Relationship between sex, age, and the minimum thickness of the roof of the glenoid fossa in normal temporomandibular joints

Superior Dislocation of the Mandibular Condyle into the Middle Cranial Fossa: A Comprehensive Review of the Literature

The superior dislocation of the condyle into the cranium occasionally requires invasive procedures due to the absence of a timely diagnosis. This review analyzed the available clinical data to provide information on treatment decisions. The reports were assessed using electronic medical databases from inception to 31 October 2022. A total of 116 cases from 104 studies were assessed; among the patients, 60% and 87.5% of the affected women and men required open reduction, respectively. The ratio of closed to open procedures within 7 days after injury was maintained; however, closed reduction decreased over time, and all cases required open reduction after 22 days. Eighty percent of the patients with a total intrusion of the condyle required open reduction, whereas the frequency for both procedures was comparable in the remaining patients. Open reduction was significantly more frequently performed for men (p = 0.026, odds ratio; 4.959, 95% confidence interval; 1.208-20.365) and less frequently performed in cases with partial intrusion (p = 0.011; odds ratio: 0.186; 95% confidence interval: 0.051-0.684); the frequency varied according to the time until treatment (p = 0.027, odds ratio; 1.124, 95% confidence interval; 1.013-1.246). Appropriate diagnostic imaging and prompt diagnosis are indispensable for minimally invasive treatment of this condition.

Morphometric evaluation of the temporomandibular joint on cone-beam computed tomography

INTRODUCTION

Evaluation of the temporomandibular joint (TMJ) pathologies with cone-beam computed tomography (CBCT) provides essential information about the bone structures of the TMJ. It is important to know the normal reference range when defining these pathologies. The aim of this study is to examine the morphometric and morphologic analyses of the bone structures of TMJ on the CBCT images in detail according to age, gender, and joint side.

MATERIAL AND METHODS

A total of 35 parameters related to the condylar process, articular tubercle, mandibular fossa, ramus of mandible, and joint space were examined on the CBCT images. These parameters were compared with the joint sides and gender, and correlated with age.

RESULTS

Thirty-five parameters were evaluated. A statistically significant difference was found between genders in 22 parameters and joint sides in 6 parameters. When the correlation of parameters with age was examined; it was found that there was a very weak positive relationship in nine parameters, a weak positive relationship in one parameter, and a very weak relationship in the negative direction in two parameters.

CONCLUSION

In this study, the condylar process, articular tubercle, mandibular fossa, ramus of mandible, and joint spaces, which are usually examined separately in the literature, were examined, and the normal reference range was determined for all these parameters. We think that these normal reference ranges will be useful for researchers interested in TMJ pathologies.

Volumetric and morphological analysis of condyle and glenoid fossa on computed tomography

AIM

The aim of this study was to evaluate temporomandibular joint (TMJ) condyle and glenoid fossa morphology with measurements on Computed Tomography (CT) and volumetric analysis using InVesalius software program.

MATERIALS AND METHODS

250 condyles in 125 patients (mean age: 40.64) was evaluated on CT. Length, width, and height of the condyle, condylar volume, the thickness of glenoid fossa (TGF), condyle surface area, anterior space (AS), superior space (SS), and posterior space (PS) were measured in this study. Two left and right sides of the jaw have been measured. Linear measurements were performed with the image analysis program (Image J, 1.4 v version, National Institutes of Health, Bethesda, MD). Volume and surface area measurements were performed with InVesalius software (CTI, Campinas, SãoPaulo, Brazil).

RESULTS

To compare the dimensions of the condyle between males and females, there was only a significant difference in left AS and SS and no significant difference was found between males and females in other measured factors. There was a significant difference between the age groups and left SS. A significant difference was also found between the age groups and condylar height, condyle surface area, and condylar volume on both right and left sides.

CONCLUSION

Evaluation of condylar morphology is important to assess the TMJ anomalies and bony changes. This study showed no significant differences between gender and all measured factors except in the left AS and SS. However, age factor had a major effect on the morphology.

Imaginology Tridimensional Study of Temporomandibular Joint Osseous Components According to Sagittal Skeletal Relationship, Sex, and Age

OBJECTIVE

To assess the temporomandibular joint (TMJ) osseous components morphology and the condyle position in patients with different sagittal skeletal relationships, sex, and age, using cone-beam computed tomography (CBCT).

