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Articles by Edwin A. Ernest
Sphenopalatine Ganglion Neuralgia Diagnosis and Treatment
The sphenopalatine ganglion has been infrequently implicated in vague symptoms of the head, face, gums, teeth, neck and back since the early 1900s. The autonomic features often found to often be a part of the pain complex associated with the sphenopalatine ganglion tend to confound the clinician attempting to diagnose the reason for the patient’s headache that is typically described as a dull ache.
Head and Neck Pain
By Edwin A. Ernest, III, DMD, FAANaOS, Mario E. Martinez, DMD, MS, David B. Rydzewski, MD and E. George Salter, PhD Edwin A. Ernest III, DMD Chronic headache and pain of the temporal tendon has been recognized since the early 1980s by a relatively small number of clinicians. However, much of the prescribed therapy has only been anecdotal because evidence of histopathology for temporal tendonitis has been lacking.
Sphenomandibularis Muscle and Retro-Orbital Headache
Patients experiencing retro-orbital headaches that are not adequately managed by drugs may be an indication of sphenomandibularis referred pain.
Superior Pharyngeal Constrictor Muscle Dysfunction
Sprain or tendinitis of this large quadrilateral constrictor muscle may present as soreness, tightness, or pain at the pterygoid plate and may involve palatal muscles and ear symptoms as well. Diffuse facial pain “deep” to the temporomandibular joint with superior pharyngeal muscle soreness and pain, together with ear symptoms, is often enigmatic. This paper is intended to be an introduction to this previously unpublished disorder.
Orbital-Inner Canthus Headache due to Medial Temporal Tendonitis
Pain presenting as an intense headache apparently radiating from the inner canthus of the eye or orbit, but actually referred from medial temporal tendonitis, underlines the complexity of facial structures. In 1983, this author documented the painful condition noted as temporal tendinitis. The described pain originated at the insertion of the lateral tendon of the temporal muscle at the mandibular coronoid process (not coracoid).
Ernest Syndrome and Insertion of the SML at the Mandible
Characterized as a painful complex of symptoms related to the insertion of the stylomandibular ligament (SML) at the mandible, onset of this syndrome 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,...
Hyoid Bone Syndrome
A condition characterized by both dental and non-dental referral sites, this degenerative injury of the middle pharyngeal constrictor muscle is confirmed by photomicroscopic evidence of insertion tendinosis. By Edwin A. Ernest, III, DMD, FAANaOS and E.
Temporal Tendinitis Migraine Mimic
Diagnosis and treatment of temporal tendonitis—a very common disorder that is often mistaken for migraine. This article describes a very common headache disorder called temporal tendinitis1-7 which is often initiated by auto accident trauma and is complicated diagnostically by the intrinsic and extrinsic components of the temporomandibular joint (TMJ) and dental occlusion. In pain management, diagnosis is key.
Craniofacial Pain of Cardiac Origin
Cardiac-induced referred pain to the craniofacial region may drive a referral to a dentist and potentially miss the diagnosis of a life-threatening cardiac condition. Twenty years ago, health professions were not aware that certain oral bacteria, if permitted entrance into the gingival blood vessels, could cause some strokes and heart attacks.
Splenius Capitis Muscle Syndrome
This syndrome—a commonly occurring headache, neck ache, and facial pain disorder—typically mimics the respective pain patterns of temporal tendonitis and migraine headache. By Edwin A. Ernest, III, DMD, FAANaOS and Mark W. Ernest, BA This article describes a very painful and commonly occurring pain syndrome associated with the splenius capitis muscle insertion. This syndrome was first described in the 1980’s by this author.
Hand Tremor with Dental Medicine Implications
While many hand tremor cases may be linked to genetic predisposition or other origin, some hand and body tremors may be trigeminal nerve-related. This article has a distinctly personal application for me. In May of this year, I experienced elective neurosurgery for a movement disorder defined as Essential Tremor. The disorder of hand tremors in my case was bilateral in nature with the onset of symptoms occurring around age 60.
Adenoid Cystic Carcinoma of the Parotid Gland
A mimic of craniofacial pain symptoms of Ernest Syndrome and stylomandibular ligament injury, ACC in this case presented with ear, jaw and tooth pain, as well as pain on chewing and opening wide—all as a result of a growing mass affecting the trigeminal nerve with perineural invasion, the carotid artery, and the parotid gland. Craniofacial pain symptoms are often complex in nature and can represent a variety of unrelated conditions.
