ARTICLE IN PRESS

Ann Anat 189 (2007) 314—319

www.elsevier.de/aanat

On the development, morphology and function of

the temporomandibular joint in the light of the
orofacial system
Jochen Fanghänela,, Tomasz Gedrangeb

a
Abteilung für Oralanatomie im Zentrum für Zahn-, Mund- und Kieferheilkunde, Ernst-Moritz-Arndt-Universität
Greifswald, Rotgerberstraße 8, D-17475 Greifswald, Germany
b
Poliklinik für Kieferorthopädie, Präventive Zahnmedizin und Kinderzahnheilkunde, Ernst-Moritz-Arndt-Universität
Greifswald, Rotgerberstraße 8, D-17475 Greifswald, Germany

Received 21 December 2006; accepted 20 February 2007

KEYWORDS Summary
Orofacial system;
The temporomandibular joint has a key role in the biocybernetic functional cycle of
Temporomandibular
the orofacial system. It has developed as a ‘‘secondary joint’’ and displays a number
joint;
of features relating to the articular tubercle, the mandibular condyle, the articular
Growth centre;
disc, the joint cartilage and the retroarticular pad. The joint cartilage of the
Neuromuscular re-
mandibular condyle is a primary compensatory growth centre also comprising distant
flux
effects. The coordinate course of the mandibular movements is controlled by a
complex reflex mechanism and neuronal controller cycles. Morphology, function and
clinical aspects are of equal interest to both physicians and dentists.
& 2007 Published by Elsevier GmbH.

On the orofacial system ing the individual tooth positions (Schumacher,

The orofacial system (stomatognathic system,
maxillomandibular apparatus, masticatory system)
is a functional unit composed of numerous parts.
Among those, a central position is occupied by the
temporomandibular joint whose structure shows
very close coordination with shape features includ-
Corresponding author. Tel.: +49 3834867110;
fax: +49 3834867113.
E-mail address: fanghaen@uni-greifswald.de (J. Fanghänel).
1993; Fanghänel et al., 2006). Resulting from the
cooperation of numerous professional disciplines
and their specific issues, temporomandibular joint
research comprises a broad range extending from
medical–theoretical fundamentals to clinical prac-
tice. A comprehensive definition of the orofacial
system is complicated by its poor regional delimit-
ability and across-the-board functions. From a
biogenetical point of view, the orofacial system is
mainly derived from the structures of the gill
region. Therefore, conceiving of the orofacial

0940-9602/$ - see front matter & 2007 Published by Elsevier GmbH.

