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International Journal of Advanced Engineering Research and Science (IJAERS) [Vol-6, Issue-6, June- 2019]

https://dx.doi.org/10.22161/ijaers.6.6.6 ISSN: 2349-6495(P) | 2456-1908(O)

Discomallear Ligament: A Review with a clinical


Approach
Thaisa Rebeca de Moura Vicente1, João Vitor Tadashi Cosin Shindo 1, Daniela
Vieira Buchaim2,3, Elio Hitoshi Shinohara4, Patrícia Lopes Alcântara1, Getúlio
Duarte Júnior2, Carlos Henrique Bertoni Reis2, Adriana do Socorro Lima
Figueiredo Flato 2, Rogério Leone Buchaim1,2*
1
Department of Biological Sciences (Anatomy), Bauru School of Dentistry, University of São Paulo (USP), Ba uru (SP) 17012-901, Bra zil
2
Postgraduate Program in Structural and Functional Interactions in Rehabilitation, University of M arilia (UNIM AR), M arília (SP) 17525-
902, Brazil
3
Department of Human Anatomy and Neuroanatomy, M edical School, University Center of Adamantina (UniFAI), Adamantina (SP)
17800-000, Brazil
4
School of Dentistry, Ibirapuera University , São Paulo (SP) 04661-100, Brazil
*Corresponding author: rogerio.buchaim@unimar.br

Abstract— The discomallear ligament is described as a temporomandibular joint, as well as the existence of the
fibrous connection that anatomically and functionally discomallear ligament and its possible influence on the
relates the malleus bone in the middle ear to the otologic symptoms caused by temporomandibular
posteromedial portion of the joint capsule through the disorders.
petrotympanic fissure. It is a structure that presents Keywords— Temporomandibular joint, Malleus, Middle
important clinical aspects, since it may be related to ear, Temporomandibular joint disorders.
otologic symptoms in temporomandibular joint
dysfunctions. The objective of the present study was to I. INTRODUCTION
perform a systematic review of the presence of the The stomatognathic system is closely related
discomallear ligament, its possible influences on otologic anatomically and ontologically to the region surrounding
symptoms and correlation with temporomandibular the middle ear structures (RAMÍREZ ARISTEGUIETA,
dysfunction. The analyzed sources of the literature review BALLESTEROS ACUÑA, & SANDOVAL ORTIZ,
were searched in PubMed, Scielo, Web of Science, Lilacs, 2009)(RODRÍGUEZ VÁZQUEZ, J, MERÍDA
Google Scholar and Ebsco databases through a VELASCO, J, & JIMÉNEZ COLLADO, 1993). The
combination of keywords. An analysis of anatomical discomallear ligament is one of the fibrous connections
specimens was performed through the inspection of 277 that relates the malleus to the posteromedial portion of the
adult skulls and 9 infant skulls, in order to verify the temporomandibular joint capsule (PINTO, 1962), is also
presence of foramina in the petrotympanic fissure on both described as a triangular-shaped band of connective tissue
sides. A computed tomography image was included in this whose base is continuous with the posterior region of the
study and showed a hypodense circular structure joint capsule and disc, which is directed to the middle ear
suggestive of foramen and possible passage of this through the petrotympanic fissure (COLEMAN, 1970).
ligament towards the disc of the temporomandibular Little mentioned in the anatomy books
joint. The evaluation of the anatomical parts showed that (MORGAN, 1982)(BOCHENEK & REICHER,
the adult skulls analyzed, about 90% had a foramen on 1997)(STANDRING, 2005)(ALVES & DEANA, 2010),
both sides, 1.44% on the right side only, 4.33% on the left the discomallear ligament was first referred to in 1954
side only and 3.61% did not present foramen in any of the (REES, 1954), but its detailed description was performed
sides. About the children's skulls, 33.3% had a foramen in 1962 and is also described and demonstrated by several
on both sides, 33.3% on the right side and 33.3% had no other authors (PINTO, 1962). It is a structure that
foramen on either side. In results, the methods evaluated penetrates the caudal end of Meckel's cartilage
and the studies analyzed show the anatomical corresponding to an embryological remnant of the lateral
relationship between the tympanic cavity and pterygoid muscle (CHEYNET, GUYOT, RICHARD,

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International Journal of Advanced Engineering Research and Science (IJAERS) [Vol-6, Issue-6, June- 2019]
https://dx.doi.org/10.22161/ijaers.6.6.6 ISSN: 2349-6495(P) | 2456-1908(O)

