Multiple system atrophy presenting as oromandibular dystonia and bruxism

Parkinsonism includes a spectrum of hypokinetic neurodegenerative movement disorders with the potential to cause a substantial clinical diagnostic challenge due to their complex manifestation and numerous phenotypes. Oromandibular dystonia is a relatively common type of dystonia within the oral and facial region.

A 44-year-old woman had repeated involuntary mandibular movements, neck and back stiffness, and symptoms of bruxism. She also had balance issues and abnormal gait and posture. Her orofacial symptoms included rigidity, abnormal sensations in the head and neck, and mandibular and cervical abnormal movements. The patient had consulted multiple specialists and had reportedly undergone various tests and procedures. She reported failing dental appliances and facial injections with medications. A thorough orofacial pain evaluation was followed by a prompt referral to a movement disorder specialist who rendered the diagnosis of a parkinsonian disorder, specifically, multiple system atrophy.

When a patient has uncontrolled movements (ie, dystonias), especially those affecting multiple cranial motor nerve territories, the differential diagnosis should include parkinsonism and other neurodegenerative disorders.