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CONTENTS

1. Introduction
2. Evolution of TMJ
3. Development of TMJ
4. Anatomy of parts of TMJ
a) Bony structures
i. Condyle
ii. Glenoid fossa
iii. Articular eminence
b) Soft tisse
i. Articular disc
ii. Articular capsule
iii. Ligaments
5. Muscles of TMJ
6. Lever action of TMJ A review of literature
7. TMJ movements
-

Free movement

Masticatory movement

Reflex control movements

Bennets movement

8. Age changes
TEMPOROMANDIBULAR JOINT
Anatomy & Physiology
Introduction
The temporomandibular joint
joint is a form of articulation found
modern evolutionary feature being
vertibrates had various types of

which is also called as cranimandibular


only in mammals, and is a comparatively
just 70 x 10 6 years old. Prior to this
jaw anticulations. This joint connects

mandible to the skull or formed by articulation of the mandibular condyle to


the base of the cranium.
Temporomandibular joint takes various names by nature of the joint.
a) Diaorthorodial joint : So called because of its capacity for free
movements.
b) Ginglymodiathrodial joint : As both hinge and gliding movements are
possible.
c) Compound joint : A compound joint by definition requires 3 or more
bones. Though TMJ is made of only 2 bones, it is still considered as
compound joint, as disc acts as a third bone.
d) Synovial joint : As the non articulating surface within the joint capsule
are lined by a synovial membrane.
e) Modified ball and socket joint: As it allows movement in all three
planes. E.g. Sagittal, transverse and coronal.
The physiologic activities of the TMJ may be voluntary or reflex and
ranges from mastication degulitation and phonation to gasping and
yawning.
Evolution of TMJ:
TMJ is about 70 million years old. Millions of years ago the vertebrates
had various types of jaw articulation.
1. Agnatha: The earliest type of vertebrae had its mouth opening on the
vertical side anterior by along the vertebral axis. This opening led
through an oropharyngeal channel to the gut proper.
2. Gnathostomes : more highly evolved than the agnatha.
3. Osteichthyes : It is a more highly developed movable joint.
4. In amphibians, the dentary bone was seen at the anterior end of the
original cartilaginous jaw.
5. In mammals, the dentary bone increased in size. As the function of this
dentary bone increased the coronoid process and temporal fossa was
formed.
The function and morphology of the TMJ differs from species to
species, especially according to eating habits. This can be considered in
four groups:
a) Carenivorus: eg. Grizzly Bear.

TMJ is characterized mainly by hinge movement,


cylindrical. Long axis of condyles oriented mesiodistally.

condyles

are

b) Herbivores: e.g Gaint Panda.


Jaws mainly move laterally. Long axis of the condyle oriented
anteriomedially.
c) Rodents: e.g Rabbit
Type of chewing movement in rodents is described as a cutting function
by continuous erupting central incisor and strong grinding force by molars.
Long axis of the condyle anterioposteriorly.
d) Omnivores eg.: Pigs and humans
Adopted to chew every type of food involving cutting, splitting and
grinding. The long axis of the condyle runs slightly posterior the horizontal
section and lines extended from both sides meet posterior mandible.
Embryology of TMJ:
The mammalian craniomandibular articulation develops anteriolateral
to otic capsule from the first branchial arch mesenchyme and hence
innervated by fifth cranial nerve. This is early embryonic joint.
This primary embryonic joint formed by joining malleus and incus
which develops from first branchial arch. This joint serves as the primary
TMJ upto 16 week of prenatal life. This is a uniaxial hinge joint capable of
no lateral motion.
By end of 7-11 week of gestation the secondary TMJ begins to develop.
At about 9 t h week a condensation of mesenchyme appears surrounding
the upper posterior surface of rudimentary ramus. This mass condrifies at
about 10-11 week to form cartilaginous mandibular condyle with progressive
endochondral ossification. The cartilage fuses with the posterior part of bony
mandibular body. At about 9-10 weeks the muscle fibers become more
differentiated. Blood vessels, nerve etc can be seen to the joint region at
about 10 week of gestation.
The appearance of mandibular fossa of the temporal bone is seen
earlier than that of condyle at about 7-8 weeks.
Ossification of fossa is more prominent at about 10-11 weeks.
Ossification continues in this region and at about 22 weeks the mandibular
fossa shows both medial and lateral walls and the articular eminence is also
evident.
The shape of the fossa is concave at about 9 t h week and it takes a
definite concave shape to match convex condyle.

