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MANAGEMENT OF INVOLUNTARY SELF-INFLICTED ORAL TRAUMA IN AN UNCONSCIOUS
PATIENT WITH ANTI-NMDAR ENCEPHALITIS IN INTENSIVE CARE: A CASE REPORT

Wong CXJ, Rossid IA, Vedha Raj DR

Introduction: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is an autoimmune
condition in which the body produces antibodies that act against receptors in the brain,
resulting in both neurologic and psychiatric symptoms. It primarily affects the young and
mostly women, where orofacial dyskinesia is a distinctive feature with few patients may
present with prominent neuropsychiatric symptoms. Orofacial dyskinesias can occur
almost exclusively at night, indicating that this sign could be overlooked. Severe orofacial
dyskinesia may result in self-inflicted oral injury, including lip and tongue injuries and
broken teeth. Case report: A 25-year-old Malay lady, was referred to the Special Needs
Dentistry team for persistent tongue biting leading to laceration wounds over the anterior
one third of tongue. She was diagnosed with NMDAR encephalitis and was intubated in
intensive care to preserve her airway. She presented with involuntary eye blinking, lip
smacking, forceful clenching of teeth, and masticatory-like movements of her maxilla and
mandible. Her medical conditions include ovarian teratoma, liver micro abscesses, deep
vein thrombosis and pulmonary embolism. In view of prolonged intubation, tracheostomy
was performed. Daily oral toilet with application of 0.2% hyaluronic acid gel and the
construction of an extra-orally anchored acrylic appliance was fabricated to stabilize her
jaws to prevent further self-inflicted injury thus assisting in the healing of the tongue lesion.
Conclusion: Involuntary oral self-inflicted injuries in unconscious patients should be
promptly managed to prevent further deterioration of oral health. The use of customized
rigid oral appliances anchored extra orally can be utilized to prevent further oral trauma
and to encourage healing of traumatized oral tissues.

th
Virtual oral presentation at National KKM Special Needs Dentistry Clinical Audit and Journal Club meeting on 30 June 2020
Dr Charis Wong Xian Jun
Dr Izyan Athirah Rossid
Dr Dasera Raj Vedha Raj
Specials Care Dentistry Unit
Seberang Jaya Hospital
Perai Penang

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