Biomecnica*Ar-culacin*Temporo*

Mandibular*(ATM)*
Profesores:
Angelo Bartsch
Cristin Cuadra

Aspectos(Osteolgicos(

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Alineacin*de*las*Estructuras*
440

Pa

the articular emin

provides attachm
The zygomatic p
matic bone anter

SPHENOID BON

Articular
tubercle
Mandibular
fossa

Styloid
process

External
acoustic
meatus
Mastoid
process

Figure 23.3: Articulating surface on the temporal bone. The

mandibular fossa and articular eminence, which form the articular surface for the head of the mandible, lie on the inferior surface of the temporal bone. The styloid and mastoid processes lie
posterior to the mandibular fossa.

middle and inner ears, lying within the temporal bone. The
proximity of the external, middle, and inner ears to the TMJ
may help explain why some individuals with TMJ dysfunction
also report impaired hearing [3,9,19].

The sphenoid art

poral bone, con
[20,47]. Along w
also contributes t
surface of the s
aspect of the bas
tains structures th
lateral aspect of
contributes to the
imal attachment
tication, the med
al border of the
plate, which pro
the sphenoid bon
for the medial a
pterygoid plate a
face of the sphen
goid plate; it end
palpated intraora

Cl

PALPATION OF
sphenoid bone i
the palpating fin
molar (Fig. 23.5
a fibrous band t
mandible, also h
where it too is re
mucous membr
just lateral to th

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Relevancia*mecnica*
Part III
Tejido Conectivo Fibroso

442

Coronoid
processes

Condylar processes
(head of mandible)

Rami of mandible

Angle of
mandible
Body of mandible
Figure 23.7: The mandible consists of a body and two rami, each
ending in coronoid and condylar processes.

| KIN

MANDIBLE

The mandible, or jaw bo

containing the lower row
posteriorly and superiorly
the body of the mandible
mandible marks the junct
easily palpated at the pos
side of the face (Fig. 23.8
important landmarks, lyin
the hyoid bone and infer
processes of the first cerv
Each mandibul
processes. The an
1
attachment for the
border of the coronoid p
zygomatic arch. The post
its superior end to form th
ulates with the temporal
rows inferiorly, forming th
attachment for a portion
The condyles of the m
cut in half that tilt ante
other (Fig. 23.9). The c

Aspectos(Artrolgicos(

Cpsula*Ar-cular>*Ligamentos*
Tejido(Conec4vo(de(Soporte(en(la(ATM(
Disco*Ar-cular*
Cpsula*Fibrosa*
Ligamentos*Colaterales*
Ligamento*temporomandibular*lateral*
Ligamento*Esfenomandibular**
Ligamento*Es-lomandibular**

Cpsula*Ar-cular>*Ligamentos*
separate ax
Ligament Disc

Aspectos(Artrolgicos(

TMJ Disorders, Treatments, and Biom

Articular fossa
Muscle

lation are
translation
two possib

TEMPO

Tempor
term used
Injury to th
of the head
Condyle
causes incl
puts a lot
disc; presen
in the TMJ
The temporomandibular joint
facial and
aging.7,15,31
FIGURE 1. Anatomical structure of the temporomandibular
joint (TMJ). Source: American Association of Oral and Maxilare pain dy
lofacial Surgeons.5
arthritis, a
Ingawale y cols (2009). Temporomandibular Joint: Disorders, Treatments, and Biomechanics. Annals of Biomedical
TMD is
Engineering, Vol. 37, No. 5, pp 976996

Aspectos(Artrolgicos(

Cpsula*Ar-cular>*Ligamentos*
Zona Retrodiscal Inferior (Colgeno): Se une a la periferia
del cuello de la mndibula y Cpsula
Zona Retrodiscal superior (Elastina): Se une a zona
timpnica del temporal

70

Zona Anterior se une a:

Periferia del cuello y cpsula
Tendn de la cabeza superior del Pterigoideo Lateral
Hueso Temporal, anterior a la eminencia

Aspectos(Artrolgicos(

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Upper joint
space

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Cpsula*Ar-cular>*Ligamentos*
Muscles of the TMJ

