Temporomandibuler Eklem Anatomisi
Özet
Temporomandibuler eklem (TME), beslenme ve konuşma gibi hayati fonksiyonların merkezinde yer alan, yüksek adaptasyon kabiliyetine sahip, insan vücudunda büyüme merkezi barındıran tek ve en fazla yük gelen bikondiler eklem yapısıdır. Temporal kemik ile bağımsız mandibula arasındaki bu kompleks sistem, sert ve yumuşak dokulardan meydana gelir. Sert dokularda kranial bileşenler olan artiküler eminens, fossa glenoidalis ve timpanik plaka ile mandibuler bileşen olan ovoid şekilli kondil başı bulunur. Yumuşak doku bileşenleri ise eklem hareketlerini sınırlayan kapsüler, kollateral ve temporomandibular fonksiyonel ligamentlerin yanı sıra sfenomandibular ve stylomandibular aksesuar ligamentlerinden oluşur. Eklem yüzeyleri fibrokartilaj ile döşeli olup, eklem boşluğunu ikiye bölen şok emici discus articularis, eklemi besleyen ve yağlayan sinovyal membran ile sıvı ve zengin damar-sinir barındıran retrodiskal yapı fonksiyon için kritiktir. TME'nin beslenmesi a. temporalis superficialis ve a. maxillaris dallarıyla sağlanırken, innervasyonu n. auriculotemporalis ve n. massetericus tarafından gerçekleştirilir. Mandibula hareketlerinde rol oynayan masseter, temporal, lateral ve medial pterygoid kaslar n. trigeminus tarafından uyarılır. Eklemin biyomekaniği, alt eklem boşluğundaki rotasyon ile üst eklem boşluğundaki translasyon hareketlerinin kombinasyonuna dayanarak protruzyon, retraksiyon, açılma ve kapanma fonksiyonlarını koordine eder.
The temporomandibular joint (TMJ) is a bicondylar joint structure with high adaptation capability, located at the center of vital functions such as nutrition and speech, being the only joint in the human body containing a growth center and bearing the most load. This complex system between the temporal bone and the independent mandible consists of hard and soft tissues. Hard tissues include cranial components such as the articular eminence, glenoid fossa, and tympanic plate, as well as the mandibular component, the ovoid-shaped condylar head. Soft tissue components consist of functional ligaments limiting joint movements, such as capsular, collateral, and temporomandibular ligaments, alongside accessory ligaments like sphenomandibular and stylomandibular ligaments. The joint surfaces are lined with fibrocartilage, and the shock-absorbing articular disc dividing the joint cavity into two, the synovial membrane and fluid providing nutrition and lubrication, and the retrodiskal structure rich in vessels and nerves are critical for function. The vascularization of the TMJ is provided by branches of the superficial temporal and maxillary arteries, while its innervation is carried out by the auriculotemporal and masseteric nerves. The masseter, temporal, lateral, and medial pterygoid muscles involved in mandibular movements are stimulated by the trigeminal nerve. The biomechanics of the joint coordinate protrusion, retraction, opening, and closing functions flawlessly based on the combination of rotational movement in the lower joint cavity and translational movement in the upper joint cavity.
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