Oromandibular dystonia, mental distress and orofacial dysfunction ‐ a follow‐up 8‐10 years after start of treatment with botulinum toxin

Abstract

Background

Oromandibular dystonia (OMD) with involuntary jaw and tongue movements may be misdiagnosed as temporomandibular disorders (TMD) and because of the complex muscle activity and involvement of several small muscles OMD is also considered difficult to treat.

Objectives

The aim was to evaluate OMD in patients 8‐10 years after start of treatment with botulinum toxin (BoNT) by self‐reported and standardized global scales and questionnaires.

Methods

Of 21 previously reported patients with OMD 14 responded to a mail health questionnaire to describe the disease course and treatment effect as well as the overall impact of OMD by a visual analogue scale (VAS), the Patient Health Questionnaire (PHQ) for depression and anxiety, and the Jaw Functional Limitation Scale (JFLS). The results were analyzed with non‐parametric statistical analysis (Wilcoxon Matched Pairs Test, Spearman Rank Order Correlations).

Results

The OMD was still present in 13 patients. In 9 patients the BoNT treatment had continued as monotherapy or combined with oral medication. VAS for OMD was significantly reduced (P < 0.04) over the years and most patients felt improvement from the treatment. However, the patients had still some functional limitations, typically regarding jaw mobility and communication, and both JFLS and mental distress (PHQ) were significantly correlated with the OMD VAS (r_S 0.77 and 0.74).

Conclusion

The results showed marked reduction of the experienced OMD with treatment and over time, and also stressed similarities between OMD and TMD. Both dentists and neurologists should be aware of this overlap and reduce misdiagnosis by applying an interdisciplinary approach.

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