It all started when...

... I was leaving the room in a hurry. I can't recall the time or the day; I don't know exactly how I did it. I just remember the pain I felt when the door hit my face.

But I was in a hurry - no time for tears or complains. The pain would ease sooner or later.

But it didn't.

A month went by and the pain on the right side of my face was still there. The right TMJ felt weird, uncomfortable. Even worse was the noise the joint was making every time I opened my mouth. Someone standing next to me could hear it, just like fingers getting cracked.

It was time to get it checked. My mum got me an appointment with a oral-maxillofacial surgery specialist at a private clinic. Going private would be faster, and it wouldn't be so expensive with my health insurance.

The specialist barely looked at me. He gave me the papers for an MRI scan to be done, and prescribed me a medicine. He sent me away telling me to come back with the scan results. I wasn't inside the consultation room for more than 5 minutes. I didn't like the guy at all.

Later that day, my mum and I went to the local pharmacy to get the medicine. The pharmacist found the prescription odd and asked us what was it for. The reply to my mum's explanation was "Your daughter should be given an anti-inflammatory, not diazepam!". DIAZEPAM. We didn't have any clue of what could be the problem, but surely diazepam was not going to fix it! Or so we thought...

We left the pharmacy without the drug, thinking the guy was nuts and promising we would never go back there. At least we had the papers for an MRI scan.

With the scan results and thanks again to my health insurance, we went to see another oral-maxillofacial surgeon, at a very prestigious private hospital. This specialist was a respected Professor at the Faculty of Medicine of the University of Lisbon. "He must be good", we hoped. And he was.

He spent almost one hour with us, if not more. He explained all the little details and drew diagrams of the TMJ and its function. It was a proper lecture on the TMJ. He checked and re-checked the MRI scan. Bad news - I had ruptured some of the ligaments of the disc. He diagnosed anterior disc displacement with reduction due to rupture of the posterior disc ligaments. This meant my disc was positioned abnormally in front of the condyle but, as I opened my mouth, the disc would be temporally repositioned over the condyle head (its normal place). The clicking and popping sounds coming from my joint were caused by this disc repositioning. The diagram below shows the relative position of the disc (yellow) and condyle (grey) during mouth opening and closing.

 Anterior disc displacement with reduction 

(source Kelley's Textbook of Rheumatology)

Because my condyle was slightly misshaped, he also suspected that the right TMJ was already compromised before the accident. We were told that there was not much to do at that time, except learning to live with it and avoiding putting unnecessary pressure on the TMJ. With time things would get worse, and most likely I would need some kind of surgery in the future. "But don't worry about surgeries right now; it will be several years until you get to that stage", he assured.

This was early 2005. The door hit my face sometime in the late months of 2004. I was still a geology undergraduate student, living with my mum, my brothers and little sister, in a small village around Lisbon (Portugal).

Since then, I never had the pleasure of bitting a fresh apple and feeling its juice running from the corner of my lips.

Since then, I envy every child I see chewing a gum. Oh!, the joy of blowing a balloon and making it pop in your face! *Splat*

Since then, every yawn is followed by a muscle spasm. Every click, pop and crack noise feels like my jaw is breaking.

Since then, my life would never be the same.

This was just the beginning. And just like my surgeon predicted, things got worse. A lot worse...