The TMJ is involved in activities such as talking, chewing,

Lower
joint Retrodiscal Inferior (Colgeno): Se
biting,
and yawning. Several muscles come
Zona
uneswallowing,
a la periferia
space
del cuello de la mndibula y Cpsula into play, often synergistically. The muscles primarily
involved are listed below. Unless stated otherwise, the
Zona Retrodiscal superior (Elastina): Seaction
uneisaconsidered
zona to be bilateral and occurs at each
joint (right and left) simultaneously.
Atimpnica del temporal
Articular eminence
Superior lamina

Temporalis
Masseter

Medial pterygoid
Lateral pterygoid

Upper
Otherjoint
muscles involved in TMJ movements are the
space

following:
Inferior lamina
Capsule

Suprahyoid muscles
Lower joint
Mylohyoid
space
Geniohyoid
Stylohyoid
Digastric

Infrahyoid muscles
Sternohyoid
Sternothyroid
Thyrohyoid
Omohyoid

A
The temporalis is a rather broad and fan-shaped
muscle that lies in the temporal fossa (see Figs. 14-8 and
Articular
eminence
14-15). Because
of its fan
shape, the more anterior fibers
run almost vertically, the middle fibers are at a diagonal,
Superior lamina
and
the posterior fibers are nearly horizontal. From the
Lateral movement also occurs in the horizontal temporal fossa, the fibers
come
together tose
form
a tenZona
Anterior
une
a:
plane. It involves one condyle rotating in the articular don that passesPeriferia
deep to thedel
zygomatic
arch
insert on
cuello
y tocpsula
Inferior lamina
fossa while the other condyle glides forward. To move the coronoid process and anterior border of the ramus of
la cabeza
superior
del Pterigoideo
Lateral
the mandible toward the left, the left Tendn
condyle willde
spin
the mandible.
Its primary
function is to elevate
the
Capsule
and the right condyle will glide forward (Fig. 14-14). Hueso
mandible.
Because of the
horizontaladirection
of the posTemporal,
anterior
la eminencia
This rotation occurs around a vertical axis.
terior fibers, they also retract the jaw. In side-to-side
Figure 14-13. Joint motion during mandibular depression
(mouth opening). (A) The condyle first rotates in the
mandibular fossa, and (B) the condyle then glides downward
and forward over the articular tubercle.

Aspectos(Artrolgicos(

Cpsula*Ar-cular>*Ligamentos*
Fibras
Horizontales

Fibras
Oblicuas

Aspectos(Artrolgicos(

Cpsula*Ar-cular>*Ligamentos*

Estilomandibular

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*
Depresin>*Elevacin*01>*02*(Vista*
Lateral*y*Medial)*

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*
Protrusin>*Retrusin*07>*08*(Vista*
Lateral*y*Medial)*

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*
Excursin*Lateral*04>05*(Vista*Lateral>*
Medial*

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*
Excursin*Lateral*06*(Vista*Inferior)*

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Horizontal axis

Ejes*y*Planos*de*Movimiento*

444

Part III | KINESIOLOGY OF THE HEAD AND SPINE

Osteocinem4ca(

Retrusion
Elevation

Horizontal axis

Protrusion

Depresssion

Anterior-posterior
axis

Retrusion
Elevation

Protrusion

Depresssion

Vertical axis

Vertical axis

Anterior-posterior
axis

Figure 23.10: The TMJ exhibits three-dimensional motion that includes rotations about mediallateral (A), anteriorposterior (B), and
vertical (C) axes. It also allows translation in the sagittal and transverse planes.

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*

mandibular fossa, and (B) the condyle then glides downward

and forward over the articular tubercle.

Lateral movement also occurs in the horizontal

plane. It involves one condyle rotating in the articular
fossa while the other condyle glides forward. To move
the mandible toward the left, the left condyle will spin
and the right condyle will glide forward (Fig. 14-14).
This rotation occurs around a vertical axis.

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*
Lateral Deviation

1
r
a
t
d
t
t
m
t
m
i

Glide
Spin
Left
mandibular
condyle

Right
mandibular
condyle

Figure 14-14. Mandibular motion during lateral deviation

to the left side (superior view).

