Maxillomandibular asymmetries and cranio-vertebral morphostructural and postural alterations.Report 2.Atlo-occipital-vertebral and postural modifications

Aims The Authors performed an anatomical and structural CT and MR analysis of the skull base in 75 subjects with maxillomandibular asymmetries and suffering from cranio-cervical-mandibular pain sindrome, brachialgias, postural alterations. This study revealed a spatial alteration of the skull base and morphological and structural alterations of the “gleno-occipital-mastoid triangle” defined by the Authors in the skull base on the one and on the other hand of the median line. These reliefs have been described in the Report 1. In this paper the Authors point out the morphological, structural and spatial alterations of the glenoid temporal fossae and of the occipital condyles which constitute two of the vertices of the above-mentioned triangle (the third vertex is the mastoid process). Materials and Methods Standardized CT and MR studies are performed on the skull base and cranio-vertebral structures of 75 subjects with maxillomandibular asymmetries (39 mandibular asymmetries, 23 maxillary asymmetries, 13 maxillomandibular asymmetries) and suffering from temporomandibular pain syndrome, vertebral and brachial pain and postural troubles. Results and Conclusions The alterations of the glenoid structures and of the occipital condyles cause in the subjects with maxillomandibular asymmetries, respectively, an asymmetric arrangement of the temporomandibular joints with repercussions on the mandibular condyles (spatial and structural alterations) and a modification of the articular atlo-occipital relations and of the atlo-occipital-epistrophical complex. These alterations are worse because of the changes of the atlas (rotations in the spatial planes). A biomechanical impairment of the cranio-mandibular-occipital-atlo-epistrophical system and of the cervical and vertebral column establish. Indeed evident changes of the intervertebral joints are present with postural alterations as modifications of the lordosis but mostly cervical, dorsal and lumbar scoliosis. These alterations found the anatomical, structural and physiopathological substratum of the cervical, brachial and vertebral pain syndromes. The Authors point out that the surgical correction of the maxillomandibular asymmetry beared the resolution of the algic troubles more than 70% of the cases. At present these data are subjected to statistical analysis.