Talk:Joint Development - Temporomandibular Joint

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Cite this page: Hill, M.A. (2024, April 14) Embryology Joint Development - Temporomandibular Joint. Retrieved from


Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis

Dentomaxillofac Radiol. 2018 Oct 4:20180144. doi: 10.1259/dmfr.20180144. [Epub ahead of print]

Almeida FT1, Major P1, Jaremko JL2, Le LH2, Flores-Mir C1, Pachêco-Pereira C1.


OBJECTIVES:: The purpose of this systematic review was to determine the diagnostic capability of Ultrasound (US) to assess TMJ alterations as disc displacement (DD), joint effusion (JE) and condylar changes (CC) using 3D imaging modalities as reference standard. METHODS:: Studies were gathered by searching several electronic databases and partial grey literature up to January eighth, 2018 without restrictions of language and time. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). The grading of Recommendation, Assessment, Development and Evaluation (GRADEpro system) instrument was applied to assess the level of evidence across the studies. RESULTS:: After applying the eligibility criteria, 28 studies were identified and synthesized. All studies were methodologically acceptable presenting low applicability concerns, although none of them fulfilled all QUADAS-2 criteria. The quantitative analysis included 22 studies, 2829 joints in total. The quality of the evidence evaluated by GRADE system suggested moderate confidence in estimating the outcomes. CONCLUSION:: This systematic review demonstrated the US has acceptable capability to screen for DD and JE in TMD patients. For screening of condylar changes, US needs further studies using CT or CBCT as reference standard to support its use. More advanced imaging such as MRI can thereafter be used to confirm the diagnosis if deemed necessary. PMID: 30285469 DOI: 10.1259/dmfr.20180144


Overexpression of Indian hedgehog partially rescues short stature homeobox 2-overexpression‑associated congenital dysplasia of the temporomandibular joint in mice

Mol Med Rep. 2015 Jun 18. doi: 10.3892/mmr.2015.3959. [Epub ahead of print]

Li X1, Liang W2, Ye H1, Weng X3, Liu F1, Lin P3, Liu X1.


The role of short stature homeobox 2 (shox2) in the development and homeostasis of the temporomandibular joint (TMJ) has been well documented. Shox2 is known to be expressed in the progenitor cells and perichondrium of the developing condyle. A previous study by our group reported that overexpression of shox2 leads to congenital dysplasia of the TMJ via downregulation of the Indian hedgehog (Ihh) signaling pathway, which is essential for embryonic disc primordium formation and mandibular condylar growth. To determine whether overexpression of Ihh may rescue the overexpression of shox2 leading to congenital dysplasia of the TMJ, a mouse model in which Ihh and shox2 were overexpressed (Wnt1-Cre; pMes-stop shox2; pMes-stop Ihh mice) was utilized to assess the consequences of this overexpression on TMJ development during post-natal life. The results showed that the developmental process and expression levels of runt-related transcription factor 2 and sex determining region Y-box 9 in the TMJ of the Wnt1-Cre; pMes-stop shox2; pMes-stop Ihh mice were similar to those in wild‑type mice. Overexpression of Ihh rescued shox2 overexpression-associated reduction of extracellular matrix components. However, overexpression of Ihh did not inhibit the shox2 overexpression-associated increase of matrix metalloproteinases (MMPs) MMP9, MMP13 and apoptosis in the TMJ. These combinatory cellular and molecular defects appeared to account for the observed congenital dysplasia of TMJ, suggesting that overexpression of Ihh partially rescued shox2 overexpression‑associated congenital dysplasia of the TMJ in mice.

PMID 26096903


Analysis by Light, Scanning, and Transmission Microscopy of the Intima Synovial of the Temporomandibular Joint of Human Fetuses during the Development

Anat Res Int. 2014;2014:732720. doi: 10.1155/2014/732720. Epub 2014 Jan 12.

Alvez CS1, Carvalho de Moraes LO2, Marques SR2, Tedesco RC2, Harb LJ3, Rodríguez-Vázquez JF4, Mérida-Velasco JR4, Alonso LG2.


Objective. To characterize morphologically and ultrastructurally using light microscopy, the scanning electron microscopy and transmission electron microscopy the intima synovial of the temporomandibular joint (TMJ) of human fetuses between the 10th and the 38th week of development. Materials and Methods. The TMJ was dissected bilaterally in 37 human fetuses belonging to the Institute of Embryology of the University Complutense of Madrid and of the Federal University of São Paulo. Results. The outcome by light microscopy showed the morphology of the TMJ and that the formation of inferior joint cavity precedes the superior joint cavity and the presence of blood vessels in the synovial. Conclusion. By scanning and transmission electron microscopy we observed the presence of two well-defined cell types in the intima layer of synovial of the TMJ of human fetuses, macrophage-like type A cell and fibroblast-like type B cell, and the presence of the a third cell type, defined by the name of intermediate lining cell in the intima layer of the synovial.

PMID 24527214


Spry1 and spry2 are essential for development of the temporomandibular joint

J Dent Res. 2012 Apr;91(4):387-93. doi: 10.1177/0022034512438401. Epub 2012 Feb 10.

Purcell P1, Jheon A, Vivero MP, Rahimi H, Joo A, Klein OD.


