs only during compression but not all other movements.

12th May 2004 -Seminar


T M J Functional Anatomy
COMPONENTS OF THE TMJ
CONDYLAR HEAD
GLENOID FOSSA
ARTICULAR EMINENCE
MUSCLES OF THE TMJ:
MUSCLES OF MASTICATION
SOFT TISSUE COMPONENTS:
ARTICULAR DISC
JOINT CAPSULE
LIGAMENTS
ARTERIAL AND NERVE SUPPLY TO THE JOINT

12th May 2004 -Seminar


T M J Functional Anatomy
CONDYLAR HEAD
• The oval condylar head is shaped like a rugby ball
• The lateral pole is slightly at a a lower level to the medial pole
• The long axis makes a line of 140 degrees with the line joining
the external acoustic meatus
The cartilage layer is thicker
laterally and posteriorly
suggesting the growth direction
is more active in these areas.
Anteromedially the cartilage
becomes thin early and bone
forms in this region of
attachment of the lateral
pterygoid
12th May 2004 -Seminar
T M J Functional Anatomy The glenoid fossa
Shallow oval depression in the infratemporal area
Bone of the deepest part is quite thin and shows that this part
of the joint is not designed to play an active functional role in
the joint.
The articular
eminence
The two slopes of the
articular eminence are
considered to be a
functional part of the
joint.
The posterior slope
resorbs with
edentulism
12th May 2004 -Seminar
T M J Functional Anatomy
Muscles of mastication
mastication is a a harmonious and skillful activity which requires the
presence and co ordination of not only the muscles of mastication but
also the supra infrahyoid muscles, and the facial muscles

12th May 2004 -Seminar


T M J Functional Anatomy The strongest of the
masticatory muscles The temporalis
Divided into three parts
Well developed in
carnivores and animals Temporalis
muscle
requiring a strong bite tendon
force
It elevates the mandible
when it contracts.
Contraction of the
anterior part raises the
mandible
Contraction of the middle
part elevates and retrudes
the mandible
12th May 2004 -Seminar
T M J Functional Anatomy
Powerful elevator muscle
The masseter
Superficial muscle helps in
protruding the mandible

Deep portion helps in


stabilizing the condyle against
the articular eminence when
biting in a protruded position.

Unilateral movement helps in


lateral movement of the
mandible

Well developed in ruminants


Deep portion
Superficial portion
12th May 2004 -Seminar
T M J Functional Anatomy
The medial pterygoid muscle
Originates from the
pterygoid fossa and extends
downwards backwards and
outwards to insert in the
medial side of the ramus of
the mandible forming a
sling along with the
masseter at the angle of the
mandible.

It assists in closing of the jaw and


contraction of the muscle also causes
protrusion.
12th May 2004 -Seminar
T M J Functional Anatomy
The lateral pterygoid muscle
Superior lateral pterygoid muscle
Originates form the infratemporal
surface of the greater wing of the
sphenoid, extends almost
horizontally backward and outward
to insert on the articular capsule the
disc and the neck of the condyle.
60 to 70% of the fibres attach to the
condyle and the rest to the disc.
Plays an active role not during
opening but during closing (power
stroke)

12th May 2004 -Seminar


T M J Functional Anatomy Originates at the outer surface of
the lateral pterygoid plate and
extends backward upward and
outward to insert into the neck of
the condyle.
When there is bilateral contraction
the condyles are pulled down the
articular eminences and the
mandible is protruded.

Unilateral contraction causes a


mediotrusive movement of that
condyle and lateral movement of
the mandible to the other side
. The inferior lateral pterygoid is
active during opening in contrast
to the superior part.
12th May 2004 -Seminar
T M J Functional Anatomy
Soft tissue components of the TMJ

Articular disc, capsule, ligaments and muscles


12th May 2004 -Seminar
T M J Functional Anatomy Articular Disc
Articular disc

Superior head of the


lateral pterygoid

Inferior head of the


lateral pterygoid
12th May 2004 -Seminar
T M J Functional Anatomy
ARTICULAR DISC
Divides the joint into two compartments

According to Rees divided into 4 parts:


Anterior band –thickened
Intermediate band- narrow and thin
Posterior band – again thick
Bilaminar zone-

upper part having ELASTIC fibres and


attaching to the posterior margin of the glenoid
fossa and the tympano squamous fissure,
forms the posterior border of the upper
compartment.
lower part: mainly collagen fibres and attached
to neck of condyle.
Posterior border of the lower compartment.
12th May 2004 -Seminar
T M J Functional Anatomy Articular disc

