Patel Amit A, Lerner Michael Z, Blitzer Andrew
1 New York Center for Voice and Swallowing Disorders, New York, New York, USA.
Ann Otol Rhinol Laryngol. 2017 Apr;126(4):328-333. doi: 10.1177/0003489417693013. Epub 2017 Feb 1.
Temporomandibular disorder (TMD) involves dysfunction of the temporomandibular joint and associated muscles of mastication causing pain with chewing, limitation of jaw movement, and pain. While the exact pathophysiology of TMD is not completely understood, it is thought that hyperfunction of the muscles of mastication places stress on the temporomandibular joint, leading to degeneration of the joint and associated symptoms. We hypothesize that chemodenervation of the muscles of mastication with IncobotulinumtoxinA (Xeomin) will decrease the stress on the temporomandibular joint and improve pain associated with temporomandibular joint and muscle disorder (TMJD).
Twenty patients were randomized to IncobotulinumtoxinA (170 units) or saline injection of the masticatory muscles. Patient-reported pain scale (0-10) was recorded at 4-week intervals following injection for 16 weeks. Patients who received saline injection initially were assessed for reduction in pain at the first 4-week interval and if still had significant pain were rolled over into the IncobotulinumtoxinA arm.
Preinjection pain scores were similar between patients. While there was a statistically significant reduction in pain score in the placebo group one month, there was an overall larger drop in average pain scores in those patients injected with IncobotulinumtoxinA initially. All patients initially injected with placebo crossed over into the IncobotulinumtoxinA group. Similar results were seen when examining the composite masticatory muscle tenderness scores. There was no significant change in usage of pain medication.
We demonstrate utility of IncobotulinumtoxinA in treating patients with TMD with pain despite pain medication usage and other conventional treatments.
颞下颌关节紊乱病（TMD）涉及颞下颌关节功能障碍以及相关咀嚼肌功能异常，可导致咀嚼时疼痛、下颌运动受限及疼痛。虽然TMD的确切病理生理学机制尚未完全明确，但据认为咀嚼肌功能亢进会给颞下颌关节带来压力，进而导致关节退变及相关症状。我们假设使用因可瑞素（IncobotulinumtoxinA，Xeomin）对咀嚼肌进行化学去神经支配可减轻颞下颌关节的压力，并改善与颞下颌关节和肌肉紊乱（TMJD）相关的疼痛。
20例患者被随机分为接受因可瑞素（170单位）注射组或咀嚼肌注射生理盐水组。注射后每4周记录一次患者报告的疼痛评分（0 - 10分），共记录16周。最初接受生理盐水注射的患者在第一个4周间隔时评估疼痛减轻情况，若仍有明显疼痛，则转入因可瑞素注射组。
患者注射前的疼痛评分相似。安慰剂组在1个月时疼痛评分有统计学意义的降低，但最初接受因可瑞素注射的患者平均疼痛评分总体下降幅度更大。所有最初接受安慰剂注射的患者均转入因可瑞素组。检查复合咀嚼肌压痛评分时也观察到类似结果。止痛药物的使用情况无显著变化。
我们证明了因可瑞素在治疗尽管使用了止痛药物及其他传统治疗但仍有疼痛的TMD患者中的有效性。
