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Case Reports
. 2022 Feb 22;14(3):158.
doi: 10.3390/toxins14030158.

Ultrasound-Guided OnabotulinumtoxinA Injections to Treat Oromandibular Dystonia in Cerebral Palsy

Fabiola I Reyes  1   2 , Hannah A Shoval  3   4 , Amy Tenaglia  5 , Heakyung Kim  5
Affiliations
Case Reports

Ultrasound-Guided OnabotulinumtoxinA Injections to Treat Oromandibular Dystonia in Cerebral Palsy

Fabiola I Reyes et al. Toxins (Basel). .

Abstract

Cerebral palsy (CP) is a group of non-progressive disorders of motor function in children resulting from an injury to an immature brain. In addition to abnormal limb and trunk movement, individuals with CP can experience involuntary muscle contractions of the lower facial muscle groups, causing oromandibular dystonia (OMD). Contraction of the lateral pterygoids and submandibular muscles depresses the mandible. OMD involving the lateral pterygoids can therefore lead to involuntary jaw opening posture, affecting the ability to feed and speak effectively. We present a case series of five patients with CP and OMD that received novel ultrasound-guided onabotulinumtoxinA to the lateral pterygoid muscles. Our goal was to determine if chemodenervation would improve the mouth-closing ability, thus in turn improving the ability to swallow, chew, manage secretions, and communicate. We describe this unique injection method and report a subjective improvement in eating abilities and communication, in addition to a positive upward trend in most patients' weights, with no significant adverse side effects.

Keywords: botulinum toxin; cerebral palsy; lateral pterygoid; oromandibular dystonia; ultrasound guidance.

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Conflict of interest statement

Heakyung Kim has received research grant support from Ipsen, an honorarium from the American Academy of Physical Medicine and Rehabilitation (AAPM&R) and AiCME—Catalyst Medical Education LLC, and has served as a consultant and advisory board member for Ipsen, Allergan, Merz and Pacira Pharmaceuticals.

Figures

Figure 1
Figure 1
(a) Ultrasound view without label, (b) Ultrasound view with muscle and bone labeled, (c) Placement of ultrasound probe and needle.
See this image and copyright information in PMC

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