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Oromandibular dystonia

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Oromandibular dystonia
Other namesOrofaciomandibular dystonia, lingual dystonia, orofacial buccal dystonia, jaw dystonia, adult onset facial dystonia, and cranial dystonia.
SpecialtyNeurology Edit this on Wikidata

Oromandibular dystonia (OMD) is an uncommon focal neurological condition affecting the jaws, face, and mouth.[1] Oromandibular dystonia is characterized by involuntary spasms of the tongue, jaw, and mouth muscles that result in bruxism, or grinding of the teeth, and jaw closure. These conditions frequently lead to secondary dental wear as well as temporomandibular joint syndrome. In addition, problems with chewing, speaking, and swallowing may result from jaw opening, involuntary tongue movements, or jaw deviation.[2]

Meige's syndrome is the combination of upper facial dystonic movements, blepharospasm, and OMD.[3]

While the use of oral appliances has been documented, effective management typically consists of a combination of physiotherapy, oral medications, and botulinum toxin injections.[4]

Signs and symptoms

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Clinical manifestations vary depending on the muscles involved, the extent of OMD, and its distribution.[5] Impaired mastication, dysphagia, dysphonia (alteration of speech), mandibular disorders (TMD) such as open locks, unconscious mandibular opening and closing, and pulling and twisting of the mandible forward or laterally are examples of dysfunctions.[6][7]

Indications of dystonic spasms include platysma spasms, mouth corner retractions, tongue dyskinesia, bruxism, lip pursing or sucking, facial grimacing, and nasal contractions.[1] Breathing issues or dysarthria are also infrequently reported.[8]

The onset of symptoms is more common in women and typically occurs between the ages of 40 and 70. The symptoms only show up when speaking or masticating, for example.[1] Typically, patients list stress, talking, chewing, praying, and chewing objects as triggers.[9] Routine lab tests are typically normal.[6] Most of the time, it is reported that poor oral function is linked to social embarrassment, a lower quality of life, depression, and weight loss.[1]

Causes

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OMD can be acquired, inherited, or idiopathic. The clinical presentation of a more complicated degenerative movement disorder may include inherited OMD.[10] Patients with inherited focal OMD have also been documented to have dystonia type 6,[11] dystonia type 4, and dystonia type 16.[12][13] Medication-induced OMD is the most prevalent type of acquired OMD. Although there have been several reports of OMD cases following dental work, it is still unknown whether these procedures are linked to the onset of dystonic symptoms.[14][15] Similarly, it is unknown how much peripheral trauma[16][17] contributes to OMD risk.[18][19][20]

Diagnosis

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Because OMD can manifest in a variety of ways and to varying degrees, diagnosing it is a clinical and challenging process. Since there is no medical test that can diagnose it, the diagnosis is made based on the patient's medical history, physical examination, neurological examination, and intramuscular electromyography (EMG) confirmation.[1]

Hemifacial spasm, psychological disorders, and TMJ disorders (such as bruxism or spontaneous condylar dislocation) are included in the differential diagnosis.[1]

Treatment

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The effectiveness of the different medications currently used to treat dystonia is not well-documented.[21] Nonetheless, lithium, levodopa, dopamine receptor antagonists, carbamazepine, anticonvulsants, antiparkinson drugs, benzodiazepines, baclofen, and anticholinergic are a few of the medications used to treat OMD.[22]

It is believed that over time, physiotherapy will encourage brain rewiring, which will lessen dystonic movements. This response is widely recognized among musicians.[23]

Injections of botulinum neurotoxins (BoNT), a potent neurotoxin that inhibits acetylcholine release at the presynaptic junction and causes transient chemical denervation of skeletal muscles, are a promising treatment for OMD.[1]

Epidemiology

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OMD is thought to affect 68.9 cases per million people.[24] OMD typically manifests itself during the sixth decade of life.[25] Almost twice as many women as men are impacted.[26]

