Mechanisms of functional asymmetry of the face formation in patients with dysfunctional condition of temporomandibular joint

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Abstract

Objective. To give a detailed description of clinical manifestations, diagnosis and treatment of functional asymmetry of the face in patients with dysfunctional condition of temporomandibular joint (TMJ).

Materials and methods. A complete examination of 34 (25 %) patients with symptomatic facial asymmetry of the 3rd type according to H.S. Hwang classification was carried out. The group consisted of 5 males (14,71 %) and 29 females (85,29 %). Screening protocol included standard dental care, cone beam computer tomography of both jaws and TMJ, MRI of TMJ with functional load.

Results. 24 patients (70.59 %) completed complex dental treatment; 10 (29.41 %) people stopped treatment for various reasons and were excluded from further study. Complete restoration of facial symmetry was achieved in 21 people (87.5 %), partial restoration in 3 (12.5 %) patients. The height of the lower facial part and the synchrony of occlusal contacts were restored in all patients. Noise in the joint area persisted in 3 (8.8 %) cases, which is associated with arthrosis in the articular heads. In patients with unreducible dislocations, the intensity of the clicks decreased, and there was no pain at the end of treatment. It should be noted that all patients of this group refused subsequent surgical treatment.

Conclusion. Functional asymmetry of the face results from multifactorial impact on the human organism and is multimorbid by nature. This condition is accompanied by complicated dental pathology, such as increased hard tooth tissues attrition, functional overload with traumatic nodes formation, disturbance of muscles and TMJ functions. It requires following diagnostic and treatment algorithm under the supervision of internal medicine specialists to correct sleep, postural stability, impaired psychoneurological status.

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Introduction

Modern orthopedic dentistry is primarily concerned with resolving dental defects and achieving the individual’s aesthetic and functional optimum. Symmetry is one of the most critical aesthetic parameters for the patient’s face. As ideal facial symmetry is extremely rare in nature, all beauty standards aim to attain dynamic symmetry with a minor deviation from the ideal while preserving the function of the dental apparatus [1–5]. According to some authors, facial asymmetry can result from developmental anomalies, hereditary factors, traumatic deformities, tumor processes, imbalance of the masticatory muscles, displacement of the articular disc, and disproportionality between the right and left sides [3; 6–12]. Conversely, some researchers believe that the discrepancy between the right and left sides of the face may not be related to dental reasons [13; 14]. Research indicates that the human body exhibits motor and sensory functional asymmetry, including an imbalance of the proportions of the maxillofacial apparatus. The study and description of gustatory, tactile, and visual asymmetries have revealed a correlation between them1[15]. However, these types of asymmetry are not of significant concern in orthopedic dentistry, as they are within physiological limits. It was discovered that facial asymmetry increases with age, which is linked to bone remodeling and age-related changes in soft tissues (e.g., decreased tissue tone, elasticity, etc.) [16; 17].

Traditionally, the diagnostic processes employed include the collection of subjective data, physical examination, photometry, cone beam tomography, cephalometric analysis, and MRI. The clinician assesses skeletal and soft tissue disproportions, the condition and spatial arrangement of the dental rows and individual teeth, functional alterations (unilateral mastication, muscle-tonic syndrome, etc.), and compensation analysis [8; 17–20]. The most frequently identified causes of facial asymmetry include varying lengths of the mandibular branch on the right and left sides, functional asymmetry resulting from partial absence of teeth, anomalies and deformities of dental rows and individual teeth, occlusal interference, and local hypertonus of individual masticatory muscles [6; 21; 22].

Temporomandibular joint dysfunction can lead to the development of compensatory restructuring in the dentoalveolar apparatus, which can result in an adaptive anomaly of development and/or deformation of the dental rows in three mutually perpendicular directions: sagittal, transversal, and vertical [23; 24]. In the initial stages of compensatory processes, the teeth shift in the mesiodistal, and vestibulo-oral directions, rotate around their axis, or undergo a combination of these changes [7; 25–27]. The inclination of the occlusal plane changes, compression and dilation of intraarticular structures occur, and the position of the mandible changes, which ultimately results in remodeling of the condyles and subsequently to osteoarthritis [6; 7; 27–29].

