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Healthcare News Provided by Minnesota Head and Neck Pain Clinic

November 1, 2022

Physical therapy or physiotherapy (often abbreviated to PT) is a health care profession that remediates impairments and promotes mobility, function, and quality of life through examination, diagnosis, and physical intervention (therapy using mechanical force and movement). It is carried out by physical therapists (known as physiotherapists in most countries) and physical therapist assistants (known as physical rehabilitation therapists or physiotherapy assistants in some countries). In addition to clinical practice, other activities encompassed in the physical therapy profession include research, education, consultation, and administration. In many settings, physical therapy services may be provided alongside, or in conjunction with, other medical or rehabilitation services, including occupational therapy.


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April 28, 2022 0

Temporomandibular Joint

The temporomandibular joint is the joint of the jaw and is frequently referred to as TMJ. The TMJ is a bilateral synovial articulation between the mandible and temporal bone. The name of the joint is derived from the two bones which form the joint: the upper temporal bone which is part of the cranium (skull), and the lower jawbone or mandible. The temporomandibular is pronounced “tem-puh-roe-man-DIB-u-lur” joint. The acronym for it is TMJ. However, this acronym has also been used to refer to a group of health conditions related to your jaw. The easiest way to visualize it is that it acts like a sliding hinge, connecting your jawbone to your skull. You have one joint on each side of your jaw. TMJ disorders — a type of temporomandibular disorder or TMD — can cause pain in your jaw joint and in the muscles that control jaw movement.

Many people suffering from a TMJ disorder may not think of it unless a dentist diagnoses them with it. It can be a chronic pain issue with serious conditions that can cause much pain and discomfort. Untreated, this disorder can make it difficult to chew and even speak. Instead of suffering and being in agony, you can speak to your dentist.

Where is the Temporomandibular Joint Located?

The temporomandibular joint (TMJ) is the joint that connects your mandible (lower jaw) to your skull. The joint can be found on both sides of your head in front of your ears. It allows your jaw to open and close, letting you easily speak, eat, yawn, and other normal daily functions – when the joint is healthy.

When it works the way it was created to, it enables you to talk, chew, and yawn. Individuals suffering from TMJ dysfunction commonly have problems with the joint and muscles around it. When this joint is inflamed or traumatized, it may cause :

  • Pain that travels throughout the face, jaw, or neck region
  • Stiff jaw muscles that limit normal functioning
  • Limited movement, operation, or locking of the jaw
  • Painful clicking or popping in the jaw when opened and closed
  • A change in the way the upper and lower teeth fit together that increases pain

Jaw pain may go away with little or no treatment. Treatment may include simple things you can do yourself, such as eating soft foods or applying ice packs. It may also include pain medicines or devices to insert into your mouth. In very rare cases, you might need surgery.

In most cases, a person’s pain and discomfort associated with TMJ disorders are temporary. Commonly, when the Temporomandibular is inflamed or traumatized, it can be relieved with self-managed care or nonsurgical treatments. Surgery is typically a last resort after conservative measures have failed, but some people with TMJ disorders may benefit from surgical treatments. Conservative care has the best results for most people and starts with non-invasive, and no-opioid treatment to the jaw.

Symptoms that the Temporomandibular is Mis-functioning may include:

Signs and symptoms of TMJ disorders may include:

  • Pain or tenderness in your jaw area
  • Pain in one or both of the temporomandibular joints as you seek to move them
  • Aching pain in and around your ear where it connects entities
  • Difficulty chewing or pain while chewing tougher foods
  • Aching facial pain in general without the ability to identify the exact location it is coming from
  • Locking of your jaw joint, making it difficult to open or close your mouth

The best medical specialized person to help with Temporomandibular joint issues is an orofacial pain specialist. Once you have a clear diagnosis and the jaw pain has become more manageable, TMJ  supervised jaw pain treatment integrated with self-care may provide the pain relief you need.


