Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study

Muhammed Enes Naralan; Binali Çakır

Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study

Abstract

Aims: This pilot study aimed to investigate the relationship between petrotympanic fissure (PTF) classification and mandibular condyle morphology using cone-beam computed tomography (CBCT), and to analyze the effects of age and sex on these anatomical characteristics. Methods: A retrospective, cross-sectional analysis was conducted on 88 patients, yielding 176 temporomandibular joints (TMJs). PTF types were categorized on sagittal CBCT sections according to Sato’s classification (Types 1-3), while condylar morphology was assessed on coronal sections using the Yale system (Types 1-4). To maintain statistical independence, right and left joints were evaluated separately. A supplementary analysis was performed on the pooled dataset. Associations were evaluated using Pearson’s chi-square with permutation-derived p-values. A multinomial logistic regression model incorporating intra-patient clustering was applied for multivariate analysis. Results: The cohort mean age was 36.0±13.2 years; 79.5% were female. No significant association between PTF type and condylar morphology was detected in side-specific analyses (Right: p=0.252; Left: p=0.244). A marginal association emerged only in the pooled analysis (χ²=13.12, p=0.041), which is interpreted as a statistical artifact driven by duplicated TMJ counts and within subject dependency, rather than a biologically meaningful correlation. Multivariate modelling demonstrated a weak inverse association between age and Type 4 condylar form (p=0.028). Sex did not exert a significant influence on morphology. Conclusion: When analyzed under conditions that respect joint independence, PTF type is not correlated with condylar morphology. Observed pooled-data significance reflects sample inflation bias. PTF classification should therefore not be used as a clinical predictor of condylar shape.

Keywords

Supporting Institution

None

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Ataturk University, Faculty of Dentistry (Approval No: 05/2025:50).

Thanks

None

References

Almăşan OC, Hedeşiu M, Băciuţ G, Leucuţa DC, Băciuţ M. Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders. Clin Oral Investig. 2013;17(4):1243-1250. doi:10.1007/s00784-012-0803-4
Kinniburgh RD, Major PW, Nebbe B, West K, Glover KE. Osseous morphology and spatial relationships of the temporomandibular joint: comparisons of normal and anterior disc positions. Angle Orthod. 2000;70(1):70-80. doi:10.1043/0003-3219(2000)070<0070:OMASRO>2.0.CO;2
Kurita H, Kojima Y, Nakatsuka A, Koike T, Kobayashi H, Kurashina K. Relationship between temporomandibular joint (TMJ)-related pain and morphological changes of the TMJ condyle in patients with temporomandibular disorders. Dentomaxillofac Radiol. 2004;33(5):329-333. doi:10.1259/dmfr/13269559
Liu ZJ, Yamagata K, Kuroe K, Suenaga S, Noikura T, Ito G. Morphological and positional assessments of TMJ components and lateral pterygoid muscle in relation to symptoms and occlusion of patients with temporomandibular disorders. J Oral Rehabil. 2000;27(10):860-874. doi: 10.1046/j.1365-2842.2000.00622.x
Palconet G, Ludlow JB, Tyndall DA, Lim PF. Correlating cone beam CT results with temporomandibular joint pain of osteoarthritic origin. Dentomaxillofac Radiol. 2012;41(2):126-130. doi:10.1259/dmfr/60489374
Roberts WE, Goodacre CJ. The temporomandibular joint: a critical review of life-support functions, development, articular surfaces, biomechanics and degeneration. J Prosthodont. 2020;29(9):772-779. doi: 10.1111/jopr.13203
Tun Oo L, Miyamoto JJ, Takada JI, Cheng SE, Yoshizawa H, Moriyama K. Three-dimensional characteristics of temporomandibular joint morphology and condylar movement in patients with mandibular asymmetry. Prog Orthod. 2022;23(1):50. doi:10.1186/s40510-022-00445-0
Ye C, Fan P, Zhang J, Cheng Q, Xiong X, Wang J. Craniofacial morphology of temporomandibular disorder patients with different disc positions: stratifying features based on sex and sagittal skeletal pattern. J Clin Med. 2023;12(2):652. doi:10.3390/jcm12020652

