Temporomandibular joint innervation: Anatomical study and clinical implications

Background: Temporomandibular disorders and related pain are commonly seen in clinical practice. Due to its recurrent nature, they adversely affect a patient's social life. Current knowledge on the temporomandibular joint (TMJ) innervation is debatable and insufficient to ensure optimal treatment for the underlying pathology. This study aimed to elucidate the pathophysiology of temporomandibular pain by revealing the TMJ innervation topography, its variations, and its relationships with the surrounding anatomical structures. This will aid in creating a guide for temporomandibular, infratemporal, and preauricular interventions. Methods: A total of 20 cadaver half heads, 10 fresh frozen and 10 embalmed, were used. The TMJ nerves were dissected together with the surrounding anatomical structures. Results: We showed that the TMJ is mainly innervated by the auriculotemporal nerve posteriorly, the masseteric nerve anteriorly, the posterior deep temporal nerve anteromedially, and the TMJ branch originating directly from the mandibular nerve medially, and that there are variations in these innervation pathways. Additionally, we emphasized how these nerves might be affected in certain clinical conditions based on their anatomical relationships and pathophysiological mechanisms. To our knowledge, this is the first study showing the existence of a branch of the mandibular nerve directly innervating the TMJ. Conclusion: In light of our findings, elucidating TMJ pain based on the anatomical characteristics of the region will allow precise treatment algorithms and better clinical outcomes in these patients. Based on this study, new clinical studies and interventions can be designed to reduce healthcare costs and alleviate the burden of temporomandibular disorders. (c) 2021 Published by Elsevier GmbH.