Concurrent sorgical and craniofacial and a view of empric and basic science evidence

Because many patients present themselves for treatment with both craniofacial and craniocervical pain, two questions arise: 1) What are the sensory and motor consequences of dysfunction in either of these areas on the other? 2) Do craniofacial and craniocervical pain have a similar cause? These questions formed the impetus for this review article. The phenomenon of concurrent pain in craniofacial and cervical structures is considered, and clinical reports and opinions are presented regarding theories of cervical-to-craniofacial and craniofacial-tocervical pain referral. Because pain referral between these two areas requires anatomic and functional connectivity between trigeminally and cervically in-nervated structures, basic neurophysiologic and neuroanatomic literature is reviewed. The published data clearly demonstrate neurophysiologic and structural convergence of cervical sensory and muscle afferent inputs onto trigeminal subnucleus caudalis nociceptive and non-nociceptive neurons. Moreover, changes in metabolic activity and blood flow in the brainstem and cervical dorsal horn of the spinal cord in both monkeys and cats have been demonstrated after electric stimulation of the V1innervated superior sagittal sinus. In conclusion, the animal experimental data support the findings of human empiric and experimental studies, which suggest that strong connectivity exists between tri-.