Temporomandibular Joint Dislocation Mistaken as Dystonia

To the Editor.—  The recently encountered a case in which dislocation of the temporomandibular joint was mistaken as dystonia.

Report of a Case.—  A 42-year-old woman was admitted to the inpatient psychiatric unit for treatment of an acute exacerbation of a chronic schizophrenic disorder.On the 18th day, she experienced a phenothiazine-induced extrapyramidal reaction, including cogwheel rigidity, bradykinesia, and orofacial dystonia with spasmodic movements of the tongue. She was given benztropine mesylate, 1 mg intramuscularly, which relieved the rigidity and bradykinesia. Her face remained distorted and she was unable to close her mouth. This problem was treated for 24 hours as a dystonic extrapyramidal side effect. Finally, the correct diagnosis of temporomandibular joint dislocation was made and the condition treated manually by the oral surgeon.Six days later, the dislocation recurred. The patient was treated again in the oral surgery clinic; on the way back to the psychiatric unit, she