LAYOUN, & GOLA, 2003). However, other researchers 2.2 Anatomical Pieces Evaluation
stated that Meckel's cartilage has no influence on the This stage was based on a careful evaluation of
development of the temporomandibular joint and also that skulls belonging to the Department of Biological
during the embryonic stage there is no evidence that the Sciences, Anatomy Discipline of School of Dentistry of
lateral pterygoid muscle attaches to the malleus Bauru- University of São Paulo (FOB-USP). The
(FURSTMAN, 1963)(YUODELIS, 1966). inspection of the pieces was done with the naked eye and
The discomallear ligament is a structure that with the aid of a hand magnifier with lighting 75 mm in
presents important clinical aspects (ALVES & DEANA, diameter and increase of 6 times, of the brand Western
2010). Some authors state that dysfunctions in the 3455. It consisted in identifying the presence or absence
temporomandibular joint (TMD) cause alteration of the of foramina in the region of the petrotympanic fissure on
discomallear ligament, causing a displacement of the the left and right sides of 277 (two hundred and seventy -
malleus, resulting in some symptoms such as tinnitus and seven) adult skulls and 9 (nine) children skulls.
deafness (PINTO, 1962)(IOANNIDES & HOOGLAND,
1983). Although the risks of otological symptoms are 2.3 Data source
greater in individuals presenting with disorders such as This literature review contains information
pain during the opening and closing of the mouth or available in the databases PubMed, Scielo, Web of
palpation of the temporomandibular joint (PASCOAL, Science, Lilacs, Google Scholar and Ebsco, using the
2001)(LAM, LAWRENCE, & TENENBAUM, 2001). following keywords: discomallear ligament /
The origin and possible relations between these structures discomalleolar ligament, temporomandibular disorders,
are not fully understood (FELICIO, FARIA, & DA temporomandibular dysfunction, and petrotympanic
SILVA, 2004). This structure can usually be observed in fissure. This led to the initiation of a search strategy and
dissected anatomical pieces. However, it is also possible articles published between 2006 and 2016 were included,
to visualize it in concomitant computed tomography in using a keyword search to obtain information about the
sagittal sections. In the images, furthermore to discomallear ligament (figures 1-6).
discomallear ligament, structures related to
temporomandibular joint are also observed within the 2.4 Data extraction
petrotympanic fissure. In Cone Beam CT images, the After analyzing and reviewing the researched
petrotympanic fissure resembles a small lumen that scientific articles, ten relevant studies related to the
extends in the direction of the epitympanic recess in the objectives of the study were found. Several studies
upper portion of the tympanic cavity, where inferiorly the resulting from the research were read with the objective
malleus bone is located. Studies demonstrate the of identifying relevant information on the subject in
visualization in tomographic images and anatomical question.
pieces that discomallear ligament connects to the head
and anterior region of the malleus bone, disposed from
the posterior and superior portion of the mandibular fossa,
located in the temporal bone (ARAI & SATO, 2012).
Thus, the aim of the present study was to perform a
systematic review of the presence of the discomallear
ligament, its possible influences on otologic symptoms
and correlation with temporomandibular dysfunction .

II. MATERIALS AND METHODS


2.1 Computed tomography (CT)
A computed tomography image was used to
evaluate the presence of the discomallear ligament. The
image covers the region of a temporomandibular joint on Fig.1: Scielo Keywords combination.
the left side and was obtained by a scanner I-CAT CT
(Cone Beam Volumetric Tomography [I- Papers extracted from the Scielo database:
CATVisionProgram]). 1- Frequency of occurence of the discomalleolar
ligament in the adult man (ALVES; DEANA, 2010).

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International Journal of Advanced Engineering Research and Science (IJAERS) [Vol-6, Issue-6, June- 2019]
https://dx.doi.org/10.22161/ijaers.6.6.6 ISSN: 2349-6495(P) | 2456-1908(O)

Fig.2: PubMed Keywords combination.

Papers extracted from the PubMed database:


1- Prevalence of the types of the petrotympanic fissure
in the temporomandibular joint dysfunction (ÇAKUR et
al., 2011).
Fig.3: Web of Science Keywords combination.
2- Classifications of tunnel-like structure of human
petrotympanic fissure by cone beam CT (SATO et al.,
Papers extracted from the Web of Science
2008).
database:
1- Correlation between tinnitus and petrotympanic
fissure status among patients with temporomandibular
joint dysfunction (ÇAKUR; YASA, 2016).