METHODS

The CBCT images of 180 asymptomatic patients (60 class I, 60 class II, and 60 class III) were assessed retrospectively. Groups were also divided according to age (<40 years, n = 90; ≥40 years, n = 90) and sex (male, n = 90; female, n = 90). Right- and left-sided TMJ spaces, articular eminence inclination (AEI) and height (AEH), thickness of the roof of the glenoid fossa (TRGF) and the anteroposterior position of the condyle in glenoid fossa were evaluated. Differences were tested using the analysis of variance, Tukey and t-tests (P < 0.05).

RESULTS

For condylar position, no differences were found between sex and age groups, but spatial differences existed among skeletal classes. Significant differences were found between the right and left angular position in patients with malocclusion. Class II individuals presented lower anterior articular spaces. The condyle-glenoid fossa relationship presented a moderate correlation of bilaterality. The AEI and AEH were significant lower in class III individuals and class I patients presented the lowest values for TRGF. The values of AEH, TRGF and of all joint spaces of males were higher. In individuals over the age of 40 years, the AEI and AEH measurements were significant greater.

CONCLUSION

Sagittal skeletal relationships have a significant effect on condyle position, AEI, and AEH. The eminence inclination and height and TRGF are influenced by sex and age.

Interaction effect of tegmen tympani and superior semicircular canal statuses on the thickness of the roof of the glenoid fossa: a cross-sectional descriptive study

PURPOSE

Homogeneous development of temporal bone structures is explained by their ontogenic origin; tegmen tympani (TT) and superior semicircular canal (SSC) are related with the glenoid fossa at the temporomandibular joint (TMJ). Therefore, our objective was to determine a possible relationship between TT status (dehiscence or integrity) and the roof of the glenoid fossa (RGF) thickness; SSC status has also been considered.

METHODS

This cross-sectional descriptive study was conducted in two tertiary hospitals on 95 patients (109 ears) presenting hypoacusia, facial palsy, vertigo, tinnitus, and other single or combined symptoms, and submitted to a thin-section multidetector-row computed axial tomography (CT) scan.

RESULTS

A significant interaction effect of TT × SSC statuses on RGF thickness was found (p = 0.049). A significant difference in RGF thickness was found only for SSC integrity status between TT integrity and TT dehiscence (p = 0.004). The TT dehiscence increased the risk for RGF dehiscence 12.047 times (p = 0.002).

CONCLUSIONS

There is an interaction effect of the statuses of both TT and SSC on the thickness of the RGF, instead of an independent effect of the TT status. When RGF dehiscence is found, TT and SSC statuses should be assessed, to discard associated dehiscences.

Comparison between Glenoid Fossa Roof Thickness in TMD and non-TMD Patients, a CBCT Study

Statement of the Problem

Various pathologic conditions can affect the thickness of the roof of glenoid fossa (RGF). The relationship between the RGF thickness and temporomandibular joint disorder (TMD) is not explicitly investigated. Considering the changes in RGF thickness, as a radiographic sign for TMD diagnosis, the phenomenon may necessitate specific treatment and may influence the treatment course and results.

Purpose

This research was designed to examine the relationship between TMD and RGF thickness changes compared to non-TMD group.

Materials and Method

In this cross sectional analytic research CBCT images of 70 TMD patients (140 joints) and 70 non-TMD individuals (140 joints) as control group were evaluated for thickness of RGF and presence of discontinuity in RGF. The distance between superior and inferior cortex of glenoid fossa was measured as RGF thickness. Inability to follow the course of cortex in any given image was considered as discontinuity. T-test, Chi-square and odds ratio (OR) were used for statistical analysis. In this study, p< 0.05 was considered meaningful.

Results

The mean thickness of RGF in our non-TMD samples was 1.12 mm. RGF thickness was significantly increased in TMD patients compared non-TMD group (p= 0.00). This value was also greater in males. On the other hand, TMD patient showed a higher incidence of discontinuity in RGF, in comparison with non-TMD patients (p= 0.006).

Conclusion

The increased thickness of RGF can be considered as a sign of TMD, which may help in diagnosis of TMD. It seems that there is a direct relationship between TMD and discontinuity of RGF.

Morphometric analysis for evaluating the relation between incisal guidance angle, occlusal plane angle, and functional temporomandibular joint shape variation

OBJECTIVE

The correlations between morphology of the temporomandibular joint structure, the anterior guidance angle, and occlusal plane were investigated.

