516:
its growth capacity, unlike a typical long bone. This area of cartilage within the bone grows in length by appositional growth as the individual grows to maturity. Over time, the cartilage is replaced by bone, using endochondral ossification. This mandibular growth center in the condyle allows the increased length of the mandible needed for the larger permanent teeth, as well as for the larger brain capacity of the adult. This growth of the mandible also influences the overall shape of the face and thus is charted and referred to during orthodontic therapy. When an individual reaches full maturity, the growth center of bone within the condyle has disappeared.
327:
among these. The central area is also thinner but of denser consistency than the peripheral region, which is thicker but has a more cushioned consistency. The synovial fluid in the synovial cavities provides nutrition for the avascular central area of the disc. With age, the entire disc thins and may undergo the addition of cartilage in the central part, changes that may lead to impaired movement of the joint. The synovial membrane covers the inner surface of the articular capsule in the TMJ, except for the surface of the articular disc and condylar cartilage.
691:, or the mandibular division of the trigeminal nerve, work in different groups to move the mandible in different directions. Contraction of the lateral pterygoid acts to pull the disc and condyle forward within the glenoid fossa and down the articular eminence; thus, the action of this muscle serves to protrude the jaw, it with the assistance of gravity, and the digastricus muscle also opens the jaw. The other three muscles close the mouth; the masseter and the medial pterygoid by pulling up the angle of the mandible and the temporalis by pulling up on the
648:, or front teeth of the mandible, are moved so that they first come edge to edge with the maxillary (upper) incisors and then surpass them, producing a temporary underbite. This is accomplished by translation of the condyle down the articular eminence (in the upper portion of the joint) without any more than the slightest amount of rotation taking place (in the lower portion of the joint), other than that necessary to allow the mandibular incisors to come in front of the maxillary incisors without running into them. (This is all assuming an ideal
205:
351:, is actually the thickened lateral portion of the capsule, and it has two parts: an outer oblique portion (OOP) and an inner horizontal portion (IHP). The base of this triangular ligament is attached to the zygomatic process of the temporal bone and the articular tubercle; its apex is fixed to the lateral side of the neck of the mandible. This ligament prevents excessive retraction or moving backward of the mandible, a situation that might lead to problems with the joint.
528:
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47:
388:. The inferior alveolar nerve descends between the sphenomandibular ligament and the ramus of the mandible to gain access to the mandibular foramen. The sphenomandibular ligament, because of its attachment to the lingula, overlaps the opening of the foramen. It is a vestige of the embryonic lower jaw, Meckel cartilage. The ligament becomes accentuated and taut when the mandible is protruded.
562:, which divides the joint into two distinct compartments. The inferior compartment allows for rotation of the condylar head around an instantaneous axis of rotation, corresponding to the first 20mm or so of the opening of the mouth. After the mouth is open to this extent, the mouth can no longer open without the superior compartment of the temporomandibular joints becoming active.
599:
71:
903:(the muscles that move the jaw). TMD does not fit neatly into any one etiologic category since the pathophysiology is poorly understood and it represents a range of distinct disorders with multifactorial etiology. TMD accounts for the majority of pathology of the TMJ, and it is the second most frequent cause of
570:. Although this had traditionally been explained as a forward and downward sliding motion, on the anterior concave surface of the mandibular fossa and the posterior convex surface of the articular eminence, this translation actually amounts to a rotation around another axis. This effectively produces an
791:). Upon closing, the condyle will slide off the back of the disc, hence another "click" or "pop" at which point the condyle is posterior to the disc. Upon clenching, the condyle compresses the bilaminar area, and the nerves, arteries, and veins against the temporal fossa, causing pain and inflammation.
