The document discusses the anatomy and surgical approaches of the temporomandibular joint (TMJ). It begins with the introduction and then describes the anatomy of the TMJ in detail, including its cranial and mandibular components, capsule, ligaments, articular disk, blood supply, nerve supply and movements. It then discusses various surgical approaches to the mandibular condyle and neck, such as the postauricular, endaural, submandibular, postramal, preauricular and coronal approaches. The preauricular approach is considered the most basic and standard while the coronal approach provides the most extensive access.

1. DR DAVIS
NADAKKAVUKARAN

2.  INTRODUCTION
 ANATOMY OF TMJ
 RELATIONS OF TMJ
 BLOOD SUPPLY
 NERVE SUPPLY
 MOVEMENTS
 SURGICAL APPROACHES TO MANDIBULAR
CONDYLE AND ITS NECK

3.  Temporomandibularjoint is the articulation between
squamous part of the temporal bone and the head of
the mandibular condyle.
 It is also known ascraniomandibular joint.
 a type of synovial andginglymodiarthrodial type of
joint.

4.  ARTICULATORY SYSYTEM:
Temporomandibularjoint
Masticatory and accessory muscles
Occlutionof teeth

6. CRANIAL COMPONENT – GLENOIDFOSSA
 Also called as mandibular fossa
 It is an anterior articular area formed by inferior
aspect of temporal squama.
 smooth oval and deeply hollowed out.
 Roof : creates a partition between middle cranial
fossa and the joint.
 Lined by dense avascular fibrocartilage.

8. MANDIBULAR COMPONENT–
MANDIBULAR CONDYLE
Articular part of the mandible is an ovoid
condylar process
 covered by fibrocartilaginous tissue .

10. TMJ CAPSULE
It is a thin sleeve of fibrous tissue investing
the joint completely.
It is attached aboveanteriorly to the anterior
border of articular eminence and posteriorly
to the lip of squamotympanic fissure .

11. LIGAMENTS
A . Lateral ligament :it reinforces andstrengthens the
lateral part of capsular ligament.
 andalso limits the anterior excursion of jawand
posterior dislocation and hence calledcheck ligament of
TMJ.
 Composed of collagenous fibers directeddownwards
and backwards to the external and posterior side of
condylar necks.

13. B . Accessory ligaments :
i) sphenomandibular ligament: a remnant of
meckel’s cartilage.
- it is an important landmark during surgery as
internal maxillary artery and auriculotemporal
nerve lies between it and mandibular neck.
ii) Stylomandibular ligament : it is a thick band of deep
cervical fascia from styloid process to mandibular
angle.

14.  ARTICULAR DISK OR MENISCUS
 The meniscus divides thearticular space into two
compartments:
Lower or inferior compartment: between
condyle and disk.
Upper or superior compartment: between disk
and glenoid fossa.

16.  Anteriorly: attached to articular eminence above and
articular margin of condyle below.
 Posteriorly: to posterior wall of glenoid fossa above
and neck of condyle below- this area is called posterior
bilaminar zone rich in neurovascular supply.
 Disk has 3 zones (Rees 1954) :
posterior band
intermediate zone
anterior band

18.  Histologicallydisk is made of firmly woven
avascular connective tissue .
 It is designed to transmit the forces generated
through condyle to the articular eminence.
 It promotes lubrication and is a main shock
absorber.

19. RELATIONS OF TMJ
• Lateraly : skin , parotid gland , temporal
branches of facial nerve
• Medialy : tympanic plate, spine of sphenoid ,
auriculotemporal and chorda tympani nerves
• Anteriorly : lateral pterygoid , massetric nerve
and artery.

20. • Superiorly : middle cranial fossa , middle meningeal
vessicles.
• Inferiorly : maxillary artery andvein

22.  NERVE SUPPLY
• Auriculotemporal nerve and massetric nerve

23.  MOVEMENTS
 Jaw opening (depression) : dominated by
digastricmuscle contraction assisted by
suprahyoid, sternohyoidand geniohyoid muscle.
 Lateral pterygoid- pull the condylar head
downwardand forward
 Jaw closure (elevation) : due to contraction of
masseter medial pterygoid and temporalis
muscles.

25.  Protrusive movement : contracture of lateral and
medial pterygoid muscles
 Retrusion : by posterior fibres of temporalis
muscle assisted bymasseter , digastric and
geniohyoidmuscle.
 Lateral movements : due to unilateral contacture
of medial and lateralpterygoid muscles on each
side acting alternatively.

27. SURGICAL APPROACHES TO MANDIBULAR
CONDYLE AND ITS NECK
 Postauricular approach :-
 The incision is taken behind the external ear in the
crease near the superior aspect of externalpinna and
extended to the tip of the mastoid process
 highly cosmetic incision
 disadvantages: small surgical exposure with poor
visibility,stenosisof external auditory meatus,
parasthesia of external pinna and deformity of
auricle.

28.  Endaural approach:-
 Short facial skin incision with extension in to
external auditory meatus .
 incision begins above the level of zygomatic arch
and extends downward to tragus and then extend
along the roof of auditory meatus.
 excellent cosmetics but limited access and possibility
of meatal stenosis.

30. Submandibular(risdon) approach :-
• incision is taken about 1 cm below the angle of the
mandible. It extends forwards and parallel to the
border of mandible and curves downward behind the
angle.
• aproach to neck of condyle and ramus is achieved by
sharply incising throughpterygomassetric sling and
reflecting themasseter muscle.
• poor access to the condylar head region.

32. Postramal (hind) approach:-
• incision is placed 1 cm behind the ramus and
extends 1 cm below the ear lobe.
• Parotidomassetric fascia is seperated and
posterior border of ramus is exposed.then the
pterigomassetricsling is incised at the angle and
massetricmuscle and parotid gland are reflected
upward to expose the neck ofcondyle.

33.  perforationof posterior facial veinand injury to the
maintrunk of facial nerve is avoided.

34. Preauricular approach:-
• most basic and standard approach to TMJ.
• Incision is made on preauricular area to the depth
of superficial layer of temporalis fascia.
• Blunt dissection withperiosteal elevator is made.
The flap is retractedanteriorly and an oblique
incision is made through the superficial layer of
temporalisfascia

35.  Modifications of preauricular incision:
 Blair’s approach-inverted hockey stick incision
 Thoma’s approach-angulated vertical incision
 Popowich’s modification of Al-kayat and Bramley.
Advatages:
> reduction in incidence of facial nerve palsy
> Decreased heamorrhage
> excellent visibility
> good cosmetic results

37. Coronal Approach:-
 More extensive
 But versatile approach to upper and middle
region of the facial skeleton includingzygomatic
arch and tmj joint areas
 It provide excellent access with minimum
complications

39. REFERANCE
Textbook of oral and maxillofacial surgery-
NeelimaAnil malik
Human anatomy- B D Chaurasia