Andere naam:
Embouchure Dystonia, Oromandibulaire dystonie
 

Korte omschrijving:
Oromandibulaire dystonie: beïnvloedt de spieren van de kaak, tong en mond. Bij blazers belemmert of verhindert dit het embouchure.

 

 Focale dystonieën komen bij musici betrekkelijk vaak voor, betreffen meestal een hand of één of meerdere vingers, en zijn meestal taakspecifiek. Slechts zelden is een dergelijke taakspecificatie hand- of vingerdystonie het eerste teken van een aandoening van het centrale zenuwstelsel. Wel worden er vaker dan bij andere "beroepskrampen" compressieneuropathieën of beperkende peesverbindingen in de arm gevonden, die mogelijk luxerend werken op het ontstaan van een dystonie. Het effect van injecties met botuline-toxine is bij deze beroepsgroep die zeer hoge eisen stelt aan de hand-en vingerbewegingen, meestal niet volledig bevredigend. Herkenning van de bewegingsstoornis als een dystonie en vroege behandeling van eventueel bijkomende aandoeningen blijft echter van belang.

Embouchure dystonia is a focal task-specfic disorder involving abnormal non-coordinated movements and involuntary muscle contraction around the mouth.
In professional brass players it is often so disabling that patients have to limit or give up their occupation.

In patients with dystonia, technical retraining appeared to be the preferred treatment method but remained unsatisfactory in most cases.

The natural history of embouchure dystonia
Steven J. Frucht, MD, Stanley Fahn, MD, et  al. (2001)

Abstract
Focal task-specific dystonias are unusual disorders of motor control, often affecting individuals who perform complex repetitive movements.
Musicians are especially prone to develop these disorders because of their training regimens and intense practice schedules.
Task-specific dystonia occurring in keyboard or string instrumentalists usually affects
the hand. In contrast, there have been few descriptions of musicians with task-specific dystonia affecting the muscles of the face and jaw.
We report detailed clinical observations of 26 professional brass and woodwind players afflicted with focal task-specific dystonia of the embouchure (the pattern of
lip, jaw, and tongue muscles used to control the flow of air into a mouthpiece).
This is the largest and most comprehensively studied series of such patients. Patients developed embouchure dystonia in the fourth decade, and initial symptoms were usually limited to one range of notes or styleof playing.
Once present, dystonia progressed without remission and responded poorly to oral medications and botulinum toxin injection.
Patients with embouchure dystonia could be separated by the pattern of their abnormal movements into several groups, including embouchure tremor, involuntary lip movements, and jaw closure.
Dystonia not infrequently spread to other oral tasks, often producing significant disability.
Effective treatments are needed for this challenging and unusual disorder.

 


Oromandibular dystonia (cranial dystonia)

Oromandibular dystonia is a focal dystonia characterized by forceful contractions of the face, jaw, and/or tongue causing difficulty in opening and closing the mouth and often affecting chewing and speech. Another word used to describe dystonia of this kind is cranial dystonia.Cranial dystonia is a broad description for dystonia that affects any part of the head. Dystonia that affects the facial muscles and lips of musicians who play wind instruments is called embouchure dystonia. Dystonia that specifically affects the tongue is called lingual dystonia. Oromandibular dystonia may be primary or secondary.

Terms used to describe oromandibular dystonia include: orofaciomandibular dystonia; orofacial-buccal dystonia; jaw dystonia, tongue dystonia (lingual dystonia); embouchure dystonia; cranial dystonia; adult onset focal dystonia. When oromandibular dystonia occurs with blepharospasm, it may be referred to as Meige's syndrome.

Symptoms
Oromandibular dystonia is often associated with dystonia of the neck muscles (cervical dystonia/spasmodis torticollis), eyelids (blepharospasm), or larynx (spasmodic dysphonia). The combination of upper and lower dystonia is sometimes called cranial-cervical dystonia. Sometimes symptoms of oromandibular are task-specific and occur only during activities such as speaking or chewing. Paradoxically, in some people, activities like speaking and chewing reduce symptoms. Difficulty in swallowing is a common aspect of oromandibular dystonia if the jaw is affected, and spasms in the tongue can also make it difficult to swallow.

