MASTICATORY SYSTEM

AND
TEMPOROMANDIBULAR JOINT (TMJ)

NOVA SOUTHEASTERN UNIVERSITY

COLLEGE OF DENTAL MEDICINE
Department of Prosthodontics 1

Dr. Liliana Mosquera © Copyright, 2023

Popayan - Colombia (South America)

2
Popayan – Colombia
(South America)
3
Manizales – Colombia (South America)

4
Manizales – Colombia
Universidad Autonoma

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 Temporomandibular
Occlusion of teeth
joint

Masticatory and
Mandible
accessory muscles

TEMPOROMANDIBULAR
ARTICULATORY SYSTEM

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 PHYSIOLOGY OF MASTICATORY MUSCLES

“You cannot successfully treat dysfunction unless

you understand function”

MASTICATION DEGLUTITION SPEECH

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 ACTIVITES OF THE MASTICATORY SYSTEM

• Speaking

FUNCTIONAL • Chewing

• Swallowing

• Clenching/Grinding of teeth
PARAFUNCTIONAL/NONFUNCTIONAL

• Oral habits

• Parafunctional activities + general

MUSCLE HYPERACTIVITY increase in level of muscle tone

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 MASTICATION OR CHEWING

Process by which food is crushed and ground by teeth

The first step of digestion

Increases the surface area of food to allow more efficient

breakdown by enzymes

Food after swallowing is called BOLUS

Voluntary, cyclical , Reflex

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 THE CHEWING CYCLE

Mastication is the repetitive sequence of jaw opening and closing with a profile in the
vertical plane called CHEWING CYCLE

THREE PHASES:

OCCLUSAL OR
INTERCUSPAL PHASE:
OPENING PHASE: CLOSING PHASE:
The mandible is stationary
the mouth is opened and The mandible is raised
and maxillary and
mandible depressed towards the maxilla
mandibular teeth
approximate

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MECHANISMS THAT MODULATE MUSCLE
ACTIVITY DURING CHEWING

Muscle spindle receptors

Mechanoreceptors in the
PDL

Tendon organ reflexes

Joint reflexes
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 SKELETAL MUSCLES

SLOW: TYPE 1 MUSCLE FIBERS FAST: TYPE II MUSCLE FIBERS

* Deeper in red color (higher * Whiter (lower concentration of
concentration of myoglobin) myoglobin)

* Capable of slow sustained * Rely more on anaerobic activity

contraction to function (Fewer mitochondria)

* Aerobic metabolism so they * Capable of quick contraction

resist fatigue but fatigue more quickly
ACCORDING
TO THE
AMOUNT OF
MYOGLOBIN:
MUSCLES

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 SKELETAL MUSCLES

The skeletal components of the body are held together and moved
by the skeletal muscles

Muscles Fibers ranging between 10-18 mm Subunits

All skeletal muscles contain fast and slow fibers mix that reflect their
function

Muscles that respond quickly: White fast fibers predominantly

Muscles for slow continuous activity : Higher concentration of slow

fibers
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 MUSCLES OF MASTICATION

•Inserted in the mandible

COMMON •Innervated by the mandibular division of the

CHARACTERISTICS trigeminal nerve

•Concerned with biting and chewing

•Move the mandible

•Secure and stabilize mandibular positions

FUNCTIONS
•Determine the direction of mandibular movements

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 MUSCLES OF MASTICATION

Participate in all jaw movements involved in

mastication, deglutition and other non
masticatory movements

Voluntary muscles

Originate from the skull, span the TMJ, and

insert into the mandible

On contraction, they act to move the

mandible
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 MUSCLES OF MASTICATION

PRIMARY ACCESORY

• Masseter • SUPRAHYOID MUSCLES

• Digastric
• Temporal
• Mylohyoid
• Medial Pterygoid
• Stylohyoid
• Lateral Pterygoid
• Geniohyoid

• INFRAHYOID MUSCLES:
• Sternohyoid

• Omohyoid

• Thyrohyoid
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 BASED ON FUNCTIONAL MOVEMENTS:

