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,
THE UNIVERSITY
Elizabeth Nielsen4, Tomas Romero4 Clifford  Barnes4, Tim Noteboom4, Gwendolen Jull1 OF QUEENSLAND
AUSTRALIA

Introduction: Results:
•Persistent pain and disability • Whiplash subjects had
following whiplash is not significantly smaller CSA and
uncommon shape ratios when compared to
healthy controls (p < 0.001).
•It is well-documented that many
persons present with a myriad • Self-reported levels of
of symptoms in association with pain/disability and duration of
pain. symptoms did not influence
a b size/shape (p = 0.75 & p = 0.99,
•Some less recognized
respectively)
symptoms include throat and
voice deficits. Figure 2- shape-ratios (AP/Lateral) for the • Age/BMI influenced size/shape
oropharynx at C1-2 vertebral level- a) whiplash b) (p = 0.01 and p < 0.001,
•The purpose of this
respectively) but only 20 to 30%
retrospective investigation was control
of the variance was explained by
to quantify differences in the
these factors.
size/shape of the oropharynx
between female subjects with
chronic whiplash and healthy Group Age BMI NDI Duration Comp Discussion:
controls (18-45 years). n = 113 (years) (kg/m2) (SD) (mos) Status • Throat and voice symptoms have been
Female (SD) (SD) (SD) (% yes) attributed to a whiplash injury.
Materials/Methods: • This study found marked differences in the
• 113 female subjects (79 with
WAD 29.7 25.1 45.5 20.3 51/79 = CSA and shape-ratio of the oropharynx
whiplash associated disorders
(n = 79) (7.7) (5.73) (15.9) (9.55) 65% measured at the C1-2 landmark in a group
(WAD), 34 healthy controls;
with a recalcitrant WAD.
18-45 years, 3 months-3
years post injury). Control 27.0 23.0 -- -- --
• It is unknown if this observation is related to
(n = 34) (5.6) (4.44) any specific symptom or mechanism.
• T1-weighted MRI was used to
measure 1) cross-sectional
Table 1- Demographic details of subjects. Data • The presence of such changes warrants
area (mm2) and 2) shape
presented as mean (SD) further dedicated prospective clinical and
ratios for the oropharynx at
mechanistic research to better understand the
C1-2
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 Whiplash Control
MRI of cervical spine outlining area of oropharynx and b)
axial T1-weighted MRI outlining C1-2 segment where Figure 3- shape ratio for oropharynx (mean ± SD)
oropharynx size 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