References

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  1. ^ a b c d e f g Raoofi, Saeed; Khorshidi, Hooman; Najafi, Maryam. "Etiology, Diagnosis and Management of Oromandibular Dystonia: an Update for Stomatologists". Journal of Dentistry. 18 (2). Shiraz University of Medical Sciences. PMC 5463774. PMID 28620630.
  2. ^ Jankovic, Joseph (2003). "Primary and Secondary Generalized Dystonias". Office Practice of Neurology. Elsevier. pp. 816–821. doi:10.1016/b0-44-306557-8/50130-1. ISBN 978-0-443-06557-6.
  3. ^ Pandey, Sanjay; Sharma, Soumya (2017). "Meige's syndrome: History, epidemiology, clinical features, pathogenesis and treatment". Journal of the Neurological Sciences. 372. Elsevier BV: 162–170. doi:10.1016/j.jns.2016.11.053. ISSN 0022-510X. PMID 28017205.
  4. ^ Watt, Eileen; Sangani, Indiya; Crawford, Fiona; Gillgrass, Toby (2013-12-02). "The role of a dentist in managing patients with dystonia". Dental Update. 40 (10): 846–848. doi:10.12968/denu.2013.40.10.846. ISSN 0305-5000. PMID 24597030.
  5. ^ Khan, Junad; Anwer, Hafiz Muhammad Moin; Eliav, Eli; Heir, Gary (2015). "Oromandibular dystonia". The Journal of the American Dental Association. 146 (9). Elsevier BV: 690–693. doi:10.1016/j.adaj.2014.09.001. ISSN 0002-8177. PMID 26314978.
  6. ^ a b Bakke, Merete; Larsen, Bo Madvig; Dalager, Torben; Møller, Eigild (2013). "Oromandibular dystonia—functional and clinical characteristics: a report on 21 cases". Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology. 115 (1). Elsevier BV: e21–e26. doi:10.1016/j.oooo.2012.04.023. ISSN 2212-4403. PMID 22999966.
  7. ^ Chidiac, José Johann (March 2, 2011). "Oromandibular dystonia treatment following a loss of vertical dimension". Dental Update. 38 (2). Mark Allen Group: 120–122. doi:10.12968/denu.2011.38.2.120. ISSN 0305-5000. PMID 21500622.
  8. ^ Schneider, Robert; Hoffman, Henry T. (2011). "Oromandibular dystonia: A clinical report". The Journal of Prosthetic Dentistry. 106 (6). Elsevier BV: 355–358. doi:10.1016/s0022-3913(11)60145-5. ISSN 0022-3913. PMID 22133391.
  9. ^ Gonzalez-Alegre, Pedro; Schneider, Robert L.; Hoffman, Henry (April 30, 2014). "Clinical, Etiological, and Therapeutic Features of Jaw-opening and Jaw-closing Oromandibular Dystonias: A Decade of Experience at a Single Treatment". Tremor and Other Hyperkinetic Movements. 4. Ubiquity Press, Ltd.: 231. doi:10.5334/tohm.194. ISSN 2160-8288.
  10. ^ Manzo, Nicoletta; Ginatempo, Francesca; Belvisi, Daniele; Defazio, Giovanni; Conte, Antonella; Deriu, Franca; Berardelli, Alfredo (2022). "Pathophysiological mechanisms of oromandibular dystonia". Clinical Neurophysiology. 134. Elsevier BV: 73–80. doi:10.1016/j.clinph.2021.11.075. ISSN 1388-2457.
