Head and Neck Pain
by Edwin A. Ernest, III, DMD
Ernest Syndrome is a painful complex of reproducible symptoms (see Figure 1) related to
the insertion of the stylomandibular ligament (SML) at the mandible.1-21 The
onset of Ernest Syndrome may be a consequence of auto accident, whiplash, blunt trauma,
law enforcement submission techniques, general anesthesia, dental surgery, excessive
yawning, and other etiologies. The disorder is not easily diagnosed due to the multiple
areas of pain reference sites found distant from the insertion of the ligament. This
article describes two cases having an ultimate diagnosis of Ernest Syndrome resulting from
motor vehicular trauma but were inappropriately operated for TMJ arthroplasty.
History
Pain of the stylomandibular ligament with a referral pattern (see Figure 1) was first
discovered by this author in 1981 and published in 1982.1 Sataloff,12,17
an otolaryngologist at Thomas Jefferson School of Medicine in 1983, was the second to
report pain at the stylomandibular ligament insertion but made no mention of referred
sites of pain. Sataloff noted that the pain was remitted following a mandibular saggital
osteotomy procedure. Sataloff reported a restricted mandibular excursion prior to surgery
which returned to normal following surgery. This finding is supported by other reports in
the literature associating mandibular range of movement restriction with injury to the
stylomandibular ligament.3
In some cases SML restraint causes posterior displacement of the mandible with the
results of TMJ disc clicking and/or acute anterior dislocation of the TMJ articular disc.
This particular joint complication can really confound the diagnostic picture (see Figure
2).
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— October 2006
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