505:
its growth capacity, unlike a typical long bone. This area of cartilage within the bone grows in length by appositional growth as the individual grows to maturity. Over time, the cartilage is replaced by bone, using endochondral ossification. This mandibular growth center in the condyle allows the increased length of the mandible needed for the larger permanent teeth, as well as for the larger brain capacity of the adult. This growth of the mandible also influences the overall shape of the face and thus is charted and referred to during orthodontic therapy. When an individual reaches full maturity, the growth center of bone within the condyle has disappeared.
316:
among these. The central area is also thinner but of denser consistency than the peripheral region, which is thicker but has a more cushioned consistency. The synovial fluid in the synovial cavities provides nutrition for the avascular central area of the disc. With age, the entire disc thins and may undergo the addition of cartilage in the central part, changes that may lead to impaired movement of the joint. The synovial membrane covers the inner surface of the articular capsule in the TMJ, except for the surface of the articular disc and condylar cartilage.
680:, or the mandibular division of the trigeminal nerve, work in different groups to move the mandible in different directions. Contraction of the lateral pterygoid acts to pull the disc and condyle forward within the glenoid fossa and down the articular eminence; thus, the action of this muscle serves to protrude the jaw, it with the assistance of gravity, and the digastricus muscle also opens the jaw. The other three muscles close the mouth; the masseter and the medial pterygoid by pulling up the angle of the mandible and the temporalis by pulling up on the
637:, or front teeth of the mandible, are moved so that they first come edge to edge with the maxillary (upper) incisors and then surpass them, producing a temporary underbite. This is accomplished by translation of the condyle down the articular eminence (in the upper portion of the joint) without any more than the slightest amount of rotation taking place (in the lower portion of the joint), other than that necessary to allow the mandibular incisors to come in front of the maxillary incisors without running into them. (This is all assuming an ideal
340:, is actually the thickened lateral portion of the capsule, and it has two parts: an outer oblique portion (OOP) and an inner horizontal portion (IHP). The base of this triangular ligament is attached to the zygomatic process of the temporal bone and the articular tubercle; its apex is fixed to the lateral side of the neck of the mandible. This ligament prevents excessive retraction or moving backward of the mandible, a situation that might lead to problems with the joint.
194:
517:
377:. The inferior alveolar nerve descends between the sphenomandibular ligament and the ramus of the mandible to gain access to the mandibular foramen. The sphenomandibular ligament, because of its attachment to the lingula, overlaps the opening of the foramen. It is a vestige of the embryonic lower jaw, Meckel cartilage. The ligament becomes accentuated and taut when the mandible is protruded.
551:, which divides the joint into two distinct compartments. The inferior compartment allows for rotation of the condylar head around an instantaneous axis of rotation, corresponding to the first 20mm or so of the opening of the mouth. After the mouth is open to this extent, the mouth can no longer open without the superior compartment of the temporomandibular joints becoming active.
36:
596:
892:(the muscles that move the jaw). TMD does not fit neatly into any one etiologic category since the pathophysiology is poorly understood and it represents a range of distinct disorders with multifactorial etiology. TMD accounts for the majority of pathology of the TMJ, and it is the second most frequent cause of
588:
60:
559:. Although this had traditionally been explained as a forward and downward sliding motion, on the anterior concave surface of the mandibular fossa and the posterior convex surface of the articular eminence, this translation actually amounts to a rotation around another axis. This effectively produces an
780:). Upon closing, the condyle will slide off the back of the disc, hence another "click" or "pop" at which point the condyle is posterior to the disc. Upon clenching, the condyle compresses the bilaminar area, and the nerves, arteries, and veins against the temporal fossa, causing pain and inflammation.
