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Difference between revisions of "Temporomandibular Joint"

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Lo RDC ha cercato di stabilire alcuni riferimenti clinici e di laboratorio per la diagnostica dei Disturbi della ATM denominati DTM e della degenerazione tissutale come forme artrosiche, rimodellanti ecc. ma, prima di entrare nella discussione più approfondita della diagnostica per immagini della ATM è bene introdurre alcuni aspetti generali:


Da quanto si evince dall'articolo di Priscila Brenner Hilgenberg-Sydney, <ref>Priscila Brenner Hilgenberg-Sydney,1 Danielle Veiga Bonotto, José Stechman-Neto, Liete Figueiredo Zwir,3Camila Pachêco-Pereira, Graziela De Luca Canto, and  André Luís Porporatti. Diagnostic validity of CT to assess degenerative temporomandibular joint disease: a systematic review. Dentomaxillofac Radiol. 2018 Jul; 47(5): 20170389. Published online 2018 Mar 2. doi: 10.1259/dmfr.20170389 PMCID: PMC6196046 PMID: 29480019


</ref>il Disturbo temporomandibolare (TMD) è un termine generico che comprende condizioni che coinvolgono l'articolazione temporomandibolare (TMJ), i muscoli masticatori e/o le strutture associate.<ref>de Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis and management. 5th ed Hanover Park, IL: The British Institute of Radiology.; 2013. 312.</ref> Dislocazione del disco, suoni dell'ATM, malformazione congenita, malattia degenerativa delle articolazioni (DJD) sono possibili condizioni che interessano l'ATM . La DJD è caratterizzata dal deterioramento e dall'abrasione dei tessuti duri e molli dell'ATM e dal concomitante rimodellamento dell'osso subcondrale sottostante. La DJD ha un'eziologia multifattoriale che presenta alcuni fattori di rischio quali età, genetica, traumi, disturbi muscolari o articolari e condizioni sistemiche. I sintomi clinici possono includere dolore, rumori articolari, come crepitio, rigidità articolare e/o restrizione del movimento mandibolare.<ref>Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992; 6: 301–55. </ref>
The DRC has tried to establish some clinical and laboratory references for the diagnosis of ATM disorders called DTM and tissue degeneration such as arthritic, remodeling forms, etc. but, before entering into the more in-depth discussion of TMJ imaging diagnostics, it is good to introduce some general aspects:  


