Abstract
BackgroundJuvenile idiopathic arthritis (JIA) can cause osseous deformity in the temporomandibular joint (TMJ) and may impair mandibular growth. This study aimed to evaluate whether facial asymmetry determined clinically or by morphometric analysis of three-dimensional (3D) photographs in JIA patients is associated with an asymmetric affection of theTMJ.MethodsOf 76 consecutive JIA patients with a mean age of 11.7 years (range: 6.3–17.9), facial asymmetry was evaluated clinically (chin asymmetry, gonion asymmetry), and stereophotogrammetrically with 3D photographs. The facial surfaces were demarcated, then mirrored, superimposed using semi-automated landmarks, and quantitatively assessed (chin asymmetry, Hausdorff distances). Clinical and digital measurements were related to the diagnosis of right and left TMJ involvement derived from magnetic resonance images (MRI).ResultsTwenty-seven (34%) patients had an asymmetrical osseous deformity of the TMJ. By clinical evaluation, chin asymmetry was related to asymmetrical osseous destruction (p = 0.02), but gonion asymmetry was not (p = 0.14). In regard to 3D-photograph based morphometric measurements, chin asymmetry was also related to asymmetrical osseous destruction (p = 0.01), but neither the mean (p = 0.06) nor the maximal Hausdorff distance (p = 0.67). Despite the attested significance, none of the chin asymmetry evaluation methods appeared to hold sufficient predictive value (positive predictive values ≤54%; coefficient of determination ≤7%).ConclusionsFor the assessment of facial asymmetry in JIA patients, morphometric measurements originating from 3D-photographs seem to deliver results comparable to the clinical assessment methods. The asymmetry of the face, especially around the chin, appears to be related to asymmetrical TMJ destruction, but none of the investigated measurement methods of the face were able to reliably predict the TMJ affection. Thus, facial asymmetry assessments, both qualitatively in a clinical setting and quantitatively based on 3D-photographs, have limited diagnostic value for TMJ involvement in JIA patients.
Highlights
Juvenile idiopathic arthritis (JIA) can cause osseous deformity in the temporomandibular joint (TMJ) and may impair mandibular growth
Previous reports indicate that certain facial morphological features, such as an antegonial notching or chin asymmetry, could be interpreted as signs of impaired growth representing a structural damage in the TMJ [11, 12]
With the introduction of three-dimensional (3D) photography as documentation method for facial morphology [14], it is assumed that the diagnostic value of facial assessment to detect TMJ involvement can be increased
Summary
Juvenile idiopathic arthritis (JIA) can cause osseous deformity in the temporomandibular joint (TMJ) and may impair mandibular growth. This study aimed to evaluate whether facial asymmetry determined clinically or by morphometric analysis of three-dimensional (3D) photographs in JIA patients is associated with an asymmetric affection of theTMJ. Juvenile idiopathic arthritis (JIA) is a term that encompasses all forms of autoimmune, non-infective inflammatory joint diseases of unknown aetiology with an onset before the age of 16 years [1]. It is the most common rheumatoid disorder in childhood [2], with an estimated involvement of the temporomandibular joint (TMJ) in approximately 40–96% of the children [3]. The advocated advantages of an evaluation of the face by means of stereophotogrammetry include an improved reproducibility, high spatial resolution, and no ionizing radiation, and the possibility to conduct quantitative analyses from morphometric measurements
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