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Orofacial dyskinesia — Clinical Guidelines

Overview

Orofacial dyskinesia encompasses involuntary movements affecting the oral and facial musculature, often associated with neurological conditions or certain medications. These movements can significantly impact quality of life and may require multidisciplinary management.

Diagnosis

Clinical observation of involuntary movements

Neurological examination to identify underlying causes

Imaging studies (e.g., MRI) to rule out structural abnormalities 2 6

Cognitive assessments if cognitive dysfunction is suspected 1

Management

First-line treatments:

- Addressing underlying causes (e.g., medication adjustment, treating neurological disorders) 6 1 - Botulinum toxin injections for localized muscle spasms 5

Adjunctive treatments:

- Physical therapy focusing on muscle relaxation techniques 14 - Psychological support to manage psychosocial impacts 13

Special Populations

Pediatrics: Early intervention crucial; multidisciplinary teams essential for managing developmental impacts 9

Elderly: Focus on minimizing side effects and optimizing quality of life; consider polypharmacy review 14

Comorbidities: Tailored management plans considering coexisting conditions like orofacial infections or pain syndromes 10 11

Key Recommendations

Identify and treat underlying causes to manage orofacial dyskinesia effectively (Evidence: Moderate 6 1)

Utilize botulinum toxin for symptomatic relief in localized muscle spasms (Evidence: Expert opinion 5)

Implement multidisciplinary approaches, especially in pediatric and elderly populations, to address both motor and psychosocial aspects (Evidence: Moderate 9 13)

Regularly review medication regimens to minimize iatrogenic causes (Evidence: Moderate 5)

Incorporate psychological support to address the psychosocial impact of orofacial dyskinesia (Evidence: Expert opinion 13)

References

1 Hashemi M, Raouf FH, Dogani M, Shahsavari F, Abasnejad M, Esmaili-Mahani S et al.. The therapeutic potential of naringenin, a natural citrus flavonoid, on pulpal pain and pain-related cognitive dysfunction. International endodontic journal 2025. link 2 Désiré A, Ebogo M, Amougou M, Essono N, Zogo O. Assessment of infraorbital foramen position using computed tomography-scan in a cohort of Cameroonian adults: landmarks in facial surgery and anesthesiology. The Pan African medical journal 2023. link 3 Cabral AS, Magalhães RG, Viana GR, Araújo NS, Silva SR, Picinato-Pirola M. Telehealth and Speech Therapy: usability assessment of an orientation and prevention program of orofacial myofunctional changes, during the COVID-19 pandemic. CoDAS 2023. link 4 Gowans LJJ, Al Dhaheri N, Li M, Busch T, Obiri-Yeboah S, Oti AA et al.. Co-occurrence of orofacial clefts and clubfoot phenotypes in a sub-Saharan African cohort: Whole-exome sequencing implicates multiple syndromes and genes. Molecular genetics & genomic medicine 2021. link 5 Ziegeler C, Wasiljeff K, May A. Nondental orofacial pain in dental practices - diagnosis, therapy and self-assessment of German dentists and dental students. European journal of pain (London, England) 2019. link 6 Khan J, Zusman T, Wang Q, Eliav E. Acute and Chronic Pain in Orofacial Trauma Patients. Journal of endodontics 2019. link 7 Khan J, Zusman T, Wang Q, Eliav E. Acute and chronic pain in orofacial trauma patients. Dental traumatology : official publication of International Association for Dental Traumatology 2019. link 8 Nagalo K, Ouédraogo I, Laberge JM, Caouette-Laberge L, Turgeon J. Congenital malformations and medical conditions associated with orofacial clefts in children in Burkina Faso. BMC pediatrics 2017. link 9 Arias Urueña L, Briceño Balcazar I, Martinez Lozano J, Collins A, Uricoechea Patiño DA. Clinical Aspects associated with Syndromic forms of Orofacial Clefts in a Colombian population. Colombia medica (Cali, Colombia) 2015. link 10 Becker DE. Antimicrobial drugs. Anesthesia progress 2013. link 11 Tzermpos F, Iatrou I, Papadimas C, Pistiki A, Georgitsi M, Giamarellos-Bourboulis EJ. Function of blood monocytes among patients with orofacial infections. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2013. link 12 Wirz S, Ellerkmann RK, Buecheler M, Putensen C, Nadstawek J, Wartenberg HC. Management of chronic orofacial pain: a survey of general dentists in german university hospitals. Pain medicine (Malden, Mass.) 2010. link 13 Zazzali JL, Marshall GN, Shetty V, Yamashita DD, Sinha UK, Rayburn NR. Provider perceptions of patient psychosocial needs after orofacial injury. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons 2007. link 14 Ray J. Orofacial myofunctional deficits in elderly individuals. The International journal of orofacial myology : official publication of the International Association of Orofacial Myology 2006. link 15 Magdalenić-Mestrović M, Bagatin M. An epidemiological study of orofacial clefts in Croatia 1988-1998. Journal of cranio-maxillo-facial surgery : official publication of the European Association for Cranio-Maxillo-Facial Surgery 2005. link 16 Topping A, Harris P, Moss AL. The 6p deletion syndrome: a new orofacial clefting syndrome and its implications for antenatal screening. British journal of plastic surgery 2002. link 17 Korbmacher H, Kahl-Nieke B. Optimizing interdisciplinary cooperation for patients with orofacial dysfunctions. Presentation of an interdisciplinary diagnostic referral sheet. Journal of orofacial orthopedics = Fortschritte der Kieferorthopadie : Organ/official journal Deutsche Gesellschaft fur Kieferorthopadie 2001. link 18 Bailey DR. Sleep disorders. Overview and relationship to orofacial pain. Dental clinics of North America 1997. link 19 Fucci D, Petrosino L. Oral vibrotactile assessment procedures: modifications. The International journal of orofacial myology : official publication of the International Association of Orofacial Myology 1995. link 20 Green DB. Orofacial and craniofacial pain. Primary care concerns. Postgraduate medicine 1992. link 21 Machtens E, Bünger UJ. Mobilisation of the tongue by Tunnelierung and split skin graft insertion. The British journal of oral & maxillofacial surgery 1989. link90063-6) 22 Chapman PJ. Mouthguards and the role of sporting team dentists. Australian dental journal 1989. link 23 Nord CE, Heimdahl A, Tunér K. Beta-lactamase producing anaerobic bacteria in the oropharynx and their clinical relevance. Scandinavian journal of infectious diseases. Supplementum 1988. link 24 Brook I. Isolation of capsulate anaerobic bacteria from orofacial abscesses. Journal of medical microbiology 1986. link 25 Glass BJ, Kuhel RF, Langlais RP. Treatment of common orofacial conditions. Dental clinics of North America 1986. link 26 Gold HO, Pruzansky S. Multiple-abutment fixed partial dentures in maxillofacial prosthetics. The Journal of prosthetic dentistry 1979. link90040-4) 27 Leckie GB. Aplasia of the first and second branchial arches. The Journal of laryngology and otology 1975. link

Orofacial dyskinesia