Negli ultimi anni sono stati compiuti molti sforzi per sviluppare criteri standardizzati per la diagnosi di TMD. Il Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), è un protocollo di ricerca largamente utilizzato per valutare il TMD. Nel 2014 è stata pubblicata una versione rivista come Criteri diagnostici (DC/TMD), con l'obiettivo di essere fattibile anche per i medici. Nel primo documento di convalida, l'imaging dell'ATM era facoltativo per la diagnostica, mentre il secondo lo raccomanda per una corretta valutazione.<ref>Petersson A. What you can and cannot see in TMJ imaging-an overview related to the RDC/TMD diagnostic system. J Oral Rehabil2010; 37: 771–8. doi: 10.1111/j.1365-2842.2010.02108.x</ref><blockquote>Al giorno d'oggi, ci sono molte modalità di imaging per indagare l'ATM, come la TC, la TC cone-beam (CBCT), la risonanza magnetica, la radiografia normale, l'ecografia, il pantomografo (comunemente chiamato "panoramico"), l'artrografia, tra gli altri.<ref>Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, et al.. Imaging of the temporomandibular joint: an update. World J Radiol 2014; 6: 567–82. doi: 10.4329/wjr.v6.i8.567 </ref> La letteratura è ancora poco chiaro quando un paziente con TMD dovrebbe sottoporsi a un'immagine dell'ATM, soprattutto quando viene proposta una diagnosi di DJD. Non esiste una chiara associazione tra la morfologia del condilo e il DJD.<ref>Cömert Kiliç S, Kiliç N, Sümbüllü MA. Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg 2015; 44: 1268–74. doi: 10.1016/j.ijom.2015.06.023</ref> Inoltre, non esiste un'associazione statistica tra l'intensità del dolore dell'ATM e la gravità del riassorbimento condilare.<ref>Cevidanes LH, Hajati AK, Paniagua B, Lim PF, Walker DG, Palconet G, et al.. Quantification of condylar resorption in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 110–7. doi: 10.1016/j.tripleo.2010.01.008</ref></blockquote>L'RDC/TMD ha un protocollo di esame che suggerisce tre tipi di immagini: pantomografo, risonanza magnetica e TC/CBCT. Usando l'RDC/TMD come standard di riferimento, Ahmad et al. hanno scoperto che mentre le immagini TC rilevavano il 75% di OA, la risonanza magnetica ne rilevava il 40% e le radiografie panoramiche lo 0%.10 Si pensava che l'uso di TC/CBCT fosse lo standard di riferimento delle immagini per valutare DJD.5, 11 Secondo RDC/TMD, DJD è presente quando c'è un crepitio grossolano nell'ATM. Se è accompagnata da auto-segnalazione di dolore nella regione dell'ATM e durante la palpazione è considerata come diagnosi IIIb, di artrosi. In caso contrario, non è presente dolore all'ATM, si considera diagnosi IIIc, di osteoartrosi. Secondo il DC/TMD, il DJD è presente quando c'è un'autovalutazione durante la consultazione o una storia di rumore dell'ATM e i risultati degli esami mostrano crepitio durante la massima apertura attiva, apertura passiva, movimento laterale destro, laterale sinistro o protrusivo rilevato dall'esaminatore . La conferma diagnostica potrebbe essere effettuata con un'immagine TC.4, 12<blockquote>Non esiste una revisione sistematica in letteratura che affronti l'argomento menzionato in vivo, il che esalta l'importanza di questa sezione di Masticationpedia per capire quanto sia corretto o limitante fare diagnosi attraverso imaging (TC, Cone beam, MNR ecc.) in una manifestazione algico funzionale multifattoriale. La domanda specifica è la seguente:
According to Priscila Brenner Hilgenberg-Sydney's article,<ref>Priscila Brenner Hilgenberg-Sydney,1 Danielle Veiga Bonotto, José Stechman-Neto, Liete Figueiredo Zwir,3Camila Pachêco-Pereira, Graziela De Luca Canto, and  André Luís Porporatti. Diagnostic validity of CT to assess degenerative temporomandibular joint disease: a systematic review. Dentomaxillofac Radiol. 2018 Jul; 47(5): 20170389. Published online 2018 Mar 2. doi: 10.1259/dmfr.20170389 PMCID: PMC6196046 PMID: 29480019
</ref> temporomandibular disorder (TMD) is an umbrella term encompassing conditions involving the temporomandibular joint (TMJ), masticatory muscles and/or associated structures.<ref>de Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis and management. 5th ed Hanover Park, IL: The British Institute of Radiology.; 2013. 312.</ref> Disc dislocation, TMJ sounds, congenital malformation, degenerative joint disease (DJD) are possible conditions affecting the TMJ. DJD is characterized by hard and soft tissue deterioration and abrasion of the TMJ and concomitant remodeling of the underlying subchondral bone. DJD has a multifactorial aetiology that has certain risk factors such as age, genetics, trauma, muscle or joint disorders, and systemic conditions. Clinical symptoms may include pain, joint noises such as crepitus, joint stiffness and/or restriction of jaw movement.<ref>Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992; 6: 301–55. </ref>


Concentrando l'attenzione sulla diagnostica per immagini in un soggetto che riferisce dolore orofacciale e/o disturbi della funzione masticatoria potrebbe compromettere la diagnosi differenziale? </blockquote>L'interpretazione dell'imaging dell'ATM richiede una comprensione della normale anatomia dell'articolazione.  
Much effort has been made in recent years to develop standardized criteria for the diagnosis of TMD. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), is a widely used research protocol to evaluate TMD. A revised version was published as Diagnostic Criteria (DC/TMD) in 2014, with the aim of being feasible for clinicians as well. In the first validation paper, TMJ imaging was optional for diagnostics, while the second recommends it for proper evaluation.<ref>Petersson A. What you can and cannot see in TMJ imaging-an overview related to the RDC/TMD diagnostic system. J Oral Rehabil2010; 37: 771–8. doi: 10.1111/j.1365-2842.2010.02108.x</ref>


