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Rate ePoster

Pain and Spine Medicine

Speechless and Jaw Dropping Results: A Case Comparison of Botulinum Toxin for Oromandibular Dystonia

Saturday, October 25, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 4

    Poster Presenter(s)

  • Nicole C. Feng, MD

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

    • Co-Author(s)

  • Ryan Kelly, MD

    Resident Physician
    McGaw Medical Center of Northwestern University (SRAL) PM&R Program
    Chicago, Illinois

  • SM

    Stacy McCarty, MD

    Assistant Professor- PM&R
    McGaw Medical Center of Northwestern University; Shirley Ryan Ability Lab
    La Grange Park, Illinois

Disclosure(s):
Ryan Kelly, MD: No financial relationships to disclose
Stacy McCarty, MD: No financial relationships to disclose
Case Diagnosis: Two patients with oromandibular dystonia (OMD) received 100 units of botulinum toxin A (BoNT-A) to facial muscles; one patient developed dysarthria while the other tolerated the dose.

Case Description or Program Description: Patient A, a 64-year-old woman with history of migraines and temporomandibular joint disorder (TMJD) and Patient B, a 40-year-old woman with history of fibromyalgia and TMJD presented to our procedure clinic for OMD botulinum toxin injections. Both patients experienced bruxism resulting in dental attrition and severe jaw pain.

Setting: An outpatient botulinum toxin procedure clinic.

Assessment/Results: OnabotulinumtoxinA was injected into bilateral temporalis (BT) and masseter (BM) muscles identified by palpation of the activated muscle. Patient A initially received 60 total units, gradually titrating up to 100 units (BT-15 units, BM-35 units) after five- and four-month intervals, all in a 1:1 preparation. The 100-unit dose provided full pain relief but caused transient dysarthria resolving within a week. After a six-month washout period, 90 units were administered safely and effectively in three-month intervals. Patient B first received 75 units in a 1:1 preparation with incomplete symptom improvement. Three months later, she received 100 units (BT-20 units, BM-30 units) in a 2:1 dilution, reporting effective pain relief without adverse reactions.

Discussion (relevance): BoNT-A injections are an effective therapy for OMD. The rate of dysarthria occurring after injecting BoNT-A into facial muscles is not well documented, though some sources report a rate up to 0.9%. The dysarthria that occurred in Patient A but not in Patient B may be attributed to a higher concentration of toxin in the 1:1 dilution diffusing into adjacent muscles involved in speech. Three-month intervals were also the ideal frequency for both patients.

Conclusions: This case comparison illustrates the importance of an individualized BoNT-A injection protocol including dosing, dilution, and frequency for safe and successful treatment of OMD.