JAW AND

TEMPOROMANDIBU
LAR JOINT

drg. Shanty Chairani, M. Si

JAWS
 Overview
• The jaws are the tooth-bearing bones, and
comprise three bones.
• The two maxillary bones form the upper jaw,
while the lower jaw is a single bone termed the
mandible
Maxilla
 Overview
 Maxilla – pair of bones forming the upper jaw, the lower
border of the orbital cavities, the base of the nose and
the anterior portion of the hard palate
 The maxilla consists of a body and four processes: the
frontal, zygomatic,alveolar and palatine processes.
 The maxilla is a hollow, pyramidal structure with the
following features. It consists of four surfaces, four
processes, multiple foramina and a sinus
• The body of the maxilla has
the following four surfaces:
1. Anterior (facial)
2. Posterior (infratemporal)
3. Orbital
4. Nasal
Important landmarks on the body of the maxilla
 The infraorbital foramen through which the infraorbital nerve and
vessels pass is on the anterior surface of the body just above the
canine fossa
 The alveolar ridge over the root of the canine tooth is pronounced
and is called the canine eminence
 The shallow concavity anterior to the canine eminence, overlying the
root of maxillary lateral incisor is known as the incisive fossa
 A deeper concavity that lies posterior to the canine eminence, over
the roots of maxillary premolars is named the canine fossa
 The anterior nasal spine is a sharp, midline, anterior projection
of the inferior nasal border.
Important landmarks on the body of the maxilla
 The inferior portion of the infratemporal surface that overhangs the
root of the 3rd molar is more prominent and is called the maxillary
tuberosity
 The nasal surface forms the lateral wall of the nasal fossa
 The orbital surface of the maxillary body is smooth and
forms most of the orbital floor
 The junction of the orbital surface and the anterior surface forms the
infraorbital margin
 Processes
1. Alveolar process: It is part of the maxilla that supports the upper teeth.
2. Palatal process: It is medial extension towards the midline meeting
the maxilla of the opposite side. It forms the floor of the nasal cavity
and the roof of the oral cavity.
3. Zygomatic process: It is a lateral extension of the maxilla, forming the
apex of the pyramidal structure.
4. Frontal process: It is upward projection of the bone that articulates
with the frontal bone
Anterior view
Lateral view
Posterior view
Medial view
 The palatine process of the maxilla forms the front section of the
hard palate, and is fused in the midline at the median palatine
suture.
 Just palatal to the central incisors is the incisive foramen, where the
nasopalatine nerve emerges and supplies sensation to the palatal soft
tissue covering of this area
 The posterior edges of the palatine processes articulate with the
horizontal plates of the two palatine bones to form the transverse
palatine suture.
Inferior view.
 Maxillary sinus
1. The maxillary sinus is the largest paranasal air sinuses and is
situated in the body of the maxilla.
2. It is shaped as a four sided pyramid, the base of which faces medially
towards the nasal cavity and apex is pointed laterally towards the
zygomatic bone.
3. The roots of the posterior teeth, especially the 1st and 2nd molars and
sometimes premolars are closely related to the floor of the maxillary
sinus. The alveoli of these teeth are separated from the sinus floor by
only a thin layer of bone.
Mandible
 Overview
 The mandible is a U-shaped bone forming the lower jaw of
the face, which is unique in numerous aspects.
 It is the largest, strongest bone of the face and the only
movable bone of the skull.
 It articulates with the skull by paired temporomandibular
joints
 The mandible has a horizontal portion, or body, and two
vertical portions, or rami. The rami join the body
posteriorly at an oblique angle at the angle of the
mandible.
 Anatomical Zones
 Body (corpus) of mandible : the base of bone that supports the full
length of the lower alveolar process

 Ramus of mandible : Broad, superior, vertical extension from the

posterior part of the body

 Angle of mandible : Junction formed by the ramus and the

body of the mandible

 Symphysis: Region corresponding to the midline of the mandible

 Processes
 Condylar process: Rounded projection from the upper border of the
ramus which articulates with the temporal bone to form the
temporomandibular joint