L'ATM è un'articolazione sinoviale tra la fossa glenoidea dell'osso temporale e il condilo mandibolare. La struttura anatomica centrale dell'ATM è il disco articolare o menisco. Il disco è una struttura fibrocartilaginea di forma ovale composta da bande articolari anteriori e posteriori e da un centro più sottile, chiamato zona intermedia. La zona intermedia conferisce al disco un aspetto biconcavo nella vista sagittale. La banda posteriore è generalmente più spessa della banda anteriore ed entrambe le bande sono più larghe nella dimensione trasversale che nella dimensione anteroposteriore. Il tessuto retrodiscale o zona bilaminare è un ricco tessuto neurovascolare che funge da attacco posteriore del disco, fondendo il disco con la capsula articolare e l'osso temporale. (Figura 1)


L'aspetto laterale del disco si collega con la capsula articolare e si inserisce nel collo condilare. Anteriormente, le inserzioni del disco sono variabili e chiamate “complesso disco-capsulare”. Le fibre muscolari pterigoidee laterali e i tendini attaccano la fascia anteriore del disco a questo complesso. La posizione del disco viene valutata dalla posizione della banda posteriore e della zona intermedia rispetto al condilo mandibolare. (Figura 1)


L'ATM ha due compartimenti che funzionano come due piccole articolazioni all'interno di una stessa capsula. Ciò consente una maggiore libertà di movimento rispetto alle dimensioni dell'articolazione. Il compartimento superiore separa la fossa glenoidea dell'osso temporale dal disco, mentre il compartimento inferiore separa il disco dal condilo mandibolare. Nella fase iniziale dell'apertura della bocca, il condilo ruota nel compartimento articolare inferiore. Successivamente trasla anteriormente nel compartimento superiore.<ref>Som P.M., Curtin H.D.  Head and Neck Imaging—2 Volume Set. Mosby Elsevier; Maryland Heights, MO, USA: 2011. Expert Consult—Online and Print.</ref> Il muscolo pterigoideo laterale contribuisce all'apertura della mascella e i muscoli pterigoideo mediale, massetere e temporale facilitano la chiusura della mascella. Quando il condilo si trasla anteriormente, il disco dovrebbe spostarsi tra il condilo e l'eminenza articolare. Un disco normale non si muove sul piano coronale durante l'apertura della bocca. (Figura 2)
<blockquote>Nowadays, there are many imaging modalities to investigate TMJ, such as CT, cone-beam CT (CBCT), MRI, plain radiography, ultrasound, pantomograph (commonly called "panoramic "), arthrography, among others.<ref>Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, et al.. Imaging of the temporomandibular joint: an update. World J Radiol 2014; 6: 567–82. doi: 10.4329/wjr.v6.i8.567 </ref> The literature is still unclear when a patient with TMD should undergo a TMJ imaging, especially when a diagnosis of DJD is proposed. There is no clear association between condyle morphology and DJD.<ref>Cömert Kiliç S, Kiliç N, Sümbüllü MA. Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg 2015; 44: 1268–74. doi: 10.1016/j.ijom.2015.06.023</ref> Furthermore, there is no statistical association between TMJ pain intensity and the severity of condylar resorption.<ref>Cevidanes LH, Hajati AK, Paniagua B, Lim PF, Walker DG, Palconet G, et al.. Quantification of condylar resorption in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 110–7. doi: 10.1016/j.tripleo.2010.01.008</ref></blockquote>The RDC/TMD has an examination protocol that suggests three types of images: pantomograph, MRI and CT/CBCT. Using the RDC/TMD as a reference standard, Ahmad et al. found that while CT images detected 75% of OA, MRI detected 40% and panoramic radiographs 0%.10 The use of CT/CBCT was thought to be the gold standard of imaging to evaluate DJD.5, 11 According to RDC/TMD, DJD is present when there is a gross crackling sound in the ATM. If it is accompanied by self-report of pain in the TMJ region and during palpation it is considered as diagnosis IIIb, osteoarthritis. Otherwise, no TMJ pain is present, diagnosis IIIc, of osteoarthritis is considered.
 
According to the DC/TMD, DJD is present when there is a self-assessment during the consultation or a history of TMJ noise, and test results show crepitus during maximum active open, passive open, right lateral, left lateral, or protrusive detected by the examiner.
 
