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DOI: 10.1051/odfen/2011202 J Dentofacial Anom Orthod 2011;14:203� RODF / EDP Sciences

1

Conflicts of interest: noneReceived: 10-2010.Accepted: 02-2011.

TMJ :Sense of motion

Pierre CARPENTIER, Rufino FELIZARDO,

Jean-Pierre YUNG, Geraldine CLEDES

ABSTRACT

In an article published in the ODF Review in 1987, we described the staticrelationships existing between and among the different components of thetemporomandibular joint. This new article completes that work by supplying adynamic vision of the range of movement, as well as recent anatomical andelectromyographic data concerning the lateral pterygoid muscle.

KEYWORDS

Temporomandibular joint

Anatomy

Physiology

Lateral pterygoid muscle.

In the article entitled "TMJ in movement:sense of the form" published in the ODFReview in 1987, we described the relation-ships existing between and among thedifferent components of this particular jointon the basis of a study using serialanatomical sections and 3D reconstruc-tion30.

In terms of the traditional, static approachof the joint, the anatomical data concerning

the muscle-disc-condyle complex havechanged very little; therefore, we refer thereader to this article and more recentpublications combining anatomy and ima-ging1. Here, with the help of three histolo-gical sections, we will be limited torepeating the principal structures in currentanatomical terminology (fig. 1 to 3).

In the etiophysiopathological approach ofthis new article, it seems more appropriate

Address for correspondence:

G. CLEDES,5-6, avenue des Marronniers,94130 [email protected]

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to us to concentrate on the recentinformation concerning the joint bio-mechanics and kinematics, as well asthe physiology of the lateral pterygoidmuscle. Indeed, these facts seem to

us to be fundamental to the under-standing of the complex functioning ofthese two ‘Siamese’ joints, and there-fore mechanisms that can lead to theirdysfunction.

COMPLEX ANATOMY WHERE ASYMMETRY PREDOMINATES

While the two TMJs are roughlysymmetrical, asymmetry predomi-nates, with each joint consideredseparately. Also, at the bone level,the condylar mass is not distributedequally on both sides of the neck: themedial part has a more obvious over-hang than the lateral part, bringingabout an insertion recess for thelateral pterygoid muscle which ap-proaches the joint medially. As severalstudies have shown6,8,9,13 there is aconcentration of strains sustainedduring function in the lateral part of

the joint, with these biomechanicaldata being expressed from a patholo-gical point of view by the predomi-nance of cartilaginous lesions in thelateral third of the joint. Note that forHylander12, this stress gradient wouldbe connected to the deformation ofthe mandible during function ratherthan to the mandibular head asymme-try.

Asymmetry also exists at the disclevel, with the joint disc not as thick inthe lateral part of the joint as in itsmedial part. This difference could

1: External auditory meatus2: Tympanic bone3: Tympanosquamous

fissure4: Upper fibers of the

bilaminar zone5: lower fibers of the

bilaminar zone6: Retrodiscal venous plexus7: Mandibular fossa8: Posterior band9: Intermediate zone

10: Anterior band11: Temporal eminence12: Prediscal tendinous sheet13: Disc fibers of the superior head

of the lateral pterygoid muscle14: Bone fibers of the superior head

of the lateral pterygoid muscle15: Inferior head of the lateral

pterygoid muscle16: Neck of the mandibular condyle17: Parotid gland.

Figure 1Sagittal section of right TMJ in closed mouth position.

PIERRE CARPENTIER, RUFINO FELIZARDO, JEAN-PIERRE YUNG, GERALDINE CLEDES

2 Carpentier P, Felizardo R, Yung JP, Cledes G. TMJ: Sense of motion

logically result from a modeling of thedisc under the influence of functionand the stress gradient, if it did not

already exist in utero. This asymmetrycould then be explained by consider-ing, as analysis of some embryological

1: Parotid gland2: Lateral disco-condylar

ligament3: Temporal muscle4: Posterior band of the

disc5: Medial disco-condylar

ligament6: Insertion of the lateral

pterygoid muscle7: Auriculotemporal

nerve8: Maxillary artery9: Maxillary vein

10: Neck of the condyle

Figure 2Oblique frontal section going through the condylar zones.

