Objective: Orofacial dystony is a type of focal dystonia that affects the facial and masticatory, cervical, laryngeal, eyelid, and pharyngeal muscles.

Background: We present a patient who suffered involuntary contractions around the mouth and forehead which interfered in patient’s well-being and quality of life by hampering her ability to talk and we wanted to highlight the sensory tricks, especially nose-trick as an important clinical finding in orofacial dystonia.

Method: Case Report. Thirty-five year-old male patient visited our outpatient clinic due to speech disorders, changes in facial expressions, involuntary contractions around the mouth. He had a history of head trauma four years ago. He had no history of consanguineous marriage and had no first-degree relative with neurological disorders. His complaints were improved when he placed chewing gum or similar food between his upper palate and his lip, or when he touched his nose (Video 1-5).

Results: Hemogram (CBC), biochemical liver tests, serum ceruloplasmin (CPN) and serum copper levels were in normal limits. 24-h urinary copper level was 92.34 µg (3-50). Kayser-fleischer ring has not been detected. Contrast-enhanced cranial magnetic resonance had normal findings. Botulinum toxin injection therapy was administered to the patient.

Conclusion: Sensory tricks are manoeuvres performed by the patient to prevent dystonia and alleviate symptoms. Many different forms of sensory tricks have been shown so far such as motor tricks, imaginary tricks, forcible tricks and reverse sensory tricks (1-4). In this case, we wanted to show the response to the botulinum injection treatment and aimed to highlight the nose tricks rarely seen in orofacial dystonia with video images.

References: 1. Ramos VFML, Karp BI, Hallett M. J Neurol Neurosurg Psychiatry 2014. Doi: 10.1136/jnnp-2013-306971 2. LeDoux MS. Dystonia: phenomenology. Parkinsonism Relat Disord. 2012 Jan; 18( Suppl 1):S162–4. [PubMed: 22166421] 3. Patel N, Jankovic J, Hallett M. Sensory aspects in movement disorders. Lancet Neurol. 2014 Jan; 13(1):100–12. [PubMed: 24331796] 4. Frucht S, Fahn S, Ford B, et al. A geste antagoniste device to treat jaw-closing dystonia. Mov Disord. 1999 Sep; 14(5):883–6. [PubMed: 10495062]

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MDS Abstracts - https://www.mdsabstracts.org/abstract/touching-nose-alleviating-maneuvers-sensory-tricks-in-orofacial-dystonia/