he most important functions of the temporomandibularjoint (TMJ) are mastication and speech and are of great
nterest to dentists, orthodontists, clinicians, and radiologists.his interest stems from the standpoints of structure, function,daptability, symptomatology, pathology, and imaging.
The TMJ is a ginglymoarthrodial joint, a term that is de-ived from ginglymus, meaning a hinge joint, allowing mo-ion only backward and forward in one plane, and arthrodia,eaning a joint of which permits a gliding motion of the
urfaces.1 The right and left TMJ form a bicondylar articula-ion and ellipsoid variety of the synovial joints similar to kneerticulation.2
The common features of the synovial joints exhibited byhis joint include a disk, bone, fibrous capsule, fluid, synovialembrane, and ligaments. However, the features that differ-
ntiate and make this joint unique are its articular surfaceovered by fibrocartilage instead of hyaline cartilage. Move-ent is not only guided by the shape of the bones, muscles,
nd ligaments but also by the occlusion of the teeth, sinceoth joints are joined by a single mandible bone and cannotove independently of each other.
Department of Radiology, Creu Blanca, Barcelona, Spain.International University of Catalunya (UIC), Clinical Residency in TMD,
Barcelona, Spain.Department of Anatomy and Embriology, International University of Cata-
lunya; Barcelona, Spain.Department of Anatomy, University of Barcelona, Barcelona, Spain.ddress reprint requests to Dr. Xavier Alomar, Department of Radiology,
Clinica Creu Blanca, Paseo Reina Elisenda de Montcada, 17, 08034
his component consists of an ovoid condylar process seatedtop a narrow mandibular neck. It is 15 to 20 mm side to sidend 8 to 10 mm from front to back. Thus, if the long axes of two
igure 1 Perpendicular axial CT imaging in both condyles. The blueine represents the angle formed between the right and left condyle.he normal value is between 145 and 160°. (Color version of figure
s available online.)
ondyles are extended medially, they meet at approximately the
ba(amupf
tw
acad
orpholr versio
Anatomy of the temporomandibular joint 171
asion on the anterior limit of the foramen magnum, forming anngle that opens toward the front ranging from 145° to 160°Fig. 1). The lateral pole of the condyle is rough, bluntly pointed,nd projects only moderately from the plane of ramus, while theedial pole extends sharply inward from this plane. The artic-lar surface lies on its anterosuperior aspect, thus facing theosterior slope of the articular eminence of the temporal bone. It
Figure 2 Variations in the morphologic architecture of theof 2950 TMJ (adapted from Yale SH3). (A) Type A mmorphology: 12%. (D) Type D morphology: 3%. (Colo
urther continues medially down and around the medial pole of v
he condyle to face the entoglenoid process of the temporal bonehere the jaw is held in an occluded position.The appearance of the mandibular condyle varies greatly
mong different age groups and individuals. Morphologichanges may occur on the basis of simple developmental vari-bility as well as remodeling of the condyle to accommodateevelopmental variations, malocclusion, trauma, and other de-
ibular condyle in coronal plane, observed over a sampleogy: 25%. (B) Type B morphology: 60%. (C) Type Cn of figure is available online.)
mand
elopmental abnormalities3 (Figs. 2 and 3). The morphology of
172 X. Alomar et al.
Figure 3 Variations in the morphologic architecture of the mandibular condyle in axial plane, observed over same sample ofTMJ (adapted from Yale SH3). (A) Anterior side flat, posterior side convex: 44%. (B) Biconvex: 28%. (C) Anterior side
concave, posterior side convex: 22%. (D) Flat: 5%. (E) Biconcave: 3%. (Color version of figure is available online.)
tr
CTi
pb
al cranone. (D.)
Anatomy of the temporomandibular joint 173
he condyle may be observed by axial and coronal magneticesonance (MR) imaging.
ranial Componenthe articular surface of the temporal bone is situated on the
Figure 4 Bone anatomy and synovial insertion of the twtemporal bone. Blue line: capsular insertion in the condarticular tubercle; Co: condyle; pop: postglenoid proceplane; Gf: glenoid fossa; Cp: condylar process. (A) CaudTMJ without the condyle. (C) Lateral view of the TMJ bcranial bone. (Color version of figure is available online
nferior aspect of temporal squama anterior to tympanic
late. Various anatomical terms of the joint are elaboratedelow.
