MRI Analysis of the Size and Shape of the Oropharynx in Chronic Whiplash

James Elliott1-3, Emma Cannata4, Eric Christensen4, Joel DeMaris4, John Kummrow4, Erin Manning4,
Elizabeth Nielsen4, Tomas Romero4 Clifford Barnes4, Tim Noteboom4, Gwendolen Jull1

Introduction:
•Persistent pain and disability
following whiplash is not
uncommon
•It is well-documented that many
persons present with a myriad
of symptoms in association with
pain.
•Some less recognized
symptoms include throat and
voice deficits.
•The purpose of this
retrospective investigation was
to quantify differences in the
size/shape of the oropharynx
between female subjects with
chronic whiplash and healthy
controls (18-45 years).
Materials/Methods:
• 113 female subjects (79 with
whiplash associated disorders
(WAD), 34 healthy controls;
18-45 years, 3 months-3
years post injury).
• T1-weighted MRI was used to
measure 1) cross-sectional
area (mm2) and 2) shape
ratios for the oropharynx at
C1-2
a b
Figure 2- shape-ratios (AP/Lateral) for the oropharynx
at C1-2 vertebral level- a) whiplash b) control
Table 1- Demographic details of subjects. Data
presented as mean (SD)
Results:
• Whiplash subjects had
significantly smaller CSA and
shape ratios when compared to
healthy controls (p < 0.001).
• Self-reported levels of
pain/disability and duration of
symptoms did not influence
size/shape (p = 0.75 & p = 0.99,
respectively)
• Age/BMI influenced size/shape
(p = 0.01 and p < 0.001,
respectively) but only 20 to 30%
of the variance was explained by
these factors.
Discussion:
• Throat and voice symptoms have been
attributed to a whiplash injury.
• This study found marked differences in the
CSA and shape-ratio of the oropharynx
measured at the C1-2 landmark in a group
with a recalcitrant WAD.
• It is unknown if this observation is related to
any specific symptom or mechanism.
• The presence of such changes warrants
further dedicated prospective clinical and
mechanistic research to better understand the
possible sequelae of a whiplash injury.

Dens
Shape_Ratio_A/P
Dens
Oropharynx
Atlas 0.8
Tip of Uvula
0.7
AP/Lateral_mm^

0.6
Oropharynx
0.5 **
0.4
0.3
0.2
a b
Condyles of Atlas 0.1
0
Figure 1- A healthy control subject – a) Sagittal T2-weighted MRI Whiplash Control
of cervical spine outlining area of oropharynx and b) axial T1-
weighted MRI outlining C1-2 segment where oropharynx size Figure 3- shape ratio for oropharynx (mean ± SD)
and shape measures were obtained ** p < 0.001

Conclusions:
• This is the first study to demonstrate that female subjects with chronic WAD have quantifiable changes in the size/shape of the
oropharynx

•These data may reflect a number of different mechanisms. Further work is warranted to investigate the 1) temporal development of
such changes, 2) potential mechanisms, 3) relationship to signs/symptoms and 4) whether multi-disciplinary treatment regimes can
influence outcomes in patients with whiplash related symptoms of voice deficits.
Elliott J et al., Otol Head Neck Surg 2008;138:747-51

1 2 3 4

* j.elliott2@uq.edu.au