786:
In most instances of disorder, the disc is displaced anteriorly upon translation, or the anterior and inferior sliding motion of the condyle forward within the fossa and down the articular eminence. On opening, a "pop" or "click" can sometimes be heard and usually felt also, indicating the condyle is
663:
When the mandible is moved into a lateral excursion, the working side condyle (the condyle on the side of the mandible that moves outwards) only performs rotation (in the horizontal plane), while the balancing side condyle performs the translation. During actual functional chewing, when the teeth are
515:
A growth center is located in the head of each mandibular condyle before an individual reaches maturity. This growth center consists of hyaline cartilage underneath the periosteum on the articulating surface of the condyle. This is the last growth center of bone in the body and is multidirectional in
611:
610:
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The central area of the disc is avascular and lacks innervation, thus getting its nutrients from the surrounding synovial fluid. In contrast, the posterior ligament and the surrounding capsules along have both blood vessels and nerves. Few cells are present, but fibroblasts and white blood cells are
330:
The lower joint compartment formed by the mandible and the articular disc is involved in rotational movement—this is the initial movement of the jaw when the mouth opens. The upper joint compartment formed by the articular disc and the temporal bone is involved in translational movement—this is the
511:
between condylar cartilage of the mandible and the developing temporal bone. Two slits like joint cavities and intervening disk make their appearance in this region by 12 weeks. The mesenchyme around the joint begins to form the fibrous joint capsule. Very little is known about the significance of
782:
The most common disorder of a temporomandibular joint is disc displacement. In essence, this is when the articular disc, attached anteriorly to the superior head of the lateral pterygoid muscle and posteriorly to the retrodiscal tissue, moves out from between the condyle and the fossa so that the
626:
When measuring the vertical range of motion, the measurement must be adjusted for the overbite. For example, if the measurement from the edge of the lower front teeth to the edge of the upper front teeth is 40 millimeters and the overbite is 3 millimeters, then the jaw opening is 43 millimeters.
342:
There are three ligaments associated with the temporomandibular joints: one major and two minor ligaments. These ligaments are important in that they define the border movements, or in other words, the farthest extents of movements, of the mandible. Movements of the mandible made past the extents
659:
During chewing, the mandible moves in a specific manner as delineated by the two temporomandibular joints. The side of the mandible that moves laterally is referred to as either the working or rotating side, while the other side is referred to as either the balancing or orbiting side. The latter
612:
582:
The resting position of the temporomandibular joint is not with the teeth biting together. Instead, the muscular balance and proprioceptive feedback allow a physiologic rest for the mandible, an interocclusal clearance, or freeway space, which is 2 to 4 mm between the teeth.
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512:
newly forming muscles in joint formation. The developing superior head of the lateral pterygoid muscle attaches to the anterior portion of the fetal disk. The disk also continues posteriorly through the petrotympanic fissure and attaches to the malleus of the middle ear.
315:. The disc divides each joint into two compartments, the lower and upper compartments. These two compartments are synovial cavities, which consist of an upper and a lower synovial cavity. The synovial membrane lining the joint capsule produces the
578:
The necessity of translation to produce further opening past that which can be accomplished with a sole rotation of the condyle can be demonstrated by placing a resistant fist against the chin and trying to open the mouth more than 20 or so mm.
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mandible and temporal bone contact is made on something other than the articular disc. This, as explained above, is usually very painful, because, unlike these adjacent tissues, the central portion of the disc contains no sensory innervation.
303:. The disc is composed of dense fibrocartilagenous tissue that is positioned between the head of the mandibular condyle and the mandibular fossa of the temporal bone. The temporomandibular joints are one of the few
1571:
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F (October 2011). "Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings".
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At this point, if the mouth continues to open, not only are the condylar heads rotating within the lower compartment of the temporomandibular joints, but the entire apparatus (condylar head and articular disc)
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which can be termed the resultant axis of mandibular rotation, which lies in the vicinity of the mandibular foramen, allowing for a low-tension environment for the vasculature and innervation of the mandible.
252:
The main components are the joint capsule, articular disc, mandibular condyles, articular surface of the temporal bone, temporomandibular ligament, stylomandibular ligament, sphenomandibular ligament, and
244:
of the skull above and the condylar process of mandible below; it is from these bones that its name is derived. The joints are unique in their bilateral function, being connected via the mandible.
608:
739:(TMD). This term is used to refer to a group of problems involving the temporomandibular joints and the muscles, tendons, ligaments, blood vessels, and other tissues associated with them.
334:
In some cases of anterior disc displacement, the pain felt during movement of the mandible is due to the condyle compressing this area against the articular surface of the temporal bone.
641:, or chewing, are known as excursions. There are two lateral excursions (left and right) and the forward excursion, known as protrusion. The reversal of protrusion is retrusion.
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In disc displacement without reduction, the disc stays anterior to the condylar head upon opening. Mouth opening is limited and there is no "pop" or "click" sound on opening.
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functionally allowed by the muscular attachments will result in painful stimuli, and thus, movements past these more limited borders are rarely achieved in normal function.
