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Clinical and radiologic findings in contact-sports' athletes who sustained injury to the Vital Cranial Triad (VCT), a complex of bones consisting of the temporomandibular joint (TMJ), the tympanic temporal bone and the inferior surface of the petrous temporal bone, were studied. Approaches to the diagnosis of temporomandibular disorders focused on findings from patient history, clinical examination and a modified transcranial radiographic examination. Indications for radiography included headache, earache, nausea, vomiting, vertigo, impaired hearing and balance, muscle weakness, occlusal disturbances, TMJ pain and other symptoms associated with neurologic and circulatory deficit secondary to trauma. Radiologic findings included compression fractures, condylar neck fracture, degenerative condylar remodeling, obliteration of the articular eminence, atresia of the ear canal and other damage to the VCT. Structural damage to the VCT is described and the associated symptoms are discussed in the context of 4 exemplary cases. The use of a customized mandibular orthopedic repositioning appliance to prevent injuries to the VCT is discussed. Damage to the VCT leads to painful and tragic sequelae which can and must be prevented in contact sports.
vital cranial triad, tempomandibular disorders, modified transcranial radiography, intraoral jaw-joint protection appliance, strength testing, symptomatology, diagnosis, prevention, repetitive impact loading, sequelae, jaw-joint disorders, contact sports
CEO, WIPSS Inc., Philadelphia, PA