Relationships between the Temporomandibular Joint

and the Middle Ear in Human Fetuses

J.F. RODRIGUEZ VAZQUEZ, J.R. MERIDA VELASCO, and J. JIMENEZ COLLADO
Departamento de Ciencias Morfol6gicas, Facultad de Medicina, Universidad Complutense, E-28040 Madrid, Spain
A study was conducted, on 30 human fetuses, of the
structures passing through the tympanosquamosal fissure. The tympanosquamosal fissure lies between the
middle ear and the temporomandibular region. Meckel's
cartilage passes through the tympanosquamosal fissure
and continues on into the middle ear with the cartilaginous anlage of the malleus. A tract of fibrous tissue arises
from the mesenchyme, located cranial and lateral to
Meckel's cartilage, that enters from the posterior area of
the temporomandibularjoint disc to the middle ear through
the tympanosquamosal fissure, and attaches onto the
area of continuity of Meckel's cartilage with the malleus.
Transformation of Meckel's cartilage into the sphenomandibular ligament and anterior ligament of the malleus determines their continuity through the tympanosquamosal fissure. The posterior fibers of the temporomandibular joint disc giving rise to the discomalleolar
ligament insert into the anterior ligament ofthe malleus.

J Dent Res 72(1):62-66, January, 1993

Introduction.
Numerous descriptive studies have provided a solid basis
for the study of the development of the temporomandibular joint (Kjellberg, 1904; Harpman and Woollard, 1938;
Furstman, 1963;Yuodelis, 1966; Van Dongen, 1968; Baume
and Holz, 1970; Perryetal., 1985; Wongetal., 1985; Burdi,
1992).
Some investigators analyzed the fibrous connections
between the middle ear and the temporomandibular joint
structures during fetal development (Cameron, 1915;
Burch, 1966; Coleman, 1970; Couly and Hureau, 1976).
Connections between the temporomandibular joint capsule and disc and the malleus of the middle ear have been
described in adults (Pinto, 1962; Coleman, 1970; Toledo
Filho et al., 1985; Komori et al., 1986). Likewise, there
have been descriptions of the fibrous connection between
the sphenomandibular ligament and the anterior ligament of the malleus (Burch, 1966; Coleman, 1970; Toledo
Filhoetal., 1985; Loughneretal., 1989; Rodriguez Vaizquez
etal., 1992).
At present, the relationships between the middle ear
and the temporomandibularjoint have gained much clinical relevance, as reported by Couly and Hureau (1976),
Ioannides and Hoogland (1983), Loughner et al. (1989),
and Eckerdal (1991). The aim of this study was to
determine the development and arrangement of these
structures during human fetal development.

Received for publication March 2, 1992

Accepted for publication July 13, 1992

Materials and methods.

Thirty human fetuses from the Jimenez Collado collection
of the Institute of Embryology at the University
Complutense of Madrid were studied. The specimens
ranged from 35 to 300 mm crown-rump (C-R) length,
based on Carnegie's stages (Corliss, 1979). Light microscopic studies were done on the 20 fetuses up to 150 mm
C-R length. These specimens were previously preserved
in 10% neutral formalin. Serial sections ranging from 10
to 25 [tm in thickness, depending on specimen size, were
sliced along the three spatial planes. The slices were
stained according to McManus and Mowry's techniques
(1968). The Table shows the technical data for this group
of specimens.
Fetuses with C-R lengths greater than 170 mm were
preserved in 15% formalin. These specimens were microdissected, and the structures were identified with the help
of a magnifying lens. To this end, the fetal calvaria were
sectioned transversely, thereby approaching the middle
cranial fossa, and the middle ear was opened through a
section of the tegmen tympani. The horizontal portion of
the squamous part of the temporal bone was dissected so
that the temporomandibular joint disc would be exposed.