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664:
not only moved side to side but also up and down when biting of the teeth is incorporated as well, rotation (in a vertical plane) also plays a part in both condyles.
1095:
RodrĂguez Vázquez JF, MerĂda
Velasco JR, Jiménez Collado J (January 1993). "Relationships between the temporomandibular joint and the middle ear in human fetuses".
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Internal derangements, an abnormal relationship of the disc to any of the other components of the joint. Disc displacement is an example of internal derangement.
406:
180:
653:
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323:. The posterior portion attaches to the temporal bone. Both upper and lower compartments do not communicate with each other unless the disc is damaged.
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that fills these cavities. The disc is biconcave in shape. The anterior portion of the disc serves as the insertion site for the superior head of the
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208:
Skull of a sheep. Temporal bone (os temporale) coloured. Line: tympanicum: articular face for temporomandibular joint; arrow: external acoustic pore.
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Zadik Y, AktaĹź A, Drucker S, Nitzan DW (December 2012). "Aneurysmal bone cyst of mandibular condyle: a case report and review of the literature".
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The two minor ligaments, the stylomandibular and sphenomandibular ligaments are accessory and are not directly attached to any part of the joint.
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when the joint spaces and the articular disc develop. At approximately 10 weeks the component of the fetus future joint becomes evident in the
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294:
156:
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Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. (June 2007). "Anatomy of the temporomandibular joint".
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terms, although a bit outdated, are actually more precise, as they define the sides by the movements of the respective condyles.
17:
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The temporomandibular joints can be felt in front of or within the external acoustic meatus during movements of the mandible.
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Normal full jaw opening is 40-50 millimeters as measured from the edge of lower front teeth to edge of upper front teeth.
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conditions may also affect the function of temporomandibular joints, causing pain and swelling. These conditions include
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Myofascial pain dysfunction syndrome, primarily involving the muscles of mastication. This is the most common cause.
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899:(TMD, also termed "temporomandibular joint pain-dysfunction syndrome") is pain and dysfunction of the TMJ and the
373:; it separates the parotid and submandibular salivary glands. It also becomes taut when the mandible is protruded.
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Since the TMJ is connected to the mandible, the right and left joints function together and interdependently.
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The
American Association of Oral and Maxillofacial Surgeons (AAOMS) - The Temporomandibular Joint (TMJ)
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1452:"Temporomandibular Joint Arthrocentesis: A Prospective Study and Audit of 500 Joints of Central India"
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450:, innervate the bones, ligaments, and muscles of the TMJ. The fibrocartilage that overlays the
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103:
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1361:. Proceedings of the American Institute of Oral Biology 29th Meeting. Chicago. pp. 59–66.
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1241:
Sessle BJ (1999). "The neural basis of temporomandibular joint and masticatory muscle pain".
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Sessle, Barry J. (2011). "Peripheral and central mechanisms of orofacial inflammatory pain".
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Dynamics of temporomandibular joint during voluntary mouth opening and closing visualized by
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471:
370:
1624:
1049:
995:"Synovial membrane in the temporomandibular joint--its morphology, function and development"
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Illustrated
Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, page 118.
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759:
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Each temporomandibular joint is classed as a "ginglymoarthrodial" joint since it is both a
31:
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RodrĂguez-Vázquez JF, MĂ©rida-Velasco JR, MĂ©rida-Velasco JA, JimĂ©nez-Collado J (May 1998).
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Okeson JP (21 July 2014). "Chapter 10: Classification of temporomandibular disorders".
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of the temporomandibular joint, a degenerative joint disease of the articular surfaces.
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National
Institute of Dental and Craniofacial Research, National Institutes of Health
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National Center for
Biotechnology Information, U.S. National Library of Medicine
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Nozawa-Inoue K, Amizuka N, Ikeda N, Suzuki A, Kawano Y, Maeda T (October 2003).
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The temporomandibular joint is less stable when teeth are clenched together (
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285:. Its loose attachment to the neck of the mandible allows for free movement.
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Oral
Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
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1374:"Real-Time Magnetic Resonance Imaging of Temporomandibular Joint Dynamics"
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Journal of
International Society of Preventive & Community Dentistry
1201:. International Review of Neurobiology. Vol. 97. pp. 179–206.
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273:) is a thin, loose envelope, attached above to the circumference of the
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Temporomandibular joint pain is generally due to one of four reasons.