The strategies for overcoming facial asymmetry and reduced bite height are contingent upon the patient’s age, etiology, and degree of disharmony. Orthopedic, orthodontic, surgical, or a combination of these methods are frequently employed [1–3; 8; 19].

This study aimed to detail the clinical manifestations, diagnosis, and treatment of functional facial asymmetry in patients with temporomandibular joint (TMJ) dysfunction.

Materials and methods

This study included 136 patients aged 18–81 years (average age, 43.17 years) with TMJ dysfunction. These patients included 25 men (18.38 %) and 111 women (81.62 %). The study participants encompassed 34 (25 %) patients with symptomatic type 3 facial asymmetry based on the H.S. Hwang classification [6] consisting of five males (14.71 %), and 29 (85.29 %) females. The type 3 facial asymmetry is distinguished by the identical length of the lower jaw branches and a deviation of the chin. However, the chin and lower jaw deviate from the center of the face to one side due to a functional shift resulting from various types of occlusal interference (for example, an anomaly in the position of teeth, a crossbite or a narrowing of the maxillary row). Patients with dynamic facial symmetry, facial asymmetry due to impaired facial skeleton development, hereditary pathology, and different lengths of the right and left branches of the mandible were excluded from the study. Withdrawing from treatment at any stage was also an exclusion criterion. The examination protocol included standard dental treatment, cone beam computed tomography of both jaws and TMJ, and MRI of the TMJ with functional load.

Results and discussion

Most patients [31 (91 %)] with facial asymmetry presented with complaints related to TMJ dysfunction. Based on the health questionnaire completed by patients, the life history and disease data were subsequently clarified (Fig. 1). In the history, the most significant prevalent signs of TMJ dysfunction were: postural disturbance (82.4 %), head and neck spasms (67.65 %), headaches (44.12 %), impairment of sleep duration and quality (55.88 %), not feeling rested following sleep (44.12 %), and neuropsychiatric disorders (41.18 %). Patients attached great importance to the dental alterations over the past five years (shortening of teeth, change of position, appearance of cracks, etc.) (55.88 %), mastication disorders (unilateral chewing, pain, discomfort during mastication) (50 %), and finding a comfortable position of the lower jaw (47.06 %). The frequency of dental visits averaged 3.3 years. Seven patients (20.59 %) reported an unfavorable experience during the previous dental treatment.

 

Fig. 1. Results of patient questionnaires, %

 

The diagnosis of facial asymmetry with a shift of the lower mandible to the right was primarily made through an external examination, which revealed a mismatch in the height of the right and left halves of the face, as well as a shift of the chin to the right in 29 (85.3 %) and to the left in 5 (14.7 %). No change in the height of the lower face was detected in 22 (65 %) patients, a decrease in height was observed in 11 (32 %) and an increase in height was noted in one (2.9 %). The degree of mouth opening was impaired in 21 (61.76 %) patients, limited in 20 (58.82 %), increased in one (2.94 %) and remained within the normal range in 13 (38.24 %). The mandible’s trajectory of displacement relative to the midline of the face was symmetrical in 16 (47.06 %) patients, asymmetric in 18 (52.94 %). In seven (20.59 %) patients, the opening and closing trajectories of the oral cavity did not coincide. Furthermore, the lower jaw deviated both to the right and left sides from the central line with the mouth completely open in an equal number of patients [10 (29.41 %)]. Intraarticular pathology was detected in 24 individuals (70.59 %) through acoustic phenomena such as clicks, crepitation, murmuring, and other extraneous sounds in the joint. Asynchronous occlusive knocking was detected in 29 (85.29 %) patients, which indicated the presence of premature contacts.