There is no systematic review in the literature that addresses the topic mentioned in vivo, which highlights the importance of this section of Masticationpedia to understand how correct or limiting it is to make a diagnosis through imaging (CT, Cone beam, MNR, etc.) in a multifactorial functional pain manifestation. (Figures 1-4)
<center>
<gallery widths="350" heights="282" perrow="4" mode="slideshow">
 
File:Politomography TMJ.jpg|'''Figure 1:''' Polytomography of TMJ with closed mouth
File:MR Sagital TMJ.jpg|'''Figure 2:''' MRI, sagittal view of the ATM
File:MR frontal TMJ .jpg|'''Figure 3:''' MRI, frontal view of the TMJ
File:TC -TMJ.jpg|'''Figure 5:''' CT of the temporomandibular joints
</gallery>
</center>
The specific question is as follows:{{q2|Could focusing on diagnostic imaging in an individual reporting orofacial pain and/or masticatory function disturbances compromise the differential diagnosis?}}Interpretation of TMJ imaging requires an understanding of normal joint anatomy.  
 
As well described in the article by Seyed Mohammad Gharavi et al.<ref>Seyed Mohammad Gharavi, Yujie Qiao, Armaghan Faghihimehr, and  Josephina Vossen. Imaging of the Temporomandibular Joint. Diagnostics (Basel). 2022 Apr; 12(4): 1006. Published online 2022 Apr 16. doi: 10.3390/diagnostics12041006. PMCID: PMC9031630. PMID: 35454054</ref> the TMJ is a synovial joint between the glenoid fossa of the temporal bone and the mandibular condyle. The central anatomical structure of the TMJ is the articular disc or meniscus. The disc is an oval-shaped fibrocartilaginous structure composed of anterior and posterior articular bands and a thinner center, called the intermediate zone. The intermediate zone gives the disc a biconcave appearance in the sagittal view. The posterior band is generally thicker than the anterior band and both bands are wider in the transverse dimension than in the anteroposterior dimension. The retrodisc tissue or bilaminar zone is rich neurovascular tissue that serves as the posterior attachment of the disc, fusing the disc with the joint capsule and temporal bone. (Figure 5)
 
[[File:TMJ anatomy 1.jpg|link=https://wiki.masticationpedia.org/index.php/File:TMJ%20anatomy%201.jpg|center|thumb|500x500px|'''Figure 5:''' Anatomical dissection of a right TMJ. '''1)''' Head of the articular condyle; '''2)''' Articular eminence; '''3)''' upper compartment; '''4)''' lower compartment; '''5)''' bilaminar area; '''6)''' bilaminar ligament; '''7)''' posterior band of the articular meniscus; '''8)''' intermediate zone of the articular meniscus; '''9)''' anterior band of the articular meniscus; '''10)''' pterygoid muscle lateral head superior; '''10a)''' insertions of lateral pterygoid muscle fibers and tendons to the anterior fascia of the articular disc; '''10b)''' insertions of lateral pterygoid muscle fibers and tendons at the condylar head]]
 
 
 
The lateral aspect of the disc connects with the joint capsule and inserts into the condylar neck. Anteriorly, the disc insertions are variable and called the "disc-capsular complex". The lateral pterygoid muscle fibers and tendons attach the anterior fascia of the disc to this complex. The position of the disc is assessed by the position of the posterior band and the intermediate zone with respect to the mandibular condyle.
 
The ATM has two compartments that work like two small joints within the same capsule. This allows for more range of motion relative to the size of the joint. The superior compartment separates the glenoid fossa of the temporal bone from the disc, while the inferior compartment separates the disc from the mandibular condyle. In the initial stage of mouth opening, the condyle rotates in the inferior articular compartment. It then translates anteriorly into the upper compartment.<ref>Som P.M., Curtin H.D.  Head and Neck Imaging—2 Volume Set. Mosby Elsevier; Maryland Heights, MO, USA: 2011. Expert Consult—Online and Print.</ref> The lateral pterygoid muscle helps open the jaw, and the medial pterygoid, masseter, and temporal muscles help close the jaw. As the condyle translates anteriorly, the disc should move between the condyle and the articular eminence. A normal disc does not move in the coronal plane during mouth opening.  
 
