Can pterygoid plate asymmetry be linked to temporomandibular joint disorders?

Anatomical variations of the lateral pterygoid plate and their implications for temporomandibular disorders: A CBCT study

OBJECTIVE

TMD is a multifaceted condition with various contributing factors, but the actual impact of the lateral pterygoid plate on the development of TMD remains uncertain. This research aims to investigate the relationship between anatomical variations of the lateral pterygoid plate (LPP), including its angle and proximity to the condyle, and the prevalence of temporomandibular disorders (TMD), to improve diagnostic accuracy and therapeutic approaches for TMD.

MATERIALS & METHODS

A retrospective analysis was conducted on 189 Cone Beam Computed Tomography (CBCT) images of individuals aged 18 to 45. Inclusion criteria were based on definitive diagnoses of degenerative joint disease, excluding individuals with orthodontic treatments, injuries, or craniofacial disorders.Participants were divided into TMD and control groups using standardized DC/TMD protocols for assessment. A radiologist, blinded to the patient's clinical status, then analyzed the CBCT images. LPP dimensions, angles, and condyle distances were measured using OnDemand 3D Imaging Software.

RESULTS

The study found a statistically significant higher average LPP length in females compared to males (right LPP p < 0,001, left LPP p = 0,004), with no significant differences in LPP-condyle distances and angles between genders. Comparing the TMD and control groups revealed a positive correlation between lateral plate angles and TMJ disorders (p = 0,044), suggesting a potential biomechanical linkage.

CONCLUSION

Conclusively, the study challenges the assumption that LPP anatomical variations significantly impact TMD while underscoring a potential link between LPP angle and TMD. The novel insight into the potential role of the LPP angle in TMD provides a new direction for research and clinical practice, emphasizing the importance of considering subtle anatomical differences in the management of TMD.

An unusual clinical vignette of oro-pharyngeal discomfort: Pterygoid Hamulus syndrome

Background

A straightforward clinical reasoning is always difficult in patients with persistent orofacial pain with vague symptoms. Craniofacial pain or Orofacial pain can have a mixture of causes ranging from neurogenic, myogenic, and psychogenic factors intertwined amidst the intricate anatomy with a high vascular network. This plethora of uncertainty blurs the judgment for such patients to whom we provide care. We hereby present a case of a 17 year old female with vague pain on talking, chewing and even swallowing when initially examined; this chronic orofacial pain often worsened her quality of life. The aim of this manuscript is to present a case of Pterygoid Hamulus syndrome that was misdiagnosed as glossopharyngeal and myofascial neuralgia.

Methods

The condition was managed by surgical excision of the elongated pterygoid hamulus, following a recurrence of her symptoms.

Results

The patient was relieved of pain only after the surgical excision of the elongated hamulus.

Conclusions

The surgery was decided upon only after conservative management had not provided much relief and the manuscript also discusses the ambiguous composite pain referral pattern in Pterygoid Hamulus syndrome.

Pterygoid Hamular Bursitis: A Possible Link to Craniofacial Pain

A striking feature of the skull base is the pterygoid hamulus known for its bizarre morphology and biomechanical location. Pterygoid hamular bursitis is an inflammation of bursae located between the tendon, muscle, and bony prominences. The minimal objective finding in an apparently normal orofacial apparatus and dependence on the subjective symptoms experienced by the patient with widespread referral pattern often perplexes the clinician. Bursitis should be considered in the differential diagnosis of craniofacial neuralgia, temporomandibular joint dysfunction, and chronic craniofacial pain. Clinical signs and symptoms of this intriguing entity are diverse and multifaceted that can sometimes demand services of clinicians across various specialties considering the anatomic density of the region. Care must be taken to avoid delay, misdiagnosis, and overtreatment.

[TMJ, eating and breathing]

The study of the relationship between temporomandibular joints (TMJ), mastication and ventilation and the involvement of these two functions in the genesis of primary Temporomandibular Disorders (TMD) and in some dentofacial deformities, was initiated in France, more than 30years, by Professor Raymond Gola. Once criticized the weakness of the scientific literature in this domain, the originality of the TMJ within the masticatory system is recalled with its huge adaptation potential to very different biomechanical constraints according to the age and masticatory activities during the day. But the biomechanics of the masticatory system does not stop at night and the positions of the mandible and head during sleep should be studied carefully. In case of nocturnal mouth breathing with open mouth, the predominant sleeping position (generating small but long-term strengths) may be deleterious to the condyle-disc complex, to the surrounding muscles and the occlusal relationships. Some condyle-disc displacements and asymmetric malocclusions occur in this long portion of life what sleep, especially as oral breathing leads to a lot of dysfunctions (low position of the tongue, labio-lingual dysfunctions, exacerbation of bruxism sleep…). The aim of this work was to share our multidisciplinary experience of the biomechanical consequences of the nocturnal mouth breathing on the face involving orthodontists, maxillofacial surgeons, ENT, allergists, speech therapists, physiotherapists and radiologists.