Diagnosis of
oromandibular dystonia
When diagnosing patient’s that exhibit involuntary movements we record their medical history and symptoms and make careful diagnosis. During this process, it is necessary to differentiate oromandibular dystonia from temporomandibular joint disorder, bruxism, oral dyskinesia, hyperplasia of the mandibular coronoid process, and masticatory muscle hyperplasia tendon-aponeurosis hyperplasia.
Fig. 7. Muscles that can be injected to treat involuntary contractions. Also, the genioglossus muscle, tensor veli palate muscle, and the muscles involved in facial expression can contract involuntarily.
1: zygomaticus major muscle, 2: orbicularis oris muscle, 3: mentalis muscle, 4: masseter muscle, 5: temporalis muscle, 6: coronoid process, 7: posterior belly of the digastric muscle, 8: anterior belly of the digastric muscle, 9: buccinators muscle, 10: sternocleidomastoid muscle, 11: trapezius muscle, 12: platysma, 13: medial pterygoid muscle, 14: lateral pterygoid muscle
1. Self-check for oromandibular dystonia
If you have symptoms such as involuntary movements or contractions involving the mouth and/or jaw muscles, you might have oromandibular dystonia. Please check any of the following statements that apply to you.
1. ( ) You experience unconscious contractions of the mouth and/or jaw muscles.
2. ( ) The direction of the movement (mouth closing, opening or tongue protrusion) is always the same.
3. ( ) The symptoms only appear during a specific task (speaking, eating, or mouth opening, etc.).
4. ( ) When something (chewing gum, candy, or a mouth piece, etc.) is in your mouth, the symptoms are temporarily relieved.
5. ( ) The symptoms do not occur during sleep.
6. ( ) Your symptoms are less severe or absent in the morning. However they gradually become worse during the day.
7. ( ) You are taking or have previously taken psychiatric drugs.
8. ( ) The severity of your symptoms is affected by tension or relaxation.
9. ( ) The symptoms first occurred after dental treatment or a tooth or jaw injury.
10. ( ) You are being treated for other forms of dystonia (spasmodic torticollis, blepharospasm, writer's cramp, etc.)
If you checked 2-3 answers, you might have oromandibular dystonia.
If you checked 4-5, you are likely to have oromandibular dystonia.
If you checked more than 6, you are highly likely to have oromandibular dystonia.
2. Contact us
If you wish us to diagnose and/or treat your oromandibular dystonia, please fill in the detailed questionnaire below and email it to Dr. Kazuya Yoshida (yoshida.kazuya.ut@mail.hosp.go.jp) as an attachment or fax it to +81-75-643-4325. Alternatively, you could post it to: Department of Oral and Maxillofacial Surgery, Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan. Please note that due to the number of inquiries we receive from patients, it might take us some time to reply. We take care to manage patients’ personal information in an appropriate manner; however, transmitting personal information over the internet carries a risk of it being lost or disclosed. This site is my own (Dr. Kazuya Yoshida). Personal questions about medical care for other physicians at the Kyoto Medical Center cannot be accepted. If you have been treated elsewhere, you should have your physician write a letter of introduction. Also, if you are on any oral medication, we ask you to bring your prescription to your initial consultation.
3. Sending images and video
To obtain a definitive diagnosis, you should visit our hospital. However, if it is difficult for you to do this due to travel constraints, please make a video recording your involuntary movements, and email me it as an attachment using such as Hightail. We take care to manage patients’ personal information in an appropriate manner; however, transmitting personal information over the internet carries a risk of it being lost or disclosed. Any images and video data received are stored on a password-protected computer in a responsible manner. We keep the computer room locked when unattended and always strive to prevent theft.
4. Remote diagnosis
We can also communicate via Skype (Skype ID: kazuyayoshida1), and remote diagnosis via email can also be attempted (yoshida.kazuya.ut@mail.hosp.go.jp). Remote diagnosis is available after hospital hours (after 18:00 Japanese time). If you have the typical symptoms of dystonia, I will be able to say whether you are likely to have dystonia based on the information images, questionnaire results, and video you provide. However, for a definitive diagnosis you must visit our department to undergo electromyography (EMG), muscle palpation, and other tests such as X rays, computed tomography (CT), and MRI. Furthermore, in some cases consultations with the departments of Neurology, Psychiatry or Neurosurgery are also necessary. Please note that we cannot be held responsible for remote diagnoses based solely on questionnaire results and/or images.
5. Appointment for an initial consultation
If you wish to visit our department but you have been treated somewhere else already, please get your doctor to write a letter of introduction. Please tell your doctor to fill out a request form which can be downloaded from the Regional Medical Liaison Office’s website, and fax it to our hospital to make a reservation for your initial consultation. If it is not possible for your doctor to fax the form, you cannot make an appointment on your own. We ask you to make an appointment for 10:30 or earlier on Monday through Thursday. On Friday, we perform surgery under general anesthesia. If you have to travel far, and contact Dr. Kazuya Yoshida (yoshida.kazuya.ut@mail.hosp.go.jp) in advance, you can make reservation for the afternoon and be hospitalized immediately after your initial visit. However, because of the condition of the ward we cannot always offer the type of room you request (a large room, private room, special private room, etc.). In addition, you should check my schedule before visiting the hospital because I am occasionally absent because of business trips or scientific conferences. Alternatively, you can call our clinic on 075-641-9161, extension 3141. In addition, if you are taking any oral medication we ask you to bring your prescription.
