偏侧咀嚼肌痉挛3例报告并文献复习

Hemimasticatory spasm:three cases report and related literatures review

目的加强对偏侧咀嚼肌痉挛这一罕见疾病的认识。方法对我科收治的3例偏侧咀嚼肌痉挛患者的临床资料进行回顾分析,并对相关文献进行复习。结果 3例青年患者,病程长,反复发作性一侧咀嚼肌痉挛,累及咀嚼肌和颞肌,发作时不能张口,病初发作程度较轻,随病程发展,痉挛发作的持续时间及频率加重。诱发痉挛发作的常见因素有咀嚼、咬牙以及说话等。短暂的痉挛通常不伴有肌肉疼痛,严重时可以伴有疼痛。1例患者伴有痉挛侧面部肌肉肥大,2例伴有痉挛侧面部萎缩,无其他神经系统阳性体征。肌电图显示痉挛的咀嚼肌运动单位电位持续发放。2例患者经肉毒毒素局部注射治疗效果显著。结论对于偏侧咀嚼肌痉挛,肉毒毒素局部注射治疗通常能够获得满意疗效。

Objective Three cases of hemimasticatory spasm（HMS） were reported with emphasis on its clinical characteristics.Methods The history and clinical characteristics of HMS were described,and the related literatures were reviewed.Results Three young patients presented with a long history of unilateral,involuntary,paroxysmal contractions of the jaw-closing muscles.During the spasm the patient was not able to open the mouth.The spasms were mild in the early stage,however,it increased gradually in duration and frequency.The most frequent triggers that precipitate spasms were chewing,talking or eating.Brief spasms were generally painless,prolonged spasms might induce pain.On physical examination,hypertrophy of the involved masseter and temporalis muscles was noted in one case,while the atrophy of the subcutaneous tissue that occurred in the other two cases.Simultaneous electromyography recording from the masseter and temporalis muscles showed continuous bursts of activity during the prolonged spasms.Two patients received treatment with botulinum toxin injection and showed an excellent response.Conclusion Our case further illustrates that botulinum toxin should be considered as the first choice treatment for this rare and often disabling condition.