1: Anterolateral venousplexus

2: Deep masseter muscle

3: Temporal muscle4: Lateral pterygoid

muscle5: Bilaminar zone6: Tympanic portion of

the temporal bone7: Cartilage of the exter

nal auditory meatus8: Lateral portion of joint

capsule9: Mandibular condyle

10: Anterior band of thedisc

Figure 3Axial section going through the anterior ridge.

TMJ: SENSE OF MOTION

J Dentofacial Anom Orthod 2011;14:203 3

data suggests11,26, the disc as aninsertion tendon of the lateral ptery-goid muscle. Since the muscle isthicker medially than laterally, thedifference in disc thickness is thenunderstood, and would go hand inhand with the asymmetry of theattachments of the disc on the con-dyle. However, for other authors25,the disc is developed independently ofthe lateral pterygoid muscle. Accord-ing to Naidoo23, it is impossible todraw definitive conclusions on thispoint. Nevertheless, laterally, the col-lagen fibers derived from the anteriorand posterior bands fuse and join thelateral pole of the condyle, to form aslender and exclusively fibrous disco-condylar attachment. Conversely, themedial attachment is reinforced at itsperiphery by medial fibers of thelateral pterygoid, which at the sametime are inserted back, under, and infront of the medial pole of the disc,giving this medial attachment a resis-tance much greater than that of itslateral homologue. It is again curiousto note that the zone sustaining mostmechanical stress has the most fragiledisc attachment, especially since thisattachment is subjected to lateral

pterygoid muscular tension duringthe opening movement, with the discand the condyle being pulled antero-medially. Moreover, it is commonlyagreed that the stretching of thelateral attachment forms the startingpoint of disc displacements, as theMRI images that illustrate this asso-ciation suggest.

On the vascular level, a structuralasymmetry is also noted: the lateralpart of the joint is less vascularized,with the medullary arteries, branchesof the maxillary artery, being detachedin the stylomandibular outlet facingthe medial joint zone. Most probably,this constitutes a handicap for thelateral zone in the matter of tissuerepair.

Would the TMJ have been poorlydesigned with functional stressesbeing concentrated in the anatomicallyweakest zone? Certainly not, but thecomplexity of the biomechanical spe-cifications has certainly created someweaknesses that appear when themasticatory apparatus is diverted fromits original function, and especiallywhen patients inflict permanent stresson it by clenching their teeth.

THE LATERAL PTERYGOID: WAR OF THE HEADS

On the muscle level, numerousauthors have considered the distribu-tion of insertions of the lateral pter-ygoid muscle on the disc and thecondyle, with the thought that thelatter could oppose the disco-condylardisunity. Analysis of the literaturerevealed a great disparity on thissubject, some studies5 even goingso far as to deny the existence of adisc insertion of the lateral pterygoid.

This great variability certainly origi-nates in part from interethnic varia-tions, but also from bias related to themethods of investigation or to thehuman material examined.

In a carefully conducted histomor-phometric study24, the disc fiberswere found to represent, on average,30 % of the fibers of the superiorhead of the lateral pterygoid, with a



significant standard deviation sincethis percentage varied from 10 % to60 % without any connection havingbeen established with age or sex.Further, there does not seem to be arelationship between the resistance torupture of this lateral attachment, thewidth of the muscular insertions of thelateral pterygoid on the anterior ridge,and the sex of the subjects3.

Concerning the actual anatomy ofthe lateral pterygoid muscle, the "warof the heads" still rages. Only recently,articles have described one, two, eventhree muscle heads. How is thatpossible? In reality, everything de-pends on the access route, the dis-section technique, and the approachof the author of the muscle function-

ing mode. Thus, the design of anactivity that is mainly perceived in thesagittal plane leads to a dissectionalapproach aimed at identifying divi-sions in this plane, with superior andinferior heads (fig. 4 a and 4 b) orsheets piled above one another.

