Joint Structure and Function 5th

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Chapter 6: The Temporomandibular Joint

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. Which of the following statements is true concerning the functions of the posterior bilaminar
retrodiscal pad during normal temporomandibular joint (TMJ) osteokinematics?
a. The elastic superior lamina allows disc translation anteriorly along the articular
eminence during mandibular depression.
b. The elastic inferior lamina serves to enhance disc motion during mandibular
depression.
c. The superior lamina is inelastic and serves to tether the disc from forward
translation.
____ 2. The articular disc of the TMJ is attached laterally to the ____________________ and anteriorly to
the ____________________.
a. fibrous capsule, mandibular condyle
b. articular eminence, mandibular condyle
c. mandibular condyle, fibrous capsule
d. fibrous capsule, articular eminence
____ 3. Which of the following is true concerning the structure of the temporomandibular joint (TMJ)?
a. The lower joint is formed by the articulation of the articular eminence of the
mandible with the superior surface of the disc.
b. The upper joint is formed by the articulation of the anterior surface of the condyle
with the posterior surface of the disc.
c. The lower joint is formed by the superior surface of the disc and the posterior
surface of the condyle.
d. The upper joint is formed by the articulation of the articular eminence of the
temporal bone and the superior surface of the disc.
____ 4. The first phase of mandibular depression occurs in the ____________________ joint and consists
of anterior ____________________ of the condylar head.
a. upper, rotation
b. lower, rotation
c. upper, translation
d. lower, translation
____ 5. Upon examination of your patient’s temporomandibular joint (TMJs), you observe the following
amount of active range of motion (AROM): opening 55 mm; (L) lateral deviation 8 mm; (R)
lateral deviation 8 mm; and protrusion 12 mm. Based on your knowledge of normal values of
AROM of the TMJ, you would conclude that there is:
a. Less than expected opening and protrusion
b. Less than expected lateral deviation bilaterally
c. Greater than expected opening and protrusion
d. Excessive motion in all directions
____ 6. During normal mandibular lateral deviation to the left, the left condylar head
____________________, and the right condylar head and disc ____________________.
a. glides posteriorly and superiorly, spins
b. glides anteriorly and inferiorly, spins
c. spins, glides posteriorly and superiorly
d. spins, glides anteriorly and inferiorly
____ 7. Contraction of which muscle will pull the articular disc anteriorly during mouth opening?
a. Medial pterygoid
b. Lateral pterygoid
c. Digastric
d. Temporalis
____ 8. Which of the following muscles is considered to be a prime mover for mandibular depression
against resistance?
a. Digastric
b. Bilateral medial pterygoid
c. Masseter
d. Temporalis
____ 9. Which of the following muscles is considered to be a prime mover for mandibular lateral deviation
to the right?
a. Right masseter
b. Right medial and lateral pterygoid
c. Left medial and lateral pterygoid
d. Left temporalis
____ 10. Retrusion of the temporomandibular joint (TMJ) is primarily limited by the:
a. Horizontal portion of the temporomandibular ligament
b. Stylomandibular ligament
c. Anterior portion of the temporomandibular joint capsule
____ 11. During normal mandibular lateral deviation to the left, the left condylar head moves in this
manner.
a. Gliding posteriorly and superiorly
b. Gliding anteriorly and inferiorly
c. Spinning posteriorly
d. Spinning anteriorly
____ 12. With which of the following pathological conditions will the patient experience joint noise at two
different intervals during mandibular depression and elevation?
a. Disc displacement
b. Capsulitis
c. Joint hypermobility
d. Capsular fibrosis
____ 13. Which of the following muscles may become shortened when the posterior suboccipital muscles
become tight as a result of a forward head posture?
a. Medial pterygoid
 b. Lateral pterygoid
c. Temporalis
d. Posterior belly of the digastic

True/False
Indicate whether the statement is true or false.

____ 1. Biting down on the left side of the mouth promotes unloading of the right temporomandibular joint
(TMJ).

Short Answer

1. Describe the attachments of the articular disc of the temporomandibular joint (TMJ).

2. Describe the articulations and functions of the upper and lower joint spaces.

3. What is the relationship of the temporomandibular joint (TMJ) with the cervical spine?

4. What is the significance of a “reciprocal click”?

Chapter 6: The Temporomandibular Joint
Answer Section

MULTIPLE CHOICE

1. ANS: A
The bilaminar retrodiscal pad is highly innervated with an ample blood supply and is often the
source of pain at the TMJ. The two bands of the retrodiscal pad each serve a different purpose. The
superior lamina is very elastic and allows the superior band to stretch with forward translation of
the disc. Its elastic properties help to reposition the disc posteriorly during mouth closing. The
inferior lamina is inelastic and serves to tether the disc, limiting anterior translation, but does not
assist with repositioning of the disc upon mouth closing.

