This case report describes a 68-year-old female patient with secondary closed-mouth oromandibular dystonia (OMD) following intracerebral hemorrhage, presenting with severe trismus that significantly impairs eating and speech. The patient underwent precise Botulinum Toxin Type A (BoNT-A) injection guided by ultrasound and electromyography. Systematic temporomandibular joint (TMJ) manual rehabilitation therapy commenced the following day and was administered 5 sessions per week for three weeks. Mouth opening degree and Modified Barthel Index (MBI) were assessed at baseline, 1 week post-treatment, 2 weeks post-treatment, 6 weeks post-treatment, and at the 2-month follow-up. Following treatment, the patient’s mouth opening degree increased from 0 mm to 36 mm, and the MBI score improved from 35 to 65. The patient resumed oral feeding, with significantly enhanced speech function. At the 2-month follow-up, therapeutic efficacy remained stable with no adverse reactions observed. Ultrasound- and electromyography-guided precise BoNT-A injection combined with TMJ manual rehabilitation represents an effective treatment strategy for this patient, significantly improving their mouth opening function and quality of life.
Wang et al. (Sat,) studied this question.