Temporomandibular Joint Anatomy

Temporomandibular Joint Anatomy, Neck Pain, and Headaches

By Ann McCulloch

Understanding the temporomandibular joint anatomy helps explain its crucial role in the daily functionality and harmony of your jaw, neck, and head.

While commonly associated with jaw movement and chewing, the temporomandibular joint’s (TMJ) intricate anatomy and connection to the neck can significantly impact headaches and craniofacial pain. This article explores the TMJ anatomy and sheds light on the fascinating interplay between your jaw joint, the neck, and headaches.

Table of Contents

• What is the Basic Anatomy of the Temporomandibular Joint?
• What Treatment Options Address TMJ Anatomy Issues?
• What Role Does the Trigeminal Nerve Have in TMJ?
• How does TMJ Affect the Trigeminal Nerve?
• What is the Temporomandibular Joint’s Connection to the Neck?
• What is the Temporomandibular Joint’s Nerve Structure?
• What is the Anatomical Connection Between TMJ and Headaches?
• What Bones are Involved in the Temporomandibular Joint?
• What is a Common Injury to a Person’s Temporomandibular Joint?
• How can TMJ Splint Therapy Protect My Temporomandibular Joint?
• How Can Splint Therapy Assist Patients with TMD?
• Conclusion: A Healthy TMD Anatomy Assits Daily Movement & Functionality

What is the Basic Anatomy of the Temporomandibular Joint?

The TMJ is a bilateral joint located in front of each ear, connecting the lower jaw (mandible) to the skull’s temporal bone.

There are several main components referred to as the TMJ Complex:

1. The articular disc and mandibular condyle cartilage – The cushion of cartilage between the head of the jawbone and the skull. They are essential in jaw function and in reducing loads on underlying bones.
2. Ligaments and Tendons – Three ligaments, lateral ligament,
   sphenomandibular ligament, and stylomandibular ligament are highly adaptable to the demands placed on the jaw. However, these can become overstretched and strained.
3. Muscles – The muscles attached to and surrounding the TMJs control their position and movement. The masseter, temporal, lateral, or external pterygoid function in coordination to close your jaw. The medial or internal pterygoid, geniohyoideus, mylohyoideus, and digastric muscles work to open your jaw. Any of these muscles can become strained from over-stretching or sustained force contraction.
4. Retrodiscal tissue – This is considered the nerve center of the TMJ.

The articular disc acts as a cushion between the mandibular condyle and the temporal bone, facilitating smooth jaw movement. To open the jaws, chew with different degrees of force depending on the type of food, to not bite your tongue or lips starts with specific needs. The brain regulates complicated movements requiring coordination of the muscles and nerves.

What Role Does the Trigeminal Nerve Have in TMJ?

The trigeminal nerve, also known as cranial nerve V, is responsible for providing sensation to the face and transmitting motor signals to the muscles involved in chewing.

The trigeminal nerve’s three main branches:

1. The ophthalmic nerve (V1).
2. The maxillary nerve (V2).
3. The mandibular nerve (V3).

The mandibular nerve, the largest of the three branches, innervates the muscles responsible for jaw movement, including those involved in TMJ function.

How does TMJ Affect the Trigeminal Nerve?

The trigeminal nerve has direct connections with the TMJ, as its branches send sensory fibers to the joint. These nerve fibers transmit pain, temperature, and touch signals from the TMJ to the brain.

Dysfunction or irritation of the TMJ can lead to the activation of trigeminal nerve fibers, causing pain and discomfort in the jaw, face, and even head regions. This connection between the TMJ and the trigeminal nerve explains why TMJ disorders often manifest as facial pain, headaches, and referred pain to other areas supplied by the trigeminal nerve. As well, ENT pain can be TMJ related.

Understanding the intricate relationship between the TMJ and the trigeminal nerve is vital for diagnosing and treating conditions such as temporomandibular joint disorders (TMD) and orofacial pain. When specialists evaluate a patient that suffers from a TMJ disorder, they use diagnostic procedures to determine if the patient has a muscle-related disorder, a condition such as arthritis of the joint, or a nerve-related disorder. There are 30 types of TMJ disorders, the most common being muscle-related. The most difficult to treat are neuropathic disorders.

