J Korean Assoc Oral Maxillofac Surg.  2023 Jun;49(3):125-134. 10.5125/jkaoms.2023.49.3.125.

Comparative analysis of craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders: a cross-sectional study

• Pradhan A
• Bhattacharya P
• Singh S
• Chandna AK
• Gupta A
• Bhandari R

• KMID: 2544314
• DOI: http://doi.org/10.5125/jkaoms.2023.49.3.125

Abstract

Objectives
The aim of the study was to quantify and compare craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders (TMDs).
Materials and Methods
A total of 126 adult subjects were categorized into two groups (63 with a TMDs and 63 without a TMDs), based on detection of symptoms using the Temporomandibular Joint Disorder-Diagnostic Index (TMD-DI) questionnaire. Posteroanterior cephalograms of each subject were traced manually and 17 linear and angular measurements were analyzed. Craniofacial asymmetry was quantified by calculating the asymmetry index (AI) of bilateral parameters for both groups.
Results
Intra- and intergroup comparisons were analyzed using independent t-test and Mann–Whitney U test, respectively, with a P<0.05 considered statistically significant. An AI for each linear and angular bilateral parameter was calculated; higher asymmetry was found in TMD-positive patients compared with TMD-negative patients. An intergroup comparison of AIs found highly significant differences for the parameters of antegonial notch to horizontal plane distance, jugular point to horizontal plane distance, antegonial notch to menton distance, antegonial notch to vertical plane distance, condylion to vertical plane distance, and angle formed by vertical plane, O point and antegonial notch. Significant deviation of the menton distance from the facial midline was also evident.
Conclusion
Greater facial asymmetry was seen in the TMD-positive group compared with the TMD-negative group. The mandibular region was characterized by asymmetries of greater magnitude compared with the maxilla. Patients with facial asymmetry often require management of temporomandibular joint (TMJ) pathology to achieve a stable, functional, and esthetic result. Ignoring the TMJ during treatment or failing to provide proper management of the TMJ and performing only orthognathic surgery may result in worsening of TMJ-associated symptoms (jaw dysfunction and pain) and re-occurrence of asymmetry and malocclusion. Assessments of facial asymmetry should take into account TMJ disorders to improve diagnostic accuracy and treatment outcomes.

Keyword

Facial asymmetry; Orthognathic surgery; Posteroanterior cephalogram; Temporomandibular joint disorders; Asymmetry index

Figure

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  Fig. 1 Reference planes. Refer to Table 1 for the definition of landmarks. (HP: horizontal reference plane, VP: vertical reference plane, O: O point)

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  Fig. 2 Unilateral midline linear parameters. Refer to Table 1 for the definition of landmarks. (ANS-VP: anterior nasal spine to vertical plane, Me-VP: menton to vertical plane)

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  Fig. 3 Bilateral linear parameters. Refer to Table 1 for the definition of landmarks. (Co-VP: condylar superioris to vertical plane distance, ZA-VP: zygomatic arch to vertical plane distance, J-VP: jugulare to vertical plane distance, Ag-VP: antegonial notch to vertical plane distance, Ag-Me: antegonial notch to menton distance, ZA-VP’: zygomatic arch to vertical plane distance, Co-VP’: condylar superioris to vertical plane distance, J-VP’: jugulare to vertical plane distance, Ag-VP’: antegonial notch to vertical plane distance, Ag-Me’: antegonial notch to menton distance, Co-HP: condylion to horizontal plane distance, J-HP: jugulare to horizontal plane distance, Co-Ag: condylion to antegonial distance, Ag-HP: antegonial to horizontal plane distance, Co-Me: condylion to menton distance, Co-HP’: condylion to horizontal plane distance, J-HP’: jugulare to horizontal plane distance, Co-Ag’: condylion to antegonial distance, Ag-HP’: antegonial to horizontal plane distance, Co-Me’: condylion to menton distance)

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  Fig. 4 Bilateral angular parameters. Refer to Table 1 for the definition of landmarks. (VP-O-J: angle between vertical plane and O-J line, Co-Ag-Me: angle between Co-Ag line and Ag-Me line, Z-Ag-ZA: angle between Z-Ag line and Ag-ZA line, VP-O-J’: angle between vertical plane and O-J line, Co-Ag-Me’: angle between Co-Ag line and Ag-Me line, Z-Ag-ZA’: angle between Z-Ag line and Ag-ZA line, VP-O-Ag: angle between vertical plane and O-Ag line, Co-Go-Me: angle between Co-Go line and Go-Me line, VP-O-Ag’: angle between vertical plane and O-Ag line, Co-Go-Me’: angle between Co-Go line and Go-Me line)

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  Fig. 5 Comparison of asymmetry indices between the temporomandibular joint disorder (TMD)-positive and TMD-negative groups. Refer to Fig. 3 and 4 for the definition of linear and angular parameters.

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