MANDIBULAR MANDIBULAR Lateral

ELEVATORS DEPRESSORS Pterygoid

Masseter
Anterior
Digastric

Temporal

Geniohyoid
Medial
Pterygoid

Mylohyoid
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 MANDIBULAR MOVEMENTS

ELEVATION • Closing of the mouth

DEPRESSION • Opening of mouth

PROTRACTION
• Movement of the mandible
anteriorly

RETRACTION
• Movement of the mandible
posteriorly

ROTATION
• Anterior tip of the mandible is
skewed from side to side 18
 MUSCLES OF MASTICATION

Temporal

4 PAIRS
Medial
Masseter OF Pterygoid
MUSCLES

Lateral
Pterygoid
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MANDIBLE (FRONTAL VIEW)

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MANDIBLE (LINGUAL VIEW)

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ORIGIN: Thick. Rectangular muscle.
MASETER MUSCLE
Superficial portion: Aponeurosis from the
zygomatic process of the maxilla. Fibers
go downward and backward
Deep portion: posterior third of the lower
border and medial surface of the
zygomatic arch

INSERTION:
Superior portion: angle and lower
half of the lateral surface of the
ramus of the mandible. Fibers pass
downward and backward
Inferior portion: upper half of the
ramus and lateral surface of the
coronoid process of the mandible

FUNCTION: Elevation of the mandible and

teeth brought in contact
Superficial portion aids in protruding the
mandible
Deep portion stabilizes the condyle
against the articular eminence upon
biting forces in protrusion

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MUSCLES OF MASTICATION (ELEVATORS)

Masseter
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 ORIGIN: Large fan shaped. Broad and
radiating.
TEMPORAL
Side of the head. Temporalis fossa
MUSCLE

INSERTION: Medial surface, apex

and anterior border of the
coronoid process, and the anterior
border of the ramus of the
mandible to level of the last molar
tooth

FUNCTION: Elevation of the mandible and

teeth brought in contact. Coordinates
closing movements and it is a significant
mandibular positioning muscle
Anterior portion: Mandible elevation
vertically
Middle portion: Mandible elevation and
retrusion
Posterior Portion: Mandible elevation and
retrusion

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MUSCLES OF MASTICATION (ELEVATORS)

Temporalis
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 MEDIAL PTERYGOID
ORIGIN: Thick. Quadrialteral MUSCLE
Medial surface of the lateral
pterygoid plate and the grooved
surface of the pyramidal process
of the palatine bone

INSERTION: Lower and back

part of the medial surface of
the ramus and angle of the
mandible, as high as the
mandibular foramen

FUNCTION: Elevation of the

mandible and teeth brought in
contact. Also active in
mandibular protrusion and the
unilateral contraction allows for a
mediotrusive mandibular
movement

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 MUSCLES OF MASTICATION (ELEVATORS)

Medial Pterygoid
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ORIGIN: Divided into 2. Functions nearly
LATERAL PTERYGOID
opposites MUSCLE
Superior lateral head : Lower part of the
lateral surface of the great wing of the
sphenoid and infratemporal crest
Inferior lateral head: Lateral surface of
the lateral pterygoid plate

INSERTION: Depression in front of

the neck of the mandibular
condyle and into the front margin
of the articular disk of the TMJ

FUNCTION:
Superior lateral Pterygoid muscle :
Active during power stroke ( Mandibular
closure against resistance i.e chewing
or clenching). Becomes active only in
conjunction with the elevator muscles
Inferior lateral Pterygoid muscle:
Condyles are pulled down the articular
eminence and mandible is protruded

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 MUSCLES OF MASTICATION (DEPRESSORS)

Lateral Pterygoid
Posterior Digastric
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MUSCLES OF MASTICATION (DEPRESSORS)

Anterior Digastric
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 Temporalis

TMJ

Digastric
Angle
Body
Masseter

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 MUSCLES OF MASTICATION ACTION

