Buccolingual masticatory syndrome induced by high-potency first-generation antipsychotics: Insights on early recognition and management

Summary Buccolingual masticatory syndrome (BLMS) is a rare but clinically important consideration in patients on long-term dopamine-blocking therapy who present with orofacial dyskinesia. While it may overlap with tardive dyskinesia, BLMS is specifically characterized by repetitive backward and masticatory movements of the jaw and tongue. We present the case of a 51-year-old man with a 5-year history of haloperidol therapy for paranoid-subtype schizophreniform disorder. He developed a 1-day history of involuntary, repetitive backward and masticatory movements of the jaw and tongue. The abnormal orofacial movements were accompanied by difficulty chewing and impaired speech articulation. MRI revealed abnormal functional signals within the striatum but no structural abnormalities in the basal ganglia. Haloperidol was discontinued, and clozapine (25 mg orally twice daily) and trihexyphenidyl (5 mg orally once daily) was initiated. The patient's abnormal orofacial movements resolved within 36 hours. Marked functional recovery was observed following trihexyphenidyl administration. Haloperidol-induced BLMS is a rare but potentially disabling adverse drug reaction. Early recognition, withdrawal of the offending drug, and prompt initiation of trihexyphenidyl can lead to rapid symptom resolution. Clinicians should consider BLMS in patients presenting with acute orofacial dyskinesia during dopamine-blocking therapy to ensure timely and effective management.