{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:57:59Z","timestamp":1792612679422,"version":"4.5.0"},"reference-count":53,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T00:00:00Z","timestamp":1776902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Facial asymmetry in patients with dentofacial deformity is often associated with occlusal asymmetry, functional differences in mastication, and temporomandibular joint (TMJ) conditions. However, side-to-side differences in the stability of masticatory movement and their relationship with oral function have not been fully clarified. Therefore, this study aimed to investigate differences in masticatory movement, oral function, and the prevalence of MRI-based structural features of the temporomandibular joint between the deviated and non-deviated sides in patients with facial asymmetry. Methods: Twenty-one patients with dentofacial deformity and facial asymmetry were included in this study. Oral function was evaluated by measuring occlusal contact area, occlusal force, and masticatory performance. Masticatory movement was recorded using a mandibular movement recording system, and parameters related to the masticatory path and chewing speed were calculated. The stability of masticatory movement was evaluated using the variance of these parameters across chewing cycles. Temporomandibular joint structural features were assessed using CT and MRI. Comparisons between the deviated and non-deviated sides were performed using paired statistical tests. Results: Occlusal contact area and occlusal force were significantly greater on the deviated side than on the non-deviated side (p = 0.001 and p = 0.006, respectively), whereas no significant difference was observed in masticatory performance (p = 0.211). The deviated side showed a smaller closing angle (p = 0.005) and maximum lateral amplitude (p = 0.019), indicating a more vertical chewing pattern. The stability of masticatory movement, evaluated using the variance of masticatory path and velocity parameters, was significantly greater on the deviated side (e.g., variance of cycle axis angle, p = 0.002; variance of maximum closing velocity, p = 0.006). In addition, the prevalence of imaging-based structural features of the temporomandibular joint was significantly higher on the deviated side (p = 0.016). Conclusions: Patients with dentofacial deformity and facial asymmetry were associated with functional asymmetry between the deviated and non-deviated sides. The deviated side showed greater occlusal contact area, occlusal force, and stability of masticatory movement. These findings suggest that the deviated side may be functionally favorable for mastication and may be related to a tendency toward preferential chewing behavior. However, because the habitual chewing side was not directly evaluated in the present study, this interpretation should be considered cautiously and viewed as hypothesis-generating.<\/jats:p>","DOI":"10.3390\/diagnostics16091274","type":"journal-article","created":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T17:04:59Z","timestamp":1776963899000},"page":"1274","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Differences in Oral Function, Masticatory Movement, and MRI-Based Structural Features of the Temporomandibular Joint Between the Deviated and Non-Deviated Sides in Patients with Facial Asymmetry"],"prefix":"10.3390","volume":"16","author":[{"given":"Rintaro","family":"Kubo","sequence":"first","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Syunnosuke","family":"Toyama","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudai","family":"Shimpo","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiichiro","family":"Mizokami","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Kaneda","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minami","family":"Seki","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Tomonari","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Tsurumi University School of Dental Medicine, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"172","DOI":"10.4041\/kjod21.236","article-title":"Comparison of the bite force and occlusal contact area of the deviated and non-deviated sides after intraoral vertical ramus osteotomy in skeletal Class III patients with mandibular asymmetry: Two-year follow-up","volume":"52","author":"Kwon","year":"2022","journal-title":"Korean J. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1111\/j.1365-2842.2007.01837.x","article-title":"Occlusal pressure, contact area, force and the correlation with the morphology of the jaw-closing muscles in patients with skeletal mandibular asymmetry","volume":"35","author":"Goto","year":"2008","journal-title":"J. Oral Rehabil."