Head and Neck Pain
by Edwin A. Ernest, III, DMD, FAANaOS; Mark W. Ernest, BA; E. George Salter, PhD
 A painful syndrome originating in the oral pharynx is
described in this article. The symptoms, similar to those associated with Ernest Syndrome
(stylomandibular ligament hyperextension injury), were documented at the Ernest Clinic in
1988. A review of symptomatic cases reveals the onset of pain with motor vehicle trauma
and other trauma related events. The injury may be unilateral or bilateral in nature, and
can result in limited mandibular opening due to the loss of muscle functionality resulting
from the injury. Local anesthetic infiltration, in small volume, is the test method of
choice and remission of pain is the indicator of the origin fibers’ involvement in
the production of the painful symptoms. Cases that continue to hurt following the
anesthetic benefit may be treated very selectively with radio-frequency thermo-neurolysis
or radio-frequency pulse. It is our experience that the inclusion of the injured
mandibular origin fibers of the superior pharyngeal constrictor muscle at mandible
(SPCM-M) in the differential diagnosis of symptoms — that would otherwise suggest
Ernest Syndrome may — serve to increase the degree of successful diagnosis and
treatment.
Anatomy and Function
Gray1 describes the origin fibers of the superior pharyngeal constrictor muscle
at mandible (SPCM-M) to be found at the lingual surface of the mandible (see Figure 1).
The site of attachment is at, or below, the convexity of the mandibular lingual crest
above a point called the mylohyoid line and medial to the third molar tooth. The muscle
fibers serve to anchor and stabilize the wall of the superior pharynx in respiration,
phonation, and narrows the pharynx in deglutition.
The pharyngeal branches of the vagus nerve, known as the tenth cranial nerve, provide
innervation via the pharyngeal plexus. The only pharyngeal muscle not supplied by the
Vagus is the Stylopharyngeus muscle.
Etiology
The causes of injury to the origin fibers may be trauma, motor vehicular accident, third
molar surgery, or other traumatic events. One patient had an oral impression event as the
contributing factor to her painful episode. She experienced temporal tendinitis and SPCM-M
pain from the strain of mouth opening. Our opinion is that this patient experienced some
hyperextension of the mandible or lower jaw in the process of opening for dental
impressions, and some possible trauma from the impression tray. She did resolve with an
injection of local anesthetic and cortisone at the SPCM-M origin and temporal tendon
insertion, and did not require any further treatment.
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— September 2006
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