Severe closed-mouth oromandibular dystonia secondary to stroke

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.