doi:10.1016/j.aanat.2007.02.024
 ARTICLE IN PRESS
Development, morphology and function of the temporomandibular joint
system as a unit involved in biological functional
cycle has proved useful. Its adaptability ensures the
maintenance of the biological equilibrium. The
functions of the orofacial system, where the
temporomandibular joint plays a key role, may be
summarized as according to Schumacher (1993) as
follows:
 masticatory function for ingestion, comminution
and digestion of food
 aesthetic–physiognomic function through activ-
ity of the muscles of expression
 sensitive and sensory functions for mediation of
tactile, pressure, temperature and gustatory
sensations
 functional adaptation of the temporomandibular
joints in terms of hypertrophy or atrophy
 regenerative functions through restitution of
tissues depending on their capacity
The coordinate course of almost all functions of
the chewing process is controlled by a complex
reflex mechanism. Moreover, the chewing process is
subject to cortical control. The subtle graduation
of chewing forces, the adjustment of the chewing
rhythm, the reflex movements of the tongue, the
coordination of the muscle groups, the swallowing
act, the salivary flow and the gustatory orientation
are all involved in this regulating system.
Further, the formative functions of the tempor-
omandibular joint within the orofacial system are
noteworthy. Its high adaptability is manifested by
variations of shape and structure following changes
of the functional balance as observed in anomalies
of tooth position, various bite types or edentulous
jaws. Finally, the temporomandibular joint is the
only joint of the human body that harbours a
growth centre. The hyaline cartilage of the
mandibular head is a primary, compensatory growth
centre.
On the development and special
structures of the temporomandibular
joint
From a phylogenetic point of view, the tempor-
omandibular joint in mammals and human has
developed secondarily in addition to, but not from
the primary joint (a.o. Gaupp, 1911; Dablow,
1928). In primitive vertebrates, the posterior and
the anterior part of the first gill arch articulate in
the primitive temporomandibular joint. The se-
paration of joint parts leads to the development of
the malleus and incus, thus making the amphibian
315
and reptile jaw joint an incudomalleal joint. In
mammals and humans , the temporomandibular
joint develops by attachment of the lower jaw bone
to the temporal bone, so it may be referred to as a
secondary joint. Ontogenetical development origi-
nates in the respective bone cores of the develop-
ing articulating bones (Radlanski et al., 1993).
Displacement of the tooth rows against each other
requires a particularly jointed connection between
the upper and lower jaw. The mandibular head and
the mandibular fossa are separated by the articular
disc. Thus, each temporomandibular joint consists
of two partial joints. The upper partial joint
between the temporal bone and the disc is slightly
wider than the lower one between the articular
disc and the mandibular condyle. In fact, thus, the
mandible is connected to the cranial base by four
joint sections.
On morphology (Fig. 1)
In comparison to other joints of the human body,
the temporomandibular joints display several spe-
cific features:
 the temporomandibular joint is the most heavily
loaded joint (50–80 kp)
 the mandibular head possesses no fixed turning
point (anteroposterior sliding movement)
 both joints always need to cooperate
 the jaw bones change their shape with increas-
ing age
 the chewing surfaces of the teeth are co-
determinants of some joint shapes and move-
ments
 the temporomandibular joint forms a gear unit
with the ‘‘interincisal joint’’
 TMJ overload due to failing occlusion (e.g.
prostheses) leads to attrition
Figure 1. Morphology of TMJ.
 ARTICLE IN PRESS
316
 the TMJ cartilage represents a chondrogenic
growth centre
A special feature in the human adult is the
articular tubercle which provides the TMJ with an
s-shaped condylar path. The inclination of the
articular tubercle towards the occlusal plane
depends on age and function (Kazanjian, 1940);
however, it is largely completed at the age of 10
years. The articular tubercle and the mandibular