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.7181\/acfs.2015.16.1.1","article-title":"Analysis of facial asymmetry","volume":"16","author":"Choi","year":"2015","journal-title":"Arch. Craniofac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1016\/j.ijom.2015.03.015","article-title":"Changes in occlusal function after orthognathic surgery in mandibular prognathism with and without asymmetry","volume":"44","author":"Moroi","year":"2015","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"341","DOI":"10.37358\/MP.19.2.5183","article-title":"Comparative Study on the Efficiency of Intermaxillary Elastic Polymers Used in the Treatment of Skeletal Class II Malocclusions in Growing Patients","volume":"56","author":"Vaida","year":"2019","journal-title":"Mater. Plast."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"481","DOI":"10.4103\/jispcd.JISPCD_130_21","article-title":"Correlations between mandibular asymmetries and temporomandibular disorders: A systematic review","volume":"11","author":"Alqhtani","year":"2021","journal-title":"J. Int. Soc. Prev. Community Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/ocr.12404","article-title":"Are temporomandibular joint disorders associated with facial asymmetry? A systematic review and meta-analysis","volume":"24","author":"Marques","year":"2021","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1007\/s10006-025-01400-z","article-title":"Clinical and radiographic features of temporomandibular joint in patients with facial asymmetry","volume":"29","author":"Otake","year":"2025","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1016\/j.tripleo.2005.05.063","article-title":"Correlation of mandibular deviation with temporomandibular joint MR dimensions, MR disk position, and clinical symptoms","volume":"100","author":"Goto","year":"2005","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1007\/s10006-013-0424-3","article-title":"Factors related to the prevalence of anterior disc displacement without reduction and bony changes of the temporomandibular joint in patients with facial asymmetry","volume":"18","author":"Ooi","year":"2013","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1016\/j.ajodo.2009.07.025","article-title":"Relative contributions of occlusion, maximum bite force, and chewing cycle kinematics to masticatory performance","volume":"139","author":"Lepley","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"525","DOI":"10.2186\/jjps.21.525","article-title":"Effect of the oral sensory function on the activities of masticatory muscles","volume":"21","author":"Yamashina","year":"1977","journal-title":"J. Jpn. Soc. Prosthodont."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2329\/perio.30.22","article-title":"Masseter muscle reflex evoked by electrical stimulation of periodontal tissues in human subjects: Periodontal-masseteric reflex","volume":"30","author":"Oba","year":"1988","journal-title":"J. Jpn. Soc. Periodontol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/j.1365-2842.2004.01326.x","article-title":"Stabilization of jaw-closing movements during chewing after correction of incisor crossbite","volume":"31","author":"Yashiro","year":"2004","journal-title":"J. Oral Rehabil."},{"key":"ref_15","first-page":"64","article-title":"Response of elevator activity during mastication to treatment of functional disorders","volume":"92","author":"Sheikholeslam","year":"1984","journal-title":"Scand. J. Dent. Res."},{"key":"ref_16","first-page":"7","article-title":"Occlusal harmony and disharmony: Frauds in clinical dentistry?","volume":"38","author":"Bakke","year":"1988","journal-title":"Int. Dent. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1054\/bjom.2000.0576","article-title":"Changes in masticatory function after orthognathic treatment in patients with mandibular prognathism","volume":"39","author":"Kobayashi","year":"2001","journal-title":"Br. J. Oral Maxillofac. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.7144\/sgf.18.152","article-title":"Effect of habitual side on masticatory function","volume":"18","author":"Sakaguchi","year":"2012","journal-title":"J. Jpn. Soc. Stomatognathic Funct."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"22","DOI":"10.4103\/jofs.jofs_74_16","article-title":"Chewing side preference\u2014Impact on facial symmetry, dentition and temporomandibular joint and its correlation with handedness","volume":"9","author":"Tiwari","year":"2017","journal-title":"J. Orofac. Sci."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Str\u00f3\u017cyk, P., and Ba\u0142chanowski, J. (2023). Application of numerical simulation studies to determine dynamic loads acting on the human masticatory system during unilateral chewing of selected foods. Front. Bioeng. Biotechnol., 11.","DOI":"10.3389\/fbioe.2023.993274"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Fukagawa, Y., Ooi, K., Nishino, S., Sasajima, Y., Ueki, K., Jokaji, R., Nakade, Y., Okita, H., Yahata, T., and Kawashiri, S. (2025). Relationships Among Non-Functional Occlusal Habits, Temporomandibular Disorder Symptoms, and Skeletal Morphology in Patients with Dentofacial Deformities. J. Clin. Med., 14.","DOI":"10.3390\/jcm14238330"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"5604068","DOI":"10.1155\/2017\/5604068","article-title":"Analyzing menton deviation in posteroanterior cephalogram in early detection of temporomandibular disorder","volume":"2017","author":"Boel","year":"2017","journal-title":"Int. J. