Advertisement

Anatomy and Variations of the Temporomandibular Joint

  • Rebecca C. Ramdhan
  • Joe IwanagaEmail author
Chapter

Abstract

The temporomandibular joint (TMJ) is classified as a synovial joint that permits gliding, rotation, elevation, and depression and normally functions in mastication, suckling, swallowing, yawning, speaking, and biting. The mandibular fossa, the articular eminence of the temporal bone, and the mandibular condyle all contribute to the TMJ. This joint can be indicated by the eminentia mandibularis, a bony protuberance on the floor of the middle cranial fossa. The articular eminence is a convex bony elevation on the root of the zygomatic process that characterizes the most anterior boundary of the mandibular fossa. Both the fibrous capsule and the lateral ligament attach to the articular eminence, and the capsule also attaches to the articular cartilage of the temporal bone and the neck of the mandible. The articular surfaces of the TMJ are uniquely lined with fibrocartilage rather than the normal hyaline cartilage. Its joint cavity is divided into two (superior and inferior joint spaces) by an articular disc, and this disc attaches to the capsule separating the two joint spaces lined with synovial membranes. The synovial membranes do not extend to cover the disc or the articular surfaces. The joint moves and functions via the lateral, stylomandibular, and sphenomandibular ligaments. The ligamentous muscles that allow for TMJ articulation are the temporalis, masseter, medial, and lateral pterygoids, collectively known as the muscles of mastication. The suprahyoid muscle group (digastric, mylohyoid, geniohyoid, and stylohyoid) is also responsible for mandibular movement. The synovial joints are supplied by sensory nerve endings (mainly proprioceptive) with pain and stretch receptors. The articular capsules and ligaments are highly vascularized, forming capillary networks over the synovial membranes. From a clinical perspective, understanding the anatomy and variations of the TMJ is significant for TMJ surgery, diagnosis of temporomandibular joint disorder, and related diseases and treatments.

