Head and neck disorders

 

NOTES

HEAD & NECK

MUSCULOSKELETAL DISORDERS

620

NOTES

OSMOSIS.ORG

GENERALLY, WHAT ARE THEY?

▪ Disorders of ligaments, muscles, tendons,

bones inherent to head, neck

PATHOLOGY & CAUSES

▪ Most commonly pain

SIGNS & SYMPTOMS

DIAGNOSTIC IMAGING

▪ For confi rmation

OTHER DIAGNOSTICS

▪ History, physical examination

DIAGNOSIS

MEDICATIONS

▪ Anti-infl ammatory/muscle relaxant

SURGERY

▪ In refractory cases

OTHER INTERVENTIONS

▪ Physical therapy

TREATMENT

osms.it/TMJ-dysfunction

TEMPOROMANDIBULAR JOINT

DYSFUNCTION

▪ Category of conditions affecting jaw,

producing pain and/or dysfunction centred

around temporomandibular joint (TMJ)

CAUSES

▪ Jaw clenching

▪ Teeth grinding (bruxism)

PATHOLOGY & CAUSES ▫ Nocturnal/diurnal

▫ Commonly occurs with MDMA use

▪ Trauma

▫ Reactive oxygen species produced

by infl ammation → synovial fl uid

infl ammation → cytokine production →

TMJ destruction

▪ Arthritis

▪ Malocclusion/missing teeth

▪ Yawning → joint dislocation

OSMOSIS.ORG

 Chapter 110 Head & Neck Disorders

621

Figure 110.1 An MRI scan of the head in

the parasagittal plane demonstrating an

anteriorly dislocated disc in an individual

reporting symptoms of temporomandibular

joint dysfunction.

▪ Pain: dull, constant ache; waxing, waning

intensity (e.g. headaches, toothaches,

earaches)

▫ Jaw movement exacerbates (e.g eating,

talking)

▫ Manifests anywhere trigeminal nerve

(cranial nerve V) innervates

▪ Jaw dysfunction → poor eating/talking

ability

▪ Tinnitus

▪ Audible popping/clicking of joint

SIGNS & SYMPTOMS

DIAGNOSTIC IMAGING

Panoramic X-ray

▪ May reveal frank dislocation of mandible

from TMJ

OTHER DIAGNOSTICS

History

▪ Bruxism

▪ Trauma

Physical examination

▪ ↓ Range of motion

▪ Palpation

▫ Tenderness to examiner’s fi nger against

TMJ when mouth open

▫ Clicking/popping heard/felt when jaw

opened/closed

▪ Abnormal cranial nerve examination

▫ Likely trigeminal (CN V) symptom

distribution → muscle weakness and/or

sensory disturbance

DIAGNOSIS

MEDICATIONS

▪ Short-term NSAIDs

▪ Muscle relaxants second line (e.g.

cyclobenzaprine)

▪ Benzodiazepines: nocturnal dosing → ↓

nocturnal bruxism

SURGERY

▪ For refractory disorders

▫ Arthroscopy

▫ Individuals with underlying arthritis →

synovial space bone fragment removal

OTHER INTERVENTIONS

▪ Pain control

▫ Moist heat, cold compresses, massage,

soft diet, avoid strain

▪ Habit adjustment

▫ ↓ pen chewing, change sleeping

position, oral appliance use

▪ Physical therapy

▪ Dislocation → mandible reduction

▪ Bruxism causative → splinting

TREATMENT ▪ Associated diseases

▫ Rheumatoid arthritis (RA)

▫ Psychiatric disorders → major

depressive disorder

622 OSMOSIS.ORG

osms.it/torticollis

TORTICOLLIS

▪ Abnormal posturing of head, neck; various

etiologies

▪ AKA cervical dystonia

▪ Sternocleidomastoid (SCM) muscle connect

sternums, clavicle (muscle heads) to

mastoid process

▪ One/both SCM head shortened/

hypertrophied → contralateral neck fl exion,

lateral rotation → torticollis

TYPES

Congenital

▪ Birthing diffi culty → injury → fi broma/

hematoma formation of SCM muscle →

abnormal posturing at/soon after birth

▪ Spinal abnormalities

▪ Klippel–Feil syndrome → cervical vertebrae

fusion → torticollis

▪ Atlanto-occipital fusion → abnormal

articulation/ankylosis of C1, occipital bone

→ torticollis

Iatrogenic

▪ Side effect of dopamine agonist medication

(e.g. fi rst-generation antidepressants)

Spasmodic

▪ AKA adult-onset/idiopathic

▪ Characterized by tonic/intermittent spasms

of cervical muscles in adults

COMPLICATIONS

▪ Permanent musculoskeletal defects

▪ Neurologic defects → spinal cord

impingement

PATHOLOGY & CAUSES

▪ Abnormal posturing of the head and neck

▫ Lateral rotation (laterocollis)

▫ Forward rotation (anterocollis)

▫ Backward rotation (retrocollis)

▪ SCM muscle

▫ Hypertrophied

▫ Nontender

SIGNS & SYMPTOMS

OTHER DIAGNOSTICS

▪ Congenital

▫ Birth trauma/condition

▪ Iatrogenic

▫ Coincide with medication schedule/

change in dosing

▪ Spasmodic

▫ 5% have ⊕ family history

▫ ⅓ have other dystonias

DIAGNOSIS

MEDICATIONS

Congenital

▪ Muscular etiology → botulinum toxin

injections

▫ Botulinum toxin → inhibits zinc

endopeptidase → inhibition of

neurotransmitter vesicle release →

decreased muscle contraction →

decreased muscle tone

TREATMENT

OSMOSIS.ORG

 Chapter 110 Head & Neck Disorders

623

Iatrogenic

▪ Withdrawal/limitation of offending agent

▪ Prescription of a muscle relaxant/

antihistamine

Spasmodic

▪ Muscle relaxant

▪ Benzodiazepines

▪ Anticholinergics

▫ Side effects → limited use (dry

mouth, blurry vision, urinary retention,

tachycardia, nausea, vomiting, anxiety)

▪ Botulinum toxin injections

SURGERY

Congenital

▪ Vertebral etiology → surgical intervention if

severe

Spasmodic

▪ Refractory cases → surgical denervation of

affected cervical musculature

OTHER INTERVENTIONS

Congenital

▪ Muscular etiology → passive neck

stretching

Spasmodic

▪ Massage

▪ Physical therapy

▪ Behavioral modifi cation

▪ “Sensory trick”

▫ Sensory stimulus (e.g. lightly laying

hand on cheek) may relie