Background: Focal embouchure dystonia (FED) is a type of task-specific dystonia affecting wind instrument players, and it frequently ends their professional careers. The results of the treatments of FED in the reported literature are disappointing. Objective: We report 3 patients with FED who were brass instrument players. In 1 patient, we evaluated the usefulness of a dental splint. Methods and Results: Patient 1 was a 28-year-old trumpeter who was suffering from an intermittent tremor of the lower jaw. Following the usage of a dental splint, her symptoms disappeared completely. Patient 2 was a 29-year-old horn player with atonia of the lower facial muscles. In this case, medication with various drugs brought no benefit, and he ended his career. Patient 3 was a 43-year-old trombone player who suffered involuntary contractions and relaxation of the perioral muscles along with clumsiness of tongue movement. Extraction of double teeth and long-term cessation of playing for 20 years did not bring any positive effects. Conclusion: We propose that FED can be categorized into three subgroups according to masticatory, facial and lingual types, and that the dental splint might be a useful therapeutic strategy for the masticatory type of FED.

Frucht S, Fahn, Ford B: French horn embouchure dystonia. Mov Disord 1999;14:171–173.
Sadie S: The Groove Concise Dictionary of Music. London, Macmillan, 1994.
Marchini C, Verriello L, Mucchiut M, et al: Task-specific dystonia in a horn player. Mov Disord 2001;16:176–177.
Altenmüller E, Jabusch HC: Focal dystonia in musicians: phenomenology, pathophysiology, triggering factors, and treatment. Med Probl Perform Art 2010;25:3–9.
Kim JS, An JY, Lee KS: Cooling can relieve the difficulty of playing the tuba in a patient with embouchure dystonia. Mov Disord 2007;22:2291–2292.
Hirata Y, Schulz M, Altenmüller E, et al: Sensory mapping of lip representation in brass musicians with embouchure dystonia. Neuroreport 2004;15:815–818.
Haslinger B, Altenmüller E, Castrop F, et al: Sensorimotor overactivity as a pathophysiologic trait of embouchure dystonia. Neurology 2010;74:1790–1797.
Schmidt A, Jabusch HC, Altenmüller E, et al: Etiology of musician’s dystonia: familial or environmental? Neurology 2009;72:1248–1254.
Altenmüller E, Jabusch HC: Focal hand dystonia in musicians: phenomenology, etiology, and psychological trigger factors. J Hand Ther 2009;22:144–154.
Brandfonbrener AG, Robson C: Review of 113 musicians with focal dystonia seen between 1985 and 2002 at a clinic for performing artists. Adv Neurol 2004;94:255–256.
Frucht S, Fahn S, Greene PE, et al: The natural history of embouchure dystonia. Mov Disord 2001;16:899–906.
Lie-Nemeth TJ: Focal dystonia in musicians. Phys Med Rehabil Clin N Am 2006;17:781–787.
Pullman SL, Hristova AH: Musician’s dystonia. Neurology 2005;64:186–187.
Ragothaman M, Swaminath PV, Pal PK, et al: Embouchure dystonia and tremor in a professional windpipe ‘Nadaswaram’ player. Mov Disord 2007;22:2133–2135.
White ER, Basmajian JV: Electromyography of lip muscles and their role in trumpet playing. J Applied Physiol 1973;35:892–897.
Murase N, Rothwell JC, Kaji R, et al: Subthreshold low-frequency repetitive transcranial magnetic stimulation over the premotor cortex modulates writer’s cramp. Brain 2005;128:104–115.
Siebner H, Tormos J, Ceballos-Baumann A, et al: Low-frequency repetitive transcranial magnetic stimulation of the motor cortex in writer’s cramp. Neurology 1999;52:529–537.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.