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1016\/j.joms.2009.04.039","article-title":"Characteristics and corrective outcome of face asymmetry by orthognathic surgery","volume":"67","author":"Ko","year":"2009","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kaneda, M., Shimpo, Y., Yoshida, K., Kubo, R., Kobayashi, F., Mishima, A., Igarashi, C., and Tomonari, H. (2025). Structural features of the temporomandibular joint evaluated by MRI and their association with oral function and craniofacial morphology in female patients with malocclusion: A cross-sectional study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144921"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.jpor.2008.08.007","article-title":"Usefulness of indicators for stability of masticatory movement path","volume":"53","author":"Shiga","year":"2009","journal-title":"J. Prosthodont. Res."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Han, X., Hattori, M., Sumita, Y.I., Haraguchi, M., and Wakabayashi, N. (2024). Factors Related to Masticatory Rhythm in Patients with Oral Tumors. J. Clin. Med., 13.","DOI":"10.3390\/jcm13071926"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1080\/08869634.1992.11677897","article-title":"Classification of temporomandibular joint osteoarthrosis and internal derangement. I. Diagnostic significance of clinical and radiographic symptoms and signs","volume":"10","author":"Stegenga","year":"1992","journal-title":"Cranio"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1148\/radiology.186.3.8430181","article-title":"Temporomandibular joint: Diagnostic accuracy with sagittal and coronal MR imaging","volume":"196","author":"Tasaki","year":"1993","journal-title":"Radiology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1054\/ijom.2000.0017","article-title":"MR grading of temporomandibular joint fluid: Association with disk displacement categories, condyle marrow abnormalities and pain","volume":"30","author":"Larheim","year":"2001","journal-title":"Int. J. Oral Maxillofac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1179\/2151090314Y.0000000038","article-title":"Quantitative measurements of the articular areas of mandibular condyles with temporomandibular joint disorders using magnetic resonance imaging","volume":"34","author":"Kohi","year":"2016","journal-title":"Cranio"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.oooo.2022.09.008","article-title":"Clinical and magnetic resonance imaging findings in patients with and without improvement after mandibular manipulation and conservative physical therapy for temporomandibular joint disorders","volume":"135","author":"Igarashi","year":"2023","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Nota, A., Pittari, L., Monticciolo, F.M., Lannes, A.C., and Tecco, S. (2024). Correlations between mandibular kinematics and electromyography during the masticatory cycle: An observational study by digital analysis. Appl. Sci., 14.","DOI":"10.3390\/app14219996"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kinoshita, K., Ogino, Y., Oki, K., Yamasaki, Y., Tsukiyama, Y., Ayukawa, Y., and Koyano, K. (2021). A prospective comparative study of mastication predominance and masticatory performance in Kennedy Class I patients. Healthcare, 9.","DOI":"10.3390\/healthcare9060660"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1590\/S1806-83242011005000014","article-title":"Chewing side, bite force symmetry, and occlusal contact area of subjects with different facial vertical patterns","volume":"25","author":"Gomes","year":"2011","journal-title":"Braz. Oral Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.ajodo.2016.11.023","article-title":"Relationship between molar occlusion and masticatory movement in lateral deviation of the mandible","volume":"151","author":"Suzuki","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1053\/j.sodo.2006.01.007","article-title":"Chewing patterns in subjects with normal occlusion and with malocclusions","volume":"12","year":"2006","journal-title":"Semin. Orthod."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/joor.12222","article-title":"First molar cross-bite is more closely associated with a reverse chewing cycle than anterior or pre-molar cross-bite during mastication","volume":"41","author":"Tomonari","year":"2014","journal-title":"J. Oral Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jpor.2009.04.001","article-title":"Differences in masticatory function of subjects with different closing path","volume":"53","author":"Kobayashi","year":"2009","journal-title":"J. Prosthodont. Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2186\/jjps.49.65","article-title":"The relationship between masticatory path pattern and masticatory efficiency in gumi-jelly chewing","volume":"49","author":"Unno","year":"2005","journal-title":"J. Jpn. Soc. Prosthodont."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.archoralbio.2008.09.006","article-title":"Relationship between chewing side preference and handedness and lateral asymmetry of peripheral factors","volume":"54","author":"Palau","year":"2009","journal-title":"Arch. Oral Biol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"195","DOI":"10.2334\/josnusd.23-0101","article-title":"Path pattern and movement during mastication on habitual and non-habitual chewing sides","volume":"65","author":"Shiga","year":"2023","journal-title":"J. Oral Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1480","DOI":"10.1016\/j.joms.2006.03.036","article-title":"Relationship between the morphologies of the masseter muscle and the ramus and occlusal force in patients with mandibular prognathism","volume":"64","author":"Ueki","year":"2006","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1111\/joor.13646","article-title":"Evaluation of the effect of unilateral mastication on the morphology of temporomandibular joint from the perspective of dynamic joint space","volume":"51","author":"Ma","year":"2024","journal-title":"J. Oral Rehabil."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.archoralbio.2017.05.006","article-title":"Differences between the chewing and non-chewing sides of the mandibular first molars and condyles in the closing phase during chewing in normal subjects","volume":"81","author":"Tomonari","year":"2017","journal-title":"Arch. Oral Biol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.tripleo.2010.04.032","article-title":"Diagnosis and treatment of temporomandibular disorders: Emergence of a new care guidelines statement","volume":"110","author":"Greene","year":"2010","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod."},{"key":"ref_46","first-page":"116","article-title":"Etiological factors of temporomandibular joint disorders","volume":"2","author":"Sharma","year":"2011","journal-title":"Healthcare"},{"key":"ref_47","first-page":"27","article-title":"Oral impacts on quality of life in adult patients with Class I, II and III malocclusion","volume":"14","author":"Javed","year":"2016","journal-title":"Oral Health Prev. Dent."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1177\/154405910308200708","article-title":"Biomechanics of the human temporomandibular joint during chewing","volume":"82","author":"Naeije","year":"2003","journal-title":"J. Dent. Res."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"6","DOI":"10.11607\/jop.1151","article-title":"Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD) for Clinical and Research Applications: Recommendations of the International RDC\/TMD Consortium Network and Orofacial Pain Special Interest Group","volume":"28","author":"Schiffman","year":"2014","journal-title":"J. Oral Facial Pain Headache"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"5","DOI":"10.17219\/dmp\/181149","article-title":"Diagnostic Criteria for Temporomandibular Disorders (DC\/TMD): Polish assessment instruments","volume":"61","author":"Osiewicz","year":"2024","journal-title":"Dent. Med. Probl."},{"key":"ref_51","first-page":"1","article-title":"Reliability and validity of a quantitative color scale to evaluate masticatory performance using color-changeable chewing gum","volume":"61","author":"Hama","year":"2014","journal-title":"J. Med. Dent. Sci."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/j.1365-2842.2011.02204.x","article-title":"Association between masticatory performance using a colour-changeable chewing gum and jaw movement","volume":"38","author":"Komagamine","year":"2011","journal-title":"J. Oral Rehabil."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1111\/ors.12473","article-title":"Temporomandibular disorders: A review of current concepts in aetiology, diagnosis and management","volume":"13","author":"Kapos","year":"2020","journal-title":"Oral Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1274\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T04:22:11Z","timestamp":1778300531000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/9\/1274"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,23]]},"references-count":53,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["diagnostics16091274"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16091274","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,23]]}}}