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A Narrative Review. Una Revisión Narrativa. Bryan Quidel 4. Evelyn Borie-Echevarría 5. Ramón Fuentes 1 3. The BZ is essential for keeping the AD in its superior position and for retracting the AD to posterior in the maximum aperture position. Its composition and the disposition of its components is unclear. What foods to eat to prevent alzheimers object of composition of blood flow chart narrative review is to update concepts on the anatomy of the BZ, with its variations, histological components, vascularization and innervation.
Only studies in human beings without alterations to the TMJ, using dissection in cadavers or radiography in live subjects, were included. Systematic reviews, letters to the editor, technical articles and experimental or quasi-experimental studies in animals were excluded. This review included a total of 24 articles which corresponded to the proposed research object. Our results describe the morphology of the BZ, its anatomical relations and possible composition of blood flow chart, its histological components, types of fibre love is blind show quotes distribution percentages; the latter are discussed in the literature, but no consensus exists.
This is not the case for the vascularization and innervation of the BZ; all authors analyzed agree on these points, with just one author adding two possible arteries that may play a part in irrigation. Furthermore, a large number of authors recognize the discomalleolar ligament and its close relation with the BZ.
Esta revisión incluyó un total de 24 artículos que correspondían al objeto de investigación propuesto. Este no es el caso de la vascularización e inervación del BZ; todos los autores analizados coinciden en estos aspectos, y solo un autor agrega dos posibles composition of blood flow chart que pueden tener un papel en la irrigación. The TMJ is considered one of the most complex structures of the organism Grau et al. The composition, morphology and anatomical terminology of its structures have been described and discussed in the literature Fuentes et al.
Of these structures, the AD has received great attention due to its anatomical relations with neighbouring structures and its importance in the correct functioning of the TMJ Eder et al. In sagittal section, it is divided into four zones: the anterior zone, the middle or working zone, the posterior zone and the BZ Matamala et al. The BZ is located within the posterior margin of the AD and faces the posterior wall of the mandibular fossa and the neck of the mandibular condyle MC ; it may even fuse with the joint capsule Fuentes et al.
Irrigation is provided by the anterior branches of the posterior auricular artery Mérida-Velasco et al. The sensitive innervation is provided by the auriculotemporal nerve, which extends through the posterior region of the TMJ Fuentes et al. With respect to the functions of the BZ, the inferior portion is essential for holding the AD in its superior position; it is also evolutionary mismatch in humans examples only structure able to retract the AD to posterior on the MC to produce the highest levels of retractive force in the maximum aperture position Leonardi et al.
It has been reported that the principal inflammatory and degenerative changes in the TMJ occur mainly in the insertion zone posterior of the AD Paegle et al. Despite the many attempts to describe the biomechanics and morphological disposition of the components of the BZ, this structure is still little understood, and regional physiological variations in its traction properties and fibre organization have not been determined Coombs et al. The search was carried out during the months of May and June by two independent reviewers.
No date limits were set for the search; articles in English, Spanish and Portuguese were included. The reviewers made the first selection of articles based on reading of the titles and abstracts. Full text analysis was decided following the eligibility criteria established, selecting potentially relevant studies. All disagreements between the two reviewers on the relevance and inclusion of the studies were discussed until consensus was reached; persistent disagreements were resolved in the same way with a third reviewer.
Eligibility criteria. Studies were included which contribute to description of the innervation, vascularization, and anatomical and histological characteristics of the BZ of the TMJ, and articles that describe possible anatomical variations of the BZ. Only studies in humans composition of blood flow chart alterations to the TMJ, using dissection in cadavers or radiography in live subjects, were included.
The searches in the different databases identified a total of articles. After elimination of duplicates, potentially eligible articles remained; the titles and abstracts were read and those articles which were irrelevant for the study object were eliminated. By this process articles were selected for full text reading and selection according to all our eligibility criteria. Eighty-two articles were excluded, leaving a total of 22; to these were added 2 articles identified from other sources, giving a total sample of 24 articles as shown in the flow chart Fig.
Participants: All the articles selected were studies carried out in cadavers; only one included computerized tomography images of live subjects. The analysis methods were dissection, optical microscopy, polarised light microscopy, sweep electron microscopy and digital imaging. Of the 24 articles describing the BZ in cadavers, 20 were of adults, two of foetuses aged between 3.
Fifteen studies assessed the BZ in both sexes, two studies only in men, one only in women and six studies did not report the sex. Principal results of the studies: In line with our object, we were able to identify studies describing the anatomy of the BZ, its histological components, irrigation and innervation, and variations in its anatomical relations. Anatomy what is negative correlation in math the bilaminar zone.
Other authors, in contrast, state that this zone is not organised into a superior and an inferior lamina, and that the name BZ is incorrect, since histologically the fibers of the superficial layer of the retrodiscal area are arranged principally from medial to lateral Kino et al. Table I Anatomical extensions of the BZ.