fossa have to be viewed synoptically and show
adaptive processes (Table 1).
Both shape and dimensions of the mandibular
condyle show high variability (u.a. Solberg et al.,
1985; Scapino, 1997). The cartilage covers of the
anterior parts of the glenoid fossa and the condyle
indicate those parts of the temporomandibular
joint that are subject to the highest load. The
longitudinal axes of both mandibular condyles
intersect forming an obtuse angle at the basion
which is located at the anterior edge of the
foramen magnum.
The articular disc, a mobile fossa for the
condyle, anteriorly, medially and laterally adheres
to the articular capsule. Posteriorly, it passes to the
retroarticular connective tissue pad. Moreover,
tendon ends of the m. pterygoideus lateralis
medially radiate to the anterior disc. The disc
may be functionally divided into three areas:
anterior part, intermediate part and posterior part.
After Mc Donald (1989) and others, the disc ensures
friction-reduced sliding, damping and diversion of
peak loads. Under compressive load the disc has
viscoelastic properties. A reduction of disc thick-
ness increases strain (Nickel and Mc Lachlan, 1994).
Normally, the posterior part of the disc overlies the
superior part of the condyle. In ‘‘centric condyle
position’’ the intermediate part (the thinnest part
of the disc) is located between the anterosuperior
outline of the condyle and the articular tubercle
(a.o. Kubein-Meesenburg, 1985; van Blarcom,
Table 1. Adaptive processes in the temporomandibular
joint
Fossa Tuberculum
mandibularis articulare
Newborn Shallow Missing
Function period Distinct Distinct
Old age Shallow Shallow
Edge-to-edge Shallow Slight inclination
bite
Overbite Distinct Steep inclination
Tooth loss Various remodelling processes
J. Fanghänel, T. Gedrange
1994). The anterior part lies in front of the condyle
(a.o. Scapino, 1983).
A particular feature of the joint is the retro-
articular pad (bilaminar zone, genu vasculosa)
comprising vascular tufts, connective and fat
tissue. It is a hydropneumatic pad for dislocations
within the joint and compensates for volume
changes.
The articular capsule is relatively wide, thus
providing the condyle with large moving space.
Laterally, it is reinforced by the lateral ligament.
The ligament restrains retrusive and downward move-
ments of the condyle beyond the articular tubercle.
On the medial part, the capsule is not or only slightly
reinforced which may be accounted for by articular
bilaterality. The sphenomandibular and stylomandib-
ular ligaments medially run past the capsule. They
inhibit the protrusive movement of the mandible. The
Pinto ligament (discomallear ligament) is an analogous
connection between the malleus and the medial
articular capsule (Pinto, 1962). The Tanaka ligament
represents a string-shaped reinforcement of the
medial capsule (Tanaka, 1986).
The articular cartilage – a growth centre
The articular cartilage, a primary compensatory
growth centre, allows frictionless sliding and
evenly transmits compressive forces to the sub-
chondral bone (a.o. Kuboki et al., 1997). Degen-
erative changes are closely related to unphysiologic
strain on the joint areas.
We studied experimental changes of the condylar
cartilage in male Wistar rats (Rattus norvegicus
BERKENHOUT) during different intervals of the
postnatal growth period after loss of the maxillary
supporting areas due to crown reduction and after
feeding a soft diet in comparison to non-surgical
controls (Droste et al., 1993). The thicknesses of
the single cartilage layers and total layer thickness
were assessed. The experimental operation affects
a reduction of the vertical dimensions which is
manifested by accelerated maturation processes in
the centrally unloaded cartilage sections of the
animals.
Extraction induces altered occlusal conditions-
loss of supporting areas-mandibular rotation-
unloading of central parts of the cartilage-
discontinuation of intermittent forces-impact on
the condylar cartilage.
Application of a soft diet induces a change of the
bolus function-reduced compressive load-re-
duced transmission of forces and tension-impact
on the condylar cartilage.
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Development, morphology and function of the temporomandibular joint 317

