von Lindern Jens J, Niederhagen Bernd, Bergé Stefaan, Appel Thorsten
Department of Maxillofacial Surgery, University of Bonn, Bonn, Germany.
J Oral Maxillofac Surg. 2003 Jul;61(7):774-8. doi: 10.1016/s0278-2391(03)00153-8.
Chronic hyperactivity of the masticatory muscles is a common functional disorder associated with chronic facial pain and headache. The positive therapeutic effect of botulinum toxin type A on functional disorders and pain symptoms has been known in connection with the treatment of cervical dystonia. The purpose of this report is to assess whether the targeted reduction of masticatory muscular hyperactivity by local injection treatment with botulinum toxin type A can improve facial pain headache symptoms in the event that other treatment methods prove ineffective.
In an randomized blinded placebo-controlled study, 90 patients (60 verum and 30 placebo) with chronic facial pain were treated with botulinum toxin type A (Botox; Allergan, Ettlingen, Germany) injections into masticatory muscles.
Ninety-one percent of patients who received botulinum toxin improved by a significant mean reduction of approximately 3.2 on a visual analog pain scale. By comparison with t test and chi(2) test, there was a significant difference compared with the placebo group (P <.01).
The local injection of botulinum toxin type A constitutes an innovative and adequately efficient treatment method for chronic facial pain associated with hyperactivity of the masticatory muscles. An improvement in the painful symptoms can be expected in up to 90% of patients who do not respond to conservative treatment methods.
咀嚼肌慢性多动是一种与慢性面部疼痛和头痛相关的常见功能障碍。A型肉毒杆菌毒素对功能障碍和疼痛症状的积极治疗效果在治疗颈部肌张力障碍方面已为人所知。本报告的目的是评估在其他治疗方法无效的情况下，通过局部注射A型肉毒杆菌毒素靶向降低咀嚼肌多动是否能改善面部疼痛和头痛症状。
在一项随机双盲安慰剂对照研究中，90例慢性面部疼痛患者（60例使用A型肉毒杆菌毒素，30例使用安慰剂）接受了咀嚼肌注射A型肉毒杆菌毒素（保妥适；艾尔建公司，德国埃特林根）治疗。
接受A型肉毒杆菌毒素治疗的患者中有91%在视觉模拟疼痛量表上平均显著降低约3.2，与安慰剂组相比，经t检验和卡方检验，差异有统计学意义（P<.01）。
局部注射A型肉毒杆菌毒素是治疗与咀嚼肌多动相关的慢性面部疼痛的一种创新且有效的治疗方法。对于对保守治疗方法无反应的患者，高达90%的患者有望改善疼痛症状。