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Sensory innervation of the temporomandibular joint is provided by the
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Pain or dysfunction of the temporomandibular joint is referred to as
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Formation of the temporomandibular joints occurs at around 12 weeks
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543:(sliding) joint. The condyle of the mandible articulates with the
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486:, may also contribute to the arterial blood supply of the joint.
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Other ligaments, called "oto-mandibular ligaments", connect the
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470:. Other branches of the external carotid artery, namely the
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secondary gliding motion of the jaw as it is opened widely.
1140:"A study of the discomalleolar ligament in the adult human"
727:, for which it is considered a reliable diagnostic criteria
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When the mandible is moved into protrusion, the mandibular
1269:
Biology of
Mineralized Tissues: Prenatal Skull Development
1052:"Anatomical considerations on the discomalleolar ligament"
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moving back onto the disk, known as "reducing the joint" (
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Normal movements of the mandible during function, such as
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Its arterial blood supply is provided by branches of the
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The unique feature of the temporomandibular joint is the
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separates the infratemporal region (anterior) from the
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International
College of Cranio Mandibular Orthopedics
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Translating Mechanisms Orofacial Neurological Disorder
551:. The mandibular fossa is a concave depression in the
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Illustrated Dental Embryology, Histology, and Anatomy
937:
602:
Sagittal section of the articulation of the mandible
938:Bath-Balogh, Mary; Fehrenbach, Margaret J. (2011).
1287:"Anatomy, Head and Neck, Temporomandibular Joint"
1285:Bordoni, Bruno; Varacallo, Matthew (2021-02-07).
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446:(CN V). Free nerve endings, many of which act as
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281:immediately in front; below, to the neck of the
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1273:Columbia University College of Dental Medicine
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558:These two bones are actually separated by an
295:Articular disk of the temporomandibular joint
972:(Third ed.). Elsevier Ltd. p. 17.
667:The mandible is moved primarily by the four
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30:"TMJ" redirects here. For other uses, see
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687:. These four muscles, all innervated by V
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1512:"Chapter 5: TMD Diagnostic Categories"
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365:region (posterior), and runs from the
75:The joint seen from the inner surface.
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1516:Manual of Temporomandibular Disorders
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553:squamous portion of the temporal bone
489:The fibrocartilage that overlays the
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1138:Rowicki T, Zakrzewska J (May 2006).
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774:of the joint can also be performed.
634:movements, only the mandible moves.
402:) with the temporomandibular joint:
1741:posterior atlantooccipital membrane
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1058:. 192. 192 ( Pt 4) (Pt 4): 617–21.
733:temporomandibular joint dysfunction
442:) which is in turn a branch of the
415:(or malleolar-mandibular) ligament.
51:The temporomandibular joint is the
24:
1736:Anterior atlantooccipital membrane
1450:Kumar S, Kiran K, Yadav A (2018).
1321:Seminars in Ultrasound, CT and MRI
1231:
1207:10.1016/B978-0-12-385198-7.00007-2
999:Archives of Histology and Cytology
942:. Elsevier Saunders. p. 266.
493:is avascular in healthy subjects.
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1378:The Open Medical Imaging Journal
789:disc displacement with reduction
693:coronoid process of the mandible
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125:articulatio temporomandibularis
1510:Wright EF (16 November 2011).
1401:11858/00-001M-0000-0011-560C-6
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1172:Sinnatamby, Chummy S. (2011).
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970:Anatomy for diagnostic imaging
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409:(or disco-malleolar) ligament,
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1586:10.1016/j.tripleo.2011.04.021
1372:Zhang, Shuo (10 March 2011).
1293:. StatPearls Publishing LLC.
968:Ryan, Stephanie (2011). "1".
920:
885:Juvenile idiopathic arthritis
1550:. Elsevier Health Sciences.
1469:10.4103/jispcd.JISPCD_361_17
1109:10.1177/00220345930720010901
337:
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1778:Joints of the head and neck
1391:10.2174/1874347101105010001
1359:The non-existent hinge axis
824:abnormal tissue development
818:of mandible or cranial bone
812:of mandible or cranial bone
806:of mandible or cranial bone
735:or temporomandibular joint
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480:ascending pharyngeal artery
468:superficial temporal branch
92:Superficial temporal artery
10:
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1695:Temporomandibular ligament
1429:10.1016/j.jcms.2011.10.026
1333:10.1053/j.sult.2007.02.002
1097:Journal of Dental Research
897:Temporomandibular disorder
382:spine of the sphenoid bone
349:temporomandibular ligament
307:in the human body with an
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1705:Sphenomandibular ligament
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1518:. John Wiley & Sons.