The medial portion of the BZ consists of abundant elastic fibers originating in the petrotympanic fissure. Anastasi et al. Its insertion has been described in the posteromedial region of the joint capsule and the retrodiscal zone Loughner et al. In histological terms, it is formed of collagen fibers, mainly type I collagen surrounded by a few type lll fibers, and accompanied by abundant elastic fibers in anteroposterior disposition with small zones of adipose tissue Mérida-Velasco et al.
However, various studies have identified this structure as part of the BZ Schmolke, ; Mérida Velasco et al. Siéssere et al. Histology of the bilaminar zone: Most of the studies that analyse the histological composition of the BZ do so by its parts: superior lamina, inferior lamina or intermediate zone Table II. From the fourth month of gestation, small elastic and collagen fibers can be identified in the BZ, which increase in number and thickness over time Yang et al.
The inferior lamina, on the other hand, consists of a structure of fibrous layers which forms a network composition of blood flow chart dense fibers aligned from anterior to posterior Yang et al. In adults, the BZ generally consists of loose connective tissue characterised by the presence of a network of collagen fibers and abundant elastic fibers covered by a synovial layer Paegle et al.
Over the whole area are type I collagen fibers accompanied by fine bands of type III collagen fibers; this type I collagen also forms part of the walls of the composition of blood flow chart vessels. Parallel to the collagen fibers, elastic fibers can be identified forming composition of blood flow chart thin layer around the walls of the vascular spaces Benigno et al.
All these characteristics of the BZ allow the remarkable range of movement of the AD which prevents dislocation during mandibular aperture Siéssere et al. Type A and B synovial cells can be identified in the synovial layer covering what is the theoretical and experimental probability BZ; they cover the retrodiscal tissue which extends to include the extra tympanic portion of the discomalleolar ligament as far as the posterior zone of the AD Helmy et al.
The BZ is made up of fibroblast cells Helmy et al. Kurita et al. However, in two studies the presence of chondrocyte cells in healthy subjects was discarded Kurita et al. Helmy et al. Irrigation of the bilaminar zone. All the authors reviewed agree that the BZ is irrigated by branches of the anterior portion of the anterior tympanic artery, which courses through the connective tissue of the whole BZ via the intermediate zone Mérida Velasco et al.
However, a study by Siésser et al. The arteries and arterioles of the BZ consist of extremely thick walls containing up to four layers of muscle in the tunica media. The vein walls on the other hand are thin, and the endothelial vascular sinuses are set in a matrix of loose connective and adipose tissues Wish-Baratz et al. Innervation of the BZ. The BZ is innervated by one to three collateral and terminal branches of the auriculotemporal nerve which enter through the postero-external face of the TMJ Mérida Velasco et al.
Anatomical variations and relations. Among the many studies included, Shiraishi et al. In their dissection of 14 Japanese cadavers 13 women and 1 mancomposition of blood flow chart identified a fibrous structure attached to the posterior and lateral region of the BZ connected to structures like the fascia of the Masseter muscle in the angle of the jaw, the capsule of the parotid gland, the lateral ligament and the periost of the ramus of the mandible, accompanied by a vein approximately 1 mm in diameter which originates in the venous plexus of the BZ and then extends branches to the retromandibular, transverse facial and superficial temporal veins.
They called these structures the reticular ligament and reticular vein. However, Kino et al. Study of the BZ began in the s, one of the first authors to describe it being Rees Rees reported that the AD was divided into four zones, the last of which, the BZ, was composed of a superior and an inferior lamina. The PS-JC was identified as an independent structure. In our results, we found four studies that supported the idea of the PS-JC as part of the bilaminar zone Schmolke; Mérida Velasco et al.
Considering the technological progress of recent decades, and the first four studies are more up-to-date, our investigation supports the idea of considering the PS-JC as part of the BZ. However, more investigation is needed in this area as there are few modern studies reporting its exact morphology. However, Shiraishi et al. Considering the findings of the present study, what is morning prayer suggest that the composition of this area is in fact laminar, as indicated traditionally in the literature.
The fibers of which the BZ is composed have only been described composition of blood flow chart general terms, for example noting the presence of abundant elastic fibers Oyanguren et al. There are few studies in humans intended to provide a quantitative description of the BZ. The only such studies found in this review were Clément et al. More studies are needed in this area to unify the knowledge of professionals, investigators and students.
Descriptions of the vascularization and innervation of the BZ in the literature are consistent. Moreover, many authors recognize the discomalleolar ligament and its close relation with the BZ Kino et al. The discomalleolar ligament could therefore be considered part of the BZ and be described among the structures making up this area. The BZ is of great interest to science, however the literature is still not conclusive in some areas, such as its composition.
Further research is required to complement existing knowledge, using reliable methods of analysis like optical, polarized light or sweep electron microscopy, to obtain an accurate quantitative assessment of the number and type of fibers that make up this zone. Anastasi, M. The discomallear ligament: anatomical, microscopical, and radiologic analysis. Arai, H. Anatomical study of the human discomallear ligament using cone beam computed tomography imaging and morphological observations.
Okajimas Folia Anat. Ballesteros, L.