Even if the organization and, as wewill see later, the function of the lateralpterygoid prove to be more complexthan we imagined, the debate concern-ing the number of heads does not takeon major clinical value: this muscle,which is roughly conical at the top ofthe joint, can present different types oforganization, with fusion of the fibersmaking a single muscle body at thefront of the TMJ (fig. 5).

EVOLUTION OF ELECTROMYOGRAPHIC DATA

The evolution of anatomical con-cepts concerning the lateral pterygoidgoes hand in hand with that of the

physiological concepts concerning it.Indeed, the standard sagittal ap-proach, whereby the muscle is split

Figures 4 a and bSagittal MRI section and lateral view of the lateral pterygoid muscle in dissection, showing two well-differentiatedheads.



Figure 5Serial frontal sections of a left lateral pterygoid muscle, categorized in the anteroposterior direction.



into two superior and inferior heads, isexpressed from a physiological pointof view by a reciprocal design of theirrespective activities. Thus, the inferiorhead, oblique at the bottom, front, andinside, is essentially bone and withoutany connection to the TMJ, and isconsidered active during oral openingand in propulsion and laterality of theopposite side (contralateral abduction).It is then a true propellant of themandible. It functions in the con-centric dynamic mode, bringing itsinsertion tendons nearer when theaction potentials are highest.

As for the superior head, oblique infront, inside, and located in a horizon-tal plane, for which the insertion isbone and disc simultaneously, it isconsidered active during oral closing,retrusion, and return of laterality (con-tralateral adduction). It functions ineccentric dynamic mode, the activitypotentials being highest when theinsertion tendons located at each endmove apart, which would explain itsgreatest tissue vulnerability15,17,24.The contraction of the superior head,then, precisely controls the return ofthe condyle into the mandibular fossaduring closure by the creation of anagonist-antagonist muscle pair. Due toits location under the base of thecranium and the horizontal directionof its fibers, which are reflected underthe temporal eminence, the superiorhead is ideally located to accomplishthis ‘braking’ role. Therefore, it is anantagonist of the retrusion muscles ofthe mandible, just as the temporal partof the temporal muscle and thedigastric muscle. As for the action ofthe fibers inserted into the anterome-dial part of the disc, their assumed roleduring oral closing would be to pro-gressively bring back the posterior

band relative to the top of the condyle,and to lock the disco-condylar coapta-tion to avoid excessive tension on thedisc attachments during function.

This dichotomous description ispartially revised today due to newelectromyographic data, especiallyderived from the work of Murrayet al.21,22, which supplies a moreaccurate vision of the muscle rangeof movement.

According to these studies, theentire medial part of the muscle isactive during movements of opening,propulsion, and contralateral abduc-tion, which could correspond to theinferior and intermediate fibers ob-served on the frontal sections. Thus,the inferior head mobilizes the mand-ible due to the fibers inserted into thepterygoid recess, while the medialpart of the superior head controls themedial zone of the condyle and thedisc with these movements. Thus, themedial zone seems to be the truemotor element of the disco-condylarcomplex.

But the novelty especially concernsthe differential activity of the superiorhead in the transverse direction4.According to these authors, on thefunctional level, the superior head canbe divided into three parts, medial,middle, and lateral, while until now ithas been considered a single unit. Aswe have just mentioned, the medialpart functions in synergy with theinferior head, while the lateral partdoes not demonstrate activity in thesemovements but, conversely, is activein closing, retropulsion, and ipsilateralexcursion. As for the middle part, it hasintermediate activity (fig. 6 a to 6 c).

If one considers that the disc fibersare inserted into the third, the medial



half of the anterior band, the lateralpart of the disc, would indeed, in away, be left to itself during differentmandibular movements, creating agreater disco-condylar clearance be-tween the disc and the condylearound the lateral zone than in themedial part of the joint. Thus, hereagain is a weakness in the lateral zoneof the joint.

