Mandibular asymmetry: a three-dimensional quantification of bilateral condyles

Head & Face Medicine

Youhua Zheng¹  Yue Xu¹  Xin Shu¹  Shuangquan Wan¹  Yi Lin¹  Ping Zhu¹  Han Lin¹ 

[1] Department of Orthodontics, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Lingyuan Xilu No.56, Guangzhou 510055, China

关键词: Computed tomography;    Curvature analysis;    Condylar morphology;    Mandibular asymmetry;    Temporomandibular joint;   

Others  :  813570
DOI  :  10.1186/1746-160X-9-42

 received in 2013-08-14, accepted in 2013-12-17,  发布年份 2013

【 摘 要 】

Introduction

The shape and volume of the condyle is considered to play an important role in the pathogenesis of the mandibular deviation. Curvature analysis is informative for objectively assess whether the shape of the condyles matches that of the glenoid fossa. In this study, a three-dimensional (3-D) quantification of bilateral asymmetrical condyles was firstly conducted to identify the specific role of 3-D condylar configuration for mandibular asymmetry.

Methods

55 adult patients, 26 males (26 ± 5 yrs) and 29 females (26 ± 5 yrs), diagnosed with mandibular asymmetry were included. The examination of deviation of chin point, deviation of dental midlines, inclination of occlusal plane, and depth of the mandibular occlusal plane were conducted. After the clinical investigation, computed tomography images from the patients were used to reconstruct the 3-D mandibular models. Then the condylar volume, surface size, surface curvature and bone mineral density were evaluated independently for each patient on non-deviated and deviated sides of temporomandibular joint.

Results

Both the condylar surface size and volume were significantly larger on deviated side (surface size: 1666.14 ± 318.3 mm², volume: 1981.5 ± 418.3 mm³). The anterior slope of the condyle was flatter (0.12 ± 0.06) and the posterior slope (0.39 ± 0.08) was prominently convex on the deviated side. The corresponding bone mineral density values were 523.01 ±118.1 HU and 549.07 ±120. 6 HU on anterior and posterior slopes.

Conclusions

The incongruence presented on the deviated side resulted in a reduction in contact areas and, thus, an increase in contact stresses and changes of bone density. All aforementioned results suggest that the difference existing between deviated and non-deviated condyles correlates with facial asymmetrical development. In mandibular asymmetry patients, the 3-D morphology of condyle on deviated side differ from the non-deviated side, which indicates the association between asymmetrical jaw function and joint remodeling.

