TEMPOROMANDIBULAR JOINT been called the articular or glenoid

fossa. Posterior to the mandibular fossa is the

squamotympanic fissure, which extend
mediolaterally
Temporomandibular joint
The area where mandible articulates with the
temporal bone of the cranium. It is one of the most
complex joints in the body. It provides hinging
movement in one plane and therefore can be
considered a ginglymoid joint. However, at the
same time it also provides for gliding movements,
which classifies it as an arthrodial joint. Thus it
has been technically considered
a GINGLYMOARTHRODIAL JOINT. It is also
referred to as a synovial joint.
Dentition and supporting structure This synovial fluid serves 2 purposes:
The adult human dentition is made up to 32 teeth, [Link] the articular surfaces of the joint are
each tooth has a crown and a root, the root is nonvascular, the synovial fluid acts as a medium
embedded to alveolar bone, which in turn supports for providing metabolic requirements to these
the teeth, the presence of alveolar bone is tissues.
dependent on the presence of the teeth. Any loss
of teeth due to extraction and loss of structure due [Link] synovial fluid also serves as a lubricant
to abrasion and alike will compromise the function between articular surfaces during function.
of the TMJ. The periodontal ligaments are provide
attachment of the root to the alveolar bone Articular Disc

Skeletal component The articular disc separates the two bones from
direct articulation. Since TMJ is a compound joint,
Maxilla by definition a compound joint consist of 3 bones,
therefore the 3rd bone in the compound joint is the
also known as the upper jaw. Developmentally articular disc, though it is composed of a dense
these are two maxillary bones which are fused fibrous connective tissue. It permits the complex
together at the midpalatal suture. The border of movement of joint.
the maxilla extends superiorly to form the floor of
the orbit as well as the nasal cavity. Since it is
attached to the facial skeleton, it is a fixed bone
Mandible
or the lower jaw, is the only movable bone of the
skull, u-shaped bone comprises of a body a
horizontal part and a ramus which is the vertical
part. The superior aspect of the ramus contains
the coronoid and condylar process. It’s the
condylar process articulates or move along the
concavity of the temporal bone of the skull Ask you can see on the picture the articular disc
divides the cavity in two different compartment
Temporal Bone
the upper compartment is between the superior
The mandibular condyle articulates at the base of aspect of the articular disc and inferior surface of
the cranium with the squamous portion of the the concavity on the other hand, the lower
temporal bone. This portion of the temporal bone compartment is between the inferior aspect of the
is made up of a concave mandibular fossa, in articular. The hinge or ginglymus movement
which the condyle is situated and which has also
occurs at the lower compartment and the sliding • The remaining body of the retrodiscal tissue is
or translation occur in the upper compartment. attached posteriorly to a large venous plexus,
which fills with blood as the condyle moves
Moreover, forward.
• Anteriorly, between the attachments of the
• The articular disc is composed of dense capsular ligament, the disc is also attached by
fibrous connective tissue for the most part tendinous fibers to the superior lateral pterygoid
devoid of any blood vessels or nerve muscle.
[Link] extreme periphery of the disc,
however, is slightly innervated. Nerve Innervation
• In the sagittal plane it can be divided into
three regions, according to thickness. The Like all joints, the TMJ is innervated by the
central area is the thinnest and is called same nerve that provides motor and sensory
the intermediate zone. The posterior innervation to the muscles that control it (CN V
border is generally slightly thicker than /trigeminal nerve)
the anterior border
• The articular surfaces of the mandibular • Most innervation is provided by the
condyle and fossa are composed of 4 auriculotemporal nerve as it leaves the
distinct layers or zones. These are mandibular nerve behind the joint and ascends
• Articular zone laterally and superiorly to wrap around the
• Proliferative zone posterior region of the joint.
• Fibrocartilaginous zone • Additional innervation is provided by the deep
• Calcified cartilage zone temporal and masseteric nerves.

Retrodiscal tissue

• retrodiscal tissue or posterior attachment =

region of loose connective tissue that is
highly vascularized and innervated.

