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Anatomy of the soft palate.
Source publication
Various presentations of essential palatal myoclonus, a condition characterized by clicking noises and palatal muscle spasm, have been reported in the literature. We are reporting the first case of essential palatal myoclonus following dental treatment.
A 31-year-old Caucasian man presented to our Ear, Nose and Throat department complaining of obje...
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Citations
... the face21 It takes on average one year from the time of the lesion to develop palatal myoclonus22 . The patient herein described presented with a combination of worsening gait, imbalance, headache, vision deterioration, dysarthria and interval change in size of the cavernous angioma and appearance of HOD within 10 month follow up. ...
Background:
Hypertrophic olivary degeneration (HOD) is a rare phenomenon in the dento-rubro-olivary pathway due to lesion or disruption of the fibers of the Guillain-Mollaret Triangle. Hemorrhage of pontine and midbrain cavernous angiomas rarely can lead to hypertrophic olivary degeneration (HOD) portending neurological deterioration and possible concomitant life-threatening complications; for this reason, it may define a poignant consideration in planning intervention.
Case description:
57-year-old female with known midbrain-pontine cavernous angioma. For several years, the lesion was stable, as demonstrated by imaging follow-up until 10 months prior to presentation with falls, dysarthria and headache. Imaging demonstrated some decrease in size as well as blood product around the cavernous angioma suggesting interim period hemorrhage and interval development of unilateral hypertrophic olivary degeneration.
Conclusions:
Herein, the literature regarding imaging recommendations for stable cavernous angioma in the midbrain-pontine junction is reviewed. The implication of hypertrophic olivary degeneration for patient outcome is discussed and a comment is made on how the development of HOD may impact management of the cavernous angioma.
... [1,2,3] Palatal myoclonus have been reported even after dental surgery. [6] MRI of the brain is an important investigation for work-up of these cases. In our case, we did not do an MRI because there were no involvement of muscles of eyes and extremities, no other focal neurological features, and above all it is a costly investigation in a developing world. ...
Introduction: Palatal myoclonus is a rare condition presenting with clicking sound in ear or muscle tremor in pharynx. There are two varieties: essential and symptomatic. Various treatment options exists ranging from watchful observation to botulinum toxin injection. We have not found any reported case of palatal myoclonus from our country. Here we present a case of essential palatal myoclonus managed with clonazepam.
Case report: A young female presented in Ear Nose and Throat clinic with complain of auditory click and spontaneous rhythmic movement of throat muscles for eight months. On examination, there was involuntary, rhythmic contraction of bilateral soft-palate, uvula, and base of tongue. Neurological, eye, and peripheral examination were normal. A diagnosis of essential palatal myoclonus was made. It was managed successfully with clonazepam; patient was still on low dose clonazepam at the time of making this report.
Conclusion: Essential palatal myoclonus can be clinically diagnosed and managed even in settings where MRI is not available or affordable.
... Although many surgical procedures have been described, there are no commonly successful surgical treatments [2]. Various drugs such as cholinergic drugs, benzodiazepam, anti-Parkinsonism drugs, anticonvulsants, relaxants, 5-hydroxytryptophan, levodopa, and lithium are usually prescribed as treatment [6]. Treatment with botulinum toxin has also been reported to be effective [7,8], but attention should be paid to the adverse side effects such as neuromuscular inhibition [9]. ...
. Essential palatal tremor is a disorder of unknown etiology involving involuntary movement of the uvula and soft palate. Treatment attempts including drugs or surgery have been conducted to cease the rhythmical movement.
Case Report
. A 55-year-old female visited our department complaining of a sudden, noticeable, intermittent, and rhythmical clicking noise in her throat for five years. Oral examination revealed rhythmical contractions of the soft palate with clicking at the frequency of 120 per min. Magnetic resonance imaging (MRI) examination of the brain performed after consulting with the department of neuropathic internal medicine showed no abnormalities. Thus, essential palatal tremor was diagnosed. The symptoms improved with cognitive behavioral therapy without drugs or surgical treatments. The patient is now able to stop the rhythmical movement voluntarily.
Discussion
. Cognitive behavioral therapy might be suitable as first-line therapy for essential palatal tremor because the therapy is noninvasive.
