The Anatomy of The Temporomandibular Joint

Dem Bones.

TMJ is really the hinge that allows us to open and close our jaw. However,we commonly refer to any pain or dysfunction in the hinge as TMJ or TMD (Temporomandibular Dysfunction).  Right now we are just looking at the anatomy of the temporomandibular joint .

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Let us start by taking a look at the bony structure of the TMJ or temporomandibular joint.  There are two TMJ joints, one on each side of the skull.  The name comes from the two bones that make up the joint.  One is the bone on the side of the skull called the temporalis bone and the second is the lower jaw bone which is called the mandible. Hence the name temporomandibular joint.  These joints are located just in front of your ears.  These joints are nothing more than hinges which allow us to open and close our jaw.

Between the Bones.

Surrounding the TMJ joint is a capsule of fibrous material.  Between the bone joint is a special disc which is an extension of the capsule called an articular disc which is formed from a flexible, tough yet elastic tissue called fibrocartilage  Our ears are made up of this fibrocartilage.  This thin disc divides the joint into two cavities.  When the joint is in motion or there is pressure on the articular disc it releases synovial fluid into the cavities and this fluid acts like a shock absorber and reduces friction.  There is only one other place in the body that require an articular disc and that is where the top of the sternum, clavicle and first rib all meet.  At first, when you open your mouth a rotational movement occurs with the lower jaw and the disc but when you open the mouth even wider there is a second movement called the translational or forward and downward sliding movement of the disc and the jaw.  The two ends of the mandible or jaw are called condyles which comes from the word ”condyloma” which is derived from the Greek word ”kondylos” which means a knuckle or a knob. Further, “condyle” refers to a rounded articular surface.  This knob or condyle butts up to the underneath side of the TMJ disc.  On the mandible the glenoid or mandibular fossa meets the upper side of the disc and is a depression or concave-shaped.

Joining It All Together.

Ligaments are strong, tough, rope-like connective fibres. They connect bones to each other and connect cartilage to joints.. There is one primary and two secondary ligaments of the TMJ.  The temporomandibular ligament is the primary ligament which consists of two parts; the outer oblique portion or OOP and the inner horizontal portion or IHP.  The two minor or secondary ligaments are the stylomandibular ligament and the sphenomandibular ligament of which neither is directly attached to any part of the temporomandibular joint.

During movement only the jaw moves. Muscles attached to the bones and joints allow a variety of movements.such as yawning, chewing, talking, singing, shouting and swallowing, making the temporomandibular joints the most flexible in the human body. These sophisticated joints can move up and down and side to side in a wide range of motion and in a normal healthy jaw there is no pain or discomfort with these movements.

Muscles and The Nerve of It All.

The four muscles of mastication move the jaw or mandible.  They are the masseter, the medial pterygoid, lateral pterygoid and the temporalis.  The Trigeminal nerve is the sensory nerve for the face and the motor nerve for the mastication muscles  As the name suggests, the trigeminal nerve is made up of three branches.  The ophthalmic V1, sensory, the maxillary V2, sensory and the mandibular V3,motor and sensory branches.

TMJ Disorders, Pain and Discomfort.

Muscle fatigue from clenching the jaw or grinding your teeth, arthritis, and jaw injury are some of the causes of TMJ disorders. Understanding the anatomy of the joint will help you to better understand the workings of the TMJ and how surrounding bones,ligaments, nerves.and muscles can be affected when you experience temporomandinbular disorder.


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Tips for treatment of TMJ.

Hi my name is Lucy .  I live on the West Coast of  Canada and I am fifty-seven years old and I love sailing , painting and gardening.

I found out over 35 years ago that I had TMJ when I went to my Doctor  about an earache.  When he couldn't find any infection he referred me to an Ear, Nose and Throat Specialist.  It sounds funny but the Specialist had me stick my fingers in my ears and open and close my jaw.  It was then I felt my jaw clunk unevenly and Temporomandibular Joint Disorder was the name he gave me for the sharp pain in my ear. TMJ causes this symptom along with many others. I needed TMJ or TMD treatments.

