The Temporomandibular Joint & Jaw Bones

TMJ
Type:
ginglymoarthrodial synovial joint (modified hinge joint) Ginglymus: hinge Arthrodial: plane

1st movement: rotational

2nd movement: gliding or translational

Articulations:
Head of mandibular condyle

Ant. Part of Mandibular fossa Of temporal bone & Articular tubercle of

*articular surfaces fibrocartilage

Supporting Ligaments
Main (Intrinsic) Articular fibrous capsule surrounds the J. attached sup.: margins of the mandibular fossa inf.: neck of the mandible Lat. (TM) Lig.: runs downwards backwards between the articular tubercle & the neck of the mandible prevents the posterior dislocation of the joint protects the structures behind the joint (the tympanic plate)

Most of the dislocations of the TMJ occur anteriorly because there is no ligament to prevent this

Accessory (Extrinsic) Stylomandibular lig.: extends between the styloid process & the angle of the mandible thickened part of the investing layer of deep cervical fascia - Determines the extension of protrusion Sphenomandibular lig.: lies on medial side & extends between the spine of sphenoid & the lingula - Protects the inferior alveolar nerve & limits the lateral movements of the mandible 3. Is there any other lig.?? - The pterygomandibular ligament

*define the extents of Mandibular movements

The Articular Disc

Oval plate of fibrocartilage that is located between articular surfaces of TMJ

Ant. & post. Bands

Attachments periphery: to the fibrous capsule ant.: to the lateral pterygoid muscle & the head of the mandible post.: to the postglenoid tubecle of temporal bone & the neck of the mandible * The disc divides the Joint cavity into 2 compartments: Sup. & Inf.

Additional slide
The special characteristics of the TMJ : 1- The type of the articular cartilage on the surface of the (mandibular condyle, mandibular fossa & articular tubercle tubercle) is fibrocartilage rather than hyaline cartilage(because of the continuous movement) 2- The articular disc 3- The extrinsic ligaments

Additional slide
There are two compartments in the TMJ cavity to specialize the movements of the TMJ (two cavities two different movements) : - The rotational movements : in the inferior compartment - The translational movement : in the superior compartment The superior compartment : between the mandibular fossa & the articular disc The inferior compartment : between the articular disc & the mandibular condyle

Movements
1. Depression of mand. (mouth opening) 3 muscle groups : - Lateral pterygoid - Suprahyoid group - Infrahyoid group * Main mover : the action of the gravity - Those muscles act against resistance 2. Elevation: (mouth closing) 3 muscles: - Masseter - Medial pterygoid - The vertical fibers of temporalis

3. Protrusion: (forwards) 3 muscles : - Anterior part of masseter - Anterior part of medial pterygoid - Lateral pterygoid main one : lateral pterygoid 4. Retrusion, Retraction: (backwards) by the posterior (horizontal) fibers of temporalis 5. Lat. Movement to the sides: by the medial & lateral pterygoid muscles of the opposite side

Movements of Mouth Opening

Involves 2 kinds of movement:

1. Rotation: condyle & lower surface of articular disc ( compartment) 20o (hinge)
2. Translation: condyle & disc articular tubercle until the head of the mandible & the articular disc are located inferior to the tip of the articular tubercle (gliding)

Relations of TMJ

Ant.: masseteric a. & n. - artery : from the 2nd part of the maxillary artery - Nerve : from the anterior division of the mandibular nerve - Those go through the mandibular notch Post.: - glenoid process of the parotid gland - tympanic plate of EAM - superfacial temporal artery & vein - auriculotemporal nerve Lat.: parotid gland Med.: max. Vessels & auriculotemp. N.

Dislocation of TMJ
The head of the mandible moves ant. To the articular tubercle mandible is depressed & the pt. cannot close his mouth Cause: excessive contraction of lat. Pterygoid m. as in: taking a large bite over opening for the dentist

Rx.: pressure the mandible inf. Then post. by grasping the mandible with your thumbs over lower dentition

Clicking of TMJ
When the post. Band of articular disc is anteriorly displaced (in front of mand. Condyle) *As the pt. opens his mouth: the displaced disc, at a certain point, returns to its normal position producing the click sound in the joint Ant. Displacement with reduction

Anterior Displacement Without Reduction

The disc remains anteriorly displaced as the mouth is opening - the pt. cannot fully open his mouth - Grinding sounds are present - sometimes perforation of the disc may happened

The Jaw Bones

Maxilla
Body & 4 Processes Body pyramidal hollow inside (max. sinus) - Upper surface: the floor of the orbit (infraorbital) - Anterolateral surface: in the face - Posterolateral surface: in the infratemporal fossa - Medial surface: the lateral surface of the nasal cavity

Maxillary Processes
Zygomatic: projects lat., ant. zyg. Arch

Frontal: sup., lat. to nasal bones

Alveolar: inf., contains upper teeth Palatine: post., ant. 2/3 of hard palate

Maxillary Foramina
2 foramina: Infraorbital F. ant. wall, infraorbital n. & a. Incisive Foramen: between palatine processes post. to central incisors incisive n. (nasopalatine n.)

Mandible
Largest & strongest facial bone

Only movable skull bone beside The ear ossicles

Horizontal part: Body Vertical Parts: Rami (ramus) Jxn.: Angle

Body: mental foramen (below the 2nd premolar) alveolar process mental protuberance sup. & inf. Mental spines (attached to genioglossus & geniohyoid, respectively) mylohyoid line (demarcates the floor of the mouth) Ramus: mandibular notch coronoid process condylar process: head & neck lingula & mand. foramen

Mention 8 muscles attached to the mandible ?

Mention 8 muscles attached to the mandible ?

-Temporalis

- Masseter
- Medial pterygoid - Lateral pterygoid - Genioglossus - Geniohyoid - Mylohyoid - Anterior beally of digastric

Done by : Muad Al-Zoubi Best wishes