Whiplash and delayed TMJD and facial pain

Delayed Temporomandibular Joint Pain and Dysfunction, Tinnitus and Facial Pain Induced by Whiplash Trauma.

Whiplash, like trauma, is most frequently associated with motor vehicle accidents. We are familiar with whiplash-type symptoms - neck pain, sore muscles - but the temporomandibular joint can also be injured. 

tmj-pain.jpgA study published in The Journal of American Dental Association followed 59 patients for one year after being seen at a hospital emergency department for motor vehicle injuries. The incidence of new symptoms or dysfunction in the temporomandibular joint was five times higher in subjects that had been rear-ended. The frequency of TMJD pain was significantly higher in females as women have less neck musculature which makes them more susceptible to this type of trauma. 

Impaired and painful jaw movements can be symptoms of TJMD injury.  The pain is most commonly located just in front of the ear canal. Other symptoms can be clicking and transient locking. 

Delayed TMJD is a common injury associated with whiplash.  The symptoms of TMJD injury can take months to years to develop. Early detection and treatment, even for minor complaints, is highly recommended.

Improving Tinnitus with Mechanical Treatment of the Cervical Spine and Jaw

Tinnitus and facial pain are also common complaints after whiplash-type injuries. Treatment of these complaints respond favorable to adjusting as reported in the Journal of the American Academy of Audiology. Hear-it-Figures-Tinnitus-Severe_tinnitus_after_head_and_neck_injuries.jpgThis case report is on a 42-year-old male who described his tinnitus as a “buzzing” sound. He also complained of headaches, neck pain, dizziness and blurred vision. After 10 weeks of treatment, he reported a complete reversal of his tinnitus. 

The therapy was focused on restoring normal activity to the C-2 segment (2nd cervical vertebra in the neck). There is a strong association of muscular trigger points, tinnitus and facial pain in patients with a dysfunctional upper cervical spine. 

A tinnitus treatment approach targeting the upper cervical spine, cervical muscles, and TMJ can reduce or abolish tinnitus perception in some patients. 

Manipulative Treatment for Facial Numbness and Pain After Whiplash Injury

Trigeminal neuralgia is a debilitating condition where the patient can have sharp shooting pain throughout the jaw area. Most complaints are minor pain and discomfort.  Both the debilitating and minor conditions respond well to manipulative treatment according to the Journal of American Osteopathic Association. 

numbness-and-tingling-head-dermatomes.jpgThe trigeminal nerve has 3 divisions, ophthalmic, maxillary and mandibular. These divisions provide sensation to the face and a large part of the scalp.  Whiplash injuries can subject these neurological tissues to traction or compressive injuries, resulting in symptoms. The strain, or site of injury, to the trigeminal nerve is typically at the upper cervical spine and brain stem, the nerve’s point of origin. 

In a search of the US National Library of Medicine’s PubMed database, these authors found one study that reported 88% of the patients suffered frequent jaw or face pain as a consequence of chronic whiplash associated disorder.

Restriction anywhere along the trigeminal nerve affects facial sensation. 

“Manipulative treatment offers relief for patients by addressing the cause instead of masking the symptoms...”

“The temporomandibular system and cervical spine function as a single entity”

It has long been know that the jaw, face and upper cervical spine is intimately connected through a series of nerve junctions and feedback systems which insure our ability to function in a gravity or upright position. In 1998, the Journal of Clinical Oral Investigations reported the following: 

     “Interrelationships between the orofacial area and the cervical spine have been documented both at the neuroanatomical interconnections and neurophysiological levels.”

         “It was apparent that TMD patients exhibit significantly more segmental limitations, especially in the high cervical region, and also report significantly more tender points upon palpation of the shoulder and neck muscles.”

Treatment of TMJD must take in the whole and not focus on the single site of pain. Doing so will lead to poor outcomes and extra expenses at the cost of the patient’s recovery.


Sources:

 

Journal of the American Dental Association 
August 2007;138(8):pp. 1084-91 

Journal of the American Academy of Audiology
July-August 2013; Vol. 24; No. 7; pp. 544-55

Journal of the American Osteopathic Association
July 1, 2013; Vol. 113; No. 7; pp. 564-567

Clinical Oral Investigations 
1998, 2: pp. 54-57