• As you can see the Vascular supply of TMJ

• On the superiorly bordered a lamina of
connective tissue that contains many elastic The predominant vessels are the superficial
fibers, the superior retrodiscal lamina. temporal a from the posterior, the middle
• At the lower border is the inferior retrodiscal meningeal a. from the anterior, and the internal
lamina, which attaches the inferior border of the maxillary artery
posterior edge of the disc to the posterior margin
of the articular surface of the condyle. • Other important arteries are the
• The inferior retrodiscal lamina is composed deep auricular, anterior tympanic, and
chiefly of collagenous fibers, not elastic fibers ascending pharyngeal arteries.
like the superior retrodiscal lamina.
The condyle receives its vascular supply through 3. Temporomandibular Ligament
its marrow spaces by way of the inferior alveolar
artery and also its vascular supply by way of • Temporomandibular (TM) ligament is a tight
“feeder vessels” that enter directly into the fiber that provides stability of the joint
condylar head both anteriorly and posteriorly from • TM ligament is composed of 2 parts,
the larger vessels.
[Link] / outer oblique portion
Ligaments
[Link] / inner horizontal portion
1. The collateral ligaments attach the medial and
lateral borders of the articular disc to the poles of 4. Accessory ligament
the condyle.
• The sphenomandibular ligament is one of
• They are commonly called two TMJ accessory ligaments.
the discal ligaments, and there are two. • It arises from the spine of the sphenoid bone
• The medial discal ligament attaches the and extends downward to a small bony
medial edge of the disc to the medial pole of prominence on the medial surface of the
the condyle. ramus of the mandible called the lingula.
• The lateral discal ligament attaches the lateral • It does not have any significant limiting
edge of the disc to the lateral pole of the effects on mandibular movement. However,
condyle. this was dubbed as the 5th muscle of
• The discal ligaments are true ligaments, mastication
composed of collagenous connective tissue
fibers; therefore they do not stretch. • The second accessory ligament is the
• They function to restrict movement of the disc stylomandibular ligament.
away from the condyle. • It arises from the styloid process and
• In other words, they allow the disc to move extends downward and forward to the angle
passively with the condyle as it glides and posterior border of the ramus of the
anteriorly and posteriorly. mandible.
• The attachments of the discal ligaments
permit the disc to be rotated anteriorly and Muscles that act on TMJ
posteriorly on the articular surface of the
condyle. 1. Masseter

2. Capsular ligament. • The masseter is a powerful muscle that

provides the force necessary to chew
• The fibers of the capsular ligament are attached efficiently.
superiorly to the temporal bone along the
borders of the articular surfaces of the Its superficial portion may also aid in protruding
mandibular fossa and articular eminence. the mandible
• Inferiorly, the fibers of the capsular ligament
attach to the neck of the condyle. 2. Temporalis
• The capsular ligament acts to resist any medial,
lateral, or inferior forces that tend to separate or • When the temporal muscle contracts, it
dislocate the articular surfaces. elevates the mandible and the teeth are
• A significant function of the capsular ligament is brought into contact.
to encompass the joint, thus retaining the • When the anterior portion contracts, the
synovial fluid. mandible is raised vertically.
• The capsular ligament acts to resist any medial, • Contraction of the middle portion will elevate
lateral, or inferior forces that tend to separate or and retrude the mandible.
dislocate the articular surfaces.
• A significant function of the capsular ligament is 3. Medial pterygoid
to encompass the joint, thus retaining the
synovial fluid. • This muscle is also active in protruding the
mandible
 • Unilateral contraction will bring about a
mediotrusive movement of the mandible.

Lateral pterygoid

• When this muscle functions with the

mandibular depressors, the mandible is
lowered and the condyles glide forward and
downward on the articular eminences.

• Unilateral contraction creates a mediotrusive

movement of that condyle and causes a
lateral movement of the mandible to the
opposite side

