What are the signs and symptoms of orofacial hyperkinesia in tardive dyskinesia (TD)?

Updated: Oct 17, 2018
  • Author: James Robert Brasic, MD, MPH; Chief Editor: Selim R Benbadis, MD  more...
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As noted, neuroleptic-induced orofacial hyperkinesia is the prototypical form of TD. It is characterized by irregular movements of variable amplitude and low frequency. TD is expressed in the tongue, cheeks, mandible, perioral area, and other regions of the face, fingers, and toes. Various facial movements are observed. TD may be observed in the upper face with excessive blinking and brow wrinkling.

Orofacial dyskinesias appear as involuntary, repetitive, and stereotyped facial grimacing with twisting or protrusion of the tongue. The individual may initially be unaware of these movements until family and friends draw attention to them. Puckering, smacking, opening, and closing of the lips may occur constantly. The person may appear to be chewing or sucking on items. The movements resemble those of people with ill-fitting dentures.

Inquire about the use of dentures. Inquire if the person is aware of movements in the mouth, face, hands, and feet. Ask if dentures or teeth bother the patient. The tongue may protrude briefly out of the lips. If asked to hold the tongue in a protruded position, the person may be unable to maintain protrusion for longer than 1 second. Although the individual may attempt to disguise the movements by placing the hand to the mouth, in time, the movements become constant during waking hours and cannot be suppressed by the patient.

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