Orofacial dyskinesia

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 22/04/2025

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80 Orofacial dyskinesia

Instruction

Look at this patient.

Salient features

History

• Ask the patient about removal of teeth and how long the patient has been edentulous

• History of date of onset and duration

• Drug history (phenothiazines, levodopa and related drugs).

Examination

• Smacking, chewing or chomping movement of the lips, seen particularly in elderly patients; it usually involves the masticatory, lower facial and tongue muscles.

Proceed as follows:

• Comment if the patient is edentulous (Ann Neurol 1983;13:97).

Remember: Orofacial dyskinesia is defined as involuntary, repetitive, stereotypical movement of the face, tongue and jaw that may be painful.

Diagnosis

This patient has orofacial dyskinesia (lesion) caused by phenothiazines (aetiology) and is in considerable distress (functional status).

Question

What is the workup for orofacial movement disorders?

After taking a history and examination, contrast MRI and CT can be used to exclude a CNS pathology.

Neurological workup assesses:

• sensory vs. motor conduction deficit

• central vs. peripheral disease

• electromyography to identify specific muscles

• consider central degenerative, demyelinating or sclerotic lesion

• consider infract or tumour of brain or spina cord.

Advanced-level questions

What is Meige syndrome?

A combination of blepharospasm, oromandibular dystonia and cranial dystonia. There is spastic dysarthria when the throat and respiratory muscles are affected. The neck muscles are invariably involved.

What do you understand by tardive dyskinesia?

It represents rapid, repetitive, non-random, stereotypic movements involving the tongue, lips and jaw areas. It is a drug-induced dyskinesia that may appear long after drug therapy has been discontinued. It is troublesome and may resist all forms of treatment.

How would you manage such patients?

Anticholinergic drugs (baclofen, benzodiazepines and tetrabenazine) can be used but pharmacotherapy is usually ineffective. Injection of botulinum toxin into the masseter, temporalis and internal pterygoid muscles results in improvement in chewing and speech in approximately 80% of patients with jaw closure caused by oromandibular dystonia (Ophthalmology 1987;2:237–54).

Mention a few other dystonias

• Blepharospasm

• Spasmodic torticollis

• Laryngeal dystonias

• Writer’s cramp.

H Meige (1866–1940), a French physician, also wrote on ancient Egyptian diseases.

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80 Orofacial dyskinesia

Instruction

Look at this patient.

Salient features

History

• Ask the patient about removal of teeth and how long the patient has been edentulous

• History of date of onset and duration

• Drug history (phenothiazines, levodopa and related drugs).

Examination

• Smacking, chewing or chomping movement of the lips, seen particularly in elderly patients; it usually involves the masticatory, lower facial and tongue muscles.

Proceed as follows:

• Comment if the patient is edentulous (Ann Neurol 1983;13:97).

Remember: Orofacial dyskinesia is defined as involuntary, repetitive, stereotypical movement of the face, tongue and jaw that may be painful.

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