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Temporomandibular Joint TEMPOROMANDIBULAR JOINT Lecture by: Dr. Suhasini G P Lecturer Dept. of Oral Pathology & Microbiology Dr. Suhasini GP, Subharti Dental College, SVSU Dr. Suhasini GP, Subharti Dental College, SVSU Temporomandibular Joint • The area where the craniomandibular articulation occurs is called the temporomandibular joint • Articulation is defined as a loose joining or connecting together so as to allow motion between the parts. • When the two objects are the bones of a skeleton, the articulation is called a Joint. • One of the most complex joints in the body Dr. Suhasini GP, Subharti Dental College, SVSU • Provides for hinging movement in one plane- ginglymoid • However, at the same time it also provides for gliding movements, which classifies it as an arthroidal joint. • Thus, technically considered a ginglymoarthroidal joint. • By definition, a compound joint requires the presence of at least 3 bones, yet the TMJ is made up of only 2 bones. Functionally, the articular disc functions as a 3rd bone- compound joint Dr. Suhasini GP, Subharti Dental College, SVSU • Temporomandibular joint • Craniomandibular joint • Bilateral diarthrodial joint • Atypical synovial joint • Compound joint • Ginglymoarthrodial joint • Modified ball socket joint Dr. Suhasini GP, Subharti Dental College, SVSU CLASSIFICATION OF JOINTS • Fibrous • Cartilaginous • Synovial Dr. Suhasini GP, Subharti Dental College, SVSU Fibrous joints • In fibrous joint 2 bones are connected by fibrous tissue. They are 3 types: • 1. Sutures: Its function is to permit growth as its articulating surfaces are covered by osteogenic layer responsible for new bone formation. It permits little or no movement. Eg- skull bones • 2. Syndesmoses: Two bony compartments are apart from each other but are joined by an intraosseous ligament. It permits limited movement. Eg- b/n tibia & fibula, b/n radius & ulna Dr. Suhasini GP, Subharti Dental College, SVSU Fibrous joints • 3. Gomphoses: It is the joint that gives socketed attachment of tooth to bone by fibrous periodontal ligament. Movement is restricted to intrusion and recovery in response to biting force. Dr. Suhasini GP, Subharti Dental College, SVSU Cartilaginous joints • Primary cartilagenous joint : Bone and cartilage are in direct apposition. eg - costochondral junction • Secondary cartilagenous : Tissues in articulation occur in sequence as bone- cartilage-fibrous tissue-cartilage-bone. eg – pubic symphysis Dr. Suhasini GP, Subharti Dental College, SVSU Synovial joints • In a synovial joint, which generally permits significant movement, two bones (each with an articular surface covered by hyaline cartilage) are united and surrounded by a capsule that thereby creates a joint cavity. This cavity is filled with synovial fluid formed by a synovial membrane that lines the nonarticular surfaces. They are classified as under : A. On the number of axis in which bones involved can move – uniaxial ,biaxial, multiaxial. B. By the shapes of articulating surfaces – planar, gingylmoid, pivot, condyloid, saddle, ball and socket. Dr. Suhasini GP, Subharti Dental College, SVSU Dr. Suhasini GP, Subharti Dental College, SVSU DEVELOPMENT • PRIMARY JOINT- exists for about 4 MONTHS • MALLEUS AND INCUS • SECONDARY JAW JOINT – at about 3 MONTHS of gestation it appears. • TEMPORAL BLASTEMA • CONDYLAR BLASTEMA Dr. Suhasini GP, Subharti Dental College, SVSU Dr. Suhasini GP, Subharti Dental College, SVSU ANATOMY OF THE TEMPOROMANDIBULAR JOINT • Articular fossa • Mandibular condyle • Articular disc • Articular Capsule • Ligaments of TMJ Dr. Suhasini GP, Subharti Dental College, SVSU Dr. Suhasini GP, Subharti Dental College, SVSU Glenoid fossa / Articular Fossa/ Mandibular fossa • Concave shape depression in squamous part of temporal bone Post. Squamo & pterygo tympanic fissure Medial spine of sphenoid Lateral root of the zygomatic process of the temporal bone Anterior ridge of bone (articular eminence) Middle part- thin, upper surface forms the middle cranial fossa Dr. Suhasini GP, Subharti Dental College, SVSU Condyloid process • It is the portion of the mandible that articulates with the cranium around which movement occurs • Anterior view- it has a medial and lateral projections which are called as poles • ML length - 15 to 20 mm • AP length - 8 to 10mm. Dr. Suhasini GP, Subharti Dental College, SVSU Condyloid process • Posterior articulating surface is greater than anterior surface. • The articulating surface of condyle is quite convex anteroposteriorly and only slightly convex mediolaterally. • Pterygoid fovea on the antero-medial aspect of the mandibular neck where inferior head and most fibres of the superior head of lateral pterygoid muscle insert on the mandible. Dr. Suhasini GP, Subharti Dental College, SVSU HISTOLOGY OF THE ARTICULAR