Extraoral Versus Intraoral Botulinum Toxin Type A Injection for Management of Temporomandibular Joint Disc Displacement With Reduction

Abstract

The present study was conducted to compare between extraoral and intraoral approach for botulinum toxin type A (BTX-A) injection into the lateral pterygoid muscle (LPM) in patients suffering from anterior disc displacement with reduction (ADDWR). Fourteen patients suffering from ADDWR were included in this prospective cohort study. Patients were enrolled randomly into 2 groups according to injection approach; where extraoral used in group I, while intraoral approach used in group II. The LPM was injected with 20 IU BTX-A under electromyography (EMG) guidance. Postoperative evaluation of the patients included: mouth opening assessment, LPM tenderness, temporomandibular joint TMJ (clicking), and tenderness. The LPM insertional EMG activity was assessed. Also, magnetic resonance imaging (MRI) was performed to evaluate disc position. Descriptive and inferential analysis was conducted to compare between groups. There was significant patient's convenience during injection and significant injection time reduction in group II. A slight decrease in mouth opening immediate post-injection followed by significant improvement from 8th weeks post-injection was reported in both approaches. There was a significant improvement in TMJ clicking from 1st-week post-injection with no group difference. The EMG assessment documented LPM hyperactivity pre-injection followed by significantly decreased muscle activity at 8 and 16 weeks post-injection without statistical difference. The MRI showed no change in disc position after injection. Conclusion: The BTX-A injection into LPM is a simple technique that can be used with high success and low complication rate for treatment of ADDWR. The intraoral approach was superior to the extraoral concerning patient convenience and injection duration with no statistical difference regarding other clinical outcomes.

Intramuscular Injections and Dry Needling within Masticatory Muscles in Management of Myofascial Pain. Systematic Review of Clinical Trials

“…Importantly, it was highlighted that the attachment type is most likely just a cofactor of the internal derangements and there have to be other factors, such as trauma or a disrupted joint structure, for the displacements to occur [ 71 ]. In the cases discussed, application of the botulinum toxin into the LMPs may allow for treatment of the derangements as well as aid in the diagnosis of the acoustic symptoms originating from TMJ, as weakening the LMPs should result in a reduction of the reciprocal click [ 70 , 72 ].…”

Temporomandibular joint disorders prevalence and awareness of appropriate clinical practices, among Al-Madinah community: A prospective cross sectional study

“…2 Painful TMDs are of musculoskeletal origin and are considered the most common cause of nonodontogenic pain in the orofacial region. [3][4][5] The most prevalent symptom of TMD is tenderness of the masticatory muscles when palpated. 6,7 The prevalence of TMDs was twice higher in women compared to men, 8 also pain intensity was greater in women.…”

Temporomandibular joint (TMJ) disorders prevalence and awareness of appropriate clinical practices, among Al-Madinah community in Saudi Arabia

“… 2 Painful TMDs are of musculoskeletal origin and are considered the most common cause of non-odontogenic pain in the orofacial region. 3 – 5 The most prevalent symptom of TMD is tenderness of the masticatory muscles when palpated. 6 , 7…”