Condyle-disk-fossa position and relationship to clinical signs and symptoms of temporomandibular disorders in women

Objective. The aim of the present study was to assess the disk-condyle-fossa relationship through magnetic resonance imaging and determine its association with clinical signs and symptoms of temporomandibular disorder in patients with myofascial pain and disk displacement (with and without reduction). Study design. Sixty-two female patients with complaints of pain were clinically examined using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD)and divided into the following groups: Group I, myofascial pain (n = 19); Group IIa, disk displacement with reduction (n = 32); and Groups IIb and IIc, disk displacement without reduction (n = 11). Classification of disk position was based on the positioning on a clock face (> or < than 11 o'clock) and condylar excursion was determined as (1) the proximal side of the apex of the articular eminence; (2) at the level of the articular eminence; and (3) beyond the apex of the articular eminence. Condylar position was determined in the sagittal images based on Gelb's template (normal, posteriorly displaced). Pain was assessed using a visual analogue scale (VAS). The univariate logistic regression, Mann-Whitney, Kruskall-Wallis and Pearson's correlation tests were used in the statistical analysis (P < .05). Results. No significant association was found between the independent variables (condylar position, disk position, and condylar excursion) and the dependent variables (pain, maximal opening of the mouth, maximal lateral movement). However, there was a significant association between increased condyle excursion and pain (P = .035) and also maximum mouth opening movement was associated with lateral movement (P = .01; r = 0.31). Conclusions. Increase in condyle excursion may significantly influence pain perception in TMD patients. The type of dysfunction and severity of alterations on the imaging exams were not related to the severity of pain or range of motion of the mandible. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 108: e117-e124)