Wednesday, December 16, 2009

Musculoskeletal Etiology and Therapy of Craniomandibular Pain and Dysfunction

Coy, Richard E., Flocken, John E., Adib, Fray (1991) Musculoskeletal Etiology and Therapy of Craniomandibular Pain and Dysfunction. Cranio Clinics Intl, Williams and Wilkens, Baltimore, pp 163-173.

The investigators sent questionnaires and guidelines for submission of case histories to Fellows of the International College of Craniomandibular Orthopedics, who are geographically dispersed over the United States. The practitioners were requested to supply data and case histories on patients who were treated specifically for Craniomandibular pain or dysfunction. Sixty-eight case histories received from 20 practitioners that met the study guidelines were included.

Electronically derived measurement provides an objective quantitative database for diagnosing the existence and extent of myostatic contracture and skeletal malrelation. Compilation of the electronically derived data, correlated with the subjective evaluations of both patient and therapist, establish the existence of significant skeletal malrelation of the mandible to the cranium and consequent myostatic contracture in the pain and dysfunction population. The data reported in these case histories indicate that a common measurable etiology is responsible for the many ostensibly diverse manifestations of craniomandibular pain and dysfunction. The diagnostic validity and usefulness of the electronically derived quantitative data are supported by the correlative subjective perception by the patient of alleviation of symptoms in response to the correction of skeletal malrelation and the consequent reduction of muscle tension (table 7). The course of treatment provides rapid initial palliation followed by long-term resolution as a result of orthopedic correction of skeletal malrelation.

The data clearly established that in the patient population under study:
1. The average electromyograph activity with the patient at rest decreased substantially in the left and right anterior temporalis and masseter muscles after treatment.
2. The average electromyograph activity with the patient clenching increased substantially in the left and right anterior temporalis and masseter muscles after treatment.
3. Following the orthopedic correction of skeletal malrelation, over half of the patients had complete alleviation of symptoms, with the remaining patients experiencing a substantial reduction in the number of their symptoms.

The continuing positive responses to this noninvasive treatment based on quantitative as well as subjective diagnosis indicate the need in every case of craniomandibular pain or dysfunction to rule in or rule out musculoskeletal dysfunction as the most common underlying etiologic factor in most aspects of craniomandibular pain and dysfunction.

In cases in which the data rule out existing musculoskeletal dysfunction as a possible etiology, the patient may then be referred to other appropriate specialties such as neurology, otolaryngology, orthopedics, or psychiatry with the assurance to that specialty that the etiologic possibility of musculoskeletal dysfunction has been explored and ruled out.

Diagnosis and Treatment of Craniocervical Pain and Headache based on Neuromuscular Parameters

Lynn, Jack M., Mazzocco, Mike W., Miloser, Stephen J., Zullo, Thomas, (1992) Diagnosis and Treatment of Craniocervical Pain and Headache based on Neuromuscular Parameters, American Journal of Pain Management, 2:3, pp 143-151.


There is increasing evidence supporting the premise that hypertonicity within facial muscles is an etiologic factor for some chronic headache patients. This muscular hypertonicity is the result of neuromuscular imbalances within the head and neck. Through the analysis of electromyograph (EMG) data, it is possible to construct an intraoral orthosis which creates neuromuscular balance and subsequently relieves the pain.

This study attempted to identify (i) the relationship of EMG-measured dysfunction to reported craniocervical pain and (ii) the effectiveness of EMG-based orthoses on reversing myospastic conditions. Results of the study (N=203) indicate a significant (p<.0001) decrease in muscular myospasm at rest and a significant (p<.0001) increase in muscular activity during function following treatment with EMG-based orthoses. Reported craniocervical pain was significantly reduced. Results of this study support the hypothesis that creation of a physiologic neurovasomuscular envelope of craniocervical motion allows reduction of muscular hypertonicity resulting in reduction of pain. Furthermore, utilization of electromyography is a valuable tool during assessment and treatment of chronic facial pain patients.

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