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Oromandibular Dystonia - Types, Causes, Symptoms, and Diagnosis

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Oromandibular Dystonia - Types, Causes, Symptoms, and Diagnosis

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The tongue, jaw, and face muscles are affected by a rare disorder called oromandibular dystonia. Read the article to know more about it.

Written by

Dr. Gayathri P

Medically reviewed by

Dr. Hemalatha

Published At March 7, 2022
Reviewed AtMay 14, 2024

Introduction:

Involuntary (automatic) and rhythmic contractions of the tongue, facial muscles, and muscles involved in chewing are called oromandibular dystonia. It has been reported in about 6.9 individuals in every 100,000 population. It is more common among females and occurs between 40 to 70 years.

What Is Oromandibular Dystonia?

Oromandibular dystonia is a neurological disorder characterized by severe contractions of muscles of the lower face, leading to repetitive and uncontrolled movements of the tongue, jaw, and facial muscles. It is also referred to as cranial dystonia, orofacial buccal dystonia, lingual dystonia, etc. When the lip and facial muscles are affected by musicians who play wind instruments, it is called embouchure dystonia.

What Are the Types of Oromandibular Dystonia?

Oromandibular dystonia is a focal type (affecting a particular part or two) of muscle contraction and is further classified as follows:

  • Jaw opening.

  • Jaw closing.

  • Jaw deviating.

  • Combination of the above.

What Causes Oromandibular Dystonia?

The main causative factor of oromandibular dystonia remains unknown. However, certain factors like:

  • Neurological disorders that are already present due to hereditary or other causes can predispose to oromandibular dystonia.

  • Specific drugs like neuroleptics used to treat psychological conditions are also found to cause dystonia of the facial muscles.

  • Trauma or injury to the brain and its structures.

  • Abnormal functioning of structures of the brain (basal ganglia) leads to the production of extra signals, leading to uncontrolled movements of the jaw, tongue, and face.

  • Generalized (affecting multiple muscles) dystonia occurring due to genetic changes in the DYT1 gene also causes dystonia of the jaw.

  • After some dental procedures like tooth removal, implant placements, fitting of dentures, and other surgeries, jaw dystonia can occur.

  • Wilson's disease is a rare disorder characterized by the accumulation of copper in the brain, liver, and other parts.

  • Parkinson's disease causes difficulty in walking, balance, and coordination, and it is also found to cause the jaw-closing type of oromandibular dystonia.

  • Infections or any injury also rarely cause dystonia of the jaw.

What Are the Symptoms of Oromandibular Dystonia?

The involuntary movements of the jaw, face, and tongue are triggered mainly by speaking, chewing, or stress. The symptoms of oromandibular dystonia are as follows:

  • Difficulty in chewing and swallowing.

  • Spasmodic dysphonia (strange and whispering voice).

  • Decreased secretion of saliva.

  • Uncontrolled and repetitive movements of the tongue.

  • Grinding or clenching of teeth (Bruxism).

  • Pursing of lips.

  • Unconscious opening and closing of the jaw.

  • Twisting of the lower jaw in front or sideways.

  • Open locks (the mouth remains wide open and unable to close) and other temporomandibular joint disorders.

  • Retraction of the corners of the lips.

  • Rapid blinking of eyes.

  • Tightening of muscles of nose and face.

  • Breathing difficulties.

  • Involuntary movements of muscles (platysma) of the neck.

  • Headache, facial muscle pain, and fatigue.

  • Jaw closure oromandibular dystonia causes damage to the teeth (fracture, wear, and loss), lips, gums, and tongue.

  • It usually leads to stress, depression, social withdrawal, and other psychological issues.

  • Difficulty in performing daily activities.

How to Diagnose Oromandibular Dystonia?

The methods involved in the diagnosis of oromandibular dystonia are:

  • Physical examination of the patient is essential, along with complete dental and medical history. It aids in the evaluation of the actual cause of dystonia.

  • Electromyography (EMG) is performed to assess and record the activity of muscles and nerve cells. It aids in diagnosing any muscle and nerve dysfunction.

  • Magnetic Resonance Imaging (MRI) of the brain is done to detect any lesions, injuries, or tumors in brain structures.

What Is the Differential Diagnosis?

Oromandibular dystonia should not be misinterpreted with the following:

  • The temporomandibular joint disorder affects the joint that connects the lower jaw to the skull and is characterized by pain, locking of jaws, and difficulty chewing.

  • Hemifacial spasm is a nerve disorder in which involuntary movements and twitching of muscles on one side of the face occur.

  • Certain psychological disorders can cause muscular pain and uncontrolled movements.

How to Manage Oromandibular Dystonia?

