EMBRYOGENESIS &

DEVELOPMENT
OF THE
TEMPOROMANDIBULAR
JOINT

Dr. Fatema Haji

MDS – I
Department Of Prosthodontics & Implantology

6th Jan 2023

Content
• Classification of Joints

• The Temporomandibular Joint

• Development of TMJ

a. Pre-natal

b. Post-natal

• Disorders of TMJ
 WHAT IS A JOINT?

A joint is defined as a connection between two

bones in the skeletal system.

Joints can be classified by the type of the tissue

present (fibrous, cartilaginous or synovial), or by
the degree of movement permitted (synarthrosis,
amphiarthrosis or diarthrosis).
A gomphosis is a fibrous mobile peg-and-socket joint. The roots of
the teeth (the pegs) fit into their sockets in the mandible and maxilla
and are the only examples of this type of joint. Bundles of collagen
fibres pass from the wall of the socket to the root; they are part of
the circumdental, or periodontal membrane.
TEMPOROMANDIBULAR
JOINT
Giglymoarthroidal
Joint Synovial Joint

Giglymoid Arthroidal Boundary Weeping

(hinge) (Gliding) Lubrication Lubrication

The joint connects the mandibular condyle to the articular fossa of the
temporal bone with the temporomandibular joint articular disc interposed.
A
N
A
T
O
M
Y
 LIGAMENTS
• Collagenous connective
tissues fibers
• Do not enter actively into
joint function, but instead act
as passive restraining devices
to limit and restrict border
movements.
• Three functional ligaments
support the TMJ: (1) the
collateral ligaments, (2) the
capsular ligament, and (3) the
temporomandibular ligament.

There are also two accessory

ligaments: (4) the
sphenomandibular and (5) the
stylomandibular
 - Mérida‐Velasco - 1999

BLASTEMIC CAVITATION MATURATION

STAGE STAGE STAGE
(7w-8w) (9w-11w) (12w Onwards)

DEVELOPMENT PRE - NATAL

OF
TMJ POST - NATAL

AT
AT CONDYLE ARTICULAR
FOSSA
Week 7 (Blastematic
Stage)
• Condyle develops independent of
zygomatic process
• Mesenchymal condensation
begins
 Week 8 (Blastematic Stage)
• Intramembranous ossification of the ramus of
the mandible reached the base of the future
condyle
• Intramembranous ossification of zygomatic
process begins.
• A mesenchymal condensation occurs
craniolaterally that will form the articular disc.
 Week 9 (Cavitation Stage)
1. Small spaces or clefts appear between the articular disc and the mandibular condyle
that define the initial formation of the inferior joint cavity
2. At this week condylar chondrification begins at the centre of the condylar blastema.
 Week 10
• Completion of organization of the
inferior joint cavity,
Intramembranous ossification begins.
• The condylar cartilage has a conical
shape/ carrot and is surrounded by
intramembranous ossification.
• The base of the condylar cartilage
corresponded to the joint region and
its vertex was placed next to the
future mandibular foramen
Week 11
1. Small spaces or clefts appear between the articular disc and the mandibular condyle that
define the initial formation of the inferior joint cavity
2. At this week condylar chondrification begins at the centre of the condylar blastema.
3. Organisation of superior joint cavity begins
 • Period the organization of the temporomandibular joint
Week 12 system.
• The joint capsule (1) gets attached to the articular disc (D)
 1. The joint surface of the zygomatic process of temporal bone
(E) now has a concave morphology.
Week 13 2. The articular disc gets inserted into the external condylar
surface.
 Week 15
onwards
1. The condylar cartilage
is gradually replaced by
bone and its posterior
part persists in the
condyle as a site of
active growth.
2. During week 17 there is
a clear endochondral
ossification of the
anterior portion of the
condyle.
The primary jaw joint exists for about 3- 4 months until the cartilages start to ossify.
At 4 months IU, condyle fuses with ramus.