  11. ^ Lohmann, Katja; Uflacker, Nils; Erogullari, Alev; Lohnau, Thora; Winkler, Susen; Dendorfer, Andreas; Schneider, Susanne A; Osmanovic, Alma; Svetel, Marina; Ferbert, Andreas; Zittel, Simone; Kühn, Andrea A; Schmidt, Alexander; Altenmüller, Eckart; Münchau, Alexander; Kamm, Christoph; Wittstock, Matthias; Kupsch, Andreas; Moro, Elena; Volkmann, Jens; Kostic, Vladimir; Kaiser, Frank J; Klein, Christine; Brüggemann, Norbert (August 17, 2011). "Identification and functional analysis of novel THAP1 mutations". European Journal of Human Genetics. 20 (2). Springer Science and Business Media LLC: 171–175. doi:10.1038/ejhg.2011.159. ISSN 1018-4813. PMC 3260936. PMID 21847143.
  12. ^ Ma, Hongying; Qu, Jian; Ye, Liangjun; Shu, Yi; Qu, Qiang (March 29, 2021). "Blepharospasm, Oromandibular Dystonia, and Meige Syndrome: Clinical and Genetic Update". Frontiers in Neurology. 12. Frontiers Media SA. doi:10.3389/fneur.2021.630221. ISSN 1664-2295. PMC 8039296. PMID 33854473.
  13. ^ Camargos, Sarah; Cardoso, Francisco (2016). "Understanding dystonia: diagnostic issues and how to overcome them". Arquivos de Neuro-Psiquiatria. 74 (11). FapUNIFESP (SciELO): 921–936. doi:10.1590/0004-282x20160140. ISSN 0004-282X.
  14. ^ Thompson, P D; Obeso, J A; Delgado, G; Gallego, J; Marsden, C D (June 1, 1986). "Focal dystonia of the jaw and the differential diagnosis of unilateral jaw and masticatory spasm". Journal of Neurology, Neurosurgery & Psychiatry. 49 (6). BMJ: 651–656. doi:10.1136/jnnp.49.6.651. ISSN 0022-3050. PMC 1028846. PMID 3734821.
  15. ^ Jankovic, J; Van der Linden, C (December 1, 1988). "Dystonia and tremor induced by peripheral trauma: predisposing factors". Journal of Neurology, Neurosurgery & Psychiatry. 51 (12). BMJ: 1512–1519. doi:10.1136/jnnp.51.12.1512. ISSN 0022-3050. PMC 1032766. PMID 3221219.
  16. ^ Defazio, Giovanni; Fabbrini, Giovanni; Erro, Roberto; Albanese, Alberto; Barone, Paolo; Zibetti, Maurizio; Esposito, Marcello; Pellicciari, Roberta; Avanzino, Laura; Bono, Francesco; Eleopra, Roberto; Bertolasi, Laura; Altavista, Maria Concetta; Cotelli, Maria Sofia; Ceravolo, Roberto; Scaglione, Cesa; Bentivoglio, Anna Rita; Cossu, Giovanni; Coletti Moja, Mario; Girlanda, Paolo; Misceo, Salvatore; Pisani, Antonio; Mascia, Marcello Mario; Ercoli, Tommaso; Tinazzi, Michele; Maderna, Luca; Minafra, Brigida; Magistrelli, Luca; Romano, Marcello; Aguggia, Marco; Tambasco, Nicola; Castagna, Anna; Cassano, Daniela; Berardelli, Alfredo; Ferrazzano, Gina; Lalli, Stefania; Silvestre, Francesco; Manganelli, Fiore; Di Biasio, Francesca; Marchese, Roberta; Demonte, Giulio; Santangelo, Domenico; Devigili, Grazia; Durastanti, Valentina; Turla, Marinella; Mazzucchi, Sonia; Petracca, Martina; Oppo, Valentina; Barbero, Pierangelo; Morgante, Francesca; Di Lazzaro, Giulia; Squintani, Giovanna; Modugno, Nicola (2020). "Does acute peripheral trauma contribute to idiopathic adult-onset dystonia?". Parkinsonism & Related Disorders. 71. Elsevier BV: 40–43. doi:10.1016/j.parkreldis.2020.01.002. ISSN 1353-8020.
