Morphological and positional assessments of TMJ components and lateral pterygoid muscle in relation to symptoms and occlusion of patients with temporomandibular disorders

Disc displacement is accepted as one of major findings in temporomandibular disorders (TMD). However, the associations of disc positions with morphological and positional changes of temporomandibular joint (TMJ) components and lateral pterygoid (LP), TMD clinical symptoms, and occlusion have rarely been discussed quantitatively. In this study, the morphological and positional changes of TMJ components and LP were assessed by means of magnetic resonance imaging (MRI) and tomography of the TMJ in 41 TMD and nine control (CN) subjects. Disc positions in TMD subjects were divided into normal position (NP) and anterior displacement with and without reduction (ADR(+) and ADR(-), respectively). From MRI scans and tomograms, the morphological and positional changes of TMJ components and LP were measured and compared among CN, NP, ADR(+) and ADR(-) groups. Correlations between these measurements and the scored clinical symptoms and occlusal factors were analysed in TMD subjects. The results indicated that: (1) TMJ osseous structures and LP showed no significant difference among CN and the three TMD groups, except for a posterior seat of condyle and shorter/steeper condylar movement during jaw opening; (2) disc length and inclination were significantly shorter and steeper, respectively, in ADR(+) and ADR(-); (3) disc positions were not specified by clinical symptoms and occlusal factors, except for the dominant TMJ sounds in ADR(+); (4) an uncoordinated movement of the condyle/disc complex was found in ADR(+); and/or ADR(-); (5) TMJ osseous structures and the disc were weakly associated with clinical symptoms and occlusal factors. However, the LP showed negative associations with palpable pain for both the TMJ and jaw muscles and the static occlusal factors. These findings suggest that TMJ internal derangements are more related to the positional changes or spatial relationships of TMJ components but less to the individual morphologies of TMJ osseous structures, disc and LP, as well. as specific clinical symptoms and occlusal factors, which might be in disagreement with a large body of previous statements.