Journal of Pain & Relief
Open Access

Abstract

Objective: Oromandibular dystonia (OMD) is an infrequent condition in progressive supranuclear palsy(PSP), which may results in dysfunctional movements of facial, tongue muscles, mandible and temporomandibular joint. Regards of treatments, medical treatment usually showed a little effect on dystonia, botulinum toxin injection has been focused on an alternative treatment for OMD. In this case, we aim to report the treatment of jaw opening dystonia with botulinum toxin A in PSP using ultrasonography Methods: A 64-year-old man presented with tonic, extended dystonia of axial and OMD, open jaw type. He was diagnosed as PSP at 2014, and prescribed many medicines since then. He was suffering from constant opened jaw, which results in poor mastication, dry mouth and impaired communication. However, there was no response on medications. The patient was treated with injection of botulinumA toxin (Botox) at the lateral pterygoids and the anterior digastrics muscles involved in jaw opening dystonia using ultrasonography. The patient was treated with injections of total 25 units of botulinumA toxin at two points in each lateral pterygoid muscle, and in two points of each anterior digastric muscle of total 25 units at both sides. Results: Before the procedure, the patient showed constant open jaw state with an impossible of speaking and feeding. After the procedure, the patient showed much improved jaw movement with voluntary jaw movements and even full closed jaw. The improvement was manifested 6 days later after the procedure, and there has been no report of severe side effect after botulinum toxin injection. Conclusion: Botulinum toxin is a potent neuromuscular paralyzing agent, which cause reversible chemodenervation by blocking the presynaptic release of acetylcholine. In this regards, this case suggested that botulinum toxin A has been proved to be effective in focal dystonia.

Biography

Jin Seok Seo has completed his MD at the age of 26 years from Kyunghee University School of Medicine. He is a physical medicine and rehabilitation doctor of Veterans Health Service Medical Center, Seoul, Korea.