  17. ^ Molloy, A.; Kimmich, O.; Williams, L.; Butler, J. S.; Byrne, N.; Molloy, F.; Moore, H.; Healy, D. G.; Lynch, T.; Edwards, M. J.; Walsh, C.; Reilly, R. B.; O'Riordan, S.; Hutchinson, M. (June 24, 2014). "An evaluation of the role of environmental factors in the disease penetrance of cervical dystonia". Journal of Neurology, Neurosurgery & Psychiatry. 86 (3). BMJ: 331–335. doi:10.1136/jnnp-2014-307699. ISSN 0022-3050. PMID 24963124.
  18. ^ Sankhla, C.; Lai, E. C; Jankovic, J. (November 1, 1998). "Peripherally induced oromandibular dystonia". Journal of Neurology, Neurosurgery & Psychiatry. 65 (5). BMJ: 722–728. doi:10.1136/jnnp.65.5.722. ISSN 0022-3050. PMC 2170345. PMID 9810945.
  19. ^ Raoofi, Saeed; Khorshidi, Hooman; Najafi, Maryam. "Etiology, Diagnosis and Management of Oromandibular Dystonia: an Update for Stomatologists". Journal of Dentistry. 18 (2). Shiraz University of Medical Sciences. PMC 5463774. PMID 28620630.
  20. ^ Jang, Soo-Mi; Cho, Yeong-Cheol; Sung, Iel-Yong; Kim, Sun-Young; Son, Jang-Ho (2012). "Oromandibular dystonia after dental treatments: a report of two cases". Journal of the Korean Association of Oral and Maxillofacial Surgeons. 38 (6). The Korean Association of Oral and Maxillofacial Surgeons: 379. doi:10.5125/jkaoms.2012.38.6.379. ISSN 2234-7550.
  21. ^ Jinnah, Hyder A.; Teller, Jan K.; Galpern, Wendy R. (2015). "Recent developments in dystonia". Current Opinion in Neurology. 28 (4). Ovid Technologies (Wolters Kluwer Health): 400–405. doi:10.1097/wco.0000000000000213. ISSN 1350-7540. PMC 4539941. PMID 26110799.
  22. ^ Jinnah, H.A.; Factor, Stewart A. (2015). "Diagnosis and Treatment of Dystonia". Neurologic Clinics. 33 (1). Elsevier BV: 77–100. doi:10.1016/j.ncl.2014.09.002. ISSN 0733-8619. PMC 4248237. PMID 25432724.
  23. ^ Thorburn, D N; Lee, K H (March 2009). "Oromandibular dystonia following dental treatment: case reports and discussion". The New Zealand Dental Journal. 105 (1): 18–21. PMID 19418679.
  24. ^ Nutt, John G.; Muenter, Manfred D.; Aronson, Arnold; Kurland, Leonard T.; Melton, L. Joseph (1988). "Epidemiology of focal and generalized dystonia in Rochester, Minnesota". Movement Disorders. 3 (3). Wiley: 188–194. doi:10.1002/mds.870030302. ISSN 0885-3185. PMID 3264051.
  25. ^ Slaim, Linda; Cohen, Myriam; Klap, Patrick; Vidailhet, Marie; Perrin, Alain; Brasnu, Daniel; Ayache, Denis; Mailly, Marie (May 25, 2018). "Oromandibular Dystonia: Demographics and Clinical Data from 240 Patients". Journal of Movement Disorders. 11 (2). The Korean Movement Disorder Society: 78–81. doi:10.14802/jmd.17065. ISSN 2005-940X. PMC 5990905. PMID 29860784.
  26. ^ "Sex-related influences on the frequency and age of onset of primary dystonia". Neurology. 53 (8). Ovid Technologies (Wolters Kluwer Health): 1871–1873. 1999. doi:10.1212/wnl.53.8.1871. ISSN 0028-3878. PMID 10563645.

Further reading

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