Behandlungsstrategien bei oromandibulärer Dystonie

Kazuya Yoshida

doi:10.1055/a-1375-0669

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2021; 89(11): 562-572
DOI: 10.1055/a-1375-0669

Übersicht

Behandlungsstrategien bei oromandibulärer Dystonie

Therapeutic strategies for oromandibular dystonia

Authors

Kazuya Yoshida

Department of Oral and Maxillofacial Surgery, National Hospital Organization, Kyoto Medical Center

Abstract

Zusammenfassung

Eine oromandibuläre Dystonie ist charakterisiert durch unwillkürliche tonische oder klonische Spasmen der Kau- und / oder Zungenmuskulatur bzw. der Muskeln im stomatognathen System. Sie wird oft fälschlicherweise als kraniomandibuläre Dysfunktion oder psychiatrische Erkrankung diagnostiziert. Aufgrund der klinischen Bilder wird die oromandibuläre Dystonie in 6 Subtypen (Kieferschluss-, Kieferöffnungs-, Zungen-, Kieferdeviations-, Kieferprotrusions-, und Lippendystonie) eingeteilt. Es gibt verschiedene Behandlungsmethoden, z. B. Injektion von Botulinum-Toxin, Muskelafferenzblockierung (Injektionen von Lidocain und Äthanol in die Kau- oder Zungenmuskulatur zur Blockierung der Afferenzen der Muskelspindeln), Aufbissschiene und chirurgische Eingriffe (Coronoidotomie). In vielen Fällen können aufgrund des Subtyps die Symptome durch eine Kombination dieser Methoden erfolgreich behandelt werden. In diesem Leitthema werden spezielle Therapieempfehlungen für jeden Subtyp beschrieben. Eine genaue Diagnose und Behandlung einer oromandibulären Dystonie erfordert umfassende Kenntnisse und Fähigkeiten sowohl in der Mund-, Kiefer- und Gesichtschirurgie als auch in der Neurologie. Daher ist die Zusammenarbeit zwischen diesen Abteilungen sehr wichtig.

Abstract

Oromandibular dystonia is characterized by tonic or clonic involuntary spasms of the masticatory, lingual and / or muscles in the stomatognathic system. It is often misdiagnosed as craniomandibular dysfunction or psychiatric disease. According to clinical features, the oromandibular dystonia is classified into 6 subtypes (jaw closing-, jaw opening-, tongue-, jaw deviation-, jaw protrusion-, and lip dystonia). There are several treatment methods like botulinum toxin injection, muscle afferent block (injection of lidocaine and alcohol into the masticatory or tongue muscles for blocking muscle afferents from muscle spindle), occlusal splint, and oral surgery (coronoidotomy). Most of patients can be treated successfully according to subtype by combination of these treatments. Special treatment recommendations for each subtype were described in this focus article. Accurate diagnosis and treatment of oral dystonia requires comprehensive knowledge and skills of both oral and maxillofacial surgery and neurology. Therefore, collaboration among these departments is very important.

Schlüsselwörter

Oromandibuläre Dystonie - Behandlung - Botulinum-Toxin - Chirurgie - Aufbissschiene

Key words

Oromandibular dystonia - Treatment - Botulinum toxin - Surgery - Occlusal splint

Full Text

References

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