Temporomandibular disorders (TMDs) are multifactorial clinical conditions affecting the masticatory muscles, the temporomandibular joint (TMJ), and the surrounding structures. The most common subtype is disc displacement, which is characterized by an abnormal position of the articular disc. Magnetic resonance imaging (MRI) is considered the gold standard for the diagnosis of disc displacement because it provides excellent soft tissue contrast, allows direct visualization of the disc, and enables dynamic evaluation. The parallel nature of mandibular and head-neck movements reflects the functional relationship between the temporomandibular and cervical neuromuscular systems. In addition, various craniofacial skeletal anomalies have been reported to be associated with disorders of the cervical vertebrae. TMD restricts mandibular movements and causes pain in the surrounding muscles, which may lead to referred pain in the neck, shoulder, and cervical muscles, thereby affecting head posture. Head and neck postural abnormalities are closely associated with cervical pain and dysfunction related to TMD. This relationship is thought to be bidirectional and can be explained through biomechanical, neurological, and pathophysiological mechanisms. In particular, upper cervical vertebral dysfunctions and changes in head position may influence the severity of TMD symptoms. For this purpose, lateral cephalometric radiography is frequently used to evaluate the hyoid position and the cervical spine in relation to the TMJ. Upper cervical vertebral anomalies and craniofacial morphological characteristics can be analyzed using these images.
Presence of TMJ symptoms on at least one side, including pain, abnormal mandibular movements, or joint noises.
Parafunctional habits such as bruxism or clenching.
Patients with disc displacement of TMJ.
Presence of malformations affecting the craniofacial region.
History of trauma of the maxillofacial region.
History of cervical surgery or any procedure involving the cervical region.
Patients with tumors, cysts, hypoplasia, or hyperplasia in the TMJ region.
Temporomandibular disorder
Cohort
Prospective
cephalometric analysis
Radiationcephalometric analysis
morphologic analysis of cervical vertebrae
Morphological measurements of the C2, C3, and C4 vertebral bodies were performed on lateral cephalometric radiographs of the included patients. Morphological assessment included the presence of osteophyte formation and generalized sclerosis of the vertebrae. Osteophytes are marginal bony proliferations arising from the periosteal surface of the vertebral body endplates, typically developing at the anterior and lateral aspects as a reactive response to chronic mechanical stress and intervertebral disc degeneration. Radiologically, they appear as well-defined osseous outgrowths that may vary in size and orientation and can occasionally contribute to adjacent soft tissue or neural structure compression depending on their extent. Generalized sclerosis refers to a diffuse increase in bone density involving the vertebral bodies, characterized radiologically by homogeneous or heterogeneous areas of increased radiopacity on imaging studies.
vertebral dimension measurements and intervertebral disc height
Anterior and posterior vertebral heights were defined as the distances between the superior and inferior borders of the anterior and posterior margins of the vertebral body. Anteroposterior diameter of C2, C3, and C4 was measured as vertebral depth, and the anterior height/depth ratio was calculated to obtain a dimensionless value independent of radiographic magnification. Anterior intervertebral disc height was determined by summing the perpendicular distances from the inferoanterior corner of the upper vertebra and the superoanterior corner of the lower vertebra to the angle bisector constructed between these points. This value was divided by the depth of the lower vertebra to obtain a magnification-independent ratio.
cervical posture evaluation
NSL/OPT and OPT/HOR angles will be calculated. In determining the NSL/OPT angle, the following landmarks will be identified: Nasion (N), Sella (S), CV2tg (the superoposterior tangent point of the odontoid process of C2), and CV2ip (the inferoposterior point of the C2 vertebral body). The NSL (Nasion-Sella Line) is defined as the line connecting the geometric center of the sella turcica and the nasion (the most anterior point of the frontonasal suture). The OPT (Odontoid Process Tangent) is defined as the line tangent to the posterior surface of the odontoid process of the second cervical vertebra (C2) passing through CV2ip. The OPT/HOR angle will be calculated as the angle between the true horizontal plane and the line tangent to the posterior surface of the odontoid process. Hyoid triangle height will be determined using the triangle formed by the most superoanterior point of the hyoid bone (H), the inferoanterior point of the third cervical vertebra (C3ia), and retrognathion (RGN).
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