Abboud W A, Hassin-Baer S, Joachim M, Givol N, Yahalom R
Department of Oral and Maxillofacial Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel; Department of Neurology, Israel.
Institute of Movement Disorders, Department of Neurology, Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel.
Int J Oral Maxillofac Surg. 2017 Nov;46(11):1417-1423. doi: 10.1016/j.ijom.2017.04.020. Epub 2017 May 15.
Myofascial pain of the muscles of mastication is a common temporomandibular disorder. Patients unresponsive to conservative treatment modalities pose a therapeutic challenge to the treating clinician. The efficacy of intramuscular botulinum toxin injections for recalcitrant cases is still not well established due to mixed results from clinical trials. The Diagnostic Criteria of Temporomandibular Disorders (DC/TMD) classified chronic muscle pain broadly into a localized pattern (when pain is localized to the site of palpation or the muscle palpated) and a referring pattern (when the pain spreads beyond the boundary of the muscle being palpated). The medical records of 25 consecutive patients treated with botulinum were analysed retrospectively. Significant pain reduction was achieved in 69.2% of the patients with localized myofascial pain and 16.7% of the patients with referring myofascial pain (P=0.015). Seventy-seven per cent of the patients with localized myofascial pain reported using less analgesic throughout the follow-up period, whereas only 25% of the patients with referring myofascial pain (P=0.017). The effects of botulinum toxin in responsive patients subsided after a mean of 3.21 months. Patients with localized myofascial pain benefited from botulinum toxin injections, but patients with referring myofascial pain responded poorly to this treatment.
咀嚼肌肌筋膜疼痛是一种常见的颞下颌关节紊乱病。对保守治疗方法无反应的患者给临床治疗医生带来了治疗挑战。由于临床试验结果不一，肌肉注射肉毒杆菌毒素治疗顽固性病例的疗效仍未明确。颞下颌关节紊乱病诊断标准（DC/TMD）将慢性肌肉疼痛大致分为局部型（疼痛局限于触诊部位或所触诊的肌肉）和牵涉型（疼痛扩散至所触诊肌肉边界之外）。对连续25例接受肉毒杆菌毒素治疗患者的病历进行回顾性分析。局部型肌筋膜疼痛患者中69.2%疼痛显著减轻，牵涉型肌筋膜疼痛患者中16.7%疼痛显著减轻（P = 0.015）。77%的局部型肌筋膜疼痛患者报告在整个随访期间使用的镇痛药减少，而牵涉型肌筋膜疼痛患者中只有25%（P = 0.017）。肉毒杆菌毒素对有反应患者的作用在平均3.21个月后消退。局部型肌筋膜疼痛患者从肉毒杆菌毒素注射中获益，但牵涉型肌筋膜疼痛患者对这种治疗反应不佳。