Joint capsule

Lateral ligament of the


TMJ
Articular disc has the shape of a laterally wide ovoid.
In frontal section the disc is wedge shaped thicker medially
and thinner laterally 12th May 2004 -Seminar
T M J Functional Anatomy

Articular disc

Joint capsule

The intermediate band: It is the functional zone of the disc


Blood vessels are rarely found here in the intermediate part of
the disc

12th May 2004 -Seminar


T M J Functional Anatomy Unlike other synovial joints the TMJ
condyle and temporal bone do not fit
together in the absence of the disc.
The disc fills the wedge like gap and
stabilizes the join during rotation and
translation.

Normally there is no space between the disc and the


articulating bones except the antero- superior and inferior
recesses and the postero -superior and inferior recesses.
These recesses are filled with synovial fluid and movement of
the joint squeezes them into the other recesses so a thin film of
lubricant is obtained on the moving parts.
The disc also acts as a shock absorber.

12th May 2004 -Seminar


T M J Functional Anatomy

LIGAMENTS:

They are made up of collagenous connective tissue which do not


stretch and do not actively participate in the normal function
They act as guide wires restricting certain movements while
permitting certain others.
They restrict movement mechanically as well as through neuro
muscular reflex activity.
Ligaments do not stretch. They can be elongated by traction
forces but once they have been elongated joint activity is usually
compromised. 12th May 2004 -Seminar
T M J Functional Anatomy
Functional ligaments which support the TMJ:

• The collateral ligaments (discal)


• Capsular ligament
• TM ligament

Accessory ligaments:

Stylomandibular ligament.

Sphenomandibular ligament

12th May 2004 -Seminar


T M J Functional Anatomy
The collateral ligaments (discal)

Attach the medial and lateral poles of the articular disc to the
poles of the condyle. They are two in number:- medial and
lateral .
They function in allowing the disc to move passively with the
condyle as it glides anteriorly and posteriorly.

They also allow the disc to be rotated anteriorly and posteriorly


on the articular surface of the condyle..

Thus these ligaments are responsible for the hinging


movements of the condyle which occurs in the lower
compartment.

12th May 2004 -Seminar


T M J Functional Anatomy
Capsular ligament
The capsular ligament encompasses the joint retaining the
synovial fluid. It is fibroelastic, very well vascularised and
well innervated and provides proprioceptive feedback
regarding the position and movement of the joint.
.

Capsular ligament

Lateral ligament

12th May 2004 -Seminar


T M J Functional Anatomy TM ligament
It has two parts outer oblique and an inner horizontal.

The outer part extends from the articular tubercle to the neck of the
condyle

The outer oblique part has the following functions:


 It restricts excessive dropping of the condyle and therefore
limits the normal opening of the mandible.
Secondly during opening of the mouth, the condyle rotates
till this ligament becomes tight as its point of insertion is
rotated posteriorly. When it becomes taut the neck cannot
rotate any further.

This unique feature is found only in humans preventing excessive


rotation for the mandible from impinging on the vital mandibular
and retromandibular structures behind the jaw.
12th May 2004 -Seminar
T M J Functional Anatomy

the inner horizontal part extends backwards from the


articular tubercle to insert into to the lateral pole of the
condyle and posterior part of the articular disc.

Function:

The inner horizontal portion protects the posterior


retrodiscal tissues from trauma and also prevents the lateral
pterygoid muscle from over lengthening.

12th May 2004 -Seminar


T M J Functional Anatomy Accessory ligaments:

Sphenomandibular ligament

Stylomandibular ligament.

It becomes taut
when the mandible is protruded
and thus limits the excessive
protrusive movements of the
mandible.
12th May 2004 -Seminar
T M J Functional Anatomy
Vascular supply:

Superficial temporal artery


Middle meningeal artery
Maxillary artery

Innervation:

Auriculotemporal nerve
Deep temporal and VASCULAR SUPPLY
masseteric nerve AND INNERVATION
OF THE JOINT
Others : deep auricular ,
anterior tympanic,
ascending pharyngeal