{{q2|A little diagnostic imaging never hurts but above all it is necessary to objectively interpret the radiographic data of the TMJ}}
{{Bib}}
[[Category:Gianni]]

Latest revision as of 09:39, 17 April 2023

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Masticationpedia
Article by  Gianni Frisardi

 



The DRC has tried to establish some clinical and laboratory references for the diagnosis of ATM disorders called DTM and tissue degeneration such as arthritic, remodeling forms, etc. but, before entering into the more in-depth discussion of TMJ imaging diagnostics, it is good to introduce some general aspects:

According to Priscila Brenner Hilgenberg-Sydney's article,[1] temporomandibular disorder (TMD) is an umbrella term encompassing conditions involving the temporomandibular joint (TMJ), masticatory muscles and/or associated structures.[2] Disc dislocation, TMJ sounds, congenital malformation, degenerative joint disease (DJD) are possible conditions affecting the TMJ. DJD is characterized by hard and soft tissue deterioration and abrasion of the TMJ and concomitant remodeling of the underlying subchondral bone. DJD has a multifactorial aetiology that has certain risk factors such as age, genetics, trauma, muscle or joint disorders, and systemic conditions. Clinical symptoms may include pain, joint noises such as crepitus, joint stiffness and/or restriction of jaw movement.[3]

Much effort has been made in recent years to develop standardized criteria for the diagnosis of TMD. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), is a widely used research protocol to evaluate TMD. A revised version was published as Diagnostic Criteria (DC/TMD) in 2014, with the aim of being feasible for clinicians as well. In the first validation paper, TMJ imaging was optional for diagnostics, while the second recommends it for proper evaluation.[4]


Nowadays, there are many imaging modalities to investigate TMJ, such as CT, cone-beam CT (CBCT), MRI, plain radiography, ultrasound, pantomograph (commonly called "panoramic "), arthrography, among others.[5] The literature is still unclear when a patient with TMD should undergo a TMJ imaging, especially when a diagnosis of DJD is proposed. There is no clear association between condyle morphology and DJD.[6] Furthermore, there is no statistical association between TMJ pain intensity and the severity of condylar resorption.[7]

The RDC/TMD has an examination protocol that suggests three types of images: pantomograph, MRI and CT/CBCT. Using the RDC/TMD as a reference standard, Ahmad et al. found that while CT images detected 75% of OA, MRI detected 40% and panoramic radiographs 0%.10 The use of CT/CBCT was thought to be the gold standard of imaging to evaluate DJD.5, 11 According to RDC/TMD, DJD is present when there is a gross crackling sound in the ATM. If it is accompanied by self-report of pain in the TMJ region and during palpation it is considered as diagnosis IIIb, osteoarthritis. Otherwise, no TMJ pain is present, diagnosis IIIc, of osteoarthritis is considered.

According to the DC/TMD, DJD is present when there is a self-assessment during the consultation or a history of TMJ noise, and test results show crepitus during maximum active open, passive open, right lateral, left lateral, or protrusive detected by the examiner.

There is no systematic review in the literature that addresses the topic mentioned in vivo, which highlights the importance of this section of Masticationpedia to understand how correct or limiting it is to make a diagnosis through imaging (CT, Cone beam, MNR, etc.) in a multifactorial functional pain manifestation. (Figures 1-4)

  • Figure 1: Polytomography of TMJ with closed mouth

  • Figure 2: MRI, sagittal view of the ATM

  • Figure 3: MRI, frontal view of the TMJ

  • Figure 5: CT of the temporomandibular joints

The specific question is as follows:

«Could focusing on diagnostic imaging in an individual reporting orofacial pain and/or masticatory function disturbances compromise the differential diagnosis?»

Interpretation of TMJ imaging requires an understanding of normal joint anatomy.

As well described in the article by Seyed Mohammad Gharavi et al.[8] the TMJ is a synovial joint between the glenoid fossa of the temporal bone and the mandibular condyle. The central anatomical structure of the TMJ is the articular disc or meniscus. The disc is an oval-shaped fibrocartilaginous structure composed of anterior and posterior articular bands and a thinner center, called the intermediate zone. The intermediate zone gives the disc a biconcave appearance in the sagittal view. The posterior band is generally thicker than the anterior band and both bands are wider in the transverse dimension than in the anteroposterior dimension. The retrodisc tissue or bilaminar zone is rich neurovascular tissue that serves as the posterior attachment of the disc, fusing the disc with the joint capsule and temporal bone. (Figure 5)