775:
In most instances of disorder, the disc is displaced anteriorly upon translation, or the anterior and inferior sliding motion of the condyle forward within the fossa and down the articular eminence. On opening, a "pop" or "click" can sometimes be heard and usually felt also, indicating the condyle is
652:
When the mandible is moved into a lateral excursion, the working side condyle (the condyle on the side of the mandible that moves outwards) only performs rotation (in the horizontal plane), while the balancing side condyle performs the translation. During actual functional chewing, when the teeth are
504:
A growth center is located in the head of each mandibular condyle before an individual reaches maturity. This growth center consists of hyaline cartilage underneath the periosteum on the articulating surface of the condyle. This is the last growth center of bone in the body and is multidirectional in
315:
The central area of the disc is avascular and lacks innervation, thus getting its nutrients from the surrounding synovial fluid. In contrast, the posterior ligament and the surrounding capsules along have both blood vessels and nerves. Few cells are present, but fibroblasts and white blood cells are
319:
The lower joint compartment formed by the mandible and the articular disc is involved in rotational movement—this is the initial movement of the jaw when the mouth opens. The upper joint compartment formed by the articular disc and the temporal bone is involved in translational movement—this is the
500:
between condylar cartilage of the mandible and the developing temporal bone. Two slits like joint cavities and intervening disk make their appearance in this region by 12 weeks. The mesenchyme around the joint begins to form the fibrous joint capsule. Very little is known about the significance of
771:
The most common disorder of a temporomandibular joint is disc displacement. In essence, this is when the articular disc, attached anteriorly to the superior head of the lateral pterygoid muscle and posteriorly to the retrodiscal tissue, moves out from between the condyle and the fossa so that the
615:
When measuring the vertical range of motion, the measurement must be adjusted for the overbite. For example, if the measurement from the edge of the lower front teeth to the edge of the upper front teeth is 40 millimeters and the overbite is 3 millimeters, then the jaw opening is 43 millimeters.
331:
There are three ligaments associated with the temporomandibular joints: one major and two minor ligaments. These ligaments are important in that they define the border movements, or in other words, the farthest extents of movements, of the mandible. Movements of the mandible made past the extents
648:
During chewing, the mandible moves in a specific manner as delineated by the two temporomandibular joints. The side of the mandible that moves laterally is referred to as either the working or rotating side, while the other side is referred to as either the balancing or orbiting side. The latter
571:
The resting position of the temporomandibular joint is not with the teeth biting together. Instead, the muscular balance and proprioceptive feedback allow a physiologic rest for the mandible, an interocclusal clearance, or freeway space, which is 2 to 4 mm between the teeth.
501:
newly forming muscles in joint formation. The developing superior head of the lateral pterygoid muscle attaches to the anterior portion of the fetal disk. The disk also continues posteriorly through the petrotympanic fissure and attaches to the malleus of the middle ear.
304:. The disc divides each joint into two compartments, the lower and upper compartments. These two compartments are synovial cavities, which consist of an upper and a lower synovial cavity. The synovial membrane lining the joint capsule produces the
567:
The necessity of translation to produce further opening past that which can be accomplished with a sole rotation of the condyle can be demonstrated by placing a resistant fist against the chin and trying to open the mouth more than 20 or so mm.
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mandible and temporal bone contact is made on something other than the articular disc. This, as explained above, is usually very painful, because, unlike these adjacent tissues, the central portion of the disc contains no sensory innervation.
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599:
601:
292:. The disc is composed of dense fibrocartilagenous tissue that is positioned between the head of the mandibular condyle and the mandibular fossa of the temporal bone. The temporomandibular joints are one of the few
598:
1560:
Manfredini D, Guarda-Nardini L, Winocur E, Piccotti F, Ahlberg J, Lobbezoo F (October 2011). "Research diagnostic criteria for temporomandibular disorders: a systematic review of axis I epidemiologic findings".
554:
At this point, if the mouth continues to open, not only are the condylar heads rotating within the lower compartment of the temporomandibular joints, but the entire apparatus (condylar head and articular disc)
563:
which can be termed the resultant axis of mandibular rotation, which lies in the vicinity of the mandibular foramen, allowing for a low-tension environment for the vasculature and innervation of the mandible.
241:
The main components are the joint capsule, articular disc, mandibular condyles, articular surface of the temporal bone, temporomandibular ligament, stylomandibular ligament, sphenomandibular ligament, and
233:
of the skull above and the condylar process of mandible below; it is from these bones that its name is derived. The joints are unique in their bilateral function, being connected via the mandible.
728:(TMD). This term is used to refer to a group of problems involving the temporomandibular joints and the muscles, tendons, ligaments, blood vessels, and other tissues associated with them.
323:
In some cases of anterior disc displacement, the pain felt during movement of the mandible is due to the condyle compressing this area against the articular surface of the temporal bone.
630:, or chewing, are known as excursions. There are two lateral excursions (left and right) and the forward excursion, known as protrusion. The reversal of protrusion is retrusion.
783:
In disc displacement without reduction, the disc stays anterior to the condylar head upon opening. Mouth opening is limited and there is no "pop" or "click" sound on opening.
332:
functionally allowed by the muscular attachments will result in painful stimuli, and thus, movements past these more limited borders are rarely achieved in normal function.
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653:
not only moved side to side but also up and down when biting of the teeth is incorporated as well, rotation (in a vertical plane) also plays a part in both condyles.
