Den 018: General Anatomy 2

Module #2 Teacher’s Guide

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Lesson title: Temporo-Mandibular Joint Materials: Book, pen and notebook

Learning Targets:
At the end of the module, students will be able to:
1. Identify what type of joint is temporomandibular joint (TMJ) References:
and what actions occur at this joint; and Wineski, L. (2010). Snell’s Clinical
2. Describe attachments, articular and accessory structures Anatomy by Regions (10th ed).
around the TMJ. Philadelphia. Wolters Kluwer.
1. Levangie, P. (2019). Joint Structure and
Function A Comprehensive Analysis (6th
ed). Philadelphia. F. A. Davis Company

A. LESSON PREVIEW/REVIEW

Introduction

In this module, we will introduce the temporo-mandibular joint (TMJ). A discussion of the structure and function of the TMJ
will allow you to appreciate and understand its unique features, its relationship with the cervical spine, and the impact of
impairments and pathologies to the TMJ.

To get things started, try doing a Picture Walk. Take a quick look at the captions, activities, pictures, etc. This is to give
your brain an idea of what’s coming - it’s like watching a trailer in a movie. Doing this for a minute will help your brain
organize your thoughts before studying.

Try the Pomodoro Technique! Set your timer to 25 minutes and work during this time period. After this period, take a 5-
minute break.

Remove items from your desk or study area that may distract you such as your phone.

B. MAIN LESSON

Content and Skill-Building

Articular Structures
The temporo-mandibular joint (TMJ) is unique in both structure and function. Structurally, the mandible is a horseshoe-
shaped bone that articulates with the temporal bone at each posterior superior end and produces two distinct but highly
independent articulations. Each TMJ joints contains a disc that separates the two joint into upper and lower articulations.
Functionally, mandibular movement involves concurrent movement in the four distinct joints resulting in a complex
structure that moves in all planes of motion to achieve normal function;.

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 Den 018: General Anatomy 2
Module #2 Teacher’s Guide

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

TMJ – synovial joints formed by the condyle of the mandible inferiorly and the articular eminence of the temporal bone
superiorly.
⮚ The articular surface is covered in dense, avascular, collagenous tissue (aligned in perpendicular to the body
surface in the deeper layers to withstand stresses) that contains some cartilaginous cells (fibrocartilage).
Bones form and contribute to the function of the TMJ
● Mandible – the largest of the facial bones; highly mobile; an arch-shaped and consists of a condyle at each
posterior-superior portion.
o Has medial and lateral pole (readily palpable)
o The posterior aspect of condyle can be palpated if a fingertip is placed into the external auditory metres
and the pad of the finger is pushed anteriorly.
● Maxilla
● Temporal – the proximal or stationary segment of the TMJ
● Zygomatic
● Sphenoid
● Hyoid

Fig 2.1 The mandible

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 Den 018: General Anatomy 2
Module #2 Teacher’s Guide

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

Accessory Joint Structures

Articular disk - A disc located within each TM joint separates the articulation into distinct superior and inferior joints with
slightly different functions to allow the convex surfaces of the articular eminence and the mandibular condyle to remain
congruent throughout the ROM of the TM joint in all planes.
The articular disc of the TM joint is biconcave; that is, the superior and inferior surfaces are both concave.
Inferior TM joint - is formed by the mandibular condyle and the inferior surface of the disc and functions as a simple hinge
joint.
Superior TM joint - is formed by the mandibular condyle and the inferior surface of the disc and functions as a simple
hinge joint
The disc is attached to the joint capsule anteriorly, as well as to the tendon of the lateral pterygoid muscle. The anterior
attachments restrict posterior translation of the disc. Posteriorly, the disc is attached to a complex structure, collectively
called the bilaminar retrodiscal pad. The two bands (or laminae) of the bilaminar retrodiscal pad are attached to the disc.
The superior lamina is attached posteriorly to the tympanic plate (at the posterior mandibular fossa).

Capsule and Ligaments

The primary ligaments of the TM joint are the TM ligament, the stylomandibular ligament, and the sphenomandibular
ligament. The TM ligament is strong and composed of two parts: an outer oblique element and an inner horizontal
element. The outer oblique element attaches to the neck of the condyle and the articular eminence.

The stylomandibular ligament is the weakest of the three ligaments and is considered a thickened part of the parotid
sheath joining the styloid process to the angle of the mandible. Some investigators have identified the function of this
ligament as limiting protrusion of the mandible but others have stated that it has no known function.

The sphenomandibular ligament is described as the “strong” ligament that is the “swinging hinge” from which the mandible
is suspended. Some investigators have stated that it serves to protect the mandible from excessive anterior translation.
Others have stated that this ligament has little or no function

C. CHECK FOR UNDERSTANDING

You are tasked to answer following critical questions regarding the main lesson and provide the rationale for each item.
This will be recorded as their quiz. One (1) point will be given to the correct answer and another one (1) point for the
correct rationale. Superimpositions or erasures in their answer/ratio are not allowed.
1. The squamous portion of the temporal bone d. Medial aspect of the squamous portion of the
articulates with which structure, forming the temporal bone.
temporomandibular joint (TMJ)? 3. Which structure is a bony prominence located at the
a. Mandibular notch. base of the zygomatic process?
b. Ramus of the mandible. a. Glenoid fossa.
c. Condyle of the mandible. b. Tympanic plate.
d. Coronoid of the mandible. c. Articular tubercle.
2. Which is NOT a main load-bearing area of the TMJ? d. Articular eminence.
a. Condyle. 4. Which structure supplies attachment sites along the
b. Articular disc. posterior portion of the glenoid fossa?
c. Lateral aspect of the squamous portion of the a. Tympanic plate.
temporal bone. b. Postglenoid tubercle.