MATERIALS AND METHODS

A cone beam computed tomography analysis was performed in 158 patients (86 women and 72 men). 3D software was employed to obtain the coordinates of the shape of the incisal guidance angle, occlusal guidance angle, articular fossa, and mandibular condyle. Generalized Procrustes analysis including principal components analysis (PCA) were performed and produced principal components (PCs) scores of each shape and their centroid size (CS).

RESULTS

A significant Pearson correlation coefficient of 0.3451 (p < .001) was observed between the incisal guidance angle and occlusal plane. The CS also showed a correlation with the incisal guidance angle, but not with the occlusal plane angle. The PCA results revealed that there were no significant correlations between the temporomandibular joint structure (TMJ) shape (fossa and condyle) and the incisal guidance angle.

CONCLUSIONS

Incisor guidance angle and occlusal plane angle were correlated. In addition, there was a correlation between CS and incisal guidance angle. In the PCA, It can be concluded that the size is more related to the incisor guidance angle than the morphological factors of the constituent components of the TMJ.

Radiologic correlation between the thickness of the roof of the glenoid fossa and that of the bony covering of the superior semicircular canal

OBJECTIVES

Dehiscence of the superior semicircular canal (SSC) has been associated with alteration of the temporomandibular joint, although data explaining this association are lacking. The present study examined the correlations between the presence of dehiscences and thickness of the bone covering the SSC and the roof of the glenoid fossa (RGF).

STUDY DESIGN

Computed tomography was used in a cross-sectional analysis of the presence of dehiscences and thickness of the bone overlying the SCC and RGF in 156 temporal bones of 78 patients. The correlations of the presence of dehiscences in the SSC and ipsilateral RGF and the thickness of bone covering the SSC and RGF were analyzed by using the χ² or Fisher's exact test. The relationship between the thickness of the bone overlying the SCC and RGF was analyzed by using the Spearman correlation coefficient and the Kruskal-Wallis test. The relationship between the thickness of the RGF and the covering of the SCC and patient age and gender was analyzed with the general linear model.

RESULTS

Significant correlations were found between the presence of dehiscences and thickness of the bone overlying the SSC and RGF (P < .001).

CONCLUSIONS

There is a morphologic relationship between the structure of the SSC and RGF.

Dislocation of a mandibular condyle in the middle cranial fossa, diagnosed 54 years after trauma

Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma. We report the remarkable case of a 63-year-old patient in whom trauma 54 years prior to consultation resulted in intrusion of the right mandibular condyle into the middle cranial fossa. The diagnosis was missed because of insufficient data provided by conventional radiographies. Failure of timely diagnosis and lack of appropriate treatment resulted in temporomandibular joint ankylosis with functional impairment, disturbance of mandibular growth and dentofacial asymmetry. We emphasize the need for careful radiological investigation in case of a suspected condylar fracture or dislocation, especially when the mechanism of injury is likely to facilitate condylar intrusion. The use of CT and MR-imaging is therefore advocated.

Assessment of condyle and glenoid fossa morphology using CBCT in South-East Asians

Introduction

Proper imaging allows practitioners to evaluate an asymptomatic tempormandibular joint (TMJ) for potential degenerative changes prior to surgical and orthodontic treatment. The recently developed cone-beam computed tomography (CBCT) allows measurement of TMJ bony structures with high accuracy. A study was undertaken to determine the morphology, and its variations, of the mandibular condyle and glenoid fossa among Malay and Chinese Malaysians.

Methods

CBCT was used to assess 200 joints in 100 subjects (mean age, 30.5 years). i-CAT CBCT software and The Mimics 16.0 software were employed to measure the volume, metrical size, position of each condyle sample and the thickness of the roof of the glenoid fossa (RGF).

Results

No significant gender differences were noted in thickness of the RGF and condylar length; however condylar volume, width, height and the joint spaces were significantly greater among males. With regards to comparison of both TMJs, the means of condylar volume, width and length of the right TMJ were significantly higher, while the means of the left condylar height and thickness of RGF were higher. When comparing the condylar measurements and the thickness of RGF between the two ethnic groups, we found no significant difference for all measurements with exception of condylar height, which is higher among Chinese.

Conclusion

The similarity in measurements for Malays and Chinese may be due to their common origin. This information can be clinically useful in establishing the diagnostic criteria for condylar volume, metrical size, and position in the Malaysian East Asians population.