1084:
RodrĂguez Vázquez JF, MerĂda
Velasco JR, Jiménez Collado J (January 1993). "Relationships between the temporomandibular joint and the middle ear in human fetuses".
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704:
Internal derangements, an abnormal relationship of the disc to any of the other components of the joint. Disc displacement is an example of internal derangement.
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283:
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169:
312:. The posterior portion attaches to the temporal bone. Both upper and lower compartments do not communicate with each other unless the disc is damaged.
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that fills these cavities. The disc is biconcave in shape. The anterior portion of the disc serves as the insertion site for the superior head of the
197:
Skull of a sheep. Temporal bone (os temporale) coloured. Line: tympanicum: articular face for temporomandibular joint; arrow: external acoustic pore.
1718:
1404:
Zadik Y, AktaĹź A, Drucker S, Nitzan DW (December 2012). "Aneurysmal bone cyst of mandibular condyle: a case report and review of the literature".
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The two minor ligaments, the stylomandibular and sphenomandibular ligaments are accessory and are not directly attached to any part of the joint.
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when the joint spaces and the articular disc develop. At approximately 10 weeks the component of the fetus future joint becomes evident in the
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Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, et al. (June 2007). "Anatomy of the temporomandibular joint".
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terms, although a bit outdated, are actually more precise, as they define the sides by the movements of the respective condyles.
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The temporomandibular joints can be felt in front of or within the external acoustic meatus during movements of the mandible.
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612:
Normal full jaw opening is 40-50 millimeters as measured from the edge of lower front teeth to edge of upper front teeth.
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conditions may also affect the function of temporomandibular joints, causing pain and swelling. These conditions include
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Myofascial pain dysfunction syndrome, primarily involving the muscles of mastication. This is the most common cause.
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885:
370:
355:
337:
888:(TMD, also termed "temporomandibular joint pain-dysfunction syndrome") is pain and dysfunction of the TMJ and the
362:; it separates the parotid and submandibular salivary glands. It also becomes taut when the mandible is protruded.
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Since the TMJ is connected to the mandible, the right and left joints function together and interdependently.
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The
American Association of Oral and Maxillofacial Surgeons (AAOMS) - The Temporomandibular Joint (TMJ)
638:
1441:"Temporomandibular Joint Arthrocentesis: A Prospective Study and Audit of 500 Joints of Central India"
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20:
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439:, innervate the bones, ligaments, and muscles of the TMJ. The fibrocartilage that overlays the
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1350:. Proceedings of the American Institute of Oral Biology 29th Meeting. Chicago. pp. 59–66.
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Sessle BJ (1999). "The neural basis of temporomandibular joint and masticatory muscle pain".
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Sessle, Barry J. (2011). "Peripheral and central mechanisms of orofacial inflammatory pain".
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Dynamics of temporomandibular joint during voluntary mouth opening and closing visualized by
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984:"Synovial membrane in the temporomandibular joint--its morphology, function and development"
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472:
432:
424:
418:
414:
263:
96:
1029:
Illustrated
Anatomy of the Head and Neck, Fehrenbach and Herring, Elsevier, 2012, page 118.
524:
Each temporomandibular joint is classed as a "ginglymoarthrodial" joint since it is both a
1761:
1389:
1039:
RodrĂguez-Vázquez JF, MĂ©rida-Velasco JR, MĂ©rida-Velasco JA, JimĂ©nez-Collado J (May 1998).
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Okeson JP (21 July 2014). "Chapter 10: Classification of temporomandibular disorders".
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of the temporomandibular joint, a degenerative joint disease of the articular surfaces.
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National
Institute of Dental and Craniofacial Research, National Institutes of Health
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National Center for
Biotechnology Information, U.S. National Library of Medicine
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Nozawa-Inoue K, Amizuka N, Ikeda N, Suzuki A, Kawano Y, Maeda T (October 2003).
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798:
673:
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436:
384:
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The temporomandibular joint is less stable when teeth are clenched together (
274:. Its loose attachment to the neck of the mandible allows for free movement.
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Oral
Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics
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1363:"Real-Time Magnetic Resonance Imaging of Temporomandibular Joint Dynamics"
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45:
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Journal of
International Society of Preventive & Community Dentistry
1190:. International Review of Neurobiology. Vol. 97. pp. 179–206.
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262:) is a thin, loose envelope, attached above to the circumference of the
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Temporomandibular joint pain is generally due to one of four reasons.
