FUNCTIONAL

ANATOMY
OF TMJ
PART 4

 Superior lateral
pterygoid muscle
Smaller than inferior
muscle
Originat
infra
temporal surface of
the greater sphenoid
wing , extending
almost horizontally ,
backward
and
outward to insert on
the articular capsule,
the disc and the
neck of the condyle.

 While the inferior lateral pterygoid muscle

is active during opening ,the superior
lateral pterygoid muscle remains
inactive ,becoming active only in
conjugation with the elevator muscles.
Function -Superior lateral pterygoid muscle
is especially active during power stroke
(movements that invovle closure of
mandible against resistance, such as
chewing or clenching the teeth together)

 Approximately 80% of the fibers that make

up both lateral pterygoid muscles are slow
muscle fibers /type I which suggest that
these muscles are relatively resistant to
fatigue and may serve to brace the condyle
for long periods of time without difficulty.
Clinical examination of pterygoid muscles
by forcefully opening the jaw against
resistance
with unilateral lateral pterygoid weakness
the jaw deviates to the ipsilateral side as it
opens.

 As a person yawns ,the

head is brought back by
contraction of the posterior
cervical muscles , which
raises the maxillary teeth .
This simple example shows
that normal functioning of
the masticatory system
uses many more muscles
than those of mastication.
Muscles of mastication is
only a part of this complex
system

Other accesory muscles are

Digastric muscle
Though not a masticatory
muscle-important influence
on the function of mandible.
Divided into 2
posterior belly of digastric
anterior belly of digastric

Orgin Posterior belly originates from mastoid

notch , medial to mastoid process fibers
run forward , downward and inward to
intermediate tendon attached to hyoid
bone.

Anterior belly - originates at a fossa on

the lingual surface of mandible ,close to
the midline fibers run downward and
backward to insert at the same
intermediate tendon as does the
posterior belly.

 Function
When the right and left digastric muscle
contract and the hyoid bone fixed by
suprahyoid and infrahyoid muscles ,the
mandible is depressed and pulled backward
and teeth are brought out of contact.
When the mandible is stabilized the digastric
muscles with the suprahyoid and infra hyoid
muscles elevate the hyoid bone ,which is a
necessary function for swallowing.
The digastric are one of the many muscles
that depress the mandible and raise the
hyoid bone.

 STERNOCLEIDO MASTOID
MUSCLE

Large superficial muscles of

the neck that also play a role
during mastication
Orgin
the sternal head is tendinous
and arises from the
superolateral part of the front
of the manibrium sterni
The clavicular head is
musculotendinous and arises
from the medial one third of
the superior surface of the
clavicle.

 It passes deep to the sternal head and the

2 heads blend below the middle of the
neck.
Function When one muscle contracts it turns the
chin to opposite side .
When both muscles contract together they
draw the head forwards as in eating and in
lifting the head from pillow.

Muscles of Mastication
Temporalis muscle
elevation
Medial Pterygoid
Temporalis muscle
retrusion
depression
Mylohyoid
Inferior belly
of diagastric

Medial Pterygoid
Lateral Pterygoid
protrusion

lateral movements
Medial Pterygoid
Lateral Pterygoid

BIOMECHANICS OF TMJ
The TMJ is an extremely complex joint system -2
TMJ connected to the same bone.
TMJ structure can be divided into 2 systems1. Joint system surrounds the inferior synovial
cavity condyle and the articular disc(condyle
disc complex)
Since disc is tightly bound to condyle by
lateral and medial discal ligaments, the only
physiologic movement that can occur between
these surfaces is rotation of on the articular
surface of condyle .
This joint system responsible for rotational
movement in TMJ.

2 Second system is made up of the condyle

disc complex functioning against the
surface of the mandibular fossa.

Since the disc is not tightly attached to

the mandibular fossa , free sliding
movement is possible between these
surfaces in the superior cavity.

This movement occurs when the

mandible is moved forward transalation.

Transalation occurs between superior

surface of articular disc and mandibular
fossa.

Thus articular disc non ossified bone

 The articular surfaces of the joint have no

structural attachment or union-yet contact
must be maintained for joint stability.
Joint stability-maintained by constant activity
of muscles that pull across the joint.
Even in resting state ,these muscles are in
mild state of contraction tonus.
as muscle activity increases condyle forced
against disc and disc against mandibular fossa
- resulting in increase in interarticular pressure
.
In the absence of interarticular pressurearticular surfaces separate and joint
dislocates.

