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FUNCTIONAL ANATOMY OF

TEMPOROMANDIBULAR JOINT

Considered as a ginglymoarthrodial joint :


- hinging movement ~ ginglymoid joint
- gliding movement ~ arthrodial joint
It is formed by mandibular condyle fitting
into mandibular fossa and the two bones
is separated by articular disc
It is classified as a compound joint ( at
least 3 bones ) ~ functionally the articular
disc served as a nonossified bone

Diarthrodial synovial paired joint two


joint movement which occur in seperate
compartement, and one joint cannot
operate without other
Considered as a ginglymoarthrodial joint :
- hinging (menggantung) movement ~ ginglymoid joint
- gliding (meluncur) movement ~ arthrodial joint

TEMPOROMANDIBULAR JOINT
Two components :
PASIF COMPONENTS
1.Bone
- Fossa mandibularis ossis
temporalis
- Capitulum mandibula
( condyle )
- Tuberculum articulare
( articular eminence )

2.Capsule and ligaments


3.Articular disc
ACTIVE COMPONENTS
Masticator muscles
1. Masseter
2. Temporalis
3. Pterygoideus medialis
4. Pterygoideus lateralis
Additional muscles

MANDIBULAR FOSSA(fossa
glenoidalis)

- Part of the temporal bone ( concave )


- Anterior : articular eminence a convex bony
prominence
- Posterior : squamotympanic fissure (M-L)
The posterior roof is thin ~ not designed to sustain
heavy force
The articular eminence consists of thick dense bone ~
to tolerate such forces
- The steepness of the articular eminence surface ~
dictates the pathway of the condyle

MANDIBULAR CONDYLE
- It is the posterior portion of the ramus
mandibula that extends upward
- Mediolateral
: 15 20 mm
Anteroposterior : 8 10 mm
Individual variation size and angulation
between the right and left side
Morphologicchanges developmental
variations, malocclusion, trauma, and other
developmental abnormalities

CAPSULE AND LIGAMENTS


Capsula articularis ~ capsular ligament
It surrounds the entire TMJ
Superior attachmentarticular surface of the mandibular fossa
and articular eminence
Inferior attachmentcollum mandibular
Anterior capsule continous with pterigoid
Medially capsule is thin whereas lateraly is thicker and
strengthened by TM Ligament
- Function :
~ to resist any medial, lateral or inferior
forces that tend to separate or dislocate the
articular surface
~ to retain the synovial fluid

Collateral ( discal ) ligaments


2.Collateral ( discal ) ligaments
- From medial and lateral borders of the disc to the poles of
the condyle
~ the medial discal ligament
~ the lateral discal ligament
- Composed of collagenous connective tissue
- Function :
~ allow the disc move passively with the condyle
as it glides A P
These ligaments are responsible for the hinging movement
between the condyle and the articular disc

Temporomandibular ligament
- It lies at the lateral aspect of the capsula
ligament
- The major ligament, the temporomandibular
ligament, or lateral ligament, is really the
thickenest lateral portion of the capsule.
it limits anterior-posterior movement of the
condyle and disc

Anatomy of TMJ
capsule
TM ligament

Minor ligament
4.Sphenomandibular ligament
- From the spine of the sphenoid bone and
extends downward to lingula mandibula
5.Stylomandibular ligament
- From the styloid process and extends
downward and forward to the angle and
posterior border of the ramus mandibula
- It limits range movement in lateral direction

ARTICULAR DISC
- Composed of dense fibrous connective tissue
devoid of any blood vessels or nerve fibers
- Sagittal plane ~ can be divided into 3 regions
according to thickness
- anterior border
- posterior border ~ slightly thicker than
anterior border
- central area is the thinnest ~ intermediate
zone ~ in which condyle is located normally

Anterior region of the disc is attached to


the capsular ligament
- Superior : anterior margin of the articular
surface of the temporal bone
Inferior : anterior margin of the articular
surface of the condyle
- Composed of collagenous fibers
Anteriorly the disc is also attached by
tendinous fibers to the superior lateral
pterygoid muscle

RETRODISCAL TISSUE
- The articular disc is attached posteriorly to this region
- It is a loose connective tissue region that highly
vascularized and innervated
- Superior : superior retrodiscal lamina
( contains many elastic fibers ) ~ bilaminary zone
It attaches the disc posteriorly to glenoid fossa
Inferior : inferior retrodiscal lamina
( composed chiefly collagenous fibers )
It attaches distal aspect of neck of the condyle.

Articular Disc

The TMJ is divided into superior and inferior


cavity by the articular disc
1. Superior cavity
- Superior : fossa mandibula
Inferior : discus articularis
- Gliding action between condyle and
articular eminence
2. Inferior cavity
- Superior : discus articularis
Inferior : condyle
- Hinge action between undersurface of the
disc and the rotating surface of the condyle

Articular Disk

Acres of Collagen
Aneural & Avascular

ARTICULAR SURFACE

The articular surface of the mandibular fossa and


condyle are lined with dense fibrous
connective tissue ~ affords several advantages
over hyaline cartilage :
- less susceptible to the effects of aging
~ less likely to break down over time
- a better ability to repair
The internal surface of the joint cavity are
surrounded by specialized endothelial cells that
form a synovial lining ~ produces synovial fluid
So TMJ ~ a synovial joint

The synovial fluid serves two purposes :


1. Acts as a medium for providing metabolic
requirement, since the articular surfaces of the
joint are nonvascular
2. As a lubricant during function
Two mechanisms of the lubrication :
1. Boundary lubrication
Prevents friction in the moving joint
2. Weeping lubrication
Eliminates friction in the compressed but not
moving joint

Condylar Head

Bovine Condyle

Condylar Head

A - Fibrous layer
B - Reserve zone
C - Proliferative zone
D - Hypertrophic zone
E - Calcifying zone
F - Bone

MUSCLES OF MASTICATION

A. Temporalis Muscle

Origin: temporal fossa &


temporal fascia
Insertion: coronoid process &
anterior of ramus
Function: Elevation and
positioning of the mandible

B. Masseter Muscle
Origin: zygomatic arch
Insertion: lateral surface of
ramus, coronoid process &
angle of mandible
Function: power with vertical
elevation of the mandible;
deep portion stabilizes the
condyle in protrusive closure

C. Medial Pterygoid Muscle


Origin: medial surface of
lateral pterygoid plate,
pyramidal process of
palatine bone & Mx
tuberosity
Insertion: medial surface of
ramus & angle of mandible
Function: elevation of the
mandible, protrusion of the
mandible and lateral
movement of the mandible
with unilateral activation

Pterygomasseteric Sling

D. Inferior Lateral Pterygoid Muscle


Origin: lateral surface of lateral
pterygoid plate
Insertion: pterygoid fovea of
condyle
Function: protrusion, lateral
movement and contributes to
opening

E. Superior Lateral Pterygoid Muscle


Origin: infratemporal surface
greater wing of the sphenoid
bone
Insertion: pterygoid fovea of the
condyle and variable to the disc
Function: active with the muscles
of closure, especially aiding
stabilization of the condyle
during the power stroke

Nerve and blood suplay

Between the tragus and the


mandibular condyle lie the
superficial temporal artery
and veins. cont of the
external carotid artery
the veins course towards the
internal jugular vein

The auriculotemporal nerve,


locate in posterior to the blood
vessels, which it follows
cranially.
The upper branch of the facial
nerve (VII) passes superficially
to the blood vessels at the level
of the mandibular neck and runs
horizontally forwards before
breaking up into several
terminal branches