These changes also imply distant effects. For
instance, the height of the viscerocranium (Fig. 2)
and the width of the condylar process (Fig. 3) are
reduced in the experimental animals of different
ages.
Neuromuscular course of mandibular/
condylar movements (Fig. 4)
The ordered course of mandibular movements is
controlled by a complex reflex mechanism and
neuronal controller cycles (Schumacher, 1991;
Kubein-Meesenburg et al., 1993). For these me-
chanisms, three levels may be defined, a cortical, a
subcortical and a local level. The structures of
these levels are embedded in the required afferent
(‘‘input’’) and efferent (‘‘output’’) pathways of the
central nervous system (Schumacher, 1991). The
multitude of neuronal controller cycles accounts
for the coordinated, targeted and convenient
sequence of movements as well as for the adjust-
ment of chewing force. Voluntary and involuntary
excitations determine one another in mandibular
excursions. They finally result in movements
displaying as ‘‘slow-reflex patterns’’.

Figure 2. Height of viscerocranium.

Figure 3. Width of processus condylaris.

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318
Figure 4. Neuromuscular course of mandibular/condylar
movements after G.-H. Schumacher (1991).
Afferent pathways
The required sensory impulses are transmitted by
afferent neurons of the cranial nerves V, VII, IX and
X from the periphery to the CNS. Stimulus uptake is
affected by various receptors which are located
throughout the orofacial system. Mechanoreceptors
and thermoreceptors are located in the facial skin,
oral mucosa or in the dentinal tubules (odontoblast
processes), mechanoreceptors lie in the articular
capsule (tendon spindles) and in the muscles
(muscle spindles), Vater/Pacini corpuscles are
located in the facial skin and in the articular
capsule, and chemoreceptors in the taste buds.
Free nerve endings are present throughout the
orofacial system. The afferent neurons of the
aforementioned receptors run to the terminal
nuclei of the specified cranial nerves in hindbrain
and midbrain. Therefrom, they run to the mastica-
tory centre presumably located in the pons, or to
the thalamus. The thalamus also receives impulses
from psychological sensations from the sense
organs through the cranial nerves I, II and VIII.
Moreover, connections exist with structures of the
limbic system which comprises essential drive
structures and regulates emotions and motivation.
J. Fanghänel, T. Gedrange
Within the thalamus, impulses are switched over
either to the so-called basal ganglia (subcortical level)
or to the cortical gyrus postcentralis (cortical level).
Efferent pathways
The extrapyramidal and pyramidal tracts or
systems are in service of the efferent pathways.
The above-mentioned basal ganglia to which the
impulses are switched over by the thalamus are
part of the extrapyramidal system and form the
origin of tracts. They are responsible for initiation
and performance of unconscious slow ‘‘ramp’’
movements and for temporal and spatial coordina-
tion of muscle activity (a.o. Schmidt, 1983).
From the basal ganglia, the impulses are trans-
mitted over the nucleus ruber and the formatio
reticularis and other structures to the respective
cranial and cervical nerve nuclei. Via these tracts,
the impulses finally arrive at the motor endplates
of all muscles involved in mandibular movement.
The extrapyramidal nuclei are interconnected by
numerous neural circuits ensuring mutual informa-
tion and coordination. They control the trained and
mechanically performed mandibular movements.
The extrapyramidal system, thus, compares to a
‘‘servo mechanism’’ that autonomously and uncon-
sciously supports all voluntary mandibular excur-
sions. Involvement of the sensory thalamic nuclei
constitutes another feedback loop in the nuclear
areas of the extrapyramidal system, thus compen-
sating all ‘‘unevennesses’’ of extrapyramidal motor
activity on a higher level.
As soon as the impulses are transmitted from the
thalamus to the cortical gyrus postcentralis (pri-
mary somatosensory cortical area), they are
switched over to the gyrus praecentralis (primary
motor cortical area) (cortical level).
The motor cortex is the supreme control centre of
motor performance. It is responsible for transfor-
mation switching of cortically induced motor plans
to motor programs. Here, the corticospinal tract
originates which runs to the spinal cord. On its way
toward the spinal cord, numerous fibres running to
the motor neurons of the cranial and cervical nerves
(as corticobulbar tract) and collaterals running to
the thalamus, nucleus ruber, to the nuclei pontis
(-cerebellum), to the olive (-cerebellum) and to
the formatio reticularis are emitted.
The corticobulbar tract mediates voluntary in-
nervation of the respective muscle groups required
for current movement of the mandible. By means of
the above-mentioned pyramidal tract systems, the
cortex ‘‘controls’’ the subcortical (extrapyramidal)
motor centres. On the one hand, these fibres may
 ARTICLE IN PRESS
Development, morphology and function of the temporomandibular joint
exert a damping and inhibitory effect, while on the
other hand permanent tonic excitation emanates
therefrom. The automatic and stereotyped man-
dibular movements initiated by the subcortical
centres are considered to be modified by pyramidal
stimuli, so as to result in targeted, subtly coordi-
nated movements. Therefore, coupling between
the extrapyramidal and pyramidal tracts is of great
importance and substantially contributes to the
flow and precision of motor sequence.
The cerebellar nuclei located in the bypass of the
pyramidal and extrapyramidal systems play another
important role. From a hierarchical point of view,
the cerebellum and basal ganglia are equally
important centres involved in the programming of
cortically induced motion sequences. They coordi-
nate the function of single muscle groups which
finally results in a parsimonious and convenient
motion sequence. Furthermore, they are respon-
sible for programming and course correction of
rapid movements as well as the coordination of
posture and movement (Schmidt, 1983).
Finally, the local level is represented by the
muscle fibre of a muscle group with the motor
endplate itself. All human muscles are assigned to
the ‘‘twitch’’ type and follow the ‘‘all-or-none’’
principle. Among the muscles moving the mandible,
‘‘slow’’ and ‘‘fast’’ motor fibres are discriminable.
We were able to differentiate between them by our
own studies using, inter alia, histochemical demon-
stration of myofibrillar ATPase (a.o. Gedrange et
al., 2002). The existence of ATPase-poor type I
fibres (slow units) and ATPase-rich type II fibres (IIa:
prolonged, but also short-term, intense; IIb: fast
units) was shown (Fig. 4). It is possible that these
fibre types usefully complement one another in
muscle control and adjustment thus establishing a
kind of equilibrium.
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