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Sensory innervation of the temporomandibular joint is provided by the
182:
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Pain or dysfunction of the temporomandibular joint is referred to as
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75:
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Formation of the temporomandibular joints occurs at around 12 weeks
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59:
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532:(sliding) joint. The condyle of the mandible articulates with the
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108:
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475:, may also contribute to the arterial blood supply of the joint.
383:
Other ligaments, called "oto-mandibular ligaments", connect the
1617:
620:
459:. Other branches of the external carotid artery, namely the
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secondary gliding motion of the jaw as it is opened widely.
1129:"A study of the discomalleolar ligament in the adult human"
716:, for which it is considered a reliable diagnostic criteria
633:
When the mandible is moved into protrusion, the mandibular
1258:
Biology of
Mineralized Tissues: Prenatal Skull Development
1041:"Anatomical considerations on the discomalleolar ligament"
776:
moving back onto the disk, known as "reducing the joint" (
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Normal movements of the mandible during function, such as
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Its arterial blood supply is provided by branches of the
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The unique feature of the temporomandibular joint is the
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separates the infratemporal region (anterior) from the
1609:
International
College of Cranio Mandibular Orthopedics
1188:
Translating Mechanisms Orofacial Neurological Disorder
540:. The mandibular fossa is a concave depression in the
929:
Illustrated Dental Embryology, Histology, and Anatomy
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Sagittal section of the articulation of the mandible
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927:Bath-Balogh, Mary; Fehrenbach, Margaret J. (2011).
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28:
1276:"Anatomy, Head and Neck, Temporomandibular Joint"
1274:Bordoni, Bruno; Varacallo, Matthew (2021-02-07).
435:(CN V). Free nerve endings, many of which act as
270:immediately in front; below, to the neck of the
1262:Columbia University College of Dental Medicine
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547:These two bones are actually separated by an
284:Articular disk of the temporomandibular joint
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961:(Third ed.). Elsevier Ltd. p. 17.
656:The mandible is moved primarily by the four
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950:
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19:"TMJ" redirects here. For other uses, see
16:Joints connecting the jawbone to the skull
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1264:post-graduate dental lecture series, 2007
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676:. These four muscles, all innervated by V
1406:Journal of Cranio-Maxillo-Facial Surgery
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1341:
1339:
914:
1501:"Chapter 5: TMD Diagnostic Categories"
354:region (posterior), and runs from the
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64:The joint seen from the inner surface.
25:
1505:Manual of Temporomandibular Disorders
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1223:
542:squamous portion of the temporal bone
478:The fibrocartilage that overlays the
7:
1127:Rowicki T, Zakrzewska J (May 2006).
1025:
1023:
1021:
1019:
922:
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763:of the joint can also be performed.
623:movements, only the mandible moves.
391:) with the temporomandibular joint:
1730:posterior atlantooccipital membrane
1047:. 192. 192 ( Pt 4) (Pt 4): 617–21.
722:temporomandibular joint dysfunction
431:) which is in turn a branch of the
404:(or malleolar-mandibular) ligament.
40:The temporomandibular joint is the
1725:Anterior atlantooccipital membrane
1439:Kumar S, Kiran K, Yadav A (2018).
1310:Seminars in Ultrasound, CT and MRI
1196:10.1016/B978-0-12-385198-7.00007-2
988:Archives of Histology and Cytology
931:. Elsevier Saunders. p. 266.
482:is avascular in healthy subjects.
14:
1367:The Open Medical Imaging Journal
778:disc displacement with reduction
682:coronoid process of the mandible
114:articulatio temporomandibularis
1499:Wright EF (16 November 2011).
1390:11858/00-001M-0000-0011-560C-6
1161:Sinnatamby, Chummy S. (2011).
959:Anatomy for diagnostic imaging
398:(or disco-malleolar) ligament,
1:
1575:10.1016/j.tripleo.2011.04.021
1361:Zhang, Shuo (10 March 2011).
1282:. StatPearls Publishing LLC.
957:Ryan, Stephanie (2011). "1".
874:Juvenile idiopathic arthritis
1539:. Elsevier Health Sciences.
1458:10.4103/jispcd.JISPCD_361_17
1098:10.1177/00220345930720010901
1767:Joints of the head and neck
1380:10.2174/1874347101105010001
1348:The non-existent hinge axis
813:abnormal tissue development
807:of mandible or cranial bone
801:of mandible or cranial bone
795:of mandible or cranial bone
724:or temporomandibular joint
469:ascending pharyngeal artery
457:superficial temporal branch
81:Superficial temporal artery
1788:
1684:Temporomandibular ligament
1418:10.1016/j.jcms.2011.10.026
1322:10.1053/j.sult.2007.02.002
1086:Journal of Dental Research
886:Temporomandibular disorder
371:spine of the sphenoid bone
338:temporomandibular ligament
296:in the human body with an
281:
18:
1694:Sphenomandibular ligament
1507:. John Wiley & Sons.
