Botulinum Toxin Therapy for Oromandibular Dystonia and Other Movement Disorders in the Stomatognathic System

Abstract

Various movement disorders, such as oromandibular dystonia, oral dyskinesia, bruxism, functional (psychogenic) movement disorder, and tremors, exist in the stomatognathic system. Most patients experiencing involuntary movements due to these disorders visit dentists or oral surgeons, who may be the first healthcare providers. However, differential diagnoses require neurological and dental knowledge. This study aimed to review scientific advances in botulinum toxin therapy for these conditions. The results indicated that botulinum toxin injection is effective and safe, with few side effects in most cases when properly administered by an experienced clinician. The diagnosis and treatment of movement disorders in the stomatognathic system require both neurological and dental or oral surgical knowledge and skills, and well-designed multicenter trials with a multidisciplinary team approach must be necessary to ensure accurate diagnosis and proper treatment.

Keywords: botulinum toxin therapy; bruxism; functional (psychogenic) movement disorder; oral dyskinesia; oromandibular dystonia; palatal tremor.

Figure 1

Injection sites for the masseter and temporalis muscles [4,45,173].

Figure 2

Injection methods for the medial pterygoid muscle; intraoral approach (blue arrow) and extraoral oral approach (red arrow) [4,22,49,173,174].

Figure 3

Injection methods for the lateral pterygoid muscle: intraoral approach (blue arrow) and extraoral oral approach (red arrow) [4,22,49,173,174].

Figure 4

Submandibular sites of BoNT injection for lingual dystonia (A). Intraoral sites for BoNT injection (B) for protrusion type (➊–➍), laterotrusion type (right deviation (➊, ➌), left deviation (➋, ➍)), and curling type (➊–➏) [4,25,173].