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International Journal of Advanced Engineering Research and Science (IJAERS) [Vol-6, Issue-6, June- 2019]
https://dx.doi.org/10.22161/ijaers.6.6.6 ISSN: 2349-6495(P) | 2456-1908(O)

Fig.5: Google Scholar Keywords combination.

Fig.4: LILACS Keywords combination. Papers extracted from the Google Scholar
database:
Papers extracted from the LILACS database: 1- A direct anatomical study of the morphology and
1- Classifications of tunnel-like structure of human functionality of disco-malleolar and anterior malleolar
petrotympanic fissure by cone beam CT (SATO et al., ligaments (ARISTEGUIETA; ACUNA; ORTIZ, 2009).
2008). 2- Anatomical study of the human discomallear
ligament using cone beam computed tomography imaging
and morphological observations (ARAI; SATO, 2011).
3- A study of the discomalleolar ligament in the adult
human (ROWICKI; ZAKRZEWSKA, 2006).

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International Journal of Advanced Engineering Research and Science (IJAERS) [Vol-6, Issue-6, June- 2019]
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It can be observed that the tomographic image (figure


7) used in the present study has a circular hypodense
structure, in the region of the petrotympanic fissure, near
the mandibular fossa of the temporal bone, suggestive of
foramen and a possible passage of the discomallear
ligament towards posterior region of the joint capsule of
the disc of the temporomandibular joint.

Fig.7: Possible place of passage of the discomaleolar


ligament demonstrated by the red arrow.

The evaluation of the skulls resulted in two tables, one


for adult skulls (table 1) and one for children's skulls
(table 2). About adult skulls analyzed, 90% presented
foramen on both sides, 1.44% presented foramen only on
the right side, 4.33% presented foramen only on the left
side, and 3.61% presented no foramen on either side. Of
the children's skulls, 33.3% had a foramen on both sides,
33.3% on the right side, and 33.3% had no foramen on
either side. Two images were obtained (Figures 8 and 9)
in order to demonstrate to the naked eye, the presence of
the foramina in the petrotympanic fissure.
Table 1: Analysis of absence or presence of foramen in
the region of petrotympanic fissure in adult skulls.
BOTH JUS T ON JUS T ON
Fig.6: EBSCO Keywords combination. S IDES THE THE
RIGHT LEFT
Papers extracted from the EBSCO database: S IDE S IDE
1- Anatomical and functional aspects of ligaments ABS ENCE OF 10 X X
between the malleus and the temporomandibular joint FORAME
(SENCIMEN et al., 2008). PRES ENCE OF 251 4 12
FORAME
2- Signs and Symptoms of Temporomandibular Joint
Disorders Related to the Degree of Mouth Opening and Table 2: Analysis of absence or presence of foramen in
Hearing Loss (KITSOULIS et al., 2016). the region of petrotympanic fissure in children’s skulls.
3 - Ossification of the petrotympanic fissure: BOTH JUS T ON JUS T ON
morphological analysis and clinical implications S IDES THE RIGHT THE
(MONTEIRO; ENNES; ZORZATTO, 2011). S IDE LEFT
S IDE
ABS ENCE OF 3 X X
III. RESULTS
FORAME
Computed tomography (CT) and Anatomical
PRES ENCE OF 3 3 0
Pieces Evaluation
FORAME

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International Journal of Advanced Engineering Research and Science (IJAERS) [Vol-6, Issue-6, June- 2019]
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Fig.8: Presence of foramen in the petrotympanic fissure Fig.9: Presence of foramen in the petrotympanic
on the right side, demonstrated by the red arrow. fissure on the left side, demonstrated by the red arrow.

Literature review
After analyzing the combination of the keywords
used for this literature review, a table with a brief
summary of each of the extracted papers was obtained
(table 3).

Table 3: Summary of Articles included in this Review.