Thus, the final muscular action ofthe lateral pterygoid muscle should beviewed in three dimensions, withselective recruitment of certain groupsof fibers according to the mandibularmovement to be produced. Thus, thismuscle could be compared with anoctopus in which the body would behorizontal and the head located in thepterygoid recess, and one could ima-

gine that its multiple components arecapable of contracting independently,like the tentacles, upon request, todeform the muscle body, shrinkingsome fibers and subfibers to ‘run’ thehead of the mandible in the threespatial planes. The deformation of themuscle, which is carried out during itscontraction, is expressed by a veryclear increase in its circumference,associated with a shortening of itslength as shown by the MRI sectionscarried out in lateral excursion.

Note here that whi le someauthors2,7,16,28 have described discinsertions of deep temporal and mass-eter muscles, they cannot be com-pared with those of the lateralpterygoid muscle, whether in termsof size, function, or even the nature of

Figures 6 a and cDiagrammatic representation of the assumed action of the superior head on the disc during oral openingand closing movements, integrating electromyographic and anatomical data.



the insertion19,28. Indeed, these at-tachments, when observed in dissec-tion10,16, seem substantial; when theyare observed with light microscopy,they amount to a few thin fibers whichfit tightly around or cross an arteriove-nous plexus (fig. 7 a to 7 d). In a seriesof millimetric sagittal sections (fig. 8 ato 8 f) comparable with histologicaliconography, described in several pub-lications2,14,18,27,28, we observedthese temporomasseteric insertionsat a depth of three millimeters.

Thus, in our opinion, the lateralpterygoid muscle remains the truejoint muscle.

Whatever the differences that wehave just mentioned on the subject ofmuscle insertions on the disc, all theauthors agree on a predominance ofthese insertions at the medial zone ofthe joint, as well as on a greatvariability in the latter that may, insome cases, form an additional riskfactor for lesions of the musculo-condylar complex.

Figures 7 a to dSagittal sections involving the lateral part of a right TMJ, illustrating the fibrous connections of the deepmasseter and of the temporal fitting tightly around the anterolateral venous plexus.



JOINT BIOMECHANICS

While the anatomical organization ofthe TMJ, as we have described it upto now, seems to present a weakness

of the lateral zone, in ligament as wellas muscle and vascular terms, thiscould prove to be essential to the

Figures 8 a to fMillimetric sagittal sections made after post-mortem oral opening, starting from the medial zone of the disc*.Muscle fibers (white arrows); insertion tendons (black arrows).



mechanical specifications of the joint,enabling it to accomplish all move-ments involved in mastication.

Indeed, it is acknowledged that,during mouth opening, each TMJreleases a rotation movement in theinferior compartment, associated witha translation movement in the superiorcompartment, each individual openingwith a variable percentage of rotationand translation.

When the arches are in occlusion,the contact surface between theanterior wall of the condyle, the disc,and the temporal eminence is max-imal, thus ensuring optimal distribu-tion of the stresses (fig. 1 and 2).

During oral opening, the top of thecondyle leaves the posterior band andreaches the intermediate zone of thedisc. Since this latter is not as thick asthe posterior band, the disco-condylarligaments are loosened and release aslight range of movement betweenthe condyle and the disc, enabling thelatter to be deformed to follow theconvexity of the temporal eminence.With the contact surface between thetwo convex bone parts and the inter-posed disc being then reduced to theminimum, a great freedom of move-ment can then be expressed aroundtwo joint pivots (fig. 9 a and b). Underthe action of medial fibers of thelateral pterygoid muscle, which guidesthe medial zone to the opening, aslight lateromedial displacement ofthe disc relative to the condyle isobserved, made possible by the disco-condylar range of movement releasedat the lateral zone. The upper bilaminarzone spreads as if aspirated by the

displacement of the disco-condylarcomplex and fills with blood, whilethe disco-condylar fibers are loosened.It is somewhat likely that the upperfibers act as a mechanical brake forlimiting the amplitude of the transla-tion; their richness in mechanorecep-tors and in free endings could form aneurophysiological brake, the jointsensors being solicited in the limitedmovements of the joint.

