Clinical Oral Investigations

, Volume 23, Issue 1, pp 405–411 | Cite as

Oromandibular dystonia screening questionnaire for differential diagnosis

  • Kazuya YoshidaEmail author
Original Article



Oromandibular dystonia, which is characterized by stereotypic, task-specific, or sustained contractions of masticatory and/or lingual muscles, is frequently misdiagnosed as temporomandibular disorders or psychogenic disease. Diagnostic delay in oromandibular dystonia is not acceptable; thus, a screening tool that can distinguish this condition from a temporomandibular disorder may be helpful for medical professionals unfamiliar with involuntary movements or temporomandibular disorders.

Materials and methods

A questionnaire that included questions on the clinical features of oromandibular dystonia, such as stereotypy, task-specificity, sensory tricks, and morning benefit, and included questions to rule out temporomandibular disorders (total point range 0–40) was administered to 553 patients suspected to have involuntary movements.


Based on a careful examination and the differential diagnosis, the patients were divided into four groups: oromandibular dystonia (n = 385), oral dyskinesia (n = 84), psychogenic (functional) movement disorder (n = 50), and temporomandibular disorders (n = 34). The questionnaire had a high level of internal consistency as measured by the Cronbach’s α (0.91), and item-total correlation was significant (p < 0.001). The test-retest reliability on two separate occasions showed a significant correlation (p < 0.001). Mean total scores of the questionnaire significantly differed among oromandibular dystonia (32.0), temporomandibular disorders (10.4; one-way analysis of variance, p < 0.001), oral dyskinesia (21.0; p < 0.001), and psychogenic (functional) movement disorder (13.7; p < 0.001).


Findings of this study suggest that the present questionnaire is a simple diagnostic tool that is useful for tentative differentiation of oromandibular dystonia from temporomandibular disorders.

Clinical relevance

This screening tool can be used to distinguish oromandibular dystonia from temporomandibular disorders.


Oromandibular dystonia Questionnaire Screening Reliability Temporomandibular disorders 



This study was supported by grants from the Japanese Ministry of Health, Labor, and Welfare (24592946 and 22111201).

Compliance with ethical standards

Conflict of interest

The author declares no conflict of interest.

Ethical approval

This study was performed in accordance with the Declaration of Helsinki under the approval of the institutional review board and ethics committee of Kyoto Medical Center.


