Craniofacial and shoulder asymmetry and its relationship to temporomandibular disorder: A study of 183 patients.

We conducted a prospective study to ascertain the prevalence of features of craniofacial and shoulder asymmetry and to determine if they are related to temporomandibular disorder (TMD). Our study population was made up of 183 patients-105 females and 78 males, aged 8 to 92 years (mean: 53.5; median: 60) who presented to a private otolaryngologic practice in a rural retirement community in Arizona. These patients completed a questionnaire to determine their self-assessment of the their body asymmetry. Next, all patients underwent a nurse evaluation for the presence or absence of asymmetry, which was based on the relative position of the ears, lateral canthi, hemimandibles, and shoulders. All patients were then evaluated independently by a physician for the presence or absence of TMD. The most important finding of this study was that asymmetry as determined by the nurse evaluation was associated with a relative risk of TMD of 5.89 (p = 0.0001); the perception of asymmetry on the patient self-assessments was associated with a relative risk of only 1.86 (p = 0.0026). We conclude that the recognition and diagnosis of TMD is significantly enhanced by a brief evaluation by a health professional who has been trained in recognizing the signs of facial and shoulder asymmetry.

Temporomandibular disorder and new aural symptoms.

OBJECTIVES: To report the prevalence and demographics of temporomandibular disorder (TMD) within a population of clinic patients and to describe the prevalence of revisited and new, previously unstudied, aural symptoms described by a sample of these patients with TMD (hereinafter "TMD patients"). DESIGN: A retrospective evaluation of patient records was completed to determine the percentage and the demographics of TMD patients in a clinical setting. A prospective analysis was done on the self-reported prevalence of previously studied and new aural symptoms of 78 TMD study patients compared with 78 control patients without TMD. SETTING: A private otolaryngology practice in a rural Arizona town. PATIENTS: Patients with TMD and aural symptoms. RESULTS: Ten percent of all new otolaryngology clinic patients were diagnosed as having TMD. Of the 78 patients, 27 (35%) listed the ear as one of their sites of pain. The prevalence of each of the 8 aural symptoms assessed was significantly higher in TMD patients compared with controls (P < .001). A warm and/or fluid sensation in the ear and a stuffed cotton sensation in the ear were the most indicative symptoms of TMD because they had the highest relative risk ratios in TMD patients. Aural symptoms of loud noise sensitivity and cold air/wind sensitivity are also relevant and were approximately 5 times more frequent in TMD subjects than in controls. CONCLUSIONS: Patients with TMD are a significant component of otolaryngology practice. There are previously uninvestigated aural symptoms that occur much more frequently in TMD patients than in patients without TMD.