orofacial dystonia; orofacial dyskinesia; Meige's syndrome; Brueghel's syndrome

Introduction

Distinguish from Meigs' syndrome & primary cranial dystonia.

Etiology

-idiopathic

Epidemiology

• most common 30-70 years of age
• more common in women; ratio: 2:1
• 1 in 20,000

Pathology

• blepharospasm
• oromandibular dystonia

Clinical manifestations

• oromandibular dystonia
  • trismus
  • bruxism
  • spasms of jaw opening
  • sideways deviation or protrusion of the jaw
  • lip tightening & pursing
  • retraction of the corners of the mouth
  • deviation or protrusion of the tongue
  • jaw pain
  • difficulties eating & drinking
  • dysarthria
• blepharospasm
  • increased rate of blinking (1st symptom)
  • uncontrollable squinting/closing of eyes
  • photophobia
  • squinting/eyes closing during speech
  • uncontrollable eyes closing shut
• dystonic spasms may sometimes be provoked by
  • talking
  • chewing
  • biting

Complications

• uncontrollable & complete closing of eyes resulting in functional blindness

Differential diagnosis

• primary cranial dystonia

Management

• no cure
• sensory tricks may sometimes temporarily alleviate symptoms
  • chewing gum
  • talking,
  • placing a toothpick in the mouth
  • lightly touching the lips or chin,
  • applying pressure beneath the chin
• Botox

More general terms

• dystonia
• dyskinesia

Additional terms

• Meigs' syndrome
• primary cranial dystonia; idiopathic tosional dystonia