  1. 1.
    Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VSC, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK (2013) Phenomenology and classification of dystonia: a consensus up date. Mov Disord 28:863–873. CrossRefGoogle Scholar
  2. 2.
    Yoshida K, Kaji R, Kubori T, Kohara N, Iizuka T, Kimura J (1998) Muscle afferent block for the treatment of oromandibular dystonia. Mov Disord 13:699–705. CrossRefGoogle Scholar
  3. 3.
    Yoshida K, Kaji R, Shibasaki H, Iizuka T (2002) Factors influencing the therapeutic effect of muscle afferent block for oromandibular dystonia and dyskinesia: implications for their distinct pathophysiology. Int J Oral Maxillofac Surg 31:499–505. CrossRefGoogle Scholar
  4. 4.
    Sinclair CF, Gurey LE, Blitzer A (2013) Oromandibular dystonia: long-term management with botulinum toxin. Laryngoscope 123:3078–3083. CrossRefGoogle Scholar
  5. 5.
    Yoshida K (2017) Clinical and phenomelogical characteristics of patients with task-specific lingual dystonia: possible association with occupation. Front Neurol 8:649. CrossRefGoogle Scholar
  6. 6.
    Yoshida K, Kaji R, Kohara N, Murase N, Ikeda A, Shibasaki H, Iizuka T (2003) Movement-related cortical potentials before jaw excursions in patients with oromandibular dystonia. Mov Disord 18:94–100. CrossRefGoogle Scholar
  7. 7.
    Yoshida K, Iizuka T (2006) Botulinum toxin treatment for upper airway collapse resulting from temporomandibular joint dislocation due to jaw-opening dystonia. Cranio 24:217–222. CrossRefGoogle Scholar
  8. 8.
    Yoshida K (2017) How do I inject botulinum toxin into the lateral and medial pterygoid muscles? Mov Disord Clin Pract 4:285. CrossRefGoogle Scholar
  9. 9.
    Yoshida K (2018) Computer-aided design/computer-aided manufacturing-derived needle guide for injection of botulinum toxin into the lateral pterygoid muscle in patients with oromandibular dystonia. J Oral Facial Pain Headache (in press)Google Scholar
  10. 10.
    Yoshida K (2018) Sensory trick splint as a multimodal therapy for oromandibular dystonia. J Prosthodont Res 62:239–244. CrossRefGoogle Scholar
  11. 11.
    Yoshida K (2006) Coronoidotomy as treatment for trismus due to jaw-closing oromandibular dystonia. Mov Disord 21:1028–1031. CrossRefGoogle Scholar
  12. 12.
    Yoshida K (2017) Surgical intervention for oromandibular dystonia-related limited mouth opening: long-term follow-up. J Craniomaxillofac Surg 45:56–62. CrossRefGoogle Scholar
  13. 13.
    Macerollo A, Superbo M, Gigante AF, Livrea P, Defazio G (2015) Diagnostic delay in adult-onset dystonia: data from an Italian movement disorder center. J Clin Neurosci 22:608–610. CrossRefGoogle Scholar
  14. 14.
    Powell AT, Bidewell JW, Walker AC (1995) Diagnosing idiopathic dystonia: must it take so long? Aust Health Rev 18:120–131Google Scholar
  15. 15.
    Jog M, Chouinard S, Hobson D, Grimes D, Chen R, Bhogal M, Simonyi S (2011) Causes for treatment delays in dystonia and hemifacial spasm: a Canadian survey. Can J Neurol Sci 38:704–711CrossRefGoogle Scholar
  16. 16.
    Tiderington E, Goodman EM, Rosen AR, Hapner ER, Johns MM 3rd, Evatt ML, Freeman A, Factor S, Jinnah HA (2013) How long does it take to diagnose cervical dystonia? J Neurol Sci 335:72–74. CrossRefGoogle Scholar
  17. 17.
    Bertram KL, Williams DR (2016) Delays to the diagnosis of cervical dystonia. J Clin Neurosci 25:62–64. CrossRefGoogle Scholar
  18. 18.
    Streiner DL, Norman GR, Cairney J (2015) Health measurement scales: a practical guide to their development and use, 5th edn. Oxford University Press, OxfordCrossRefGoogle Scholar
  19. 19.
    Merz RI, Deakin J, Hawthorne MR (2010) Oromandibular dystonia questionnaire (OMDQ-25): a valid and reliable instrument for measuring health-related quality of life. Clin Otolaryngol 35:390–396. CrossRefGoogle Scholar
  20. 20.
    Albanese A, Sorbo FD, Comella C, Jinnah HA, Mink JW, Post B, Vidailhet M, Volkmann J, Warner TT, Leentjens AF, Martinez-Martin P, Stebbins GT, Goetz CG, Schrag A (2013) Dystoniaratingscales: critique and recommendations. Mov Disord 28:874–883. CrossRefGoogle Scholar
  21. 21.
    Defazio G, Hallett M, Jinnah HA, Stebbins GT, Gigante AF, Ferrazzano G, Conte A, Fabbrini G, Berardelli A (2015) Development and validation of a clinical scale for rating the severity of blepharospasm. Mov Disord 30:525–530. CrossRefGoogle Scholar
  22. 22.
    Comella CL, Fox SH, Bhatia KP, Perlmutter JS, Jinnah HA, Zurowski M, McDonald WM, Marsh L, Rosen AR, Waliczek T, Wright LJ, Galpern WR, Stebbins GT (2015) Development of the comprehensive cervical dystonia rating scale: methodology. Mov Disord Clin Pract 2:135–141. CrossRefGoogle Scholar
  23. 23.
    Thenganatt MA, Jankovic J (2015) Psychogenicmovement disorders. Neurol Clin 33:205–224. CrossRefGoogle Scholar
  24. 24.
    Hallett M (2016) Functional (psychogenic) movement disorders—clinical presentations. Parkinsonism Relat Disord 22:S149–S152. CrossRefGoogle Scholar
  25. 25.
    Schiffman R, Ohrbach E, Truelove E, Look J, Anderson G, Goulet JP, List T, Svensson P, Gonzalez Y, Lobbezoo F, Michelotti A, Brooks SL, Ceusters W, Drangsholt M, Ettlin D, Gaul C, Goldberg LJ, Haythornthwaite JA, Hollender L, Jensen R, John MT, De Laat A, de Leeuw R, Maixner W, van der Meulen M, Murray GM, Nixdorf DR, Palla S, Petersson A, Pionchon P, Smith B, Visscher CM, Zakrzewska J, Dworkin SF (2014) Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications: recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache 28:6–27. CrossRefGoogle Scholar
  26. 26.
    Müller J, Wissel J, Kemmler G, Voller B, Bodner T, Schneider A, Wenning GK, Poewe W (2004) Craniocervical dystonia questionnaire (CDQ-24): development and validation of a disease-specific quality of life instrument. J Neurol Neurosurg Psychiatry 75:749–753CrossRefGoogle Scholar
  27. 27.
    Nutt JG, Muenter MD, Aronson A, Kurland LT, Melton LJ 3rd (1988) Epidemiology of focal and generalized dystonia in Rochester, Minnesota. Mov Disord 3:188–194. CrossRefGoogle Scholar
  28. 28.
    Yoshida K (2018) Involuntary movements of the stomatognathic region. Accessed 14 March, 2018
  29. 29.
    Yoshida K (2018) Multilingual website and cyber consultations for oromandibular dystonia. Neurol Int 10:7536.

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial SurgeryNational Hospital Organization, Kyoto Medical CenterKyotoJapan

Personalised recommendations