Botulinum Toxin Therapy for Oromandibular Dystonia and Other Movement Disorders in the Stomatognathic System

Abstract

Various movement disorders, such as oromandibular dystonia, oral dyskinesia, bruxism, functional (psychogenic) movement disorder, and tremors, exist in the stomatognathic system. Most patients experiencing involuntary movements due to these disorders visit dentists or oral surgeons, who may be the first healthcare providers. However, differential diagnoses require neurological and dental knowledge. This study aimed to review scientific advances in botulinum toxin therapy for these conditions. The results indicated that botulinum toxin injection is effective and safe, with few side effects in most cases when properly administered by an experienced clinician. The diagnosis and treatment of movement disorders in the stomatognathic system require both neurological and dental or oral surgical knowledge and skills, and well-designed multicenter trials with a multidisciplinary team approach must be necessary to ensure accurate diagnosis and proper treatment.

Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia

“…Proper treatment of OMD requires multidisciplinary evaluation [16] , [17] . All patients with OMD should have an oral and dental evaluation and those with dysphagia should receive a swallowing and nutritional assessment to determine oropharyngeal function and nutritional status.…”

Effects of Botulinum Toxin Therapy on Health-Related Quality of Life Evaluated by the Oromandibular Dystonia Rating Scale

“…Dystonia is characterized by sustained or intermittent muscle contractions that cause abnormal movements or postures [ 1 ]. Oromandibular dystonia (OMD) is a focal dystonia involving the masticatory, lingual, and/or muscles in the stomatognathic system [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Based on the direction of abnormal dystonic movements, OMD is classified into six subtypes: jaw closing, jaw opening, tongue (lingual), jaw deviation, jaw protrusion, and lip (labial) dystonia [ 9 , 11 , 12 , 13 , 14 ].…”

“…Oromandibular dystonia (OMD) is a focal dystonia involving the masticatory, lingual, and/or muscles in the stomatognathic system [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Based on the direction of abnormal dystonic movements, OMD is classified into six subtypes: jaw closing, jaw opening, tongue (lingual), jaw deviation, jaw protrusion, and lip (labial) dystonia [ 9 , 11 , 12 , 13 , 14 ]. Various combinations of these subtypes have been observed in several cases.…”

“…A previously reported estimated prevalence of OMD varied from 0.1 to 9.8 per 100,000 persons [ 11 , 15 , 16 ]. Symptoms related to OMD include masticatory disturbances, limited mouth opening, muscle pain, dysphagia, dysarthria, esthetic problems, and temporomandibular joint dislocation [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. Some patients exhibit life-threatening features, such as upper airway obstruction due to temporomandibular joint dislocation resulting from severe jaw opening dystonia [ 17 , 18 ] or aspiration pneumonia related to lingual dystonia [ 19 ].…”

“…Some patients exhibit life-threatening features, such as upper airway obstruction due to temporomandibular joint dislocation resulting from severe jaw opening dystonia [ 17 , 18 ] or aspiration pneumonia related to lingual dystonia [ 19 ]. These symptoms can result in impaired activities of daily living, social embarrassment, cosmetic disfigurement, absenteeism, unemployment, and a significant impact on a patient’s overall HRQoL [ 9 , 13 , 14 ]. The symptoms and clinical features may be significantly more variable, critical, and complicated than those accompanied by other focal dystonia, including cervical dystonia or blepharospasm [ 9 ].…”