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Yıl:2010; Cilt: 47; Sayı: Özel>> Özet
TAM METİN
Nöropsikiyatri Arşivi; 2010;47(Özel):15-18
Botulinum Toksini Tedavisi ve Oromandibüler Diskinezi
MC Akbostancı, R Yılmaz
Ankara Üniv. Tıp Fak, Ankara
Oromandibüler distoni, (OMD) sıklıkla orbikülaris oküli, perioral mimik kasları, vokal kordlar ve servikal kasların eşlik ettiği bir segmental kraniyal distonidir. Blefarospazmdan sonra ikinci sıklıkta saptanan kraniyal distonidir. İzole olarak veya diğer kraniyoservikal distoni formları ile birlikte bulunabilir. Çiğneme, yutma ve konuşmayı etkilediği için özürleyici bir hastalıktır. Oromandibüler distonili hastaların büyük çoğunluğu idyopatiktir ancak Tardif Diskinezi başta olmak üzere başka hastalıklara sekonder çıkabilir. Oromandibüler distoninin botulinum toksiniyle tedavisi, diğer fokal hiperkinezilerle karşılaştırıldığında daha az etkili olsa da, bilinen en etkili tedavidir. Dil ve çiğneme kasları genellikle zor ulaşılan ve birden fazla işlevi olan kaslar olduğu için anatomileri haklarında yeterli bilgi sahibi olmak gerekir. Kasların bir bölümü yüzeyel ve palpabl olmadıklarından, hastaların hepsinde injeksiyon sırasında EMG yardımı gerekmektedir. Aynı kasa aynı dozdaki injeksiyona farklı kişisel yanıtlar alındığından, tedavinin bireyselleştirilmesi önemlidir. Yan tesirleri sıklık sırasıyla disfaji, dizartri, yüzde şişme ve çiğneme zorluğudur.
Botulinum Toxin Treatment and Oromandibular Dystonia
Oromandibular dystonia is a segmental cranial dystonia that affects the perioral mimic muscles, orbicularis oculi, vocal cords and cervical muscles. It is the second most common cranial dystonia after blepharospasm and can occur in isolation or together with other forms of craniocervical dystonia. Oromandibular dystonia is a disabling problem that impairs chewing, swallowing and speech. It is idiopathic in the majority of cases, but can be found in association with other diseases, such as tardive dyskinesia. Botulinum toxin injection in the management of oromandibular dystonia is the best-known treatment, albeit less effective than in other focal hyperkinesias. Knowledge of the anatomy of the tongue and chewing muscles is essential, since these muscles are hard to reach and have more than one function. Electromyographic guidance is needed during the injections in all patients, because some of these muscles are not superficially localized and are nonpalpable. Dosage and treatment approaches vary among patients and must be individualized. Side effects given in decreasing order of frequency are: dysphagia, dysarthria, swelling of the face and difficulty in chewing.

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