7-12 weeks 12-15 weeks 15th week onwards

 At Condyle

POST NATAL

At Articular Fossa
 CONDYLE
AT BIRTH: Condyle is covered by a thick cartilage

6 MONTHS: reduced thickness of cartilage and vascularity

7 YEARS: cartilage is a very thin layer.

LATE TEENAGE: Formation of sub articular plate & separate cartilage from cancellous bone

MATURE STATE: only surface articular layer.

 SCHOOLS OF THOUGHT
Condyle is primary growth centre
which controls growth of mandible.
Condyle determines mandibular growth As bone deposition occurs at condyle,
mandible moves forward and
downward.

Mandible is displaced into its functional

position due to growth of soft tissues.
Rest of mandible determines condylar
Bone growth occurs at condyle
growth
secondarily to maintain contact with the
cranial base.
 ENLOWS
V
PRINCIPLE
 0Y
Fossa is flat

ARTICULAR
3Y
Deepening of fossa with FOSSA
functional movements

7Yarticular
S- shaped
eminence
 DISORDERS OF THE TMJ
III. Chronic
I. Masticatory
mandibular
muscle disorders
hypomobility

A. Local muscle
A. Ankylosis
soreness
B. Muscle contracture
B. Myofascial pain
C. Coronoid
C. Myospasm
II. impedance
Temporomandibular IV. Congenital
joint (TMJ) Defects
disorders
A. Derangement of • Condylar hypoplasia
the condyle-disc / Aplasia
complex • Condylar
B. Inflammatory hyperplasia
disorders of the TMJ • Bifid condyle
C. Tumors
CONDYLAR HYPOPLASIA
• Indicates underdevelopment or nondevelopment
• Unilateral or bilateral
• The facial deformity may not become evident until many months
after the injury
Causes
• Prenatal growth disturbances
CLINICAL
Hereditary:
Chromosomal anomalies, Achondroplasia,
FEATURES
Unilateral Bilateral
Mandibulofacial Dysostosis, Progeria, Larsen’s
syndrome and Goldenhar syndrome can lead to
Hypoplasia of condyle. Body of the
mandible is
Non-hereditary: short on the Micrognathia
Pierre Robin syndrome, Radiation to fetus, Mobius affected side.
syndrome are also causative factors.
Mandible shifts
• Postnatal growth disturbances towards the Delayed
Endocrine: affected side eruption
Hypothyroidism and Hypopituitarism causes decrease upon opening
in secretion of growth hormone resulting in hypoplasia
of condyle Lack of growth
Cross Bite of mandible
Other causes:
• Trauma
Delayed
• Vit A Deficiency eruption/
Class II
• Infections like Rheumatoid Impacted or
uninterrupted Malocclusion
Arthritis teeth.
• Irradiation
Treatment: Surgery for bone augmentation / External ear
Orthodontics for correction of malocclusion. deformity
A. TREACHER COLLINS SYNDROME

