Persistent myogenic temporomandibular disorders: Are navigation-guided botulinum toxin-A injections into the lateral pterygoid muscles effective?

Autor: Martenot A; Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France. Electronic address: a1martenot@chu-besancon.fr., Devoti JF; Université de Lorraine, CHU Nancy, Service de Chirurgie Maxillo-Faciale, Plastique, Reconstructrice et Esthétique, Nancy F-54000, France., Pons M; Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France., Meyer C; Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France; Université de Franche-Comté, LNIT, Besançon F-25000, France; Université de Franche-Comté, CHU Besançon, Plateforme I3DM (Impression 3D Médicale), Besançon F-25000, France., Brumpt E; Université de Franche-Comté, LNIT, Besançon F-25000, France; Université de Franche-Comté, CHU Besançon, Radiologie, Besançon F-25000, France., Louvrier A; Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France; Université de Franche-Comté, LNIT, Besançon F-25000, France; Université de Franche-Comté, CHU Besançon, Plateforme I3DM (Impression 3D Médicale), Besançon F-25000, France., Bertin E; Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France.
Jazyk: angličtina
Zdroj: Journal of stomatology, oral and maxillofacial surgery [J Stomatol Oral Maxillofac Surg] 2024 Oct; Vol. 125 (5), pp. 101715. Date of Electronic Publication: 2023 Nov 25.
DOI: 10.1016/j.jormas.2023.101715
Abstrakt: Background: Botulinum toxin has proven effective in treating persistent myogenous temporomandibular disorders (M-TMDs) unresponsive to conservative therapies. While the usual injection sites are the masseter and temporalis muscles, the deeper lateral pterygoid muscle (LPM) is often overlooked due to its difficulty of access and the risk of local complications. This study aims to evaluate the effectiveness of botulinum toxin-A injections (BTX-A) in the LPM with MR-guided navigation of patients with persistent M-TMDs.
Methods: This retrospective study enrolled 34 patients suffering from M-TMDs despite conservative therapies with a total of 51 injection sessions. All of them were treated by BTX-A injections in the LPM using MR-guided navigation, masseter and temporalis with clinical guidance. The effectiveness of the treatment was evaluated with measures of maximum pain-intensity scores of breakthrough and background pain, maximal interincisal mouth opening (MIO), and the presence of joint sounds. The assessment was conducted before injections, and subsequently, at 1 and 3 months postoperatively. Adverse events and perception of improvement with the treatment were also reported for each injection sessions.
Results: BTX-A injections in the LPM significantly improved pain scores intensity with a reduction of 65 % and 49 % respectively at the 1- and 3-month follow-ups, with peak effectiveness at 1 month. This study showed also a statistically significant improvement in mean MIO at 3 months post-injection and a decrease in joint sounds with persistence in 9,7 % of cases at 3-month follow-up compared to 41,2 % at baseline. No significant adverse events were observed. Patients treated with BTX-A injections in the LPM had a subjective complete improvement in their perception of treatment efficacy in 63 % of cases at the end of the follow-up period.
Conclusions: This study reports clinical experience on the use of MR-guided navigation to perform accurate, reliable, and safe BTX-A injections in the LPM. Although our results appear to be encouraging regarding symptom improvement of patients suffering from persistent M-TMDs, this approach may not be feasible as a primary standard procedure for managing M-TMDs. Further research is necessary to explore potential reproducible, safe, and cost-effective alternatives to enhance the accessibility of the LPM in clinical practice.
Competing Interests: Declaration of competing interest Dr. Martenot has nothing to disclose. Dr. Devoti has nothing to disclose. Dr. Pons has nothing to disclose. Pr. Meyer has nothing to disclose. Dr. Brumpt has nothing to disclose. Dr. Louvrier is a paid expert trainer for the laboratory MERZ PHARMA FRANCE. Dr. Bertin has nothing to disclose.
(Copyright © 2023. Published by Elsevier Masson SAS.)
Databáze: MEDLINE
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