1) Pharmaceutical Management:

  • Drugs like Clonazepam, Baclofen, Carbamazepine, and antiparkinson drugs are suggested to control muscle movements. The drugs act on chemical substances that aid the transmission of signals from the brain to muscles.

  • Botulinum injections act by blocking the release of a substance called acetylcholine at the junction of nerve and muscle. Thereby, the signals to the muscle are temporarily blocked. It prevents the repetitive movements of muscles. However, its side effects include muscle weakness, and difficulty in swallowing, and the patient may become resistant to the therapy, depending on the dose provided.

  • Muscle afferent block (MAB) hinders the signals from the muscle to the spinal cord. It is found highly effective in patients with oromandibular dystonia, and the side effects are low.

2) Surgical Management:

  • There is no specific surgical treatment available. However, removal of the coronoid process of the temporomandibular joint showed increased mouth opening in severe cases of jaw-closing dystonia.

  • Selective peripheral denervation removes the nerves when they enter the overactive muscle. It is considered the last option if no other treatment is found effective.

  • Deep brain stimulation is a procedure of placing an element (electrode) inside the brain, and it is connected to a small device (generator) embedded in the chest. The generator sends signals to the brain, thereby controlling the involuntary movements.

3) Therapeutic Management:

Physical and occupational therapies are followed to improve the movement and functioning of muscles and prevent the worsening of spasms.

What Are the Lifestyle Modifications Needed?

  • Bite guards are also suggested in case of tongue biting in a few patients.

  • Use electric toothbrushes to maintain oral hygiene.

  • Know the sensory tricks: Gently touching specific areas of lips, under eyes, chin, etc., prevents irregular movements of the jaw and face temporarily.

  • Physical exercises and yoga are done to manage stress.

What Impact Does the Gut Microbiota Have on an Individual’s Life?

Oromandibular dystonia can significantly impact a person's life by causing involuntary muscle contractions in the jaw, tongue, and lower face. This can lead to difficulties with speaking, chewing, and swallowing, resulting in pain, speech difficulties, eating challenges, social embarrassment, and decreased quality of life.

Conclusion:

Oromandibular dystonia occurs rarely and may cause symptoms that affect daily activities. However, it is not a disorder to get stressed off as various treatment options are available to improve the quality of life. The group effort of health professionals aids in proper diagnosis and decision-making regarding the best treatment.

Frequently Asked Questions

1.

Does Anxiety Cause Dystonia?

Anxiety does not cause dystonia; however, dystonia can lead to non-motor disorders like anxiety and depression.

2.

Is Oromandibular Dystonia Curable?

Oromandibular dystonia or dystonia cannot be cured completely, and the treatment aims to relieve the symptoms by using medicines and surgery.

3.

Does Brain Damage Cause Dystonia?

Dystonia usually does not occur after brain damage; however, rare cases can occur following trauma to the brain or brain damage since birth.

4.

Who Is at Risk for Dystonia?

The exact cause of dystonia is unknown. People with trauma to the brain, stroke,  on medications like neuroleptics, infections, and defective genes (family history) are more prone to the risk of dystonia.

5.

Is Dystonia a Mental Disorder?

Dystonia is not a mental disorder but a bodily movement disorder. The muscles contract involuntarily, resulting in involuntary movements of the body.

6.

How Serious Is Dystonia?

Dystonia is a movement disorder. Cervicaltonia results in uncoordinated movement of the head and neck. Dystonia of the eyelids can impact vision, and Oromandibular dystonia can hamper jaw movements and swallowing abilities. In addition, Dystonia of the larynx can result in speech slurring. 

7.

Does Dystonia Show Up on Brain MRI?

Dystonia is examined physically, and magnetic resonance imaging (MRI) of the brain does not show any lesions related to dystonia. However, it helps to exclude conditions like stroke and other brain lesions.

8.

Which Doctor Treats Oromandibular Dystonia?

Oromandibular dystonia is a neurological disorder and is hence treated by neurologists. Other than that, neurosurgeons and psychiatrists also play their part in managing oromandibular dystonia.

9.

What Happens If the Dystonia Is Left Untreated?

Though dystonia is not life-threatening, leaving it untreated can result in physical disabilities. It also makes performing daily activities difficult.

10.

Are Dystonia and Stroke the Same?

Dystonia and stroke are not the same. However, Dystonia is one of the most associated features in patients after a stroke.

11.

Which Drugs Can Cause Dystonia?

Drugs that can cause dystonia are anti-psychotic drugs like schizophrenia, drugs to reduce vomiting or antiemetic drugs like domperidone and metoclopramide, and antidepressants like clomipramine and fluoxetine.
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Dr. Gayathri P
Dr. Gayathri P

Dentistry

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