Abstract
Objective: to investigate the change in volume and signal in the masticatory muscles and temporomandibular joint (TMJ) of patients with temporomandibular disorder (TMD) after whiplash injury, based on magnetic resonance imaging (MRI), and to correlate them with other clinical parameters. Methods: ninety patients (64 women, 26 men; mean age: 39.36 ± 15.40 years), including 45 patients with symptoms of TMD after whiplash injury (wTMD), and 45 age- and sex-matched controls with TMD due to idiopathic causes (iTMD) were included. TMD was diagnosed using the study diagnostic criteria for TMD Axis I, and MRI findings of the TMJ and masticatory muscles were investigated. To evaluate the severity of TMD pain and muscle tenderness, we used a visual analog scale (VAS), palpation index (PI), and neck PI. Results: TMD indexes, including VAS, PI, and neck PI were significantly higher in the wTMD group. In the wTMD group, muscle tenderness was highest in the masseter muscle (71.1%), and muscle tenderness in the temporalis (60.0%), lateral pterygoid muscle (LPM) (22.2%), and medial pterygoid muscle (15.6%) was significantly more frequent than that in the iTMD group (all p < 0.05). The most noticeable structural changes in the masticatory muscles occurred in the LPM with whiplash injury. Volume (57.8% vs. 17.8%) and signal changes (42.2% vs. 15.6%) of LPM were significantly more frequent in the wTMD group than in the iTMD group. The presence of signal changes in the LPM was positively correlated with the increased VAS scores only in the wTMD group (r = 0.346, p = 0.020). The prevalence of anterior disc displacement without reduction (ADDWoR) (53.3% vs. 28.9%) and disc deformity (57.8% vs. 40.0%) were significantly higher in the wTMD group (p < 0.05). The presence of headache, sleep problems, and psychological distress was significantly higher in the wTMD group than in the iTMD group. Conclusion: abnormal MRI findings and their correlations with clinical characteristics of the wTMD group were different from those of the iTMD group. The underlying pathophysiology may differ depending on the cause of TMD, raising the need for a treatment strategy accordingly.
Highlights
Whiplash injury refers to a macrotrauma that occurs with a hyperextension of the head and neck vertebrae followed by hyperflexion when a sudden or excessive force is applied [1]
We investigated the presence of magnetic resonance imaging (MRI) abnormalities of the temporomandibular joint (TMJ) and masticatory muscles, including disc displacement, effusion, disc deformity, condylar degeneration, and volume changes (VCs) and signal changes (SCs) in the four masticatory muscles, includ
We investigated the presence of MRI abnormalities of the TMJ and masticatory muscles, including disc displacement, effusion, disc deformity, condylar degeneration, and volume changes (VCs) and signal changes (SCs) in the four masticatory muscles, including the masseter muscle, temporalis muscle, lateral pterygoid muscle (LPM), and MPM
Summary
Whiplash injury refers to a macrotrauma that occurs with a hyperextension of the head and neck vertebrae followed by hyperflexion when a sudden or excessive force is applied [1]. Injuries occur mainly due to side-impact or rear-end collisions [2,3] (Figure 1). Such cases present with a variety of clinical manifestations, including neck stiffness, neck pain disability, psychological distress, headache, and temporomandibular disorder (TMD) [4,5,6]. The incidence of TMD in patients with whiplash injury is low to moderate and ranges from 14–37.5% [4]. It is important to note that patients suffering from chronic whiplash injury commonly have clinical pain in a wider range of their bodies [7]. 40% of patients with whiplash injuries suffer from persistent pain and chronic disability [8]
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