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April 28, 2022 0

Obstructive sleep apnea (OSA) (or apnoea)

It is the most common type of sleep apnea and is caused by obstruction of the upper airway. It is characterized by repetitive pauses in breathing during sleep, despite the effort to breathe, and is usually associated with a reduction in blood oxygen saturation. These pauses in breathing, called “apneas” (literally, “without breath”), typically last 20 to 40 seconds. The individual with OSA is rarely aware of having difficulty breathing, even upon awakening. It is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body (sequelae). OSA is commonly accompanied by snoring – in this case, oral appliance therapy is best.

Some use the term obstructive sleep apnea syndrome to refer to OSA which is associated with symptoms during the daytime. Symptoms may be present for years or even decades without identification, during which time the individual may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance. Individuals who generally sleep alone are often unaware of the condition, without a regular bed partner to notice and make them aware of their symptoms. As the muscle tone of the body ordinarily relaxes during sleep, and the airway at the throat is composed of walls of soft tissue, which can collapse, it is not surprising that breathing can be obstructed during sleep.

How Common is It?

Although a very minor degree of OSA is considered to be within the bounds of normal sleep, and many individuals experience episodes of OSA at some point in life, a small percentage of people have chronic, severe OSA. Many people experience episodes of OSA for only a short period of time. This can be the result of an upper respiratory infection that causes nasal congestion, along with swelling of the throat, or tonsillitis that temporarily produces very enlarged tonsils. The Epstein-Barr virus, for example, is known to be able to dramatically increase the size of lymphoid tissue during acute infection, and OSA is fairly common in acute cases of severe infectious mononucleosis. Temporary spells of OSA syndrome may also occur in individuals who are under the influence of a drug (such as alcohol) that may relax their body tone excessively and interfere with normal arousal from sleep mechanisms.

It is different from Central Sleep Apnea which occurs because your brain doesn’t send proper signals to the muscles that control your breathing. Obstructive sleep apnea is when you can’t breathe normally because of upper airway obstruction. Central sleep apnea is less common than obstructive sleep apnea. It falls under the medical specialty of sleep medicine.

According to Wikipedia, Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to reduced or absent breathing during sleep. These episodes are termed “apneas” with complete or near-complete cessation of breathing, or “hypopneas” when the reduction in breathing is partial. In either case, a fall in blood oxygen saturation, a disruption in sleep, or both may result. A high frequency of apneas or hypopneas during sleep may interfere with restorative sleep, which – in combination with disturbances in blood oxygenation – is thought to contribute to negative consequences to health and quality of life.[1] The terms obstructive sleep apnea syndrome (OSAS) or obstructive sleep apnea–hypopnea syndrome (OSAHS) may be used to refer to OSA when it is associated with symptoms during the daytime (e.g. excessive daytime sleepiness, decreased cognitive function).

There are 3 levels of OSA consequences: physiologic, intermediate, and clinical

The physiologic consequences of a person facing this condition are: contain hypoxia, sleep fragmentation, autonomic nervous system dysregulation, or hyperoxia. The intermediate results regroup inflammation, pulmonary vasoconstriction, general metabolic dysfunction, oxidation of proteins and lipids, or increased adiposity. The clinical repercussions of these sleep-deprived patients are composed by pulmonary hypertension, accidents, obesity, diabetes, different heart diseases, or hypertension.

Check out our post on Oral Appliance Therapy for Treating OSA.



September 30, 2021 0

The jaw is any opposable articulated structure at the entrance of the mouth, typically used for grasping and manipulating food. The term jaws is also broadly applied to the whole of the structures constituting the vault of the mouth and serving to open and close it and is part of the body plan of most animals.