The differentiating mesenchymal cells interposed between the condyle


and mandibular fossa gives raise to capsular and inter capsular structures of
TMJ.
Articular disc
Articular disc first seen at about 7 t h week, by the 10 t h week first sign of
collagenous fibers within the articular disc developes and it becomes more
prominent by 12 weeks. From 19 t h 20 t h week the disc increasingly takes on
its definite fibro cartilaginous composition. At this stage only disc shows
pattern of differential cell proliferation in which central region becomes
thinner than periphery.
Articular capsule:
Articular capsule first appears at about 9-11 weeks. By 17 t h week the
capsule is seen with fully formed tissue boundary between intracapsular and
extracapsular components of the TMJ. By then lower cavity of the fossa
enlarges and the superior joint cavity are receprocal at the time, the upper
joint cavity is concave and lower joint cavity is convex.
Work done by Hooker (1954) and Humphery (1968) shows that actual
month opening actions are observable as early as 7-8 weeks of gestation.
Others like Symons (1952), Perry (1985), Moffet (1957) said that only
scattered muscle fibers of lateral pterygoid muscle are clearly at 7-8 weeks.
Therefore prenatal jaw opening activity that both Hooker and
Humphery observed is said to have involved the articulation of the primary
TMJ.
Anatomy of temporomandibular joint
TMJ is broadly divided into bony structures of TMJ and soft tissue
structures of TMJ.
Bony structures of TMJ:
a) The condylar head of the mandible
The articular surface of the mandible is the upper and anterior surface
of the condyle which is found in the posterior of the mandible as 2 processes
that project upward on the ramus of the mandible. This articular surface is
shaped like a Rugby ball. When viewed from side the articular surface is
strongly convex and less so when viewed from the front.
The medial and lateral poles are connected by long axis of the head
which makes an angle of 140 with the line joining the external algnostic
meatus of both sides in the horizontal plane. Both poles project beyond the
surface of ramus and are roughened to receive the attachment of the articular
disc. On the anterior surface of the week of the condyle is the shallow
depression called the pterygoid fossa, the area of insertion of the lateral
pterygoid muscle. Superior surface of the condyle is covered by fibro

