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The collection of conditions affecting the temporomandibular
joint (TMJ) and masticatory muscles, the so-called temporomandibular
disorders, can be classified according to the Research
Diagnostic Criteria for Temporomandibular Disorders. Of the 3
subgroups—muscle disorders (Group I); disc displacements
(Group II); and arthralgia, arthritis, and arthrosis (Group III)—
the muscle disorders are most frequently seen in community samples;
Group II and Group III diagnoses are less prevalent. This
may explain the relative scarcity of studies involving intracapsular
TMJ disorders. In this review, new insights into the functional
anatomy, imaging, and pathology of disorders of the TMJ are presented.
Studies of TMJ dynamics may provide insight into the
functional anatomy of the TMJ and thereby into the consequences
of Group II and Group III disorders. The clinical use of imaging
modalities such as computed tomography and magnetic resonance
imaging for the TMJ and related structures remains controversial.
Nevertheless, imaging is regularly used in the diagnosis of some
Group II and Group III disorders. Magnetic resonance imaging
may be of use not only for the visualization of disc displacements
but also for the study of bone mineral density of the condyle.
Cytokines such as interleukin-1 (IL-1) and tumor necrosis factor
alpha (TNF ) play an important role in TMJ pathology. For
example, IL-1 , which has been associated with TMJ pain, hyperalgesia,
and anterior bite opening, is mostly absent in the synovial
fluid of healthy joints. Since both IL-1 and TNF are involved in
the development of chronic pain and joint destruction, they may
be the targets for specific treatments. While the advances reviewed
in this paper are significant, multidisciplinary efforts and formation
of international research collaborations will be necessary to
continue advancement in the understanding of TMJ pathology and
diagnosis. J OROFAC PAIN 2004;18:181–191
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