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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva
Minerva Anestesiologica 2007 May;73(5):281-9
Cervical pain and headache in patients with facial asymmetries: the effect of orthognathic surgical correction
Corbacelli A. 1, Cutilli T. 1, Marinangeli F. 2, Ciccozzi A. 2, Corbacelli C. 1, Necozione S. 3, Masedu F. 3, Varrassi G. 2
1 Department of Surgical Sciences, Maxillofacial Surgery Institute, University of L’Aquila, L’Aquila, Italy;
2 Department of Surgical Sciences, Anesthesiology and Pain Treatment Institute, University of L’Aquila, L’Aquila, Italy;
3 Department of Medicine and Public Health, Statistics Institute, University of L’Aquila, L’Aquila, Italy
Aim. Facial asymmetries are often associated with cervicobrachial pain and headache. The aim of the study was to evaluate the influence of surgical orthognathic correction of facial asymmetries on the intensity of cervicobrachial pain and headache in the short and long term.
Methods. Thirty-two patients affected by maxillomandibular asymmetries associated with pain referred to occipital, cervical, dorsal and scapulohumeral areas who were undergoing orthodontic surgical correction were enrolled in the study. The pain intensity at rest and on fibromyalgia trigger points was assessed using a 0-10 Visual Analogue Scale (VAS) preoperatively (T0) and 5 days (T1), 6 months (T2) and 12 months (T3) after surgery. Functional limitation was evaluated by the same method at T0, T2 and T3.
Results. VAS scores at rest were significantly lower at T1, T2 and T3 compared to T0 in every area to which pain was referred. After 12 months (T3), pain at rest was completely absent in 23 patients (71.8%) in the occipital region, in 23 patients (71.8%) in the cervical area, in 22 patients (68.7%) in the dorsal area, and in 28 patients (87.5%) in the scapulohumeral area. In the other patients, the pain scores in all areas were < 1 (0.77, 0.83, 0.95, 0.5 in the occipital, cervical, dorsal, and scapulohumeral areas respectively). The VAS at neck fibromyalgia points were significantly reduced at T1, T2, T3 and functional limitation was improved at T3 and T4 (P=0.00).
Conclusion. This study appears to demonstrate the utility of orthognathic surgery when facial asymmetry is associated with cranial-cervicobrachial pain syndrome, presumably through a new musculoskeletal rearrangement of stomatognathic apparatus. Indeed, the surgical correction has resulted in morphological, functional and symptomatic effects.