5. Digastric

• Although the digastric is not generally

considered a muscle of mastication, it does
have an important influence on the function
of the mandible. It is divided into 2 portions
or bellies.
• When the right and left digastrics contract
and the hyoid bone is fixed by the
suprahyoid and infrahyoid muscles, the
mandible is depressed and pulled backward
and the teeth are brought out of contact
MUSCLES OF MASTICATION This muscle elevates, retrudes and occlude the
mandible while also assisting the lateral pterygoid
Mastication is the process of grinding and chewing muscle to move it laterally.
food into smaller pieces in the oral cavity (Links to
an external site.) of the head (Links to an external It originates from the inferior temporal line which
site.) turning it into a food bolus. This mass can lies within the temporal fossa.
then be swallowed with ease and further digested The fibers converge in a fan like shape from all
as it passes along the alimentary canal. around the fossa and insert into the coronoid
Apart from the teeth (Links to an external process of the mandible.
site.) and the tongue (Links to an external site.),
certain muscles known as The Mandibular nerve (V3) gives off the
the masticatory muscles partake in specific superficial and deep temporal branches which
movements of the temporomandibular (Links to innervate both areas of the temporal muscle
an external site.) joint (Links to an external respectively.
site.) (TMJ) during this process to allow the initial
stages of digestion to occur. All muscles of The temporalis is the largest muscle of
mastication are supplied by branches of mastication and it consists of anteriorly-positioned
the mandibular nerve (Links to an external vertical fibers and posteriorly-positioned
site.) (V3), a branch of the trigeminal nerve (Links horizontal fibers
to an external site.). Internal (Medial) Pterygoid
This muscle elevates, protrudes and causes the
lateral excursion of the mandible. The muscle has
a deep and superficial head.
Insertion occurs upon the pterygoid tubercles that
can be found on the medial surface of the ramus
and the mandibular angle.
The medial pterygoid is sort of like a mini-
masseter in its fiber direction and function and it
also has a superficial and deep part – just like the
masseter. Both heads are innervated by the
medial pterygoid nerve and function to elevate
and protract the mandible, and when contracting
unilaterally, this muscle also assists the lateral
pterygoid in causing medial movement
for trituration.
They arise from the medial surface of the
pterygoid plate and both the maxillary tuberosity
and palatine process respectively.
The mandibular nerve (V3) innervates the medial
pterygoid via the medial pterygoid nerve branch.

Masseter Muscle
This is the main masticatory muscle which causes
mandibular elevation and protrusion and assists
the other muscles to move the mandible laterally.

Temporalis Muscle The masseter originates from the inferior border of

the anterior two thirds of the zygomatic arch and
promptly terminates at the mandibular angle and The arterial supply to the muscles of mastication
the inferior and lateral borders of the mandibular is via the maxillary artery, a branch of the external
ramus. carotid artery.
It is innervated by the masseteric branch of the
mandibular nerve (V3).
The masseter is the most powerful muscle of
mastication and consists of two parts – the
superficial part and the deep part. It is innervated
by the masseteric nerve and both layers function
to elevate the mandible so that you can occlude
your teeth. The superficial layer of the masseter
specifically assists in protrusion.

External (Lateral) Ptyergoid

The superior head originates from the
infratemporal crest on the greater wing of the
sphenoid bone and inserts into the pterygoid fovea
on the condylar neck of the mandible.
In contrast, the inferior head runs from the lateral
surface of the lateral pterygoid plate to the
condylar process of mandible.
When contracting bilaterally, the inferior head is
the main muscle for causing protrusion of the
mandible. This protrusion unlocks the mandible so
that it can then be depressed. The superior head
acts to make sure that the articular discs stays on
top of the condyle during protrusion and also has
an important role in preventing the mandibular
condyle from being pulled too far posteriorly by the
temporalis during retraction and elevation.
When contracting unilaterally, the lateral pterygoid
produces medial movement away from the side
which is contracting and this motion contributes
towards trituration or the grinding up of food.
This muscle depresses and protrudes the
mandible and moves it laterally. It consists of a
superior and inferior head.
The lateral pterygoid muscle is supplied by
the lateral pterygoid nerve branching off the
mandibular nerve (V3).

