Mangaluru : KMC Hospital, Mangalore, successfully treated a 51-year-old patient who was admitted to the hospital for a case of Oromandibular Dystonia. Mr Ravi (name changed) was diagnosed with jaw opening dystonia where he was facing difficulty in closing the jaw, speaking, and chewing food. Initially, medication was given to improve dystonia, which resulted in little improvement. Later, CT-guided Botox injection was done by Dr Keerthiraj, Interventional Neuroradiologist and Dr Rohit Pai, Neurologist, KMC Hospital, Mangalore.
Oromandibular dystonia is a type of dystonia characterized by abnormal contractions of the jaw muscles, mouth and tongue. Patients of jaw dystonia experience contractions of the lateral pterygoids and digastric muscle. These muscles are involved in the opening of the jaw. Patients with jaw opening dystonia are unable to close their jaw as it is kept open by excessive contraction of the lateral pterygoid muscle (thick facial muscle that provides movements to the joints of the skull).

Botulinum toxin is a neurotoxin produced by the bacteria Clostridium botulinum. The toxin acts in the neuromuscular junction and disrupts the release of vesicles (blisters that can appear on the skin) that contain Acetylcholine, the neurotransmitter which is responsible for muscle contraction. This causes paralysis of the muscle. There are seven main types of botulinum toxins, of which types A and B can cause disease in humans. Botulinum toxin acts in the neuromuscular junction and disrupts the release of vesicles containing the neurotransmitter Acetylcholine which is responsible for muscle contraction. This helps in paralyzing the muscles which are overactive in dystonia. This is available commercially as Botox.

Speaking about the case, Dr Rohit Pai, Neurologist, KMC Hospital, Mangalore, said, “The patient was having difficulty in closing the jaw, which caused difficulty in speaking, chewing, and consuming food. He was initially given medicines to improve dystonia. That resulted in minimal improvement. Hence, he was then given a Botox injection. Generally, Botox can be given into the lateral pterygoid muscles by extraoral (from outside the mouth) or intraoral approach (inside the mouth). The most commonly used approach is extraoral (from outside the mouth).”

Furthermore, he said, “CT-guided injection box technique was used where the muscle was identified by CT. A needle was inserted into the lateral pterygoids by the extraoral approach, a technique where the depth of the muscle is measured, and Botox injected. The advantage of this technique is that the injection can be given accurately into the desired muscles improving the outcome. Also, the side-effects associated with blind injections, which could injure the maxillary artery, can be avoided. This patient showed remarkable improvement after the procedure.”

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