Abstract
ATYPICAL ANTIPSYCHOTIC-INDUCED TEMPOROMANDIBULAR JOINT DISLOCATION: A CASE REPORT

Rono Korra*, Gagandeep Anand, Rahul Chauhan, Ramu Vadukapuram, Hemanth Chitneni Kranthi Sunkara, Syed Najeemuddin, Hitesh Talreja and Raheel Naseeruddin

ABSTRACT

Dystonia is a kind of movement disorder that leads to prolonged muscle contractions, leading to abnormal postures of the trunk, neck, face, arms or legs. It can be generalised or focal and primary or secondary depending on the etiology. It can manifest as oculogyric crisis, abnormal tongue movements, torticollis and opisthotonus. Laryngeal and pharyngeal spasms may as well be life threatening. Drug induced dystonia is most commonly caused by the drugs which alter the dopaminergic and cholinergic balance in the nigrostriatum (basal ganglia). Most of these drugs cause dystonia by blocking D2 dopaminergic receptors in the nigrostriatum which leads to an unopposed and unbalanced cholinergic output. Antipsychotics along with metoclopramide are the most common drugs which are responsible for the various dystonias and a common presentation in the psychiatric wards. However, atypical antipsychotics are less likely to cause these symptoms because along with D2 receptor blockade they also cause M1 receptor blockade.Dystonia typically present within first few hours or days of the therapeutic administration or dosage increase of the drug. Oromandibular dystonia (OMD) is a focal dystonia which leads to clenching of the jaw, deviation of the jaw, difficulty in opening of the mouth leading to problems with speech and chewing. Sometimes oromandibular dystonia can be so severe leading to temporomandibular joint (TMJ) dislocation. Young males with a positive family or personal history of dystonia are at a greater risk. Acute. dystonic reactions are more common in the younger individuals and declines with advancing age, most common age group being 10-19 years although it can affect individuals in the age group of 5 to 45. We present a case of risperidone induced bilateral temporomandibular joint dislocation following orom and ibular dystonia.

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