1 General notions

The second specificity concerns the TMJ

movement capacity. During mandibular
movements, the TMJ is the site of complex
movements, combining at the same time
translation and rotation movements. This is
made possible thanks to the specific anatomical
structure of the TMJ which, between "the osseous
components, has an ,articular disk delimiting two
distinct joint compartments .
A brief anatomical description is necessary to understand
the specificity of these joints; for further information, the
readers are invited to turn to more specialized documents.
One osseous component is located on the mandible, the other
one under the skull:
- The mandibular condyle, also called the head of the mandible,
2 Top view showing has an oblong shape and its main transverse axis is obliquely and
the orientation
of condyles. backwards orientated (Fig. 2);
- The temporal articular surface, called the "mandibular fossa", 9
is located in front of the external auditory meatus which li mits
its posterior aspect. The articular eminence represents the
anterior part of the joint, it is convex in the sagittal direction.
The mandibular and cranial articular surfaces are covered with
fibrocartilage but are not in direct contact (Fig. 3).

External

fossa

Temporal
condyle

3 Lower view of the cranial articular cavity.

 Occlusion made easy

4 Anatomical
section of the TMJ
(P. Carpentier and
J.P. Yung).

10 A dense fibrous structure, the articular disk lies between the condyle and the mandibular
fossa. Pierre Carpentier (2011) describes here a condylar disco-m uscular appa ratus which
perfectly typifies the comp lexity of this structure in which the disk, the articular capsu le
and the insertion s of the lateral pterygoid muscle have important functional implications
(Fig. 4) .
In a parasagitta l vi ew, we can then see both compartments: the upper one located between
the sk ull and the disk, and th e lower one located between the disk and the mandibular
condyle. It allows two typ es of movements: a movement of rotation of the condyle, under
th e disk, on the lower floor, and a translation movement of the condyle/disk apparatus
aga inst t he em inence of th e tempo ral bone on the upper floor.
An art icu lar capsu le encircl es the disk and connects it, on the one hand to the condyle and
on t he other hand to the skull. The integrity of the articu lar capsu le protects the condyle/
disk apparatus and conseque nt ly gua rantees th e fluidity of the articular function . Synovial
liqu id bathes each compartment, providing lubrication.

Les muscles masticateurs

The muscular system is the driving element of the manducatory apparatus . There are levator
muscles and depressor 'muscles. The lateral pterygoid muscle plays a specif ic part, because
its comp lex ro le is determin ing in the mand ibular functioning .

Levator muscles Direct depressor muscles

Temporal Geniohyoid muscle:
M assete r mylohyoid muscle and digastric
muscle
M ed ial Pterygoid
 1 General notions

Anterior
fascicle

Posterior
fascicle

5 Temporal muscle. 6 Masseter muscle.

11

The medial The temporal muscle is the most powerful

pterygoid is
of the masticatory muscles . It is a fan-shaped,
inserted on
the medial flat, broad and voluminous muscle. There are
surface of three fascicles: anterior, medial and posterior.
the pterygoid It originates from the top of the temporal fossa
apophysis . and inserts below onto the coronoid apophysis
via a tendon. It plays a levator role for its anterior
7 Medial pterygoid and medial fascicles and also controls retraction
muscles (bottom view). for the posterior fascic le (Fig. 5).
The masseter is a thick and short muscle
covering the lateral face of the mandibular
ramus. At the top, it inserts in the lower edge of
the zygomatic arch, and at the bottom on a big
portion of the external face of the ramus up to
its basilar edge. It has two fascicles, a superficial
one orientated from top to bottom towards the
back, and a deeper and thinner one, directed
from top to bottom and from back to front,
joining the insertion of the temporal muscle on
the corono id apophysis (Fig. 6).
The medial pterygoid is a "symmetric" muscle
of the masseter. Short and thick, it is inserted
on the pterygoid apophysis. It joins the medial
8 View showing the symmetry between the surface of the mandibular angle (Fig. 7-8).
masseter and the medial pterygoid muscles.
 Occlu sion made easy

9 Lateral pterygoid. 10 Cross section showing the insertions of the two heads
of the lateral pterygoid (P. Carpentier and J.P. Yung).

12 The lateral pterygoid is made of two heads: a

superior and an inferior. The infe rior or pterygoid
head which propels t he mandible only inserts
into the lower two t hirds of th e pterygoid fovea
and has no insertion on th e TMJ . Th e superior or
sphenoid head inserts into the superior third of
the pterygoid fovea, onto th e disc, penetrating
th e medial part of the anterior rim . It also inserts
into the inferior surface of the superior arti cular
capsule (retrod isca l tendinous lamina). The
fun ctiona l role of th e superior head is comp lex:
it pulls and also provides a braking ro le during
closing by checking the position of the cond yl e
11 Lateral pterygoid (view showing the and the arti cular disc (Fig. 9-10-11).
obliquity towards the medial plane).
The depressor muscles cover th e floor of the
mouth and lift the tongue during deglutition
Mylo-
(Fig. 12).
hyo'i dien

)igastric
rnterior belly

Indirect depressor Cervical muscles

muscles
Sternothyroid Sternocleidomastoid
muscle muscle
Thyrohyoid muscle Trapezius muscl e
Sternohyoid muscle
12 Main muscles of the floor of the mouth. Omohyoid muscle
 1 General notion s

Digastric
anterior belly

Omohyoid
muscle , Sternohyoid
muscle
Sternohyoid
muscle

Trapezius
muscle
iiiiliiiE~~~ ,
13 lnfrahyoid muscles. 14 Cervical muscles.

The indirect and cervical depressor muscles are located further, but they also take part in the
13
mandibular function and in the head posture (Fig. 13-14). An elaborate balance is settled
between the skull, the neck and the nape of the neck muscles to hold the head posture.
These muscles may be compared to rubber bands balancing the skull on the cervical spine.
If a rubber band happened to break, the whole balance of the system would be broken and
the posture of the head would be altered (Fig. 15). During the clinical examination, we will
see how the practitioner can do the cliniccil assessment.

15 The postural
balance is achieved
with the combined
action of the skull,
the neck and the
nuchal muscles.