The document provides an overview of the temporomandibular joint (TMJ), detailing its unique features, components, and significance in maxillofacial surgery. It highlights the joint's structure, functions, and various surgical approaches to address TMJ issues. Additionally, it emphasizes the importance of understanding TMJ anatomy for successful surgical interventions.

1. GOOD MORNING

2. Presented by :
Dr. Samarth Johari
(P.G 1st year)
Guided by :
Dr. Gagan Khare
(Professor)
TEMPOROMANDIBULAR JOINT
(Department of Oral & Maxillofacial Surgery)

3. CONTENTS
Introduction
Unique Features of TMJ
Components Of TMJ
Vasculature Of TMJ
Relation Of TMJ
Surgical Approaches To TMJ
Conclusion
References

4. INTRODUCTIO
N
 TMJ is a ginglymoarthroidal joint
ginglymus + arthrodia
Hinge joint
allowing
backward &
forward
motion only
Joint that
allows gliding
motion of the
surfaces

5. TMJ as a Compound Joint
Anatomically Functionally
• Diarthroidal joint
• Synovial joint
• Has fibrous connective
tissue capsule tightly
attached to bones
• Compound joint
composed of 4
articulating surfaces

6.  Anatomically –
• Diarthroidal Joint :
 Discontinuous articulation of 2 bones
Permitting free movement produced by
associated muscles & limited by
Ligaments
• Synovial Joint :
 Lined by synovial membrane on
inner aspect which secretes synovial fluid
Acts as a lubricant and provides metabolic & nutritional needs
non vascularized internal joint structures

7.  Funtionally –
• Composed of 4 articulating surfaces :
 Articular facets of temporal bone
 Mandibular condyle
 Superior surface of articular disc
Articular Disc
 Inferior surface of articular disc
Divides the joint into 2 compartments
1. Lower compartment – permits hinge motion &
rotation (ginglymoid)
2. Superior compartment – permits sliding/transltory
motion (arthroidal)
Ginglymoarthroidal
joint

9. UNIQUE FEATURES OF
TMJ
 Bilateral diarthrosis – right & left function together
 Articular surfaces covered by fibrocartilage instead of hyaline
cartilage
 Only joint of human body having rigid endpoint of closure (teeth
making occlusal contact)
 Last joint to start developing (in 7th week of I.U life)

10. COMPONENTS
OF TMJ
I. Mandibular Condyle
II. Articular Surfaces Of Temporal Bone
III. Cartilage and Synovium
IV. Articular Disk
V. Muscular Components
VI. Ligaments

11. I. MANDIBULAR CONDYLE :
• An ovoid process located above the mandibular neck
• It is the articulating surface of the
mandible
• Convex in all directions
but wider latero-medially
(15-20 mm) than
antero-posteriorly (8-10 mm)
• Has a medial & lateral
pole

12. Medial Pole
 Directed more posteriorly
 If long axes of 2 condyles are
extended medially, they meet
at basion on anterior limit of
foramen magnum
 Forms an angle ranging from
145º to 160º
 Extends sharply inward from
plane of ramus

13. Lateral pole
 Rough, bluntly pointed
 Articular surface lies on its
antero-superior aspect, facing
posterior slope of articular
eminence of temporal bone
 Projects moderately form
plane of ramus

14. II. ARTICULAR SURFACE OF TEMPORAL BONE :
• Situated on inferior aspect of temporal squama anterior to
tympanic plate
• Comopsed of 3 parts –
a.) Articular fossa or mandibular fossa
b.) Articular eminence
c.) Preglenoid plane

15. Mandibular Fossa
 Largest
 Concave structure extending
from posterior slope of
articular eminence to
psotglenoid fossa (ridge
between fossa & external
acoustic meatus)
 Surface is thin
 Not a major stress bearing
area

16. Articular Eminence
 Transverse bony prominence
that is continuous across
articular surface mediolaterally
 Thick & serves as major
functional component

18.  It is a flattened area anterior
to the articular eminence
Preglenoid Plane
 Articular tubercle is a
nonarticulating process on lateral
aspect of zygomatic root of
temporal bone
 Serves as point of attachment of
collateral ligaments

19. III. CARTILAGE AND SYNOVIUM :
• Inner aspect of the joint is lined by two types of tissues :
a.) Articular Cartilage
b.) Synovium
• Space bound by these two structures
synovial cavity
filled with synovial fluid

20. • Both articular surfaces of temporal bone & condyle are
covered by dense articular fibrocartilage
Capacity to regenerate & to remodel under functional
stress

