Oromandibular Dystonia Causing Recurrent Mandibular Open Lock in Two Adolescents Managed with Botulinum Toxin.

Mandibular open lock is a condition in which the patient is unable to close his/her mouth. This is an uncommon condition in children and adolescents that, when recurrent, can severely affect their quality of life. It can also prove to be a challenge for the clinician. When a mandibular open lock is caused by a sustained, recurrent, and involuntary muscle contraction of the inferior lateral pterygoid muscle, it is considered a oromandibular dystonia (OMD). A thorough understanding of the anatomy and function of the temporomandibular joint and the associated masticatory and orofacial muscles is essential to establish the correct diagnosis, allowing the selection of proper treatment. The purpose of this report is to present two cases of OMD in 13-year-old girls managed with onabotulinum toxin A injections into the inferior lateral pterygoid muscle. (J Dent Child 2019;86(1):47-52)
Received May 9, 2018; Last Revision September 3, 2018; Accepted September 4, 2018.

Recurrent TMJ Dislocation Managed with Botulinum Toxin Type A Injections in a Pediatric Patient.

Chronic recurrent temporomandibular joint (TMJ) dislocation is an uncommon condition that is painful and distressing to patients and uniquely challenging for clinicians. Sustained TMJ dislocation is not amenable to manual reduction alone when the etiology is muscular in nature. The purpose of this report was to describe the case of a child presenting with recurring temporomandibular joint dislocation secondary to muscle hyperactivity of unknown etiology that was managed with injections of botulinum toxin type A into the inferior lateral pterygoid muscles. The use of this peripheral antispasmoic neurotoxin is a reasonable, safe, and conservative, palliative treatment option for pediatric patients suffering from chronic recurring TMJ dislocation.

The incidence and prevalence of temporomandibular disorders and posterior open bite in patients receiving mandibular advancement device therapy for obstructive sleep apnea.

PURPOSE: This study aims to evaluate the incidence and prevalence of temporomandibular disorders (TMD) in patients receiving a mandibular advancement device (MAD) to treat obstructive sleep apnea using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). In addition, it also aims to assess the development of posterior open bite (POB). MATERIALS AND METHODS: Data from 167 patients were evaluated at baseline, from 159 patients after 118 days (visit II), from 129 patients after 208 days (visit III), and from 85 patients after 413 days (visit IV). The presence of TMD symptoms was evaluated through a questionnaire. TMD signs were assessed using the RDC/TMD. Clinical evaluation assessed for the presence of POB. RESULTS: The prevalence of TMD was 33/167 (19.8 %) at baseline. After an initial decrease to 14.5 % on visit II, the prevalence increased to 19.4 % on visit III and finally demonstrated a decrease to 8.2 % on visit IV. The incidence of TMD was 10.6 % on visit II. This decreased on further visits and only two (1.9 %) patients developed TMD from visit III to visit IV. POB was found to develop with an average incidence of 6.1 % per visit. The prevalence of POB was 5.8 % on visit II, 9.4 % on visit III, and 17.9 % on visit IV. CONCLUSION: The use of MADs may lead to the development of TMD in a small number of patients. Nevertheless, these signs are most likely transient. Patients with pre-existing signs and symptoms of TMD do not experience significant exacerbation of those signs and symptoms with MAD use. Furthermore, these may actually decrease over time. POB was found to develop in 17.9 % of patients; however, only 28.6 % of these patients were aware of any bite changes.