The temporomandibular joint consists of anterior and posterior triangles. The anterior triangle includes the digastric, submental, carotid, and muscular triangles. The posterior triangle includes the occipital and supraclavicular triangles. The temporomandibular joint is a synovial joint that connects the mandible to the temporal bone. It allows hinge-like opening and closing of the mouth as well as gliding movements, facilitated by muscles of mastication.

1. Triangles of Neck & Temporo-mandibular joint

2. Triangles of the neck Anatomists use the term triangles of the neck to describe the divisions created by the major muscles in the region. The side of the neck presents a somewhat quadrilateral outline, limited, above, by the lower border of the body of the mandible, and an imaginary line extending from the angle of the mandible to the mastiod process; below, by the upper border of the clavicle; in front, by the middle line of the neck; behind, by the anterior margin of the trapezius. This space is subdivided into two large triangles by sternocleidomastoid, which passes obliquely across the neck, from the sternum and clavicle below, to the mastiod process and occipital bone above. The triangular space in front of this muscle is called the Anterior Triangle Of The Neck; and that behind it, the Posterior Triangle Of The Neck.

3. Triangles of neck Consists of anterior and posterior Anterior triangles of neck: Digastric Submental Carotid Muscular

4. Triangles of neck Posterior triangles of neck Occipital Supraclavicular

6. Anterior triangles of neck Digastric Submental Carotid Muscular

7. Digastric triangle Also known as submandibular triangle Superiorly(base);base of mandible & line joining the angle of mandible to mastoid process anteroinferiorly; anterior belly of digastric m. Posteroinferiorly;posterior belly of digastric m. & stylohyoid m.

9. Digastric triangle Roof;the skin, superficial fascia, platysma and deep fascia, which contain branches of the facial and transverse cutaneous cervical nerves Floor;mylohyoid & hyoglossus

10. Digastric triangle Contents Anterior part:lymph nodes,submental artery,mylohyoid vessels and facial vein & submandibular salivary gland Posterior part :external carotid a. ,parotid gland,styloid process, styloglossus, stylopharyngeus and the glossopharyngeal nerve & internal carotid a. ,internal jugular vein

11. Applied anatomy of digastric triangle Infection in submandibular region is limited to a triangular region. Posteriorly;hyoid bone and anterolaterally on each side by halves of mandibular base Because the layer of deep fascia is attached to these bones. Triangular swelling= Ludwig’s Angina The swelling may push tongue upwards

12. Submental triangle Its apex is at the chin, Its base is the body of the hyoid bone and its floor is formed by both mylohyoid muscles. It contains lymph nodes and small veins that unite to form the anterior jugular vein

14. Muscular triangle Anteriorly by the median line of the neck from the hyoid bone to the sternum, Inferoposteriorly by the anterior margin of sternocleidomastoid, Posterosuperiorly by the superior belly of omohyoid. The triangle contains omohyoid, sternohyoid, sternothyroid and thyrohyoid

18. Inferiorly : by the superior belly of the omohyoideus

19. Superiorly : by the stylohyoideus

21. THE POSTERIOR TRIANGLES

23. The posterior triangles from its : Boundaries Root Floor Content Applied anatomy

24. A. Boundaries Posterior: anterior border of trapezius Base : middle 3rd of clavicle Apex : meeting point of sternocleidomastoid & trapezius at superior nuchal line.

26. B. Roof Skin Superficial facia Investing layer of deep cervical facia Roof is pierced by : 1. Nerves : Lesser occipital Great auricle Transverse cutaneous nerves of neck Supraclavicularnerves 2. Veins : external jugular veins and its tributaries. 3. Lypmhvessels

27. external jugular vein (blue) superficial cervical lymph nodes (green) lesser occipital nerve (lc) great auricular nerve (ga) transverse cervical nerve (tc) supraclavicular nerves (sc) spinal accessory nerve (sa)

28. C. Floor Mainly form by 2nd layer of muscle of neck (above downward) Splenius capitis. Levator scapulae. Occasionally by semispinaliscapitis at apex. Scaleneusmedius. Scaleneus posterior. Muscular floor is carpeted by preverterbralfacia.

29. splenius capitis(sc) levator scapulae (ls) scalenus posterior (sp) scalenusmedius(sm) scalenus anterior (sa) inferior belly of omohyoid(io)

30. D. Content The spinal accessory nerve and the lymph nodes are the true contents of the posterior triangle and all others are behind or in front of the facial floor. a. Muscle : inferior belly of omohyoid b. Nerves : Accessory nerves Root, trunks of brachial plexus and their branches : Nerves to rhomboideus Nerves tomserratus anterior Nerves to subclavius Suprascapular nerve

31. 3. Cervical nerves : Greater occipital nerve emerges from the apex to pass on the scalp. Great auricle nerve Lesser occipital nerve Transverse cervical nerve of neck Supraclavicularnerve 3rd and 4th cervical nerves supplying trapezius

32. 4. Arteries Occipital artery emerges from apex 3rd part of subclavian artery and branches of subclavian artery Suprascapular branches of thyrocervical trunk 1st Transverses cervical part of subclavian Transverse cervical artery divides into acending and descending branch anterior border of sternocleidomastoid. iii. Veins : external jugular veins and its tributaries. Subclavian vein is lower down and not include in the triangle. iv. Lymph nodes : Supraclavicularlymph nodes are present along the posterior border of sternomastiod. Occipital lypmh nodes

34. APPLIED ANATOMY Left supraclavicular (Virchow’s) lymph nodes are enlarge in malignancy of testis, stomach and other abdominal organs. The pressure in the external jugular vein can be recorded in the recumbent position. It is increased in right sided heart failure and in the obstruction of the superior vena cava. The retropharyngeal abscess maybe expressed in the lower part of posterior triangle.

35. Temporomandibular Joint By:Norafzalila bt Zainol

38. It is modified hinge type of synovial joint.

39. Joint capsule of TMJ is loose.

40. Fibrous layer of the capsule attach to the margin of articula, area of temporal bone and around neck of mandible.

42. - TMJ has 2 synovial membrane: »superior synovial membrane (lines the fibrous layer of the capsule superior to the articular disc) »inferior synovial membrane (lines the fibrous layer of the capsule inferior to the articular disc) - Articular disc: »it divide TMJ into 2 separate compartments; superior comp. (gliding movement of protrusion and retrusion), and inferior comp. (hinge movement of depression and elevation)

46. Movement of mandible at the TMJs and the muscles (or forces)producing them:

48. - To enable more than a small amount of depression of the mandible-that is to open the mouth wider than just to separate the upper and lower teeth- the head of mandibular and articular disc must move anteriorly on the articular surface until the head lies inferior to the articular tubercle (a movement referred to as “translation” by dentists) - If this anterior gliding occurs unilaterally, the head of the contralateral mandible rotates (pivots) on the inferior surface of the articular disc, permitting simple side-to-side chewing or grinding movements over a small range

49. - During protrusion and retrusion of the mandible, the head and the articular disc slide anteriorly and posteriorly on the articular surface of the temporal bone, with both sides moving together - TMJ movements are produced chiefly by the muscles of mastication: »temporal m. »masseter m. »medial pterygoid m. »lateral pterygoid m.

51. -Information- - Upper head of lateral pterygoid m. is active during retraction movement produced by the posterior fibers of temporal m. (retraction=retrusion)(protraction=protrusion) *commonly used for anterior and posterior movement of the shoulder - Traction is applied to the articular disc so that it is not pushed posteriorly ahead of the retraction mandible