Craniomandibular/temporomandibular/cervical implications of a forced hyper-extension/hyper-flexion episode (i.e., whiplash).
Clinicians now appreciate the full chain of tissue damage of the interconnecting muscles, tendons, ligaments and fascia: this compromised linkage from the skull through the suboccipital musculature to the cervical spine and anterior/posterior cervical muscles, from the check-rein ligaments and muscles extending from the skull and maxilla to the mandible, from the suprahyoid musculature connecting the mandible through to the hyoid bone, from the hyoid through the infrahyoid to the supporting shoulder girdle, all contribute to damaged interconnecting matrices. Consequently, unresolved tissue damage in any of this linkage becomes mutually provocative during function to any part of the linkage. Diagnostics, therefore, must necessarily include examination of this total linkage; similarly, eventual treatment protocols must resolve tissue damage in all of this interconnecting linkage if treatment is to be successful beyond palliative applications. The influence of an angular component in any such trauma must be emphasized; force vectors then attack the craniomandibular/temporo-mandibular/cervical complex where it is most vulnerable, at the most restrictive parameters of functional mobility. Thus, the angular component brings an exponential increase in tissue damage potential to all of the craniomandibular/temporomandibular/cervical complex. Finally, if we are to treat the occlusion of these victims intelligently, we must understand the effects of this trauma on the 'whole body', and not just focus singularly on the restoration or the malocclusion or the TMJoint problem. There are lessons to be learned from this acute trauma which provide valuable insights into the diagnosis of chronic pain patients. If these victims do not come to us for help immediately following the acute trauma episode, but arrive in our offices months or years later, our clinical examinations must include head and neck mobility or functional restrictions, observations of the patients' gait, other residual postural deficits, et al. Failure to implement these observations in our clinical examination will ultimately compromise our treatment success. As a final note, an axiom to bear in mind when studying the function of the musculoskeletal system is that when muscle is put into an adversarial relationship with bone, muscle always wins! Example #1: Compare a lateral cervical radiograph taken on the day of a rearend collision to one completed five months later; if tissue damage is unresolved, there will inevitably be a loss of lordotic curve of the cervical spine with a kyphosis at C-4, C-5!; Example #2: If a patient has developed a parafunctional habit like bruxism using pathological forces over a long period of time, the clinician will inevitably observe antigonial notching on the mandible at the masseter insertion! Although at first glance integrating these precepts into our examination protocols may appear to complicate matters, it actually makes our tasks easier and allows us to provide more comprehensive services for our patients. Those of us who are "functionally aware", will always be three steps ahead of the field in functional orthopedics or functional orthodontics. Let me conclude with a premise I learned many years ago from a very learned Osteopath, Dr. John Harakal, of Fort Worth, Texas: "If, as a clinician, you are able to put the body into a position to heal, it will heal itself."
O'Shaughnessy
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D002574:Cervical Vertebrae / Q000293:injuries; D017271:Craniomandibular Disorders / Q000209:etiology; D006801:Humans; D019838:Neck Injuries / Q000209:etiology; D013704:Temporomandibular Joint / Q000293:injuries*; D013705:Temporomandibular Joint Disorders / Q000209:etiology*; D018677:Tooth Injuries / Q000209:etiology; D014911:Whiplash Injuries / Q000150:complications*