9.1

Oromandibular dystonia (difficult to open mouth)

From Werner KM, Ooi WW, McQuillen, DP et al. Chapter 44 – Bacterial Diseases. In: Srinivasan J, Chaves CJ, Scott BJ, Small JE, eds. Netter’s Neurology. 3 ^rd ed. Elsevier; 2020

• 1.
  

  Called lockjaw.

  
  
• 2.
  

  Clinical feature: reduced mouth opening caused by involuntary spasm of the mastication muscles.

  
  
• 3.
  

  Botulinum toxin injection:

  
  
  
  
  • a.
    

    Primary target muscles: temporalis (1-1) and masseter (1-2).

    
    
  • b.
    

    Secondary target muscles: medial pterygoid (1-3) only because of technical difficulties.

  
  

∗In addition, if jaw is deviated to right (left) side, then right (left) lateral pterygoid (1-4) is indicated for injection.

9.2

Oromandibular dystonia (difficult to close mouth)

From Teemul TA, Patel R, Kanatas A, Carter LM. Management of oromandibular dystonia with botulinum A toxin: a series of cases. British Journal of Oral and Maxillofacial Surgery. 2016;54(10):1080–1084

• 1.
  

  Clinical feature: difficult to close mouth caused by involuntary spasm of the mouth opening muscles.

  
  
• 2.
  

  Botulinum toxin injection:

  
  
  
  
  • a.
    

    Primary target muscle: lateral pterygoid muscle (1-4).

  
  

9.3

Bruxism (teeth grinding)

From Allen RP, Salas RE, Gamaldo C. Chapter 11.2 – Movement Disorders in Sleep. In: Kryger MH, ed. Atlas of Clinical Sleep Medicine. 2 ^nd ed. Elsevier/Saunders; 2014

• 1.
  

  Clinical feature: teeth grinding (similar to oromandibular dystonia, difficult to open mouth)

  
  
• 2.
  

  Botulinum toxin injection:

  
  
  
  
  • a.
    

    Primary target muscles: temporalis (1-1), masseter (1-2), and lateral pterygoid (1-4).

    
    
  • b.
    

    Secondary target muscle: medial pterygoid (1-3) It is recommended as secondary target muscle only because of technical difficulties. If approach to this muscle is not difficult, it could be a primary target muscle.

  
  

9.4

Torticollis

(A) From Seliverstov Y, Arestov S, Klyushnikov S, Shpilyukova Y, Illarioshkin S. A methodological approach for botulinum neurotoxin injections to the longus colli muscle in dystonic anterocollis: A case series of 4 patients and a literature review. Journal of Clinical Neuroscience. 2020;80:188–194 ; (B, C) From Herring JA. Chapter 11 – Disorders of the Neck, Tachdjian’s Pediatric Orthopaedics. 5 ^th ed. Elsevier/Saunders; 2014

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