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Temporomandibular joint and the infratemporal fossa

  • - The temporomandibular joint is the jaw joint between the temporal bone above and the mandible below. It is one of only two synovial joints in the body (the other being the sternoclavicular joint) that has an intra- articular disc (composed of fibrocartilagenous tissue, located between the two bones that form the joint). This separates the joint cavity into two spaces. There is no hyaline cartilage on the articulating surfaces, only fibrous tissue. The lower of the two joint compartments is involved rotational movement (i.e. opening and closing the mouth), and is formed by the articular disc and the mandible. The upper joint compartment, between the articular disc and the temporal bone, is involved in translational movements (sliding the lower jaw forward or from side to side). The first 20mm or so that the jaw opens can be done solely through the action of the inferior compartment, however further opening of the mouth requires involvement of the superior compartment.

Temporomandibular joint and the infratemporal fossa - The temporomandibular joint is the jaw joint between the
Temporomandibular joint and the infratemporal fossa - The temporomandibular joint is the jaw joint between the
Temporomandibular joint and the infratemporal fossa - The temporomandibular joint is the jaw joint between the
  • - The temporomandibular joint has a capsule around the margins of the fossa and neck of the mandible, which incorporates the articular eminence. The joint is strengthened by internal ligaments.

  • - There are three main ligaments associated with the temporomandibular joint. These are the stylomandibular, the sphenomandibular and the temporomandibular ligaments.

  • - The temporomandibular is the major ligament of the area. It is really a thickened lateral portion of the capsule, with two parts, an outer oblique proportion and an inner hoziontal portion.

  • - The sphenomandibular and the stylomandibular are minor ligaments. The sphenomandibular runs from the spine of the sphenoid bone to the lingula of the mandible whilst the stylomandibular ligament runs from the styloid process to the angle of the mandible, and separates the infratemporal, anterior, region from the parotid (posterior) region. They are both accessory ligaments, that do not directly attach to any part of the joint and their role is to define border movements- the farthest extent that the temporomandibular joint can move. However painful stimuli generated from extending beyond the function allowed by muscular attachment generally prevents this extent of movement ever being reached. Movement is also stabilised/constrained by the pterygomandibular raphe.

- The temporomandibular joint is primarily moved by four muscles of mastication , the masseter ,
  • - The temporomandibular joint is primarily moved by four muscles of mastication, the masseter, medial pterygoid, lateral pterygoid and temporalis, all of which are innervated by the mandibular branch of the trigeminal nerve (Viii). The mandibular branch gives a nerve off to the medial pterygoid soon after leaving the foramen ovale, following this is splits into anterior and posterior branches. The anterior branch supplies motor innervation to the lateral pterygoid, masseter, temporalis. It also provides sensory innervation to the inner cheek through the long buccal nerve. The posterior branch provides mixed innervation to the inferior alveolar, and sensory to the auriculotemporal and lingual nerves. Sensory innervation to the temporomandibular joint also comes from Viii, through the auriculotemporal and masseteric branches of the nerve. The auriculotemporal branch is sensory to the side of the temple and top of the pinner. It sends postganglionic parasympathetic fibres to the parotid gland.

- The aforementioned muscles of mastication are responsible for the circular movement of chewing. The pterygoid
  • - The aforementioned muscles of mastication are responsible for the circular movement of chewing. The pterygoid muscles work alternately, to facilitate side to side chewing movements. The medial pterygoid, or pterygoideus internus, is a thick quadrilateral muscle of mastication. It has two heads. The bulk of the muscle arises as a deep head from just above the medial side of the lateral pterygoid plate. The smaller, superficial head arises from the maxillary tuberosity. It inserts into the medial aspect of the mandible. It elevates and protrudes the mandible. The lateral pterygoid, or pterygoideus externus, also has two heads, a superior head arising from the infratemporal surface of the greater wing of the sphenoid and an inferior head from the lateral side of the lateral pterygoid plate. Both insert into the disc and anterior aspect of the neck of the mandible at the pterygoid fossa. The lateral pterygoid protrudes and depresses the mandible.

- The temporalis muscle arises at the side of the temporal bone and temporal fascia within
  • - The temporalis muscle arises at the side of the temporal bone and temporal fascia within the perimeter of the temporal line, passes medial to the zygomatic arch and inserts onto the coronoid process of the mandible and anterior border of the ramus. It can be seen and felt on the temple, contracting while the jaw is clenching.

- Masseter is a thick muscle consisting of predominantly two layers, a superficial and a deep
  • - Masseter is a thick muscle consisting of predominantly two layers, a superficial and a deep layer. They run from the zygomatic arch to ramus and angle of the mandible and serve to elevate the mandible. Masseter is the strongest muscle in the human body, capable of closing the jaw with enough force to shatter the enclosed teeth.

- Masseter is a thick muscle consisting of predominantly two layers, a superficial and a deep
  • - Whilst not a muscle of mastication, the muscle buccinator is essential for keeping food in the oral cavity. It is a thin muscle, arising from the alveolar processes of the maxilla and mandible and the anterior border of the pterygomandibular raphe and converging at the angle of the mouth. The fibres from below are continuous with the upper segment of orbicularis oris. It is innervated by the facial nerve (VII), NOT the trigeminal.

- Blood supply to the temporomandibular joint comes from branches of the external carotid artery ,
- Blood supply to the temporomandibular joint comes from branches of the external carotid artery ,
  • - Blood supply to the temporomandibular joint comes from branches of the external carotid artery, predominantly the superficial temporal branch.

  • - Also in the area is the infratemporal fossa, an irregular shaped cavity situated below, and medial to, the zygomatic arch. It contains the lower part of temporalis and the medial and lateral pterygoid muscles. It also contains several nerves, such as the mandibular division of the trigeminal (Viii), the

chorda tympani (from the facial nerve, VII), the otic parasympathetic ganglion, the maxillary artery and its branches and the pterygoid venous plexus. The foramen ovale (from which the mandibular branch of trigeminal exits the cranium) and the foramen spinosum (although it is absent in 2% of the population, in whom its usual contents exit via the foramen ovale) open in its roof and the alveolar canals exit in its anterior wall (through which the posterior superior alveolar vessels and nerves).

chorda tympani (from the facial nerve, VII), the otic parasympathetic ganglion, the maxillary artery and its
  • - Innervation of the teeth (alveolar bone, periodontal ligaments and gingiva) comes from two sources. The maxillary, or upper, teeth are innervated by the superior dental plexus (from Vii, the maxillary branch of the trigeminal). The lower teeth are innervated by the inferior dental plexus (from Viii, or the mandibular branch of trigeminal).