Osteocinem4ca(

Ejes*y*Planos*de*Movimiento*

Osteocinem4ca(

Rangos*de*Movimiento*Normal*
y*Funcional*
11 mm

50 mm
18 mm Funcional

Regla*de*Movimiento*
Atrocinem4ca(

Chapter 23 | STRUCTURE AND FUNCTION OF THE ARTICULAR STRUCTURES OF THE TMJ

1
2

Inferior joint
space

Figure 23.11: The articulating surface of the temporal bone

consists of the mandibular fossa and the articular eminence.
Opening and closing require rotation of the mandible about a
medial lateral axis and translation of the mandibular head along
the articular eminence, producing anterior and inferior translation of the mandible.

Atrocinem4ca(

Regla*de*Movimiento*
Compartimiento Superior:
Traslacin

Compartimiento Inferior:
Convexo- Cncavo

Atrocinem4ca(Elevacin<(Dep.(

Tipo*de*Movimiento*
Artrocinem-co*

35- 50% del

RoM

Atrocinem4ca(Traslacin(

Tipo*de*Movimiento*
Artrocinem-co*

TMJ Disorders, Treatme

Traslacin

FIGURE 11. Schematic diagram of a lateral movement of the

mandible: (I) ipsilateral condyle, (C) contralateral condyle.
Source: Perez-Palomar and Doblare.77

and higher tensile stress in the contralateral ligaments

than that in the ipsilateral ligaments.77 This study
suggested that a continuous lateral movement of the
jaw may lead to perforations in the lateral part of both

Atrocinem4ca(Pro<(Retraccin(

Tipo*de*Movimiento*
Artrocinem-co*
Protraccin
Retraccin

Mecnica(Muscular(

Osteocinem-ca*y*Accin*
Muscular*
Apertura*y*Cierre*00*(Disco*en*
apertura)*
Accin*Muscular*01*(Vista*lateral)*

Mecnica(Muscular(

Msculos*Primarios/*
Secundarios*
Msculo

Elevacin Depresin

Excursin
Protraccin Retraccin
Lateral
X (IL)
x
-XXX (CL)
x
--

Masetero
Pterigoideo Medial
Pterigoideo Lateral
(cabeza superior)
Pterigoideo Lateral
(cabeza inferior)

XXX
XXX

---

--

XXX (CL)

XXX

--

--

XXX

XXX (CL)

XXX

Temporal

XXX

--

X (IL)

--

-XXX (Fibras
post)

--

XXX

--

--

Grupo Muscular
Suprahioideo

X: Accin Mnima
XX: Accin Moderada
XXX: Accin Mxima
E: Estabiliza el disco articular
IL- CL: Ipsi- Contralateral

BIOMECHRNICS

OF THE TEMPOROMANDIBULAR

was based on the mandible in the postural, or

rest, position, with the muscles of each side
acting equally. The muscle forces considered
in the analysis were those produced by the
masseter (denoted by FM), temporalis (Fr)
and the internal and external pterygoid (F,
and FE) muscles (see Fig. 2).

JOINT

SY,

Mecnica(Muscular(

Interaccin*de*Torques*

Fig. 3. Occlusal load and joint force parameters.

Fig. 2. Muscles considered in the anaiysis are the Masseter (M ), Tempo&s

(7). and the Internal and External
Pterygoids (I and E).

axis and utilising the determined

components we obtain
0.84FM+

O&IF,+

muscle

0*77F, -0.17FE

Mecnica(Muscular(

Interaccin*de*Torques*

Patomecnica(Ar4cular(

Alteraciones*

TMJ Disorders, Treatments, and Biomechanics

979

FIGURE 2. A schematic representation of the position of the TMJ disc in three different conditions: a healthy joint, anterior disc
displacement with reduction (ADDWR), and anterior disc displacement without reduction (ADDWOR). Source: Perez-Palomar and
Doblare78.

Ingawale y cols (2009). Temporomandibular Joint: Disorders, Treatments, and Biomechanics. Annals of Biomedical
free
radical-mediated
can be extremely
patient prevalence is reported to be varying from 3:1 to
Engineering,
Vol. 37, No.reactions
5, pp 76996

Patomecnica(Ar4cular(

Alteraciones*

RELACIN(ATM(Y(RAQUIS(

Aparato*Estomatogn-co*
El sistema estomatogntico o
sistema masticatorio
unidad funcional
Dientes
Periodonto
Mucosas orales
Maxilar y mandibula
ATM
Musculatura oral y masticatoria
Glndulas salivales
Vasos y nervios