Interdisciplinary recognizing and managing of drug-induced tardive oromandibular dystonia: two case reports

Abstract

Tardive dystonia is a risk factor in medical antipsychotic treatment. It often begins with repetitive involuntary jaw and tongue movements resulting in impaired chewing and detrimental effect on the dentition. The orofacial dysfunction may go unrecognized in a neurological setting. The diagnosis may be difficult so we suggest interdisciplinary collaboration.

Keywords: Antipsychotics; botulinum toxin; bruxism; masticatory muscles; tardive dystonia.

Figure 1

(A) Medical history for Patient A prior to the referral to the University Hospital. (B) Medical history for Patient B prior to the referral to the University Hospital.

Figure 2

The effect of BTX injections on daily life in two patients with drug‐induced tardive oromandibular dystonia as measured by subjective visual analog scales. Patient A with dystonic biting and bruxing movements was treated with 25 units IncobotulinumtoxinA in the anterior temporal and lateral pterygoid muscles on both sides. Patient B with dystonic jaw opening and repeated tongue protrusion was treated with 15 units IncobotulinumtoxinA in the genioglossus muscles on both sides. All injections were guided by electromyography.