TMJ 'dysfunction' - Health implications

Compression of the internal jugular vein by the transverse process of the atlas

Researchers who conducted a study on microsurgical anatomy of 36 internal jugular veins in adult cadaveric specimens have noted a common occurrence of compression of the internal jugular vein by the transverse process of the atlas in the upper cervical region. Their findings revealed that in every specimen, the posterior wall of the internal jugular vein was in contact with the transverse process of the atlas as the vein descended below the jugular foramen. Additionally, they discovered that in some cases, the transverse process indented the posterior wall of the vein, causing it to be angulated as it descended across the anterior surface of the transverse process.

Furthermore, the researchers also found that obstruction of the internal jugular vein by an asymmetric atlas is a prevalent phenomenon, with a Swiss study claiming that 97% of the population may have this asymmetry. Although their findings revealed a lesser incidence, they confirmed this observation and stressed the potential for adverse effects on the internal jugular vein.

The asymmetric atlas has a direct relationship with the asymmetry of the jaws, specifically a midline discrepancy. As such, the atlas balances with what is wrong in the front of the mouth, causing the muscles around the neck to constantly fire to correct the dental anomaly. These muscles, however, fail to correct the alignment due to the rigid structure of the jaw and teeth that require realignment. This constant contraction of the muscles, particularly the scalenes, leads to stiffness and often hypertrophy. In turn, these muscles can put pressure on the internal jugular veins, further complicating the obstruction from the asymmetric atlas vertebra, leading to a restriction of blood outflow from the cranium.

This obstruction causes slowed perfusion or transition across the brain, leading to poorer oxygenation. Hypoperfusion or slowed blood flow remains a constant finding in people with multiple sclerosis, leading to other cognitive problems and symptoms such as brain fog, lethargy, poor memory, iron accumulation, cell death, and an immune system response. Additionally, MS patients are often diagnosed with obstructions or stenosis of their internal jugular veins, which can be corrected using balloon angioplasty, leading to a dramatic improvement of symptoms in some patients.

Moreover, the build-up of venous back pressure can lead to a rise in cerebrospinal fluid pressure, leading to an increased size of the ventricles and extravasation of CSF into the brain stroma. Tinnitus and humming in the ear is also a common occurrence due to venous obstruction, with the temporomandibular joint playing a significant role.

Thus, it is crucial to correct jaw asymmetry and indirectly, the atlas asymmetry, to prevent IJV stenosis or blockage and improve arterial perfusion of the brain. The CCSVI procedure first practised by Dr. Zamboni, using balloon angioplasty, can be a major help in MS patients, but its failures could be attributed to the fact that it does not include the correction of the jaws and, indirectly, the atlas vertebrae.

To gain further insight into the anomalies of the vertebral artery due to the transverse processes of the atlas vertebrae, readers are urged to read the article, Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature.

Reference: Lima Neto AC, Bittar R, Gattas GS, Bor-Seng-Shu E, Oliveira ML, Monsanto RDC, Bittar LF. Pathophysiology and Diagnosis of Vertebrobasilar Insufficiency: A Review of the Literature. Int Arch Otorhinolaryngol. 2017 Jul;21(3):302-307. doi: 10.1055/s-0036-1593448. Epub 2016 Oct 26. PMID: 28680502; PMCID: PMC5495592.

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