TMJ & JOINTS OF THE CRANIOFACIAL COMPLEX

Oral Histology Dent 206

Joints

Functions

Mobility
Temporomandibular joint Joints in the trunk Joints in the upper and lower limbs

Growth

Craniofacial joints including TMJ

Craniofacial joints

Temporomandibular Joint Synchondroses Symphysis menti Sutures

Simple sutures Serrated sutures

Bone Formation

Endo-chondral ossification

Base of the skull Nasal septum Coronoid process Condylar process

Intra-membranous ossification

Cranial vault Facial skeleton Body of the mandible

Endo-chondral bone Formation

Deposition of bone matrix on a pre-existing cartilage matrix

Mesenchymal tissue

Cartilage

Bone

The primary transitional cartilage is a hyaline cartilage whose shape resembles a small version of the bone to be formed

Intra-membranous Bone Formation

Direct mineralisation of matrix secreted by osteoblasts

Mesenchymal tissue
(Condensed)

Bone

Epiphyseal growth
Endo-chondral ossification in a long bone

Intra-membranous bone collar forms within the perichondrium of the cartilage model Cartilage degeneration (by hypertrophy) and calcification starting at the central portion of diaphysis Blood vessels penetration bringing osteoblasts Continuous primary bone deposited over calcified cartilage Calicified cartilage resorbed by giant mutinucleated cells Primary ossification center Secondary ossification centers at the epiphyses in a similar pattern In secondary ossification centers cartilage remains in 2 regions

The articular cartilage

Protection and mobility Growth until closure at 20 ys

The epiphyseal plate

Epiphyseal plate
HISTOLOGY

Histological zones

Resting zone Proliferative zone

Chondrocytes divide to form parallel columns (interstitial growth) Large chondrocytes with cytoplasm filled with glycogen Thin septa of cartilage become calcified Osteoblasts deposit primary bone over the calcified cartialge

Hypertrophic cartilage zone

Calcified cartilage zone

Ossification zone

Temporomandibular Joint

Functions

Articulation between the mandible & the cranium Hinge with some some gliding Growth of the mandible Fibrous articular surface (not hyaline cartilage)

Unique features

Reflects the intra-membranous development of the joint Upper joint cavity Lower joint cavity

The intra-articular disc

Two reciprocal joints Condylar process Glenoid fossa of temporal bone Articular eminence

Bony Components

Temporomandibular Joint

Soft tissue components

Intra-articular disc

Divides TMJ into 2 joint cavities

Capsule - fibrous Ligaments

Temporomandibular Joint

Synovial joint

Synovial membrane

Lines the internal surface of the fibrous capsule Lines the margins of the disc Does not cover the articular surfaces Secrets the synovial fluids Consists of

a layer of flattened endothelial-like cell type, resting on a vascular layer Number of folded projections increase with age

Folded at rest & flattens out during movement

Synovial fluids

Lubrication Nutrition

Temporomandibular Joint
HISTOLOGY

Adult condyle

Soft covering Calcified cartilage Compact Bone Cancellous bone

Fibrous articular surface Bone Dense fibrous tissue

Glenoid fossa & eminence

Intra-articular disc

Joint cavities

Layers covering the head of the adults bony condyle

Fibrous articular surface zone

Mainly collagenous although elastin are also present In uppermost layers, fibers are parallel to surface In deeper layer they run more vertically Articular surface covering the glenoid fossa & eminence is similar though thinner Proliferation zone fibrous layer with remnants cartilage-like cells Remnants of secondary condylar cartilage Different staining from that of bone

Cellular-rich zone

Fibrocartilaginous zone

Zone of calcified cartilage

TMJ of the child

Condyle

Fibrous articular surface Proliferative zone Thicker secondary condylar cartilage Ossification front Cancellous bone

TMJ of the child

Fibrous articular surface

Proliferative zone
Thicker secondary condylar cartilage Ossification front Cancellous bone (woven bone mature bone)

Intra-articular disc

Dense collagenous fibrous tissue Fibers run

anteroposteriorly in the central region transverse & superoinferior fibers may occur circumferentially at the periphery crimped or wavy

Type I collagen although type II & III may occur Cells more at birth The bulk of the disc is avascular

Derives nutrition from the synovial fluids Blood vessels at periphery The superior lamella of the bilaminar zone has numerous blood vascular spaces which are filled with blood upon forward migration of condyle in jaw opening

Intra-articular disc

Synchondroses

Remnants of the primary chondocranial cartilages after endo-chondral ossification of cranial base bones
Fontanels/sutures are remnants of mesenchyamal tissues after intra-membranous ossification of cranial vault and facial skeleton bones

Synchondroses
of the cranial base

Spheno-occipital

Growth continues until early teens

Spheno-ethmoidal

Replaced by fibrous tissue shortly after birth

Midsphenoidal

Active prenatally Obliterated to form the body of the sphenoid at birth

Synchondrosis
HISTOLOGY

Inherent growth potential Bi-directional growth pattern Layers

Central resting zone Proliferative zone on either sides Zone of hypertrophy Replacement zone

Sutures

Fontanels/sutures are remnants of mesenchyamal tissues after intra-membranous ossification of cranial vault and facial skeleton bones

Layers

Central zone (loose connective tissue) Fibrous capsular zone Cambial zone (osteogenic zone) Bone

Types of sutures

Simple vs. serrated Suture type vs.

Growth potential Age

Symphysis Menti
Symphysis mandibulae / Symphysis mentalis

The fibrocartilaginous union of the two halves of the mandible in the fetus It becomes an osseous union during the first year Fibrocartilaginous tissue

Cartilage

Not derived from Meckels cartilage but differentiates from connective tissue in the midline At either sides of the center At the center Develop at the end of 1st year Fuse together and ossify the joint.

Fibrous tissue

Mental ossicles

Epiphyseal plate vs. condylar cartilage

Epiphyseal plate Cartilage cells are in long columns Cells hypertrophy with division Grows interstitially Chondrocytes die eventually

Condylar cartilage Cartilage cells are scattered Cells hypertrophy without division Grows by apposition of cells Chondrocytes still living in ossification front

Synchondrosis vs. epiphyseal plate

Synchondrosis
A joint Two proliferation zones Bi-sided growth

Epiphyseal plate
Not a joint one proliferation zones Uni-sided growth

Synchondrosis vs. Condylar cartilage

Synchondrosis
Primary cartilage Inherent growth potential in tissue culture Proliferative zones on either side of center Bi-sided growth Cartilage cells are in long columns Cells die eventually Cells hypertrophy with division Grows interstitially (mitotic divisions) Considerable production of matrix

Condylar cartilage
Secondary cartilage Little intrinsic growth potential in tissue culture Undifferentiated fibroblast cells proliferate One-sided growth in more than one direction Cartilage cells are scattered Cells are still living at ossification front Cells hypertrophy without division Grows by apposition of cells Less production of matrix