cartilage, below which is a thin layer of cortical bone which is supported by a


small trabeculae. However this cartilage does not form a part of articular
surface because it is covered with periosteum derived fibro articular tissue
unlike others which is covered by hyaline cartilage. The articulating surfaces
are non vascularized and non innervated as a adaptation for load bearing. The
adult condyle is about 15-20mm meditalirally and 8-10 mm anterior
posteriorly.
The Glenoid fossae:
The glenoid fossa of the TMJ is a shallow, oval depression to the
infratemporal area. It is located between base of the zygomatic process
anteriorly and external arostic meatus posteriorly. Anterior to the fossa the
articular/eminence arises gently and posteriorly, the thin bone of the
tympanic area forms the posterior wall of the fossa. The fossa is lined by
articular tissue the posterior part of the fossa is elevated to a ridge called the
posterior auricular lip. This is higher and thicker at its lateral end and is
known as post glenoid process. Medially the articular fossa is bound by a
bony plate that leans against the spine of sphenoid called as temporal spine.
Articular eminence:
It is important to understand the difference between articular eminence
and articular tubercle. The articular eminence is the transverse bar of dense
bone that forms the posterior root of the zygomatic arch and the anterior wall
of the articular fossa. It has a large articular surface. The articular tubercule
is the small bony projection situated laterally to the articular eminence. It is
not a articular surface, instead it serves as the attachment area for the portion
of the TMJ. The articular eminence is a saddle shaped elevation at the base of
the zygomatic process of the temporal bone.
Soft tissue structures of TMJ
Articular disc
The articular disc is a firm, oval, fibrous plate positioned between the
mandibular condyle and articular fossa and eminence. It divides the joint
space into upper and lower compartment. It also adapts to the changing
contour of the rotating condylar head as it glides to the different parts of the
temporal bone, this is possible as the disc is not uniformly thick and the
periosteal covering of the temporal bone is padded. The underside of the disc
is concave and fits closely over the condylar head like a cap. This enables the
rotatory movement of the condyle.
In frontal section the disc is wedge shaped thicker medially and thinner
laterally. It is suggested that lateral half of the glenoid fossa is subjected to
pressure, since blood vessels are seldom present in the later half of the disc
and bony structure of the fossa is thicker laterally than medially.
In sagittal section the disc is divided into three regions, thinnest called
as intermediate zone. In normal position the condyle is located in the

intermediate zone of the disc, bordered by thicker anterior and posterior


region.
From anterior to posterior region, the disc shows 5 zones. Anterior
extension, anterior band, posterior extension, posterior band and the
intermediate zone in between. Blood vessels are found in the anterior and
posterior parts of disc and seldom in intermediate zone, since it is the stress
bearing area, structural tissue adaptation so as to avoid necrosis. In case of
extra eye stress, it is the site for perforation, displacement or thickening.
Articular capsule or joint capsule:
The capsule is a thin, fibrous connective tissue, sleeve about the joint,
tappers above down the neck of the condyle. Its attachment extends from
around the glenoid fossa to around the week of the condyle. Inner surface of
the capsule is lined by synovial membrane which has a cilia like folds and
secrets synovial fluid. Synovial fluid is dialystate of plasma with added
mucin and plasma. It acts as a lubricant and as well as nutriative purpose.
Since the cells it contains are macrophage in type, this fluid also exhibits
phagocytic activity. The thickened anterolateral and lateral portion of the
capsule which is attached to the articular tubercule is called as
temporomandibular ligament.
3. Ligaments:
The ligaments of the temporomandibular joint are broadly divided into
intrinsic ligament and extrinsic ligament.
The articular capsule is too delicate of a structure to support the joint
unaided and so stability is actived by intrinsic and extrinsic ligament.
Ligaments limit the movement of TMJ.
INTRINSIC LIGAMENT:
a) Lateral ligament or TM ligaments:
This ligament arises from the zygomatic process and articular eminence
of the temporal one, runs downwards and posteriorly and consist into area
just below the lateral pole of the condylar head and into posterior aspect of
neck of condyle. Anatomically, its hard to distinguish this ligament from joint
capsule excepting histologically, as there are bloodvessels present between
these structures. This ligament is strong and supports the joint preventing
lateral displacement of the condyle and restricting its anterior and posterior
movement.
b) Collateral ligament:
It is rather a narrow band of collagen fibers that run horizontally
backward or the inner aspect of the capsule from lateral and medial aspect of
articular eminence, to respective condylar poles. They restricts the
displacement of condylar head distally. These collateral ligament along with

