Use Of Cervical Collar Research Articles

Patient with occipital pressure ulcer requiring continued cervical collar use

Patient with occipital pressure ulcer requiring continued cervical collar use

Some Observations on Whiplash Injuries

Motor vehicle accidents with a whiplash mechanism of injury are one of the most common causes of neck injuries, with an incidence of perhaps 1 million per year in the United States. Proper adjustment of head restraints can reduce the incidence of neck pain in rear-end collisions by 24%. Persistent neck pain is more common in women by a ratio of 70:30. Whiplash injuries usually result in neck pain owing to myofascial trauma, which has been documented in both animal and human studies. Headaches, reported in 82% of patients acutely, are usually of the muscle contraction type, often associated with greater occipital neuralgia and less often temporomandibular joint syndrome. Occasionally migraine headaches can be precipitated. Dizziness often occurs and can result from vestibular, central, and cervical injury. More than one third of patients acutely complain of paresthesias, which frequently are caused by trigger points and thoracic outlet syndrome and less commonly by cervical radiculopathy. Some studies have indicated that a postconcussion syndrome can develop from a whiplash injury. Interscapular and low back pain are other frequent complaints. Although most patients recover within 3 months after the accident, persistent neck pain and headaches after 2 years are reported by more than 30% and 10% of patients. Risk factors for a less favorable recovery include older age, the presence of interscapular or upper back pain, occipital headache, multiple symptoms or paresthesias at presentation, reduced range of movement of the cervical spine, the presence of an objective neurologic deficit, preexisting degenerative osteoarthritic changes; and the upper middle occupational category. There is only a minimal association of a poor prognosis with the speed or severity of the collision and the extent of vehicle damage. Whiplash injuries result in long-term disability with upward of 6% of patients not returning to work after 1 year. Although litigation is very common and always raises questions of secondary gain in patients with persistent symptoms, most patients are not cured by a verdict. Acute treatment of neck pain consists of ice for 24 hours followed by heat applications, pain pills, NSAIDs, and muscle relaxants. Trigger point injections can be beneficial in both the acute and the persistent phases. Use of cervical collars should probably be kept to a minimum during the first 2 to 3 weeks after the injury and then avoided. Early passive mobilization and range of motion exercises may accelerate recovery. Physical therapy and transcutaneous nerve stimulators may be helpful in reducing pain and improving movement.(ABSTRACT TRUNCATED AT 400 WORDS)

The role of suprahyoid myotomy in surgical advancement of the mandible via sagittal split ramus osteotomies

The suprahyoid muscles have been implicated as primary effectors of relapse following surgical advancement of the deficient mandible. Accordingly, suprahyoid myotomy and/or the use of cervical collars have been recommended as adjunctive procedures to minimize postoperative relapse. This computerized morphometric evaluation of 16 patients revealed that suprahyoid myotomy is not essential to skeletal stability following surgical advancement of the mandible.

Help a Snorer

To the Editor.— Snoring caused by upper airway obstruction is commonly considered not more than a domestic nuisance. However, as Guilleminault et al 1 have pointed out, it may be associated with the sleep apnea syndrome—a matter of serious clinical concern. Guilleminault et al reported that no less than 96% of people who suffer from apneic periods lasting 20 sec or more had snored before the age of 21 years. Concomitant features such as excessive daytime somnolence, hypnagogic hallucinations, automatic behavior, morning headaches, abnormal motor activity during sleep, nocturnal enuresis, and cyclic hypertension should alert the physician to intervention. Robins 2 recommends simple positioning in bed. Yet, many people change their position while asleep and end up lying on their back. In a recent letter inThe Journal, Broomes (1980;244:1783) advised, more specifically, a novel use of the cervical collar. It is to counteract the forward sagging of the head.