(a) Articular eminence: This is the entire transverse bonybar that forms the anterior root of zygoma. This artic-
onents of the TMJ. Red line: capsular insertion in thek. E: Articular eminence; enp: entogolenoid process; t:ateral border of the mandibular fossa; pep: preglenoidial view of the TMJ bone. (B) Caudal cranial view of the) Cranial caudal view of the condyle bone without the
o compyle necss; lb: l
ular surface is most heavily traveled by the condyle
andib
174 X. Alomar et al.
and disk as they ride forward and backward in normaljaw function.
(b) Articular tubercle: This is a small, raised, rough, bonyknob on the outer end of the articular eminence. Itprojects below the level of the articular surface andserves to attach the lateral collateral ligament of thejoint.
(c) Preglenoid plane: This is the slightly hollowed, almosthorizontal, articular surface continuing anteriorlyfrom the height of the articular eminence.
(d) Posterior articular ridge and the postglenoid process:The tympanosquamosal suture is divided by the pro-truding inferior edge of the tegmen tympani into ananterior petrosquamosal and a posterior petrotym-panic fissure. The posterior part of the mandibular
Figure 5 Components of the disk. AB: Anterior band;pterigoide lateral muscle; RT: retrodiskal tissue; TL: temfossa; E: articular eminence; Co: condylar head of the m
fossa is an anterior margin of the petrosquamous su- t
ture and is elevated to form a ridge known as theposterior articular ridge or lip. This ridge increases inheight laterally to form a thickened cone-shapedprominence called the post glenoid process immedi-ately anterior to the external acoustic meatus.
(e) Lateral border of the mandibular fossa: This structureis usually raised to form a slight crest joining the artic-ular tubercle, in front, with the postglenoid processbehind.
(f) Medially the fossa narrows considerably and isbounded by a bony wall that is the entoglenoid process,which passes slightly medially as the medial glenoidplane.
The roof of the mandibular fossa, which separates it from
termedius zone; PB; posterior band; SPLM: superioramina; IL: inferior lamina; JC: joint capsule; Gf: glenoidle. (Color version of figure is available online.)
IZ: inporal l
he middle cranial fossa, is always thin and translucent, even
itcc
ATtbcia
ipmtt
tc
i
3mdstdtfiico
thncccbycb
Anatomy of the temporomandibular joint 175
n the heavy skull. This demonstrates that, although the ar-icular fossa contains the posterior rim of the disk and theondyle, it is not a functionally stress-bearing part of theraniomandibular articulation4 (Fig. 4).
rticular Diskhe articular disk is the most important anatomic structure of
he TMJ. It is a biconcave fibrocartilaginous structure locatedetween the mandibular condyle and the temporal boneomponent of the joint. Its functions to accommodate a hing-ng action as well as the gliding actions between the temporalnd mandibular articular bone.
The articular disk is a roughly oval, firm, fibrous plate withts long axis being traversely directed. It is shaped like aeaked cap that divides the joint into a larger upper compart-ent and a smaller lower compartment. Hinging movements
ake place in the lower compartment and gliding movementsake place in the upper compartment.
The superior surface of the disk is said to be saddle-shapedo fit into the cranial contour, while the inferior surface isoncave to fit against the mandibular condyle.
The disk is thick, round to oval all around its rim, divided
Figure 6 Dml: collateral disko-mandibular ligaments of thligament; Gf: glenoid fossa; E: articular eminence; IZ: inbranches of the facial nerve; ATN: auriculotemporal nerSFL: sphenomandibular ligament. (A) Schematic view othe TMJ disk and ligaments in the coronal plane. (C) Schplane. (Color version of figure is available online.)