Articular eminence inclination, height, and condyle morphology on cone beam computed tomography

Aim. The aim of the present study was to examine the relationship between articular eminence inclination, height, and thickness of the roof of the glenoid fossa (RGF) according to age and gender and to assess condyle morphology including incidental findings of osseous characteristics associated with osteoarthritis (OA) of the temporomandibular joint (TMJ) using cone beam computed tomography (CBCT). Materials and Methods. CBCT images of 105 patients were evaluated retrospectively. For articular eminence inclination and height, axial views on which the condylar processes were seen with their widest mediolateral extent being used as a reference view for secondary reconstruction. Condyle morphology was categorized both in the sagittal and coronal plane. Results. The mean values of eminence inclination and height of males were higher than those of females (P < 0.05). There were significant differences in the RGF thickness in relation to sagittal condyle morphology. Among the group of OA, the mean value of the RGF thickness for “OA-osteophyte” group was the highest (1.59 mm), whereas the lowest RGF values were seen in the “OA-flattening.” Conclusion. The sagittal osteoarthritic changes may have an effect on RGF thickness by mechanical stimulation and changed stress distribution. Gender has a significant effect on eminence height (Eh) and inclination.

Relationship between the thickness of the roof of glenoid fossa, condyle morphology and remaining teeth in asymptomatic European patients based on cone beam CT data sets

OBJECTIVES

The aim of this study was to examine the relationship between the roof of the glenoid fossa (RGF) thickness and condyle morphology and the influence of the number of remaining teeth and age.

METHODS

Cone beam CT data sets from 77 asymptomatic European patients were analysed retrospectively in this study. The thinnest area of RGF was identified among the sagittal and coronal slices on a computer screen; distance measurement software was used to measure the thickness. Moreover, we applied a free digital imaging and communications in medicine viewer for classification of condyle head type. It was also used to analyse any relation between RGF thickness and the number of remaining teeth. We performed a correlation analysis for RGF, age and missing teeth. Finally, we investigated combining sagittal condyle morphological characterization with coronal condyle morphology in relation to the number of joints and RGF thickness.

RESULTS

The Kruskal-Wallis test revealed no significant differences in RGF thickness among any of the coronal condyle head morphology groups (p > 0.05). There were significant differences in the thinnest part of RGF in relation to the sagittal plane for condyle morphological characterization, because we observed increased RGF thickness in joints with osteoarthritis features (p < 0.05). There is a non-significant correlation between the thinnest part of the RGF and the number of remaining teeth (p > 0.05).

CONCLUSIONS

We found that the RGF thickness is unaffected by the coronal condyle head morphology and the number of remaining teeth. Osteoarthritic changes (sagittal condyle morphology) have an effect on RGF.

Evaluation of the usefulness of magnetic resonance imaging in the assessment of the thickness of the roof of the glenoid fossa of the temporomandibular joint

OBJECTIVE

The aim of this study was to evaluate the usefulness of magnetic resonance imaging (MRI) in measuring thickness of the roof of the glenoid fossa (RGF) of the temporomandibular joint (TMJ).

STUDY DESIGN

Minimum RGF thickness in 95 TMJs of 59 patients with temporomandibular disorders were measured and compared on both sagittal-section MRI and cone-beam computed tomography (CBCT). RGF thickness on MRI was also compared with MRI, CBCT, and arthrographic findings.

RESULTS

Minimum RGF thickness was greater on MRI (1.46 mm) than on CBCT (0.90 mm). Spearman's correlation coefficient by rank for these 2 types of measurements was 0.63. RGF thickness on MRI differed significantly between those with and without degenerative joint changes (1.69 vs 1.32 mm; P < .01) and between those with and without disk displacement (1.58 vs 1.35 mm; P = .04), but showed no associations with disk deformity, joint effusion, or disk perforation.

CONCLUSIONS

MRI is useful in measuring RGF thickness from diagnostic as well as radiation protection standpoints.

Extension of the one-piece orbitozygomatic frontotemporal approach to the glenoid fossa: cadaveric study

OBJECTIVE

Resection of the glenoid fossa has been described as part of cranial approaches to the clivus and subtemporal approaches. However, radical resection carries a significant risk of postoperative temporomandibular joint dysfunction. We examine a simple variation of our previously described one-piece frontotemporal orbitozygomatic (FTOZ) osteotomy that adds en bloc resection of the root of the zygomatic arch and a portion of the glenoid fossa.

METHODS

Five cadaveric fixed heads injected with colored silicone underwent an FTOZ osteotomy that extended to the root of the zygomatic arch and glenoid fossa.

RESULTS

A step-by-step guide to the surgical technique is described, with illustrations to depict the glenoid fossa keyhole and bony cuts that free the zygomatic arch and portions of glenoid fossa. The first cut was made through the posterior root, and the second cut was made through the anterior root of the zygomatic arch.

