TMJ Surgery After Whiplash

Tempomandibular disorders (TMD) after whiplash are well-documented in the literature. 1,2,3,4 One possible mechanism of damage to the TMJ is that caused by the pressure of the shoulder restraint on the neck or jaw. 5

A new study6 examined how patients fared after surgery for TMD. Fifty consecutive surgical patients were questioned on pre- and post-operative pain. Of the 43 respondents to the questionnaire, 33 of these attributed the onset of TMJ pain to whiplash injuries. The patients were questioned an average of 7.14 months after surgical intervention.

The study looked at overall pain, tinnitus, dizziness, headache, neck pain, and shoulder pain; and found that the average decrease in symptoms was 61% after surgery. Ninety eight percent of the patients reported a decrease in overall pain. While these are dramatic improvements, all categories of pain levels remained at a level of 4 on a 10 point scale, showing that significant pain remained for these patients after surgery.

The authors point out very strongly that symptoms of headache, neck pain, dizziness, and tinnitus after whiplash may be a consequence of TMJ disorder, and that injury to the TMJ should be ruled out early in the treatment process. "Failure to appreciate that these symptoms can arise from temporomandibular joint-specific pathology portends for delay in diagnosis by the general practitioner and less than optimal application of therapy by the TMD treatment team."

Many of the patients reported an immediate relief of pain following the surgery, even though most of the patients had been in pain for about six months. Especially interesting was the finding that after surgery, "...not only did the muscles relax and become non-tender, but trigger points were inactivated as well, possibly explaining some of the cases of immediate resolution of headache and dizziness." In short, many of the myofascial symptoms disappeared after surgery.

The study does not mention whether any of these patients were involved in litigation, but dramatic improvement of this kind refutes claims of malingering for chronic TMJ pain.

It should be noted that this study was retrospective, and depended on patient recollection for much of the data. The prevalence of joint-specific TMD is, therefore, unknown.

  1. Pullinger AG, Monteiro AA. History factors associated with symptoms of temporomandibular disorders. Journal of Oral Rehabilitation 1988;16:117-124.
  2. Braun BL, DiGiovanna A, Schiffman E, et al. A cross-sectional study of temporomandibular joint dysfunction in post- cervical trauma patients. Journal of Craniomandibular Disorders 1992;6(1):24-31.
  3. Kronn F. The incidence of TMJ dysfunction in patients who have suffered a cervical whiplash injury following a traffic accident. Journal of Orofacial Pain 1993;7(2):209-213.
  4. Roydhouse RH. Whiplash and temporomandibular joint dysfunction. Lancet 1973;1:394.
  5. Roydhouse RH. Torquing of neck and jaw due to belt restraint in whiplash-type accidents. Lancet 1985;June 8:1341.
  6. Steigerwald DP, Verne SV, Young DN. A retrospective evaluation of the impact of temporomandibular joint arthroscopy on the symptoms of headache, neck pain, shoulder pain, dizziness, and tinnitus.

 

 

 

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