• Mandibulofacial dyostosis / ‘Franceschetti • Fish/Bird Appearance, Slanting

syndrome Palpebral fissures
• Failure or incomplete migration of neural crest • Micrognathia(mandibular hypoplasia),
cells to the facial region Macrostomia, High palate, Open bite
• Bilaterally Symmetrical abnormalities • Mandible appears to bend inferiorly
B. HEMIFACIAL MICROSOMIA
• Half of the face is underdeveloped and does not grow
normally
• Areas of the face that may be underdeveloped in HFM
include:
eye
external and middle ear
side of the skull
cheek tissue
upper and lower jaws
teeth
some of the nerves that allow facial movement
•Ear abnormalities: Small nodules of excess skin around the
ear, underdeveloped or absent external ear, underdeveloped
or absent inner ear structures, and hearing loss
•Jaw abnormalities: A small or underdeveloped jaw, upward
slanted mouth/jaw, appearance of a “crooked smile,” and
inability to chew
•Facial findings: Flat cheek and/or forehead, overall facial
asymmetry (unevenness), weakness of muscles, and loss of
sensation
C. OCULOAURICULOVERTEBRAL SYNDROME
• Unilateral microstomia,
mental retardation,
hypoplastic zygomatic
arch.
• Facial features—there
is downward slanting
of palpebral fissures,
malformed pinna and
iris coloboma.
• Oral features—there is
high arched palate,
palatal and uvular
cleft with
malocclusion
• Often considered a
variant of hemifacial
microsomia but can
include skeletal,
genitourinary, renal
and cardiac
abnormalities
C. OCULOAURICULOVERTEBRAL SYNDROME
 CONDYLAR HYPERPLASIA
Causes Clinical Features Clinical Features
(Unilateral) (Bilateral)
Hereditary – Kleinfelters
Syndrome Mandibular enlargement Mandibular enlargement
on affected side on both sides
Neoplastic
Increased Mandibular
Bone Diseases: Fibrous Facial Asymmetry
Arc
Dysplasia, Paget’s
Disease Malocclusion (Cross
bite, Open Bite, Malocclusion (Anterior
Trauma during birth
asymmetric protrusion Crossbite)
on affected side)
Endocrine – Gigantism

Hypertrophic Arthritis Shift in Midline Relative Microdontia

Management: Surgical (Condylectomy, Maxillary Osteotomy), Orthodontic t/t.

CONDYLAR HYPERPLASIA
CONDYLAR AGENESIS
Seen in hemifacial macrostomia, Goldenhar syndrome and Hallermann-
Streiff syndrome
BIFID MANDIBULAR CONDYLE
Subluxation (Hypermobility)
Condyle moves anterior to the crest of the articular eminence.

Aetiology:
• Patients have a steep posterior slope followed by a long flat
anterior slope.
Condyle jumps forward upon maximal mouth opening.
Symptoms:
• Lock jaw on opening mouth too wide, but can get jaw back
to original position with little difficulty.
Treatment:
• Supportive Therapy:
- Patient Education
- Restriction of mouth opening
- Intraoral device to achieve Myostatic Contracture
(functional shortening of elevator muscles). Worn for 2
months.
• Definitive Therapy: Surgery (Eminectomy- reduces
steepness of articular eminence.)
Luxation (Open Lock)
Both the condyle and the disc are totally displaced in front of the eminence and the
patient cannot voluntary return them to their normal positions.
Aetiology:
• Extreme muscle contraction (Pterygoids and Infrahyoid
muscles)
• Anatomical discrepancies of TMJ
• Disc can be displaced anteriorly or posteriorly, condyle
gets stuck in front of the articular eminence.
Symptoms:
• Patient presents with a wide open mouth, and the
inability to close it.
Treatment:
• Patient education/ self reduction
• Reduction of TMJ manually by clinician
• LA in Inf. Lateral Pterygoid muscle.
• Botulinum Toxin in muscle (shows effects for 3-4months)
Thank you.
REFERENCES
• Gauri Shankar, Textbook of Orthodontics.
• Shafer’s textbook of Oral Pathology
• Okeson’s Management of TMD’s and Occlusion
• Textbook of Oral Medicine - Ghom
• Development of the Human Temporomandibular Joint- J.R. MERIDA-
VELASCO ET al.
• Congenital deformities and developmental abnormalities of the
mandibular condyle in the temporomandibular joint- Keiseki Kaneyama,
Natsuki Segami, and Toshihisa Hatta.
• Congenital Abnormalities of the Temporomandibular Joint, Christopher J.
Galea et al.
• Bifid mandibular condyle: CT and MRI appearance- Onur Tutar, Ahmet Bas,
Gökçe Gülsen, Elmar Bayraktarov.
• Goldenhar syndrome: A case report and review- Sonika Achalli, Subhas G.
Babu, Murali Patla, Medhini Madi, Shishir Ram Shetty.