21. • Lining of capsular ligament – synovial membrane
thin, smooth, richly innervated vascular tissue
without epithelium
Synovium is capable of rapid & complete regeneration following
injury
• Synovial fluid contains high concentration of hyaluronic acid
(reason for viscous nature of fluid)
• Other contents of fluid – high % of albumin & low % of -2-
globulin, alkaline phosphatase, leucocytes (<200/cubic mm)

22. Functions Of Synovial Fluid
 Lubrication of joint
 Phagocytosis of particulate debris
 Nourishment of articular cartilage

23. IV. ARTICULAR DISK :
• Composed of dense fibrous connective tissue
• Non-vascularized & non-innervated
• Adapted to resist pressure
• 3 anatomic parts of disk
as viewed from lateral
aspect-
a.) anterior band
b.) central intermediate
zone
c.)posterior band

24. • Intermediate zone is thinnest & generally the area of
function between mandibular condyle and temporal bone
• Disk is flexible & adapts to functional demands of articular
surfaces
• Attached to capsular ligament anteriorly, posteriorly, medially
& laterally
• Some fibres of superior head of lateral pterygoid muscle
insert on the disk at its medial aspect
This stabilizes the disk to mandibular condyle during function

25. V. MUSCULAR COMPONENTS :
• Total 12 bilateral muscles influence mandibular motion & are
divided into 2 groups by anatomic position -
SUPRAMANDIBULAR
GROUP
 Attaches to ramus & condylar neck
 Consists of :
a.) temporalis
b.) masseter
c.) medial pterygoid
d.) lateral pterygoid
 Predominantly acts as elevator, however,
lateral pterygoid has depressor action also

26. INFRAMANDIBULAR
GROUP
 Attaches to body & symphyseal area &
hyoid bone
 Consists of :
I. suprahyoid muscles (attach to both
hyoid bone & mandible) -
a.) digastric
b.) geniohyoid
c.) mylohyoid
d.) stylohyoid
II. Infrahyoid muscles –
a.) sternohyoid
b.) omohyoid
c.) sternothyroid
d.) thyrohyoid
Suprahyoid muscles depress
mandible when hyoid bone is
fixed & elevate hyoid bone
when mandible is fixed
Infrahyoid muscles fix hyoid
bone during depressive
movements of mandible

27. LATERAL PTERYGOID & MEDIAL
PTERYGOID MUSCLES

28. MASSETER MUSCLE TEMPORALIS MUSCLE

30. VI. LIGAMENTS :
• Composed of collagen
• Act as restraints to motion of condyle & disk
2 sets of
ligaments
Functional Accessory

31. FUNCTIONAL LIGAMENTS
 Serve as major anatomic
components of joints
 Types of functional ligaments
:
• Collateral
• Capsular
• Temporomandibular
ACCESSORY LIGAMENTS
 Serve as passive restraints
on mandibular motion
 Types of accessory
ligaments :
• Sphenomandibular
• Stylomandibular

32. COLLATERAL LIGAMENTS
 k/a diskal ligaments
 Attaches disk to lateral & medial
poles of each condyle
 Function – restrict movement of
disk away from condyle
 Permit rotation of condyle but
forces disk to accompany condyle
during translatory motion

33. CAPSULAR LIGAMENTS
 Attaches joint superiorly to temporal bone
(mandibular fossa & eminence) & inferiorly to
neck of condyle (along edge of articular facet)
 Surrounds joint spaces & disk
 Attaches anteriorly, posteriorly, medially,
laterally
 Blends with collateral ligaments
 Function – resist medial, lateral & inferior
forces
 Contains synovial fluid in superior & inferior
joint spaces

34. TEMPOROMANDIBULAR LIGAMENTS
 k/a lateral ligaments
 Located on lateral aspect of each TMJ
 Single structures that function in
paired manner with corresponding
ligament on opposite TMJ
 Divided into – outer oblique portion
inner horizontal
portion

35. SPHENOMANDIBULAR
LIGAMENTS
 Arises from spine of sphenoid
bone
 Descends into fan like insertion
on lingual & lower portion of
medial side of condylar neck
 Serves as point of rotation
activation of lateral pterygoid
muscle
 Helps in translation of mandible

36. STYLOMANDIBULAR
LIGAMENTS
 Descends from styloid process
to posterior border of angle of
mandible
 Blends with fascia of medial
pterygoid muscle
 Functions similar to
sphenomandibular ligament
 Limits excessive protrusion of
mandible

38. VASCULATURE OF TMJ
 Nerve supply of TMJ :
a.) Auriculotemporal Nerve –
(i) runs below and behind
the joint
(ii) supplies posterior,
medial & lateral parts
of joint

