What is the treatment for jaw deviation to the left due to a stroke?

Treatment of Jaw Deviation to the Left Due to Stroke

Jaw deviation following stroke should be managed through a comprehensive interdisciplinary rehabilitation approach focusing on motor therapy, dysphagia treatment if swallowing is affected, and addressing any associated facial muscle weakness through task-specific exercises and potentially botulinum toxin for focal spasticity if present. 1

Initial Assessment and Evaluation

The first priority is determining the extent of oro-facial impairment and associated functional deficits:

• Screen for dysphagia immediately before allowing any oral intake, as jaw deviation often accompanies swallowing dysfunction in stroke patients 1, 2
• Assess for facial asymmetry, reduced lip force, impaired tongue strength, and mastication difficulties, which commonly occur together with jaw deviation 3
• Evaluate for focal spasticity in the facial and jaw muscles that may be contributing to the deviation 1

Rehabilitation Interventions

Motor Therapy Approaches

Task-specific practice targeting the affected oro-facial musculature should be the foundation of treatment 1:

• Implement exercises focused on improving strength and coordination of jaw muscles, similar to principles used for limb rehabilitation 3
• Consider mirror therapy adapted for facial movements, which has shown benefit for motor impairment in stroke rehabilitation 1
• Rhythmic auditory stimulation may be incorporated into oral-motor exercises 1

Dysphagia-Specific Interventions (if present)

If swallowing is affected alongside jaw deviation:

• Chin tuck against resistance exercises targeting suprahyoid musculature can improve oropharyngeal function and may help with jaw positioning 1, 2
• Respiratory muscle strength training for patients without tracheostomy may reduce aspiration risk 1, 2
• Modify food textures and consider thickened liquids if aspiration risk is present 2

Spasticity Management

If focal spasticity is contributing to jaw deviation:

• Botulinum toxin injection may be considered for focal spasticity in jaw muscles, though evidence is primarily for limb spasticity 1
• Oral baclofen (15-30 mg daily) is an option but has significant limitations including sedation and cognitive effects, particularly problematic in older stroke patients 4, 5
• Avoid baclofen in patients with cognitive impairment or dementia due to safety concerns 5

Functional Rehabilitation Focus

• Address impaired masticatory performance through exercises targeting tongue forces and oral sensitivity 3
• Work on facial symmetry exercises, though improvement may be discrete 3
• Provide meticulous oral hygiene care to reduce aspiration pneumonia risk 2

Interdisciplinary Team Approach

Management requires coordination between multiple specialists 2:

• Speech-language pathologist for oro-motor assessment and therapy
• Physical/occupational therapist for motor rehabilitation principles
• Nutritionist if oral intake is compromised
• Physician oversight for spasticity management if needed

Important Caveats

• Oro-facial impairment following stroke does not spontaneously improve without functional rehabilitation 3
• The rehabilitation approach should be initiated as early as safely possible, though very early intensive therapy (within 24 hours) has not shown clear superiority over therapy started at 24-48 hours 6
• Functional outcomes and quality of life should drive treatment decisions, not just cosmetic appearance 3
• Consider screening for poststroke depression, as it adversely affects rehabilitation outcomes across all domains 6