Facial asymmetry in patients with cervicobrachial pain and headache.

An increasing number of patients are visiting our hospital who have a chief complaint of neck and shoulder pain and/or headache but who do not have temporomandibular disorders (TMD). We carried out this study with a view to comparing the asymmetry of the facial skeleton or expression of such patients with those of healthy subjects. The incidence of such symptoms of patients and healthy subjects was examined by means of questionnaires. Asymmetry of the facial skeleton of patients was investigated by means of posterioanterior (PA) cephalograms. Facial asymmetry was analysed using the frontal view photographs of faces. We found that the patients had a higher incidence of various symptoms, including fatigability and irritability, in addition to neck and shoulder pain and headache, than the healthy subjects did. Both the healthy subjects and the patients had mandibular skeletal asymmetry to some degree, however, there was no significant difference between the two groups. On the other hand, the patients had a greater level of asymmetry of facial expression, chiefly of the lower face, than the healthy subjects did.