Recently doctors at the University of Valencia in Spain wrote that Ernest syndrome involves damage to the stylomandibular ligament. It is characterised by pain in the preauricular area (external ear) and mandibular angle (jaw), radiating to the neck, shoulder, and eye on the same side, and associated with pain during palpation of that ligament. Further this disorder is sometimes confused with other types of orofacial pain, and may therefore be more prevalent than the literature would indicate.1
Identifying Ernest Syndrome as a real problem has been discussed in the medical literature for decades.
In 1987, Dr. WE Shankland II, described a detailed clinical analysis of 68 patients diagnosed as suffering from Ernest’s syndrome. He wrote:
- “Injury to the stylomandibular ligament is a real and frequent disorder causing craniomandibular pain.
- Symptoms of Ernest’s syndrome, in decreasing order of occurrence, are:
- TMJ and temporal pain,
- ear and mandibular pain,
- posterior tooth sensitivity,
- eye pain, and
- throat pain.
- In addition, shoulder pain may be involved.
Of the patients in this study, 77.94% were treated successfully via nonsurgical management of their complaints. Resolution of this disorder is usually accomplished by a combination of a diagnostic injection of local anesthetic at the insertion of the ligament, localized injection of cortisone substitute, and placing the patient on a soft diet.2
Our Prolotherapy Approach to Ernest Syndrome
As Ernest syndrome is caused by ligament weakness, our treatment approach is to strengthen the stylomandibular ligament with Prolotherapy. Once it is strengthened, the chronic ear-mouth pain, tinnitus, dizziness, vertigo and other pain complaints subside.
Below are discussions and treatments:
1 Peñarrocha-Oltra D, Ata-Ali J, Ata-Ali F, Peñarrocha-Diago MA, Peñarrocha M. Treatment of orofacial pain in patients with stylomandibular ligament syndrome (Ernest Syndrome). Neurologia. 2013 Jun;28(5):294-8. doi: 10.1016/j.nrl.2012.06.009. Epub 2012 Aug 14.