12th May 2004 -Seminar


T M J Functional Anatomy JAW MOVEMENTS AND JOINT MECHANICS

12th May 2004 -Seminar


T M J Functional Anatomy

The border area of the movement of the mandibular


incisor point is known as Posselt’s figure

12th May 2004 -Seminar


T M J Functional Anatomy MOVEMENTS IN THE MANDIBLE:
Two types of movement occur in the
mandible:
Rotational
Translational
Rotation is the movement of a body around
its axis
The mandible can rotate in all three reference
planes
Horizontal/Frontal/Sagittal
Translation movement:
It is defined as a movement in which every
part of the moving body has the same
direction and velocity of movement.
Translation occurs in the superior cavity of
the joint while rotation occurs in the inferior
cavity of the joint.
12th May 2004 -Seminar
T M J Functional Anatomy SAGITTAL PLANE BORDER MOVEMENTS
AND FUNCTIONAL MOVEMENTS:

Mandibular motion in the sagittal direction has 4


distinct movement components:

*posterior opening border movement

*anterior opening border movement

*superior contact border movement

*functional movements

12th May 2004 -Seminar


T M J Functional Anatomy
EFFECT OF POSTURE ON FUNCTIONAL MOVEMENT:

NORMAL DIRECTED 45 ALERT


degrees
FEEDING
UPWARD POSTURE

12th May 2004 -Seminar


T M J Functional Anatomy

HORIZONTAL PLANE BORDER AND FUNCTIONAL


MOVEMENTS
The horizontal plane border movements are traced by the
gothic arch tracing.
The mandibular movements are in a rhomboid pattern with 4 distinct
movement components.
Left lateral border
Continued left lateral border with protrusion
Right lateral border
Continued right lateral border with protrusion.
12th May 2004 -Seminar
T M J Functional Anatomy Functional movements:

Centric relation
Intercuspal position
Area used just before swallowing
Area used in early stage of mastication

End to end position of anterior teeth

During chewing the range of jaw movements begins some


distance from the maximum Intercuspal position but as the food
is broken down into smaller particle sizes the jaw action comes
closer to the ICP . The exact position of the mandible during
chewing is dictated by the occlusal configuration

12th May 2004 -Seminar


T M J Functional Anatomy
FRONTAL BORDER (VERTICAL) AND
FUNCTIONAL MOVEMENTS:

The border movement has a shield


shaped movement along with the
functional movement.
Left lateral superior border
Left lateral opening border
Right lateral superior border
Right lateral opening border

12th May 2004 -Seminar


T M J Functional Anatomy
ENVELOPE OF MOTION:

By combining the
mandibular border movements
in the three planes a three
dimensional envelope of
motion can be produced that
represents the maximum range
of movement of the mandible.
Although it has a
characteristic shape it varies
from person to person.

12th May 2004 -Seminar


T M J Functional Anatomy

In normal intercuspal position, the force generated by the


masticatory muscles is concentrated on the teeth thus the joint
receives only a small amount of the force.
12th May 2004 -Seminar
T M J Functional Anatomy

8
7 1
2
6 3
5
4

The work of GIBBS is well know in the field of masticatory movements.


Gibbs classified one masticatory cycle into 8 steps:-

12th May 2004 -Seminar


T M J Functional Anatomy
CLENCHING IN THE
INCISOR REGION

Superficial portion of the masseter and the medial and


lateral pterygoid work during this.

Lateral pterygoid is especially active

In an individual without molars and premolars the same


muscles work with the exception of the temporalis.

12th May 2004 -Seminar


T M J Functional Anatomy
UNILATERAL
CLENCHING IN THE
MOLARS

The temporalis on the working side is active whereas the


one on the balancing side is not. In contrast the lateral
pterygoid on the working side is inactive while the one on
the balancing side is active.
The masseter contracts powerfully on the working side
while slightly but firmly on the balancing side.
12th May 2004 -Seminar
T M J Functional Anatomy
CLENCHING IN THE
INTER CUSPAL POSITION

All the muscles of mastication work except the lateral


pterygoids on both sides

12th May 2004 -Seminar


T M J Functional Anatomy

MASTICATORY
MOVEMENT

The temporalis works through all stages of the cycle.


On the working side all the muscles are in action except the
lateral pterygoid.
On the balancing side the temporalis and the medial pterygoid
work strongly while the lateral pterygoid works slightly
12th May 2004 -Seminar
T M J Functional Anatomy
Thus the workings of the masticatory system are extremely complex.
It is a remarkable phenomenon that in most instances it functions
without complication in a person’s lifetime.
When the breakdown does happen however a situation is produced
which is as complicated as the system itself.
Therefore without a sound understanding of normal function
dysfunction cannot be comprehended…

12th May 2004 -Seminar