Mandibular bone effects of botulinum toxin injections in masticatory muscles in adult

Kahn, A; Kün‐Darbois, Jean‐Daniel; Bertin, Hélios; Corre, Pierre; Chappard, Daniel

doi:10.1016/j.oooo.2019.03.007

Cited by 25 publications

(36 citation statements)

References 47 publications

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“…Lee et al 21 reported that bone volume of the mandibular gonial angle area was reduced significantly more in patients receiving two sets of masticatory muscle injections 4 month apart than a group receiving a single injection. Another small study 18 reported grey scale non‐uniformity increased in condylar and alveolar bone after masticatory muscle Btx treatment and that 6 of their 12 treated patients showed condylar bone increase or decrease, depending on the specific area. While all of these studies showed statistical significance, the clinical significance of all these findings is uncertain.…”

Section: Discussionmentioning

confidence: 99%

“…Despite concerning evidence from the animal literature, the clinical significance of isolated findings of masticatory muscle Btx effects on bone in human studies 6,18‐22 remains unclear. Small effects seen from one or perhaps two treatments may not adequately represent any clinically important risks associated with long‐term, repeated injection cycles in individuals suffering from chronic TMJD.…”

Section: Introductionmentioning

confidence: 99%

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Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Raphael

Tadinada

Santiago

et al. 2020

J of Oral Rehabilitation

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Background Adverse effects of masticatory muscle injections of Botulinum Toxin (Btx) have been noted in animal and, less dramatically, human studies. Objective Among women treated in multiple community‐based private practices, to compare TMJ bone density and mandibular condylar volume between patients with myofascial TMJD receiving multiple masticatory muscle Btx treatments and similarly diagnosed women not receiving such treatment. Methods Cohorts consisted of women whose treatment charts indicated a diagnosis of myofascial TMJD: 35 received at least 2 Btx treatment cycles; 44 received none. Bone density at pre‐specified regions of interest (ROI) was defined by grey scale values from Cone Beam CT, adjusting for a fixed density phantom included in each scan. Mean bone density and mandibular condyle volume were compared between groups. Dose‐response effects were tested within the Btx‐exposed group. Results The mean density of primary and secondary ROIs was similar between exposure groups, as was condylar volume. Among Btx‐exposed women, increasing dose of Btx to the temporalis muscle was inversely proportional to the density of the trabecular area of the mandible body. Many Btx‐exposed women received smaller doses of Btx to the masseter muscles than in most TMJD Btx clinical trials. Conclusion Masticatory muscle injections of Btx failed to produce clinically significant TMJ bone‐related changes. Should Btx receive regulatory approval for treatment of myofascial TMJD, a phase IV study is recommended to evaluate potential adverse effects of Btx on bone and muscle when administered at higher doses and/or for more treatment cycles.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Raphael

Tadinada

Santiago

et al. 2020

J of Oral Rehabilitation

View full text Add to dashboard Cite

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“…Some human studies ever tried to investigate the effects of masticatory muscle paralysis induced by BTX injection on the mandibular bone quality. One study revealed that 30 U BTX injection in per masseter muscles and 20 U per temporalis muscles could cause reduced cortical bone thickness of the mandibular condyles and mandibular bone texture 28 . However specific protocols for dose and injection intervals of BTX injection which could elicit mandibular bony changes have not been established yet.…”

Section: Discussionmentioning

confidence: 99%

“…However, this study used a subjective method to evaluate changes in the trabecular density, therefore, the reliability of the results was inevitably compromised. Another study showed cortical thinning at the anterior portion of the condyles and decreased bone textures in TMJ condyles and digastric fossa, but this study could not provide information on changes in the cortical bone qualities in muscle insertion sites and adopted two-dimensional (2D) method to evaluating the cortical bone qualities 28 .…”

mentioning

confidence: 93%

Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults

Hong

Kang

2020

Sci Rep

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this study aimed to clarify how masticatory muscle atrophy induced by botulinum toxin (BtX) injection affects cortical bone quality of the mandible using 3D modeling technology. A total of 39 young (26.9 ± 6.0 years) and 38 post-menopausal (55.3 ± 6.3 years) females were included. Computed tomography (CT) images were obtained before and after 12 months of treatment. Predictor variables were application of a stabilization splint, and/or two times of BtX injection in the bilateral temporalis and masseter muscles within a six-month interval. Outcome variables were changes in average Hounsfield units (HU) and cortical thickness of region of interest (ROI). 3D mandibular models were reconstructed using CT images, and models were used to calculate average HU and cortical thickness of Rois, including inferior half of the lateral surface of ascending ramus, coronoid process, and temporomandibular joint condyle. Cortical bone quality at muscle insertion site was influenced by decreased muscle thickness but seemed not to be affected by decreased functional loading. Reduced functional loading seemed to influence cortical bone quality of the condyles. These effects were more remarkable in post-menopausal females. Hence, decreased masticatory muscle thickness may lead to alterations of the mandibular cortical structures, especially in post-menopausal females. Bone is a dynamic structure that continuously undergoes a remodeling process through resorption and apposition to meet environmental requirements. The adaptation rate of the bone to functional loading is mediated by dynamic forces of the associated muscles 1. Skeletal muscles transduce mechanical loading to the bone in three ways: (1) the tensile force developed by a muscle contraction at its insertion site, (2) the compressive force developed by muscles that transduce loading across the joints, and (3) the bending force experienced by long bone associated muscles for lifting distally held objects 2. The role of mechanical stimulation by muscles to maintain bone density has been well known and the association among the amount of physical activity, body muscle mass, and quality of both cortical and trabecular bones has also been investigated 3-6. Botulinum toxin (BTX) acts as a pre-synaptic neurotoxin that blocks neuromuscular transmission by inhibiting acetylcholine release from the motor and sympathetic nerve terminals 7 as well as inflammatory mediators including substance P and glutamate 7,8. Muscle paralysis induced by BTX injection was related with not only reduced active loading but also an increased passive elastic modulus of muscle fiber bundles 9. BTX has been used not only for cosmetic purposes but also to improve symptoms associated with temporomandibular disorders (TMDs), myofascial pain syndrome, and headaches. The majorities of adverse effects associated with the application of BTX in the orofacial region are mild and transient including bruising, swelling, pain around the injection site, and masticatory muscle weakness 10. Several previous studies have rev...

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“…A recent study from our group identified alveolar and condylar bone changes in adult patients at the mandible after BTX injections into masticatory muscles. 5 Furthermore, hypertrophic bone metaplasia at a muscle enthesis of the mandible has been evidenced in this rat model of BTX injections. 1 Herbst appliance anchored with miniscrews: Some unsettled questions T he Herbst appliance (HA) is one of the most useful fixed functional appliances for the functional orthopedic correction of Class II malocclusion.…”

mentioning

confidence: 73%

Herbst appliance anchored with miniscrews: Some unsettled questions

Zhang¹

2020

American Journal of Orthodontics and Dentofacial Orthopedics

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Mandibular bone effects of botulinum toxin injections in masticatory muscles in adult

Cited by 25 publications

References 47 publications

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Effect of multiple injections of botulinum toxin into painful masticatory muscles on bone density in the temporomandibular complex

Decreased mandibular cortical bone quality after botulinum toxin injections in masticatory muscles in female adults

Herbst appliance anchored with miniscrews: Some unsettled questions

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