nto an anterior band of 2 mm in thickness, a posterior band s
mm thick, and thin in the centre intermediate band of 1m thickness. More posteriorly there is a bilaminar or retro-iskal region. The disk is attached all around the joint cap-ule except for the strong straps that fix the disk directly tohe medial and lateral condylar poles, which ensure that theisk and condyle move together in protraction and retrac-ion.2 The anterior extension of the disk is attached to abrous capsule superiorly and inferiorly. In between it gives
nsertion to the lateral pterygoid muscle where the fibrousapsule is lacking and the synovial membrane is supportednly by loose areolar tissue.The anterior and posterior bands have predominantly
ransversal running fibers, while the thin intermediate zoneas anteroposteriorly oriented fibers. Posteriorly, the bilami-ar region consists of two layers of fibers separated by looseonnective tissue. The upper layer or temporal lamina isomposed of elastin and is attached to the postglenoid pro-ess, medially extended ridge, which is the true posterioroundary of the joint. It prevents slipping of the disk whileawning. The inferior layer of the fibers or inferior laminaurve down behind the condyle to fuse with the capsule andack of the condylar neck at the lowest limit of the joint
; Scl: superficial collateral ligament; Dcl: deep collateraldius zone; IPLM: inferior pterigoid lateral muscle; FN:: maxillary artery; Co: condylar head of the mandible;J ligaments in the sagittal plane. (B) Schematic view of
view of both TMJ muscles and ligaments in the coronal
e TMJtermeve; MA
f the TMematic
pace. It prevents excessive rotation of the disk over the con-
dbeicdjfpgSltap
ptbccowtpvlt
pusac
stiaz
i
tispp
FTrcoft
Fpagl
Ftes
176 X. Alomar et al.
yle.5 In between the two layers, an expansile, soft pad oflood vessels and nerves are sandwiched and wrapped inlastic fibers that aid in contracting vessels and retracting diskn recoil of closing movements. When the mandible is in thelosed-mouth position, the thick posterior band lies imme-iately above the condyle near the 12 o’clock position. The
unction of the posterior band and the bilaminar zone shouldall within 10 grades of vertical position to be within the 95%ercentile of normal. If the angle of displacement exceeds 10rades, a pathologic condition is considered to be present.5
ome studies have shown that disk displacement is seen in aarge number of asymptomatic volunteers (33%),6 while au-hors use the intermediate zone as a point of reference, anpproach which does not take into account the angle of dis-lacement of the posterior band.7
The retrodiskal attachment tissues are the intra-articularart of the joint posterior to the condyle and the disk. Func-ionally, the condyle and the disk are seated more anteriorly,eing strictly defined when the condyle and the disk are inentric relation. The volume of retrodiskal tissue must in-rease instantaneously when the condyle translates anteri-rly. This tissue is folded and compressed in the joint spacehen the jaw is in a closed position. When the jaw is opened,
he condyle moves down and forward (translates). The upperart of the retrodiskal attachment has a rather prominentascular shunt and this vascular network is contained withinoosely organized fat, collagen, and elastin. Perhaps because
igure 7 Schematic view of the TMJ ligaments in the central sagittallane. SFL: Sphenomandibular ligament; STL: stylomandibular lig-ment; JC: joint capsule; IAN: inferior alveolar nerve; OG: otic gan-lion; LN: lingual nerve; ATN: auriculotemporal nerve; MA: maxil-ary artery. (Color version of figure is available online.)
he disk tends to merely rotate against the condyle (as op- m
osed to translating, as the disk does against the upper artic-lar surface), the inferior lamina or inferior retrodiskal tissuetretches out and serves to stabilize the disk on the condylend is composed of relatively inelastic and tightly packedollagen (Fig. 5).
On sagittal MR imaging, the disk appears as a biconcavetructure with homogeneous low signal intensity that is at-ached posteriorly to the bilaminar zone, which demonstratesntermediate signal intensity. The anterior band lies immedi-tely in front of the condyle and the junction of the bilaminarone, and the disk lies at the superior part of the condyle.5
The posterior band and retrodiskal tissue are best depictedn the open-mouth position.8
In the coronal plane the posterior band of the disk is iden-ified as low signal intensity tissue above the condyle, whilen the axial plane, the anterior band is demonstrated as lowignal tissue in front of the condyle. The coronal and axiallanes are ideal to demonstrate medial and lateral disk dis-lacement.
ibrous Capsulehe fibrous capsule is a thin sleeve of tissue completely sur-ounding the joint. It extends from the circumference of theranial articular surface to the neck of the mandible. Theutline of the capsular attachment on the cranial base can beollowed anterolaterally to the articular tubercle, laterally tohe lateral rim of the mandibular fossa, posterolaterally to the
igure 8 Lateral cadaveric specimen view of the TMJ with removal ofhe condyle and the cygomatic arch. Gf: Glenoid fossa; E: articularminence; IZ: intermedius diskal zone; RT: retrodiskal zone; SPLM:uperior pterygoid lateral muscle; IPLM: inferior pterygoid lateral
uscle. (Color version of figure is available online.)
priac
sahm
stetaAeiod
ttditpmt
itfaaTw
TLCoTdftTowbautz
FaTtencb5rtcpcnglldfigure is available online.)