We discovered intriguing outcomes comparing right and left muscle soreness during palpation. (Fig. 2). Pain in the medial pterygoid muscle (61.76 %) and the superficial masticatory muscle (50 %) was identified more often on the right. Conversely, the pain intensity response in the lateral pterygoid (64.71 %) muscle and the base of the tendon of the temporal muscle (52.94 %) was higher on the left. When evaluating the posterior poles of the joint heads in rotation, pain was diagnosed on the right side in six (17.65 %) patients, on the left side in four (11.76 %), as well as in the posterior joint space on the right side in 10 (29.41 %) and on the left side in 10 (29.41 %). This indicates the interest of the bilaminar zone and displacement of the jaw heads in this zone. Additionally, neck and shoulder girdle muscle examination revealed a high prevalence of a painful response on palpation of the scapulothyroid and trapezius muscles also on the right side. Pain on TMJ palpation was detected in six (17.65 %) patients. A significant requirement for oral cavity sanitation was identified during the dental assessment. On average, the CPI index was 15.03 ± 8.18 with an intensity of the carious process of 4.21 ± 3.82, the number of fillings of 7.47 ± 5.72, and the number of teeth extracted were 3.26 ± 3.73. Increased abrasion of hard tooth tissues was detected in 31 (91.18 %) patients, enamel cracks in 15 (44.12 %), abfractive defects in 16 (47.06 %), and secondary deformations of the dentition were observed in 17 (50 %). In 28 (82.35 %) patients, the marginal periodontal tissues exhibited physiological coloration, while in 21 (61.76 %), the contour and volume of the gum remained unaltered. Dental mobility was detected in three (8.82 %) patients, hyperemia in five (14.71 %), edema in two (5.88 %), periodontal pockets in six (17.65 %), bleeding gums of varying degrees in four (11.76 %), and gum atrophy and recessions in 13 (38.23 %).

 

Fig. 2. Soreness during palpation of muscles, %

 

It was revealed that 19 (55.88 %) patients had never used prosthetics before, and 15 (44.12 %) used removable (8.82 %) and non-removable (38.24 %) prostheses, which necessitated replacement in 23.53 %.

When examining joint gap width on cone beam computed tomography (CBCT) of the TMJ, we made a comparative evaluation with the data of the literature (see Table) defining normal and pathologic joint gap alterations. Articulating surface pathological changes were diagnosed on the right side in 13 (38.24 %) patients, and on the left in 5 (14.71 %). The interest of both articular heads was noted in 13 (38.24 %) cases. A comprehensive study identified the variation in the levels of the right and left articular heads in the joint gap in the anterior, middle, and posterior directions as well as in the movement of both heads. Fig. 3 illustrates the results. In 13 patients (38.24 %), erosion of the articular heads was observed, while 15 patients (44.12 %) experienced subluxation of one of the articular heads. Additionally, six patients (17.65 %) developed osteophytes that limited the articular head mobility.

 

Comparative analysis of the size of the joint gap in normal and dysfunction with the data obtained

Joint gap size data

Anterior part

Middle part

Posterior part

Normal, according to the literature

3.6 ± 0.32

3.1 ± 0.18

3.0 ± 0.18

Dysfunction, according to the
literature

3.2 ± 0.21

2.5 ± 0.14

2.4 ± 0.10

Laterality

On the right

On the left

On the right

On the left

On the right

On the left

Dysfunction, according to the
literature

3.3 ± 0.23

3.5 ± 0.37

2.4 ± 0.33

2.6 ± 0.21

1.8 ± 0.19

1.7 ± 0.16

Dysfunction, based on the data obtained

2.69 ± 0.84

2.76 ± 1.01

2.79 ± 0.94

2.8 ± 1.06

2.0 ± 0.7

2.05 ± 0.56

 

Fig. 3. The change in the size of the joint gap in three mutually perpendicular directions

 