September 17, 2021 0

Major depressive disorder (MDD) (also known as clinical depression, major depression, unipolar depression, or unipolar disorder; or as recurrent depression in the case of repeated episodes) is a mental disorder characterized by a pervasive and persistent low mood that is accompanied by low self-esteem and by a loss of interest or pleasure in normally enjoyable activities. The term “depression” is used in a number of different ways. It is often used to mean this syndrome but may refer to other mood disorders or simply to a low mood. Major depressive disorder is a disabling condition that adversely affects a person’s family, work or school life, sleeping and eating habits, and general health. In the United States, around 3.4% of people with major depression commit suicide, and up to 60% of people who commit suicide had depression or another mood disorder. The diagnosis of major depressive disorder is based on the patient’s self-reported experiences, behavior reported by relatives or friends, and a mental status examination. There is no laboratory test for major depression, although physicians generally request tests for physical conditions that may cause similar symptoms. The most common time of onset is between the ages of 20 and 30 years, with a later peak between 30 and 40 years. Typically, people are treated with antidepressant medication and, in many cases, also receive counseling, particularly cognitive behavioral therapy (CBT). Medication appears to be effective, but the effect may only be significant in the most severely depressed. Hospitalization may be necessary in cases with associated self-neglect or a significant risk of harm to self or others. A minority are treated with electroconvulsive therapy (ECT). The course of the disorder varies widely, from one episode lasting weeks to a lifelong disorder with recurrent major depressive episodes. Depressed individuals have shorter life expectancies than those without depression, in part because of greater susceptibility to medical illnesses and suicide. It is unclear whether or not medications affect the risk of suicide. Current and former patients may be stigmatized. The understanding of the nature and causes of depression has evolved over the centuries, though this understanding is incomplete and has left many aspects of depression as the subject of discussion and research. Proposed causes include psychological, psycho-social, hereditary, evolutionary and biological factors. Long-term substance abuse may cause or worsen depressive symptoms. Psychological treatments are based on theories of personality, interpersonal communication, and learning. Most biological theories focus on the monoamine chemicals serotonin, norepinephrine and dopamine, which are naturally present in the brain and assist communication between nerve cells. This cluster of symptoms (syndrome) was named, described and classified as one of the mood disorders in the 1980 edition of the American Psychiatric Association’s diagnostic manual.



September 17, 2021 0

Psychological pain is an unpleasant feeling (a suffering) of a psychological, non-physical, origin. A pioneer in the field of suicidology, Edwin S. Shneidman, described it as “how much you hurt as a human being. It is mental suffering; mental torment.” There is no shortage in the many ways psychological pain is referred to, and using a different word usually reflects an emphasis on a particular aspect of mind life. Technical terms include algopsychalia and psychalgia, but it may also be called mental pain, emotional pain, psychic pain, social pain, spiritual or soul pain, or suffering. While these clearly are not equivalent terms, one systematic comparison of theories and models of psychological pain, psychic pain, emotional pain, and suffering concluded that each describe the same profoundly unpleasant feeling. Psychological pain is believed to be an inescapable aspect of human existence. Other descriptions of psychological pain are “a wide range of subjective experiences characterized as an awareness of negative changes in the self and in its functions accompanied by negative feelings”, “a diffuse subjective experience … differentiated from physical pain which is often localized and associated with noxious physical stimuli”, and “a lasting, unsustainable, and unpleasant feeling resulting from negative appraisal of an inability or deficiency of the self.”



September 2, 2021 0

A tension headache (renamed a tension-type headache by the International Headache Society in 1988) is the most common type of primary headache. The pain can radiate from the lower back of the head, the neck, eyes, or other muscle groups in the body. Tension-type headaches account for nearly 90% of all headaches. A number of medications have been found to be useful for prevention, including tricyclic antidepressants and SSRIs. Evidence is poor for propranolol and muscle relaxants. Tension headaches affect about 1.4 billion people (20.8% of the population) and are more common in women than men (23% to 18% respectively).



September 1, 2021 0

Orofacial pain is a general term covering any pain which is felt in the mouth, jaws and the face. Orofacial pain is a common symptom, and there are many causes. It is estimated that over 95% of cases of orofacial pain result from dental causes (i.e. toothache caused by pulpitis or a dental abscess). After dental pain, the second most common cause of orofacial pain is temporomandibular joint dysfunction (TMD, pain-dysfunction syndrome). All other causes of orofacial pain are rare in comparison, although the full differential diagnosis is extensive.


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September 1, 2021 0

Chronic Pain and how to define it?

