Abstract
Oromandibular dystonia is a focal dystonia that manifests as involuntary masticatory and/or tongue muscle contractions. Jaw opening, jaw deviation, and jaw protrusion types of oromamdibular dystonia are caused by involuntary contraction of the lateral pterygoid muscles. The medial pterygoid can be very hyperactive in jaw closing dystonia as a result of the so‐called “whack‐a‐mole phenomenon,” after repeated botulinum toxin injections into the masseter and temporalis muscles. The more accurately the botulinum toxin is injected into the muscles, the more likely the improvement in the patient's symptoms, and the lower the risk of complications, such as hematoma or arterial bleeding. Both pterygoid muscles can be accessed by intra‐ and extraoral routes. Safe and correct injection of botulinum toxin into both pterygoid muscles is described in this video. With understanding of the anatomy of the muscles, indications for injection, and technique of needle placement, injection of botulinum toxin into the lateral and medial pterygoid muscles is safe and effective for oromandibular dystonia.
Disclosures
Ethical Compliance Statement: I confirm that I have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.
Funding Sources and Conflicts of Interest: This study was supported by grants from the Japanese Ministry of Health, Labor, and Welfare (15K09370, 24592946, and 22111201). The author reports no conflicts of interest.
Institutional review board (IRB) approval: This study was performed in accord with the Declaration of Helsinki under the approval of the IRB and ethics committee of Kyoto Medical Center.
Financial Disclosures for previous 12 months: The author declares that there are no disclosures to report.
Supporting information
A video accompanying this article is available in the supporting information here.
Video S1. How do I inject botulinum toxin into the lateral and medial pterygoid muscles?
Relevant disclosures and conflicts of interest are listed at the end of this article.
Supporting information may be found in the online version of this article.
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Supplementary Materials
A video accompanying this article is available in the supporting information here.
Video S1. How do I inject botulinum toxin into the lateral and medial pterygoid muscles?