Assessing neck extension-flexion as a basis for temporomandibular joint dysfunction

Howard, Richard P.; Benedict, James V.; Raddin, James H.; Smith, Harry L.

doi:10.1016/0278-2391(91)90418-l

Cited by 31 publications

(17 citation statements)

References 3 publications

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“…Since no attempt was made to anaesthetize the nerve more proximally the possibility exists that in these patients the actual prevalence of ON could be greater. Whiplash injury has been described as a factor in the development of temporomandibular joint (TMJ) dysfunction (30,31) and the trauma has been held responsible for an internal derangement of the TMJ (32), although even this view has its opponents (33). In the present study, 10.5% of patients had oromandibular dysfunction with joint crepitation, brux-ism, pain on jaw function, and in one case locking of jaw opening, although a further 18.5% had articular pain and tender points in the joint capsule.…”

Section: Discussionmentioning

confidence: 99%

Extracervical Symptoms After Whiplash Trauma

Magnússon

1994

Cephalalgia

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Thirty-eight patients with late whiplash syndrome were investigated with regard to symptoms which conform with the criteria for other specific diagnoses. All had pain and tender points in the neck and 37 (97.4%) suffered from headache. Seven patients (18.4%) had occipital neuralgia in accordance with the IHS criteria and 16 (42.1%) if the IASP criteria were used. Four patients (10.5%) had oromandibular dysfunction, 20 (52.6%) had periarticular shoulder disorder, and 12 (31.6%) had thoracic outlet syndrome. Five (13.2%) had chronic mechanical low back pain and two (5.3%) segmental instability of the lumbar spine. Four (10.5%) had symptoms concurring with the diagnosis of fibromyalgia. It is concluded that many of the symptoms of patients that suffer from late whiplash syndrome conform with the criteria of other specific diagnoses.

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Section: Discussionmentioning

confidence: 99%

Extracervical Symptoms After Whiplash Trauma

Magnússon

1994

Cephalalgia

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“…In other words, it is reasonable to assume that the human TMJ can with impunity tolerate a maximum acceleration that is approximately 20 times that due to Earth's gravity. It is of relevance that theoretical considerations similar to the latter have in principle been substantiated through direct experimental evidence (Howard et al . 1991, 1998).…”

Section: Kinetics Of Whiplash Manoeuvresmentioning

confidence: 94%

“…In this section, kinetic concepts are introduced and discussed extensively on the basis of Newton's classic second law of motion (momentum = mass × velocity), simply because theoretical as well as practical studies have shown the fundamental applicability and relevance of the modern version of the law (force = mass × acceleration) to the kinetics of the head, neck, and mandible (Ashhurst 1966; Howard et al . 1991).…”

Section: Kinetics Of Whiplash Manoeuvresmentioning

confidence: 99%

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: Speculations and facts

McKay

Christensen

1998

J of Oral Rehabilitation

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Referring to the temporomandibular joint (TMJ) of the human mandibular locomotor system, it has been asserted that displacement of the TMJ disc and inflammation of TMJ tissues are the results of acute and indirect trauma to the TMJ; on occasion this is allegedly experienced in motor vehicle accidents and commonly known as a TMJ whiplash injury. It is postulated that the TMJ whiplash injury is released in the occupant or occupants of a target vehicle when its rear end is impacted by the front end of a bullet vehicle. On the basis of detailed analyses of TMJ trauma/pain histories and TMJ magnetic resonance images, presented as circumstantial evidence in favour of the postulated TMJ whiplash injury, and detailed analyses of the mathematical biophysics of the mandibular locomotor system as well as direct experimental evidence, it is concluded that the postulated TMJ whiplash injury does not exist as a single and independent disease entity caused by motor vehicle accidents. If TMJ disc displacement and inflammation are present, they are expressions of an insidious and progressive pre-existing (pre-accident) disease entity that is comprised of TMJ synovitis/osteoarthritis (phase of inflammation with presence of immune system cells), TMJ internal derangement (phase of disc displacement and deformation with presence of proteinases), and TMJ osteoarthrosis (phase of degeneration with absence of immune system cells). For the asserted TMJ whiplash manoeuvre and ensuing injury to occur as postulated, the laws of physics and biology would have to be suspended.

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“…This theory, based on extension–flexion TMJ injury (17), has been refuted (18–21). In a critical analysis of this theory, Howard et al (18), indicated that forces experienced at the TMJ, resulting from mild to moderate extension–flexion inertial motion of the neck, would not only act in a direction similar to that of the forces generated in normal chewing activity, but would also be of a substantially lesser magnitude.…”

Section: Introductionmentioning

confidence: 99%

Mandibular kinematics associated with simulated low‐velocity rear‐end impacts

Hernández¹,

Fyfe²,

Heo³

et al. 2006

J of Oral Rehabilitation

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Rear-end-impact motor vehicle accidents may result in cervical and temporomandibular-related pain complaints. Head kimematics in simulated low-impact rear-end impacts have been investigated but mandibular kinematics have not been described. Thirty healthy adult subjects underwent three impacts (4.5 m s(-2) expected, 10.0 m s(-2) unexpected, and 10.0 m s(-2) expected). Onset time and peak magnitude of angular head acceleration, angular mandibular acceleration and angular mandibular displacement were measured. Significant mandibular opening acceleration was not identified with rearward head rotation. The peak magnitude of mandibular closing angular acceleration approximately doubled with increased impact magnitude. No differences in peak angular mandibular acceleration regarding expectation were identified. Gender differences were detected in the fast unexpected impact. The peak time for the angular mandibular acceleration (mandibular closure) was approximately 84-120 ms later than peak rearward angular head acceleration for all impacts. Onset and peak times for angular mandibular acceleration (mandibular closure) were similar to the onset and peak times for forward head acceleration. There was also a positive correlation between the magnitude of the forward angular acceleration of the head and angular acceleration of the mandible for the slow (0.65, P = 0.015) and fast expected (0.844, P = 0.001) impacts. The average angular mandibular angular displacement (mandibular closure) was approximately 6 degrees . The hyperextension hypothesis regarding mechanism of temporomandibular joint injury in low-impact rear-end collisions cannot be supported.

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Assessing neck extension-flexion as a basis for temporomandibular joint dysfunction

Cited by 31 publications

References 3 publications

Extracervical Symptoms After Whiplash Trauma

Extracervical Symptoms After Whiplash Trauma

Whiplash injuries of the temporomandibular joint in motor vehicle accidents: Speculations and facts

Mandibular kinematics associated with simulated low‐velocity rear‐end impacts

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