The term “embouchure dystonia” describes a type of dystonia that affects brass and woodwind players. The term embouchure refers to the adjustment of the mouth to fit the mouthpiece of a wind instrument. The anatomy of this form of dystonia includes muscles of the mouth, face, jaw, and tongue.
The abnormal movements that characterize embouchure dystonia are often very subtle and occur only while the musician is playing, buzzing into the mouthpiece, or forming the embouchure. Most brass and woodwind players use a combination of puckering and smiling to play. At least twelve muscles are involved in positioning the mouth in this way, not including the equally complicated structure of the tongue and jaw. Pinpointing the most important muscles necessary for shaping the mouth to play a brass or woodwind instrument is difficult.
Symptoms of embouchure dystonia may include:
• Air leaks at the corners of the mouth: Sometimes worse in higher registers and accompanied by a noticeable tremor.
• Involuntary, abnormal contractions of the muscles in the face: Involuntary puckering; Excessive elevation of the corners of the mouth; Involuntary closing of the mouth.
Some musicians’ difficulties are limited to sustained notes in particular registers or to certain passages at specific speeds. The dystonia is typically painless but may elicit intense psychological stress.
There is no one isolated cause of embouchure dystonia, and the neurological origins are not entirely understood. As a child develops, he/she learns many different movements (such as walking, writing, or playing an instrument) that are stored in the brain as motor programs. Instances of embouchure dystonia that are highly task-specific have been described as a “computer virus” or “hard drive crash” in the sensory motor programs that are essential for playing music. However, additional factors, such as a genetic predisposition, are likely to play a significant role in the development of such a sensory-motor dysfunction. Why this “computer virus” cannot be easily overcome by establishing a new and improved sensory-movement pattern remains an important question for researchers.
The treatment of embouchure dystonia, like the treatment of all dystonias, is purely symptomatic at this stage. The following therapies may be attempted, but typically provide little relief for embouchure dystonia:
• Oral medications, including Artane® (trihexyphenidyl), Klonopin® (clonazepam), and Lioresal® (baclofen)
• Botulinum toxin injections, but the anatomy of the area must be carefully considered to avoid unacceptable oral weakness