Authors Objective Methods Results Conclusion
Çakur et al. To investigate the 134 TMD patients In the DVT (dental The low percentage
(2011) prevalence of examined for type of tomography) scans, PTF of type 2 PTF and
petrotympanic fissure petrotympanic fissure (petrotympanic fissure) high percentage of
types in by means of dental types 1, 2 and 3 were type 1 PTF should
temporomandibular tomography. Three observed in 67.2%, be taken into
dysfunction with dental types were described: 1.5% and 31.3% of the account during pre-
tomography and wide tunnel structure cases, respectively. We surgery planning
correlation with age. (type 1); tunnelled found no significant related to TMD.
structure at the relationship between
entrance of the age or gender and PTF
petrotympanic fissure type`.
that gradually
decreases towards the
tympanic cavity (type
2), a tunnel-shaped
structure that is well
open at the entrance of
the mandibular fossa,
with a flat shape in the
middle and a narrow
exit in the tympanic
cavity (type 3).
Sato et al. To define the The CBCT of PSR The CBCT images The structures are
(2008) morphological 9,000 N (Asahi revealed three types of important to define
characteristics of the Roentgen Industry, structures in the middle the malleus limited
discomallear ligament Kyoto, Japan) was used region of the movement and the
by Cone-Beam to acquire petrotympanic fissure morphological
Computed temporomandibular toward the malleus characteristic of the

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Tomography (CBCT) joint images of 14 bone: wide tunnel ligaments in this


and the anatomical human cadavers that (29.2%, 7/24, type 1), a bone may be related
dissection of Japanese later had this region widely open tunnel form to
cadavers. dissected. at the entrance of the temporomandibular
petrotympanic fissure joint pain,
. (20.8%, 5/24, type 2), dysfunction and
and the tunnel form is auditory function.
widely open at the
entrance of the
mandibular fossa, with a
tunnel and flat form in
the middle and narrow
exit in the tympanic
cavity (41.7% 10/24,
type 3).
Alves et al. To determine the 20 hemi-heads In all cases, the malleus The discomallear
(2010) frequency of dissected with the and disc of the ligament was found
occurrence of the purpose of exposing temporomandibular in all cases and may
discomallear ligament the articular disc, joint were connected by be considered an
in the adult man. ossicles of the middle ligaments that formed a intrinsic ligament of
ear, lateral pterygoid fibrous structure in the the
muscle and other form of a thin blade. temporomandibular
structures of the region. joint.
Çakur et al. To evaluate the 100 patients with TMD Although there was a A short and broad
(2016) correlation between (50 with tinnitus, 50 negative correlation petrotympanic
tinnitus and without tinnitus) between tinnitus and fissure (type 1) may
petrotympanic fissure underwent concomitant petrotympanic fissure be associated with a
subtypes in patients computed tomography type (P <0.001), there higher incidence of
diagnosed with (CBCT) had the images was no correlation tinnitus in patients
temporomandibular analyzed and between age and with TMD.
joint dysfunction petrotympanic fissure tinnitus or between age
(TMD). classified as type 1 and petrotympanic
(wide tubular fissure subtype. There
formation), type 2 was no significant
(double conical association between
structure) or type 3 gender and tinnitus or
(single conical petrotympanic fissure
structure). (P> 0.05).
Ramirez et al. Study of morphometric 3 temporal bone pieces Mean lengths of the There was an
(2009) and functional aspects of 12 cadavers were anterior discomallear anatomic and
of anterior microdissected to and malleolar ligaments functional
discomallear and expose ligaments under of 6.88 mm (SD 0.81) relationship between
malleolar ligaments. study. Electronic and 4.22 mm (SD 1.17), the human
caliber (Mitutoyo) for respectively. Malleus temporomandibular
recording movement with joint and the middle
measurements in mm discomallear traction in ear.
and applying forces to 30.5% of samples.
the mandible for Correlation between the
reproduction of some movement of the
physiological and malleus and the length
of the discomallear (R2

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pathological scenarios. = -0.499, p <0.05). Both


ligaments present in all
specimens.
Arai et al. Study of the Dissection and The posterior area of the The structure of the
(2011) morphological, extraction of temporal DML articulates with petrotympanic
macroscopic, bones containing the the head and anterior fissure by which the
histological structure temporomandibular process of the malleus discomallear
of the discomallear joint of 27 human through the ligament attaches to
ligament (DML) and cadavers. Parts petrotympanic fissure, the malleus, as well
evaluation of neuronal submitted to forming a narrow as the histological
structures within the concomitant computed channel. This was and radiographic
distribution of tomography, associated with bone profiles of its
substance P (SP) and measurements and mobility. In the anterior structure, showed a
peptide related to the immunohistochemical and posterior connective relation with the
calcitonin gene methods. tissue of the DML mobility of the
(CGRP). associated with the disc, malleus.
fibers of the nerves
CGRP-, PGP9.5- and
SP-positive were
located around
numerous blood vessels.
Rowicki et al. To determine the Evaluate of 14 samples 4 cases had a strip of There is a clear
(2006) frequency of of the tissue in the connection between
occurrence and temporomandibular temporomandibular the
morphology by means and tympanic cavity by joint, known as Pinto's temporomandibular
of endoscopic means of an endoscope ligament. Presence of joint and the
visualization of the and then by coarse DML in 11 cases, tympanic cavity.
discomallear ligament dissection of an triangular in 7 cases,
(DML) and its operating microscope. and longitudinal in 4
attachments, and if the cases. Malleus
applied tension could movement present in 3
trigger the movement cases.
of the malleus.