Sencimen M, Varol A, Baykal B, et al. Histological characteristics of ligaments between the middle ear and temporomandibular joint. Eur J Dent. 2009;3(4):280-284. doi:10.1055/s-0039-1697445
Almășan O, Leucuța DC, Dinu C, Buduru S, Băciuț M, Hedeșiu M. Petrotympanic fissure architecture and malleus location in temporomandibular joint disorders. Tomography. 2022;8(5):2460-2470. doi:10.3390/tomography8050204
Eberliköse H, Tuğtağ Demir B, Akbarihamed R, Karasu HA. Association of anatomical features of the petrotympanic fissure and presence of foramen of Huschke with temporomandibular disorders. J Oral Rehabil. 2025;52(5):597-603. doi:10.1111/joor.13923
Kijak E, Szczepek AJ, Margielewicz J. Association between anatomical features of petrotympanic fissure and tinnitus in patients with temporomandibular joint disorder using CBCT imaging: an exploratory study. Pain Res Manag. 2020;2020:1202751. doi:10.1155/2020/1202751
Caruso S, Storti E, Nota A, Ehsani S, Gatto R. Temporomandibular joint anatomy assessed by CBCT images. Biomed Res Int. 2017;2017:2916953. doi:10.1155/2017/2916953
Holberg C, Steinhäuser S, Geis P, Rudzki-Janson I. Cone-beam computed tomography in orthodontics: benefits and limitations. J Orofac Orthop. 2005;66(6):434-444. doi:10.1007/s00056-005-0519-z
Buckens CF, de Jong PA, Mol C, et al. Intra and interobserver reliability and agreement of semiquantitative vertebral fracture assessment on chest computed tomography. PLoS One. 2013;8(8):e71204. doi:10.1371/journal.pone.0071204
Olch AJ, Alaei P. How low can you go? A CBCT dose reduction study. J Appl Clin Med Phys. 2021;22(2):85-89. doi:10.1002/acm2.13164
Prarthana G, Krishna S, Deepak T, Pawar VR, Ramnarayan B, Lokapriya M. Association between clinical diagnosis of temporomandibular disorders using Research Diagnostic Criteria and morphological changes of the condyle and abnormal joint spaces using CBCT. J Indian Acad Oral Med Radiol. 2023;35(4):577-582. doi:10.4103/jiaomr.jiaomr_121_21
Costa Mendes L, Delrieu J, Gillet C, Telmon N, Maret D, Savall F. Sexual dimorphism of the mandibular conformational changes in aging human adults: a multislice computed tomographic study by geometric morphometrics. PLoS One. 2021;16(6):e0253564. doi:10.1371/journal.pone.0253564
Nikita E. Age-associated variation and sexual dimorphism in adult cranial morphology: implications in anthropological studies. Int J Osteoarchaeol. 2014;24(5):557-569. doi:10.1002/oa.2241
Rieder CE, Martinoff JT. Comparison of the multiphasic dysfunction profile with lateral transcranial radiographs. J Prosthet Dent. 1984;52(4): 572-580. doi:10.1016/0022-3913(84)90351-2
Lei J, Han J, Liu M, Zhang Y, Yap AU, Fu KY. Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults. J Craniomaxillofac Surg. 2017;45(3):408-413. doi:10.1016/j.jcms.2016.12.017
Ariyürek OM, Karabulut N, Yelgeç NS, Gülsün M. Anatomy of the minor fissure: assessment with high-resolution CT and classification. Eur Radiol. 2002;12(1):175-180. doi:10.1007/s003300100907
Sato I, Arai H, Asaumi R, Imura K, Kawai T, Yosue T. Classifications of tunnel-like structure of human petrotympanic fissure by cone beam CT. Surg Radiol Anat. 2008;30(4):323-326. doi:10.1007/s00276-008-0327-4
Yale SH, Ceballos M, Kresnoff CS, Hauptfuehrer JD. Some observations on the classification of mandibular condyle types. Oral Surg Oral Med Oral Pathol. 1963;16:572-577. doi:10.1016/0030-4220(63)90146-4
Heinze G. A comparative investigation of methods for logistic regression with separated or nearly separated data. Stat Med. 2006;25(24):4216-4226. doi:10.1002/sim.2687
Ahmed J, Sujir N, Shenoy N, Binnal A, Ongole R. Morphological assessment of TMJ spaces, mandibular condyle, and glenoid fossa using cone beam computed tomography (CBCT): a retrospective analysis. Indian J Radiol Imaging. 2021;31(1):78-85. doi:10.1055/s-0041-1729488
Almpani K, Tran H, Ferri A, Hung M. Assessment of condylar anatomy and degenerative changes in temporomandibular joint disorders-a scoping review. J Oral Biol Craniofac Res. 2023;13(6):764-780. doi:10. 1016/j.jobcr.2023.10.004
Huang FL, Zhang B, Li X. Using robust standard errors for the analysis of binary outcomes with a small number of clusters. J Res Educ Eff. 2023; 16(2):213-245. doi:10.1080/19345747.2022.2100301
Iliescu AR, Capitaneanu CV, Hürter D, Fieuws S, De Tobel J, Thevissen PW. Quantifying the potential of morphological parameters for human dental identification: part 3-selecting the strongest skeletal identifiers in the mandible. Int J Legal Med. 2022;136(6):1811-1820. doi:10.1007/s00414-022-02852-8
Barghan S, Tetradis S, Mallya S. Application of cone beam computed tomography for assessment of the temporomandibular joints. Aust Dent J. 2012;57(Suppl 1):109-118. doi:10.1111/j.1834-7819.2011.01663.x
Friendly M. Mosaic displays for multi-way contingency tables. J Am Stat Assoc. 1994;89(425):190-200. doi:10.1080/01621459.1994.10476460
Bevan JC. Consent in the crossfire. Can J Anaesth. 2008;55(8):495-500. doi:10.1007/BF03016668
Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14(17):1933-1940. doi:10.1002/sim.4780141709

