Author: Richard H. Adler

Temporomandibular joint (TMJ) symptoms are a common finding in motor vehicle accident patients with hyperextension/hyperflexion injuries to the cervical spine. TMJ injury resulting from direct trauma to the mandible is a well-established phenomenon.(1) Literature also establishes a relationship between TMJ symptoms and hyperextension/hyperflexion injury to the cervical spine without direct trauma to the mandible.(2)

A recent study by Ralph Garcia, Jr., D.D.S., and John Arrington, M.D., reported in the Journal of Cranial Mandibular Practice, analyzed the relationship between cervical whiplash and TMJ injuries. Eighty-seven consecutive motor vehicle accident cervical whiplash patients who (1) presented with TMJ symptoms; (2) had no direct trauma to the face, head, or mandible; and (3) had no prior TMJ complaints were required to undergo magnetic resonance imaging.(3) Since the study involved 87 patients, a total of 174 jaw joints were imaged with MRI. Ten joints were eliminated from the study because of poor film quality, inability to visualize the disk, or inability of the patient to close into centric occlusion due to pain. The results of the MRI indicated the following:

Internal derangement was present in 143/164 (87%) of the TMJs, 118/164 (72%) demonstrated disk displacement with reduction (DDR), and 25/164 (15%) demonstrated disk displacement without reduction (DDNR); only 21/164 (13%) of the TMJs were found to be normal (Table 2).

Abnormal joint fluid was present in 132/164 (80%) of the TMJs: effusion (fluid in the retrodiskal tissue) was present 84/164 (51%) of the TMJs.

This study documents the high rate of TMJ abnormalities in a consecutive group of motor vehicle accident patients who had no TMJ-related complaints prior to their motor vehicle accidents. The authors indicate:
“The fact that previously asymptomatic patients became symptomatic after a post MVA cervical whiplash injury supports the position that TMJ symptoms are reasonably related to cervical whiplash injury.”

The authors make several conclusions and compare their findings with other researchers:

1. Joint fluid (effusion or` inflammation/edema) is extremely common (65% to 83%) in our MVA cervical whiplash patients and similar patient groups and extremely rare in asymptomatic/normal subjects (2%).
2. Internal derangement (DDR or DDNR) is significantly more prevalent in our MVA cervical whiplash patients and similar patient groups than in asymptomatic/normal subjects. In fact, the cervical whiplash patients in our group and similar groups were approximately two to seven times more likely to demonstrate internal derangement (DDR or DDNR) than were the asymptomatic/normal subjects.
3. Total joint abnormalities are much more prevalent in our MVA cervical whiplash patients and similar patient groups than they are in asymptomatic/normal subjects.

According to conventional thinking about cervical whiplash injury, many attribute symptoms such as headaches, facial pain, earache, tinnitus, difficulty swallowing, etc., to the hyperextension/flexion injury or "whiplash." However, the present study, as well as references cited in that study, indicate that the temporomandibular joint may be an overlooked cause of a patient's symptoms following hyperextension/flexion injury. This study concludes that TMJ analysis should be part of a comprehensive patient evaluation following a hypertension/hyperflexion motor vehicle accident.

Very truly yours,
Adler Giersch, P.S.

Richard H. Adler
Attorney at Law

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Wilkes, C.H., Arthrography of the Temporomandibular Joint in Patients with the TMJ Pain Dysfunction Syndrome, Minn Med, Vol. 61, 1978, pp. 645-652.

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Pressman, B.D., Shellock, F., et al., MR Imaging of Temporomandibular Joint Abnormalities Associated with Cervical Hyperextension/Hyperflexion (Whiplash) Injuries, JMRI, Vol.2, 1992, pp. 569-574.

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(3) Garcia, R, and Arrington, J.A., The Relationship Between Cervical Whiplash and Temporomandibular Joint Injuries: An MRI Study, J Craniomandib Prac, Vol. 14, No. 3, 1996, pp. 223-239.