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 Den 018: General Anatomy 2
Module #2 Teacher’s Guide

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

c. Articular tubercle. a. Inferior lamina.

d. Articular eminence. b. Tympanic plate.
5. The surface of the squamous portion of the temporal c. Superior lamina.
bone is composed of which material? d. Retrodiscal pad.
a. Synovial fluid. 13. Which is a compartment of the TMJ?
b. Hyaline cartilage. a. Lateral.
c. Fibrous connective tissue. b. Inferior.
d. Collagenous connective tissue. c. Anterior.
6. The articular disc is located between which structure d. Posterior.
and the squamous portion of the temporal bone? 14. The TMJ is which type of joint?
a. Tympanic plate. a. Fibrous.
b. Articular eminence. b. Synovial.
c. Mandibular condyle. c. Symphysis.
d. Postglenoid tubercle. d. Cartilaginous.
7. Which area of the articular disc is avascular and 15. Which is the volume of the superior compartment of
aneural? the TMJ for synovial fluid?
a. Lateral. a. 0.5 mL.
b. Central. b. 0.9 mL.
c. Anterior. c. 1.2 mL.
d. Posterior. d. 1.5 mL.
8. Which is NOT a division of the bands of the articular 16. The superior compartment of the TMJ provides for
disc? which type of movement?
a. Superior. a. Pivotal.
b. Anterior. b. Rotational.
c. Posterior. c. Translational.
d. Intermediate. d. Circumductional.
9. Which portion of the articular disc is the main load- 17. The articular surfaces of both the condyle and the
bearing area? temporal bone are enclosed by which component of the
a. Medial. TMJ?
b. Lateral. a. Capsule.
c. Anterior. b. Ligaments.
d. Posterior. c. Articular disc.
10. Which attachment is adjacent to the bilaminar zone? d. Compartments.
a. Medial. 18. Which component of the TMJ does NOT have a
b. Lateral. synovial lining?
c. Anterior. a. Capsule.
d. Posterior. b. Collateral ligaments.
11. Which component of the TMJ attaches the posterior c. Inferior compartment.
portion of the disc to the condyle? d. Superior compartment.
a. Inferior lamina. 19. Ligaments toughen which aspects of the capsule by
b. Retrodiscal pad. providing joint stability?
c. Medial attachment. a. Medial and lateral.
d. Anterior attachment b. Inferior and anterior.
12. Which is NOT a component of the bilaminar zone of c. Superior and inferior.
the posterior attachment complex of the TMJ? d. Anterior and posterior.

This document is the property of PHINMA EDUCATION

 Den 018: General Anatomy 2
Module #2 Teacher’s Guide

Name: _________________________________________________________________ Class number: _______

Section: ____________ Schedule: ________________________________________ Date: ________________

20. Which site of attachment of the capsule is located c. Anterior tympanic.

along the retrodiscal pad? d. Superficial temporal.
a. Medial. 25. Which vein receives branches from the TMJ for
b. Inferior. venous drainage?
c. Superior. a. Maxillary.
d. Posterior. b. Deep facial.
21. Which ligament of the TMJ limits the anterior c. Transverse facial.
protrusion of the mandible? d. Posterior auricular.
a. Medial collateral ligament. 26. Which vein is formed by the joining of the superficial
b. Stylomandibular ligament. temporal and maxillary veins?
c. Sphenomandibular ligament. a. Common facial.
d. Temporomandibular ligament. b. Retromandibular.
22. Which artery does NOT supply the TMJ? c. Posterior auricular.
a. Deep auricular. d. Superficial temporal.
b. Posterior auricular. 27. The posterior division of the trigeminal nerve that
c. Anterior tympanic. innervates the TMJ is the ______.
d. Superficial temporal. a. masseteric.
23. Which artery passes through the petrotympanic b. mylohyoid.
fissure to supply the TMJ? c. auriculotemporal.
a. Deep auricular. d. posterior deep temporal.
b. Middle meningeal. 28. Which nerve supplies the joint before innervating the
c. Anterior tympanic. temporalis muscle?
d. Superficial temporal. a. Masseteric.
24. Which artery DOES NOT supply branches to the b. Inferior alveolar.
TMJ? c. Auriculotemporal.
a. Deep auricular. d. Posterior deep temporal.
b. Transverse facial.

C. LESSON WRAP-UP

This time, mark (encircle) their place in the work tracker which is simply a visual to help students track how much work
they have accomplished and how much work there is left to do. This tracker will be part of the student activity sheet.

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