Details

Primary Language

English

Subjects

Oral and Maxillofacial Radiology

Journal Section

Research Article

Authors

Muhammed Enes Naralan ^*
0000-0002-2444-4322
Türkiye

Binali Çakır
0000-0002-8525-1444
Türkiye

Publication Date

May 22, 2026

Submission Date

December 16, 2025

Acceptance Date

March 25, 2026

Published in Issue

Year 2026 Volume: 8 Number: 3

IZ

https://izlik.org/JA97GD74NW

Cite

RIS / Bibtex

APA

Naralan, M. E., & Çakır, B. (2026). Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study. Anatolian Current Medical Journal, 8(3), 417-423. https://izlik.org/JA97GD74NW

AMA

1.Naralan ME, Çakır B. Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study. Anatolian Curr Med J / ACMJ / acmj. 2026;8(3):417-423. https://izlik.org/JA97GD74NW

Chicago

Naralan, Muhammed Enes, and Binali Çakır. 2026. “Association Between Petrotympanic Fissure and Condylar Morphology on CBCT: A Retrospective Pilot Study”. Anatolian Current Medical Journal 8 (3): 417-23. https://izlik.org/JA97GD74NW.

EndNote

Naralan ME, Çakır B (May 1, 2026) Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study. Anatolian Current Medical Journal 8 3 417–423.

IEEE

[1]M. E. Naralan and B. Çakır, “Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study”, Anatolian Curr Med J / ACMJ / acmj, vol. 8, no. 3, pp. 417–423, May 2026, [Online]. Available: https://izlik.org/JA97GD74NW

ISNAD

Naralan, Muhammed Enes - Çakır, Binali. “Association Between Petrotympanic Fissure and Condylar Morphology on CBCT: A Retrospective Pilot Study”. Anatolian Current Medical Journal 8/3 (May 1, 2026): 417-423. https://izlik.org/JA97GD74NW.

JAMA

1.Naralan ME, Çakır B. Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study. Anatolian Curr Med J / ACMJ / acmj. 2026;8:417–423.

MLA

Naralan, Muhammed Enes, and Binali Çakır. “Association Between Petrotympanic Fissure and Condylar Morphology on CBCT: A Retrospective Pilot Study”. Anatolian Current Medical Journal, vol. 8, no. 3, May 2026, pp. 417-23, https://izlik.org/JA97GD74NW.

Vancouver

1.Muhammed Enes Naralan, Binali Çakır. Association between petrotympanic fissure and condylar morphology on CBCT: a retrospective pilot study. Anatolian Curr Med J / ACMJ / acmj [Internet]. 2026 May 1;8(3):417-23. Available from: https://izlik.org/JA97GD74NW