Asimetrija mandibule u pacijenata s unilateralnim pomakom diska temporomandibularnoga zgloba potvrđenog magnetskom rezonancijom

Objectives: The study aimed to determine the relationship between the mandibular asymmetry index according to Kjellberg between patients with painful unilateral anterior disc displacement (DD) and asymptomatic volunteers without disc displacement. Vertical measurements were performed on a panoramic single-image radiograph, and the disc status was confirmed by magnetic resonance imaging (MRI). Material and methods: Two groups of subjects were retrospectively selected, 40 patients (the overall mean age was 35.5 years; 75% female) with temporomandibular disorder symptoms confirmed by RDC/TMD axis I and manual functional analysis. Unilateral DD was determined by MRI. A comparative group of asymptomatic volunteers (20 dental students with a mean age of 23.4 years; 72% female) had the physiological position of the disc determined by MRI. The vertical asymmetry of the condyle was determined by the method of Kjellberg et al. The symmetry of the gonial angle of the mandible was also measured. Results: A comparison of the mean of the asymmetry index between patients (average 90.89±7.08%) and asymptomatic volunteers (mean 95.86±4.44%) showed a statistically significant difference (p=0.0029). There was no difference (p=0.088) in gonial angle symmetry between the patients (mean 96.48±2.96°) and the asymptomatic volunteers (mean 97.52±2.31°). The distribution of the presence of individual DD diagnoses (partial and total displacement with reduction, displacement without reduction) in patients diagnosed with asymmetry of the mandible was without statistical significance (p>0.05). Conclusion: This study actually points to the asymmetry of the mandible as a potential morphological risk of anterior DD.Svrha istraživanja: Cilj istraživanja bio je utvrditi povezanost indeksa asimetrije mandibule prema Kjellbergu između pacijenata s bolnim unilateralnim anteriornim pomakom diska i asimptomatskih dobrovoljaca bez pomaka diska. Vertikalna mjerenja obavljena su na ortopatomogramima, a status diska potvrđen je magnetskom rezonancijom. Materijal i metode: Retrospektivno su odabrane dvije skupine ispitanika od 40 pacijenata (prosječna dob 35,5 godina; 75 % ženskoga spola) sa simptomima temporomandibularnog poremećaja potvrđenima RDC/TMD-om os I i manualnom funkcijskom analizom. Unilateralni pomak diska ustanovljen je magnetskom rezonancijom. Usporednoj skupini asimptomatskih dobrovoljaca (20 studenata stomatologije prosječne dobi 23,4 godine; 72 % ženskoga spola) utvrđen je fiziološki položaj diska magnetskom rezonancijom. Vertikalna asimetrija kondila određena je metodom prema Kjellbergu i suradnicima. Mjerena je i simetrija gonijalnog kuta mandibule. Rezultati: Usporedba prosjeka indeksa asimetrije između pacijenata (prosjek 90,89 ± 7,08 %) i asimptomatskih dobrovoljaca (prosjek 95,86 ± 4,44 %) pokazala je statistički značajnu razliku (p = 0,0029). Nije bilo razlike (p = 0,088) u simetriji gonijalnog kuta između pacijenata (prosječno 96,48 ± 2,96°) i asimptomatskih dobrovoljaca (prosječno 97,52 ± 2,31°). Bez statističke značajnosti (p > 0,05) bila je distribucija prisutnosti pojedinih dijagnoza pomaka diska (djelomični i potpuni pomak s redukcijom, pomak bez redukcije) kod pacijenata kojima je utvrđena asimetrije mandibule. Zaključak: Ova studija dopušta povezivati asimetriju manidbule kao potencijalni morfološki rizik za nastanak anteriornoga pomaka diska

The Asymmetry of the Mandible in Patients with Unilateral Temporomandibular Joint Disc Displacement Confirmed by Magnetic Resonance Imaging

Objectives: The study aimed to determine the relationship between the mandibular asymmetry index according to Kjellberg between patients with painful unilateral anterior disc displacement (DD) and asymptomatic volunteers without disc displacement. Vertical measurements were performed on a panoramic single-image radiograph, and the disc status was confirmed by magnetic resonance imaging (MRI). Material and methods: Two groups of subjects were retrospectively selected, 40 patients (the overall mean age was 35.5 years; 75% female) with temporomandibular disorder symptoms confirmed by RDC/TMD axis I and manual functional analysis. Unilateral DD was determined by MRI. A comparative group of asymptomatic volunteers (20 dental students with a mean age of 23.4 years; 72% female) had the physiological position of the disc determined by MRI. The vertical asymmetry of the condyle was determined by the method of Kjellberg et al. The symmetry of the gonial angle of the mandible was also measured. Results: A comparison of the mean of the asymmetry index between patients (average 90.89±7.08%) and asymptomatic volunteers (mean 95.86±4.44%) showed a statistically significant difference (p=0.0029). There was no difference (p=0.088) in gonial angle symmetry between the patients (mean 96.48±2.96°) and the asymptomatic volunteers (mean 97.52±2.31°). The distribution of the presence of individual DD diagnoses (partial and total displacement with reduction, displacement without reduction) in patients diagnosed with asymmetry of the mandible was without statistical significance (p>0.05). Conclusion: This study actually points to the asymmetry of the mandible as a potential morphological risk of anterior DD