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Image of the (A) sphenomandibular, (B) stylomandibular, and (C) pterygomandibular accessory ligaments to the temporomandibular joint.
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Temporomandibular joint disorders are characterized by chronic or acute musculoskeletal or myofascial pain with dysfunction of the masticatory system. Treatment modalities include occlusal splints, patient education, activity modification, muscle and joint exercises, myofascial therapy, acupuncture, and manipulative therapy. In the physiology of th...
Citations
... (4) Ligaments Tension perceived by the articular ligaments is crucial for TMJ function. Five representative ligaments are involved in regulating movement and force within the TMJ, transmitting numerous proprioceptive afferents to the central nervous system 19 . The anatomical relationship between the ligaments of the TMJ and middle ear is considered one of the explanations for the aural symptoms associated with TMD ( Fig. 2). ...
The temporomandibular joint (TMJ) is one of the most unique joints in the human body that orchestrates complex movements across different orthogonal planes and multiple axes of rotation. Comprising the articular eminence of the temporal bone and the condylar process of the mandible, the TMJ integrates five major ligaments, retrodiscal tissues, nerves, and blood and lymph systems to facilitate its function. Cooperation between the contralateral TMJ and masticatory muscles is essential for coordinated serial dynamic functions. During mouth opening, the TMJ exhibits a hinge movement, followed by gliding. The health of the masticatory system, which is intricately linked to chewing, energy intake, and communication, has become increasingly crucial with advancing age, exerting an impact on oral and systemic health and overall quality of life. For individuals to lead a healthy and pain-free life, a comprehensive understanding of the basic anatomy and functional aspects of the TMJ and masticatory muscles is imperative. Temporomandibular disorders (TMDs) encompass a spectrum of diseases and disorders associated with changes in the structure, function, or physiology of the TMJ and masticatory system. Functional and pathological alterations in the TMJ and masticatory muscles can be visualized using various imaging modalities, such as cone-beam computed tomography, magnetic resonance imaging, and bone scans. An exploration of potential pathophysiological mechanisms related to the TMJ anatomy contributes to a comprehensive understanding of TMD and informs targeted treatment strategies. Hence, this narrative review presents insights into the fundamental functional anatomy of the TMJ and pathological changes that evolve with TMD progression. [J Korean Dent Sci. 2024;17(1):14-35]
... The anterior border of the PMR attaches to the bucinator, while the posterior border attaches to the SPC [13]. Covered by mucosa, it forms, on average, a 25-30 mm long pterygomandibular fold (PMF) right behind the third molar ( Fig. 1) [3,17]. The SPC is also reported to have continuous fiber to the soft palate and the root of the tongue [18,19]. ...
... Contrastingly, in a recent description of this buccotemporal fascia, researchers describe it inserting anterior to the PTM [24]. This existence of the PMR is supported by various other studies as well [8,9,17]. Subsequent studies done by www.acbjournal.org ...
... Studies on OSA treatment have led to the discovery of certain findings, such as the PMR's ability to stabilize the mandible and temporomandibular joint [8,31]. Additionally, mandibular advancement has been found to result in more lateral than anterior-posterior movement, which is believed to be related to the function of the PMR [17]. Shimada reasoned that, without the PMR, the separate functions of the bucinator and SPC would be challenging. ...
The pterygomandibular raphe (PMR) is a tendinous structure connecting the bucinator and the superior pharyngeal constrictor muscles. With its implications in the spread of oral cancer, the proper treatment of obstructive sleep apnea, and dental procedures, it is important to obtain a thorough understanding of the PMR. We reviewed the existing literature to compile the published information regarding its anatomy, embryology, imaging, variations, functions, pathologies, and clinical relevance of the pterygomandibular raphe.
... Today, clinicians and therapists should consider the whole person as a unique and global system in which muscular and fascial components can influence body posture, SS and its functions (chewing, speaking and swallowing), which are almost impaired in neurological patients. Some authors stated [77,78] that the SS should be considered a part of the proprioceptive system, among balance, sight and postural control of the whole body. This could explain why manual treatments (such as OMT), physical exercise and postural reeducation can be more effective than other pharmacological or non-conservative treatments. ...
Patients affected by neurological disorders can develop stomatognathic diseases (SD) related to decreased bite force and quality of mastication, bruxism, severe clicking and other temporomandibular disorders (TMD), which deeply affect patients’ swallowing, masticatory and phonation functions and, therefore, their quality of life. The diagnosis is commonly based on medical history and physical examination, paying attention to the temporomandibular joint (TMJ) range of movements, jaw sounds and mandibular lateral deviation. Diagnostic tools such as computed tomography and magnetic resonance imaging are used instead in case of equivocal findings in the anamnesis and physical evaluation. However, stomatognathic and temporomandibular functional training has not been commonly adopted in hospital settings as part of formal neurorehabilitation. This review is aimed at describing the most frequent pathophysiological patterns of SD and TMD in patients affected by neurological disorders and their rehabilitative approach, giving some clinical suggestions about their conservative treatment. We have searched and reviewed evidence published in PubMed, Google Scholar, Scopus and Cochrane Library between 2010 and 2023. After a thorough screening, we have selected ten studies referring to pathophysiological patterns of SD/TMD and the conservative rehabilitative approach in neurological disorders. Given this, the current literature is still poor and unclear about the administration of these kinds of complementary and rehabilitative approaches in neurological patients suffering from SD and/or TMD.