Chronic pain is defined as pain that has lasted longer than three to six months, though some theorists and researchers have placed the transition from acute to chronic pain at 12 months. Others apply acute to pain that lasts less than 30 days, chronic to pain of more than six months duration, and subacute to pain that lasts from one to six months. A popular alternative definition of chronic pain, involving no arbitrarily fixed durations, is “pain that extends beyond the expected period of healing”. There is little evidence for effectively treating most types of severe, acute pain with opioids. An exception is ongoing, intense pain due to cancer. While they may improve pain in the short term there is no evidence of improved long-term pain or functioning. Risks include overdose and addiction. In the United States, about 100 million people have chronic pain, with 25% of those having more severe pain.

Ongoing scientific evidence suggests that some multidisciplinary health approaches may help people better manage chronic pain.

Definitions from Several Experts:

  • Hopkins Medical defines it as “Chronic pain is long-standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be “on” and “off” or continuous. It may affect people to the point that they can’t work, eat properly, take part in physical activity, or enjoy life.
  • Chronic Pain Institute: “Many of us have experienced pain to some degree throughout the course of our lives. We may understand what pain can feel like, but it can still be difficult to fully define. A good definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue damage. While most definitions give the scientific description of pain, the emotional and physical effects can be difficult to describe, as they vary from person to person. The following sections are available to help you better understand pain so that you can seek proper treatment from your pain specialist.
  • Mayo Clinic says: “Chronic pain is pain that isn’t due to a temporary cause and typically lasts longer than three months. Chronic pain can be constant or can come and go. You might have some painful days during the week and some pain-free, or you might have pain at certain times of the day and not others.
  • NIH defines it as: “It is pain that lasts more than several months (variously defined as 3 to 6 months, but longer than “normal healing”). It’s a very common problem. Results from the 2012 National Health Interview Survey show that:

– About 25.3 million U.S. adults (11.2 percent) had pain every day for the previous 3 months.

– Nearly 40 million adults (17.6 percent) had severe pain.

– Individuals with severe pain had worse health, used more health care, and had more disability than those with less severe pain.

Guidelines for the Treatment of Chronic Pain Conditions

National health professional organizations like the CDC have issued guidelines for treating several chronic pain conditions. Some mention ways in which health approaches to treating head and neck pain can be incorporated into treatment plans. Others discourage the use of certain opioid prescription approaches.

A clinical practice guideline from the American College of Physicians encourages the use of nonpharmacologic approaches as initial treatment for chronic low-back pain. The options they suggest include several complementary approaches—acupuncture, mindfulness-based stress reduction, tai chi, yoga, progressive relaxation, biofeedback, and spinal manipulation—as well as conventional methods such as exercise and cognitive behavioral therapy.

In light of the human and healthcare costs of chronic pain, as well as evidence that many patients who have chronic pain turn to pain specialists for relief. The CDD, FDA, and NCCIH place a high priority on pain-related research. Yet today, researchers in this area still face challenges: much remains to be understood about the nature of chronic pain and about the best ways of studying its many causes, people’s different responses, and the value of various treatment approaches— including conservative and conventional. The ultimate goal is to build an evidence base that can guide pain management decisions and complement clinician judgment. These decisions often involve combining treatment approaches in cost-effective ways to best help chronic pain patients minimize pain, carry out everyday activities, and improve their quality of life.

At the Minnesota Head and Neck Pain Clinics, we know that acute pain is a complex challenge that often affects many areas of a person’s life. Our goal is to provide chronic pain relief, reduce or manage chronic pain to improve a patient’s life, and allow them to return to a more normal, active, and productive lifestyle. 

It is persistent pain that lasts weeks to years.
The pain may be caused by inflammation, dysfunctional nerves, or trauma to the jaw.
The primary symptom is a persistent painful experience that lasts weeks to years.
Pain clinic treatments include medications, proper diagnosis, physical therapy, cognitive-behavioral therapy, a close look at all prescriptions used and medical history, and in extreme cases may need a surgery referral.