As for the closing movement, thisrequires the coordinated action of thelevator and retrusion muscles of themandible, the action of these latterbeing counterbalanced by that of thelateral pterygoid muscle, which, dueto its bone insertions, controls therecoil of the condyle. In this closingmovement, the activity of the supero-lateral fibers of the lateral pterygoid isdirected at progressively repositioningthe lateral part of the joint disc. Asemphasized by Matsunaga et al.16, themuscle fibers that rejoin the pterygoidrecess are oriented posterolaterally,while those that spread to the dischave a true posterior direction. It ispossible, then, that these two musclegroups, according to their relativestrength, could create shearing forcesbetween the disc and the condyle,favoring the distension of the lateralattachment and the creation of discdisplacements.

During oral closing, the superiorbilaminar zone is compressed, playingthe role of hydraulic shock absorberand synovial fluid pump, while thedisco-condylar lower fibers are tigh-tened and flattened on the posteriorwall of the condyle.



FROM ANATOMY TO CLINICS

As we have just seen, the TMJ is ajoint with complex anatomy and bio-mechanics, reinforced by its synergywith the contralateral joint. Within thecontext of a short article, we cannotaddress all pathological aspects of theADAMs. Therefore, we have chosento emphasize the key points that thepractitioner must keep in mind inapproaching these pathologies: theadaptive potential of the joint, theanatomo-clinical dissociation, the etio-pathogenic significance of dentalclenching, and psychosocial factors.

Adaptive potential

In contrast to the other synovialjoints, the joint surfaces of the TMJare covered with fibrocartilage and not

hyaline cartilage. Besides its biochem-ical composition, characterized by thepresence of type I cartilage, thisfibrocartilage is differentiated fromthe hyaline cartilage by the presenceof an external fibrous layer calledperichondrium, and an undifferentiatedmesenchyme layer composed of pre-chondroblasts that may become in-volved in different differentiationpathways. To this is added the factthat the cells of different layers aredistributed at random, and not in acolumn as in hyaline cartilage, confer-ring on the fibrocartilage a strongadaptive potential without pre-estab-lished functional orientation, especiallyallowing for the reorientation of man-dibular growth in dentofacial orthope-dic treatments, and explaining the lowprevalence of temporomandibular

Figures 9 a and bSagittal MRI sections made with open mouth.

With the contact surface between the two convex bone parts and the interposed intermediate zone being thenreduced to the minimun, a great freedom of movement can then be expressed around two joints pivots.



osteoarthritis in comparison with os-teoarthritis of the knee, for example.The particular adaptive potential of thejoint surfaces is found at the level ofthe disc, in which the histologicalstructure of the dense zone ap-proaches that of the perichondrium.This especially explains why, wheninitially reducible disc dislocation be-comes non-reducible and once thepainful phase has past, one observesa regression in the symptoms and thebeginnings of functional recovery ifadapted kinesiotherapy is set up. Inthis situation, the richly innervated andvascularized bilaminar zone that isresponsible for pain when it is inter-posed between the condyle and thetemporal is progressively transformedto a pseudodisc, allowing for normaljoint range of movement. It is thesame in osteoarthritic lesions, wherethe joint function is not greatly dis-turbed apart from painful phases ofinflammatory episodes.

Anatomo-clinical dissociation

The second essential characteristicof the ADAMs, related to the preced-ing, is a strong dissociation betweenstructural damage, as can be demon-strated by imaging, for example, andsigns and symptoms. Thus, in con-junction with osteoarthritis, a slightstructural attack in the inflammatoryphase can cause significant functionalharm accompanied with pain, whilesignificant damage can be a fortuitousdiscovery of imaging in a patientpresenting, upon auscultation, onlyjoint crepitation (sound of wet sand)as a single sign. This anatomo-clinical

dissociation is found in the context ofdisc displacements, with the MRIexaminations showing a significantprevalence of non-reducible displace-ments in asymptomatic subjects.