 Coronoid process: Sharp triangular projection from the upper

border of the ramus that provides attachment to muscles of
mastication

 Alveolar process: Part of the mandible that bears the teeth

 Ridges
 External oblique ridge: Linear bony elevation/crest on the lateral
aspect of the mandible that extends from the first molar
region and continues upwards as the anterior border of the ramus of
mandible

 Internal oblique ridge (mylohyoid ridge): Linear bony elevation/

crest on the medial aspect of the mandible
 Notches
1. Mandibular/sigmoid notch: The curvature
or depression between the condyle and the coronoid processes

2. Coronoid notch: Depression/concavity on the anterior border of

ramus of mandible
 Foramina
1. Mental foramen: Present on the anterolateral aspect of the body of
the mandible between the two premolars. Mental nerve and vessels
pass through the foramen.

2. Mandibular foramen: Present on the medial surface of the ramus

of mandible. The inferior alveolar nerve and vessels are transmitted
through the foramen.
 Fossae
 The incisive fossa is a shallow depression immediately overlying
the incisor roots

 Submandibular fossa: Shallow depression present on the medial

surface of the mandible to lodge the submandibular gland

 Sublingual fossa: Shallow depression present on the medial surface

of the mandible to lodge the sublingual gland
 Fossae
 The retromolar fossa is a roughened shallow fossa distal
to the last molar and bounded medially by the lowest portion
of the temporal crest and laterally by the external oblique
ridge

 Digastric fossa: Depression on the lingual surface of the mandible

near the symphysis menti from where the anterior belly of the
digastric muscle originates

 The pterygoid fossa is an anterior depression on the neck of

the condyle for insertion of the lateral pterygoid muscle
 Tubercle
 Genial tubercles (mental spine): Small bony elevations (superior and
inferior) that provide attachment to the geniohyoid and genioglossus
muscles

 The mental tubercles are small elevations on either side of

the triangular base.

