Tm joint, mandibular nerve, otic ganglion

1. TEMPORO-MANDIBULAR JOINT,
MANDIBULAR NERVE AND
BRANCHES, OTIC GANGLION
DR PRATIK MISTRY

2. TEMPORO-MANDIBULAR JOINT

3. INTRODUCTION
 Type of joint
 Articular surface
 Above:
 Below:

4.  Atypical synovial joint
 Articular surface
covered with fibro-
cartilage
 Complex joint
 Articular disc divide
completely into upper
menisco-mandibular
and lower menisco-
temporal compartment.

5. LIGAMENTS
 Capsular ligament with synovial membrane
 Articular disc
 Lateral ligament
 Accessory ligaments

6. CAPSULAR LIGAMENT WITH SYNOVIAL MEMBRANE
 Attachments
 Above, below and in
front
 Synovial membrane
lines inner aspect in
both compartments.

7. 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
 Structurally, consists of
5 parts:
1. Anterior extension
2. Anterior thick band
3. Intermediate zone
4. Posterior thick band
5. Bilamellar region

8. 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

9. ACCESSORY LIGAMENTS
 Spheno-
mandibular
ligament
 Stylo-mandibular
ligament

10. 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

11. BLOOD SUPPLY NERVE SUPPLY
 Branches of superficial
temporal and maxillary
arteries
 Auriculo-temporal nerve
 Masseteric nerve

12. MOVEMENTS AND MECHANISM
 Movements are:
 Protrusion
 Retraction
 Depression
 Elevation
 Side to side
chewing
movements

13. 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

14. MUSCLES PRODUCING MOVEMENTS

15. 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

17. FACTORS MAINTAINING STABILITY
 BONES:
 Articular tubercle
 Post glenoid tubercle
 LIGAMENTS:
 Lateral ligament of
T.M. joint
 MUSCLES:
 Protrusion – temporalis
 Retraction – lat.
Pterygoid

18. CLINICAL ANATOMY
 Forward dislocation
 Clicking and pain due
to degeneration or
displacement of disc
 Referred pains

20. MANDIBULAR NERVE AND ITS
BRANCHES

21. 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.

22. 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

23. FROM THE TRUNK
 Meningeal branch
(nervous spinosus)
 Nerve to medial
pterygoid. Also supply
tensor tympany and
tensor veli palatini
muscles.

24. FROM ANTERIOR DIVISION
 3 motor and 1 sensory
 Masseteric nerve
 Deep temporal nerves
 Nerve to lateral
pterygoid
 Buccal nerve

25. 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

26. CHORDA TYMPANI NERVE

27.  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

28. 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.

29. SITUATION
 Below foramen ovale
 Medial to trunk of
mandibular nerve,
lateral to tensor veli
palatini
 In front of middle
meningeal artery

30. CONNECTIONS
 Parasympathetic or
secretomotor root
 Form by lesser
petrosal nerve
 Sympathetic root
 Derived from plexus
around middle
meningeal artery,
pass ganglion without
relay

31. 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

32. 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

33. THANK YOU