TEMPORAL, MASSSETER and MEDIAL PTERYGOID

muscles raise the mandibular against the maxilla

LATERAL PTERYGOID muscle protrudes the mandible,

draw forward the condyle and articular disk, assists in
opening the mouth and is assisted by the Medial
Pterygoid

The posterior fibers of the TEMPORAL muscle retract

the mandible

When the MEDIAL and LATERAL PTERYGOID muscles of

one side are active, then the mandible of that side is
drawn forward and the opposite side remains fixed.
This allows for the side-to-side movements during the
mastication of food
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 MUSCLES OF MASTICATION

MUSCLE ORIGIN INSERTION NERVE SUPPLY ACTION

Masseter Inferior aspect of the Lateral aspect of ramus Mandibular division Elevation, protrusion and
zygomatic arch and of the mandible of the trigeminal ipsilateral mandibular
zygomatic process of nerve (V3), excursion. Bring teeth in
the maxilla masseteric nerve contact
Temporal Floor of the temporal Coronoid process and Mandibular division Anterior and superior fibers
fossa and temporal anterior border of the of the trigeminal elevate mandible
fascia ramus of the mandible nerve (V3), deep Posterior fibers retract
temporal nerves mandible. Maintains resting
position and ipsilateral
mandibular excursion
Lateral Pterygoid Greater wing of Neck of the mandible Mandibular division Pulls neck of mandible
sphenoid Articular disk of the trigeminal forward, protrudes the
Lateral pterygoid plate nerve ( V3) mandible, pulls disc anteriorly
and deviates to the opposite
side
Medial Pterygoid Tuberosity of maxilla Medial aspect of ramus Mandibular division Elevates and protrudes
Lateral pterygoid plate and angle of mandible of the trigeminal mandible, deviates to the
nerve ( V3) opposite side

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ACCESORY MUSCLES
OF MASTICATION

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 DIGASTRIC
ORIGIN: MUSCLE
Anterior belly: Digastric fossa of the mandible
Posterior belly: Mastoid notch of the temporal
bone

INSERTION: Intermediate tendon

INNERVATION: mylohyoid nerve and

facial nerve

FUNCTION: Depression of the mandible and

elevation of the hyoid bone during deglutition

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ORIGIN: Forms anatomically and functionally
the floor of the oral cavity. Right and left side
join in the midline between the mandible and
the hyoid bone by the mylohyoid raphae MYLOHYOID
Lower border of the mandible (Anterior fibers)
and alveolus of the third molar (Most posterior
fibers)
MUSCLE

INSERTION: Fibers run downward and

forward and attach to the body of the
hyoid bone and also join contralateral
muscles in the mylohyoid raphae

INNERVATION: Mylohyoid nerve

FUNCTION: Elevates and supports the floor od

the oral cavity, acts as elevator of the tongue,
helps in the early stages of swallowing and
depresses the mandible

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 GENIOHYOID
MUSCLE

ORIGIN: From the inferior genial tubercle (In the midline of inner surface of the mandible)

INSERTION: Into the hyoid bone

INNERVATION: Hypolossal nerve

FUNCTION: Depresses the mandible

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 STYLOHYOID
MUSCLE
ORIGIN: Arises from the posterior and lateral
surfaces of the styloid process of the
temporal bone

INSERTION: Into the body of the Hyoid

bone, just superior to the Omohyoid
muscle

INNERVATION: Facial nerve

FUNCTION: Draws the Hyoid bone upward,

backward and elongates the floor of the
mouth

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INFRAHYOID MUSCLES

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NERVE SUPPLY OF INFRAHYOID MUSCLES

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 MUSCLES OF MASTICATION

Temporal muscle
Elevation

Medial Pterygoid Medial Pterygoid

Retrusion Lateral Pterygoid
Protrusion

Mylohyoid Medial Pterygoid

Inferior belly of Lateral Pterygoid
digastric
Lateral Movements
Depression
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 TEMPOROMANDIBULAR JOINT