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Kitsoulis et al. Examination of the 464 university students. Overall incidence of Signs and symptoms
(2011) relation between signs Mouth opening signs and symptoms of of TMD are more
and symptoms of measured with Vernier TMD were 73.3%, common and severe
temporomandibular calipers. Anamnestic higher in women (p- in women. The
dysfunction (TMD) questionnaire applied value 0.0001 <0.05). severity of TMD
and mouth opening, to stratify them into Hearing symptoms were correlated with the
gender, joint and four groups based on associated with TMD degree of mouth
auditory symptoms and the severity of TMD. severity (p-value 0.0001 opening and the
hearing loss. Hearing symptoms and <0.05) as well as number of auditory
a recorded audiogram maximu m mouth symptoms. The
for each subject as opening (p-value 0.004 absence or presence
well. <0.05). Audiometry of mild TMD was
showed that moderate associated with
and severe TMD was normal audiograms,
associated with hearing while moderate and
loss of medium and low severe TMD were
tones, respectively (p- related to hearing
value 0.0001 <0.05). loss in low and low
TMJ pain (p value tones, respectively.
0.0001 <0.05), TMJ Bruxism, joint
ankylosis (p-value ankylosis, joint pain
0.0001 <0.05), bruxism and ear itching were
(p-value 0.0001 <0.05) more common in
and ear itching (p-value TMD than patients
0.0001 <0.05) were also without TMD.
statistically different
between TMD and non-
TMD.

Sencimen et To investigate the The malleus, incus, In 12 cases two The overstretched of
al. (2008) anatomical topography petrotympanic fissure ligaments connected to the condyle together
and the relation (PTF), chorda tympani, the anterior part of the with the ligaments
between the ligaments, anterior malleolar malleus. Of this same between the inner
malleus and ligament (AML), portion, another ear ossicles and the
temporomandibular discomallear ligament ligament that went to TMJ may be the
joint and to determine (DML), PTF was seen in 3 reason for
the role of these malleomandibular cases. In all of cases, the unexplained
ligaments in the ligament, DML joined the otological problems.
movement of the sphenomandibular retrodiscal tissues. In
malleus. ligament and disc joint the other 3 cases, the
were explored in 15 medial and lateral parts
skulls. Tensile and of the ligament were
tensile tests performed attached to the
to clarify the role of retrodiscal tissue after
these structures in the passage through
movement of the PTF.The thickness of
malleus. the ligaments differed
among the specimens.
When the tension was
applied to the DML, no
malleolar movement

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occurred, but when the


AML was overloaded,
the movement was
significant in 5 corpses;
small movement in 6
corpses, and no
movement in 4 corpses.
Monteiro et al. To characterize Macroscopic and Macroscopic analysis: Macroscopic
(2011) morphologically the stereomicroscopic areas suggestive of analysis was not an
calcification in the analysis of the calcification in 27 appropriate method
petrotympanic fissure petrotympanic fissure fissures (45%). for this evaluation
through three of 30 human skulls. Stereomicroscopic and the ossification
observations: Analysis of scanned analysis: areas of of fissures increased
macroscopic images with the calcification in 40 with aging,
observation to the UTHSCSA ImageTool fissures. (66.6%). The suggesting its
naked eye, 3.0 computer program. location of the areas of influence on the
stereomicroscopic Measurement of the calcification was not causes of otalgia in
observation and total extension of the regular considering the cases of
measurements made areas of cracks and total length of the temporomandibular
from digital images. ossification. various fissures and joint dysfunction.
their division into
median and lateral
regions, occurring
randomly along the total
length of the fissures.

