MORPHOLOGICAL CHANGES OF THE TEMPOROMANDIBULAR JOINT IN WOMEN WITH TEMPOROMANDIBULAR JOINT DYSFUNCTION AND HORMONAL DISORDERS (BASED ON CBCT DATA)

Abstract

To determine the features of morphological changes in the temporomandibular joint (TMJ) in women with its dysfunction (TMD) against the background of systemic hormonal disorders using cone-beam computed tomography (CBCT) data and to establish the relationship of these changes with clinical manifestations assessed by the Helkimo Index (Di), taking into account the age factor. Materials and methods of the study. A prospective cohort study was conducted involving 207 women with an established diagnosis of TMD. Participants were divided into two groups: the main group (n=119) – patients with concomitant confirmed hormonal disorders (hypothyroidism, menopause, osteoporosis), and the comparison group (n=88) – women with TMD without endocrine pathology. All underwent a clinical examination with assessment of TMJ function using the Helkimo Index (Di) and bilateral CBCT scanning of the joints. Tomogram analysis included measurement of joint space width in three compartments, assessment of bone tissue density, detection and description of osteophytes, bone erosions, subchondral cysts, flattening and sclerosis of joint surfaces. The Statistica 10.0 package was used for statistical processing with the application of parametric and nonparametric criteria, as well as correlation analysis. Scientific novelty. For the first time on a significant clinical sample using an objective imaging method, a direct quantitative dependence between systemic hormonal disorders, particularly estrogen deficiency in postmenopause, and the accelerated development of specific degenerative-dystrophic changes in TMJ structures in women has been proven. It has been established that hormonal imbalance is an independent risk factor that significantly exacerbates joint space narrowing, leads to almost obligatory osteophyte formation and the appearance of bone defects, regardless of age, which had not been comprehensively documented before. The obtained data objectify the role of the endocrine component as a key driver of the progression of structural damage to the TMJ. Conclusions. The study revealed a statistically significant association between the presence of hormonal disorders and the severity of TMJ morphological changes, which progressed with age. In women with endocrine pathologies, the need for CBCT to diagnose degenerative changes sharply increased from 38.1% in the early reproductive period to 92.9% in postmenopause. In this group, critical narrowing of the joint space (to 1.2±0.7 mm in osteoporosis) and a 100% prevalence of osteophytes in older age were recorded, significantly exceeding the control indicators. These structural changes correlated with higher Helkimo Index values, confirming their clinical significance. Thus, systemic hormonal disorders are an important factor accelerating TMJ degeneration, necessitating the mandatory assessment of endocrine status in the comprehensive diagnosis and treatment of TMD in women