As a craniomanibular, oromaxillary, and facial pain specialist, I see a lot of cases that other specialists don't know what to do with. I evaluated a 23 year old pharmacy student who is home for the summer. She has a history of recurrent sinus infections and went to see her ENT a month ago when she developed left ear pain. She also noticed left facial pain and a "bump" in her ear at the anteiror portion of her auditory canal. The ENT prescribed antibiotics which cleared up her sinus issues, but she was left with ear pain and the "bump." By the time I saw her, onset was about 2-3 weeks and it was mostly unchanging.
Evaluation revealed an ectomorphic female, hypermobile, forward head. Symptoms were worse with eating at the "bump" or mass felt in her ear was worse at night. Objectively, she had full cervical ROM. Mandible depression was 32 mm with a deflection to the left, indicating a capsular pattern with left capsule involvement. There was no palpable clicking. Subcranial spine was restricted grade 2 moderate at OA for forward bending. Myofascia was moderately restricted in left masseter, left cervical paraspinals, upper trap, levator scapula. First rib was also restricted grade 2 moderate on the left with inferior glide. She mostly slept on her left.
Treatment
We changed her sleeping to supine or on her right with a pillow supported under left arm. Postural correction and cervical retraction was given to be performed hourly. She was to have a soft food diet for 1 week. Treatment consisted of fascial release/stripping to left upper quarter. Shear distraction as taught by Rocabado was used to gap the subcranial spine. Tool assisted STM was used to release the above mentioned tissues with the exception of the masseter. I don't use the fascialator on the face. It only took one bruise on one out of hundreds of patients for me to discontinue that. At the end of her session, she felt much better and did state it felt better when she wore earbuds to run. The "bump" she felt was either swelling from the bilaminar zone posterior to the mandible condyle or the actual mandible condyle posteriorly from her protracted head. Cervical protraction = mandible retraction. I told her also to wear her earbuds at night. Three visits later with some progression of TASTM and joint mobilization and she is 100%. She only needed to wear her earbuds nightly twice prior to the "bump" going away. Next visit is discharge with a lecture on keeping up with her home program and postural correction FOR LIFE and we have another happy patient and happy referring doctor.
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