Tomographic assessment of glenoid fossa morphology and position in symmetric and asymmetric patients

Objective: To assess positional and morphological characteristics of the glenoid fossa in patients with and without craniofacial asymmetry using cone-beam computed tomography (CBCT), and to identify structural adaptations associated with temporomandibular joint (TMJ) compensation. Methods: An observational study analyzed CBCT scans from 47 patients: 36 with facial asymmetry and 11 symmetric controls. Morphometric measurements (vertical, anteroposterior, and transverse positions; angular and depth parameters) were taken in sagittal, coronal, and axial planes using standardized anatomical references. Statistical analyses included independent and t-tests, Wilcoxon signed-rank tests, multivariate analysis of variance (MANOVA), and Pearson correlations. Results: Asymmetric patients showed significantly greater anteroposterior displacement of the glenoid cavity (anteroposterior location of the glenoid cavity in millimeters (APCGmm): 8.42 ± 8.01 mm vs. 4.19 ± 2.41 mm, p = 0.011) and reduced axial angulation (axial angulation of the glenoid cavity in degrees (AAGC°): 62.96° ± 8.24° vs. 66.01° ± 4.18°, p = 0.032) compared with symmetric controls. Transverse angular variation (transverse angulation of the glenoid cavity in degrees (TMGC°)) was also significantly higher in asymmetric patients (56.24° ± 7.94° vs. 52.95° ± 7.63°, p = 0.046). The contralateral side exhibited greater glenoid cavity depth and height. Correlation heatmaps demonstrated an inverse relationship between APCGmm and AAGC°, suggesting a rotational compensatory mechanism. MANOVA confirmed significant overall morphometric differences between groups (p < 0.05). Conclusion: CBCT-based evaluation reveals distinct morphological adaptations in the glenoid fossa of asymmetric patients, including anterior displacement, rotational shifts, and contralateral deepening. These findings support the concept of compensatory TMJ remodeling in response to craniofacial imbalance. The integration of three-dimensional morphometric and angular data enhances diagnostic precision and can inform orthodontic and surgical planning.