I was given some stretching and resistance exercises  to do and was suggested I take some muscle relaxants and avoid eating things like Big Macs.  I was interested in what had caused this and was told that it could have been dental work (some of which I had done recently) or it was stress related;( also a possibility) as stress can be one of a number one tmj causes.
It wasn't until recently that I became very very interested in TMJ jaw disorders after I experienced a wicked episode of neck pain, shoulder pain, jaw pain and head pain that sent me in search of some serious help for the pain TMJ was giving me.

What is TMJ Disorder?


TMJ disorders (TMJD) cause pain and tenderness in the TemporoMandibular joint (TMJ) — the joint just in front of your ears on either side of your head where your lower jawbone meets your skull. It is by far the most complex and most over-worked joint in the human body.
TMJ jaw disorders can be caused by many different types of problems — TMJ causes are often very individualized and there is a long list of causes including arthritis, jaw injury, or muscle fatigue from clenching or grinding your teeth.
In most cases, the pain TMJ causes and the discomfort associated with TMJ disorders can be alleviated with self-managed care or nonsurgical treatments. About 5% of all TMJ cases are severe, such as TMJ dislocation and may need to be treated with dental or surgical interventions. TMJ surgery should be a last resort and your decision to have TMJ surgery should be arrived at with the help from a TMJ specialist.

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Symptoms of TMJ

- Headaches, migraine headaches.
- Jaw locks opened or closed.

- Ringing or buzzing in the ears.

- Hearing loss.

- Problems swallowing.

- Neck pain and shoulder pain and back pain.

- Stiffness in jaw joint.

- Inability to open mouth wide.

- Inflammation, swelling.
- Clicking and popping sounds.

Types of Treatments for TMJ.


There are many  treatments  for TMJ that range from very passive of exercises to the extreme of invasive surgical procedures.

Exercises.  Ranging from passive movements to stretching and resistance.

Diet and stress management.

Medications.  Anti-inflammatories, muscle relaxants. 

Mouth appliance or Splint             

Corrective dental procedures.

 Physiotherapy.

Acupressure.

Transcutaneous electrical nerve stimulation (TENS).

Ultrasound.

Botox treatments.

Trigger-point injections and Radio Wave Therapy.

Acupuncture

Prolotherapy _Injections of an irritant to stimulate repair of ligaments and  tendons.

Surgical intervention.


Easy Exercises to help relieve TMJ.

These TMJ exercises below were given to me as a simple ways to reduce TMJ pain.  Do them in the privacy of you own home.  Done regularly, you can expect to have increased movement in your TM joints and more relaxed muscles. Start with 3 repetitions and increase over time to 10 repetitions.

 1. First, with  mouth closed place the palm of your hand under your chin and creating resistance with your hand slowly open your mouth wide.  Now that mouth is wide open place two fingers of the same hand on the lower teeth, then slowly close the mouth again using resistance. Go slowly and be gentle. Do repetitions.

2. This exercise is similar to 1.  except you  thrust your jaw straight forward with the palm of you hand  against the chin giving resistance.  Once the jaw is fully extended place two fingers of the hand on the lower teeth and now using resistance pull the jaw straight back to its resting position. Do repetitions.

3. Make a fist with your left hand and place flat side of your fist against the left side your jaw.  Using resistance slowly move your jaw to the left, once fully extended to the left place a right hand fist against the right side of jaw and using resistance move the jaw all the way to the right. Do repetitions.

4. Gently close your mouth and touch the roof of your mouth with your tongue.  Hold  the tongue on the roof of your mouth as you slowly and gently open and close your mouth. Do repetitions.

One important thing to note: if you have severe TMJ symptoms, it is always a good idea to consult with a doctor in order to determine the best treatment plan. These exercises may be helpful to relieving the pain, but there may be other treatments to consider as well.

If you do these exercises daily it will increase flexibility  the joint and also strengthen and help to relax the jaw muscles.  These TMJ exercises can greatly alleviate the pain and discomfort associated with TMJ, and contribute the the healing of this disorder.

NY Times Article Best Treatment for TMJ May be Nothing, worth a read at http://www.nytimes.com/2009/02/03/health/03brod.html

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