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Hyperextension/Hyperflexion Injuries to the Cervical Spine and Temporomandibular Joint Injury
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:
“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:
Very truly yours, Adler Giersch, P.S. Richard H. Adler Attorney at Law (1) Bassett, R.W., et al., Diagnosis and Reconstruction of the Human Temporomandibular Joint After Trauma or Internal Derangement, Plast Reconstr Surg, Vol. 75, 1985, pp. 192-205. Goddard, C., Articular Disk Displacement of TMJ Due to Trauma, J Craniomandib Paper, Vol. 11, 1993, pp. 221-223. Harkins, S.J., et al., Extrinsic Trauma: A Significant Factor in Temporomandibular Dysfunction, J Prosthet Dent, Vol. 54, 1985, pp. 271-272. Schellhas, K.P., Temporomandibular Joint Injuries, Radiology, Vol. 173, 1989, pp. 211-216. Wilkes, C.H., Arthrography of the Temporomandibular Joint in Patients with the TMJ Pain Dysfunction Syndrome, Minn Med, Vol. 61, 1978, pp. 645-652. (2) Weinberg, S., and LaPoints, H., Cervical Extension-Flexion Injury (Whiplash) and Internal Derangement of the Temporomandibular Joint, J Oral Maxillofac Surg, Vol 45, 1987, pp. 653f-656. Braun, B.L., et al., A Cross-Sectional Study of Temporomandibular Joint Dysfunction in Post-Cervical Whiplash Patients, J Craniomandib Disord Facial Oral Pain, Vol. 6, 1992, pp. 24-31. Garcia, R., and Arrington, J.A. , TMJs Evaluated in Patients with Cervical Whiplash Injuries, TM Diary, Vol. 4, 1992, pp.30-31. Mahan, P.E., and Alling, C.C., Facial Pain, 3rd ed., Lea & Febiger, Philadelphia, 1991. Mannheince, J., Allanasio, R., et al., Cervical Strain and Mandibular Whiplash: Effects Upon the Craniomandibular Apparatus, Clinical Prevent Dent, Vol. 11, 1989, pp. 29-32. O'Shaughnessy, T., Craniomandibular/Temporomandiular/Cervical Implications of a Forced Hyperextension/Hyperflexion Episode (i.e., Whiplash), The Functional Orthodontist, Vol. 11, 1994, pp. 5-12. 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. Rogal, O.J., Mandibular Whiplash, Medical-Legal Aspects of Whiplash and TMJ Injuries, Mandibular Whiplash Seminar, Los Angeles, 1988. Shellock, F., Report on a Study of 19 Patients with Cervical Whiplash Injuries with Evidence of Jaw Damage, Radiological Society of North America Meeting, Chicago, November 1990. Shellock, F., Pressman, B.D., et al., MR Imaging Evaluation of the Temporomandibular Joint Following Cervical Extension-Flexion Injury (Whiplash) , Radiological Society of North America Meeting, Chicago, November 1990. (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. |
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