The role of soft tissue mobilization in reducing orofacial and general complaints in a patient with Kimmerle anomaly and temporomandibular joint disorder: A case report

Abstract

Background: Kimmerle anomaly belongs to the anatomic varieties of the first cervical vertebra. The clinical pattern is dominated by vascular- and neurogenic-type headaches, dizziness, decreased postural muscle tension, and vegetative symptoms. Clinical Presentation: A 37-year-old woman who suffered from headache and pain in the left temporomandibular joint underwent clinical examination, electromyography of masticatory muscles, temporomandibular joint vibration analysis, cone beam computed tomography, and soft tissue mobilization. Radiologic examination revealed Kimmerle anomaly on the right side of the atlas. Clinical Relevance: Myofascial release decreased the tension within anatomic structures projected to the vertebral artery groove. Better movements of the cervical spine and fewer headaches were noted. Increased cervical and masseter muscle tension were considered the main cause of the ailments. The proprioceptive system of the cervical spine was accepted as a reason for persistent headaches. Soft tissue mobilization revealed positive healing effect in the patient with temporomandibular joint disorder and Kimmerle anomaly. Abbreviations: C1: First cervical vertebra; DC/TMD: Diagnostic Criteria for Temporomandibular Disorders (DC/TMD); BDI: Beck Depression Inventory; PSS: Perceived Stress Scale; NDI: Neck Disability Index; BioEMG: Surface electromyography; sEMG: Surface electromyography; ICC: Intraclass correlation coefficient; T-Scan® III: computer evaluation of dental occlusion; JVA: Joint Vibration Analysis; CBCT: Cone Beam Computed Tomography; TO: Occlusion time; the time from the first contact of the teeth to the maximum intercuspidation; reference value in patient with natural teeth <0.2 s; TDL: Disclusion time to the left; the time from the maximum intercuspidation to obtain complete lack of the teeth contact in lateral movement to the left; reference value in patient with natural teeth <0.4 s; TDR: Disclusion time to the right; the time from the maximum intercuspidation to obtain complete lack of the teeth contact in lateral movement to the right; reference value in patient with natural teeth <0.4 s; NHP: Natural head position; μSv: micro-Sievert; kV: kilovolt; mA: miliampere; cm: centimeter; μm: micrometer; s: second; Hz: Hertz; C1-C2: Segment of atlas and axis; AOD: Atlantooccipital dislocation; RV: Reference value; TrP: Trigger point; VAS: Visual Analog Scale; CN V: Cranial nerve V, trigeminal nerve; OC-C1: Occiput and first vertebra junction.

Keywords: Headache; Kimmerle anomaly; electromyography; joint vibration analysis; myofascial release; orofacial pain; soft tissue mobilization; temporomandibular joint.