... The tension exposed to the articular ligaments plays a significant role in the stability of TMJ. 26 These ligaments provide the functional continuity of TMJ by stabilizing it. Sphenomandibular ligament protects TMJ from excessive translation movements following mouth opening at 10°, stylomandibular ligament limits extensive protrusion of jaw, while collateral ligament serves to anchor the disk to the condyle. ...
Aim Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD.
Patients and Methods Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded.
Results Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% (p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups (p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate (p ≈ 0.029).
Conclusions In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.
... Temporomandibular dysfunction (TMD) is a term that describes a number of clinical problems that involve the hard and soft tissue structures of the temporomandibular joint (TMJ) (1). Variety symptoms are related to TMD including clicking or grating within the joint, mechanical restrictions, headache, neck pain, or stiffness (2). ...
Objective: The purpose of this case report was to present a digital mandibular tracing technique that is used to evaluate a patient with temporomandibular joint dysfunction (TMD). Clinical features: A 65-year-old Caucasian female patient presented with chronic jaw pain in her temporomandibular joint (TMJ) area. The patient describes a dental history of orthodontic and prosthodontic treatment. Orally patient exhibits super erupted teeth, multiply fractured restorations, facial gingival recession, and rotated teeth. The patient also had an uneven occlusal plane and non-working side contact at maxillary first and mandibular second molars. Evaluation and outcome: A digital mandibular tracing technique, cone beam computed tomography, and full-arch optical impressions were used to evaluate the patient’s condition. The left condyle was slightly flat compared with the right one on the anterior surface. Limited protrusion and lateral movements and asymmetric border movements were detected. Apparently, an incomplete orthodontic treatment at the patient’s early age, iatrogenic mandibular anterior restorations, and hit and slight effect are considered causes of temporomandibular joint problems. The recommended treatment plan sequence for this patient is an occlusal adjustment, replacement of defective restorations, and fabrication of an occlusal guard for one of the arches. Conclusion: A digital mandibular tracing system can help the dentist to diagnose and analyze the causes of TMD patients specifically and individually. It also provides quick resolution and management for patients with TMD.
... Temporomandibular joint dysfunction (TMD) is a term that describes a number of clinical problems that involve the hard and soft tissue structures of the temporomandibular joint (TMJ) [1]. Variety symptoms are related to TMD including clicking or grating within the joint, mechanical restrictions, headache, neck pain, or stiffness [2]. ...
Objective. The purpose of this case report was to present a digital mandibular tracing technique that is used to evaluate a patient with temporomandibular joint dysfunction (TMD). Clinicalfeatures.A65-year-oldCaucasianfemalepatientpresentedwithchronicjawpaininhertemporomandibularjoint(TMJ)area.Thepatientdescribesadentalhistoryoforthodonticandprosthodontictreatment.Orallypatient exhibitssupereruptedteeth,multiplyfracturedrestorations,facialgingivalrecession,androtatedteeth.Thepatient also had an uneven occlusal plane and non-working side contact at maxillary first and mandibular second molars. Evaluation and outcome. A digital mandibular tracing technique, cone beam computed tomography, and full-arch optical impressions were used to evaluate the patient’s condition. The left condyle was slightly flat compared with the right one on the anterior surface. Limited protrusion and lateral movements and asymmetric border movements were detected. Apparently, an incomplete orthodontic treatment at the patient’s early age, iatrogenic mandibular anterior restorations, and hit and slight effect are considered causes of temporomandibular joint problems. The recommended treatment plan sequence for this patient is an occlusal adjustment, replacement of defective restorations, and fabrication of an occlusal guard for one of the arches. Conclusion. A digital mandibular tracing system can help the dentist to diagnose and analyze the causes of TMD patients specifically and individually. It also provides quick resolution and management for patients with TMD.
... The structure of TMJ is stable because the fibrous ligaments protect it from stress and tension in the joint [20]. Abnormalities in the chewing system due to increased masticatory muscle tone affect masticatory dysfunction [21]. ...
