EC Neurology

Background: Oromandibular dystonia (OMD) is a rare focal dystonia involving involuntary contractions of masticatory, lingual, and facial muscles, leading to impaired speech, mastication, and swallowing. Its diagnosis is often delayed, and misinterpretation as psychogenic or temporomandibular joint disorders is common.

Case Presentation: We report the case of a 52-year-old woman with a history of depressive disorder, who presented with a two-year history of painful involuntary jaw-closing contractions, trismus, and dysarthria, severely impairing nutrition and daily life. Neurological examination confirmed jaw-closing OMD associated with temporomandibular joint osteoarthritis. Previous trials with psychiatric and anticonvulsant medications yielded no benefit. The patient received repeated botulinum toxin injections (100-200U) into the masseter, temporalis, and medial pterygoid muscles, combined with intra-articular platelet-rich plasma (PRP) injections into the temporomandibular joints. This combined strategy led to significant improvement in mouth opening (from 0.5 cm to 3 cm), reduction of joint pain, restoration of prosthesis use, and complete resolution of spasms at one-year follow-up.

Discussion: This case highlights the diagnostic challenges of OMD, frequently misattributed to psychiatric or dental disorders. Botulinum toxin remains the treatment of choice for focal dystonias, providing sustained symptomatic relief. PRP injections may offer additional benefits in patients with concomitant temporomandibular joint pathology, owing to their regenerative and anti-inflammatory properties.

Conclusion: Early recognition of OMD is crucial to avoid misdiagnosis and inappropriate treatment. Combined therapy with botulinum toxin and PRP may represent a promising approach, especially in patients with associated temporomandibular joint osteoarthritis. Further studies are warranted to confirm these findings.

 Keywords: Oromandibular Dystonia; Botulinum Toxin; Platelet-Rich Plasma; Temporomandibular Joint Osteoarthritis; Case Report

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