What is the Temporomandibular Joint’s Connection to the Neck?

There is a significant connection between neck pain and temporomandibular joint (TMJ) pain. The TMJ and the neck share common muscles, nerves, and skeletal structures, and often irritation in TMJ muscles can manifest as referred pain in the neck and other facial muscles. Dysfunction or imbalance in one area can often affect the other, especially when muscle strain/strain is not addressed promptly and leads to lingering pain and pain expansion.

Muscle imbalances and tension in the jaw can contribute to neck pain and vice versa. The muscles that control jaw movement connect to the neck and upper back muscles. Excessive strain or tightness in the TMJ muscles can lead to increased muscle tension in the neck, causing discomfort, stiffness, and pain. Similarly, neck muscles that are overworked or strained can refer pain to the TMJ region, resulting in jaw pain, clicking, or limited jaw movement.

Recognizing and addressing the connection between neck pain and TMJ pain is essential for effective treatment. Healthcare professionals specializing in TMJ disorders and neck pain often take a comprehensive approach, evaluating the entire musculoskeletal system to identify underlying causes and develop individualized treatment plans.

Posture is also crucial in connecting neck and TMJ muscle and nerve health. Poor postures, such as forward head posture or slouching, can place strain on both the TMJ and the neck structures. This can lead to muscle imbalances, increased tension, and pain in both areas.

What is the Temporomandibular Joint’s Nerve Structure?

Nerves that innervate both the TMJ and the neck region can overlap, leading to shared pain pathways. Irritation or compression of nerves in either area can produce radiating pain that extends from the TMJ to the neck or vice versa. This can contribute to a cycle of pain where TMJ pain exacerbates neck pain, and neck pain can aggravate TMJ symptoms.

What is the Anatomical Connection Between TMJ and Headaches?

TMJ dysfunction can contribute to various types of headaches, including tension headaches and migraines. The intricate relationship between the TMJ and neck muscles can result in referred pain, meaning pain originating from the TMJ can radiate to the neck and head regions. Additionally, muscle tension and imbalances caused by TMJ dysfunction can trigger or worsen headaches.

Several mechanisms explain the connection between TMJ dysfunction and headaches. Firstly, the trigeminal nerve, a major cranial nerve responsible for sensation in the face and head, has connections to both the TMJ and various structures involved in headaches. Disruption in TMJ function can influence trigeminal nerve activity, potentially contributing to headache development.

Some dentists report patients’ underbite malocclusion occurring secondary to trigeminal nerve issues.

Furthermore, TMJ dysfunction can lead to altered jaw movements and malocclusion (misalignment of the teeth). These factors can cause muscle strain, inflammation, and increased stress on the surrounding structures, including the neck muscles. The resulting tension and irritation can trigger headache symptoms.

Penn Medicine calls TMJ “The Small Joint That Can Cause Big Pain”

The TMJ sits right behind a major nerve in the face, which is at the center of a network of nerves that cross and connect throughout the face, head and neck. So when the TMJ is affected, pain can spread throughout the eyes, ears, mouth, forehead, cheeks, tongue, teeth and throat. Even the muscles of the neck and upper back can become involved.” – Eric Granquist, DMD, MD, director of the Center for Temporomandibular Joint Disease.

What Treatment Options Address TMJ Anatomy Issues?

Effective management of TMJ-related headaches sometimes involves a multidisciplinary approach. It depends on the complexity and nature of the disorder. Dentists, neurologists, and orofacial pain specialists often collaborate with physical therapists, chiropractors, and other healthcare professionals to address the underlying causes of TMJ dysfunction and associated headaches.

Common TMJ dysfunction and associated headaches treatment options:

• Jaw exercises and physical therapy to improve TMJ mobility and muscle function.
• Oral appliances (splints or mouthguards) to alleviate TMJ pressure and neuromuscular tension.
• Medications to relieve pain, inflammation, and muscle tension.
• Stress management techniques to reduce clenching or teeth-grinding habits.
• Thermo/Cryotherapy helps soothe stressed muscles and relieve pain.

