Temporomandibular joints

The temporomandibular joints, one on each side, allow opening and closing of
the mouth and complex chewing or side-to-side movements of the lower jaw.

•Each joint is synovial and is formed between the head of mandible and the
articular fossa and articular tubercle of the temporal bone.

•Unlike most other synovial joints where the articular surfaces of the bones are
covered by a layer of hyaline cartilage, those of the temporomandibular joint are
covered by fibrocartilage. In addition, the joint is completely divided by a
fibrous articular disc into two parts:
 the lower part of the joint allows mainly the hinge-like depression and
elevation of the mandible;
 the upper part of the joint allows the head of the mandible to translocate
forward (protrusion) onto the articular tubercle and backward (retraction) into
the mandibular fossa.

 Opening the mouth involves both depression and protrusion.

The forward or protrusive movement allows greater depression of the mandible
by preventing backward movement of the angle of mandible into structures in
the neck.
Temporomandibular joint. A. Mouth closed. B. Mouth open.
Joint capsule
The synovial membrane of the joint capsule lines all non-articular surfaces
of the upper and lower compartments of the joint and is attached to the
margins of the articular disc.
The fibrous membrane of the joint capsule encloses the temporomandibular
joint complex and is attached:
above along the anterior margin of the articular tubercle;
laterally and medially along the margins of the articular fossa;
posteriorly to the region of the tympanosquamous suture; and
below around the upper part of the neck of mandible.
The articular disc attaches around its periphery to the inner aspect of the
fibrous membrane.
Extracapsular ligaments
Three extracapsular ligaments are associated with the temporomandibular
joint-the lateral, sphenomandibular, and the stylomandibular ligaments:
the lateral ligament is closest to the joint, just lateral to the capsule, and runs
diagonally backward from the margin of the articular tubercle to the neck of
the mandible;
the sphenomandibular ligament is medial to the temporomandibular joint,
runs from the spine of the sphenoid bone at the base of the skull to the lingula
on the medial side of the ramus of mandible;
the stylomandibular ligament passes from the styloid process of the
temporal bone to the posterior margin and angle of mandible.
Movements of the mandible
A chewing or grinding motion occurs when the movements at the
temporomandibular joint on one side are coordinated with a reciprocal set of
movements at the joint on the other side. Movements of the mandible include
depression, elevation, protrusion, and retraction.
Except for the geniohyoid muscle, which is innervated by the C1 spinal
nerve, all muscles that move the temporomandibular joints are innervated by
the mandibular nerve [V3] by branches that originate in the infratemporal
fossa.
Ear
The ear is the organ of hearing and balance. It has three parts:
the first part is the external ear consisting of the part attached to the lateral aspect
of the head and the canal leading inward;
the second part is the middle ear-a cavity in the petrous part of the temporal bone
bounded laterally, and separated from the external canal, by a membrane and
connected internally to the pharynx by a narrow tube;
the third part is the internal ear consisting of a series of cavities within the
petrous part of the temporal bone between the middle ear laterally and the internal
acoustic meatus medially.
 
The internal ear converts the mechanical signals received from the middle ear,
which start as sound captured by the external ear, into electrical signals to transfer
information to the brain. The internal ear also contains receptors that detect motion
and position.
External ear
The external ear consists of two parts. The part projecting from the side of the head is the
auricle(Pinna) and the canal leading inward is the external acoustic meatus.
Auricle
The auricle is on the side of the head and assists in capturing sound. It consists of cartilage
covered with skin and arranged in a pattern of various elevations and depressions
External acoustic meatus
The external acoustic meatus extends from the deepest part of the concha to the tympanic
membrane (eardrum), a distance of approximately 1 inch (2.5 cm). Its walls consist of
cartilage and bone. The lateral one-third is formed from cartilaginous extensions from some
of the auricular cartilages and the medial two-thirds is a bony tunnel in the temporal bone.
Throughout its length the external acoustic meatus is covered with skin, some of which
contains hair and modified sweat glands producing cerumen (earwax). Its diameter varies,
being wider laterally and narrow medially.
 Tympanic membrane
The tympanic membrane separates the external acoustic meatus from the middle ear, it consists of a connective
tissue core lined with skin on the outside and mucous membrane on the inside.
Middle ear
The middle ear is an air-filled, mucous membrane-lined space in the temporal bone
between the tympanic membrane laterally and the lateral wall of the internal ear medially. It
is described as consisting of two parts:
the tympanic cavity immediately adjacent to the tympanic membrane;
the epitympanic recess superiorly.
 
The middle ear communicates with the mastoid area posteriorly and the nasopharynx (via
the pharyngotympanic tube) anteriorly. Its basic function is to transmit vibrations of the
tympanic membrane across the cavity of the middle ear to the internal ear. It accomplishes
this through three interconnected but movable bones that bridge the space between the
tympanic membrane and the internal ear. These bones are:
the malleus (connected to the tympanic membrane),
the incus (connected to the malleus by a synovial joint), and
the stapes (connected to the incus by a synovial joint, and attached to the lateral wall of the
internal ear at the oval window).
Internal ear
The internal ear consists of a series of bony cavities (the bony labyrinth) and membranous
ducts and sacs (the membranous labyrinth) within these cavities. All these structures are
in the petrous part of the temporal bone between the middle ear laterally and the internal
acoustic meatus medially,
The bony labyrinth consists of the vestibule, three semicircular canals, and the cochlea.
The membranous labyrinth, which consists of the semicircular ducts, the cochlear
duct, and two sacs.
 
The structures in the internal ear convey information to the brain about balance and hearing:
the cochlear duct is the organ of hearing;
the semicircular ducts and the two sacs are the organs of balance.
The nerve responsible for these functions is the vestibulocochlear nerve [VIII], which
divides into vestibular (balance) and cochlear (hearing) parts after entering the internal
acoustic meatus.