 A prominent triangular surface made by the symphysis

and these two tubercles is called the mental protuberance

 Lingula: Lip-like projection on the medial surface of the mandible

just above the mandibular foramen
TEMPOROMANDIBU
LAR JOINT
 Overview
 The temporomandibular joint is a ginglymoarthrodial synovial
joint that undergoes both translational and rotational movements
 The temporomandibular joint consists of the mandibular condyle,
the portion of the temporal bone that includes the mandibular fossa
and the articular eminence, the articular disc, the ligaments that
hold the condyle in place, the joint capsule and associated structures,
and the muscles that move the joint
 Its main function is to allow opening and closing of the mouth and
movements of the mandible during mastication and speech.
STRUCTURE OF TMJ
 Temporal bone
 The areas of the temporal bone that are of interest for the TMJ
are the mandibular fossa and the articular eminence.
 The mandibular fossa, also called the articular fossa or glenoid fossa,
is a concave area in the squamous portion (squama) of the
temporal bone, limited anteriorly by the articular eminence and
posteriorly by the postglenoid process, which is localized
immediately anterior to the external acoustic meatus.
 The articular eminence is a convex bar of bone upon which the
articular disc slides during mandibular function
 Mandible
 The area of the mandible that is of direct interest of
the TMJ is the condylar head or condyle, which
articulates with the temporal bone.
 The anterior surface of the condyle is concave while
the posterior surface is convex.
 On the coronal plane the condyle is observed to have
two poles, the lateral pole and the medial pole; the
latter is more prominent, extending farther beyond
the neck of the condyle
 Intra-Articular disc
 The articular disc (meniscus) is interposed between the condyle and
themandibular fossa.
 It is composed of a dense fibrous connective tissue (type I collagen),
and it is only innervated on its periphery.
 On the sagittal plane the disc can be divided into three distinct
regions: the posterior region, which is the thickest one; the central
region or intermediate zone, which is the thinnest area; and the
anterior region. Ideally the condyle should be positioned on the
intermediate zone
 Articular disc
 The disc is attached posteriorly to the retrodiscal tissue (bilaminar
zone), which is a well-vascularized and innervated tissue
 It is bordered superiorly by the superior retrodiscal lamina (SRL),
and inferiorly by the inferior retrodiscal lamina (IRL).
 The SLR consists of connective tissue with many elastic fibers.
 Both the IRL and SRL attach to the articular disc.
 Unlike the SRL, the IRL is formed by collagenous and nonelastic
tissue
 Articular disc
 The disc is completely surrounded by attachments, therefore creating
two separated spaces: the superior articular space (or superior joint
cavity), where the translation between the disc and the mandibular
fossa/articular eminence occurs; and the inferior articular space (or
inferior joint cavity), where the rotation between the condyle and the
disc occurs
 The superior space is delineated by the mandibular fossa and by the
superior surface of the articular disc.
 The inferior space is delineated by the inferior surface of the articular
disc and the mandibular condyle.
 The synovial fluid fills both articular spaces
Fibroblast, chondrocyte
 JOINT CAPSULE
 The TMJ is enclosed in a capsule that is attached at the borders of
the articulating surfaces of the mandibular fossa and eminence of the
temporal bone and to the neck of the mandible.
 The fibrous capsule is a thin sleeve of tissue completely
surrounding the joint.
 The capsule consists of an internal synovial layer and an outer
fibrous layer containing veins, nerves, and collagen fibers.
 LIGAMENTS OF TMJ
 The TMJ has one major and two minor ligaments.
 The temporomandibular ligament is the major ligament
that supports the joint.
 The two minor ligaments, the stylomandibular and
sphenomandibular ligaments are accessory and are not directly
attached to any part of the joint, but they may stabilize the articular
system during jaw movements.
 Temporomandibular Ligament /Lateral
Ligament
 The joint capsule is strengthened by the temporomandibular
ligament.
 It is in fact the thickened lateral portion of the capsule, and cannot be
readily separated from the capsule.
 This ligament provides the main means of support for the joint,
resists dislocation during functional movements by restricting distal
and inferior movements of the mandible.
 Sphenomandibular Ligament
The sphenomandibular ligament is a remnant of the dorsal
part of Meckel’s cartilage. It is attached superiorly to the
spine of the sphenoid, and inferiorly to the lingual of the
mandibular foramen.

 Stylomandibular Ligament
It is a reinforced lamina of the deep cervical fascia. It is
attached above to the lateral surface of styloid process and below
to the angle and posterior border of the ramus of the mandible
 Synovial Membrane (Synovium)
 The synovial membrane lines the inner surface of the fibrous capsule
of the TMJ and the margins of the intra-articular disc
 The synovial membrane consists of two layers: (1) an intimal
cellular layer and (2) a vascular subintimal layer.
 The intimal layer contains two types of cells: type A cells appear to
be phagocytic, and type B cells synthesize hyaluronate found in
synovial luid.
 The subintimal layer contains blood vessels and lymphatics within
a loose connective tissue matrix.
 Synovial fluid
 The synovial membrane secretes the synovial fluid that occupies the
joint cavities.
 Synovial fluid acts as a lubricant for the TMJ and is thought to
provide a source of nutrition for the adjacent tissues of the articular
disc and lining articular surfaces.
 Although mainly composed of water, the molecule thought to play
the most important role in lubrication is hyaluronan. Other
molecules present and thought to aid lubrication are lubricin
(proteoglycan4) and surface-active phospholipids.
 JOINT MOVEMENT
Two basic types of movement :
1. The gliding (sliding/translation) movement of the TMJ occurs mainly between the
disc and the articular eminence of the temporal bone in the upper synovial cavity,
with the disc plus the mandibular condyle moving forward or backward, down and up
the articular eminence. The gliding movement allows the lower jaw to move forward
or backward
2. The rotational (hinge) movement of the TMJ occurs mainly between the disc and the
mandibular condyle in the lower synovial cavity. The axis of rotation of the disc plus
the mandibular condyle is transverse, and the movements accomplished are
depression or elevation of the mandible.

With these two types of movements, gliding and rotation, and with the right and left
TMJs working together, the finer movements of the jaw can be accomplished. These
include opening and closing the jaws and shifting the lower jaw to one side.
THANK
YOU