DOB 201 /2563 semester 2 /1hrs.

Objective : understanding
1. Developmental of TMJ
2.Normal physiology of TMJ
3.Function of TMJ

TEMPOROMANDIBULAR JOINT
(TMJ) Assist Prof. Piyanuch karnasuta DDS, PhD
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Classification of Joints

2
 Synovial Joints

Articular cartilage
Articular capsule
Fibrous capsule
Synovial membrane
Articular disc
6 types,
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 Temporomandibular Joint

“synovial sliding-ginglymoid joint”

Synovial joint TMJ Other synovial

working Two side One
Articular surface Fibro cartilage Hyalin cartilage
(Dense avascular fibrous
tissue) 10
 Lateral view of cross-section through the TMJ
[1] Posterior slope of the eminentia;
[2] condyle;
[3] disc;
[4] superior lateral pterygoid muscle;
[5] inferior lateral pterygoid muscle;
[6] synovial tissue;

[7] retrodiscal tissue;

[8] posterior ligamentous attachment of
disctocondyle.

https://cdeworld.com/courses/5042functional_Considerations_of_the_Masticatory_System_Duri
ng_Prosthodontic_Procedures#sthash.uGNRS9hP.dpuf 11
 1
Developmental
TEMPOROMANDIBULAR JOINT

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 Temporomandibular Joint Development
Stage 1 : Blastemic phase Stage 2: Cavitation
Temporal
blastema
Temporal
blastema Inf. Joint.cavity
Meckel’s

condylar
condylar
blastema
blastema

sup. Joint.cavity

condylar
cartilage

Stage 3 Maturation stage Stage 3: Maturation stage (12th week)

Condylar cartilage appears
Head of condyle = endochondral ossification
Mandibular fossa = intramembranous ossification

Articular disc, Articular capsule, Articular ligaments =

mesenchymes
Association of Meckel’s cartilage with mandible
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THE OTHER PART OF THE JAW= REMODELLING
 2
Normal physiology
TEMPOROMANDIBULAR JOINT

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 Condyle

• Ellipsoid structure
• Mediolaterally slightly convex.
• Medial pole : att. w Articular disc
• Lateral pole : Temporomandibular
ligament
• Sagittal
• Dimension : approx 12-20 mm long
AP = 8-12mm. thick

• The shape varies :

flattened, rounded, or convex

http://scienceblogs.com/afarensis/upload/2007/04/bon
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 Condyle and related structures

1. Condylar process
2. Mandibular notch

Condyle 3. Pterygoid fovea

4. Mandibular foramen
5. Coronoid process

Medial pole = 15-33 degree of sagittal plane

Cross @ ant to foramen magnum 16
http://zemlin.shs.uiuc.edu/skull/slide-Pages/13.htm
Histology of Condylar head

Bovine Condyle

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Histology of Condylar head

Endochondral ossification

A – Fibrous articular covering layer

B - Reserve zone

C - Proliferative zone

D - Hypertrophic zone

E - Calcifying zone

F - Bone

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 Mandibular fossa ( Glenoid fossa)

• Inferior aspect of the squamous

part of the temporal bone
Known as
temporal component of TMJ

• Anterior : Articular eminence (AE)

• Posterior : Squamatotympanic
+pertrotympanic fissure (SF)

• Upper :Middile cranial fossa

• Medial : Spine of phenoid bone

• Lateral : Articular tubercle

http://scienceblogs.com/afarensis/upload/2007/04/bonemand.jpg
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 Histology of Temporomandibular joint

Mandibular fossa, Articular tubercle & eminence, Head of condyle

ኪ outer surface ᓦ compact bone
ኪ Inner surface ᓦ spongy bone

Articular cartilage : fibrocartilage

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Histology of Mandibular fossa

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 Histology of Articular fossa lining

“INTRAMEMBRANOUS
OSSIFICATION”

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 Articular capsule : Dense fibrous tissue