CONCLUSION

In this cadaveric study, extension of the one-piece FTOZ approach included the posterior root of the zygoma and the lateral part of the glenoid fossa. En bloc resection of the glenoid fossa and root of the zygomatic arch, together with the FTOZ osteotomy, facilitated reconstruction of the temporomandibular joint and increased the amount of exposure obtained with this FTOZ osteotomy. Comprehensive understanding of functional outcomes awaits further clinical study.

Relationship between patient characteristics, mandibular head morphology and thickness of the roof of the glenoid fossa in symptomatic temporomandibular joints

OBJECTIVE

The purpose of this clinical study was to investigate the minimum thickness of the roof of the glenoid fossa (RGF) of grossly normal temporomandibular joints (TMJ) and to correlate this with patient gender, age and the morphological classification of the mandibular head.

METHODS

The study was performed on 191 TMJs from 109 patients (25 male and 84 female, age range 3-79 years, mean age 28.1 years) who visited Nihon University Dental Hospital, Japan with suspected TMJ disorders. The patients underwent cone beam computed tomography (3DX CT) to enable observation of the morphological features of the mandibular head. The minimum thickness of the RGF was measured using frontal section images acquired by CT. The morphology of the mandibular heads was classified according to the method of Yale and colleagues. Mean linear measurements were used for statistical analyses of patient gender, age and mandibular head morphology.

RESULTS

The average minimum thickness of the RGF was 0.79 mm. No significant difference in thickness was found between male and female patients. In addition, no differences were recorded as a result of variation in age or mandibular head morphology.

CONCLUSIONS

These results indicate that RGF thickness is not significantly correlated with gender, age, or mandibular head morphology, at least in this cohort of patients.

Bony eminence on the middle cranial fossa corresponding to the temporomandibular joint

We report a nameless bony eminence over the temporomandibular joint (TMJ) and its possible clinical significance. Forty-two half heads of 21 UK Caucasian cadavers (61-95 years old, mean 84.3 +/- 8.2 years, male:female = 11:10) were used to investigate the surface of the middle cranial fossa (MCF) over the TMJ. The thickness of the bony roof of the glenoid fossa was also measured. A bony eminence over the glenoid fossa was observed in half of the specimens. Some showed a complete oval bulge, which completely reflected the contour of the glenoid fossa. The others showed a bony bulge, which partially reflected that contour. The mean (+/-SD) thickness of the bone in the roof of glenoid fossa was 1.5 +/- 1.2 mm. The mean bony thickness of specimens showing the eminence was 0.8 +/- 0.5 mm, whereas it was 2.3 +/- 1.2 mm in specimens without an eminence. These differences were statistically significant (P < 0.01). The osteological features we describe may be relevant to certain clinical problems. Traumatic dislocation of mandibular condyle, for example, might relate to a weakness of the glenoid fossa.

The thickness of the roof of the glenoid fossa in the temporomandibular joint: relationship to the MRI findings

OBJECTIVES

The purpose of this study was to clarify the relationship between the thickness of the roof of the glenoid fossa (RGF) and magnetic resonance imaging (MRI) findings of temporomandibular joint (TMJ) disorders (TMDs).

METHODS

Eighty-seven patients with symptoms and indications of TMD in one or both TMJs were referred for MRI. Cone-beam CT (3DX) was used to measure the thickness of the RGF at its thinnest point. Linear measurements were made three times on the monitor by three separate investigators and the mean values obtained were used for the statistical analyses.

RESULTS

The joints were categorised as normal (70 joints), anterior disc displacement with reduction (ADWR; 53 joints) or anterior disc displacement without reduction (ADWOR; 51 joints). The joint disorders were also categorised into the following subgroups: with osteoarthritis (OA) (21 joints), without OA (153 joints), with disc deformation (33 joints), without disc deformation (141 joints), with joint effusion (JE) (61 joints) and without JE (113 joints). The average minimum thickness of the RGF was 0.85 mm for normal joints, 0.90 mm with ADWR, 0.93 mm with ADWOR, 0.99 mm with OA, 0.87 mm without OA, 0.87 mm with disc deformation and 0.89 mm without disc deformation. There was no significant difference between these figures. There was a significant difference in the thickness of the RGF with (0.97 mm) and without (0.84 mm) JE.

CONCLUSIONS

These results suggest that RGF thickness is influenced by JE, but is unaffected by disc position and configuration.