Computed tomography data suggest that the mandible is predominantly symmetrically displaced in the horizontal direction distally in 76 % of patients. However, the lower jaw rotates in a relatively high percentage of patients with a predominant posterior and rightward direction. This is demonstrated by an increase in the joint gap on the right side in the central region of the articular cavity and a decrease in the joint gap on the left side in its anterior and middle regions. Rotational alterations in the jaw position under the action of muscular force also provide an overall appearance of facial asymmetry. The MRI analysis of both the TMJs with functional load revealed that the cortical plate was disrupted in 18 (52.94 %) patients, a change in the structure of bone tissue was found in 19 (55.88 %), and a change in the position of both the TMJ heads was similar to the CBCT results. Magnetic resonance imaging enabled visualization of the degenerative changes in both articular discs in 38.24 % of patients; unilateral disc damage occurred mainly on the left side (17.65 %). The most prevalent of all dislocations was ventral bilateral displacement of articular discs (26.47 %), with predominant unilateral displacement observed on the left side (23.53 %). In 20.59 % of cases, lateral displacements of both discs were observed, while unilateral displacement was only detected on the left (11.76 %) (Fig. 4). The data obtained was used to develop a set of therapeutic measures for each patient. The neuropsychiatric status was addressed by a neurologist and psychotherapist through the prescription of medications (myorelaxants, antidepressants, anticonvulsants) and non-medications (physiotherapy, psychotraining, meditation practices, etc.). Orthopedicians rectified the impaired postural status by employing orthopedic aids (corsets, collars, orthotics), physiotherapists, and kinesiotherapists with the selection of individual exercise complexes, as well as osteopaths and massage therapists. Patients were advised to undergo lifelong supportive therapy at a minimum of twice a month and ensure correction of the aids annually following fabrication. The dental treatment included the use of muscle relaxation trays on the lower jaw for 1–3 months, followed by the use of stabilizing trays for the next 1–3 months. All of the trays were produced in an articulator using the hot polymerization method, with the individual angles being adjusted. The trays were corrected in accordance with the established protocol: the initial correction was performed on the following day after the tray was applied, and the subsequent corrections were performed every 2–4 weeks, contingent upon the patient’s complaints. The treatment was monitored using visual, objective examination methods, cone beam tomography, and magnetic resonance imaging based on the indications. This was followed by correction of occlusion-articulation relationships using selective grinding, composite protocol, and indirect restorations. The defects in dentition were reconstructed using removable structures or prostheses that were based on implants modeled on the clinical picture. Twenty-four patients (70.59 %) completed the complex dental treatment. Ten (29.41 %) patients withdrew from the treatment for various reasons and were excluded from further study. Complete restoration of facial symmetry was achieved in 21 people (87.5 %), while partial restoration was observed in three (12.5 %). The height of the lower face and the synchronicity of occlusal contacts were restored in all patients. Noise phenomena in the joint area persisted in three (8.8 %) patients, which was due to the presence of arthrosis in the articular heads. The intensity of clicks decreased in patients with non-correctable dislocations, and there was no pain at the conclusion of the treatment. It should be noted that all patients in this group refused subsequent surgical treatment. In 20 (83.33 %) patients, the degree of mouth opening achieved normal because of therapy, whereas in 4 (16.67 %), it improved but remained restricted. In most patients, palpation of the maxillary and shoulder girdle muscles did not elicit pain. Almost all patients managed to achieve correction of the position of the articular heads in the articular cavity and bring them closer to their normal location, as indicated by the X-ray examination.

 

Fig. 4. The findings of the analysis of alterations in the discs, temporal ligaments of the TMJ and lateral pterygoid muscles

 

The biomechanics of the dental apparatus, in conjunction with the data of visual examination, muscle palpation, and the results of X-ray examination, suggest that the lower mandible has shifted primarily to the right, causing functional asymmetry. The questionnaire data indicated that impaired neuropsychiatric, postural status, and changes in sleep duration and quality were predictors of a dysfunctional state, in addition to dental difficulties, which also require correction.

A change in the condition of the hard tissues of the teeth and their position, an impairment in mastication, and an need to identify a comfortable position of the lower mandible were reported by over half of the patients with the disease history. Simultaneously, actual changes in the dental apparatus (cracks, abfractive defects, secondary deformations, recessions, and loss of gum level) associated with functional overload were diagnosed based on the complaints. Notably, the presence of worn facets of dental hard tissues and premature contacts were detected in 91,18 and 85 % of patients, respectively, which indicates a partially latent course of the pathologic process.

Palpation of the lateral pterygoid muscle and the base of attachment of the temporalis muscle tendon were painful, mainly on the left side. MRI data suggested a preponderant dislocation of the left articular disc, as well as a high percentage of premature contacts that impeded the proper closure of the jaw. These alterations are responsible for lower jaw rotation, especially on the left side, as the body attempts to achieve an adaptive functional optimum. The elevated contractility of the right masseter muscle and right medial wing muscle, manifested by pain response and local hypertonus, are compensatory reactions that are designed to achieve uniform occlusal contacts during the routine occlusion on the right side.