 Width of articular disc space varies with

interarticular pressure.
When pressure is low- closed rest position
disc space widens.
When pressure is high clenching of teeth
disc space narrows.
As interarticular pressure increases condyle
seats itself on the intermediate zone
When pressure is decreased disc space widens
and thicker portion of disc is rotated to fill the
space.
Since anterior and posterior bands are thicker
than intermediate zone disc rotates anteriorly
or posteriorly to accomplish the task.

 Disc attached posteriorly retrodiscal tissues

which are highly elastic- hence condyle can
move out of fossa without creating damage to
superior retrodiscal lamina.
During mandibular opening condyle is
pulled forward down the articular eminence
,the superior retrodiscal lamina becomes
increasingly stretched , creating increased
forces to retract the disc.
The interarticular pressure and the
morphology of the disk prevent the disc from
being overetracted posteriorly.
Superior retrdiscal lamina only structure
capable of retracting the disc posteriorly on
the condyle.

 Anterior border of articular disc attached to

-superior lateral pterygoid
Constantly maintained in a mild state of
contraction or tonus exerts slight anterior
and medial force on the disc.
In the resting closed joint position thus
anterior and medial force will normally
exceed that of nonstretched Superior
retrodiscal lamina.

 Therfore in the resting closed joint position

when the interarticular pressure is low and
disc space widened disc will occupy most
anterior rotary position on the condyle and
the condyle in contact with intermediate and
posterior zones of the disc.
This disc relationship is maintained during
minor passive rotational and transalatory
mandibular movements.
As condyle moves more forward Superior
retrodiscal lamina gets stretched greater
force than the superior lateral pterygoid
allows disc to be rotated posteriorly to extent
permitted by width of articular disc space.

At rest condyle rests on posterior band; beginning of translation, it lies over the
intermediate zone; when mouth is fully open, it lies over the anterior band.

Power stroke
When resistance is met during mandibular
closure
(biting hard food) interarticular pressure
on biting side is decreased because force
of closure applied to food not to joint .
With condyle forward and disc space
increased tension of Superior Retrodiscal
lamina will tend to retract the disc from a
functional position-resulting in separation
of articular surfaces leading to dislocation.

 To avoid this superior lateral pterygoid

becomes active during power stroke rotating
disc forward on condyle so thicker posterior
border of disc maintains articular contacttherfore joint stability maintained.
As teeth pass through the food and approach
intercuspation interarticular pressure is
increased disc space decreased disc
rotated posteriorly so thinner intermediate
zone fills the space.
When the force of closure is discontinued the
resting closed joint position is once again
assumed.

 Joseph H. Kronman et al (ajodo

1994;105:257-64.)
Investigated the site of lateral pterygoid
muscle insertion into the TMJ disk, and the
relationship between that attachment and
the disk.
Results indicated a statistically significant
relationship between functional muscle
attachment and disk displacement.
the SLP can maintain disk displacement
only when it inserts directly into the disk.

 In cases of normal disk arrangement and

condylar attachment, the muscle may not
play a clinically significant role in disk
displacement because disk attachment at
the medial and lateral poles of the condyle
allows the disk to move freely with the
condyle.
This movement of the condyle and the
disk may overcome the pull of the SLP
when normal disk attachment is
maintained.

CONCLUSION
It is impossible to comprehend the fine
points of occlusion without an in depth
awareness of the anatomy ,physiology
,and biomechanics of the TMJ.
The first requirement for successful
occlusal treatment is stable, comfortable
TMJ.
The jaw joints must be able to accept
maximum loading by the elevator
muscles with no signs of discomfort.

 It is only through an understanding of how

the normal, healthy TMJ functions that we
can make sense out of what is wrong when
it isn't functioning comfortably.
This understanding of TMJ is foundational
to diagnosis and treatment.

References
1. Grays Anatomy
2. Fundamentals of occlusion and TMJ disorders
-- Okeson
3. Grants Atlas of Human Anatomy
4. Occlusion Ash RamfJord
5. Orthodontics Principles and Practice
-- T.M.Graber
6. Joseph H. Kronman et al (ajodo 1994;105:25764.)
7. Stavros Kiliaridis et al ,European Journal of
Orthodontics 25 (2003) 259263

8. Acta Odontologica Scandinavica, 2008;

66: 2330
9. Vincent .P.Willard Archieves of oral biology
(2012) 599- 606
10. A IKAI et al (ajodo 112;634:8)