SURFACES • Articular surface of the condyle (and the mandibular fossa) are composed of 4 zones 1. Superficial layer- articular zone – Unlike most other synovial joints, this articular layer is made of dense fibrous CT, rather than hyaline cartilage – Tightly packed Col fibers –arranged parallel to the articular surafce – Advantage of fibrous covering over hyaline cartilage- less susceptible to aging effects, less likely to break down over time, better repairing ability Dr. Suhasini GP, Subharti Dental College, SVSU 2. Proliferating layer - cellular -responsible for proliferation of articular cartilage in response to functional demands placed on articular surface -undifferentiated mesenchymal cells found Dr. Suhasini GP, Subharti Dental College, SVSU 3.Fibrocartilagenous zone -Collagen fiber bundles in crossing pattern - fibrocartilage in random orientation , provides 3 dimensional network that offers resistance against compressive & lateral forces 4. Calcified zone -deepest zone, made up of chondrocytes &chondroblasts distributed throughout the articular cartilage - chondroblasts become hypertrophic, endochondral ossification occurs, loss of chondrocytes, differentiation of osteoblasts Dr. Suhasini GP, Subharti Dental College, SVSU Dr. Suhasini GP, Subharti Dental College, SVSU • Condyle of mandible- cancellous bone covered by a thin layer of compact bone • Trabeculae are grouped in such a way that they radiate from neck of mandible & reach cortex at right angles; max. strength to condyle • Large marrow spaces decrease in size with progressing age • Red marrow in the condyle is of the myeloid type Dr. Suhasini GP, Subharti Dental College, SVSU CARTILAGE • Condylar cartilage • Proliferative layer of replicating cells functioning as progenitor cells for growth of cartilage chondroblasts type II collagen (extracellular matrix of cartilage) • Endochondral ossification • Mineralized cartilagenous framework is formed Dr. Suhasini GP, Subharti Dental College, SVSU • Fibrous layer covering the articular surface of temporal bone- thin in articular fossa thick on post. slope of articular surfaces in thickened region – fibrous tissue is arranged in 2 layers Dr. Suhasini GP, Subharti Dental College, SVSU ARTICULAR DISC • Dense fibrous connective tissue devoid of blood vessels and nerves • Plate of flexible dense connective tissue • Bi-concave 1-2mm thick in centre & 3-4mm thick at its periphery • Devoid of blood vessels and nerves in the centre • Vascular peripherally • Divides joint cavity into upper & lower compartment Dr. Suhasini GP, Subharti Dental College, SVSU • Sagittal plane divided into 3 regions according to the thickness • Central area is thinnest and it is called intermediate zone • Anterior and posterior - thick • Articular surface of the condyle located on the intermediate zone of the disc bordered by the thicker anterior and posterior regions • Shape of the disc governed by the morphology of the condyle and the mandibular fossa Dr. Suhasini GP, Subharti Dental College, SVSU Articular disc Dr. Suhasini GP, Subharti Dental College, SVSU • The articular disc is attached posteriorly to the region of loose connective tissue that is highly vascularized and innervated which is called as retrodiscal tissue or posterior attachments or bilaminar region. – Superior retrodiscal lamina is fibrous & elastic that attaches AD posteriorly to tympanic plate – Inferior retrodiscal lamina is non-elastic that attaches AD to posterior margin of articular surface of the condyle Dr. Suhasini GP, Subharti Dental College, SVSU Anterior region of the disc is attached to the capsular ligament .Superior attachment is to the anterior margin of the articular surface of temporal bone .Inferior attachment is to the articular surface of the condyle The articular disc is attached to the capsular ligament not only anteriorly and posteriorly and also medially and laterally this divides the joint into two distinct cavities. Dr. Suhasini GP, Subharti Dental College, SVSU ARTICULAR DISC HISTOLOGY • In young adults -Disc is composed of dense fibrous tissue interlacing fibres are straight & tightly packed elastic fibres found in small no. -Fibroblasts in the disk are elongated and send cytoplasmic processes b/w bundles Dr. Suhasini GP, Subharti Dental College, SVSU • Chondrocytes, with typical territorial matrices stains heavily with basic dyes • increase the resistance & resilience of fibrous tissue • Fibrous tissue covering articular eminence & condyle & in central area of the disc -- Avascular, no nerves -- Limited reparative ability Dr. Suhasini GP, Subharti Dental College, SVSU JOINT CAPSULE Fibroelastic sac – ascending slope of the articular eminence anteriorly – Squamotympanic fissure posteriorly – Glenoid fossa superiorly – Neck of the condyle inferiorly
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