Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia
Oromandibular dystonia (OMD) is a form of focal dystonia that involves the masticatory, lower facial, labial, and lingual musculature. It is a disabling disorder which had limited treatment options until the recent introduction of botulinum toxin (BoNT) as the recommended first-line therapy by most...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-01-01
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| Series: | Clinical Parkinsonism & Related Disorders |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590112522000317 |
| _version_ | 1818085350150504448 |
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| author | Roongroj Bhidayasiri Suppata Maytharakcheep Daniel D. Truong |
| author_facet | Roongroj Bhidayasiri Suppata Maytharakcheep Daniel D. Truong |
| author_sort | Roongroj Bhidayasiri |
| collection | DOAJ |
| description | Oromandibular dystonia (OMD) is a form of focal dystonia that involves the masticatory, lower facial, labial, and lingual musculature. It is a disabling disorder which had limited treatment options until the recent introduction of botulinum toxin (BoNT) as the recommended first-line therapy by most experts and evidence-based literature. Owing to the complex relationship between the muscles of mastication and surrounding muscles, there is a wide variety of dynamic clinical presentations, making clinical recognition and the corresponding approach to BoNT injection therapy difficult. In this review, the authors provide a framework for practical clinical approaches, beginning with the recognition of clinical subtypes of OMD (jaw-opening, jaw-closing, jaw-deviating, lingual, peri-oral, and/or pharyngeal dystonias), followed by patient selection and clinical evaluation to determine function interferences, with injection techniques illustrated for each subtype. Careful stepwise planning is recommended to identify the muscles that are primarily responsible and employ a conservative approach to dosing titration. Treating physicians should be diligent in checking for adverse events, especially for the first few injection cycles, as muscles involved in OMD are small, delicate, and situated in close proximity. It is recommended that future studies should aim to establish the clinical efficacy of each subtype, incorporating muscle targeting techniques and patient-centred outcome measures that are related to disturbed daily functions. |
| first_indexed | 2024-12-10T20:08:23Z |
| format | Article |
| id | doaj.art-370923569196435d8d4de451106f7197 |
| institution | Directory Open Access Journal |
| issn | 2590-1125 |
| language | English |
| last_indexed | 2024-12-10T20:08:23Z |
| publishDate | 2022-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Parkinsonism & Related Disorders |
| spelling | doaj.art-370923569196435d8d4de451106f71972022-12-22T01:35:20ZengElsevierClinical Parkinsonism & Related Disorders2590-11252022-01-017100160Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystoniaRoongroj Bhidayasiri0Suppata Maytharakcheep1Daniel D. Truong2Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; The Academy of Science, The Royal Society of Thailand, Bangkok 10330, Thailand; Corresponding author at: Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Chulalongkorn University Hospital, 1873 Rama 4 Road, Bangkok 10330, Thailand.Chulalongkorn Centre of Excellence for Parkinson’s Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, ThailandThe Parkinson's and Movement Disorder Institute, Orange Coast Memorial Medical Center, Fountain Valley, CA 92708, USAOromandibular dystonia (OMD) is a form of focal dystonia that involves the masticatory, lower facial, labial, and lingual musculature. It is a disabling disorder which had limited treatment options until the recent introduction of botulinum toxin (BoNT) as the recommended first-line therapy by most experts and evidence-based literature. Owing to the complex relationship between the muscles of mastication and surrounding muscles, there is a wide variety of dynamic clinical presentations, making clinical recognition and the corresponding approach to BoNT injection therapy difficult. In this review, the authors provide a framework for practical clinical approaches, beginning with the recognition of clinical subtypes of OMD (jaw-opening, jaw-closing, jaw-deviating, lingual, peri-oral, and/or pharyngeal dystonias), followed by patient selection and clinical evaluation to determine function interferences, with injection techniques illustrated for each subtype. Careful stepwise planning is recommended to identify the muscles that are primarily responsible and employ a conservative approach to dosing titration. Treating physicians should be diligent in checking for adverse events, especially for the first few injection cycles, as muscles involved in OMD are small, delicate, and situated in close proximity. It is recommended that future studies should aim to establish the clinical efficacy of each subtype, incorporating muscle targeting techniques and patient-centred outcome measures that are related to disturbed daily functions.http://www.sciencedirect.com/science/article/pii/S2590112522000317Oromandibular dystoniaSegmental craniocervical dystoniaBotulinum toxinMeige’s syndromeJaw-openingJaw-closing |
| spellingShingle | Roongroj Bhidayasiri Suppata Maytharakcheep Daniel D. Truong Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia Clinical Parkinsonism & Related Disorders Oromandibular dystonia Segmental craniocervical dystonia Botulinum toxin Meige’s syndrome Jaw-opening Jaw-closing |
| title | Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia |
| title_full | Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia |
| title_fullStr | Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia |
| title_full_unstemmed | Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia |
| title_short | Patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia |
| title_sort | patient selection and injection techniques for botulinum neurotoxin in oromandibular dystonia |
| topic | Oromandibular dystonia Segmental craniocervical dystonia Botulinum toxin Meige’s syndrome Jaw-opening Jaw-closing |
| url | http://www.sciencedirect.com/science/article/pii/S2590112522000317 |
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