A combination of therapies such as manual therapy, exercises, posture correction, stress management, and relaxation techniques to alleviate pain, restore function, and promote overall well-being. By simultaneously addressing the TMJ and headache, healthcare providers can help patients find relief and improve their quality of life.

What Bones are Involved in the Temporomandibular Joint?

Two prominent bones are involved in the formation of your temporomandibular joint. They are the mandible and the temporal bone. The temporal bone involves the superior part of your jaw joint. It has two components: mandibular fossa and articular tubercle. The inferior part of the joint is largely formed by the head of the mandible.

When a person has the sensation of cheekbone pain, often it is a sensitivity in the temporal bone and the supporting musculature.

What is a Common Injury to a Person’s Temporomandibular Joint?

The National Institute of Dental and Craniofacial Research classifies TMD by the following three most common injuries: ^[1]

1. Myofascial pain is the most common form of TMD. It generates fascia discomfort or pain, which is connective tissue covering the muscles. It involves a person’s muscles that control jaw, neck, and shoulder function.
2. Internal derangement of the joint. This refers to when a dislocated jaw or displaced disk occurs. Or it may mean an injury to the condyle. This is the rounded end of the jawbone that articulates with the temporal skull bone.
3. Degenerative joint disease. Examples are osteoarthritis or rheumatoid arthritis in the jaw joint. Early diagnosis of TMJ helps prevent further complications to your jaw joint later on.

How can TMJ Splint Therapy Protect My Temporomandibular Joint?

Jaw or TMJ Splint Therapy helps protect your temporomandibular joint in many ways. This joint has a unique mechanism; an articular disk separates the articular surfaces of the bones. If the functional anatomy of your temporomandibular joint needs support, splint therapy can help.

Dentists who offer splint therapy are trained in TMJ anatomy for:

• Relaxing your jaws’ joints and muscles to assist in releasing tension in your head, neck, and jaw.
• Aiding in the recovery of your fascia from the stress of jaw reflexes, such as teeth clenching.
• Helping prevent further bruxism.
• Helping to protect your teeth from additional wear.

How Can Splint Therapy Assist Patients with TMD?

A person’s peripheral and central neural basis in the brain impacts the common conditions of TMD. This is where the temporary use of an oral splint can improve oral parafunctional behavior.

MRI neuroimaging techniques offer insights as to what happens to brain structure and function within TMD patients’ anatomy. The BMC Journal of Headache and Pain reported in 2020 that “compared with 40 pain-free controls, 22 patients with TMD showed a significant increase of MD in the ipsilateral spinal trigeminal nucleus, bilateral trigeminal nerve tract”.

Author Yuanyuan Yin also reports detecting a significant increase in blood flow in several brainstem regions in TMD patients’ anatomy. This includes the right SpVc, right Vp, and rostral pons encompassing the ventral trigemino-thalamic tract.

Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes.” – The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies

Understanding the intricate connection between the TMJ, neck, and headaches is essential for effective diagnosis and treatment of TMJ dysfunction. By addressing TMJ-related issues and restoring proper function, healthcare professionals can provide relief for patients experiencing headaches and improve their overall quality of life.

One way to conduct a simple diagnostic trial to see if your headaches are partly caused by TMJ-related dysfunction is to ask your dentist to make a QuickSplint for you to wear at night. Often the QuickSplint anterior bite plane will provide short-term relief of jaw muscle tension and also relax neck muscles. You can also try the Speed2Treat Home Healing Kit which includes exercises and hot/cold therapy.

Conclusion: A Healthy TMD Anatomy Assists Daily Movement & Functionality

If there is a possibility of TMJ involvement in your headaches or you are experiencing jaw-related symptoms, consult a qualified healthcare provider specializing in orofacial pain to receive a comprehensive evaluation and personalized treatment plan.

Author bio

Ann McCulloch, MBA is co-founder and president of Orofacial Therapeutics, this site, and oversees the company’s expanding portfolio of resources and tools for jaw and headache pain diagnosis and treatment. Her chronic jaw pain issues continue to inspire her to investigate the needs and challenges of patients suffering from orofacial pain.

 

 

References

[1] Medical Reviewers: Jessica Gotwals RN BSN MPH, Michael Kapner MD, and Rita Sather RN, https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=85.