Embouchure Dystonia: Phenomenology, Natural History and Mimicks (P3.005)

Abstract

Objective: To define the phenomenology, natural history and differential diagnosis of embouchure dystonia (ED). Background: ED refers to a form of focal task-specific dystonia affecting complex movements of lower cranial muscles in brass and woodwind musicians during playing. We expand our previous series of 89 patients by adding 19 new patients with ED, and 30 musicians with non-dystonic embouchure problems. Methods: Retrospective review of medical records and patient videos. Results: 109 ED patients were classified into 6 main phenotypes: 39 tremor variant (T), 22 jaw dystonia (J), 21 lip-pulling (LP), 15 lip-locking (LL), 4 tongue dystonia (Tg), 4 Meige syndrome (M), and 4 unspecified. Of 20 newly added patients, T remained the most common (10/20), followed by LP and LL (3/20 each). Male-to-female ratio was 2.4 (77/32). Mean age at onset was 37.6 years. The most common instrument in each phenotype was French horn (FH) in T and LP; trombone in LL; flute in J and Tg; and trumpet in M. The most common phenotype in each instrument was: T in FH, tuba and trumpet; LL in trombone; J in flute, clarinet, and saxophone. Of 30 patients in the non-ED group (22 men, 8 women), the most common diagnosis was anterior superior alveolar neuropathy (36.7[percnt]), followed by overuse (23.3[percnt]), orbicularis oris tear (13.3[percnt]), essential tremor (ET), and miscellaneous (Bell’s palsy, temporomandibular joint irritation, and glossopharyngeal neuralgia). Time from age at onset to age at evaluation was shorter in the non-ED group, compared to the ED group (median 1 vs 3 years). Conclusions: This is the largest series of ED reported and the largest report of patients with embouchure related difficulty. It is critical to distinguish conditions that mimick ED, as these disorders have distinctly different prognosis and management strategies.

Disclosure: Dr. Termsarasab has nothing to disclose. Dr. Frucht has received personal compensation for activities with Merz Pharmaceuticals as a consultant.