Etiopathogeny of the ADAMs

The adaptive potential and theanatomo-clinical dissociation that wehave just discussed pose the questionof the etiopathogeny of the ADAMs.Indeed, what factors lead to exceed-ing the adaptability threshold to tip thescales into a pathological context?Concerning disc displacements, inaddition to the specific anatomic pre-dispositions, such as hyperlaxity, ex-plaining the frequent appearance ofthese disorders in young girls oforthodontic age, teeth clenching is anessential etiopathogenic factor. Infact, while the disc is designed to be"chewed" during meals, it must beable "to recover" apart from meals,especially by finding a sufficient hydricload. In fact, the dense part of the discis neither vascularized nor innervated,and owes its tissue nutrition toabsorption of synovial fluid. Prolongedtooth clenching prevents this phenom-enon, and increases the friction forcespresent at the cartilage/disc interfacesthat may in the end lead to stretchingof the disc attachments29.

Concerning myofascial pain, thereare psychosocial factors which consti-tute an essential etiological factor. Wewill not linger on this point here, sincethese pathologies most often requiremultidisciplinary management, caus-ing a psychologist or psychiatrist tointervene.



CONCLUSION

The TMJ has a complex anatomy inwhich the obvious weakness of thelateral joint zone is an integral part ofits biomechanical specifications. Therelated integration of the specificitiesof this joint and of the ADAMs leads tothe elaboration of a noninvasive ther-apeutic outline, including:

patient education and information20,management of the pain with medica-tion, re-establishment of orthopedic

stability of the joint (obtained first byocclusal appliances), and the settingup of adapted physical therapy oncethe acute phase has resolved. Thishandling obviously constitutes theoutcome of a rigorous diagnosticapproach, which should be re-evalu-ated in the event of lack of improve-ment in, or worsening of, signs andsymptoms.

REFERENCE

1. Alomar X, Medrano J, Cabratosa J, Clavero JA, Lorente M, Serra I, Monill JM, SalvadorA. Anatomy of the temporomandibular joint. Semin Ultrasound CT MR 2007;28(3):170-83.

2. Bade H, Schenck C, Koebke J. The function of discomuscular relationships in thehuman temporomandibular joint. Acta Anat (Basel) 1994;151(4):258-67.

3. Ben Amor F, Carpentier P, Foucart JM, Meunier A. Anatomic and mechanical propertiesof the lateral disc attachment of the temporomandibular joint. J Oral Maxillofac Surg1998;56(10):1164-7 (discussion:1168-9).

4. Bhutada MK, Phanachet I, Whittle T, Peck CC, Murray GM. Regional properties of thesuperior head of human lateral pterygoid muscle. Eur J Oral Sci 2008;116(6):518-24.

5. Christo JE, Bennett S, Wilkinson TM, Townsend GC. Discal attachments of the humantemporomandibular joint. Aust Dent J 2005;50(3):152-60.

6. Donzelli PS, Gallo LM, Spilker RL, Palla S. Biphasic finite element simulation of the TMJdisc from in vivo kinematic and geometric measurements. J Biomech2004;37(11):1787-91.

7. El Haddioui A, Laison F, Zouaoui A, Bravetti P, Gaudy JF. Functional anatomy of thehuman lateral pterygoid muscle. Surg Radiol Anat 2005;27(4):271-86.

8. Gallo LM, Airoldi GB, Airoldi RL, Palla S. Description of mandibular finite helical axispathways in asymptomatic subjects. J Dent Res 1997;76(2):704-13.

9. Gallo LM. Modeling of temporomandibular joint function using MRI and jaw-trackingtechnologies-mechanics. Celles Tissues Organs 2005;180(1):54-68.

10. Gaudy JF, Zouaoui A, Bravetti P, Charrier JL, Guettaf A. Functional organization of thehuman masseter muscle. Surg Radiol Anat 2000;22(3-4):181-90.

