Você está na página 1de 31

FUNCTIONAL

ANATOMY
OF TMJ
PART 2

Capsular
ligament
attachment
medially
and
laterally also
dividing joint into
2 cavities.
Superior cavity
mandibular fossa
and
superior
surface of disc.
Inferior cavity
mandibular
condyle
and
inferior surface of
disc

The internal surface of the cavities are


surrounded by specialized endothelial cells
that form a synovial lining.
This lining along with a specialized synovial
fringe located at the anterior border of the
retrodiscal tissue produces synovial fluid
which fills both the joint cavities
TMJ synovial joint.

Synovial fluid serves 2 purposes


1. Medium for providing metabolic
requirements to the non vascular articular
surface of the joint.
2. Lubricant between articular surfaces during
function.
2 mechanisms by which synovial fluid
lubricates are
3. Boundary lubrication
4. Weeping lubrication

Boundary lubrication
Occurs when joint is moved and synovial
fluid is forced from one area of cavity into
another.
The synovial fluid located in the border or
recess areas is forced on the articular
surface thus providing lubrication.

Weeping lubrication
Refers to the ability of articular surfaces to
absorb a small amount of synovial fluid
During function of a joint , forces are
created between the articular surfaces
These forces drive a small amount of
synovial fluid in and out of articular tissues.
This is the mechanism by which metabolic
exchange occurs.

Under compressive forces therefore, a small


amount of synovial fluid is released.
This synovial fluid acts as a lubricant between
articular tissues to prevent sticking,
Weeping lubrication helps eliminate friction in
compressed but not a moving joint.
Only a small amount of friction is eliminated by
weeping lubrication.
Therefore prolonged compressive forces to the
articular surfaces will exhaust this supply.

HISTOLOGYOF
ARTICULAR
SURFACES
The articular
surfaces of the
condyle and the
mandibular fossa
are composed of
four
distinct
layers or zones.

Articular zone
Most superficial layer
Found adjacent to the joint cavity and
forms the outermost functional surface.
Made up of dense fibrous connective tissue
.
The collagen fibres are arranged in bundles
and oriented nearly parallel to the articular
surface.

The fibres are tightly packed and are able


to withstand the forces of movement.
It is less susceptible to the effects of
aging and therefore is less likely to
breakdown over time.
It also has much better ability to repair
than does hyaline cartilage.
The importance of these two factors is
significant in tmj function and
dysfunction.

Proliferative zone
Undifferentiated mesenchymal tissue
This is responsible for the proliferation of
articular cartilage in response to the
functional demands placed on articular
surfaces during loading.

Fibrocartilagenous zone
Collagen fibrils are arranged in bundles in a
crossing pattern.
The fibrocartilage appears in a random
orientation ,providing three dimensional
network that offers resistance against
compressive and lateral forces.

Calcified zone
Made up of chondrocytes and
chondroblasts distributed throughout the
articular cartilage.
In this zone , the chondrocytes become
hypertrophic, die and have their
cytoplasm evacuated , forming bone cells
from within the medullary cavity.

The articular cartilage is composed of


chondrocytes and intercellular matrix.
The chondrocytes produce collagen ,
proteoglycans , glycoproteins , and
enzymes that form the matrix.
Proteoglycans complex molecule
composed of a protein core and
glycosaminoglycan chains.

The proteoglycans are connected to a


hyaluronic acid chain , forming proteoglycan
aggregates that make up a great protein of
the matrix.
These aggregates are very hydrophilic and
are intertwined throughout the collagen
network .
Since these aggregates tend to bind water
,the matrix expands and the tension in the
collagen fibrils counteracts the sweeping
pressure of the proteoglycan aggregates.

In this way the interstitial fluid contributes


to support joint loading .
The external pressure resulting from joint
loading is in equilibrium with the internal
pressure of the articular cartilage.
As joint loading increases , tissue fluid
flows outward until a new equilibrium is
achieved.
As loading is decreased , fluid is
reabsorbed and the tissue regains its
original volume.