References

  1. Abramowicz S, Marshall CJ, Dolwick MF et al (2007) Vascular malformation of the temporomandibular joint: report of a case and review of the literature. Oral Surg Oral Med Oral Path Oral Radiol 103:203–206.  https://doi.org/10.1016/j.tripleo.2006.05.002CrossRefGoogle Scholar
  2. Al-Koshab M, Nambiar P, John J (2015) Assessment of condyle and glenoid fossa morphology using CBCT in south-east Asians. PLoS One 10(3):e0121682.  https://doi.org/10.1371/journal.pone.0121682CrossRefPubMedPubMedCentralGoogle Scholar
  3. Angel JL (1948) Factors in temporomandibular joint form. Am J Anat 83:223–246CrossRefGoogle Scholar
  4. Antonopoulou M, Iatrou I, Paraschos A et al (2012) Variations of the attachment of the superior head of human lateral pterygoid muscle. J Craniomaxillofac Surg 41:1–7.  https://doi.org/10.1016/j.jcms.2012.11.021CrossRefGoogle Scholar
  5. Barton JM, Ellenbecker MA (1987) Anatomical variations in the articular disc of the human temporomandibular joint. Trans Nebraska Acad Sci XV:1–4Google Scholar
  6. Bell WE (1990) Temporomandibular disorders: classification, diagnosis, management, 3rd edn. Year Book Medical Publishers, ChicagoGoogle Scholar
  7. Canger EM, Celenk P (2012) Aplasia of the mandibular condyle associated with some orthopaedic abnormalities: a case report. Dentomaxillofac Radiol 31:259–263.  https://doi.org/10.1259/dmfr/93380292CrossRefGoogle Scholar
  8. Carter LC, Haller AD, Calamel AD et al (1999) Zygomatic air cell defect (ZACD). Prevalence and characteristics in a dental clinic outpatient population. Dentomaxillofac Radiol 28:116–122CrossRefGoogle Scholar
  9. Chauhan P, Gupta S (2011) Bilateral elongated coronoid processes of mandible. Int J Anat Var 4:25–27Google Scholar
  10. Fallahi HR, Naeini M, Mahmoudi M et al (2010) Congenital zygomatico-maxillo-mandibular fusion: a brief case report and review of literature. Int J Oral Maxillofac Surg 39:930–933CrossRefGoogle Scholar
  11. Isberg A (2001) Temporomandibular joint dysfunction: a practitioner’s guide. Informa Healthcare, LondonCrossRefGoogle Scholar
  12. Iwanaga J, Kikuta S, Nakamura M et al (2017) Intraoral vertico-sagittal ramus osteotomy: modification of the L-shaped osteotomy. Int J Oral Maxillofac Surg.  https://doi.org/10.1016/j.ijom.2017.06.003CrossRefGoogle Scholar
  13. Katzberg RW, Westesson PL, Tallents RH et al (1996) Anatomic disorders of the temporomandibular joint disc in asymptomatic subjects. J Oral Maxillofac Surg 54:147–153CrossRefGoogle Scholar
  14. Kazanjian VH (1956) Bilateral absence of the ascending rami of the mandible. Br J Plast Surg 9:77–82CrossRefGoogle Scholar
  15. Kilic G, Dergin G, Yazar F et al (2010) Insertions of the lateral pterygoid muscle to the disc-capsule complex of the temporomandibular joint and condyle. Turk J Med Sci 40:435–441.  https://doi.org/10.3906/sag-0808-29CrossRefGoogle Scholar
  16. Lang J (1995) Clinical anatomy of the masticatory apparatus and Peripharyngeal spaces. Thieme, New YorkGoogle Scholar
  17. Magnusson T, Carlsson GE, Egermark I (1994) Changes in clinical signs of craniomandibular disorders from the age of 15 to 25 years. J Orofac Pain 8:207–215PubMedGoogle Scholar
  18. Mathew AL, Sholapurkar AA, Pai KM (2011) Condylar changes and its association with age, TMD, and dentition status: a cross-sectional study. Int J Dent 2011:1–7.  https://doi.org/10.1155/2011/413639CrossRefGoogle Scholar
  19. Meunissier M, Meunier A, Carpentier P et al (1993) Disc movements over the condylar head: radiographical study on autopsy materials. J Orofac Rehabil 20:501–515CrossRefGoogle Scholar
  20. Moffett B (1966) The morphogenesis of the temporomandibular joint. Am J Orthod 52:401–415CrossRefGoogle Scholar
  21. Motta-Junior J, Aita TG, Pereira-Stabile CL et al (2013) Congenital Frey’s syndrome associated with nontraumatic bilateral trifid mandibular condyle. Int J Oral Maxillofac Surg 42:237–239.  https://doi.org/10.1016/j.ijom.2012.06.016CrossRefPubMedGoogle Scholar
  22. Naidoo LCD (1996) Lateral pterygoid muscle and its relationship to the meniscus of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:4–9CrossRefGoogle Scholar
  23. Nell A, Niebaurer G, Sperr W et al (1994) Special variations of the lateral ligament of the human TMJ. Clin Anat 7:267–270.  https://doi.org/10.1002/ca.980070507CrossRefGoogle Scholar
  24. Neville BW, Damm DD, Allen C, Bouquot J (2008) Oral and maxillofacial pathology, 3rd edn. Saunders, PhiladelphiaGoogle Scholar
  25. Pinto O (1962) A new structure related to the temporomandibular joint and the middle ear. J Prosthet Dent 12:95–103.  https://doi.org/10.1016/0022-3913(62)90014-8CrossRefGoogle Scholar
  26. Sahman H, Etoz OA, Sekerci AE et al (2011) Tetrafid mandibular condyle: a unique case report and review of the literature. Dentomaxillofac Radiol 40:524–530.  https://doi.org/10.1259/dmfr/62082661CrossRefPubMedPubMedCentralGoogle Scholar
  27. Sala-Perez S, Vazquez-Delgado E, Rodriguez-Baeza A et al (2010) Bifid mandibular condyle: a disorder in its own right. J Am Dent Assoc 131:1076–1085CrossRefGoogle Scholar
  28. Shams MG, Motamedi MHK, Abad HLD (2006) Congenital fusion of the maxilla and mandible: brief case report. Oral Surg Oral Med Oral Path Oral Radiol 102:e1–e3.  https://doi.org/10.1016/j.tripleo.2005.10.051CrossRefGoogle Scholar
  29. Simonds E, Iwanaga J, Oskouian RJ et al (2017) Duplication of the Sphenomandibular Ligament. Cureus 9:e1783.  https://doi.org/10.7759/cureus.1783CrossRefPubMedPubMedCentralGoogle Scholar
  30. Standring S (2009) Gray’s anatomy, 40th edn. Churchill Livingstone, LondonGoogle Scholar
  31. Stefanou EP, Fanourakis IG, Vlastos K et al (1998) Bilateral bifid mandibular condyles: report of four cases. Dentomaxillofac Radiol 27:186–188.  https://doi.org/10.1038/sj/dmfr/4600343CrossRefPubMedGoogle Scholar
  32. Super S, Cotton JS Jr (1982) Bilateral pseudoankylosis of the TMJ due to synostoses between the mandible and maxilla. J Oral Maxillofac Surg 40:590–592CrossRefGoogle Scholar
  33. Super S, Cotton JS Jr (1986) A case of pseudoankylosis between the pterygoid plate and mandible. J Oral Maxillofac Surg 44:467–468CrossRefGoogle Scholar
  34. Szentpetery A, Gabor K, Marcsik A (1990) The problem of the bifid mandibular condyle. J Oral Maxillofac Surg 48:1254–1257CrossRefGoogle Scholar
  35. Tominaga K, Konoo T, Morimoto Y et al (2007) Changes in temporomandibular disc position during growth in young Japanese. Dentomaxillofac Rad 36:397–401.  https://doi.org/10.1259/dmfr/40410443CrossRefGoogle Scholar
  36. Tubbs RS, Shoja MM, Loukas M (2008) Letter to the editor. Clin Anat 21:609CrossRefGoogle Scholar
  37. Wongwatana S, Kronman JH, Clark RE et al (1994) Anatomic basis of disc displacement in temporomandibular joint dysfunction. Am J Orthod Dentofacial Orthop 105:257–264CrossRefGoogle Scholar
  38. Zarb GA, Carlsson GE (eds) (1979) Temporomandibular joint: function and dysfunction. Mosby, MissouriGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Seattle Science FoundationSeattleUSA

Personalised recommendations