the temperomandibular ligaments helps to attain the clinical ligamentation


position.
EXTRINSIC LIGAMENT:
Though these also aid to restricting jaw movement, less significant
functionally due to their distance from the joint and lack of strength.
b) Spenomandibular ligament: Superiorly arise from the new of the
sphenoid bone and attached to the lingula of the mandibular foramen
inferiorly. It is the remnant of the cephalic end of Meckels cartilage.
c) Stylomandibular ligament: Arises from the styloid process of temporal
bone and stylohyoid ligament and inserts into mandibular angle and
lower part of the posterior border of the ramus.
Muscles of TMJ:
The muscles inovled in the functioning and stablising of TMJ are
1) The masticatory muscles.
2) Supra hyoid muscles.
1. The masticatory muscles:
These muscles move the mandible during mastication, speech, and
other functional and para functional activities of the mandible. They are
derived from one muscle mass and are arranged in that order from the
superficial to the deep plane. They develop from mesoderm of the first
branchial arch and are supplied by the nerve of that arch. Jaw closing is
controlled by the temporalis, masseter and medial pterygoid. The lateral
pterygoid however aids in opening of the jaws, assisted by suprahyoid and
infra hyoid muscles.
a) Masseter:
Origin : This muscles has got two parts. The superficial and deep part.
Superficial layer arises from the anterior 2/3 of the zygomatic arch and adjoining zygomatic
process of maxilla. Deep layer arises from the deep layer of the zygomatic arch.
Insertion: Superficial layer into the lower part of the lateral surface of the
ramus of mandible and the deep part into the upper part of ramus and
coronoid process.
Action : equation of the mandible.
Blood supply : a) Massetric branch of the maxillary artery. Facial artery of the
carotid and its direct branch.
Nerve supply : Massetric nerve.

Temporalis:
Temporalis is the strongest of the masticatory muscle. It is fan shaped.
Origin: Arises from the bony floor of the temporalis fossa and from the deep
surface of the temporal fossa.
Insertion: Muscle fibers converge to tendon, which passes deep to the
zygomatic arch and is inserted into the coronoid process of mandible and the
anterior border of ramus of the mandible.
Action: Anterior and superior fibers elevate, the mandible and the posterior
fibers retract the mandible.
Blood supply : Auriculotemporal branch maxillary artry.
Nerve supply : Deep temporal nerve branch of mandibular nerve.
c) Medial pterygoid
Origin : superficial head arises from the tuborosity of the maxilla. Deep head
arises from the medial surface of the lateral pterygoid plate.
Insertion : into the medial surface of the angle of the mandible.
Action : Assists in elevating the mandible.
Blood supply : Medial pterygoid branch of maxillary artery.
Nerve supply : medial pterygoid branch of trigeminal nerve.
d) Lateral pterygoid:
Origin: Upper head arises from the infratemporal surface of the greater wing
of the sphenoid. Lower head arises from the lateral surface of the lateral
pterygoid plate.
Insertion: Two heads converge as they pass backward and are inserted into
the front of the neck of the mandible and the articular disc.
Action: Muscle functions by pulling the condyle anteriorly while opening the
mouth slightly. Same time the articular disc advances simultaneously along
with the condyle. The mandible moves laterally when this muscle contract
bilaterally.
Blood supply : pterygoid branch of maxillary artery.
Nerve supply : lateral pterygoid branch of trigeminal nerve.
Suprahyoid muscle:
These muscles are located in the floor of the mouth and act to pull the
mouth downward for opening and raise the mouth for swallowing.

They are the digastric, stylohyoid, mylohyoid, geniohyoid.


Lever action of the temporomandibular joint Review of literature
Hylander W.L. in 1975 concluded the mandible acts as a Class III lever,
where the condyle acting as the fulcrum. It is said that the condyle might be a
stress bearing fulcrum and the muscle force is always divided between the
bite force along the tooth row and the reaction force of the condyle.
Hylander W.L. in 1975 carried out experiments in macae monkey in
which strain gauges were placed within the bone of the condyle below the
joint surface and recorded stains of differencing degrees. The strains were
greater on the contialateral side than the epsilateral side.
Taylor in 1980 showed shall no evidence was found of stress in glenoid
fossa and it is believed that the articular disc has no protective function. It is
however admitted that certain action do occur in the TMJ but these changes
do not reflect the lever action.
Therefore it is contended that continued representation of the mandible
as a Class III lever was an error as said by Taylor R.M. in 1980.
TMJ movement:
TMJ movements or the mandibular movements can be classified as
1) Free movement
2) Masticatory movements
3) Reflex control of TMJ movements:
Coming back to the TMJ movements
1) Free movements
a) Depression of mandible
When the mouth is opened, the condyle rotate on the undersurface of
the articular disc around the horizontal axis. In order to prevent the angle of
the mandible from impinging on the parotid gland and sternocleido mastroid
muscle, the mandible is pulled forward. This accomplished by the contraction
of the lateral pterygoid muscle. This pulls the neck of the mandible and the
disc forward and hence the disc moves onto the tubercle.
Depression of mandible is brought about by contraction of digastric,
geniotyoid and mylohyoid. The lateral pterygoid play a major role.
b) Elevation of mandible

