Oral Surgery Department, Dental School, University of Sevilla, 41009 Sevilla, Spain.
Toxins (Basel). 2020 Feb 11;12(2):112. doi: 10.3390/toxins12020112.
Botulinum neurotoxin (BoNT) is a potent biological toxin and powerful therapeutic tool for a growing number of clinical orofacial applications. BoNT relaxes striated muscle by inhibiting acetylcholine's release from presynaptic nerve terminals, blocking the neuromuscular junction. It also has an antinociceptive effect on sensory nerve endings, where BoNT and acetylcholine are transported axonally to the central nervous system. In dentistry, controlled clinical trials have demonstrated BoNT's efficiency in pathologies such as bruxism, facial paralysis, temporomandibular joint (TMJ) disorders, neuropathic pain, sialorrhea, dystonia and more.
This study's aim was to conduct a systematic literature review to assess the most recent high-level clinical evidence for BoNT's efficacy and for various protocols (the toxin used, dilution, dosage and infiltration sites) used in several orofacial pathologies.
We systematically searched the MedLine database for research papers published from 2014 to 2019 with randomly allocated studies on humans. The search included the following pathologies: bruxism, dislocation of the TMJ, orofacial dystonia, myofascial pain, salivary gland disease, orofacial spasm, facial paralysis, sialorrhea, Frey syndrome and trigeminal neuralgia.
We found 228 articles, of which only 20 met the inclusion criteria: bruxism (four articles), orofacial dystonia (two articles), myofascial pain (one article), salivary gland disease (one article), orofacial spasm (two articles), facial paralysis (three articles), sialorrhea (four articles) or trigeminal neuralgia (three articles).
The clinical trials assessed showed variations in the dosage, application sites and musculature treated. Thus, applying BoNT can reduce symptoms related to motor muscular activity in the studied pathologies efficiently enough to satisfy patients. We did not identify the onset of any important side effects in the literature reviewed. We conclude that treatment with BoNT seems a safe and effective treatment for the reviewed pathologies.
肉毒神经毒素（BoNT）是一种强效生物毒素，也是越来越多临床口腔颌面应用的有力治疗工具。BoNT 通过抑制神经末梢前膜乙酰胆碱的释放来松弛横纹肌，从而阻断神经肌肉接头。它对感觉神经末梢也有镇痛作用，BoNT 和乙酰胆碱通过轴突运输到中枢神经系统。在牙科领域，对照临床试验已经证实 BoNT 在磨牙症、面瘫、颞下颌关节紊乱、神经病理性疼痛、流涎、肌张力障碍等疾病中的疗效。
本研究旨在进行系统文献回顾，以评估 BoNT 治疗各种口腔颌面疾病的最新高级别临床证据，以及不同方案（使用的毒素、稀释度、剂量和渗透部位）的疗效。
我们系统地在 MedLine 数据库中搜索了 2014 年至 2019 年期间发表的、针对人类的随机分配研究的研究论文。搜索的疾病包括磨牙症、TMJ 脱位、口腔面肌痉挛、肌筋膜疼痛、唾液腺疾病、口面痉挛、面瘫、流涎、Frey 综合征和三叉神经痛。
我们共发现 228 篇文章，其中只有 20 篇符合纳入标准：磨牙症（4 篇文章）、口腔面肌痉挛（2 篇文章）、肌筋膜疼痛（1 篇文章）、唾液腺疾病（1 篇文章）、口面痉挛（2 篇文章）、面瘫（3 篇文章）、流涎（4 篇文章）或三叉神经痛（3 篇文章）。
评估的临床试验显示，剂量、应用部位和治疗肌肉存在差异。因此，BoNT 的应用可以有效减轻研究疾病中与运动肌活动相关的症状，足以满足患者的需求。我们在文献综述中没有发现任何重要的不良反应。我们的结论是，BoNT 治疗似乎是一种安全有效的治疗方法，可用于治疗所综述的疾病。
