Fady Bou Malhab

Abstract:
Objectives: To introduce the trigeminal cervical complex (TCC) as a comprehensive framework for understanding the anatomical and functional scope of the afferences and efferences of the trigeminal system and explaining common otolaryngologic symptoms, including head and neck myofascial pain syndrome. Additionally, it explores how the bidirectional transmission of neurotransmitters contributes to the sensitization of the TCC and motor nuclei. Methods: The study was conducted as a narrative review. The authors performed a comprehensive search of multiple databases, including Medline/OVID, Embase, Scopus, and PubMed, covering publications from inception until August 2023. Results: This review discusses the multiple afferent connections from cranial nerves, specifically VII, IX, X, and XI, to the TCC, and their respective efferent pathways. These connections may explain various clinical manifestations in the head and neck that cannot be attributed to other medical conditions. Additionally, the review highlights: 1- the dual sensory and motor nature of cranial nerves, 2- the bidirectional transmission of neurotransmitters in head and neck areas, which leads to the sensitization of both the TCC and motor nuclei innervating the cervicofacial muscles, 3- How sensitization of the TCC by cervicofacial muscles could affect the sensorineural organs (Ear, Eye, Nose) and other organs. Conclusion: The central and peripheral sensitization and the intricate connections of the TCC can elucidate the pathophysiology of conditions such as otalgia, tinnitus, hearing loss, vertigo, headache, cervicogenic dizziness, bruxism, and other symptoms affecting the head and neck.
Biography:
Dr. Fady Bou Malhab is currently the Medical Director of Consilia Medicare Group, Beirut-Lebanon and consultant at the Otorhinolaryngology – Head & Neck Surgery department St. Joseph university Hospital, Beirut-Lebanon. He received his degree of Medicine at St. Joseph University- Beirut in 1993 and of Otorhinolaryngology-Head & Neck Surgery at Paris VII University in 1999. Dr Fady is an active Member of Lebanese Society of Otorhinolaryngology-Head & Neck Surgery. He completed his training on botulinum toxin injections in the head and neck at the Rothschild Foundation in Paris. Dr Fady is practicing in Lebanon since 2000 focusing on Head & Neck Myofascial Pain Syndrome. He has many publications in French and Northern American Journals and organized many local Meetings and attended many International Meetings.