Anatomy of the temporomandibular joint 177
ostglenoid process, posteriorly to the posterior articularidge, medially to the medial margin of the temporal bone atts suture with the greater wing of the sphenoid, and finally,nteriorly it is attached to the preglenoid plane so as to en-lose the same within the joint cavity.4
The outline of attachment on the mandibular neck lies ahort distance below the edge of the articular surface in frontnd a considerable distance below the articular margin be-ind. Laterally, it is attached to the lateral condylar pole butedially it dips below the medial pole.On the lateral part of the joint, the capsule is a well-defined
tructure that functionally limits the forward translation ofhe condyle. This capsule is reinforced more laterally by anxternal TMJ ligament, which also limits the distraction andhe posterior movement of the condyle. Medially and later-lly, the capsule blends with the condylodiskal ligaments.nteriorly, the capsule has an orifice through which the lat-ral pterygoid tendon passes. This area of relative weaknessn the capsular lining becomes a source of possible herniationf intra-articular tissues, and this, in part, may allow forwardisplacement of the disk9 (Fig. 5).Since the articular disk is attached to the inner surface of
he capsule, dividing the joint cavity into two compartments,he fibers extend from the condyle to the disk and from theisk to the temporal bone to form two joint capsules. It is
mportant to realize that this capsule is an incomplete struc-ure on the posterior side of the condyle. In fact, the posteriorart of the TMJ is bounded by the tympanic plate on theedial two-thirds of the joint and by external ear cartilage on
he lateral third.The synovial membrane lining the capsule covers all the
ntra-articular surfaces except the pressure-bearing fibrocar-ilage. The lower and upper compartments form fluid-filledolds (sulci) in marginal gutters of the joint cavity. Thus therere four capsular or synovial sulci situated at the posteriornd anterior ends of the upper and lower compartments.hese sulci change shape during translatory movements,hich requires the synovial membrane to be flexible.10
emporomandibularigaments Complexollateral Ligamentsf the Bilateral Jaw Jointshe ligament on each side of the jaw is designed in twoistinct layers. The wide outer or superficial layer is usuallyan-shaped and arises from the outer surface of the articularubercle and most of the posterior part of the zygomatic arch.here is often a roughened, raised bony ridge of attachmentn this area. The ligamentous fascicles run obliquely down-ard and backward to be inserted on the back, behind, andelow the mandibular neck. Immediately medial to this layer,narrow ligamentous band arises from the crest of the artic-lar tubercle continuously, with attachment of the outer por-ion at this site. This narrow inner or deep band runs hori-
ontally back as a flap strap to the lateral pole of the condyle.
igure 9 Axial plane of normal anatomy of TMJ, T1 weighted imagesnd cryosectional cadaveric specimen correlation. (A) Craneal plane1 weighted image. (B) Craneal cryosection image. Osseos and ar-
n upper part of this band continues on to attach to the backf the disk, lateral to the condylar pole.Medial slippage of the condyle is prevented medially by
he entoglenoid process and laterally by the temporomandib-lar ligament.The outer oblique band becomes taut in the protraction of
he condyle, which accompanies the opening of the jaw,hereby limiting the inferior distraction of the condyle inorward gliding and rotational movements, while the innerorizontal band tightens in retraction of the head of the man-ible, thereby limiting posterior movement of the condyle11
Fig. 6).
phenomandibular Ligamenthis ligament arises from the angular spine of the sphenoidnd petrotympanic fissure and then runs downward and out-
igure 10 (A) Middle plane T1 weighted image. (B) Middle planeryosection image. (Color version of figure is available online.)
ard to insert on the lingula of the mandible. c
The ligament is related laterally to the lateral pterygoiduscle, with the auriculotemporal nerve running posteri-
rly, the maxillary artery running anteriorly, the inferior al-eolar nerve and vessels running inferiorly and entering theandibular foramen and a lobule of the parotid gland, andnally, medially to the medial pterygoid with the chordaympani nerve and the wall of the pharynx with fat and theharyngeal veins intervening. The ligament is pierced by theyelohyoid nerve and vessels. This ligament is passive dur-
ng jaw movements, maintaining relatively the same degree ofension during both opening and closing of the mouth.
tylomandibular Ligamenthis is a specialized dense, local concentration of deep cer-ical fascia extending from the apex and being adjacent to thenterior aspect of the styloid process and the stylohyoid lig-
ryosection image. (Color version of figure is available online.)
