Macroscopic and microscopic aspects of the temporomandibular joint related to its clinical implication

In order to obtain a precise diagnosis and treatment for temporomandibular dysfunctions, it is necessary to have morphological and functional knowledge of the temporomandibular joint. Anatomic components are important to the understanding of the complexity of temporomandibular joint. Nonetheless, just as important are the anatomic relationships that this joint has with the neighboring structures. Thus, the aim of this study was to present the anatomic relationships of the temporomandibular joint in its various surfaces: external or lateral, anterior, posterior, medial, superior, and posterosuperior, considering the morphological and histological aspects. Nine human heads, fixed in formalin (10%) underwent sagittal medial section and were subsequently dissected, evidencing the anatomic components of all surfaces to be analyzed. Components of the external surface were: skin, subcutaneous tissue, lymphatic ganglia, parotid gland, superficial temporal artery, transverse facial artery, zygomatic-orbital artery, superficial temporal vein, facial and auriculotemporal nerves, masseter muscle, and pre-auricular lymphonodus. The anterior surface comprised the masseter and lateral pterygoid muscles (upper and inferior heads), pterygoid venous plexus, mandibular notch, posterior deep temporal artery, masseteric nerve, and deep posterior temporal branches. Medial surface components were: internal maxillary artery, of which middle meningeal artery was one of the closest branches to the TMJ, anterior tympanic artery, inferior alveolar, lingual, auriculotemporal, and chorda tympani nerves, which belonged to the surface posterior to the anterior wall of the auditory duct; auricolotemporal nerve, parotid gland; and petrotympanic fissure. The cerebral fossa (meninges and encephalon) belonged to the superior surface and the ear belonged to the posterosuperior surface. Histologically, the temporomandibular joint is composed by different tissues that compound the mandibular head, mandibular fossa, and articular eminence of the temporomandibular joint. It was concluded that the temporomandibular joint is a complex structure and the clinician must have the ability to formulate the diagnosis based on the understanding of morphological aspects of the structures that compose the stomatognatic system.