The purpose of this study was to compare the muscle thickness and tone of the masseter and sternocleidomastoid (SCM) muscles and maximum mouth opening (MMO) in subjects with and without temporomandibular disorders (TMD), and perform a correlation comparison on the results of the TMD group. Sixty patients were allocated to the TMD group (n = 30) or the non-TMD group (n = 30). Ultrasound imaging, myotonometer, and vernier calipers were used to determine the related changes in muscle thickness and muscle tone in masseter and SCM, and MMO, respectively. The TMD group revealed a significant decrease than the non-TMD group in the muscle thickness of masseter and SCM, respectively (p < 0.001), with a significant increase in frequency (p < 0.001) and stiffness (p < 0.001) in the masseter muscle tone, with a significant increase in frequency (p < 0.001) and stiffness (p = 0.005) in the SCM muscle tone, a significant decrease in the MMO (p < 0.001). There was a moderate negative correlation between the relaxed state of masseter muscle thickness and stiffness of SCM muscle tone (r = −0.40, p = 0.002), and a moderate negative correlation between the relaxed state of SCM muscle thickness and frequency of SCM muscle tone (r = −0.42, p = 0.001). There was a moderate negative correlation between the clenching state of SCM muscle thickness and the frequency of SCM muscle tone (r = −0.47, p < 0.001). In addition, a moderate negative correlation between MMO and frequency of SCM muscle tone (r = −0.44, p < 0.001). The muscle thickness was decreased, and the muscle tone was increased in the masseter and SCM muscle, respectively. Additionally, MMO was decreased in patients with TMD compared with non-TMD.
... Temporomandibular joint is a ginglymoarthrodial joint composed of synovial cavity, articular cartilage and a capsule that covers the same joint [3 ,4]. Through its complex movements on different orthogonal planes and multiple rotation axes it coordinates various functions such as mouth opening, swallowing, breathing and also various facial expressions along with dental structures including mandible, muscle tenons, salivary glands etc. [3][4][5]6]. Temporomandibular joint disorders are a class of degenerative musculoskeletal conditions associated with morphological and functional deformity [7,8]. ...
... Normal jaw function may be affected if there is damage to the articular disc, for example, dislocation of the disc and the condyle, resulting in excessive stretching of the TMJ ligaments [44]. This disorder, designated as DD or ID, can be defined as a malfunction and/or irregular location of the disc, often anteriorly [45,46]. ...
The temporomandibular joint (TMJ) is an important structure for the masticatory system and the pathologies associated with it affect a large part of the population and impair people’s lifestyle. It comprises an articular disc, that presents low regeneration capacities and the existing clinical options for repairing it are not effective. This way, it is imperative to achieve a permanent solution to guarantee a good quality of life for people who suffer from these pathologies. Complete knowledge of the unique characteristics of the disc will make it easier to achieve a successful tissue engineering (TE) construct. Thus, the search for an effective, safe and lasting solution has already started, including materials that replace the disc, is currently growing. The search for a solution based on TE approaches, which involve regenerating the disc. The present work revises the TMJ disc characteristics and its associated diseases. The different materials used for a total disc replacement are presented, highlighting the TE area. A special focus on future trends in the field and part of the solution for the TMJ problems described in this review will involve the development of a promising engineered disc approach through the use of decellularized extracellular matrices.
... The posterior portion attaches superiorly to the temporal bone and inferiorly to the posterior condyle. Several ligaments, TMJ disc, articular capsule and masticatory muscles stabilize the TMJ and manage the TMJ forces [12]. Both TMJ dysfunction and abnormalities within masticatory muscles may lead to Temporomandibular Disorders (TMDs). ...
The presented study aimed to analyze and compare the electromyographic patterns of masticatory muscles in subjects with active myofascial trigger points (MTrPs) within upper trapezius, patients with temporomandibular disorders (TMDs) and healthy adults. Based on the diagnostic criteria of MTrPs according to Travell & Simons and the Research Diagnostic Criteria for Temporomandibular Disorders, 167 people were qualified for the study. Subjects were divided into 3 groups: with active MTrPs in the upper trapezius, with diagnosed temporomandibular disorders (TMDs) and healthy adults. Measurements of the bioelectric activity of the temporalis anterior (TA) and masseter muscle (MM) were carried out using the BioEMG III ™. Based on statistical analysis, significantly lower values of TA resting activity were observed among controls in comparison to MTrPs (1.49 μV vs. 2.81 μV, p = 0.00) and TMDs (1.49 μV vs. 2.97 μV, p = 0.01). The POC index values at rest differed significantly between MTrPs and TMDs (86.61% vs. 105%, p = 0.04). Controls presented different electromyographic patterns within AcI in comparison to both MTrPs (4.90 vs. −15.51, p = 0.00) and TMDs (4.90 vs. −16.49, p = 0.00). During clenching, the difference between MTrPs and TMDs was observed within MVC TA (91.82% vs. 116.98%, p = 0.02). TMDs showed differences within AcI in comparison to both MTrPs group (−42.52 vs. 20.42, p = 0.01) and controls (−42.52 vs. 3.07, p = 0.00). During maximum mouth opening, differences between MTrPs and TMDs were observed within the bioelectric activity of masseter muscle (16.45 μV vs. 10.73 μV, p = 0.01), AsI MM (0.67 vs. 11.12, p = 0.04) and AcI (13.04 vs. −3.89, p = 0.01). Both the presence of MTrPs in the upper trapezius and TMDs are related to changes in electromyographic patterns of masticatory muscles.