Figure 5: Anatomical dissection of a right TMJ. 1) Head of the articular condyle; 2) Articular eminence; 3) upper compartment; 4) lower compartment; 5) bilaminar area; 6) bilaminar ligament; 7) posterior band of the articular meniscus; 8) intermediate zone of the articular meniscus; 9) anterior band of the articular meniscus; 10) pterygoid muscle lateral head superior; 10a) insertions of lateral pterygoid muscle fibers and tendons to the anterior fascia of the articular disc; 10b) insertions of lateral pterygoid muscle fibers and tendons at the condylar head


The lateral aspect of the disc connects with the joint capsule and inserts into the condylar neck. Anteriorly, the disc insertions are variable and called the "disc-capsular complex". The lateral pterygoid muscle fibers and tendons attach the anterior fascia of the disc to this complex. The position of the disc is assessed by the position of the posterior band and the intermediate zone with respect to the mandibular condyle.

The ATM has two compartments that work like two small joints within the same capsule. This allows for more range of motion relative to the size of the joint. The superior compartment separates the glenoid fossa of the temporal bone from the disc, while the inferior compartment separates the disc from the mandibular condyle. In the initial stage of mouth opening, the condyle rotates in the inferior articular compartment. It then translates anteriorly into the upper compartment.[9] The lateral pterygoid muscle helps open the jaw, and the medial pterygoid, masseter, and temporal muscles help close the jaw. As the condyle translates anteriorly, the disc should move between the condyle and the articular eminence. A normal disc does not move in the coronal plane during mouth opening.

«A little diagnostic imaging never hurts but above all it is necessary to objectively interpret the radiographic data of the TMJ»
Bibliography & references
  1. ↑ Priscila Brenner Hilgenberg-Sydney,1 Danielle Veiga Bonotto, José Stechman-Neto, Liete Figueiredo Zwir,3Camila Pachêco-Pereira, Graziela De Luca Canto, and  André Luís Porporatti. Diagnostic validity of CT to assess degenerative temporomandibular joint disease: a systematic review. Dentomaxillofac Radiol. 2018 Jul; 47(5): 20170389. Published online 2018 Mar 2. doi: 10.1259/dmfr.20170389 PMCID: PMC6196046 PMID: 29480019
  2. ↑ de Leeuw R, Klasser GD. Orofacial pain: guidelines for assessment, diagnosis and management. 5th ed Hanover Park, IL: The British Institute of Radiology.; 2013. 312.
  3. ↑ Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 1992; 6: 301–55.
  4. ↑ Petersson A. What you can and cannot see in TMJ imaging-an overview related to the RDC/TMD diagnostic system. J Oral Rehabil2010; 37: 771–8. doi: 10.1111/j.1365-2842.2010.02108.x
  5. ↑ Bag AK, Gaddikeri S, Singhal A, Hardin S, Tran BD, Medina JA, et al.. Imaging of the temporomandibular joint: an update. World J Radiol 2014; 6: 567–82. doi: 10.4329/wjr.v6.i8.567
  6. ↑ Cömert Kiliç S, Kiliç N, Sümbüllü MA. Temporomandibular joint osteoarthritis: cone beam computed tomography findings, clinical features, and correlations. Int J Oral Maxillofac Surg 2015; 44: 1268–74. doi: 10.1016/j.ijom.2015.06.023
  7. ↑ Cevidanes LH, Hajati AK, Paniagua B, Lim PF, Walker DG, Palconet G, et al.. Quantification of condylar resorption in temporomandibular joint osteoarthritis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 110: 110–7. doi: 10.1016/j.tripleo.2010.01.008
  8. ↑ Seyed Mohammad Gharavi, Yujie Qiao, Armaghan Faghihimehr, and  Josephina Vossen. Imaging of the Temporomandibular Joint. Diagnostics (Basel). 2022 Apr; 12(4): 1006. Published online 2022 Apr 16. doi: 10.3390/diagnostics12041006. PMCID: PMC9031630. PMID: 35454054
  9. ↑ Som P.M., Curtin H.D.  Head and Neck Imaging—2 Volume Set. Mosby Elsevier; Maryland Heights, MO, USA: 2011. Expert Consult—Online and Print.
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