The Case of the Totally Necessary TMJ SurgeryAs many of you already know, I see a lot of patients who are afflicted with Tourette’s Syndrome. This is truly an awful disorder- the patient can be blinking their eyes nonstop while their whole body twitches and shakes and the whole thing can be both embarrassing and painful at the same time. Tourette’s is difficult at best to deal with, but I think I have some ideas that might give a little insight into this terrible disorder. In the last two weeks, two of my patients, both adults, have had the micro surgery to put the TMJ discs back into proper position. The results were nothing less than miraculous according to the patients. The first one, we will call him Bill, did not even take the morphine drip that was offered post surgery because he felt no pain at all. But the good thing was that when he came back to my office to be checked, his tics were 60-70% gone (and now they are almost completely gone he told me!). And he then told this other guy (who also had Tourette’s) what he went through these past weeks so the second fellow did the surgery yesterday and came in to see me today. When I saw the young man, he only blinked heavily a couple times compared to constant eye wrenching and twisting- it was amazing to see. But more importantly, the spasms of his chest and stomach were over with.

As it turned out, the second patient had a totally perforated disc on one side! In other words, the surgery was beyond necessary and not just to attempt to repair the discs- there was serious damage in that joint and it needed immediate repair. Just imagine if your knee caps were way off to the side and you wondered why it hurt so bad every time you took a walk- well, this guy’s disc was literally blown apart on that side and it needed to be repaired. No wonder he was hurting so badly!

Now, dear readers, let’s get into something that is beyond coincidental, beyond what any of us has ever believed, understood, or even surmised over the years. In both these Tourette’s cases, the discs in the joints were tipped medially or inward. As a doctor, I am making a fairly bold statement here. I am stating that categorically when you have medially inclined discs, the likelihood of a movement disorder is likely higher…likely that is.  (Sorry, like I could not resist that one) So what this means is that I am attracting movement disorder patients who ALL seem to have medially displaced discs!  Or is it that patients with movement disorders actually, in reality, have articular discs that are medially displaced? That seems more likely, doesn’t it?

Anyway, I am so excited to bring this concept forward, and at the same time a bit sad too. You see, dear reader, I see so many patients with movement disorders and many of them have been misdiagnosed terribly. You need a great MRI and a great radiologist to see that the discs are tipped medially and I just don’t find too much of that happening in the real world. Because all I do is TMJ work, I am lucky enough to have the best radiologist working with me on reading the MRI’s so I admit that I might have the advantage here. This concept on the medial displacement is holding to be true in ALL cases that I see when there is a movement disorder here. Quite seriously, it is not at all likely that I attract patient with medially displaced discs. However, it is more likely that I attract patients who have movement disorders and I am lucky enough to have the tools in place to identify what is going on with them. As time goes by I hope to write a paper on this concept, but in the meantime I will just keep plugging along taking care of one patient at a time.