Blood Supply of Muscles of Mastication

What are the two most common joint sounds Articular Eminence:
associated with TMJ disorders? How do they
differ? • is a strong bony prominence of the
base of the zygomatic process
• Clicking and crepitus are the two
most common joint sounds Articular Tubercle:
associated with TMJ disorders.
• clicking is a distinct popping or • Lateral part of the articular eminence
snapping sound, • serves as the attachment for the
• Crepitus is a scraping, continuous capsule and lateral
sound. Sounds are best distinguished temporomandibular ligament
by use of a stethoscope.
Glenoid Fossa:
INTRODUCTION
is a depression where the condyle is located
TMJ superiorly- middle cranial fossa
-is a complex articulation of the movable Tympanic Plate:
mandible and the base of the skull. It is called
ginglymus-arthroidal joint is the vertical plate located anteriorly to the
external acoustic meatus
The TMJ has 6 features:
Postglenoid Tubercle:
• Squamous portion of the temporal is the inferior extension makes up the posterior
bone aspect of the glenoid fossa and attachment for
• Mandibular condyles capsule and retrodiscal pad
• Articular Disc
• Bilaminar zone (posterior attachment
complex)
• TMJ Compartments The Mandibular condyles
• Capsule
• Articulates with the articular disc
• Ligaments
• Football in shape
• Mediolateral: 20mm
• Avascular articular surface is
• Anteroposterior: 10mm
composed of fibrous connective
• Articular surface is made up of fibrous
tissue that is the thickest in the load-
bearing areas connective tissue
• Main load-bearing area:
• Main load-bearing areas:
• Lateral aspect
• Lateral aspect of squamous portion
• Condyle
• Articular disc The Articular disc

• Made up of dense fibrous connective

Anterior structure of the temporal bone
tissue
• Located between the squamous
• articular eminence
• articular tubercle portion of the temporal bone and the
• Intermediate: condyle
• Central part:
• glenoid fossa
• Avascular and aneural
• Peripheral area:
Posterior structure is
• Vascular and innervated
• Main load-bearing area:
• tympanic plate tapering to the
postglenoid tubercle
 • Lateral aspect is the area of potential • Located posteriorly to the articular
perforation disc and highly distortable

The articular disc is divided into 3 bands and Parts:

these are
• Superior lamina consists of elastic
Anterior: Thick band fibers
• Anterior to the condyle when mouth is o Anchors superior aspect of
closed the posterior portion of the
disc to the capsule
Intermediate: Thinnest band
• Retrodiscal pad is a highly vascular
• Located along the articular eminence and neural portion of the TMJ, made
when the mouth is closed of collagen, elastic fibers, fat, nerves
Posterior: Thick band and blood vessels
o Large venous plexus fill
• Located superior to the disc when the with blood when the
mouth is closed condyle moves anteriorly
Articular Disc • Inferior lamina is consists of collagen
fibers and anchors inferior aspect
• Articular disc divides the TMJ into two of the posterior portion of the disc to
compartments the condyle
Superior THREE FUNCTIONAL LIGAMENTS
Inferior SUPPORT
THE TMJ
• Internal surfaces contain endothelial • 1. The Collateral Ligament
cells which form a synovial lining, that • 2. The Capsular Ligament
produces synovial fluid which makes • 3. The Temporomandibular (TM)
the TMJ a synovial joint Ligament
• Synovial fluid: lubricant and provides •
the metabolic requirements to the
articular surface TWO ACCESSORY
LIGAMENTS
Superior compartment:
• 1. Sphenomandibular Ligaments
• is between the squamous portion of the • Blood Supply of the TMJ
temporal and the articular disc • [Link] temporal artery
• provides for translational movement of • [Link] branches of the maxillary
the TMJ artery
• has a volume: 1.2ml • Nerve Supply
• Inferior compartment: • [Link] of the temporalis N.
• [Link] of the auriculotemporal N.
• is between the articular disc and the
• [Link] of the masseteric N.
condyle
• it provides rotational movement of the MUSCLES OF MASTICATION
TMJ
• has a volume: 0.9ml The primary muscles of mastication (chewing
food) are the temporalis, medial pterygoid,
Retrodiscal tissue lateral pterygoid, and masseter
muscles. The four main muscles of mastication
attach to the rami of the mandible and function
to move the jaw (mandible). The cardinal
mandibular movements of mastication
are elevation, depression, protrusion,
retraction, and side to side movement. To
augment the process of eating, the muscles of
mastication also move the mandible in a side to
side motion to assist in the grinding of food. The
muscles of mastication also function to
approximate (bring together or close) the
teeth. The superficial muscle of the neck, the
platysma muscle, also assists with depression
of the mandible against resistance.