Joint cartilage is nourished predominantly


by diffusion of synovial fluid, which
depends on this pumping action during
normal activity.
The pumping action is the basis for the
weeping lubrication, and this action is
thought to be very important in
maintaining healthy articular cartilage.

Vincent .P. Willard Archieves of oral biology


(2012) 599- 606
Vincent concluded that although the TMJ disc
and its attachments form a seamless complex
within the joint ,a closer look at the
biochemical constituents reveals that these 2
components are distinct .
While the disc and attachments both contain
the same major constituents ,the relative
amounts of these components vary based on
functional requirements of the tissue
Disc region have more higher sulfated GAG and
collagen content than the attachment regions.
In contrast attachment regions contains more
DNA content than disc region.

INNERVATION OF TMJ
Most innervation is
provided by the
auriculotemporal nerve as
it leaves the mandibular
nerve behind the joint and
ascends laterally and
superiorly to wrap around
the posterior region of the
joint
Additional innervations by
deep temporal and
massetric nerve.

VASCULARIZATION OF TMJ
Predominant vessels are
Superficial temporal artery - from the
posterior
Middle meningeal artery - from the anterior
Internal maxillary artery from the inferior
Other important arteries are the deep
auricular ,anterior tympanic and ascending
pharyngeal arteries.
The condyle through marrow spaces by
way of the inferior alveolar artery .

Superficial temporal artery


Middle meningeal artery
Maxillary artery

LIGAMENTS
Ligaments play an important role in
protecting the structures
The ligaments of the joints are made up of
collagenous connective tissue, which do
not stretch.
They do not enter actively into joint
function but instead act as a passive
restraining devices to limit and restrict
border movements.

3 funtcional ligaments support the TMJ :


1. Collateral ligaments
2. Capsular ligament
3. TM ligament
2 accessory ligaments
4. Sphenomandibular ligament
5. Stylomandibular ligament

Collateral (discal)
ligaments
Attach the medial and
lateral borders of the
articular disc to the poles of
the condyle
Commonely called as discal
ligaments medial and
laterlal
Medial discal ligament
attaches the medial edge of
the disc to the medial pole
of the condyle.
Lateral discal ligament
attaches the lateral edge of
the disc to the lateral pole
of the condyle,

These ligaments are responsible for


dividing the joint mediolaterally into the
superior and inferior joint cavities.
The discal ligaments are true ligaments
,composed of collagenous connective
tissue fibres , therefore they do not stretch.
They allow the disc to move passively with
the condyle as it glides anteriorly and
posteriorly on the articular surface of the
condyle

Thus these ligaments are responsible for


the hinging movement of the TMJ , which
occurs between the condyle and the
articular disc.
These ligaments have a vascular supply
and are innervated .
Strain on these ligaments produces pain.

Capsular ligament
The entire TMJ is
surrounded
and
encompassed by the
capsular ligament .
The fibres of the
capsular ligament are
attached superiorly to
the temporal bone
along the borders of
the articular surface of
the mandibular fossa
and articular eminence

Inferiorly the fibers of the capsular


ligament attach to the neck of the condyle.
The capsular ligament -resist any medial,
lateral or inferior forces that tend to
separate or dislocate the articular surfaces.
1 significant function to encompass the
joint thus retaining the synovial fluid.
Capsular ligament is well innervated and
provides proprioceptive feedback
regarding position and movement of joint.

Temporomandibular
ligament
The lateral aspect of
the capsular ligament
is
reinforced
by
strong , tight fibres
lateral ligament or TM
ligament.
TM ligament has 2
parts
Outer oblique portion
Inner horizontal portion

Outer portion extends


from outer surface of the
articular tubercle and
zygomatic process
posteroinferiorly to the
outer surface of the
condylar neck.
Inner horizontal portion
extends from the outer
surface of the articular
tubercle and zygomatic
process posteriorly and
horizontally to the lateral
pole of the condyle and
posterior part of articular
disc.

Oblique portion resists excessive drooping


of the condyle limiting the extent of
mouth opening.
During the initial phase of opening ,the
condyle can rotate around a fixed point
until the TM ligament becomes tight as its
point of insertion on the neck of the condyle
is rotated posteriorly.