IV. DISCUSSION ligament consists of a layer of superior fibers that insert


The aim of the present study was to perform a into the anterior malleus process and the bone wall of the
systematic review of the presence of the discomallear squamous portion of the petrotympanic fis sure, and a
ligament, its possible influences on otological symptoms layer of inferior fibers surrounding the anterior malleolar
and correlation with temporomandibular dysfunction. ligament (AML), the remnant of Meckel's cartilage, the
Therefore, the methods evaluated and the studies chorda tympani and insert into the tympanic wall of the
analyzed shows the anatomical relationship between the temporal bone (OGÜTCEN-TOLLER, 1995). Besides, it
tympanic cavity and temporomandibular joint, as well as is considered an intrinsic ligament of the
the existence of the discomallear ligament and its possible temporomandibular joint (RODRÍGUEZ VÁZQUEZ,
influence on the otologic symptoms caused by MÉRIDA VELASCO, & JIMÉNEZ COLLADO,
temporomandibular disorders. 1992)(RODRÍGUEZ VÁZQUEZ, J et al.,
In addition, several studies state that there is an 1993)(RODRÍGUEZ VÁZQUEZ et al., 1998)(ALVES &
obvious anatomic and functional relationship between DEANA, 2010).
temporomandibular joint and the tympanic cavity Some authors consider discomallear ligament as part
(RODRÍGUEZ VÁZQUEZ, MÉRIDA VELASCO, of AML (BURCH, 1966)(TOLEDO FILHO,
MÉRIDA VELASCO, & JIMÉNEZ COLLADO, ZORZETTO, & NAVARRO, 1985)(CESARIANI,
1998)(CHEYNET et al., 2003)(ROWICK & TOMBOLINI, FAGNANI, & DOMENECH MATEU,
ZAKRZEWSKA, 2006)(RAMÍREZ ARISTEGUIETA et 1991), superior extension of the sphenomandibular
al., 2009) (ÇAKUR, SÜMBÜLLÜ, DURNA, & AKGÜL, ligament in the tympanic cavity (BURCH, 1966) or the
2011). The discomallear ligament is one of the structures "small ligament" described by Pinto in 1962 (PINTO,
that allows this relationship and is not described in 1962). In contrast, other authors do not agree with the
anatomical books (PATURET, 1951)(SAPPEY, statement that AML and discomallear ligament are part of
1867)(CRÉPY, 1967)(TESTUT & LATARJET, the same structure and say that there is a well-established
1975)(ROMANES, 1987)(ROUVIÈRE & DELMAS, difference between them (COLEMAN, 1970)(KOMORI,
1987)(DUBRUL, 1990)(WILLIAMS, 1995). This SUGISAKI, TANABE, & KATOH, 1986)(OGÜTCEN-

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TOLLER, 1995)(RODRÍGUEZ VÁZQUEZ et al., capsulitis or even rupture of the ossicle joint
1998)(Dai, Cheng, Wood, & Gan, 2007)(SENCIMEN et (LOUGHNER et al., 1989). In contrast, other authors say
al., 2008). that the ligament has no role in otological manifestations
Individuals with temporomandibular dysfunction may (CHEYNET et al., 2003)(ALVES & DEANA, 2010),
frequently exhibit otological symptoms. The dissonance because it does not contain sufficient force to mobilize the
of the stomatognathic system, such as muscular pain, bones of the middle ear once it is firmly adhered to
TMJ pain, cervical pain, tooth sensitivity, joint noise and, petrotympanic fissure (ALVES & DEANA, 2010).
in general, functional difficulties, were significantly
associated with otologic symptoms in cases of V. CONCLUSION
temporomandibular disorders (FELICIO et al., 2004) For this purpose, that the methods evaluated and the
(KITSOULIS, MARINI, ILIOU, GALANI, & ZIMPIS, studies analyzed show the anatomical relationship
2011)(ÇAKUR & YAŞA, 2016). between the tympanic cavity and the temporomandibular
The discomallear ligament presents mobility as it joint, as well as the existence of the discomallear ligament
passes through petrotympanic fissure, caused by stretches and its possible influence on the otologic symptoms
in the TMJ disc during movements of the mandible caused by temporomandibular disorders.
(COULY & HUREAU, 1976)(CESARIANI et al., .
1991)(SATO, ARAI, IMURA, KAWAI, & YOSUE, REFERENCES
2008)(ARAI & SATO, 2012). Consequently, it is [1] ALVES, N., & DEANA, N. F. (2010). Frequency of
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