TMJ – NORMAL

ANATOMY
 The Temporomandibular
joint (TMJ) is composed of
the temporal bone and the
mandible, as well as a
specialized dense fibrous
structure, the articular disk,
several ligaments, and
numerous associated
muscles.

 Also called as
craniomandibular joint /
articulation.
 ANATOMICALLY :-
TMJ is diarthrodial ( which
is a discontinuous articulation of bones
permitting freedom of movement )

 Itis also a synovial joint, lined on its inner

aspect by a synovial membrane, which
secretes synovial fluid. The fluid acts as a
joint lubricant and supplies the metabolic
and nutritional needs of the
nonvascularized internal joint structures.
 BONY
ANATOMY
 FUNCTIONALLY

The TMJ is a compound

joint, composed of four articulating surfaces:
the articular facets of the temporal bone and
of the mandibular condyle and the superior
and inferior surfaces of the articular disk.
TMJ CORONAL VIEW
ARTICULAR CARTILAGE
 Mandibular (glenoid) fossa
 Limits :- anteriorly, the articular eminence
or tubercle
posteriorly, a small conical post
glenoid tubercle

 Articular eminence :- small prominence on the zygomatic

arch. Strongly convex anteroposteriorly n somewhat
concave mediolaterally.

 Post glenoid tubercle :- separates fossa laterally from

tympanic plate n tympanic plate separates the TMJ from
the bony part of the external auditory canal.

 Glenoid fossa :- lined by a dense avascular fibrocartilage

n in crosssection the fossa n eminence form a hazy ‘s’
posteroanteriorly.
 Mandibular component
 Mandibular condyle :-
 broad laterally n narrow medially.
 Mediolaterally – bt. 13 to 25 mm
 Anteroposteriorly – bt. 5.5 to 16 mm
N.T.-The articular part of condyle is covered by
fibrocartilagenous tissue n not with hyaline cartilage,
as in most joints of the human body
SOFT TISSUE ANATOMY

TMJ capsule
TMJ ligaments
Disc(meniscus)
Synovial membrane
CAPSULAR LIGAMENT
(LATERAL VIEW)
 It encompasses each joint, attaching superiorly to the
temporal bone along the border of the mandibular
fossa and eminence and inferiorly to the neck of the
condyle along the edge of the articular facet.

 It surrounds the joint spaces and the disk, attaching

anteriorly and posteriorly as well as medially and
laterally, where it blends with the collateral ligaments.

 FUNCTION of the capsular ligament is to resist

medial, lateral, and inferior forces, thereby holding the
joint together. It offers resistance to movement of the
joint only in the extreme range of motion.

 A secondary function of the capsular ligament is to

contain the synovial fluid within the superior and
inferior joint spaces
 Synovial fluid
 Synovial fluid is considered an ultrafiltrate of plasma. It
contains a high concentration of hyaluronic acid, which is
thought to be responsible for the fluid’s high viscosity.
 The proteins found in synovial fluid are identical to plasma
proteins.
 Alkaline phosphatase, which may also be present in synovial
fluid, is thought to be produced by chondrocytes.
 Leukocytes are also found in synovial fluid.
 Only a small amount of synovial fluid, usually less than 2 mL,
is present within the healthy TMJ.

 Functions of the synovial fluid include lubrication of the joint,

phagocytosis of particulate debris, and nourishment of the
articular cartilage.
TMJ LIGAMENTS
 Accessory ligaments
 Sphenomandibular ligament :- it is a flate band
arising from the spine of sphenoid & the
petrotympanic fissure,runs downward n medially
to the TMJ capsule n gets inserted on the lingula
of the mandible.

 Remnant of meckle’s cartilage.

N.T :- maxillary artery n auriculotemporal nerve

lies bt. It n mandubular neck.

 The stylomandibular ligament :- it is dense thick

band of deep cervical facia extending from the
styloid process to the mandibular angle.
 Articular disc ( meniscus )
 Composed of dense fibrous connective tissue
and is nonvascularized and noninnervated.
 Anatomically the disk can be divided into three
general regions as viewed from the lateral
perspective:
 The anterior band
the central intermediate zone, and
the posterior band.
TMJ LATERAL VIEW
 It promotes lubrication , energy absorption
n joint range of motion.
 It acts as shock absorber enabling the
articulating bones to move against each
other with minimum friction n heat
production.
 Disc has very little potential for repair after
insult.
 TEMPORALIS MUSCLE
(WITH ZYGOMATIC ARCH & MASSETER MUSCLE REMOVED)
MASSETER MUSCLE
LATERAL & MEDIAL PTERYGOID
Blood supply-
Branches from Superficial
temporal & Maxillary Artery

Nerve supply-
Auriculotemporal
& Masseteric Nerve
TMJ PATHOLOGY – PT’S HISTORY
 TMJ PATHOLOGY , PATIENT'S HISTORY
 Age - Younger-MPDS common
Older degenerative disease common

 Occupation -
Higher class people

 H/O pain - MPDS - dull & morning time

TMJ pain - Sharp & increased
during function

 Jaw & joints symptoms

 Oral habit : Bruxism
Chewing pattern

 Medical history : Rheumatoid arthritis

Extraction
Trauma

 H/O : Headache
Back pain
Ear ache

Family history : Rheumatoid arthritis

Osteoarthritis
CLINICAL EXAMINATION

 Facial symmetry
 Mouth opening
 TMJ palpation
 Muscle palpation
 Dental examination
DIAGNOSTIC STUDY
Plain radiography:
Trans orbital view or antero-posterior view.
 Trans cranial or lateral view.
 Trans pharyngeal
 Reverse towne’s
 Cephalometric
 Water’s view
 Xeropadiography

Conventional tomography:

 Orthopantamography
 Linear tomography
 Corrected tomography
 Computed tomography;

Adv. It provide superior osseous anatomical images

without any superimposition than conventional x-
ray.And in different plane.
e.g. axial
saggital
coronal
It is good for hard tissue.

Disadv. Can’t asses dynamic depiction of soft tissue

components.
( MRI )

Adv. - Doesn’t use ionising radiation.

non invasive
excellent for soft tissue

Disadv. - very expensive

patient discomfort
Arthrography:-
Defect in position or structure of the
joint disc & its attachment can be determined using
arthrography.
arthrography is performed by injecting the
contrast madia in to the joint space and after it
radiograph is taken.
Arthroscopy

Electromyography
CONCLUSION