Cervical-Medullary Meningioma
Differential diagnosis of referred pain to TMJ and ear should also consider the rare possibility of tumor. Cervical-Medullary Meningioma, associated with acute and persisting pain of the head and neck, is a diagnostic challenge for doctors and patients. Pain associated with the Temporomandibular joint (TMJ), ear pain, headache and other radiating pains to include radiculopathy often suggests a co-morbid condition.
Head and Neck: Temporal Arteritis and Temporal Tendonitis Co-morbidity
It is evident to those who daily treat pain of the head and neck that it is almost a rule that head pain patients may suffer from two or more painful conditions present at the same time. In that context, please consider the following quote. Berman and Sinburg, two orthopedic surgeons, wrote in the Journal of Bone & Joint Surgery that “the injury of the temporomandibular joints is part of a more diffuse injury to the head and neck.
TMJ Pain and Temporal Tendonitis with Autonomic Features
A case review of a patient who presented with symptoms of trigeminal autonomic cephalalgia as well as TMJ and temporal tendon-related pain symptoms. This article reveals the complex nature of co-dependent structures neurally linked with the temporomandibular joint (TMJ) that can produce pain. Many of us know that facial and cranial pain are too often a challenge that yields disappointment for the patient and clinician.
Superior Pharyngeal Constrictor Muscle Pain
This retrospective observational study of patients with unresolved wrist pain noted improvements in many quality of life parameters after Hackett-Hemwall dextrose prolotherapy. By Edwin A. Ernest, III, DMD, FAANaOS, Mark W. Ernest, BA and 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.
Painful Herpetic Reactivation and Degenerative Musculoskeletal Injury
A pain patient presenting with herpetic neuralgia and multiple musculoskeletal issues provides an interesting and challenging case study. A patient suffering multiple sources of pain may present the clinician with a complex challenge especially when obvious skin lesions of herpetic reactivation and typical painful symptoms of herpetic neuralgia are present.
Head and Neck Pain
By Edwin A. Ernest, III, DMD, FAANaOS and E. George Salter, PhD Interventional blockade of the major sensory nerve to the TMJ can be a valuable diagnostic tool for the pain practitioner. The block is not unduly difficult, carries no risk of morbidity, and the resulting diagnostic information gain can be of paramount benefit. The complex pain patient who presents with TMJ symptoms and cervical pain not affected by previous therapies may benefit from this diagnostic block.
Head and Neck Pain
It is our hope at PPM Journal that this brief, but important tutorial will help to provide a bridge of critical information for the pain management disciplines. The bridge conveys foundational information about the TMJ. Some TMJ cases exhibit diffuse, aching pain and pressure while others exhibit ear pain, or neuralgic pains mimicking Trigeminal neuralgia.
TMJ Derangement and SUNCT Syndrome Co-morbidity
Case report of signs and symptoms of internal derangement of the temporomandibular joint (TMJ) co-morbid with short-lasting unilateral neuralgiform headache attacks from conjunctival injection and tearing (SUNCT) syndrome. The patient who suffers head and or neck pain is often a complex pain patient, meaning that the suffering can be the result of multiple, often unrelated conditions.
Cervical Disc Disease with Referred Pain to TMJ
A case report of cervical injury from a motor vehicle accident resulting in a cascade of physical changes over six months and referring pain to the TMJ and face. For many patients and doctors, issues that may relate to cervical pain are often complex and frustrating. It is not easy to determine why a patient suffers cervical, occipital or temporal pain, determine an accurate diagnosis, or create a successful treatment plan.
Injection Needle Injury of Oral Sensory Nerves
A discussion of inferior alveolar nerve and lingual nerve needle injury from transdermal and trans-mucosal injections concomitant with ipsilateral temporal tendonitis.
Patulous Eustachian Tube: Part 2
Often unrecognized, the symptoms of patulous eustachian tube may, and often do, mimic other ear conditions.
Patulous Eustachian Tube: Part 1
Often unrecognized, the symptoms of patulous eustachian tube may, and often do, mimic other ear conditions. This article describes a relatively little known otologic condition called Patulous Eustachian Tube. The symptoms often go unrecognized since the complaints may, and often do, mimic other ear conditions. This article discusses the assessment, differential diagnosis, and types of treatment currently being utilized for this often challenging condition.
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