aliafiamwta
MStmmf
aopaam
matdamj
mdb
Fir(
F
Anatomy of the temporomandibular joint 179
ment to the mandible’s angle and posterior border. Thisigament then extends forward as a broad fascial layer cover-ng the inner surface of the medial pterygoid muscle. Thenterior edge of the ligament is thickened and sharply de-ned. It is lax when the jaws are closed and slackens notice-bly when the mouth is opened because the angle of theandible swings up and back while the condyle slides down-ard and forward. This ligament becomes tense only in ex-
reme protrusive movements. Thus, it can be considered onlys an accessory ligament of uncertain function (Fig. 7).
uscular Componentince so many TMJ problems involve the muscles, it is ex-remely helpful to know their names and how they work. Theasticatory muscles surrounding the joint are groups ofuscles that contract and relax in harmony so that the jaws
igure 12 Paracoronal plane of normal anatomy of TMJ, T1 weightedmages and cryosectional cadaveric specimen correlation. (A) Ante-ior plane T1 weighted image. (B) Anterior cryosection image.Color version of figure is available online.)
unction properly. When the muscles are relaxed and flexible c
nd are not under stress, they work in harmony with thether parts of the TMJ complex. The muscles of masticationroduce all the movements of the jaw. These muscles beginnd are fixed on the cranium extending between the craniumnd the mandible on each side of the head to insert on theandible.Different muscles are therefore required for the oppositeovements of the mandible. The muscles of mastication are
bductors (jaw openers) and adductors (jaw closers). Theemporalis, masseter, and medial pterygoids muscles are ad-uctors, while the lateral pterygoids muscles are the primarybductors of the jaw. The muscles that produce forwardovement (protrusive) are also used alternately to move the
aw from side to side (laterally).The principal and strongest muscle of mastication is theasseter, which stems from the temporal bone and extendsown the outside of the mandible to its lower angle, with aroad insertion along the lateral border of the conyle.
ryosection image. (Color version of figure is available online.)
wjTe
aeft
csdopa
oi
mppdtltmi
a
Fc
F
180 X. Alomar et al.
The second muscle for closing is the medial pterygoid,hich runs parallel to the masseter but on the inside of the
aw. It originates at a wing-shaped protrusion of the cranium.his and the masseter muscle form a sling around the backnd of the mandible and work together to pull it shut.
The third muscle for closing is the temporalis. It looks likepartially spread fan on the side of the head. It has a broad
nd that originates high on the temporal fossa and temporalascia, while its narrow end inserts on the coronoid process ofhe lower jaw.
When you chew, you not only move your mouth verti-ally, but also forward and backward (protrusively) and fromide to side (laterally). These movements are largely pro-uced by the pair of lateral pterygoid muscles. These musclesriginate from the same regions of the cranium as the medialterygoid muscles and extend backward and outward (later-
igure 14 (A) Central plane T1 weighted image. (B) Central planeryosection image. (Color version of figure is available online.)
lly) toward the condyles. The lateral pterygoid is composed c
f two portions or bellies, the superior belly (upper) and thenferior belly (lower).
The pair of inferior bellies are primarily responsible foroving the jaw forward, thus, opening the mouth, andulling the mandible to one side. The inferior belly isredominately attached to the top of the lower jaw (man-ibular condyle). When these bellies contract, they pullhe condyles forward out of the fossa and down to theowest points of the eminences. Contracting alternately,he inferior bellies allow the jaw to move laterally. Thisovement also takes place spontaneously when the mouth
s opened wide.The superior belly fibers pass through the joint capsule
nd connect with the front of the articular disk. The supe-
ryosection image. (Color version of figure is available online.)
rowbaasf
LTbse
uwc
BTpiecnf
TTA
Fidi
Fs
Anatomy of the temporomandibular joint 181
ior belly is responsible for proper disk movement in co-rdination with movement of the lower jaw, especiallyhen closing the mouth, just the opposite of the inferiorelly. It then exerts forward pressure on both the condylend the disk, stabilizing their relationship to each othernd assuring the most effective position possible when thetrong forces of chewing move the condyle backward andorward (Fig. 8).
