Disclosures: Sarah M. Smith, MBBS: No financial relationships or conflicts of interest

Case Description: A 38 year old man was found to have a type A aortic dissection and underwent emergency mechanical Bentall and ascending hemiarch replacement. 48 hours after the procedure, the patient developed severe agitation and acute neurological change resulting in code stroke. He received 10 mg IV haloperidol for agitation that day, and received 2-5mg IV haloperidol daily over the next several days. His MRI confirmed multiple acute infarcts in the right frontal, anterior corpus callosum, and right occipital lobe. About 4 days later, he began to complain of jaw pain, tongue biting, and difficulty opening his mouth. The patient had a complex hospital course complicated by respiratory failure and severe agitation, and his jaw symptoms were thought to be “behavioral” or perhaps related to trauma from difficult intubations. His symptoms continued for the remainder of the patient’s acute hospital course and were present on admission to inpatient rehabilitation (IPR) one month later.

Setting: Tertiary care academic center

Patient: 38 year old male with acute oromandibular dystonia Assessment/

Results: While admitted to IPR, an EMG demonstrated strong motor activity in the masseters bilaterally at rest. He subsequently underwent onabotulinum toxin injections to bilateral masseters and temporalis muscles.

Discussion: The etiology of his dystonia is not entirely clear. Oromandibular dystonia secondary to stroke has been reported infrequently in the literature, and the location of this patient’s lesions on MRI do not explain his symptoms. Tardive dystonia secondary to antipsychotics is also possible given that the patient received high doses of haloperidol prior to the onset of his symptoms. Regardless of the cause, early diagnosis and treatment of this condition can significantly improve ability to perform oral hygiene, manage food boluses, decrease trauma to oral structures, and decrease pain.

Conclusion: Oromandibular dystonia is an important diagnosis to consider in patients who experience jaw tightness, pain, or difficulty with mouth opening.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-oromandibular-dystonia-complex-contributing-factors/