5Īrticular disks, masticatory muscles, capsules, and ligaments stabilize the condyle in TMJs. This structure has a greater capacity to resist degenerative change and regenerate itself than the hyaline cartilage of other synovial joints. 4 The articular surface of the joint, covered by a fibrous connective tissue, is avascular and noninnervated. In the TMJ, proprioception is provided principally by the capsule, spindles of masticatory muscles, cutaneous receptors, and periodontal mechanoreceptors. 2 Branches from internal maxillary, superficial temporal, transverse facial, and middle meningeal arteries also supply the TMJ. Branches of the auriculotemporal, masseteric, and posterior deep temporal nerves supply the TMJ it is still uncertain whether branches of the facial nerve and the lateral pterygoid nerve supply the joint. Pain associated with temporomandibular joint disorders (TMDs) is thought to originate in the synovial joint capsule and surrounding musculature. The TMJ works properly when the right-sided and left-sided joints are synchronized during movement. These movements allow a number of functions such as chewing, sucking and swallowing, articulating sounds, breathing, and making facial expressions. The TMJ is responsible for all movements of the jaw, which take place in different orthogonal planes and around multiple axes of rotation. The TMJ is a synovial joint consisting of the condyle of the mandible, the mandibular fossa of the temporal bone, a thin articular disk, and a capsule ( Figure 1). The TMJ makes muscular and ligamentous connections to the cervical region, forming a functional complex called the cranio-cervico-mandibular system. 1 This system includes also the hyoid bone and the muscles that connect it to the manubrium of sternum, mandible, scapula, the facial sheets within the anterior cervical region, and other structures in the neck. These structures act in harmony to perform different functional tasks such as speaking, chewing, and swallowing. The stomatognathic system is characterized by several structures including skeletal components (eg, maxilla, mandible), dental arches, soft tissues (eg, salivary glands, nervous and vascular supplies), masticatory muscles, and the temporomandibular joint (TMJ). The authors review the literature concerning the accessory ligaments of the temporomandibular joint and describe treatment options, including manual techniques for mobilizing the accessory ligaments. Although general principles regarding the anatomy of the ligaments are relatively clear, very little substantiated information on the dimension, orientation, and function of the ligaments has been published, to the authors' knowledge. A thorough knowledge of the anatomy of accessory ligaments is necessary for good clinical management of temporomandibular joint disorders. In the physiology of the temporomandibular joint, accessory ligaments limit the movement of the mandible. Treatment modalities include occlusal splints, patient education, activity modification, muscle and joint exercises, myofascial therapy, acupuncture, and manipulative therapy. Temporomandibular joint disorders are characterized by chronic or acute musculoskeletal or myofascial pain with dysfunction of the masticatory system.
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