Skeletal muscles are also involved in the process to maintain postural stability, as demonstrated by an impairment of posture in 82.4 % of the surveyed patients. The scapula-hyoid muscle is responsible for maintaining the vertical position of the head, and contributes to the mechanisms that cause migraine-like headaches, and its increased tone and soreness are observed on the right side. The trapezius muscle is responsible for turning and extending the neck, provides an anti-gravity effect, and is directly related to emotional imbalance. The presence of soreness predominantly on the right side during palpation also indicates the involvement of the right half of the shoulder girdle in maintaining the position of the lower jaw and adaptive postural correction.

Conclusions

Functional facial asymmetry occurs because of multifactorial effects on the human body, is associated with polymorbidity, and has distinct biomechanical characteristics and mechanisms of development. Facial asymmetry is not only an aesthetic issue requiring external correction but also a functional disorder, the severity of which is ascertained by multiple etiopathogenetic mechanisms. Concomitant with this condition is the presence of complicated dental pathology, including increased abrasion of the hard tissues of the teeth, functional overload with the formation of traumatic nodes, impaired muscle function, and TMJ.

In connection with the aforementioned factors, this pathological condition necessitates adherence to a definite diagnostic algorithm: dental examination, identification of risk factors through the determination of neuropsychiatric and postural statuses, and CBCT and MRI of temporomandibular joints. For this cohort of patients, it is essential to conduct CBCT and MRI of the TMJ within the same protocol, since these studies complement and elucidate the clinical presentation.

The abrupt disruption of adaptive processes can result in a decrease or inability to form new compensatory mechanisms when dental treatment is conducted without consideration of the general somatic status and the state of soft tissue structures in the joint. The effectiveness of therapy is enhanced, and the effect is more enduring as a result of the gradual formation of new adaptation patterns as a result of the complex treatment of patients with facial asymmetry and dysfunctional TMJ, which involves the involvement of internists to correct sleep, postural stability, and disturbed neuropsychiatric status.

 

1 Kadyrova E.V. The study of taste asymmetry to substances of threshold concentrations in young people. Scientific session of the Perm State Medical University named after Academician E. A. Wagner. Perm 2014; 52–54.

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About the authors

N. B. Astashina

E.A. Vagner Perm State Medical University

Email: martyushevamari@mail.ru
ORCID iD: 0000-0003-1135-7833

DSc (Medicine), Professor, Head of the Department of Orthopedic Dentistry

Russian Federation, Perm

M. V. Martyusheva

E.A. Vagner Perm State Medical University

Author for correspondence.
Email: martyushevamari@mail.ru
ORCID iD: 0000-0003-3689-6358

PhD (Medicine), Associate Professor of the Department of Orthopedic Dentistry

Russian Federation, Perm

N. B. Shchekolova

E.A. Vagner Perm State Medical University

Email: martyushevamari@mail.ru
ORCID iD: 0000-0002-3911-4545

DSc (Medicine), Professor of the Department of Traumatology, Orthopedics and Neurosurgery

