title: Oromandibular dystonia: long-term management with botulinum toxin.
abstract: OBJECTIVE
  To review the long-term management of patients with oromandibular dystonia (OMD) treated using botulinum toxin.
  
  
  METHODS
  Retrospective chart review at a clinical research center.
  
  
  METHODS
  Between 1995 and 2011, 59 patients with a diagnosis of OMD were treated with botulinum toxin. Data were collected on patient demographics, disease characteristics, and long-term treatment outcomes. Differences in management between an earlier published series of the first 20 OMD patients treated with botulinum toxin at this center and subsequent patients were analyzed.
  
  
  RESULTS
  Patients were more commonly female (72% vs. 28%) with an average age at first botulinum treatment of 56.6 years. The median number of treatments was five (range, 1-35 treatments). Average time between treatments was 3.8 months (± 5.2). Overall, 47.5%, had the jaw-closing form of OMD, which was associated with a preferential deviation to one side in 53.6%. These patients received initial injections to the masseter ± temporalis muscle; the external pterygoid was injected for associated lateral jaw deviation. Internal pterygoid injections were rarely used (3.4%). For the jaw-opening form, injections were initially administered to the external pterygoid, with the addition of anterior digastric for ongoing symptoms. When compared with patients in the older series, more patients since 1988 had treatments to the external pterygoid (P = .001) and anterior digastric (P = .006) in accordance with an increase in the diagnosis of jaw-opening OMD (P = .05).
  
  
  CONCLUSIONS
  Long-term management of OMD with botulinum toxin has minimal morbidity and is useful for all clinical forms. Injections can be titrated by dose and location to address the predominant muscle groups involved.
authors.affiliation: New York Center for Voice and Swallowing Disorders, St. Luke's Roosevelt Medical Center, New York, New York, U.S.A.
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Sinclair
authors.forename: Lowell E
authors.initials: LE
authors.lastname: Gurey
authors.forename: Andrew
authors.initials: A
authors.lastname: Blitzer
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D004421:Dystonia / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008336:Mandibular Diseases / Q000188:drug therapy*; D008410:Masticatory Muscles / Q000187:drug effects; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Oromandibular dystonia; botulinum toxin; movement disorders; muscle dystonia