OROMANDIBULAR DYSTONIA: PREVALENCE, CLINICAL AND DEMOGRAPHIC DATA, THERAPEUTIC STRATEGIES OUT-COME FOR HUNDRED PATIENTS IN SANA’A CITY, YEMEN
Authors: Aldeen Haifa Mohammed Abdulmaged Sharaf , Abbas Al-Kasem Mohammed A , Al-Kibsi Taghreed Ahmed M , Al-Shamahy Hassan Abdulwahab , Jahaf Sara Hussien Ahmed , AL-Kaff Reem Hussein Sheikh Omar 
Published: May 2023

Background and aims: Dystonia is a movement disease characterized by persistent, uncontrollable muscle contractions that often lead to abnormal postures. The tongue, jaw, and mouth are all affected by OMD, which is an uncommon focal dystonia. OMD is a rare public health problem that takes time to diagnose and treat because it is frequently identified as psychogenic. This study sought to ascertain the frequency, demographics, clinical features, and treatment outcomes of patients with mandibular dystonia (OMD) in Sana'a, Yemen.
Methods:  A prospective cross-sectional study was conducted; the study included 100 Yemeni adults attending the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Sana'a University Clinics and Departments of Oral, Maxillofacial and Neurosurgery at Kuwait University Hospital and some private centers for maxillofacial medicine and neurosurgery in the city of Sana’a during the year 2022. The selected patients were complaining of contraction or involuntary movement of the masticatory, lingual and/or lower facial muscles. Age, gender, age at onset of illness, duration of illness, personal habits, type of OMD, previous and current treatments, and their outcomes were recorded on a standard, pre-designed questionnaire.
 Results: The incidence rate of OMD is 19/100,000/year. Most of the patients (92%) are male while only 8% are female. The first episode onset is after stress (29%), 11% after illness, 6% after dental treatment, and 48% without causes. Jaw deviation dystonia was dominant at 65%, followed by jaw closing dystonia (42%), jaw protrusion dystonia  (29%), and jaw opening dystonia (27%). After current treatment out-come, there was improvement on ability to eat ( from 12% to 24%, p=0.02), to speak (from 25% to 43%, p=0.007),  the rate of no pain raised from 46%  to 57%,  the rate of no discomfort raised  from 21%  to 34% (p=0.04) and the score ≤ 5  of OMD  raised  from 47%  to 72% (p=0.0003).
Conclusion: The incidence of OMD in Sana’a city is remarkably high, predominantly male, and peaks at 30, 40, and 50 years of age. Jaw deviation dystonia was the dominant type followed by jaw closing dystonia. After the current treatment outcome, the ability to eat has improved, the rate of pain and discomfort has decreased.
                       
Peer Review History:
Received: 25 February 2023; Revised: 17 March; Accepted: 28 April 2023, Available online: 15 May 2023
Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, sally.elzahaby@yahoo.com
Received file:                             Reviewer's Comments:
Average Peer review marks at initial stage: 5.5/10
Average Peer review marks at publication stage: 7.0/10
Reviewers:
Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com
Dr. Ogbonna B. Onyebuchi, Nnamdi Azikiwe University, Awka,  Nigeria, summitpharm@yahoo.com