Russian Federation, Perm

E. V. Kadyrova

E.A. Vagner Perm State Medical University

Email: martyushevamari@mail.ru

PhD (Medicine), Associate Professor of the Department of Normal Physiology

Russian Federation, Perm

References

  1. Takano-Yamamoto T., Kuroda S., Rocca M. Diagnostic et traitement de patients adultes présentant une asymétrie faciale [Diagnosis and therapy of adult patients with facial asymmetry]. L'Orthodontie francaise 2009; 80 (3): 313–329. doi: 10.1051/orthodfr/2009022
  2. Thiesen G., Gribel B.F., Freitas M.P. Facial asymmetry: a current review. Dental press journal of orthodontics 2015; 20 (6): 110–125. doi: 10.1590/2177-6709.20.6.110-125.sar
  3. Bishara S.E., Burkey P.S., Kharouf J.G. Dental and facial asymmetries: a review. The Angle orthodontist 1994; 64 (2): 89–98. doi: 10.1043/0003-3219(1994)064<0089: DAFAAR> 2.0.CO;2
  4. Потрясова А.М., Кабиева Х.А. Диагностика функционального характера асимметричного положения нижней челюсти. Инновационные подходы в современной науке: сб. ст. по материалам XCIII Международной научно-практической конференции 2021: 9 (93). doi: 10.32743/25878603.2021.9.93.269779 / Potryasova A.M., Kabieva H.A. Diagnostika funkcional'nogo haraktera asimmetrichnogo polozheniya nizhnej chelyusti. Innovacionnye podhody v sovremennoj nauke: sb. st. po materialam XCIII Mezhdunarodnoj nauchno-prakticheskoj konferencii 2021: 9 (93). doi: 10.32743/25878603.2021.9.93.269779 (in Russian).
  5. Потрясова А.М., Еловская А.А., Кабиева Х.А., Быковская Т.В., Морозова Н.С. Анализ распространенности скелетного компонента асимметрии нижней челюсти. Институт стоматологии 2021; 1 (90): 44–45 / Potryasova A.M., Elovskaya A.A., Kabieva H.A., Bykovskaya T.V., Morozova N.S. Analiz rasprostranennosti skeletnogo komponenta asimmetrii nizhnej chelyusti. Institut stomatologii 2021; 1 (90): 44–45 (in Russian).
  6. Hwang, Hyeon-Shik et al. Classification of facial asymmetry by cluster analysis. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2007; 132 (3): 279.e1–6. PMID: 17826592 doi: 10.1016/j.ajodo.2007.01.017
  7. Cheong Y.W., Lo L.J. Facial asymmetry: etiology, evaluation, and management. Chang Gung medical journal 2011; 34 (4): 341–351. PMID: 21880188
  8. Ko E.W., Huang C.S., Chen Y.R. Characteristics and corrective outcome of face asymmetry by orthognathic surgery. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 2009; 67 (10): 2201–2209. doi: 10.1016/j.joms.2009.04.039
  9. Kai R., Umeki D., Sekiya T., Nakamura Y. Defining the location of the dental midline is critical for oral esthetics in camouflage orthodontic treatment of facial asymmetry. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2016; 150 (6): 1028–1038. doi: 10.1016/j.ajodo.2015.10.035
  10. Linden O.E., He J.K., Morrison C.S., Sullivan S.R., Taylor H.O.B. The Relationship between Age and Facial Asymmetry. Plastic and reconstructive surgery 2018; 142 (5): 1145–1152. doi: 10.1097/PRS.0000000000004831
  11. Azevedo A.R., Janson G., Henriques J.F., Freitas M.R. Evaluation of asymmetries between subjects with Class II subdivision and apparent facial asymmetry and those with normal occlusion. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2006; 129 (3): 376–383. doi: 10.1016/j.ajodo.2005.12.002
  12. Bernini J.M., Kellenberger C.J., Eichenberger M., Eliades T., Papageorgiou S.N., Patcas R. Quantitative analysis of facial asymmetry based on three-dimensional photography: a valuable indicator for asymmetrical temporomandibular joint affection in juvenile idiopathic arthritis patients? Pediatric rheumatology online journal 2020; 18 (1): 10. doi: 10.1186/s12969-020-0401-y
  13. Dinsdale A., Liang Z., Thomas L., Treleaven J. Is jaw muscle activity impaired in adults with persistent temporomandibular disorders? A systematic review and meta-analysis. Journal of oral rehabilitation 2021; 48 (4): 487–516. doi: 10.1111/joor.13139
  14. Lächler S., Hirthammer B.J., Rösing F.W. Quantifying the asymmetries of the human face. Homo: internationale Zeitschrift fur die vergleichende Forschung am Menschen 2020; 71 (2): 91–99. doi: 10.1127/homo/2020/1022
  15. Кадырова Е.В. Исследование сенсорной асимметрии челюстно-лицевой области у молодых людей. Фундаментальные и прикладные научные исследования: материалы международной научно-практической конференции. Самара 2016; 286–287 / Kadyrova E.V. Issledovanie sensornoj asimmetrii chelyustno-licevoj oblasti u molodyh lyudej. Fundamental'nye i prikladnye nauchnye issledovaniya: materialy mezhdunarodnoj nauchno-prakticheskoj konferencii. Samara 2016; 286–287 (in Russian).
