Download - Tm joint, mandibular nerve
![Page 1: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/1.jpg)
TEMPORO-MANDIBULAR JOINT, MANDIBULAR NERVE AND
BRANCHES, OTIC GANGLION
DR PRATIK MISTRY
![Page 2: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/2.jpg)
TEMPORO-MANDIBULAR JOINT
![Page 3: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/3.jpg)
INTRODUCTION
Type of joint Articular surface Above: Below:
![Page 4: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/4.jpg)
Atypical synovial joint
Articular surface covered with fibro-cartilage
Complex joint Articular disc divide
completely into upper menisco-mandibular and lower menisco-temporal compartment.
![Page 5: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/5.jpg)
LIGAMENTS Capsular ligament with synovial
membrane Articular disc Lateral ligament Accessory ligaments
![Page 6: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/6.jpg)
CAPSULAR LIGAMENT WITH SYNOVIAL MEMBRANE
Attachments Above, below and in
front Synovial membrane
lines inner aspect in both compartments.
![Page 7: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/7.jpg)
ARTTICULAR DISC Oval plate of fibro-
cartilage divide the joint Represent degenerated
primitive insertion of lateral pterygoid
Attachments: Posteriorly, splits into
upper and lower lamella which are attached to squamo-tympanic fissure and neck of mandible
Structurally, consists of 5 parts:
1. Anterior extension2. Anterior thick band3. Intermediate zone4. Posterior thick band5. Bilamellar region
![Page 8: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/8.jpg)
LATERAL LIGAMENT OF T.M JOINT Blends with lateral
part of capsule Attached above to
the tubercle of root of zygoma to below lateral aspect of neck
![Page 9: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/9.jpg)
ACCESSORY LIGAMENTS
Spheno-mandibular ligament
Stylo-mandibular ligament
![Page 10: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/10.jpg)
RELATIONS In front
Lateral pterygoid Temporalis Masseteric vessels and
nerve Behind
External acoustic meatus
Parotid gland Auriculo temporal n Superficial temporal
vessels
Laterally subcutaneous
Medially Lateral pterygoid Roots of auriculo
temporal nerve enclosing medial meningeal artery
Spine of sphenoid and sphenomandibular lig
Chorda tympani n. Above
Floor of middle cranial fossa
![Page 11: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/11.jpg)
BLOOD SUPPLY NERVE SUPPLY
Branches of superficial temporal and maxillary arteries
Auriculo-temporal nerve Masseteric nerve
![Page 12: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/12.jpg)
MOVEMENTS AND MECHANISM Movements
are: Protrusion Retraction Depression Elevation Side to side
chewing movements
![Page 13: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/13.jpg)
MECHANISM OF MOVEMENTS Menisco-temporal
(upper) compartment permit gliding movement in protrusion, retraction and in chewing
Menisco-mandibular (lower) compartment permit rotation around two axis:
1. Transverse axis for depression and elevation
2. Vertical axis for side to side movements
![Page 14: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/14.jpg)
MUSCLES PRODUCING MOVEMENTS
![Page 15: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/15.jpg)
MECHANISM OF DEPRESSION Three phase
Rotatory Rolling (gliding) Rotatory
Initial phase:- transverse axis remain fix
Next phase:- transverse axis move forward
Final phase:- transverse axis remain fix
![Page 16: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/16.jpg)
![Page 17: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/17.jpg)
FACTORS MAINTAINING STABILITY BONES: Articular tubercle Post glenoid
tubercle
LIGAMENTS: Lateral ligament of
T.M. joint
MUSCLES: Protrusion –
temporalis Retraction – lat.
Pterygoid
![Page 18: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/18.jpg)
CLINICAL ANATOMY
Forward dislocation Clicking and pain
due to degeneration or displacement of disc
Referred pains
![Page 19: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/19.jpg)
![Page 20: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/20.jpg)
MANDIBULAR NERVE AND ITS BRANCHES
![Page 21: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/21.jpg)
INTRODUCTION Largest of all 3 divisions Nerve of 1st arch Mixed nerve with large
sensory and small motor root Both roots emerge from pons
& emerge through foramen ovale and unite to form trunk.
Bet. tensor veli palatini & lateral pterygoid. Otic ganglion sandwiched between trunk of nerve and tensor muscle and lie in front of middle meningeal artery.
Divide into small anterior and large posterior divisions.
![Page 22: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/22.jpg)
BRANCHES From the trunk
Meningeal branch Nerve to medial
pterygoid From the anterior division
Buccal nerve (sensory) Motor branches:
masseteric nerve, deep temporal nerves and nerve to the lateral Pterygoid
From the posterior division Auriculotemporal nerve Lingual Inferior alveolar nerve
![Page 23: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/23.jpg)
FROM THE TRUNK Meningeal branch
(nervous spinosus) Nerve to medial
pterygoid. Also supply tensor tympany and tensor veli palatini muscles.
![Page 24: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/24.jpg)
FROM ANTERIOR DIVISION 3 motor and 1
sensory Masseteric nerve Deep temporal
nerves Nerve to lateral
pterygoid Buccal nerve
![Page 25: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/25.jpg)
FROM POSTERIOR DIVISION 3 sensory branches Auriculo-temporal
nerve Inferior alveolar
nerve which carry few motor fibres to supply mylohyoid and anterior belly of digastric as nerve to mylohyoid
Lingual nerve
![Page 26: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/26.jpg)
CHORDA TYMPANI NERVE
![Page 27: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/27.jpg)
Branch of facial nerve which convey preganglionic secretomotor fibres to submandibular and sublingual glands and carry taste sensations from anterior 2/3 of tongue
Origin and course
![Page 28: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/28.jpg)
OTIC GANGLION Small, oval parasympathetic ganglion,
2-3 mm in size, reddish grey in colour situated in the infratemporal fossa
Topographically connected to mandibular nerve but functionally related to glossopharyngeal nerve.
![Page 29: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/29.jpg)
SITUATION Below foramen
ovale Medial to trunk of
mandibular nerve, lateral to tensor veli palatini
In front of middle meningeal artery
![Page 30: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/30.jpg)
CONNECTIONS Parasympathetic
or secretomotor root
Form by lesser petrosal nerve
Sympathetic root
Derived from plexus around middle meningeal artery, pass ganglion without relay
![Page 31: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/31.jpg)
BRANCHES Post ganglionic
parasympathetic fibres join auriculo-temporal nerve
Post ganglionic sympathetic fibres pass without relay join auriculo-temporal nerve
Fibres from nerve to medial pterygoid to supply tensor tympany and tensor veli palatini
![Page 32: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/32.jpg)
APPLIED ANATOMY Trigeminal neuralgia-
pain along the branches sensory root divided to
relieve pain Mandibular nerve block During removal of
wisdom teeth, avoid injury to lingual nerve
Referred pain to ear while teeth pain
Inferior alveolar nerve block for removal of teeth of lower jaw
![Page 33: Tm joint, mandibular nerve](https://reader036.vdocuments.us/reader036/viewer/2022062522/58a31ce81a28ab1d068b686d/html5/thumbnails/33.jpg)
THANK YOU