Role
: sealing joint cavity
: enhance joint stability
: insert into joint cavity = disc
Upper: squamous part of temporal bone
Lower: Condylar neck
Ant: Periosteum of anterior slope of articular eminence
http://www.google.co.th/imgres?q=capsule+TMJ&um=1&hl=th&biw=1043&bih=656&tbm=isch&tbnid=-
5QgLTG4xYouiM:&imgrefurl=http://gopokes.exblog.jp/i2&docid=-
IRHUWxTZrK0NM&imgurl=http://pds.exblog.jp/pds/1/200511/02/86/a0057586_1434717.jpg&w=738&h=538&ei=40QzT-
GmMojTrQeUqqi9DA&zoom=1&iact=hc&vpx=127&vpy=339&dur=1232&hovh=138&hovw=189&tx=107&ty=55&sig=115741318454837965092&page=2&tbnh=122&tbnw
=167&start=15&ndsp=20&ved=1t:429,r:0,s:15

Post: Condylar neck

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http://www.drtenhulzen.com/procedures/tmj.html
 Histology of capsule and synovial

Functions:
❖ Seals joint space
❖ Passive stability
❖ Synovial lining
❖ Proprioceptive nerve endings

Note: synovial membrane over villi (arrow):

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 Articular disk
• Interarticular disk (meniscus)
• Fibrous connective tissue
• Biconcave shape with a thick anterior band,
thicker posterior band
• Located between the condylar head
• Divided superior and inferior joint cavity

• Upper compartment betw. articular surf of temporal bone/ disc

: sliding and gliding movement
• Lower compartment betw articular surf of condyle / disc
: rotary and hinge movement

Laterally and medially, the disk attaches to the

condylar poles (not attach to capsule), helping to
ensure passive movement of the disk . The rest
is attached to the capsule

http://scienceblogs.com/afarensis/upload/2007/04/bonemand.jpg
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 Articular disk
Medio-lateral view Lateral view

articular disc (AD)

capsular ligament (CL)
inferior joint cavity (IC)
lateral discal ligament (LDL)
medial discal ligament (MDL)
superior joint cavity (SC)

Ant : directly attach w capsule

Post : attach to capsule through retro discal tissue
Medial and lateral : not attach to capsule
http://www1.umn.edu/dental/courses/dent_5725/tmj.html

http://scienceblogs.com/afarensis/upload/2007/04/bonemand.jpg
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 Histology of Articular disk
Fibrous layer: collagen type I, avascular (self-
contained and replicating)

Proliferating zone (4)that formes condylar

cartilage
Condylar cartilage (5) is fibrocartilage that
does not play role in articulation nor has formal
function

Disk: separates the cavity into two compartments

Posteriorly attach w capsule by retrodiscal pad or

bilaminar zone

divides into two lamellae one towards the capsule, 1. Articular disc
2. Synovial cavity
the other towards the condyle
3. Fibrous zone
4. Prolierative zone& Fibrocartilage
vascular in the preiphery, avascular in the center 5. Cartilage

http://www1.umn.edu/dental/courses/dent_5725/tmj.html

http://scienceblogs.com/afarensis/upload/2007/04/bonemand.jpg
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Histology of Articular disk

“Acres of Collagen”
Aneural & Avascular

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Histology of Posterior ligament

Retrodiscal tissue
: Bilaminar zone
upp: fibrous and elasitc
Lower: Collagen fiber

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 Synovial membrane

:Loose CNT lined inner surface of capsule ….

Produce synovial fluid (plasma with mucin and proteins cells)

: lines capsule (does not cover disk and articular surface.

(except posterior region)
; folds or Villi protrude in the joint cavity
(increase in pathologic conditions or older)

Two layers:
a cellular intima (synovial cells in fiber-free matrix)
a vascular subintima

Synovial cells:
Type A (macrophage-like) : low rER / phagocytosis
Type B (fibroblast-like) : high rER / synthesized hyaluronan in the fluid 30
 Histology of synovial membrane

Synovial membrane : loose CT

Cellular intima : synovial cells in amorphous

intercellular matrix
⭶Type A cell (macrophage like cells)
⭶Rich in lysozyme, mitochondria, golgi complex
⭶rER
⭶Phagocytosis

⭶Type B cell (fibroblast like cells)

