temporomandibular joint
TRANSCRIPT
TEMPOROMANDIBULAR JOINT
Batallones, Amery Rose Galeno, Chris Carlo
Saunar, Maurice CheekzTalag,Bryan Matthew
Ursal, Alyssa MaeVillacorta, Aimee Carmina
INTRODUCTION TO TMJ(FUNCTION, FEATURES, CLASSIFICATION OF JOINTS)
Prepared by Chris Carlo M. Galeno
Temporomandibular Joint
• Craniomandibular Joint
• Articulation between the condylar head of mandible and the anterior part of the glenoid fossa of two temporal bones.
• Frequently termed as TMJ
Features of TMJ
• Coordinated movements of the right and left joints are complex and usually are controlled by reflexes.
• The maxillae and mandible carry teeth whose shape and position greatly affect the most closed portions of mandibular movements.
• Articulating surface of the TMJ is not formed of Hyaline cartilage but of a sturdy avascular fibrous layer.
• Only synovial joint in the human body with an articulating disc which is present between the joint surfaces of cranium and mandible which makes the TMJ a double joint.
Classifications of Joints
• Fibrous Joint
• Cartilaginous Joint
• Synovial Joint
Classifications of Joints
• Fibrous joints
• Suture- articulation by processes and indentation interlocked together
• Gomphosis- articulation by insertion of a conical process into a socket
• Syndesmosis- united by interosseous ligament
Classifications of Joints
• Cartilaginous joints
• Primary Cartilaginous
• Secondary Cartilaginous
Classifications of Joints
• Synovial joints– According to number of axes in which the bones involved can move:
• Uniaxial• Biaxial• Multiaxial or Polyaxial
– According to the shapes of the articulating surface:• Planar• Ginglymoid• Pivot• Condyloid• Saddle• Ball-and-socket
Fibrous: A-syndesmosis (tibiofibular), B-suture (skull). Cartilaginous: C-symphysis (vertebral bodies), D-synchondrosis (first rib and sternum). Synovial: E-condyloid (wrist), F-gliding (radioulnar), G-hinge or ginglymus (elbow), H-ball and socket (hip), I-saddle (carpometacarpal of thumb), J-pivot (atlantoaxial).
Hilton’s Law
• The principle that the nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles.
Type of joint of Temporomandibular Joint
• Synovial joint
• Described as synovial sliding-ginglymoid joint articulation
• Rotational movements• Translational movements
Innervation and Vascularization
• Sensory innervation from auriculotemporal and masseteric branches of mandibular branch of the trigeminal nerve
• Branches of the external carotid artery, predominately the superficial temporal branch, deep auricular artery, anterior tympanic artery, ascending pharyngeal artery, and maxillary artery
Specific Mechanics of Proprioception
• Ruffini endings
• Pacinian corpuscles
• Golgi tendon organ
• Free nerve endings
ANATOMY AND HISTOLOGY OF THE STRUCTURES INVOLVED IN THE TMJ
Prepared by: Maurice Cheekz A. Saunar
Anatomy of TMJ•Condyle of the Mandible•Mandibular Fossa/Glenoid Fossa/Temporoman-dibular Fossa
•Articular Surface Proper:
Articular DiscArticular Capsule
Ligaments
•Lateral Temporomandibular Ligament
•Sphenoparietal Ligament
•Stylomandibular ligament
•Stylohyoid Ligament
Synovial Tissue
-filled with Synovial Fluid
Function:-Lubricant
- Nutrition
- Regulatory
HISTOLOGY OF THE COMPONENTS OF TMJ
Condyle of the Mandible
• Composed of fibrous tissue
• Cells: Chondrocytes
Articular Disk
• Composed of fibroelastic connective tissue
Articular Capsule
Articular Tubercle
Fetal and Adult TMJ
DEVELOPMENT OF THE TMJPrepared by Aimee Carmina Villacorta
• Involves the development of the following structures– Mandible– Glenoid fossa– Condyle– Articular disc– Upper and lower joint cavity
Mandible
• Meckel’s Cartilage• Begins at week 6 to 7
• At week 12 of gestation:– temporal/ glenoid blastema
• Ossifies and becomes glenoid fossa – condylar blastema
• Becomes the condylar cartilage
• Clefts are formed– lower joint cavity– upper joint cavity
1. Primitive articular disc
2. Upper cleft3. Lower cleft4. Temporal
blastema5. Condylar
blastema
4
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1. Glenoid fossa2. Upper joint cavity3. Articular disc4. Lower joint cavity5. Condyle
Prepared by: Talag, Bryan Matthew E.
MUSCLES OF MASTICATION
Masseter
- Thick- Quadrilateral muscle- Superficial and deep portion
Masseter: Superior portion
Origin: thick, tendinous aponeurosis from the zygomatic process of the maxilla
Insertion: angle and lower half of the lateral surface of the ramus of the mandible
• its fibers pass downward and backward
Masseter: deep portion
• Smaller and more muscular in texture• Downward and forward• Partly concealed• Origin: posterior third of the lower border and
from the whole of the medial surface of the zygomatic arch
• Insertion: the upper half of the ramus and the lateral surface of the coronoid process of the mandible
Masseter
Temporal Muscle
• Broad• Radiating• Side of the head• Origin: Whole of the temporal fossa (except that
portion of it which is formed by the zygomatic bone)• Insertion: the medial surface, apex, and anterior
border of the coronoid process, and the anterior border of the ramus of the mandible nearly as far forward as the last molar tooth
Temporal muscle
Lateral pterygoid muscle
• A.k.a. pterygoideus externus or external pterygoid muscle
• Short• Thick• Conical• Upper and lower part
– Common insertion: depression in front of the neck of the condyle of the mandible, and into the front margin of the articular disk of the temporomandibular articulation.