【 授权许可】

   
2013 Lin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Zhou S, Yan J, Da H, Yang Y, Wang N, Wang W, Ding Y, Sun S: A correlational study of scoliosis and trunk balance in adult patients with mandibular deviation. PLoS One 2013, 8:e59929.
• [2]Yamada K, Hanada K, Sultana MH, Kohno S, Yamada Y: The relationship between frontal facial morphology and occlusal force in orthodontic patients with temporomandibular disorder. J Oral Rehabil 2000, 27:413-421.
• [3]Okeson JP: Management of Temporomandibular Disorders and Occlusion. 7th edition. USA: Mosby; 2013.
• [4]Zhao C, Kurita H, Kurashina K, Hosoya A, Arai Y, Nakamura H: Temporomandibular joint response to mandibular deviation in rabbits detected by 3D micro-CT imaging. Arch Oral Biol 2010, 55:929-937.
• [5]Derlin T, Busch JD, Habermann CR: 99mTc-MDP SPECT/CT for assessment of condylar hyperplasia. Clin Nucl Med 2013, 38:e48-e49.
• [6]Ueki K, Moroi A, Sotobori M, Ishihara Y, Marukawa K, Yoshizawa K, Kato K, Kawashiri S: Changes in temporomandibular joint and ramus after sagittal split ramus osteotomy in mandibular prognathism patients with and without asymmetry. J Craniomaxillofac Surg 2012, 40:821-827.
• [7]Ikenna Isiekwe G, Olatokunbo DaCosta O, Chukwudi Isiekwe M: A cephalometric investigation of horizontal lip position in adult Nigerians. J Orthod 2012, 39:160-169.
• [8]Saccucci M, Polimeni A, Festa F, Tecco S: Do skeletal cephalometric characteristics correlate with condylar volume, surface and shape? A 3D analysis. Head Face Med 2012, 8:15. BioMed Central Full Text
• [9]Türp JC, Alt KW, Vach W, Harbich K: Mandibular condyles and rami are asymmetric structures. Cranio 1998, 16:51-56.
• [10]You KH, Lee KJ, Lee SH, Baik HS: Three-dimensional computed tomography analysis of mandibular morphology in patients with facial asymmetryand mandibular prognathism. Am J Orthod Dentofacial Orthop 2010, 138(540):e1-e8.
• [11]Xu Y, Zhan JM, Zheng YH, Han Y, Zhang ZG, Xi C: Computational synovial dynamics of a normal temporomandibular joint during jaw opening. J Formos Med Assoc 2013, 112:346-351.
• [12]Xu Y, Zhan J, Zheng Y, Han Y, Zhang Z, Xi Y, Zhu P: Synovial fluid dynamics with small disc perforation in temporomandibular joint. J Oral Rehabil 2012, 39:719-726.
• [13]Papachristou DJ, Papachroni KK, Papavassiliou GA, Pirttiniemi P, Gorgoulis VG, Piperi C, Basdra EK: Functional alterations in mechanical loading of condylar cartilage induces changes in the bony subcondylar region. Arch Oral Biol 2009, 54:1035-1045.
• [14]Adachi N, Matsumoto S, Tokuhisa M, Kobayashi K, Yamada T: Antibodies against mycobacterial antigens in the synovial fluid of patients with temporomandibular disorders. J Dent Res 2000, 79:1752-1757.
• [15]Herb K, Cho S, Stiles MA: Temporomandibular joint pain and dysfunction. Curr Pain Head-ache Rep 2006, 10:408-414.
• [16]Vig PS, Hewitt AB: Asymmetry of the human facial skeleton. Angle Orthod 1975, 45:125-129.
• [17]Habets LL, Bezuur JN, Naeiji M, Hansson TL: The orthopantomogram, an aid in diagnosis of temporomandibular joint problems. II. The vertical symmetry. J Oral Rehabil 1988, 15:465-471.
• [18]Tecco S, Saccucci M, Nucera R, Polimeni A, Pagnoni M, Cordasco G, Festa F, Iannetti G: Condylar volume and surface in Caucasian young adult subjects. BMC Med Imagingm 2010, 10:28. BioMed Central Full Text
• [19]Anburajan M, Rethinasabapathi C, Korath MP, Ponnappa BG, Panicker TMR, Govindan A, Prasad GNS, Evans WD, Jagadeesan K: Low cost mass screening tool for evaluating post-menopausal osteoporosis: A breakthrough for the developing world. Bombay Hosp J 2001, 43:253-260.
• [20]Kawakami M, Yamada K, Inoue M, Kawakami T, Fujimoto M, Kirita T: Morphological differences in the temporomandibular joints in asymmetrical prognathism patients. Orthod Craniofacial Res 2006, 9:71-76.
• [21]Enami K, Yamada K, Kageyama T, Taguchi A: Morphological changes in the temporomandibular joint before and after sagittal splitting ramus osteotomy of the mandible for skeletal mandibular protrusion. Cranio 2013, 31:123-132.
• [22]Scolozzi P, Momjian A, Courvoisier DS, Kiliaridis S: Evaluation of condylar morphology following orthognathic surgery on digital panoramic radiographs. Could methodology influence the range of “normality” in condylar changes? Dentomaxillofac Radiol 2013, 42:20120463.
• [23]Lee BR, Kang DK, Son WS, Park SB, Kim SS, Kim YI, Lee KM: The relationship between condyle position, morphology and chin deviation in skeletal Class III patients with facial asymmetry using cone-beam CT. Korean J Orthod 2011, 41:87-97.
• [24]Verhoeven TJ, Nolte JW, Maal TJ, Bergé SJ, Becking AG: Unilateral condylar hyperplasia: a 3-dimensional quantification of asymmetry. PLoS One 2013, 8:e59391.
• [25]Habib H, Hatta T, Udagawa J, Zhang L, Yoshimura Y, Otani H: Fetal jaw movement affects condylar cartilage development. J Dent Res 2005, 84:474-479.
• [26]Kurita H, Ohtsuka A, Kobayashi H, Kurashina K: Alteration of the horizontal mandibular condyle size associated with temporomandibular joint internal derangement in adult females. Dentomaxillofac Radiol 2002, 31:373-378.
• [27]Kurita H, Koike T, Narikawa J, Nakatsuka A, Kobayashi H, Kurashina K: Relationship between alteration of horizontal size and bony morphological change in the mandibular condyle. Dentomaxillofac Radiol 2003, 32:355-358.
• [28]Ueda M, Yonetsu K, Ohki M, Yamada T, Kitamori H, Nakamura T: Curvature analysis of the mandibular condyle. Dentomaxillofac Radiol 2003, 32:87-92.
• [29]Hohe J, Ateshian G, Reiser M, Englmeier KH, Eckstein F: Surface size, curvature analysis, and assessment of knee joint incongruity with MRI in vivo. Magn Reson Med 2002, 47:554-561.
• [30]Matsumoto K, Kameoka S, Amemiya T, Yamada H, Araki M, Iwai K, Hashimoto K, Honda K: Discrepancy of coronal morphology between mandibular condyle and fossa is related to pathogenesis of anterior disk displacement of the temporomandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol 2013, 116:626-632.
• [31]Ueki K, Nakagawa K, Marukawa K, Takatsuka S, Yamamoto E: The relationship between temporomandibular joint disc morphology and stress angulation in skeletal Class III patients. Eur J Orthod 2005, 27:501-506.
• [32]Zhang J, Jiao K, Zhang M, Zhou T, Liu XD, Yu SB, Lu L, Jing L, Yang T, Zhang Y, Chen D, Wang MQ: Occlusal effects on longitudinal bone alterations of the temporomandibular joint. J Dent Res 2013, 92:253-259.
• [33]Kanavakis G, Mehta N: The role of occlusal curvatures and maxillary arch dimensions in patients with signs and symptoms of temporomandibular disorders. Angle Orthod