⭶rER
⭶hyaluronan synthesis
⭶Synovial fluid

Vascular subintima
⭶ loose CNT, blood vessels,
⭶ fibroblasts, macrophage, mast cells,
⭶ fat cells, elastic fibers
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 Function of synovial membrane

Synovial Fluid:
❖ Liquid environment
❖ Lubrication
❖Nutrition of disc and
articular surface
(controversy)
❖Nutrition for avascular
tissue covering articular
surface of disc

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Ligament : Articular and Accessories

Medial 33
 Ligament : Articular and Accessories
nonelastic collagenous structures

1. Articular ligament

Temporomandibular ligaments (2 layers)

lateral ligament

: prevent lateral dislocation

Medial ligament

: prevent excessive retrusive

movement and posterior displacement

Conclusion : limit TMJ movement

• Medial dislocation
• Inferior displacement
• Horizontal or posterior displacement
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 Ligament : Articular and Accessories

2. Accessory ligaments
Sphenomandibular ligament :( lingular -sphenoid bone)
prevent medial leakage of Local Anaesthesia

Stylomandibular ligament : ( styloid process – angle of mandible)

limit excessive protrusive movement
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 Blood supply

Posterior to capsule

posterior deep
temporal artery

masseteric artery

lateral pterygoid artery

Anterior to capsule
branch of superficial temporal artery
deep auricular artery
anterior tympanic artery
ascending pharyngeal artery 36
Nerve supply

Auriculotemporal nerve
posterior, medial, lateral joint

Masseteric & Deep temporal

nerve
anterior part of joint

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Nerve supply : nerve ending ( Innervation)
4 Types of nerve endings:
1. Ruffini’s corpuscles (limited to capsule)
2. Pacini’s corpuscles (limited to capsule)
3. Golgi tendon organs (confined to ligament)
4. Free nerve endings (most abundant)

Pacinian Corpuscle
Onion-like encapusulated pressure receptors
Dynamic mechanoception and movement
accelerator

Ruffini’s = Posture (proprioception), dynamic

and static balance
Golgi tendon organ = Static
mechanoreception, protection (ligament)
Free nerve endings = Pain (nociception)
protection (joint)
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 Muscle of mastigation
Four main muscles

powerful closers of the joint and account for

the strenth of the bite and chewing.

masseter, temporalis and medial pterygoid

Side to side and also protrude the mandible.

The medial and lateral pterygoids

Muscle Origin Insertion Action abbv

Elevates mandible, retraction (deep

Masseter zygomatic arch Mandible ERP
portion ) ,protusion ( Sup portion)

Temporal and Elevates mandible (ant. Fiber),

Temporalis Mandible ER
frontal bones Retraction

Sphenoid
Medial Elevates mandible, protusion, moves
(medial pterygoid Mandible EPL
pterygoid mandible side to side
plate)

Sphenoid Depress mandible(upper head)

Lateral
(Lateral Mandible Opens jaws, protrudes mandible; DPLO
pterygoid
pterygoid plate) moves mandible side to side
Others : post cervical group muscle, infrahyoid group, mylohyoid muscle, anterior belly digastric 39
 3
Function of
TEMPOROMANDIBULAR JOINT

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BIOMECHANICS

Complex combinations of
muscle activity
Disk enables complex
movements

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Movement of temporomandibular joint

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 Mandibular movements

1. Opening movement
2. Closing movement Symmetrical
movement
3. Protrusion (Forward movement) Of TMJ

4. Retrusion (Backward movement)

Asymmetrical
5. Lateral movement movement
Of TMJ

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OPENING AND CLOSING
MOVEMENT
Lateral pterygoid
Geniohyoid, mylohyoid
Stylohyoid, infrahyoid

Elevation Depression
Anterior fiber of temporalis
Massester
Medial pterygoid
Upper head of lateral pterygoid
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Forward and Backward movement

Protusion Retrusion
Lateral pterygoid
Temporalis
Medial pterygoid
Massester (deep portion)
Massester ( superficial portion)
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LATERAL MOVEMENT

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 MOVIE TIME
http://www.youtube.com/watch?v=nH8KG3fIoBM&NR=1&feature=e
ndscreen (2.44 MIN)

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