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#36130 Lateral pterygoid muscle ultrasound-guided injection with botulinum toxin (xeomin®) for management of temporomandibular pain
  1. Pablo Rodriguez Gimillo1,
  2. Rafael Poveda2,
  3. Violeta Perez1,
  4. Maria Margaix3,
  5. Carlos Delgado1,
  6. Jose Vicente Bagan2 and
  7. Jose De Andres1
  1. 1Pain Unit, Consorcio Hospital General Universitario Valencia, Valencia, Spain
  2. 2Department of Stomatology and Maxillofacial Surgery, Consorcio Hospital General Universitario Valencia, Valencia, Spain
  3. 3Department of Oral Medicine, Universidad de Valencia, Facultad de Medicina y Odontología, Valencia, Spain


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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.

Abstract #36130 Figure 1

Lateral pterygoid muscle ultrasound-guided injection. A, ultrasonographic visualization of the LPM. B, annotated ultrasonography of image A. C, out- of-plane needle insertion direction (orange dashed line). D, target for injection into the lateral pteroid muscle (blue shadow). LPm, lateral pterygoid muscle; LPP, lateral pterygoid plate; MA, maxillary artery; Mm, masseter muscle; MT, maxillary tuberosity; TM, temporalis muscle

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.

Attachment CEIM.pdf

  • Toxin
  • Myofascial pain
  • Temporomandibular disorders
  • ultrasound

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