Results.
During human fetal development, there is an area that
fully connects the temporomandibularjoint and the middle
ear. This area of oto-articular connection is bounded by
the first intramembranous ossification centers of the
tympanic bone and the squamous part of the temporal
bone in the first stages of the fetal period (from 35- to 73mm C-R length). Both bony elements give rise to the
boundaries of a wide tympanosquamosal fissure (Figs. 1
and 2). The middle ear and the temporomandibular joint
are connected through this fissure.
Several cartilaginous, mesenchymal, nervous, andbony
structures course through the fetal tympanosquamosal
fissure. The largest of the cartilaginous structures corresponds to Meckel's cartilage. At the level ofthe tympanosquamosal fissure, the cartilage forms a concave curve
facing down, which continues in the region of the middle
ear with the cartilaginous anlage of the malleus (Fig. 3).
Mesenchyme surrounds Meckel's cartilage and becomes more condensed at the cranial and lateral aspects
ofthe cartilage (Figs. 1 and 2). The mesenchyme gives rise
to a tract running from the anlage of the temporomandibular joint disc to the portion of Meckel's cartilage
located where the future middle ear will be.
The chorda tympani nerve was located medial to
Meckel's cartilage (Fig. 1).
The intramembranous ossification center ofthe gonial
bone was found caudal and medial to Meckel's cartilage.
The gonial bone seemed to come into contact with the

62
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Vol. 72 No. I

TABLE
FEATURES OF THE SPECIMENS STUDIED
HISTOLOGICALLY'

Length
Cat. no.

~I

TEMPOROMANDIBULAR JOINT AND THE MIDDLE EAR

Age

C-R (mm) (weeks)

