From Volume 47, Issue 1, January 2020 | Pages 62-70
Knowledge of structures of the head and neck is an important aspect of safe and effective daily clinical practice. This article will review the relevant anatomy for the assessment of the temporomandibular joints (TMJs) and associated structures, delivery of local anaesthesia, understanding routes of spread of odontogenic infections and avoidance of anatomical complications in dento-alveolar surgery.
The TMJ is the articulation between the squamous portion of the temporal bone and the mandibular condyle. The articular surfaces of the temporal bone and the condyle are completely enclosed within a dense fibrous capsule. Interposed between the articular surfaces of the temporal bone and mandibular condyle, and contained within the capsule is an intra-articular disc. The capsule attaches to the articular eminence, the circumference of the articular disc and to the neck of the condyle. It has various sensory receptors including nociceptors, and blends with the temporomandibular (lateral) ligament. The articular disc divides the TMJ into superior and inferior compartments (Figure 1). The surfaces of these compartments contain a lining which produces a synovial fluid, thus making the TMJ a synovial joint.
Pain on palpation of the immediate pre-auricular area suggests inflammation of the capsule (capsulitis). This may be due to several reasons, such as major trauma eg assault, or minor trauma eg parafunction. A thorough patient history will aid in identification of the relevant cause and guide management.
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