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Background and Aims Temporomandibular disorders (TMDs) are a frequent cause of orofacial pain, causing functional disability and a negative impact on quality of life. Incobotulim toxin A -Xeomin®- (BTX-A) injection in lateral pterygoid muscle (LPM) is one of the treatment modalities proposed, but the blind puncture guided by EMG carries a risk of vascular puncture or diffusion of the toxin to nearby muscles. We describe an ultrasound-guided approach and show the results of a retrospective study of thirty patients.
Methods Thirty patients with unilateral temporomandibular myofascial pain were treated. An out-of-plane approach was performed using a convex probe, injecting 20 U of BTX-A (2.5 unit/0.1 ml solution – 0.8 ml) into the LPM. Before puncture, using colour Doppler mode, the maxillary artery was located to avoid its puncture.
Results Compared with baseline, patients manifested significant improvement in pain (VAS) at rest and at mandibular movement a month after treatment (p<0.05). Temporomandibular joint (TMJ) click was present prior to treatment in twenty-four patients, disappearing in 16 of them a month after injection (66.7%). No complications were detected during or after treatment.
Conclusions An ultrasound-guided approach for the injection of BTX-A into the LPM could be considered a successful and safe treatment for myofascial pain related to TMD and TMJ clicking. Therefore, further studies with larger sample sizes and longer follow-up periods are needed to study the effect of BTX and its long-term effects.
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