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Botulinum Toxin:
Oromandibular Dystonia
29 March, 2005
There is more extensive information on my Palm program for needle localization
of muscles involved in oromandibular dystonia. The BoTox doses listed are
starting doses.
Jaw Opening Dystonia (Brueghel's Syndrome)
|
Muscle |
Action |
Needle
Insertion |
BoTox (Per
side) |
Comments |
|
Lateral
Pterygoid |
Jaw
opening, prognathia |
Anterior to
mandibular condyle and just below zygomatic arch. |
15 |
Deeper than
you think. This muscle is surprisingly deep. |
|
Digastric |
Jaw
opening, retrognathia |
Anterior
belly: insert back of body of mandible, near midline |
5 |
If too
medial insertion, will be in mylohyoid or geniohyoid. |
|
Mylohyoid |
Jaw opening |
Near
midline, behind body of mandible, deep to geniohyoid. |
2.5 |
If too
superficial, will be in geniohyoid or too lateral will be in anterior
belly of digastric |
|
Geniohyoid |
Jaw opening |
Near
midline, behind body of mandible, superficial to mylohyoid. |
2.5 |
If too
deep, will be in mylohyoid or too lateral will be in anterior belly of
digastric |
Submentalis
complex: digastric anterior belly, geniohyoid, mylohyoid.
Jaw Closing
Dystonia
|
Muscle |
Action |
Needle
Insertion |
BoTox (Per
side) |
Comments |
|
Medial
Pterygoids |
Jaw
closure, jaw deviation to contralateral side |
Approach
from under chin, inner aspect of mandible just distal to angle of jaw. |
15 |
NB: Also
does jaw deviation; therefore do not inject 1 side only unless patient
also has jaw deviation dystonia. |
|
Masseter |
Jaw closure |
2 cm distal
to jaw angle & 2 cm cephalad to lower mandible edge (Muscle can be
palpated when teeth clenched). |
10 |
If needle
too anterior, will be in buccinator. If too posterior, will penetrate
parotid gland. |
|
Temporalis |
Jaw closure |
Insert in
retromolar fossa about 2 cm anterior to mandibular condyle. |
10 |
|
Jaw Deviation
Dystonia
|
Muscle |
Action |
Needle
Insertion |
BoTox (Per
side) |
Comments |
|
Medial
Pterygoids |
Jaw
closure, jaw deviation to contralateral side |
Approach
from under chin, inner aspect of mandible just distal to angle of jaw. |
15 |
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