ubrication of the Jointhe synovial fluid comes from two sources: first, from plasmay dialysis, and second, by secretion from type A and Bynoviocytes with a volume of no more than 0.05 ml. How-
igure 16 Parasagital plane of normal anatomy of TMJ, T1 weightedmages and cryosectional cadaveric specimen correlation. (A) Me-ial sagittal plane T1 weighted image. (B) Medial sagittal cryosection
mage. (Color version of figure is available online.)
ver, contrast radiography studies have estimated that the o
pper compartment could hold approximately 1.2 ml of fluidithout undue pressure being created, while the lower has a
apacity of approximately 0.5 ml.10
lood Supplyhe venous pattern is more diffuse, forming a plentifullexus all around the capsule. Posteriorly, the retrodiskal pad
s copiously riddled with wide venous channels. These cav-rnous spaces fill and empty as the condyle rocks rhythmi-ally forward and backward, providing for unhampered,imble movement in normal joint action. A similar venouseature is also seen anteriorly but to a lesser degree.
eeth and Occlusionhe way the teeth fit together may affect the TMJ complex.stable occlusion with good tooth contact and interdigi-
igure 17 (A) Middle sagittal plane T1 weighted image. (B) Middleagittal plane cryosection image. (Color version of figure is available
nline.)
tjtttt
TWopcwt
tasucai
mtpsp
Fso
Fs
182 X. Alomar et al.
ation provides maximum support to the muscles andoint, while poor occlusion (bite relationship) may causehe muscles to malfunction and ultimately cause damageo the joint itself. Instability of the occlusion can increasehe pressure on the joint, causing damage and degenera-ion.
echnical Notee obtained parasagittal, paracoronal, and axial MR images
f fresh, asymptomatic TMJ autopsy specimens and com-ared the MR images with corresponding parasagittal, para-oronal, and axial cryosections of the joints. The specimensere taken from cadavers with a cosed-jaw intercuspal posi-
igure 18 (A) Lateral sagittal plane T1 weighted image. (B) Lateralagittal plane cryosection image. (Color version of figure is availablenline.)
ion based on natural teeth. o
MR imaging was performed with a 1.5-T MR imaging sys-em (Excelart, Toshiba, San Francisco Inc) with the body coils transmitter and the 6.5 cm diameter dedicated to the TMJurface coil as a receiver. With this configuration, relativelyniform object excitation was achieved with the large bodyoils, while the smaller, sensitive volume of the surface coilllowed the signal-to-noise ratio to be increased in the vicin-ty of the coil.12-14
Tree axial planes images of normal anatomy of temporo-andibular joint in T1-Weighted images and cryosec-
ional anatomy. (Figs. 9, 10 and 11), four paracoronallanes images (Figs. 12, 13, 14 and 15) and four para-agital planes images (Figs. 16, 17, 18 and 19) are com-ared.15
igure 19 (A) Periferic sagittal plane T1 weighted image. (B) Perifericagittal plane cryosection image. (Color version of figure is available
nline.)
R
1
1
1
1
1
1
Anatomy of the temporomandibular joint 183
eferences1. Dorland WA: Medical Dictionary. Philadelphia and London, Saunders
Co., 19572. Williams PL: Gray’s anatomy, in Skeletal System (ed 38). Churchill
Livingstone, London, 1999, pp 578-5823. Yale SH: Radiographic evaluation of the temporomandibular joint.
J Am Dent Assoc 79(1):102-107, 19694. Patnaik VVG, Bala S,Singla Rajan K: Anatomy of temporomandibular
joint? A review. J Anat Soc India 49(2):191-197, 20005. Harms SE, Wilk RM: Magnetic resonance imaging of the temporoman-
dibular joint. Radiographics 7(3):521-542, 19876. Tallents RH, Katzberg RW, Murphy W, et al: Magnetic resonance im-
aging findings in asymptomatic volunteers and symptomatic patientswith temporomandibular disorders. J Prosthet Dent 75(5):529-533,1996
7. Helms CA, Kaplan P: Diagnostic imaging of the temporomandibularjoint: recommendations for use of the various techniques. AJR Am JRoentgenol 154(2):319-322, 1990
8. Helms CA, Kaban LB, McNeill C, et al: Temporomandibular joint:
morphology and signal intensity characteristics of the disk at MRimaging. Radiology 172(3):817-820, 1989
9. Kreutziger KL, Mahan PE: Temporomandibular degenerative joint dis-ease. Part II. Diagnostic procedure and comprehensive management.Oral Surg Oral Med Oral Pathol 40(3):297-319, 1975
