Long-Term Botulinum Toxin Management of OMD

How useful is botulinum toxin (BT) for treating oromandibular dystonia (OMD)?

Background: OMD has an estimated annual incidence of 3.3 to 6.9 cases per one million people and carries with it significant quality-of-life issues due to effects on chewing, swallowing and talking. OMD may be alleviated by sensory tricks including talking, singing, lip biting, tongue posturing and chewing gum. Over the past 20 years, there have been reports of the use of botulinum toxin in the treatment of OMD.

Study design: Retrospective chart review of 59 patients from 1995 and 2011, and 20 patients from 1989, with a diagnosis of OMD who were treated with botulinum toxin.

Setting: New York Center for Voice and Swallowing Disorders, St. Luke’s-Roosevelt Medical Center, New York City.

Synopsis: Data from current series patients were analyzed for patient and disease characteristics and BT management specifics including dose, injection location, response to initial injection, and timing and characteristics of subsequent injections. Two-thirds of patients had OMD as part of a segmental or generalized dystonia syndrome. Almost half had jaw-closing oromandibular dystonia (JCOD); of those, 53.6 percent had some degree of lateral jaw deviation. Concomitant lingual involvement was significantly more common among jaw-opening oromandibular dystonia (JOOD) patients. Thirty-nine patients (17 JCOD, 17 JOOD, five lateral deviation) had more than 2 injections overall, and 23 of those did not require dose adjustment within the first month of treatment. Researchers did not observe higher complication rates for JOOD treatment, likely due to avoiding deep high-dose injections into the submentalis complex and electromyography guidance to ensure accurate needle placement. Forty percent of patients in the 1989 series reported a zero to 20 percent improvement, and 60 percent had a more than 50 percent improvement.

Bottom line: Long-term management of OMD with BT 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, but there should be limitations to the injection site.

Citation: Sinclair CF, Curey LE, Blitzer A. Oromandibular dystonia: long-term management with botulinum toxin. Laryngoscope. 2013;123:3078-3083.

—Reviewed by Amy Eckner