1243:Journal of Orofacial Pain
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359:stylomandibular ligament
347:The major ligament, the
255:lateral pterygoid muscle
218:temporomandibular joints
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539:(hinging joint) and an
531:Temporomandibular joint
464:external carotid artery
283:condyle of the mandible
40:Temporomandibular joint
901:muscles of mastication
869:Degenerative disorders
847:Inflammatory disorders
835:Mandibular dislocation
669:muscles of mastication
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426:auriculotemporal nerve
313:sternoclavicular joint
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188:Anatomical terminology
104:Auriculotemporal nerve
18:Temporomandibular pain
742:Although rare, other
699:Clinical significance
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472:deep auricular artery
371:angle of the mandible
238:synovial articulation
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891:Idiopathic disorders
880:Rheumatoid arthritis
798:Congenital disorders
760:aneurysmal bone cyst
466:, predominately the
311:, another being the
236:. It is a bilateral
32:TMJ (disambiguation)
1768:Human head and neck
1012:10.1679/aohc.66.289
829:Traumatic disorders
454:is not innervated.
386:lingula of mandible
1147:Folia Morphologica
1056:Journal of Anatomy
725:Temporal arteritis
654:Class II occlusion
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434:(both branches of
279:articular tubercle
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1722:Atlanto-occipital
1672:Temporomandibular
1557:978-0-323-24208-0
1525:978-1-119-94955-8
1357:Moss, ML (1972).
1216:978-0-12-385198-7
1183:978-0-7295-3752-0
1176:(12th ed.).
949:978-1-4377-1730-3
778:Disc displacement
681:lateral pterygoid
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1302:. Retrieved
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752:osteosarcoma
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157:A03.1.07.001
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55:between the
1734:membranes (
1103:(1): 62–6.
842:Subluxation
816:Hyperplasia
766:Examination
639:mastication
497:Development
491:TMJ condyle
452:TMJ condyle
448:nociceptors
114:Identifiers
1757:Categories
1384:(1): 1–9.
921:References
858:Capsulitis
810:Hypoplasia
744:pathologic
685:temporalis
568:translates
541:arthrodial
509:mesenchyme
396:middle ear
131:Acronym(s)
1660:ligaments
909:toothache
853:Synovitis
822:Dysplasia
588:occlusion
537:ginglymus
338:Ligaments
248:Structure
1691:Lateral
1594:21835653
1488:29780737
1437:22118925
1341:17571700
1304:June 23,
1299:30860721
1255:10823036
1225:21708311
1159:16773599
1125:33739777
1021:14692685
863:Myositis
839:Fracture
737:disorder
683:and the
673:masseter
646:incisors
520:Function
504:in utero
428:and the
277:and the
59:and the
57:mandible
1730:capsule
1701:Medial
1680:Capsule
1662:of the
1479:5946520
1117:8418109
1082:9723988
1073:1467815
804:Aplasia
650:Class I
630:During
572:evolute
547:in the
400:malleus
384:to the
369:to the
363:parotid
261:Capsule
232:to the
230:jawbone
214:anatomy
145:D013704
81:Details
1773:Joints
1656:Joints
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671:: the
482:, and
226:joints
216:, the
87:Artery
1783:Skull
1143:(PDF)
1121:S2CID
438:(CN V
234:skull
192:[
181:54832
120:Latin
99:Nerve
53:joint
1658:and
1590:PMID
1552:ISBN
1520:ISBN
1484:PMID
1433:PMID
1337:PMID
1306:2021
1295:PMID
1251:PMID
1221:PMID
1211:ISBN
1178:ISBN
1155:PMID
1113:PMID
1078:PMID
1017:PMID
974:ISBN
944:ISBN
704:Pain
376:The
357:The
265:The
169:1622
152:TA98
140:MeSH
1582:doi
1578:112
1474:PMC
1464:doi
1425:doi
1396:hdl
1386:doi
1329:doi
1203:doi
1105:doi
1068:PMC
1060:doi
1007:doi
656:.)
652:or
632:jaw
590:).
222:TMJ
212:In
176:FMA
164:TA2
134:TMJ
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