11. Gola R, Chossegros C, Orthlieb JD. The discal system of the temporo-mandibularjunction. Rev Stomatol Chir Maxillofac1992;93(4):236-45.

12. Hylander WL. Functional anatomy and biomechanics of the masticatory apparatus inTemporomandibular disorders. Quintessence Publishing Co, Inc, 2006;3-34.

13. Korioth TW, Hannam AG. Mandibular forces during simulated tooth clenching. J OrofacPain 1994;8(2):178-89.

14. Luder HU, Bobst P. Wall architecture and disc attachment of the human tempor-omandibular joint. Schweiz Monatsschr Zahnmed 1991;101(5):557-70.

15. Mahan PE, Wilkinson TM, Gibbs CH, Mauderli A, Brannon LS. Superior and inferiorbellies of the lateral pterygoid muscle EMG activity at basic jaw positions. J ProsthetDent 1983;50(5):710-8.



16. Matsunaga K, Usui A, Yamaguchi K, Akita K. An anatomical study of the muscles thatattach to the articular disc of the temporomandibular joint. Clin Anat 2009;22(8):932-40.

17. McNamara JA Jr. The independent functions of the two heads of the lateral pterygoidmuscle. Am J Anat 1973;138(2):197-205.

18. Merida Velasco JR, Rodriguez Vazquez JF, Jimenez Collado J. The relationshipsbetween the temporomandibular joint disc and related masticatory muscles in humans.J Oral Maxillofac Surg 1993;51(4):390-5 (discussion:395-6).

19. Meyenberg K, Kubik S, Palla S. Relationships of the muscles of mastication to thearticular disc of the tem-poromandibular joint. Schweiz Monatsschr Zahnmed1986;96(6):815-34.

20. Minakuchi H, Kuboki T, Matsuka Y, Maekawa K, Yatani H, Yamashita A. Randomizedcontrolled evaluation of non-surgical treatments for temporomandibular joint anteriordisk displacement without reduction. J Dent Res 2001;80(3):924-8.

21. Murray GM, Phanachet I, Uchida S, Whittle T. The human lateral pterygoid muscle: areview of some experimental aspects and possible clinical relevance. Aust Dent J2004;49(1):2-8. Review.

22. Murray GM, Bhutada M, Peck CC, Phanachet I, Sae-Lee D, Whittle T. The human lateralpterygoid muscle.Arch Oral Biol 2007;52(4):377-80. Review.

23. Naidoo LC. The development of the temporomandibular joint: a review with regard tothe lateral pterygoid muscle. J Dent Assoc S Afr 1993;48(4):189-94.

24. Naidoo LC, Juniper RP. Morphometric analysis of the insertion of the upper head of thelateral pterygoid muscle. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83(4):441-6.

25. Ogutcen-Toller M, Juniper RP. The embryologic development of the human lateralpterygoid muscle and its relationships with the temporomandibular joint disc andMeckel’s cartilage. J Oral Maxillofac Surg 1993;51(7):772-8 (discussion:778-9).

26. Perry HT, Xu Y, Forbes DP. The embryology of the temporomandibular joint. Cranio1985; 3(2):125-32.

27. Scheffer P, Roucayrol AM, Boudon Briere de l’Isle R. Muscular insertions on thetemporo-mandibular disk. Physiologic implications. Rev Stomatol Chir Maxillofac1992;93(4):246-51.

28. Schmolke C. The relationship between the temporomandibular joint capsule, articulardisc and jaw muscles. J Anat 1994;184(2):335-45.

29. Tanaka E, Kawai N, Tanaka M, Todoh M, van Eijden T, Hanaoka K, Dalla-Bona DA,Takata T, Tanne K. The frictional coefficient of the temporomandibular joint and itsdependency on the magnitude and duration of joint loading. J Dent Res 2004;83(5):404-7.

30. Yung JP, Pajoni D, Carpentier P. Anatomie de l’ATM. en mouvement : le sens de laforme. Rev Orthop Dento Faciale 1987;21:531-46.



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