Orofacial dyskinesia—abnormal involuntary movements involving muscles of the face, mouth, tongue, eyes, and occasionally, the neck—may be unilateral or bilateral, and constant or intermittent. This sign occurs more commonly in women than in men, especially after age 50.
The pathophysiology of orofacial dyskinesia isn’t clearly understood. Although the dyskinesia may result from hemifacial spasm and the effects of certain drugs, it’s frequently idiopathic. Presumably, orofacial dyskinesia results from pressure on the facial nerves associated with an extrapyramidal lesion or from a chemical imbalance. Psychogenic factors may also play a role, as evidenced by the fact that emotional upset aggravates the dyskinesia.
If the patient abruptly displays orofacial dyskinesia, review his medication regimen. If he’s taking a phenothiazine or other antipsychotic, withhold the drug if possible, and prepare to give 50 mg of diphenhydramine to reverse the drug’s effects. If he has difficulty swallowing, take precautions necessary to prevent aspiration and choking and have suction equipment on hand.
If the patient’s dyskinesia is chronic, ask when it began. Then obtain a complete drug history. Also, note a history of seizures. Next, closely examine the patient’s dyskinesia. Is it unilateral or bilateral? Does it involve the entire face or only part of it? Are neck muscles involved? Does the patient have any voluntary control over the movements? Characterize the abnormal movements. Are they constant, or repetitive and intermittent? Listen to his speech—does it sound abnormal? Can he swallow?
This disorder is characterized by unilateral, intermittent spasms of muscles of the face, eye, and mouth. The patient may have some voluntary control over the spasms. Typically, the spasms are aggravated by emotional upset and disappear during sleep. Spasms may interfere with swallowing and speech.
Rarely, these drugs cause orofacial dyskinesia.
These drugs may cause orofacial dyskinesia and other extrapyramidal effects. Movements are sustained, involving the eyes, mouth, face, and neck; they occur with prolonged treatment, especially after it has been reduced. Lip retraction and dysphagia are common.
Among the phenothiazines, the piperazine derivatives (perphenazine, prochlorperazine, fluphenazine, and trifluoperazine) most commonly cause this sign. Aliphatic phenothiazines (chlorpromazine) occasionally cause it. Piperidine phenothiazines (thioridazine and thiethylperazine) rarely cause orofacial dyskinesia. Other antipsychotic drugs (haloperidol, thiothixene, and loxapine) commonly cause this sign.
Prepare the patient for diagnostic studies, such as blood screening for drugs and computed tomography or magnetic resonance imaging scan.
In children, orofacial dyskinesia is usually drug-induced. These abnormal movements may also result from Tourette syndrome, seizure disorders, and dystonia musculorum deformans.
If orofacial dyskinesia is drug-induced, assure the patient and his family that movements may disappear eventually, after the drug is stopped. If orofacial dyskinesia is uncontrollable, advise the patient and his family that drug therapy or psychotherapy may be beneficial.
Review other book chapters online related to Kartagener syndrome:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9 
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