The temporomandibular joint (TMJ) is a specialized synovial joint essential for the function of the mammalian jaw. The main components of the TMJ are the mandibular condyle, the glenoid fossa of the temporal bone, and a fibrocartilagenous disc interposed between them. The genetic program for the development of the TMJ remains poorly understood. Here we show the crucial role of sprouty (Spry) genes in TMJ development. Sprouty genes encode intracellular inhibitors of receptor tyrosine kinase (RTK) signaling pathways, including those triggered by fibroblast growth factors (Fgfs). Using in situ hybridization, we show that Spry1 and Spry2 are highly expressed in muscles attached to the TMJ, including the lateral pterygoid and temporalis muscles. The combined inactivation of Spry1 and Spry2 results in overgrowth of these muscles, which disrupts normal development of the glenoid fossa. Remarkably, condyle and disc formation are not affected in these mutants, demonstrating that the glenoid fossa is not required for development of these structures. Our findings demonstrate the importance of regulated RTK signaling during TMJ development and suggest multiple skeletal origins for the fossa. Notably, our work provides the evidence that the TMJ condyle and disc develop independently of the mandibular fossa.

PMID 22328578


Temporomandibular joint formation and condyle growth require Indian hedgehog signaling

Dev Dyn. 2007 Feb;236(2):426-34.

Shibukawa Y1, Young B, Wu C, Yamada S, Long F, Pacifici M, Koyama E.


The temporomandibular joint (TMJ) is essential for jaw function, but the mechanisms regulating its development remain poorly understood. Because Indian hedgehog (Ihh) regulates trunk and limb skeletogenesis, we studied its possible roles in TMJ development. In wild-type mouse embryos, Ihh expression was already strong in condylar cartilage by embryonic day (E) 15.5, and expression of Ihh receptors and effector genes (Gli1, Gli2, Gli3, and PTHrP) indicated that Ihh range of action normally reached apical condylar tissue layers, including polymorphic chondroprogenitor layer and articular disc primordia. In Ihh(-/-) embryos, TMJ development was severely compromised. Condylar cartilage growth, polymorphic cell proliferation, and PTHrP expression were all inhibited, and growth plate organization and chondrocyte gene expression patterns were abnormal. These severe defects were partially corrected in double Ihh(-/-)/Gli3(-/-) mutants, signifying that Ihh action is normally modulated and delimited by Gli3 and Gli3(R) in particular. Both single and double mutants, however, failed to form an articular disc primordium, normally appreciable as an independent condensation between condylar apex and neighboring developing temporal bone in wild-type. This failure persisted at later stages, leading to complete absence of a normal functional disc and lubricin-expressing joint cavities. In summary, Ihh is very important for TMJ development, where it appears to regulate growth and elongation events, condylar cartilage phenotype, and chondroprogenitor cell function. Absence of articular disc and joint cavities in single and double mutants points to irreplaceable Ihh roles in formation of those critical TMJ components.

PMID 17191253


Development of the human temporomandibular joint

Anat Rec. 1999 May 1;255(1):20-33.

Mérida-Velasco JR1, Rodríguez-Vázquez JF, Mérida-Velasco JA, Sánchez-Montesinos I, Espín-Ferra J, Jiménez-Collado J.


A great deal of research has been published on the development of the human temporomandibularjoint (TMJ). However, there is some discordance about its morphological timing. The most controversial aspects concern the moment of the initial organization of the condyle and the squamous part of the temporal bone, the articular disc and capsule and also the cavitation and onset of condylar chondrogenesis. Serial sections of 70 human specimens between weeks 7 and 17 of development were studied by optical microscopy (25 embryos and 45 fetuses). All specimens were obtained from collections of the Institute of Embryology of the Complutense University of Madrid and the Department of Morphological Sciences of the University of Granada. Three phases in the development of the TMJ were identified. The first is the blastematic stage (weeks 7-8 of development), which corresponds with the onset of the organization of the condyle and the articular disc and capsule. During week 8 intramembranous ossification of the temporal squamous bone begins. The second stage is the cavitation stage (weeks 9-11 of development), corresponding to the initial formation of the inferior joint cavity (week 9) and the start condylar chondrogenesis. Week 11 marks the initiation of organization of the superior joint cavity. And the third stage is the maturation stage (after week 12 of development). This work establishes three phases in TMJ development: 1) the blastematic stage (weeks 7-8 of development); 2) the cavitation stage (weeks 9-11 of development); and 3) the maturation stage (after week 12 of development). This study identifies the critical period of TMJ morphogenesis as occurring between weeks 7 and 11 of development.

PMID 10321990



Human Embryology And Morphology (1921)

"Mention has been made of the division of the orbital region of the primitive skull (Fig. 133) into orbital and temporal parts during the evolution of the temporomandibular joint (see page 139)."

Human Embryology And Morphology (1921)

"Two synovial cavities are also formed in the temporomandibular joint, the meniscus separating two joints, which are functionally difierent. The upper is for gliding movements, the lower for hinge-like movements."


Manual of Human Embryology Keibel, F. and Mall, F.P. (1910)

"The primitive plexiform bone is thickened by deposit of osseous substance beneath the periosteum. The latter appears soon after bone-formation has commenced. The spaces in the plexiform network of bone at an early stage become converted into canals containing blood-vessels and primitive marrow. In bone of membranous origin cartilage may subsequently be developed beneath the periosteum. Examples of this are to be found in the temporomandibular joint."

Manual of Human Embryology Keibel, F. and Mall, F.P. (1910)

"It is to be noted, however, that during the formation of many of the typical substitution bones ossification may extend into membranes attached to the cartilage, so that certain processes on these bones are membranous in origin, and that, on the other hand, certain parts of bones of membranous origin may secondarily give rise to cartilage (temporomandibular joint). Several of the definitive bones of the skull have an origin partly cartilaginous, partly membranous."