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Clinical Implications of the Innervation of the Temporomandibular Joint

Davidson, Jack A. MD, DDS*; Metzinger, Stephen E. MD†; Tufaro, Anthony P. MD, DDS*; Dellon, A. Lee MD*

Journal of Craniofacial Surgery: March 2003 - Volume 14 - Issue 2 - pp 235-239
Anatomical Studies

The successful management of temporomandibular joint (TMJ) pain remains elusive. Often, the initial relief of pain is complicated by recurrence of the symptoms. This time frame suggests that the pain may be related to neuromas of the nerves that innervate the TMJ. The current study attempted to define the innervation pattern of the TMJ as identified in 16 embalmed and 8 fresh-frozen specimens. In each specimen, the auriculotemporal nerve, a branch of the mandibular portion (V3) of the trigeminal nerve, was found to innervate the lateral capsule of the TMJ. In 75% of the specimens, the masseteric nerve, a branch of the maxillary portion (V2) of the trigeminal nerve, was found to innervate the anteromedial capsule of the TMJ. In 33% of the specimens, there was a branch coming through the mandibular notch to innervate the anteromedial capsule that was not from the masseteric nerve; this nerve is believed to have passed through the lateral pterygoid muscle after leaving V2. These consistent patterns of innervation of the TMJ suggest that diagnostic nerve blocks can be done to determine the pain pathway in these patients. It is suggested that if the nerve blocks are successful, TMJ denervation may be a future method of pain relief in patients with recalcitrant or recurrent TMJ pain.

Baltimore, Maryland

New Orleans, Louisiana

From the *Department of Surgery, Division of Plastic, Reconstructive, and Maxillofacial Surgery, The Johns Hopkins Hospital, Baltimore, Maryland; and Department of Surgery, Division of Plastic Surgery and Department of Otorhinolaryngology, Louisiana State University, New Orleans, Louisiana.

Address correspondence to Dr Dellon, Suite 370, 3333 North Calvert Street, Baltimore, MD 21218; e-mail: aldellon@erols.com.

© 2003 Mutaz B. Habal, MD