39. b.) Nerve To Masseter –
sends a twig to the joint

40. c.) Deep Temporal Nerve –
supplies anterior parts of
the joint

41.  Arterial Supply Of TMJ :
only superficial blood supply of
the joint is present
no blood supply inside the
capsule
takes nourishment from
synovial fluid
superficial blood supply is by
branches of external carotid
artery –
a.) Superficial Temporal Artery b.) Deep auricular Artery
c.) Anterior Tympanic Artery d.) Maxillary Artery
e.) Ascending Pharyngeal Artery

42.  Venous Supply Of TMJ :
a.) Maxillary Vein
b.) Transverse Facial Vein
c.) Superficial Temporal
vein

43. RELATION OF TMJ
 Anteriorly :
a) Mandibular notch
b) Lateral pterygoid
c) Masseteric nerve & artery

44. Applied Anatomy Of Masseteric Nerve
A careful dissection of 16 intact human
cadaveric head specimens revealed The
location of the masseteric artery was then
determined in relation to 3 points process:
1) the anterior-superior aspect of the
condylar neck = 10.3 mm;
2) the most inferior aspect of the articular
tubercle = 11.4 mm;
3) the inferior aspect of the sigmoid notch =
3mm
Journal of Oral and Maxillofacial Surgery.
2009;67 (2) : 369–371

45.  Posteriorly :
a) Superficial temporal vessels
(ligated during pre-auricular
approaches)
b) Parotid gland
c) Auriculotemporal nerve

46.  Laterally :
a) Skin & fascia
b) Parotid gland
c) Temporal branches of facial nerve

47. Applied Anatomy Of Facial Nerve
 Exits skull at stylomastoid formen
 Incise the superficial layer of
temporalis fascia & periosteum
over arch within 8mm boundary,
to prevent damage to branches of
upper trunk
Classic Article By Alkayat & Bramely
(1980)

48.  Medially :
a) Tympanic plate (separates from ICA)
b) Spine of sphenoid
c) Auriculotemporal & chorda
tympani nerve
a) Middle meningeal artery

49. Applied Anatomy Of
Auriculotemporal Nerve
 1st branch of 3rd division of
trigeminal nerve
 Exits from foramen ovale
 Runs medial to lateral behind
neck of condyle
 Sensory supply to skin in
temporal & preauricular region &
innervates capsule of TMJ
 Can be damaged while
approaching to TMJ

50. SURGICAL APPROACHES TO TMJ
Operator
• Humphrey
• Ricdel
• Annandale
Procedure
• Condylectomy
• Meiscectomy
• Disk Repositioning
Year
• 1856
• 1883
• 1887

51.  Preauricular
 Endaural
 Postauricular
 Rhytidectomal
 Retromandibular
 Intraoral
Types Of Surgical Approaches To TMJ

52.  Basic incision given by
Dingman in 1951
 No extensive shaving is
required
 Margin of only 1cm from
superior aspect of incision is
adequate
 Inverted hockey stick
incision that follows natural
crease in front of tragus
Preauricular Approach

53.  Cosmetic modification or
preauricular approach
 Incision is placed on
prominence of tragus itself
 Tragal cartilage has to be
protected to prevent
perichondritis
Endaural Approach

54.  Popularised by Walter’s &
Geist in 1983
 Disadvantages :
(i) Auricular Stenosis
(ii) Can not be used in
cases of joint infection &
chronic otitis externa
 Advantages :
(i) Excellent exposure to
complete joint
(ii) Ability to camouflage
scar
Postauricular Approach

55.  Used in cases where extensive
joint exposure is required e.g
major tumor resections
 Endaural incision is extended
in curvilinear fashion around
mastoid tip & S - shaped
incision ending in
submandibular incision
 Allows access to posterior
border of mandible & allows
to locate main trunk of facial
nerve
Rhytidectomy Approach

56.  Used for neck of condyle &
ramus region
 Supplemets different TMJ
approaches for tunneling
through soft tissue for placing
grafts
 Marginal mandibular branch of
facial nerve & retromandibular
vein have to be protected
Retromandibular Approach

57. CONCLUSION
The applied anatomy of
temporomandibular joint has many
significant applications in maxillofacial
surgery. Understanding these
important anatomic relations-
variations enables surgeons to perform
the surgical procedures safely.
Knowledge of these concepts helps us
to recognize the problems and
complications as and when they occur
and manage them accordingly.

58. REFERENCES
 Colour Atlas Of Temporomandibular Joint Surgery by Peter D. Quinn
 Oral Anatomy by Sicher and DuBrul
 Gray’s Anatomy
 Oral & Maxillofacial Surgery by Fonseca
 Atlas of Operative Maxillofacial Trauma Surgery by Springer
 Peterson’s Principles Of Oral & Maxillofacial Surgery