  16. Inui M., Fushima K., Sato S. Facial asymmetry in temporomandibular joint disorders. Journal of oral rehabilitation 1999; 26 (5): 402–406. doi: 10.1046/j.1365-2842.1999.00387.x
  17. Buranastidporn B., Hisano M., Soma K. Temporomandibular joint internal derangement in mandibular asymmetry. What is the relationship? European journal of orthodontics 2006; 28 (1): 83–88. doi: 10.1093/ejo/cji073
  18. Buranastidporn B., Hisano M., Soma K. Articular disc displacement in mandibular asymmetry patients. Journal of medical and dental sciences 2004; 51 (1): 75–81. PMID: 15137468
  19. Buranastidporn B., Hisano M., Soma K. Effect of biomechanical disturbance of the temporomandibular joint on the prevalence of internal derangement in mandibular asymmetry. European journal of orthodontics 2006; 28 (3): 199–205. doi: 10.1093/ejo/cji082
  20. Trpkova B., Major P., Nebbe B., Prasad N. Craniofacial asymmetry and temporomandibular joint internal derangement in female adolescents: a posteroanterior cephalometric study. The Angle orthodontist 2020; 70 (1): 81–88. doi: 10.1043/0003-3219(2000)070<0081: CAATJI>2.0.CO; 2
  21. Ahn S.J., Lee S.P., Nahm D.S. Relationship between temporomandibular joint internal derangement and facial asymmetry in women. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2005; 128 (5): 583–591. doi: 10.1016/j.ajodo.2004.06.038
  22. Jeon D.M., Jung W.S., Mah S.J., Kim T.W., Ahn S.J. The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement. Acta odontologica Scandinavica 2014; 72 (8): 776–782. doi: 10.3109/00016357.2014.906650
  23. Manfredini D., Segù, M., Arveda N., Lombardo L., Siciliani G., Alessandro Rossi, Guarda-Nardini L. Temporomandibular Joint Disorders in Patients With Different Facial Morphology. A Systematic Review of the Literature. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 2016; 74 (1): 29–46. doi: 10.1016/j.joms.2015.07.006
  24. Jung W.S., Kim H., Jeon D.M., Mah S.J., Ahn S.J. Magnetic resonance imaging-verified temporomandibular joint disk displacement in relation to sagittal and vertical jaw deformities. International journal of oral and maxillofacial surgery 2013; 42 (9): 1108–1115. doi: 10.1016/j.ijom.2013.03.012
  25. Ekrami O., Claes P., White J.D., Zaidi A.A., Shriver M.D., Van Dongen S. Measuring asymmetry from high-density 3D surface scans: An application to human faces. PloSone 2018; 13 (12): e0207895. doi: 10.1371/journal.pone.0207895
  26. Duran G.S., Di̇ndaroğlu F., Kutlu P. Hard- and soft-tissue symmetry comparison in patients with Class III malocclusion. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 2019; 155 (4): 509–522. doi: 10.1016/j.ajodo.2018.05.021
  27. Guercio-Monaco E., De Stefano A., Impellizzeri A., Galluccio G. Association between the temporomandibular joint disc position on magnetic resonance imaging and the mandibular deviation on posteroanterior cephalogram: a cross-sectional study in adolescents. La Clinica terapeutica 2020; 171 (6): e509–e516. doi: 10.7417/CT.2020.2265
  28. Ряховский А.Н., Выходцева М.А. Обоснование методики 3D-анализа височно-нижнечелюстного сустава по данным компьютерной томографии. Стоматология 2022; 101 (1): 23–32 / Ryakhovsky A.N., Vykhodtseva M.A. Validation of the technique of TMJ 3D analysis based on computer tomography. Stomatologiia 2022; 101 (1): 23–32. doi: 10.17116/stomat202210101123 (in Russian).
  29. Боян А.М. Определение пространственного перемещения суставных головок височно-нижнечелюстных суставов у больных с мышечно-суставной дисфункцией по данным компьютерно-томографического (КТ) исследования. ScienceRise 2015; 3 (16): 5–9 / Bayan A.M. Determination of spatial displacement of articular heads of temporomandibular joints in patients with musculoskeletal dysfunction according to computed tomography (CT) examination. ScienceRise 2015; 3 (16): 5–9. doi: 10.15587/2313-8416.2015.53896 (in Russian).

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2. Fig. 1. Results of patient questionnaires, %

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3. Fig. 2. Soreness during palpation of muscles, %

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4. Fig. 3. The change in the size of the joint gap in three mutually perpendicular directions

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5. Fig. 4. The findings of the analysis of alterations in the discs, temporal ligaments of the TMJ and lateral pterygoid muscles

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 75489 от 05.04.2019 г.