Drug-induced dystonia often manifests as symptoms in the facial muscles. Secondary oromandibular dystonia may persist during sleep.

Oromandibular dystonia symptoms usually begin later in life, between the ages of 40 and 70 years, and appear to be more common in women than in men.

Cause
Oromandibular dystonia may be primary (meaning that it is the only apparent neurological disorder, with or without a family history) or be brought about by secondary causes such as drug exposure or disorders such as Wilson's disease. Cases of inherited cranial dystonia have been reported, often in conjunction with DYT1 generalized dystonia.

Diagnosis
Diagnosis of oromandibular dystonia is based on information from the individual and the physical and neurological examination. At this time, there is no test to confirm diagnosis of oromandibular dystonia, and in most cases assorted laboratory tests are normal.

Oromandibular dystonia should not be mistaken for temporomandibular joint disease (TMJ), which is an arthritic condition.

Treatment
Treatment for oromandibular dystonia must be highly customized to the individual. A multitude of oral medications has been studied to determine benefit for people with oromandibular dystonia. About one-third of people's symptoms improve when treated with oral medications such as Klonopin (clonazepam), Artane (trihexyphenidyl), diazepam (Valium), tetrabenezine, and Lioresal (baclofen).

Although the symptoms may vary from person to person, approximately 70% of people with oromandibular dystonia experience some reduction of spasm and improvement of chewing and speech after injection of botulinum toxin into the masseter, temporalis, and lateral pterygoid muscles. Botulinum toxin injections are most effective in jaw-closure dystonia, while treating jaw-opening dystonia may be more challenging. Botulinum toxin injections may also be an option for lingual dystonia. Side effects such as swallowing difficulties, slurred speech, and excess weakness in injected muscles may occur, but these side effects are usually transient and well tolerated.

Oromandibular dystonia may respond surprisingly well to the use of sensory tricks to temporarily reduce symptoms. For example, gently touching the lips or chin, chewing gum, talking, biting on a toothpick, or placing a finger near an eye or underneath the chin may cause symptoms to subside temporarily. Different sensory tricks work for different people, and if a person finds a sensory trick that works, it usually continues to work.

Speech and swallowing therapy may lessen spasms, improve range of motion, strengthen unaffected muscles, and facilitate speech and swallowing. Regular relaxation practices may benefit overall well being.

Bron: dystonia-foundation.org


Oorzaak:

Oorzaak is onbekend.
Het ontstaan kan samenhangen met de persoonlijkheidsstructuur, (angsten, perfectionisme) en overbelasting.



 
 
Behandelaars:
 
Behandelingen:
    Gerelateerde blessures:
    Focale Dystonie aan de stembanden Focale Dystonie van de nek en halsFocale Dystonie van de voetGevoelverlies in lipOverbelasting embouchureFocale Dystonie aan vinger(s)Satchmo's SyndromeZenuwbeschadiging in de lip
     
    Symptomen:
    Controleverlies (functie), Co├Ârdinatieverlies, Embouchure, verlies van, Lekkage van lucht , Ongewild bewegen, Verlamming,
     
    Instrumenten:
    Dwarsfluit, Fagot, Hobo, Klarinet, Piccolo, Saxofoon, Hoorn, Trombone, Trompet,
     







     

    Literatuur:

    Embouchure Problems in Brass Instrumentalists
    Richard J. Lederman
    From: Medical Problems of Performing Artists: Volume 16 Number 2: Page 53 (June 2001)
    http://www.sciandmed.com/mppa/journalviewer.aspx?issue=1088&article=977




    Bronvermelding:

    http://www3.interscience.wiley.com/journal/85010768/abstract