Background: The mouth‐opening muscular performance in patients with temporomandibular disorders (TMDs) is unclear. Understanding the impairments of this muscle group within specific TMDs is important to develop proper management strategies.Objective: To characterise the mouth‐opening muscular performance in adults with and without TMDs.Methods: PubMed, EMBASE, CINAHL, Scopus, Web of Science and Cochrane databases were searched from inception to 12 November 2020. Bibliographies were searched for additional articles, including grey literature. Case‐control, cross‐sectional and interventional studies reporting mouth‐opening muscular strength and/or endurance were included. Risk of bias was assessed by the SIGN checklist for case‐control studies and by the NIH quality assessment tool for cross‐sectional studies. Results were pooled with a random‐effects model. Confidence in cumulative evidence was determined by means of the GRADE guidelines.Results: Fourteen studies were included; most were rated as having a moderate risk of bias. Only three studies assessed patients with TMDs and the other 11 assessed healthy adults. Significant sex differences in muscular performance were found for healthy adults in the review (strength deficit for females versus males). There was a significant reduction in maximal mouth opening performance (strength and endurance) in the three studies that assessed patients with temporomandibular disorders.Conclusion: Sex plays a significant role in maximal mouth opening strength. There is a lack of reliable data on the normal mouth‐opening strength and endurance of healthy adults as well as for patients with TMDs.Implications: Lack of reliable TMDs patient data and comparable healthy adult data highlight future direction for research.

The hyoid bone exhibits potential sex-based variations and is implicated in the severity of obstructive sleep apnea (OSA). Sex-specific comparisons are lacking. The present meta-analysis aimed to address this gap.The Embase, MEDLINE and Web of Science databases were searched. The inclusion criteria were as follows: studies that reported the measurements of the hyoid bone-mandibular plane distance (HMP), demonstrated in cephalometric imaging (CEPH) in patients with OSA of both sexes, involving a polysomnography (PSG) examination with the apnea-hypopnea index (AHI), as well as information on the body mass index (BMI) and age. The exclusion criteria comprised reviews, meta-analyses and case reports. The risk of bias was assessed with the use of the Scottish Intercollegiate Guidelines Network (SIGN) checklist. Statistical analysis was conducted using Comprehensive Meta-Analysis software (CMA) and IBM SPSS Statistics for Windows.Seven observational studies with 718 adult patients (515 males and 203 females) met the inclusion criteria. The mean HMP value was 20.5 ±3.8 mm, with a significant difference observed between males (21.6 ±3.3 mm) and females (17.8 ±3.7 mm) (p < 0.00001). The correlation between HMP and AHI was significantly stronger in females - 2.5 times higher than in males (r = 0.423 vs. r = 0.167, respectively).Although a standard range of the hyoid bone position for healthy adults and elderly individuals is currently lacking, sex significantly affects the anatomical variation of the hyoid mandibular position in patients with OSA. It is crucial to identify distinct OSA endotypes by sex to ensure accurate diagnosis and treatment planning, which could lead to sex-specific therapeutic strategies.

Introduction: Headache (HA) is one of the most prevalent disabling conditions worldwide and is classified as either primary or secondary. Orofacial pain (OFP) is a frequent pain perceived in the face and/or the oral cavity and is generally distinct from a headache, according to anatomical definitions. Based on the up-to-date classification of the International Headache Society, out of more than 300 specific types of HA only two are directly attributed to the musculoskeletal system: The cervicogenic HA and HA attributed to temporomandibular disorders. Because patients with HA and/or OFP frequently seek help in the musculoskeletal practice, a clear and tailored prognosis-based classification system is required to achieve better clinical outcomes.Purpose: The aim of perspective article is to suggest a practical traffic-light prognosis-based classification system to improve the management of patients with HA and/or OFP in the musculoskeletal practice. This classification system is based on the best available scientific knowledge based on the unique set-up and clinical reasoning process of musculoskeletal practitioners.Implications: Implementation of this traffic-light classification system will improve clinical outcomes by helping practitioners invest their time in treating patients with significant involvement of the musculoskeletal system in their clinical presentation and avoid treating patients that are not likely to respond to a musculoskeletal based intervention. Furthermore, this framework incorporates medical screening for dangerous medical conditions, and profiling the psychosocial aspects of each patient; thus follows the biopsychosocial rehabilitation paradigm.