The aim of the study was to determine and classify the shape of the mandibular fossa and the corresponding condyle in different types, relating them to sex and symmetry, in adult human skulls, from lateral, posterior and superior views. The sample included 50 human skulls from 23 to 82 years old, 32 males and 18 females. The condyle and silicone casting molds of the fossa were photographed to assess shape in the three views. Shapes were classified, validated by intra- and inter-rater analysis and frequency, sex distribution and symmetry verified. Shapes were classified as rounded, angled, flattened and mixed types in the lateral and posterior views; and as biconvex, flat-convex, biflattened and mixed in the superior view. Rounded condyle and fossa were more frequent in the lateral (57% and 66% respectively) and posterior (53% and 83%) views. In the superior view, mixed shape presented higher frequency in condyle (59%) while in fossa the biconvex shape (46%) was most common. There was no significant difference in shape distribution by sex. The same shape (symmetry) or otherwise (non-symmetry) in right and left side condyle and fossa were separately assessed and showed various combinations.

El objetivo del estudio fue determinar y clasificar la forma de la fosa mandibular y cóndilo correspondiente en diferentes tipos, relacionándolos con el sexo y la simetría en cráneos humanos adultos en perspectivas laterales, posteriores y superiores. La muestra incluyó 50 cráneos humanos de 32 hombres y 18 mujeres entre 23 a 82 años. Fueron fotografiados el cóndilo y moldes de silicona de la fosa para evaluar la forma en los tres puntos. Se clasificaron las formas, validadas por el análisis intra e inter-evaluador, la frecuencia, distribución por sexo y simetría verificada. Las formas fueron clasificadas como redondeada, en ángulo, aplanada y mixtas en las vistas lateral y posterior; y como biconvexa, convexo-plana, y mixta en la vista superior. En las vistas laterales el cóndilo y la fosa redondeada fueron más frecuentes (57% y 66%, respectivamente), mientras que en la vista posterior (53% y 83%). En la vista superior, la forma mixta presentó mayor frecuencia en el cóndilo (59%), mientras que en la fosa la forma biconvexa (46%) fue más común. No hubo diferencia significativa en la distribución de laforma por sexo. La misma forma (simétrica o no-simétrica) en el cóndilo lateral derecho e izquierdo y la fosa fueron evaluadas por separado, y se observaron varias combinaciones.

Based on the survey of records regarding the location and frequency of referred pain in patients with temporomandibular disorder when certain pre-established areas are palpated, we proposed an anatomical-topographical division of the head and neck to allow the standardization and reproducibility of locations of referred pain. Of the 835 charts reviewed, 419 (50.2%) patients had referred pain on palpation of the regions based on the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and palpation of the cervical regions, as often analyzed by the Cochran Q test. The concordance coefficient of Kendall examined the correlation between regions of referred pain concerning to palpated sites. The new regions were defined preauricular, facial lateral, temporoparietal, posterior head, posterior and lateral cervical, anterior cervical and calvaria. The region palpated that originated more referred pain was corresponding to the masseter muscle followed by the region of the sternocleidomastoid muscle, regardless of the side palpated. On palpation of the regions established by the RDC/TMD, the most frequent area of referred pain was the lateral facial region. On palpation of the neck, were the posterior and lateral cervical regions. The sites that originated more referred pain when palpated were the masseter, temporalis, sternocleidomastoid and trapezius muscles.