PTS: 1
2. ANS: C
The articular disc is firmly attached to the medial and lateral poles of the condyle of the mandible
but not to the joint capsule. Anteriorly, the disc is attached to the joint capsule and to the tendon of
the lateral pterygoid muscle.

PTS: 1
3. ANS: D
The articular disc separates the TMJ into two separate spaces. The lower joint is formed by the
articulation of the anterior surface of the condyle and the inferior surface of the articular disc. This
space allows for rotation of the condyle under the disc. The upper joint is formed by the
articulation of the articular eminence and the superior surface of the articular disc. The joint space
allows for gliding of the disc and condyle along the temporal bone.

PTS: 1
4. ANS: B
Mandibular depression or mouth opening occurs in two phases: rotation and glide (translation). In
the rotation phase, there is pure anterior rotation of the condyle on the disc occurring in the lower
joint space. The second phase involves translation of the disc-condyle complex anteriorly and
inferiorly along the articular eminence. There are some newer models of motion that indicate these
two activities may occur more simultaneously, but rotation still appears to initiate the process.

PTS: 1
5. ANS: C
Normal mouth opening is 40 to 50 mm; lateral deviation is 8 mm; protrusion is 6 to 9 mm. In the
case above, this would mean that the patient is demonstrating greater than normal opening and
protrusion.

PTS: 1
6. ANS: D
 In lateral deviation of the chin to one side, one condyle spins around a vertical axis while the other
condyle translates forward. Lateral deviation to the left would involve the left condyle spinning
while the right condyle translates anteriorly and inferiorly.

PTS: 1
7. ANS: B
The articular disc is controlled both actively and passively. Active control of the disc may be
exerted through the attachments to the lateral pterygoid muscle.

PTS: 1
8. ANS: A
The primary muscle responsible for mandibular depression is the digastric muscle. Gravity has a
great effect on this motion as well.

PTS: 1
9. ANS: C
Lateral deviation is caused by unilateral action of various muscles. The prime mover appears to be
both the medial and lateral pterygoid muscles causing deviation of the mandible to the opposite
side. At times, lateral deviation can also be accomplished by the combined action of the lateral
pterygoid and temporalis muscle of the same side.

PTS: 1
10. ANS: A
Both the horizontal and oblique portion of the temporomandibular ligament are positioned to resist
posterior translation of the condyles.

PTS: 1
11. ANS: C
During lateral deviation, the condyle on the ipsilateral side will spin or rotate in a posterior
direction while the contralateral condyle glides anterior and medial.

PTS: 1
12. ANS: A
Advanced disc displacement will result in a reciprocal click during mandibular depression and
elevation.

PTS: 1
13. ANS: D
Posterior rotation of the occiput places many muscles into a shortened position. In addition to the
obvious suboccipital and larger posterior neck muscles, this position places the posterior belly of
the digastric muscle and stylohyoid muscles into shortened positions.

PTS: 1

TRUE/FALSE
 1. ANS: F
Biting down on the left side of the mouth would create motion about an anteroposterior axis. This
would cause distraction of the left joint space and compression of the right joint space.

PTS: 1

SHORT ANSWER

1. ANS:
The articular disc of the temporomandibular joint is a biconcave structure. Both its superior and
inferior surfaces are concave, giving its peanut shape. The disc is firmly attached to the medial and
lateral poles of the condyle of the mandible but not to the capsule medially or laterally. Anteriorly,
the disc is attached to the joint capsule and to the tendon of the lateral pterygoid muscle.
Posteriorly, the disc is attached to the bilaminar retrodiscal pad, which consists of two bands
separated by loose areolar connective tissue with a rich arterial and neural supply.

PTS: 1
2. ANS:
The lower joint space consists of the articulation of the anterior surface of the condyle and the
inferior surface of the articular disc. The lower joint space is where rotation of the condyle under
the articular disc takes place. The upper joint space consists of the articulation of the articular
eminence and the superior surface of the articular disc. The upper joint space serves mostly to
allow translation of the condyle/disc complex on the articular eminence.

PTS: 1
3. ANS:
Muscles that attach to the mandible also attach to the head, hyoid bone, and clavicle.
Consequently, these muscles may act on the atlanto-occipital joint and cervical spine as well as the
TMJ. Conversely, head and neck position may affect the length-tension relationship of these
muscles and indirectly affect the function of the TMJ.

PTS: 1
4. ANS:
A person with an anteriorly displaced disc will have an audible click on opening and a second
when the mouth closes. On mouth opening, the condyle slips forward and under the disc to obtain
normal relationship with the disc. When the condyle slips under the disc, an audible click is often
present. The reverse relationship occurs upon closure of the mouth. When the click occurs early in
opening and late in closing, the displacement is relatively limited. The later the click occurs in the
opening phase, the more severe the disc dislocation.

PTS: 1