·Getting to Kyoto Medical Center
By Keihan trains:
The center is 8 minutes walk from Fujinomori station on the Keihan line.
By Kintetsu trains:
At the JR Tokaido Shinkansen station or Kyoto station change to the Kintetsu line and then transfer to the Keihan line at Tanbabashi station. The center is 8 minutes walk from Fujinomori station (Fig. 8)
By JR trains:
Get on the JR Nara line at Kyoto station. The center is 12 minutes walk from JR Fujinomori station (Fig. 8).
Alternatively, get on the JR Nara line at Kyoto station, get off at Tofukuji station and transfer to the Keihan line. The center is 8 minutes walk from Fujinomori station.
By car:
The center is 7 minutes from the Kyoto Minami interchange of the Meishin Expressway.
(There are limited spaces in the parking lot, please use the tour bus and public transport as much as possible.)
Fig. 8. Map of the area around Kyoto Medical Center
6. Oromandibular dystonia questionnaire
Please fill out the following questionnaire. You can check more than one answer. If none of the example answers are applicable, please provide as much specific information as you can.
Full Name:
Gender: Male ( ), Female ( )
Date of birth: year ( ), month ( ), day ( )
Address:
Phone:
Fax:
E-mail:
1. What kind of symptoms do you have?
Clenching teeth ( ), Mouth opening ( ), Lateral or frontal shifting of the jaw ( ), Tongue protrusion ( ), Contraction around the mouth ( ), Movement of the tongue ( ), Movement of the lips ( ),
Other, please describe them specifically ( )
2. What problems does your condition cause?
Can not eat ( ), Can not talk ( ), Can not open mouth ( ), Pain ( ), Difficulty in swallowing ( ), Discomfort ( ),
Other, please describe them specifically ( )
3. How long have you had the symptoms?
( ) year(s), ( ) month(s), ( ) day(s)
4. Were your symptoms triggered by something?
No ( ), Yes ( )
If yes: Dental treatment ( ), Injuries to the mouth or jaw ( ), Oral medication ( ),
Other, please describe ( )
5. What part(s) of your body is affected?
Mouth ( ), Mandible (lower jaw) ( ), Maxilla (upper jaw) ( ), Lips ( ), Cheek ( ), Neck ( ), Eyelid ( ),
Other, please describe ( )
6. When do you experience symptoms?
During speaking ( ), During eating ( ), During mouth opening ( ), During swallowing ( ), Always ( ),
Other, please describe specifically ( )
7. Is there anything that temporarily eases the symptoms?
No ( ), Yes ( ), Depends on time ( )
If yes: Putting something in my mouth ( ), Touching my jaw with my hand or fingers ( ), Touching my mouth with a handkerchief or mask ( ),
Other, please describe specifically ( )
8. Do you have symptoms when you are sleeping?
No ( ), Yes ( ), Not sure ( )
Other, please describe ( )
9. Do the symptoms change over time?
No ( ), Yes ( ), There is a difference from day to day ( )
No symptoms upon awakening ( ), The symptoms become worse from morning to night ( ),
Other, please explain specifically ( )
10. Have you ever taken psychiatric drugs? Or are you now taking them?
No ( ), Yes ( )
If yes: For ( ) year(s), ( ) month(s), ( ) day(s)
Which drug(s)? ( )
11. Have you ever been treated for another form of dystonia or muscle contraction?
No ( ), Yes ( )
If yes: Spasmodic torticollis (cervical dystonia) ( ), Blepharospasm (spasms of the eyelids) ( ), Writer's cramp (hand dystonia) ( ), Hemifacial spasm (hemifacial-cramp) ( ), Other ( )
12. Which clinical departments have you visited so far for treatment?
None ( ), Department of Neurology ( ), Dentistry ( ), Oral and Maxillofacial Surgery ( ), Neurosurgery ( ), Otolaryngology ( ), Psychiatry ( ), Acupuncture ( ), Other ( )
13. What kind of examinations have you had?
None ( ), MRI ( ), CT ( ), EMG ( ), X-ray ( ), Blood test ( ), Genetic testing ( ), Other ( )
14. Have you had your symptoms treated?
No ( ), Yes ( )
If yes: Oral medication ( ), Botulinum therapy (Botox) ( ), Acupuncture ( ), Magnetic stimulation ( ), Surgery ( ),
Other ( )
15. Do you have any other medical condition now?
No ( ), Yes ( )
If yes: what? ( )
And where were you treated? At the Department of Neurology ( ), Psychiatry ( ), Orthopedics ( ),
Psychosomatic ( ), Surgery ( ), Internal medicine ( ), Other ( )
16. Please add any other information or questions.
( )
Please email your responses to the above questions to Dr. Kazuya Yoshida as an attachment (yoshida.kazuya.ut@mail.hosp.go.jp) or fax them to +81-75-643-4325). Alternatively, you can post them to: Department of Oral and Maxillofacial Surgery, Kyoto Medical Center, 1-1, Mukaihata-cho, Fukakusa, Fushimi-ku, Kyoto 612-8555, Japan.
The above data will only be used for diagnostic purposes. We take care to manage personal information in an appropriate manner. Due to the number of inquiries we receive from patients, we might have to wait for some time for a reply.