Basado en la encuesta de registros relativos a la ubicación y frecuencia de dolor referido en pacientes con trastorno temporomandibular al palpar ciertas áreas preestablecidas, propusimos una division topográfica anatómica de cabeza y cuello para permitir la estandarización y reproducibilidad de los lugares de dolor referido. Al examinar los gráficos de 835 sujetos, 419 un (50,2%) de los pacientes reportaron dolor referido a la palpación de las regiones sobre la base de los Criterios Diagnósticos para la Investigación de Trastornos Temporomandibulares (CDI/TTM) y palpación de la region cervical, con análisis de frecuencia con prueba de Cochran Q. El coeficiente de concordancia de Kendall examinó la correlación entre las regiones de dolor referido en relación a los sitios palpados. Las regiones nuevas fueron definidas como, pre-auricular, facial lateral, temporoparietal, cabeza posterior, posterior y lateral cervical, cervical anterior y bóveda craneal. La región de palpado en la cual se originó el dolor mencionado con mayor frecuencia, corresponde al músculo masetero, seguido por la región del músculo esternocleidomastoideo, independientemente del lado palpado. Durante la palpación de las regiones establecidas por los CDI/TTM, la zona más frecuente de dolor referido fue la región facial lateral. A la palpación del cuello, el dolor referido se reportó en la parte posterior y en las regiones cervicales laterales. Los sitios en los que se originó el mayor dolor referido a la palpación, fueron los músculos maseteros, músculos temporales, esternocleidomastoideo y trapecio.

INTRODUÇÃO: a disfunção temporomandibular (DTM) é uma doença multifatorial, geralmente com evolução benigna. Por esse motivo, é difícil a obtenção de um diagnóstico inicial preciso e correto, levando a um consenso na prescrição de tratamentos conservadores, entre eles, os exercícios terapêuticos, que são classificados em exercícios de alongamento, relaxamento, coordenação, fortalecimento e resistência. OBJETIVO: o objetivo desse estudo foi realizar uma revisão de literatura dos trabalhos que apresentam os tipos de exercícios disponíveis e sua eficácia para o tratamento das DTM musculares. MÉTODOS: foi feito um levantamento bibliográfico, de 2000 a 2010, nas bases se dados Web of Science, PubMed, LILACS e BBO, cruzando os seguintes descritores: exercise, physical therapy, facial pain, myofascial pain syndrome e temporomandibular joint disfunction syndrome. Foram excluídos os trabalhos que não consideravam o tema exercícios e DTM, utilizavam exercícios pós-cirúrgicos e que não utilizavam critérios validados para o diagnóstico da DTM (RDC/TMD). RESULTADOS: resultaram sete artigos, que mostraram que os exercícios terapêuticos foram efetivos para o tratamento de DTM muscular. No entanto, uma das limitações desses estudos foi a não utilização exclusiva dos exercícios durante o tratamento, mas sim sua associação com outros procedimentos conservadores. Outras dificuldades apresentadas foram as amostras pequenas, a falta de grupo controle e a não descrição minuciosa da realização do exercício quanto à intensidade, número de repetições, frequência e duração. CONCLUSÃO: apesar dos exercícios terapêuticos apresentarem eficácia no controle da DTM muscular, é necessário o desenvolvimento de ensaios clínicos randomizados sobre o assunto, pois, muitos dos trabalhos existentes ainda são baseados na experiência clínica do profissional.

INTRODUCTION: Temporomandibular disorder (TMD) is a multifactorial disease. For this reason, it is difficult to obtain an accurate and correct diagnosis. In this context, conservative treatments, including therapeutic exercises classified as stretching, relaxation, coordination, strengthening and endurance, are oftentimes prescribed. OBJECTIVE: Thus, the aim of the present article was to conduct a literature review concerning the types of exercises available and the efficacy for the treatment of muscular TMD. METHODS: The review included researches carried out between 2000 and 2010, indexed on Web of Science, PubMed, LILACS and BBO. Moreover, the following keywords were used: Exercise, physical therapy, facial pain, myofascial pain syndrome, and temporomandibular joint dysfunction syndrome. Studies that did not consider the subject "TMD and exercises", used post-surgery exercises and did not use validated criteria for the diagnosis of TMD (RDC/TMD) were not included. RESULTS: The results comprised seven articles which proved therapeutic exercises to be effective for the treatment of muscular TMD. However, these studies are seen as limited, since therapeutic exercises were not applied alone, but in association with other conservative procedures. In addition, they present some drawbacks such as: Small samples, lack of control group and no detailed exercise description which should have included intensity, repetition, frequency and duration. CONCLUSION: Although therapeutic exercises are considered effective in the management of muscular TMD, the development of randomized clinical trials is necessary, since many existing studies are still based on the clinical experience of professionals.