| Interactions between the Craniomandibular System and Cervical Spine The influence of an unilateral change of occlusionon the upper cervical range of motion | 1 |
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| I Acknowledgement | 3 |
| Table of Contents | 4 |
| III Abstract | 7 |
| 1. Introduction | 8 |
| 2. Theoretical background | 10 |
| 2.1. Embryology | 10 |
| 2.1.1. Biological development and evolution of the jaw, facial and cervicalregions | 11 |
| 2.1.1.1. The gill system | 11 |
| 2.1.1.2. Differentiation of tissues in human gill arches | 11 |
| 2.1.1.3. Gill arch innervation in humans | 14 |
| 2.2. Anatomy of the human temporomandibular joint | 17 |
| 2.2.1. Neuroanatomical relationships between the CMS and the upper portion ofthe CS | 18 |
| 2.2.1.1. The nervus trigeminus pathway | 18 |
| 2.2.1.2. The area innervated by the nervus trigeminus | 19 |
| 2.2.1.3. Nervus trigeminus convergences with other areas | 20 |
| 2.2.1.4. Plexus cervicalis and its relationship to the upper CS | 21 |
| 2.2.2. Musculature in the CMS region | 22 |
| 2.2.2.1. The CMS musculature | 23 |
| 2.2.2.2. Musculature in the CS region | 25 |
| 2.2.2.3. Functional interactions between the masticatory musculature and theanterior and posterior neck musculature. | 29 |
| 2.2.3. Functional connections between the CMS, CS and shoulder girdle regions | 30 |
| 2.2.3.1. Head posture | 31 |
| 2.2.3.2. Mandibular posture | 32 |
| 3. Empirical section | 33 |
| 3.1. Investigations on neuronal interactions between areas innervated by the trigeminus and the innervation of the upper cervical areas. | 33 |
| 3.1.1. Sensory neuronal interactions between the CMS and CS regions | 34 |
| 3.1.2. Neuronal motor interactions between the CMS and CS regions | 35 |
| 3.2. Craniomandibular dysfunction | 37 |
| 3.2.1. Historical background for CMD | 37 |
| 3.2.2. Definition and diagnostics for CMD | 38 |
| 3.2.3. Overview of investigations in cases of functional impairment of the CMS. | 40 |
| 3.3. Pathophysiology of the CMS and the upper CS region in humans | 42 |
| 3.4. Biomechanical connections between the CCS and CMS | 43 |
| 4. Aims of the current study and hypotheses | 46 |
| 5. Material and methods | 47 |
| 5.1. Definition of the exclusion criteria | 47 |
| 5.2. Sample | 48 |
| 5.3. Questionnaire and clinical investigation of the CS region | 50 |
| 5.3.1. Questionnaire A: Sociodemographic data, pain assessment and measurementof the maximum opening of the mouth | 50 |
| 5.3.2. Questionnaire B: Determination of the exclusion criteria (B1) andquestioning of the subjects on subjectively perceived tension (B2) | 50 |
| 5.4. Experimental design and measurements | 51 |
| 5.4.1. Experimental design | 51 |
| 5.4.2. Chronological sequence of the entire experimental design depicted using aflow chart | 53 |
| 5.4.3. Description of an individual measurement | 54 |
| 5.4.3.1. Introduction, fitting of the metal foil, warming up | 54 |
| 5.4.3.2. Conduct of analysis of mobility in the CS | 54 |
| 6. Results and interpretation | 60 |
| 6.1. Demographic data | 60 |
| 6.2. Intergroup comparison of demographic data | 60 |
| 6.3. General evaluation of the raw data on baseline measurements | 61 |
| 6.4. Evaluation of the baseline measurements for each group | 61 |
| 6.5. Statistical analysis of measurements made under experimental conditions | 63 |
| 6.6. Results from the questionnaires on subjective perception of tension | 67 |
| 6.7. Evaluation of the hypotheses | 68 |
| 7. Discussion | 69 |
| 7.1. Discussion of the findings with reference to the theoretical and empiricalresearch background and their clinical relevance | 69 |
| 7.2. Discussion of errors | 71 |
| 7.3. Comparisons with other studies | 73 |
| 8. Conclusions | 77 |
| 8.1. Study design | 77 |
| 8.2. Results of the current investigation | 77 |
| 9. References | 79 |
| Appendix | 87 |