Objective: To investigate efficacy of pallidotomy for embouchure dystonia

Background: Complex and fine adjustments of perioral muscles, regulating airflow into the mouthpiece, known as embouchure, are essential to produce clear tones in woodwind or brass instruments. Prolonged training in generating embouchure can induce dystonia in muscles of the lips, jaw, or tongue, which is called embouchure dystonia (ED). ED can severely hamper the playing of musical instruments, which may ultimately lead to the termination of professional musical careers. Currently available treatments for ED are botulinum toxin injections; oral medications, including anticholinergics and baclofen; and retraining. However, effects of these treatments are mild to modest and mostly insufficient in addressing patient needs.

Methods: We used radiofrequency pallidotomy for two patients with embouchure dystonia under local anesthesia. The stereotactic target of the GPi was 20-23.5 mm lateral, 2 mm anterior, and 3.8-4.0 mm inferior to the midpoint of the anterior commissure–posterior commissure (AC–PC) line. Microelectrode recordings were not used. Permanent lesions were created using thermocoagulation at 70°C for 40 s.

Results: first case) a case of 47-year-old male, professional saxophone player with embouchure dystonia (lateral pulling of the left lip) predominantly on the left side received right-sided pallidotomy firstly. The symptoms completely improved, but 2 weeks after the surgery, contralateral sympotms newly developed. 6 months after the first surgery, he underwent left-sided pallidotomy which completely improved again. One year after the second surgery, he has continued to professionally play brass instruments without any dystonic symptoms. second case) a case of 47-year-old male, professional trombone player with embouchure dystonia (lip tremor). Tremor movements was symmetrical, but neck tightness was predominantly left-sided. We planned right-sided pallidotomy which significantly improved lip tremor and neck tightness. The effect has sustained for 6 months. Both cases didn’t have any neurological deficit after the surgery.

Conclusions: If available conservative treatments have failed, stereotactic pallidotomy can be considered the last resort for treating refractory embouchure dystonia.

References: 1. Frucht SJ, Fahn S, Greene PE, et al. The natural history of embouchure dystonia. Movement disorders: official journal of the Movement Disorder Society 2001;16:899-906. 2. Frucht SJ. Embouchure dystonia–Portrait of a task-specific cranial dystonia. Movement disorders : official journal of the Movement Disorder Society 2009;24:1752-1762. 3. Hashimoto T, Naito K, Kitazawa K, Imai S, Goto T. Pallidotomy for severe tardive jaw-opening dystonia. Stereotactic and functional neurosurgery 2010;88:105-108. 4. Valalik I, Jobbagy A, Bognar L, Csokay A. Effectiveness of unilateral pallidotomy for meige syndrome confirmed by motion analysis. Stereotactic and functional neurosurgery 2011;89:157-161.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/radiofrequency-pallidotomy-for-embouchure-dystonia/