1232:Journal of Orofacial Pain
1053:10.1017/S0021878298003501
367:sphenomandibular ligament
175:
57:
33:
1699:Stylomandibular ligament
896:after dental pain (i.e.
465:anterior tympanic artery
348:stylomandibular ligament
336:The major ligament, the
244:lateral pterygoid muscle
207:temporomandibular joints
528:(hinging joint) and an
520:Temporomandibular joint
453:external carotid artery
272:condyle of the mandible
29:Temporomandibular joint
890:muscles of mastication
858:Degenerative disorders
836:Inflammatory disorders
824:Mandibular dislocation
658:muscles of mastication
609:
592:
521:
415:auriculotemporal nerve
302:sternoclavicular joint
198:
177:Anatomical terminology
93:Auriculotemporal nerve
731:Although rare, other
688:Clinical significance
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590:
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461:deep auricular artery
360:angle of the mandible
227:synovial articulation
196:
880:Idiopathic disorders
869:Rheumatoid arthritis
787:Congenital disorders
749:aneurysmal bone cyst
455:, predominately the
300:, another being the
225:. It is a bilateral
21:TMJ (disambiguation)
1757:Human head and neck
1001:10.1679/aohc.66.289
818:Traumatic disorders
443:is not innervated.
375:lingula of mandible
1136:Folia Morphologica
1045:Journal of Anatomy
714:Temporal arteritis
643:Class II occlusion
610:
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423:(both branches of
268:articular tubercle
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1739:
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1711:Atlanto-occipital
1661:Temporomandibular
1546:978-0-323-24208-0
1514:978-1-119-94955-8
1346:Moss, ML (1972).
1205:978-0-12-385198-7
1172:978-0-7295-3752-0
1165:(12th ed.).
938:978-1-4377-1730-3
767:Disc displacement
670:lateral pterygoid
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310:lateral pterygoid
260:capsular ligament
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146:A03.1.07.001
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44:between the
1723:membranes (
1092:(1): 62–6.
831:Subluxation
805:Hyperplasia
755:Examination
628:mastication
486:Development
480:TMJ condyle
441:TMJ condyle
437:nociceptors
103:Identifiers
1746:Categories
1373:(1): 1–9.
910:References
847:Capsulitis
799:Hypoplasia
733:pathologic
674:temporalis
557:translates
530:arthrodial
498:mesenchyme
385:middle ear
120:Acronym(s)
1649:ligaments
898:toothache
842:Synovitis
811:Dysplasia
577:occlusion
526:ginglymus
327:Ligaments
237:Structure
1680:Lateral
1583:21835653
1477:29780737
1426:22118925
1330:17571700
1293:June 23,
1288:30860721
1244:10823036
1214:21708311
1148:16773599
1114:33739777
1010:14692685
852:Myositis
828:Fracture
726:disorder
672:and the
662:masseter
635:incisors
509:Function
493:in utero
417:and the
266:and the
48:and the
46:mandible
1719:capsule
1690:Medial
1669:Capsule
1651:of the
1468:5946520
1106:8418109
1071:9723988
1062:1467815
793:Aplasia
639:Class I
619:During
561:evolute
536:in the
389:malleus
373:to the
358:to the
352:parotid
250:Capsule
221:to the
219:jawbone
203:anatomy
134:D013704
70:Details
1762:Joints
1645:Joints
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747:, and
660:: the
471:, and
215:joints
205:, the
76:Artery
1772:Skull
1132:(PDF)
1110:S2CID
427:(CN V
223:skull
181:[
170:54832
109:Latin
88:Nerve
42:joint
1647:and
1579:PMID
1541:ISBN
1509:ISBN
1473:PMID
1422:PMID
1326:PMID
1295:2021
1284:PMID
1240:PMID
1210:PMID
1200:ISBN
1167:ISBN
1144:PMID
1102:PMID
1067:PMID
1006:PMID
963:ISBN
933:ISBN
693:Pain
365:The
346:The
254:The
158:1622
141:TA98
129:MeSH
1571:doi
1567:112
1463:PMC
1453:doi
1414:doi
1385:hdl
1375:doi
1318:doi
1192:doi
1094:doi
1057:PMC
1049:doi
996:doi
645:.)
641:or
621:jaw
579:).
211:TMJ
201:In
165:FMA
153:TA2
123:TMJ
1748::
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