VR245
BeBe47

Plane of Staining
Section Technique

9F

H-E
H-E

.-

,~

,,

Ca-6

52

Fe-21

57

10

H-E

Be-403

62

10

H-E

Mu-7

73

11

H-E

B-107

84

12

H-E

Be-608

90

12

A\H-E

Bu-18

93

13

H-E

Cu-i
B-502

100

13

H-E

105

14

H-E-

Bu-007

107

14

B-62

113

14

H-E

B-29

116

14

H-E

R-6

125

15

H-E

Cu-2

137

16

B-28
150
*Abbreviations:
F
S
T
A
H-E

A\H-E
H-E

17
T
Frontal
Sagittal
Transverse
Azocarmine
Hematoxylin-eosin

..-..

~~~-

9
10

5
F

63

4.~

~.

,f

Fig. 1-Human fetus Ca66(52 mm C-R length). Frontal section.

Delimitation of the tympanosquamosal fissure between the ossification center of the squamous part of the temporal bone (S) and the
ossification center of the tympanic hone (T). Meckel's cartilage CM).
Mesenchymal tract (B). Os goniale (G). Chorda tympani nerve (CT).

able finding in the 116-mm C-R length human fetus. Two

portions that continued on through the tympanosquamosal fissure were clearly observed: one located medial to

perichondrium of Meckel's cartilage, and was located

very close to the anterior ossification center of the tympanic bone (Figs. 1 and 2).
The following changes were observed in the tympanosquamosal fissure area of 84- to 150-mm C-R length
fetuses:
Growth ofthe ossification centers ofthe tympanic bone
and squamous part of the temporal bone, leading to a
narrowing of the tympanosquamosal fissure, gave rise to
more clearly defined boundaries. At this phase of development, the inferior border of the tegmen tympani of the
petrous part of the temporal bone has not appeared
between the tympanic bone and the squamous part of the
Fig. 2-Human fetus Ca-6 (52 mm C-R length). Frontal section.
temporal bone (Fig. 4). Therefore, the petrosquamous and Enlargement
of Fig. 1. Ossification center of the squamous part of
petrotympanic fissures have not yet formed.
the temporal bone (S). Ossification center of the tympanic bone (T).
Volume reduction of Meckel's cartilage was a notice- Meckel's cartilage (M). Mesenchymal tract (B). Os goniale (G).
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64

RODRIGUEZ VAZQUEZ et al.

Fig. 3-Human fetus Fe-21 (57 mm C-R length). Transverse

section. In the future middle ear, Meckel's cartilage (M) continues on
with the cartilaginous anlage of the malleus (MA). Os goniale (G).
Incus (I).

the temporomandibular joint or juxta-articular portion,

and the other in the middle ear, joining the malleus or
tympanic portion (Fig. 5).
Longitudinal growth of the gonial bone occurred,
stretching from the middle ear through the tympanosquamosal fissure, close to the internal aspect of the temporomandibular joint (Figs. 5 and 6).
A fibrous tract formed stretching from the posterior
area of the temporomandibular joint disc to the most
lateral aspect of the tympanosquamosal fissure, finally
inserting into the area of continuity of Meckel's cartilage
with the malleus (Fig. 7).
The specimens that were microdissected showed that
the sphenomandibular ligament penetrated the middle
ear through the tympanosquamosal fissure and continued, in the middle ear, with the anterior ligament of the
malleus, since both structures arose from the fibrous
transformation ofMeckel's cartilage. The posterior fibers
of the temporomandibular joint disc or discomalleolar
ligament entered the middle ear lateral to the spheno-

J Dent Res

January 1993

Fig. 4-Human fetus Cu-i (100 mm C-R length). Sagittal section.

The tympanosquamosal fissure appears clearly bounded between
the ossification centers of the tympanic bone (T) and squamous part
of the temporal bone (S). The tegmen tympani of the petrous portion
of the temporal bone (P) has not interposed between the tympanic
bone and the squamous part of the temporal bone, so there are no
petrotympanic or petrosquamous fissures. Meckel's cartilage (M).

Connective tissue tract (B) from the posterior portion of the temporo-

mandibular joint disc (D). Mandibular condyle (C). Malleus (MA).

Incus (I). Chorda tympani nerve (CT).

mandibular ligament and joined the anterior ligament of

the malleus (Fig. 8). The chorda tympani nerve left the
middle ear through the most internal area of the tympanosquamosal fissure.

Discussion.
A wide connection between the posterior area of the
temporomandibular region and the middle ear was observed in the course of the fetal period of development in
the specimens assessed in this study. This connecting
area corresponded to a passageway bounded by the tympanic bone and the squamous part of the temporal bone,
or tympanosquamosal fissure.
Harpman andWoollard (1938), Moffett (1957), Symons
(1952), and Coleman (1970) observed a petrotympanic

..Z

Fig. 5-Human fetus B-29 (116 mm C-R length) Transverse

section. Meckel's cartilage (M) has experienced a reduction in volFig. 6-Human fetus Bu-18 (93 mm C-R length). Transverse
ume. Tympanic bone (T). Squamous part ofthetemporal bone (S). Os section. Meckel's cartilage (M). Os goniale (G). Tympanic bone (T).
goniale (G). Temporomandibularjoint disc (D). Mandibular condyle Malleus (MA). Incus (I). Chorda tympani nerve (CT). Tensor
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(TT).

Vol. 72 No. 1

TEMPOROMANDIBULAR JOINT AND THE MIDDLE EAR

Fig. 7-Human fetus Be-608 (90 mm C-R length). Transverse

section. Fibrous tract (B) stretching from the posterior area of the
temporomandibularjointdisc(D)totheareaofcontinuityofMeckel's
cartilage (M) with the malleus (MA).

65

Fig. 8-Human fetus (270 mm C-R length). Microdissection of

the middle ear and temporomandibular joint through the middle
cranial fossa (MCF). Observe the union of the temporomandibular
joint disc (D) with the anterior ligament ofthe malleus (L). Malleus
(MA). Incus (I). Chordatympani nerve (CT). Tensortympani muscle
(TT). Scale in cm.

fissure during fetal development. However, we consider

that during fetal development the petrotympanic fissure Woollard (1938), Symons (1952), and Moffett (1957) conhas not formed yet, since the tegmen tympani of the sidered it to be the tendon ofthe lateral pterygoid muscle,
petrous part of the temporal bone has not come down at which, after helping form the temporomandibular joint
this stage, to lie between the tympanic bone and the disc, continued dorsally through the petrotympanic fissquamous part ofthe temporal bone. For this reason, the sure, to insert into the malleus.
In our opinion, the insertion of the disc fibers into
connections between the middle ear and the temporomandibular region take place through the tympanosquamosal Meckel's cartilage, giving rise to the anterior ligament of
fissure during the fetal period.
the malleus, explains the connections between the discoMeckel's cartilage was one of the structures extending malleolar ligament and the anterior ligament of the malfrom the temporomandibular region to the middle ear leus, as pointed out by Toledo Filho et al. (1985) and
through the tympanosquamosal fissure. In previous stud- Rodriguez Vazquez et al. (1992).
ies (Rodriguez Vazquez et al., 1992), we have shown that
According to Couly and Hureau (1976), the connection
the sphenomandibular and the anterior ligament of the between the middle ear and the temporomandibular joint
malleus arise from Meckel's cartilage in this region, form- during fetal development and the first months of life
ing a single fibrous structure, since both had a common would be a risk factor in the spread of infection from one
origin. Furthermore, the malleus bone was formed from area to the other.
Meckel's cartilage, with the exception of its anterior
process, which was formed from the os goniale (Rodriguez
Vazquez et al., 1991).
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