 

Image source: Photo illustration by Rayne Zaayman-Gallant of the European Molecular Biology Laboratory (Creative Commons CC BY-NC-ND 4.0)


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August 31, 2021 0

What is TMD?

Temporomandibular joint dysfunction (sometimes abbreviated to TMD or TMJD and also termed temporomandibular joint dysfunction syndrome, temporomandibular disorder or many other names), is an umbrella term covering pain and dysfunction of the muscles of mastication (the muscles that move the jaw) and the temporomandibular joints (the joints which connect the mandible to the skull).

The most important feature is pain, followed by restricted mandibular movement, and noises from the temporomandibular joints (TMJ) during jaw movement. Although TMD is not life-threatening, it can be detrimental to quality of life, because the symptoms can become chronic and difficult to manage. About 20% to 30% of the adult population are affected to some degree. Usually people affected by TMD are between 20 and 40 years of age, and it is more common in females than males. TMD is the second most frequent cause of orofacial pain after dental pain (i.e. toothache). TMD is a symptom complex rather than a single condition, and it is thought to be caused by multiple factors. However, these factors are poorly understood, and there is disagreement as to their relative importance. There are many treatments available, although there is a general lack of evidence for any treatment in TMD, and no widely accepted treatment protocol exists. Common treatments that are used include provision of occlusal splints, psychosocial interventions like cognitive behavioural therapy, and medications like analgesics (pain killers) or others. Most sources now agree that no irreversible treatment should be carried out for TMD.

Diagnosis and Management of TMD

The facial area and related cranial, oral, and dental structures are some of the most complex entities of the body. This contributes to an array of common orofacial disorders that include temporomandibular disorders (TMD), orofacial pain disorders, and orofacial sleep disorders. This site attempts to present a broad, inclusive approach to diagnosis and management of TMD that reflects both conceptual models of human systems in understanding chronic illnesses as well as systematic reviews of treatment for successful management.

An orofacial pain specialist is the best person to diagnose and manage TMD.

Click here for a table of Common diagnoses of temporomandibular disorders (TMD) and their clinical findings.

Some less common diagnoses of temporomandibular disorders (TMD).
I. TMJ
A. Joint pain
  1. Arthritis
B. Joint disorders
  1. Hypomobility disorders other than disc disorders
a. Adhesions/Adherence
b. Ankylosis (Fibrous or Osseous)
  2. TMJ dislocations
C. Joint diseases
  1. Systemic arthritides
  2. Condylysis/Idiopathic condylar resorption
  3. Osteochondritis dissecans
  4. Osteonecrosis
  5. Neoplasm
  6. Synovial Chondromatosis
D. Fractures
E. Congenital/Developmental disorders
  1. Aplasia
  2. Hypoplasia
  3. Hyperplasia
II. Masticatory Muscles
A. Muscle pain
  1. Tendonitis
  2. Myositis
  3. Spasm
B. Contracture
C. Hypertrophy
D. Neoplasm
E. Movement Disorders
  1. Orofacial dyskinesia
  2. Oromandibular dystonia
F. Masticatory muscle pain related to central/systemic pain disorder
  1. Fibromyalgia/widespread pain
III. Associated Structures
A. Coronoid hyperplasia

Table puplished by NIH (Temporomandibular Disorders: Current Concepts and Controversies in Diagnosis and Management)

 

The National Institute of Dental and Craniofacial Research classifies TMD by the following:

  • Myofascial pain. This is the most common form of TMD. It results in discomfort or pain in the fascia (connective tissue covering the muscles) and muscles that control jaw, neck and shoulder function.

  • Internal derangement of the joint. This means a dislocated jaw or displaced disk, (cushion of cartilage between the head of the jaw bone and the skull),  or injury to the condyle (the rounded end of the jaw bone that articulates with the temporal skull bone).

  • Degenerative joint disease. This includes osteoarthritis or rheumatoid arthritis in the jaw joint.

We use our jaw for so many functions, meaning that it merits attention to protect the jaw joint and prevent TMD.