Lateral pterygoid: Upper part
• Origin: lower part of the lateral surface of the great wing of the sphenoid and infratemporal crest
Lateral pterygoid: Lower part
• Origin: lateral surface of the lateral pterygoid plate
Lateral pterygoid
Medial pterygoid muscle
• A.k.a. pterygoideus internus or internal pterygoid muscle• Thick• Quadrilateral• downward, lateralward, and backward• Origin: medial surface of the lateral pterygoid plate and the
grooved surface of the pyramidal process of the palatine bone– Has a second slip of origin
• lateral surfaces of the pyramidal process of the palatine and tuberosity of the maxilla
• Insertion: lower and back part of the medial surface of the ramus and angle of the mandible, as high as the mandibular foramen
Medial pterygoid
Nerve supply
Mandibular branch of the trigeminal nerve
Action
• Temporalis, Masseter, and Medial pterygoid raise the mandible against the maxillæ with great force.
• Lateral pterygoid protrodes the mandible and the inferior incisors projectes in front of the upper antagonist– draw forward the condyle and articular disk – assists in opening the mouth– assisted by the Medial pterygoid
The posterior fibers of Temporalis retracts the mandible When Medial and Lateral pterygoid of one side act, the
corresponding side of the mandible is drawn forward while the opposite condyle remains comparatively fixed, and side-to-side movements. Such as occur during the mastication of food, take place.
SummaryMuscles of MasticationMuscle Origin Insertion Nerve Supply ActionMasseter Zygomatic arch Lateral surface
ramus of mandible
Mandibular division of
trigeminal nerve (V3)
Elevates mandible to occlude teeth
Temporalis Floor of temporal fossa
Coronoid process of mandible
Anterior and superior fibers elevate mandible: posterior fibers retract mandible
Lateral pterygoid(two heads)
Greater wing of sphenoidLateral pterygoid plate
Neck of mandibleArticular disc
Pulls neck of mandible forward
Medial pterygoid(two heads)
Tuberosity of maxillaLateral pterygoid plate
Medial surface of angle of mandible
Elevates mandible
Mandibular Positions
• Postural Position of Mandible
• Centric Occlusal Relation
• Right Lateral Occlusal Relation
• Left Lateral Occlusal Relation
• Protrusive Occlusal Relation
MOVEMENTS OF THE TMJPrepared by Alyssa Mae Ursal
Mandibular Positions• Postural Position
of Mandible
Free Way Space or
Vertical Dimension
of Rest
Mandibular Positions
• Postural Position of
Mandible
• Centric Occlusal
Relation
• Right Lateral Occlusal
Relation
• Left Lateral Occlusal
Relation
• Protrusive Occlusal
Relation
Mandibular Positions
• Postural Position of
Mandible
• Centric Occlusal Relation
• Right Lateral Occlusal
Relation
• Left Lateral Occlusal
Relation
• Protrusive Occlusal
Relation
Mandibular Positions
• Postural Position of
Mandible
• Centric Occlusal Relation
• Right Lateral Occlusal
Relation
• Left Lateral Occlusal
Relation
• Protrusive Occlusal
Relation
Mandibular Positions
• Postural Position of
Mandible
• Centric Occlusal Relation
• Right Lateral Occlusal
Relation
• Left Lateral Occlusal
Relation
• Protrusive Occlusal
Relation
Mandibular Movements
• Classification:
Border Movements
Intraborder Movements
Contact Movements
Free Movements
Mandibular Movements
• Classification:
Border Movements
Intraborder Movements
Contact Movements
Free Movements
Mandibular Movements
• Classification:
Border Movements
Intraborder Movements
Contact Movements
Free Movements
Mandibular Movements
• Classification:
Border Movements
Intraborder Movements
Contact Movements
Free Movements
Mandibular Movements
• Right Lateral Movement
• Left Lateral Movement
• Protrussive Movement
• Retrussive Movement• Bennett Movement
Mandibular Movements
• Right Lateral Movement
• Left Lateral Movement
• Protrussive Movement
• Retrussive Movement• Bennett Movement
Mandibular Movements
• Right Lateral Movement
• Left Lateral Movement
• Protrussive Movement
• Retrussive Movement
• Bennett Movement
Mandibular Movements
• Right Lateral Movement
• Left Lateral Movement
• Protrussive Movement
• Retrussive Movement
• Bennett Movement
Mandibular Movements
• Right Lateral Movement
• Left Lateral Movement
• Protrussive Movement
• Retrussive Movement
• Bennett Movement
Envelope of Mandibular Motion (by
Posselt)Lateral View
Superior View
Frontal View
CLINICAL CONSIDERATIONSPrepared by Amery Rose Batallones
Clinical Considerations
• Bruxism • Arthritis• Fractures • Structural Changes• Disharmony in the
relation of teeth and the TMJ
Clinical Considerations• Myofacial Pain
Dysfunction Syndrome
• Luxation or Dislocation of Temporomandibular Joint
• Ankylosis• Aplasia• Hyperplasia• Hypoplasia
Thank you!