Cervical pain and headache in patients with facial asymmetries: the effect of orthognathic surgical correction

AIM: Facial asymmetries are often associated with cervicobrachial pain and headache. The aim of the study was to evaluate the influence of surgical orthodontic correction of facial asymmetries on intensity of cervicobrachial pain and headache at short and long term. METHODS: Thirty-two patients affected by maxillomandibular asymmetries associated with pain referred to occipital, cervical, dorsal and scapulohumeral areas and undergoing orthodontic surgical correction were enrolled in the study. Pain intensity at rest and on fibromyalgia trigger points was assessed by using a 0-10 Visual Analogue Scale (VAS) preoperatively (T(0)), 5 days (T(1)), 6 months (T(2)) and 12 months (T(3)) after surgery. Functional limitation was evaluated, by the same method, at T(0), T(2) and T(3). RESULTS: VAS scores at rest were significantly lower at T1, T2 and T3 compared to T0 in every pain referred area. After 12 months (T(3)), 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, in 28 patients (87,5%) in the scapulohumeral area. In the other patients pain scores, in all areas, were < 1 (0.77, 0.83, 0.95, 0.5 in the occipital, cervical, dorsal, and scapulohumeral area respectively). The VAS on neck fibromyalgia points were significantly reduced at T(1), T(2), T(3) and functional limitation was improved at T(3) and T(4) (P=0.00). CONCLUSIONS: This study seems to demonstrate the utility of ortognathic 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 allowed morphological, functional and symptomatic