Dislocated diagnosis : A case of elusive dystonia

A 26-year-old African-American male diagnosed with bipolar disorder with psychotic features was referred for outpatient treatment following inpatient hospitalization. The patient developed dysarthria after receiving oral and intramuscular haloperidol at the hospital. The patient's oral symptoms were not affected by change of antipsychotic or addition of benztropine. A neurologic evaluation indicated a dystonia secondary to haloperidol. The consultant recommended an increase of benztropine that proved unsuccessful. A suggestion of botulinum injections into the jaw was not pursued. His oral symptoms worsened to include difficulty chewing and jaw tightness. The persistence of symptoms resulted in a referral to an oral surgeon. The patient's evaluation revealed bilateral anterior temporal-mandibular joint dislocation. Manual reduction of the dislocations under general anesthesia relieved all oral symptomatology.