 CRANIOMANDIBULAR JOINT THAT CONNECTS

THE MANDIBLE TO THE SKULL AND REGULATES
MANDIBULAR MOVEMENTS

 ARTICULATION BETWEEN THE CONDYLAR HEAD

OF THE MANDIBLE AND THE ANTERIOR PART OF
THE GLENOID FOSSA OF THE TEMPORAL BONE

 FREQUENTLY TERMED AS TMJ

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 INTRODUCTION TO TMJ

 MAIN FUNCTIONS OF THE TMJ : MASTICATION AND SPEECH

 SYNOVIAL BILATERAL JOINT THAT PERMITS THE MANDIBLE TO MOVE AS A UNIT WITH 2
FUNCTIONAL PATTERNS (GLIDING AND HINGE MOVEMENTS)

 LIKE ALL SYNOVIAL JOINTS IT HAS: DISK, BONE, FIBROUS CAPSULE, FLUID, SYNOVIAL
MEMBRANE AND LIGAMENTS

 TMJ IS UNIQUE BECAUSE ITS ARTICULAR SURFACE IS COVERED BY FIBROCARTILAGE

INSTEAD OF HYALINE CARTILAGE

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Dorland WA: Medical Dictionary. Philadelphia and London, Saunders Co., 1957
 PECULIARITY OF TMJ

 BILATERAL DIARTHROSIS ( RIGHT AND LEFT FUNCTION TOGETHER)

 ARTICULAR SURFACE COVERED BY FIBROCARTILAGE INSTEAD OF HYALINE CARTILAGE

 ONLY JOINT IN THE HUMAN BODY THAT HAS A RIGID ENDPOINT OF CLOSURE ( TEETH
MAKING OCCLUSAL CONTACT)

 THE LAST DIARTHRODIAL JOINT TO DEVELOP (ABOUT 7 WEEKS IN UTERO)

 DEVELOPS FROM TWO DISTINCT BLASTEMA

Dorland WA: Medical Dictionary. Philadelphia and London, Saunders Co., 1957 56
 TMJ MOVEMENTS

ROTATIONAL/HINGE • In the first 20-25 mm of mouth

MOVEMENT opening

TRANSLATIONAL • After that when the mouth is

MOVEMENT excessively opened.

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 BASIC MOVEMENTS OF THE MANDIBLE

ROTATION: Hinged movement

TRANSLATION: Protrusive and / or lateral movement

TRANSLATION
ROTATION

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 TRANSLATORY MOVEMENT

IN THE SUPERIOR PART OF THE JOINT

AS THE DISC AND THE CONDYLE
TRAVEL ANTERIORLY ALONG THE
INCLINES OF THE ANTERIOR TUBERCLE
TO PROVIDE ANTERIOR AND INFERIOR
MOVEMENT TO THE MANDIBLE

MOUTH CLOSED MOUTH OPEN

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 HINGE (ROTATION) MOVEMENT

THE INFERIOR PORTION OF THE

JOINT BETWEEN THE HEAD OF THE
CONDYLE AND THE LOWER SURFACE
OF THE DISC TO ALLOW OPENING
OF THE MANDIBLE

MOUTH CLOSED MOUTH OPEN

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 COMPONENTS

 MANDIBULAR CONDYLE

 ARTICULAR SURFACE OF THE TEMPORAL BONE (GLENOID

FOSSA)

 CAPSULE

 ARTICULAR DISC

 LIGAMENTS

 LATERAL PTERYGOID MUSCLE

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THE MANDIBULAR CONDYLE ARTICULATES WITH THE GLENOID FOSSA AND ARTICULAR
EMINENCE OF THE TEMPORAL BONE

AN ARTICULAR DISC SEPARATES THE ARTICULAR SURFACES SO THAT 2 CAVITIES ARE PRESENT:
* UPPER COMPARTMENT BETWEEN THE DISC AND TEMPORAL BONE

* LOWER COMPARTMENT BETWEEN THE CONDYLE AND THE DISC

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 THE CAPSULE

THE JOINT CAPSULE IS ATTACHED BELOW

TO THE ARTICULAR MARGIN OF THE HEAD
OF THE CONDYLE, AND ABOVE TO THE
MARGINS OF THE GLENOID FOSSA AND
ARTICULAR EMINENCE. THE INNER
ASPECT OF THE CAPSULE IS LINED BY A
SYNOVIAL MEMBRANE