This movement is reverse of that depression. First the head of the


mandible and the disc move backward and then the head rotation on the lower
surface of the disc. Elevation is brought about by contraction of temporalis,
masseter, and medial pterygoid. Head is pulled back by posterior fibers of
temporalis. Disc is pulled back by bilaminar elastic fibers.
Protrusion of mandible:
The articular disc is pulled forward onto the anterior tubercle, carrying
the head of the mandible with it. Which the elevators and depressors stabise
the position of the mandible in relation to maxilla. In this movement the
lower are drawn forward over upper teeth. Protrusion is brought about by
contraction of lateral pterygoid of both sides assisted by medial pterygoid.
Retraction of mandible:
The articular disc and head of the mandible are pulled backward into
the mandibular fossa.
Retraction is brought about the posterior fibers of the temporalis
assisted by deep fibers of messeter and geniohyoid, diagastric play a minor
role. Retraction is limited to a distance of 1mm.
Lateral movements:
For this movement to take place, one condyle along with the disc glides
forward rotating along vertical axis, while other glides backward rotating in
opposite direction. This movement take place alternatively. For this to occurs
the muscle of opposite side act alternately and not in unision. Lateral
pterygoid and medial pterygoid are the muscles responsible.
Bennet movement: found by Bennet in 1908.
It is defined as the bodily lateral movement of the mandible (or) the
lateral shift of the mandible resulting from the movements of the condyle
along the lateral thickness of the mandibular fossa in lateral jaw movements.
Bunnet angle:
Angle formed by the sagittal plane and the path of the advancing
condyle during lateral mandibular movements as viewed in horizontal plane.
Importance:
1)

Its direction and timing influences the freedom of movement to and


from the centric and eccentric jaw position.

2)

Balanced occlusion will be difficult to achieve if the direction and


timing of the Bennet movement is not accurately recorded and
transferred to the articulator capable of reproducing those movements.

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3)

When the mandible moves to one side or the other, either in opening
or closing, the condyle on the side to which the mandible is moving
rotates minimally and moves forward, downward and laterally.

Bennet movement consists of the immediate translation which takes


place before the rotation and progressive translation which accompanies
rotations.
Masticatory movements:
Masticatory movements of the TMJ differs from the free movements
due to the fact that these occur will the food in oral cavity and associated
with incision and chewing of food. They are of two kinds.
a) Incision (or) cutting movements
b) Mastication (or) brushing and grindig movements
a) Incision
Incision is divisible into 3 parts starting from rest position.
First the mouth is opened by depressing the mandible, extend of
opening depends on the dimension of food.
2 n d the mandible is elevated to an upward and forward movement of the
mandibular incisors and upward and backward movement of the condyle
during jaw closure and continuing till the upper and lower incision contact
the food.
3 r d teeth continues to move upward with the simultaneous application
of force on the food, and teeth in contact.
These three phases are refered to as opening, closing and power phase
respectively. 1 s t and 3 r d phases are similar to opening and closing of the
mandible. Once the teeth contact is reached during incision, the morphology
of the anterior teeth guides the mandibular movements to a considerable
extend.
b) Mastication:
Mastication can be described as having 3 basic strokes. Opening,
closing and power strokes. Chewing cycle associated with the mastication of
single piece of food is referred as chewing cycle / sequence. Chewing cycle
begins with the opening of the mouth by depression of the mandible, which is
accomplished by slight swing to the non chewing side and then back to the
chewing side. This is opening stroke.
From the position of the max opening, the mandibular incisors move
upward, forward and away from midline. This position of the upward
movement is called as closing or fast stroke.

