The Temporo - Mandibular

Joint. Anatomy

J-L Kahn

Les Hôpitaux
Universitaires
de STRASBOURG
 Imaging studies : CT scan and MRI

 Knowledge of the anatomical

specificities needed  correct
reading of the images
Functional and Descriptive Anatomy

2 TMJ linked and synergic

 Bicondylar-like synovial joint
 2 Functional compartiments
• Disco-temporal compartment =
translation
• Disco-mandibular = rotation
 Are in relation
 Down : single structure  the mandibular condyle
 Up : double structure
• Temporal articular cavity
• Articular tubercle of the temporal bone
 TEMPORAL ARTICULAR SURFACES

The Mandibular fossa :

Concave (for the condyle at rest)
Articular tubercle : convex
(for the jaw during any movement)
 TEMPORAL ARTICULAR SURFACES
3 zones from the front to the back
 The bottom of the mandibular fossa
 The 45° condylar slope
• The occlusion zone
• The rest zone
• The crest zone
 The anterior part of the articular tubercle
MANDIBULAR ARTICULAR SURFACES

THE CONDYLE
 MANDIBULAR SURFACE
3 zones from the front to the back :
 The notch of the lateral pterigoid muscle
 The anterior part of the condyle (obliquity of 45°)
 The posterior part of the articular surface, posterior
to the crest
 Mandibular CONDYLE :
2 poles : lateral and medial with their bundles

 Neck : 5-mm width transversally at its base 

weakness - fractures
 FIBROCARTILAGINOUS COVERAGE

 Fibrous tissue superficially

 Chondroid zones
 Ossified zone :
deeply, in chondroid zones
Fibrocartilaginous coverage :
thickness = function of strains 
especially
 Posterior part of the articular tubercle
 Anterior part of the mandibular condyle
ARTICULAR DISC AND ITS ANCHORING POINTS

Between the temporal and mandibular

articular surfaces
 Disc anchored to the
mandibular condyle by the
medial and lateral bundles
 Thin in its center, thick in
the front and in the back :
anterior and posterior
cushions
 Anterior expansion continues the anterior
cushion :
20 % of the fibers of the lateral
pterigoid muscle
 Posterior expansion continues the posterior
cushion with its BILAMINAR zone :
• Disco-temporal : supple

• Disco-mandibular : rigid
In the bilaminar zone :
• Retrodiscal venous plexus
• Synovial fringes (Histology and/or arthroscopy)
The disc divides the TMJ in :
 Superior compartment :
disco-temporal
 Inferior compartment :
disco-mandibular
 4 discal bundles :
anterior, posterior, lateral and
medial
 Disc anchored to the well defined
capsule medially and laterally
 Dehiscent capsule in the front and
unprecise in the back
Muscles attached to the disc in its anterior part
 Anteriorly and medially :
sphenoidal head of the lateral pterigoid muscle
 Anteriorly and laterally :
temporal and masseter muscles
The Disc :
« disco-capsulo-muscular complex »,
anchored to the mandibular condyle
One important ligament :
lateral collateral ligament

 Thick, always stressed, rich in

blood vessels and sensitive captors
SYNOVIAL membrane :
gliding mean
 In deepest part of the capsule

 Extends from the edge of the

articular surfaces and of the

disc
(some fringes in
the back)

 Synovial membranes of the

2 compartments : independent
 Immediate relationships
 Up : Neurocranium
 Back : external ear
 Front and Medially :
infratemporal fossa and prestylian space
 Front and laterally :
parotido-masseteric space sometimes
posterior pole of the parotide gland in the
back between the TMJ and external acoustic
meatus
 MUSCLES

 Front and laterally :

Masseter
 Front and medially :
Lateral pterigoid muscle
 EXTERNAL EAR

 External acoustic meatus : cartilage +

tympanal bone in the back

 Cellulo-adipous tissue, sometimes parotide

gland in the space between EAM and TMJ
 Posterior pole of the parotide gland :
postero-lateral relationship
 Back to the neck, under the TMJ :
The external carotide artery splits
up : maxillary artery
and superficial temporal artery
 Superficial temporal artery, its vein and the
auriculo-temporal nerve are vertical, backward to
the TMJ, in front of the EAM
 Maxillary artery and its vein
(pterigoid plexus) under the neck
 Tranverse vessels of the face laterally and
superficially
 Facial nerve (VII) : its
branches are superficial
• Temporal branch next to the TMJ
• Frontal branch in front of the TMJ
 Auriculo-temporal nerve (V3) :
medial to the neck then posterior to the TMJ
 Mandibular nerve (V3) :
arises in the infra-temporal fossa forward and medially
Celulo-adipous tissue
 Superficially in the TMJ incision
 Medially and downward :
prestylian space
 Forward :
infra-temporal space and in the
mandibular incisure
 Functionnal Anatomy
Each movement
 Both TMJ
 Includes both compartments,
simultaneously or successively
• Disco-temporal : translation
• Disco-mandibular : rotation
 OPENING-CLOSURE
 OPENING : rotation first, then
anterior translation :
12 mm downward and anteriorly
to the TMJ. The disc is pulled
forward by the lateral pterigoid
muscle
 CLOSURE : elasticity of the
posterior expansion
 return to its initial
position
OPENING : 3 supra-hyoid muscles
• Anterior belly of the digastric muscle
• Mylo-hyoid muscle
• Genio-hyoid muscle

These muscles can act only if the hyoid

bone is fixed by the infra-hyoid muscles
CLOSURE : 3 muscles of mastication
• Masseter
• Temporal
• Medial pterigoid muscle
 PROPULSION - RETROPULSION

Related to a translation in
the disco-temporal compartment
PROPULSION  contraction of the 2
lateral pterigoid muscles

RETROPULSION  posterior part of the

temporal muscle
DIDUCTION (lateral movement)
Alternative role of both TMJ