IMAGE SOURCE: NIH: Pain profiling of patients with temporomandibular joint arthralgia and osteoarthritis diagnosed with different imaging techniques


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August 31, 2021

Myofascial pain syndrome (MPS), also known as chronic myofascial pain (CMP), is a syndrome characterized by chronic pain caused by multiple trigger points and fascial constrictions. Characteristic features of a myofascial trigger point include: focal point tenderness, reproduction of pain upon trigger point palpation, hardening of the muscle upon trigger point palpation, pseudo-weakness of the involved muscle, referred pain, and limited range of motion following approximately 5 seconds of sustained trigger point pressure.



August 31, 2021 0

Fibromyalgia (FM or FMS) is characterised by chronic widespread pain and a heightened and painful response to pressure. Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term fibromyalgia syndrome for the condition. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some people also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia is frequently associated with psychiatric conditions such as depression and anxiety and stress-related disorders such as posttraumatic stress disorder. Not all people with fibromyalgia experience all associated symptoms. Its exact cause is unknown but is believed to involve psychological, genetic, neurobiological and environmental factors. There is evidence that environmental factors and certain genes increase the risk of developing fibromyalgia – these same genes are also associated with other functional somatic syndromes and major depressive disorder. The central symptom of fibromyalgia, namely widespread pain, appears to result from neuro-chemical imbalances including activation of inflammatory pathways in the brain which results in abnormalities in pain processing. The brains of fibromyalgia patients show functional and structural differences from those of healthy individuals, but it is unclear whether the brain anomalies cause fibromyalgia symptoms or are the product of an unknown underlying common cause. Some research suggests that these brain anomalies may be the result of childhood stress, or prolonged or severe stress. Fibromyalgia has been recognized as a diagnosable disorder by the US National Institutes of Health and the American College of Rheumatology. Fibromyalgia, a central nervous system disorder, is described as a “central sensitization syndrome” caused by neurobiological abnormalities which act to produce physiological pain and cognitive impairments as well as neuro-psychological symptomatology. Despite this, there is controversy as to the cause and nature of fibromyalgia, as well as how patients are described by those in the medical community. Dr. Frederick Wolfe, lead author of the 1990 paper that first defined the diagnostic guidelines for fibromyalgia, has stated he believes the causes of Fibromyalgia “are controversial in a sense” and “there are many factors that produce these symptoms – some are psychological and some are physical and it does exist on a continuum.” Fibromyalgia is estimated to affect 2–8% of the population, with a female to male incidence ratio that is somewhere between 7:1 and 9:1. The term “fibromyalgia” derives from New Latin, fibro-, meaning “fibrous tissues”, Greek myo-, “muscle”, and Greek algos, “pain”; thus the term literally means “muscle and connective tissue pain”.



August 25, 2021 0

A health professional is an individual who provides preventive, curative, promotional or rehabilitative health care services in a systematic way to people, families or communities. A health professional (also known as a health worker) may operate within medicine, surgery, midwifery (obstetrics), dentistry, nursing, pharmacy, psychology or allied health professions. A health professional may also be a public/community health expertee working for the common good of the society.



August 24, 2021 0

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders. Disruptions in sleep can be caused by a variety of issues, from teeth grinding (bruxism) to night terrors. When a person suffers from difficulty falling asleep and/or staying asleep with no obvious cause, it is referred to as insomnia. Sleep disorders are broadly classified into dyssomnias, parasomnias, circadian rhythm sleep disorders involving the timing of sleep, and other disorders including ones caused by medical or psychological conditions and sleeping sickness. Some common sleep disorders include sleep apnea (stops in breathing during sleep), narcolepsy and hypersomnia (excessive sleepiness at inappropriate times), cataplexy (sudden and transient loss of muscle tone while awake), and sleeping sickness (disruption of sleep cycle due to infection). Other disorders include sleepwalking, night terrors and bed wetting. Management of sleep disturbances that are secondary to mental, medical, or substance abuse disorders should focus on the underlying conditions.


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Our mission is to provide high-quality, effective patient care for head and neck disorders through a multispecialty, interdisciplinary approach designed to reduce pain and improve function for all our patients.

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