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Completion of this leads to power stroke. Which is the forceful


contraction between occlusal surface of the molars and premolars. During this
stroke the incisions are moved back to midline. When the power stroke ends
before the upper and lower teeth make contact is called as Punture stroke.
Reflex control movements:
The muscles of TMJ like other muscles of the body are subjected to
both reflex control and control within CNS.
There are 3 principle reflexes which control the vertical relationship
between maxilla and mandible and hence TMJ movements, they are
a) Jaw jerk reflex:
It is sometimes refered to the jaw closing reflex. It is analogous to the
knew jerk. It is a strech reflex where by stretching the jaw closing muscles
usually by applying a down ward tap on the chin, produces a reflex
contraction of these muscles. The importance of this reflex is that, it
demonstrates the existence of the feedback mechanism from jaw closing
muscle to their own motor neuron in CNS. This feedback loop comes from
muscle spindle within the muscles. This feedback mechanism helps in fine
control of the TMJ movements throughout normal function like taking
account of consistency of food. No such mechanism as jaw opening reflex is
seen as these opening muscles contain less or no muscle spindles.
ii) Jaw opening reflex:
These are effected inhibition of activity of jaw closing muscles, but do
not show any activation of jaw opening muscle. This reflex can be triggered
by stimulation of mechano receptive nerves from most structures within the
mouth. The importance of these probably lies in their ability to prevent injury
while biting or chewing objects liable to produce damage.

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iii) Jaw unloading reflex


Jaw unloading reflex also involve a cessation of autivity on jaw closing
muscles, together with an activation of jaw opening muscles. This reflex is
evoked when a hard object which is being bitten breaks suddently, thus
unloading jaw closing muscles of the resistance against which they are
working, result of which is that, the opposing teeth do not forcibly hit into
one another thereby preventing damage.
Age changes in TMJ
Though variance structures makeup the TMJ, Glenoid fossa and the
condyle shows great importance.
Condyle:
The morphology and function of the TMJ is greatly affected by aging of
the mandible, especially by the loss of teeth. The convexity of the condyle
decreases in edentulous mandible compared with the mandible with teeth and
peak of the condyle normally appears in posterior part of head as against the
anterior or central in dentulous mandible. Condylar head decreases in height
due to loss of teeth much more than coronoid process thus making the littic
appear elongated. Some times drastic age changes may result in an almost
disappearance of the condylar head. These changes may be the result of
resorption or depression on articular surface or resorption on the posterior
aspect of head against the glenoid tuberculae.
Resorption occurs more frequently on the lateral aspect of the head
than medially and least in region of pterygoid fovea. The edentulous
mandible shows decreased density and loss of regularity of the bony
trabeculae.
The region of pterygoid forea is most difficult to resorb owing to the
great density of the underlying traberculae at the insertion of lateral
pterygoid muscle, which contributes to maintenance of bony structure. These
trabeculae are arranged in same direction as that of lateral pterygoid muscle.
Age changes in glenoid fossa:
In edentulous mandible the vertical dimension decrease and lateral
movements of the jaw changes along with resorption anterior marginal area of
the glenoid fossa. Thus the zygmoid curvature from the bottom of the fossa
into the eminence becomes more flattened. Changes also occur in medial and
lateral marginal areas of the fossa. The distance from the bottom of the fossa
to the lateral and medial margin of the fossa decrease in edentulous jaw and it
almost becomes flattened. However unlike the condyle, the shape and size of
the fossa do not change much.

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