Clinic of Orthodontics and Paediatric Dentistry, Center of Dental Medicine, University of Zürich, Plattenstrasse 11, 8032, Zurich, Switzerland.
Department of Diagnostic Imaging, University Children's Hospital Zürich, Zurich, Switzerland.
Pediatr Rheumatol Online J. 2020 Jan 31;18(1):10. doi: 10.1186/s12969-020-0401-y.
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.
Of 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).
Twenty-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%).
For 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.
幼年特发性关节炎（JIA）可导致颞下颌关节（TMJ）的骨畸形，并可能影响下颌骨生长。本研究旨在评估 JIA 患者的临床或三维（3D）照片形态测量分析确定的面部不对称是否与 TMJ 的不对称受累有关。
76 例连续 JIA 患者，平均年龄 11.7 岁（范围：6.3-17.9 岁），通过临床（颏部不对称、下颌角不对称）和立体摄影术进行 3D 照片评估面部不对称。将面部表面标记出来，然后通过半自动地标进行镜像、叠加，并进行定量评估（颏部不对称、Hausdorff 距离）。临床和数字测量结果与从磁共振成像（MRI）得出的右和左 TMJ 受累诊断相关。
27 例（34%）患者存在 TMJ 不对称性骨畸形。通过临床评估，颏部不对称与不对称性骨破坏有关（p=0.02），但下颌角不对称无关（p=0.14）。关于基于 3D 照片的形态计量测量，颏部不对称也与不对称性骨破坏有关（p=0.01），但平均（p=0.06）和最大 Hausdorff 距离（p=0.67）无关。尽管有明显的意义，但颏部不对称的任何评估方法似乎都没有足够的预测价值（阳性预测值≤54%；决定系数≤7%）。
对于 JIA 患者的面部不对称评估，来自 3D 照片的形态计量测量似乎提供的结果与临床评估方法相当。面部，特别是颏部的不对称似乎与 TMJ 的不对称破坏有关，但所研究的面部测量方法均无法可靠地预测 TMJ 受累。因此，无论是在临床环境中定性评估还是基于 3D 照片的定量评估，面部不对称评估对 JIA 患者 TMJ 受累的诊断价值有限。
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