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 THE LIGAMENTS

AT THE SIDES, THE CAPSULE IS STRENGTHENED BY COLLATERAL LIGAMENTS OF WHICH THE LATERAL
TEMPOROMANDIBULAR LIGAMENT IS THE STRONGEST

THE LATERAL TEMPOROMANDIBULAR LIGAMENT IS ATTACHED ABOVE TO THE ZYGOMA, AND BELOW, IT IS ATTACHED
TO THE LATERAL SURFACES AND POSTERIOR BORDER OF THE NECK OF THE MANDIBLE

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 THE LATERAL TEMPOROMANIBULAR (TM) LIGAMENT

IT HAS 2 PARTS:
OUTER OBLIQUE PORTION:
 EXTENDS FROM OUTER SURFACE OF THE ARTICULAR TUBERCLE
AND ZYGOMATIC PROCESS POSTEROINFERIORLY TO THE
OUTER SURFACE OF THE CONDYLAR NECK

 IT RESISTS EXCESSIVE DROPPING OF THE CONDYLE LIMITING

THE EXTENT OF MOUTH OPENING

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

 IT LIMITS THE POSTERIOR MOVEMENT OF THE CONDYLE AND

DISC

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 THE TM LIGAMENT AND MANDIBULAR MOVEMENT

DURING 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

 WHEN THE LIGAMENT IS RIGID, THE NECK OF THE CONDYLE CANNOT

ROTATE FURTHER

 IF THE MOUTH WERE TO BE OPENED WIDER- THE CONDYLE HAS TO

MOVE DOWNWARD AND FORWARD ACROSS THE ARTICULAR
EMINENCE

 JAW EASILY ROTATES UNTIL TEETH ARE 20 – 25MM APART AFTER

WHICH A RESISTANCE IS FELT WHEN THE JAW IS OPENED WIDER

 THIS RESISTANCE IS BROUGHT ABOUT BY THE TIGHTENING OF TM

LIGAMENT

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 THE LIGAMENTS

 THERE ARE 2 ACCESSORY LIGAMENTS:

 THE STYLOMANDIBULAR LIGAMENT ATTACHES TO THE STYLOID PROCESS AND TO THE POSTERIOR BORDER OF
THE RAMUS

 THE SPHENOMANDIBULAR LIGAMENT EXTENDS BETWEEN THE SPINE OF THE SPHENOID BONE AND THE LINGULA
OF THE MANDIBLE

 THESE LIGAMENTS LIMIT THE RANGE OF MOVEMENT OF THE CONDYLE PREVENTING IT FROM COMING IN
CONTACT WITH THE TYMPANIC PLATE BEHIND AND PASSING BEYOND THE ARTICULAR EMINENCE IN FRONT
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 THE MANDIBULAR CONDYLE

 THE ARTICULATING SURFACE OF THE MANDIBLE

 IT IS CONVEX IN ALL DIRECTIONS BUT WIDER LATERO-MEDIALLY THAN

ANTERO-POSTERIORLY

 IT HAS LATERAL AND MEDIAL POLES:

 THE MEDIAL POLE IS DIRECTED MORE POSTERIORLY
 THE LONG AXIS OF THE TWO POLES DEVIATE POSTERIORLY AND MEETS AT
THE ANTERIOR BORDER OF THE FORAMEN MAGNUM

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 MANDIBULAR (GLENOID) FOSSA
AND ARTICULAR EMINENCE

GLENOID FOSSA:
 POSTERIORLY LIMITED BY THE SQUAMOTYMPANIC FISSURE
 ANTERIORLY BOUNDED BY THE ARTICULAR EMINENCE
 ROOF: THIN LAYER OF COMPACT BONE SEPARATING THE MIDDLE
CRANIAL FOSSA

