Clinical
Tourette’s syndrome and TMJ How effective is orthodontics in treating the symptoms of
Tourette’s syndrome? André Hedger describes the case of a patient who developed significant ‘tics’ following a seizure
T
ourette’s syndrome is characterised by certain tics or abnormal muscle movements and twitches. Various unusual tics display,
often in the shoulders or abdomen, as well as eye tics such as chronic blinking or slow blinking and vocal tics such as coughing, humming, barking or swearing. The condition starts before patients are
ı8 years old and the tics are not related to any substance or medical condition. Tics can occur multiple times a day and it is not unusual for multiple motor and vocal tics to be present.
Common signs include: • Eye movement • Facial grimacing • Head jerking movement • Shoulder shrugging • Arm or hand movement
34 Ireland’s Dental magazine
• Abdomen and pelvic movement • Bending or gyrating complex movements
• Phonic tics (shouting, screaming, coughing, clucking, swearing and spitting).
Co-morbid conditions patients may have: • They all have severe TMD • They are nearly always over-closed with a deep bite
• The condyles are distalised • They have an under developed maxilla • Most have Miserable Malalignment Syndrome. Put simply, the view is that Tourette’s
syndrome is caused by compression of the auriculo-temporal nerve by the mandibular condyle; via the trigeminal nerve (V), the effect goes through the subnucleus candalis, which affects the reticular formation, causing crossfiring
of inter-neurone connections, which then affect other cranial nerves. The other affected nerves are the facial nerve (VII) causing facial tics, the glossopharyngeal nerve (IX) causing coughing, the vagus nerve (X) causing vocal sounds and the spinal accessory nerve (XI) which causes shoulder shrugging. The main characteristics seen in
Tourette’s cases are cranial growth completed at age five, in boys the maxilla is completed by age seven, in girls the maxilla is completed by age nine and in both sexes the mandible is completed by age nine. Tourette’s is three to five times more common in males, possibly due to the maxillary cranial growth difference.
CASE STUDY
Patient history Henry was ı5 years old when he was referred to the author for treatment of
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