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Patient Description

Male, Age 19, Student:

Principle Complaints: Exactly one year ago, this very nice young man presented with complaints of headaches, migraines, facial pain, fatigue, poor sleep, jaw pain, ear pain, ear congestion and jaw clenching. Additionally, he had muscle paralysis in the right forehead/eyebrow and weakness in the right eyelid muscle.

Medical History: As a child, he suffered from ear pain but the doctor could find nothing wrong. His migraines began in the fifth grade, which were "moderate to severe", occurring about twice a week. They have progressively gotten worse, noticeably in the past three years, accompanied by nausea, dizziness, vertigo, poor balance, poor coordination, blurred vision, light and sound hypersensitivity, jaw pain and swelling. One year ago he was mugged, which exacerbated head pain and swelling. His eyebrow muscle paralysis and eyelid weakness has been chronic, the eye doctor said due to weaker muscles on the right side.

Oral Condition: He presented with a very healthy mouth and a full complement of teeth in excellent condition. His wisdom teeth had been extracted three years previously, which is when his TMD symptoms got worse. There was a noticeable jaw imbalance toward the right. His jaw shifted right upon opening and closing. Crepitus, clicking, popping and lateral and posterior lateral pole pain were present on the right side. The muscles of mastication were spastic on the right side. He had Ernst Syndrome (inflammation of stylomandibular ligament) on the right side. His maximum opening was within the normal range (55 mm), as was his right lateral excursion (12 mm), but his left lateral excursion was only 6 mm, indicating the problem was with the right joint.

Treatment Record: The patient's treatment began over Christmas break, with x-rays, models and exam. He was then fitted with a daytime MORA, (Mandibular Oral Repositioning Appliance) and the nighttime Farrar anti-grinding appliance. He was also treated with ETPS electro acupuncture, TMD protocol.

He then went to study abroad for the semester. This is what he wrote in March of the following year: "After being diagnosed with TMJ and treated, my state of health instantly began to improve. First and foremost, my headaches, which would last weeks at a time, stopped occurring. As well my face returned to its normal size, whereas before it was very swollen around my jaw.

Also, before I received treatment not only did I have trouble sleeping but I would also never dream. Now I have no problem falling asleep as well as reaching deep REM sleep. In addition, I've been able to concentrate on my studies more thoroughly and my entire state of being is much more stable."

He returned a few months (3) later and had his appliances adjusted. All of his symptoms had significantly improved, he had recovered his health, and his energy level was better. He noted that the MORA prevented his ears from clogging and causing pain during long flights. He continued to sleep well.

He occasionally would feel a twitch in his right eyebrow. The frequency of his headaches had decreased to one approximately every two weeks. He mentioned that before treatment, he had headaches every day, sometimes continuous, and they were accompanied by jaw and face pain. He then left for college in New York.

He returned home for Thanksgiving and he was still doing very well. His left lateral excursion had increased from 6 mm to 10 mm, closer to the normal range. His appliances were adjusted at that visit. He noted that he still sleeps well and since wearing the appliance feels "exponentially better in the morning".

He remarked that he missed more classes than any other male in his high school, mostly due to poor sleep, but now he has perfect attendance. He wasn't a good student in high school, either, but just got 100% on one of his college midterms.

He recently returned for an adjustment. His MORA daytime appliance had worn down due to normal wear and tear and needed relining with acrylic. He was very healthy and had excelled in school! The paralysis in his right eyebrow and forehead is slowly going away.

Risto E. Hurme, D.D.S.
Craniofacial Pain and TMJ Disorders
1017 Shook Avenue
San Antonio, TX 78212
(210) 826-4441

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