ARTICULAR EMINENCE:
 COMPOSED OF SPONGY BONE COVERED BY THIN LAYER OF
COMPACT BONE

 FIBROUS LAYER COVERING THE ARTICULATING SURFACE OF

TEMPORAL BONE

 THIN ON THE ARTICULAR FOSSA AND THICKENS ON THE POSTERIOR

SLOPE OF THE EMINENCE

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 ARTICULAR DISC (MENISCUS)

 FIBROUS, AVASCULAR, NON INVERTED PLATE

 SHAPE IS OVAL, BICONCAVE IN SAGITTAL SECTION

 THIN IN CENTRAL PART AND THICK AT POSTERIOR

BORDERS.

 ATTACHMENT: MEDIAL AND LATERAL POLES OF THE

CONDYLE BY MEDIAL AND LATERAL LIGAMENTS

 DIVIDES THE JOINT INTO: UPPER COMPARTMENT

(LARGER) AND LOWER COMPARTMENT (SMALLER)

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 ARTICULATING CAPSULE AND LIGAMENTS AND
SYNOVIAL MEMBRANE

 THE WHOLE TMJ IS ENCLOSED IN A FIBROUS CAPSULE

 IT IS ATTACHED TO:
ARTICULAR TUBERCLE (IN FRONT)
LIPS OF SQUAMOUS TYMPANIC FISSURE (POSTERIORLY)
BORDERS OF ARTICULATING GLENOID FOSSA
NECK OF THE MANDIBLE (BELOW)

 IT IS LINED BY SYNOVIAL MEMBRANE

 LATERALLY, THE CAPSULE IS REINFORCED BY TMJ LIGAMENTS

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 SYNOVIAL FLUID

 CLEAR, STRAW-COLORED VISCOUS FLUID

 IT DIFFUSES OUT FROM THE RICH CAPPILLARY NETWORK OF THE SYNOVIAL MEMBRANE

 CONTAINS HYALURONIC ACID WHICH IS HIGHLY VISCOUS

 FUNCTIONS:
LUBRICANT FOR ARTICULATING SURFACES
CARRY NUTRIENTS TO THE AVASCULAR TISSUE OF THE JOINT
CLEAR THE TISSUE DEBRIS CAUSED BY NORMAL WEAR AND TEAR OF THE ARTICULATING SURFACES

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 TMJ BLOOB AND NERVE SUPPLY

BLOOB SUPLLY NERVE SUPPLY

4 ARTERIES: BRANCHES FROM THE MANDIBULAR NERVE:

 SUPERFICIAL TEMPORAL  AURICULOTEMPORAL NERVE
 DEEP AURICULAR  MASSETERIC NERVE
 ANTERIOR TYMPANIC  DEEP TEMPORAL NERVE
 ASCENDING PHARYNGEAL

THEIR BRANCHES APPROACH THE JOINT AND SUPPLY ALL SURFACES OF THE HEAD, FOSSA,
PENETRATE THE CAPSULE CAPSULE AND PART OF THE DISK

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 TMJ AGE CHANGES

BLOOD VESSELS AND

CONDYLE DISC SYNOVIAL FOLD
NERVES
•Becomes more •Becomes thinner •Becomes fibrotic •Walls of blood
flattened with thick basement vessels thickened
•Shows hyalinization membrane
•Fibrous capsule and chondroid •Nerves decrease in
becomes thicker changes number

•Osteoporosis of
underlying bone

•Thinning or absence
of cartilaginous zone

These changes could lead to dysfunction, impairment of motion and decrease in the secretion of
synovial fluid

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THANK YOU !!!
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 REFERENCES

 B.D. Chaurassia’s human anatomy 4th edition vol. 3 The Head & Neck

 Dorland WA: Medical Dictionary. Philadelphia and London, Saunders

Co., 1957

 GRANT’S ATLAS OF HUMAN ANATOMY

 WILLIAMS PL: GRAY’S ANATOMY, IN SKELETAL SYSTEM (ED 38). CHURCHILL

LIVINGSTONE, LONDON, 1999

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