Shipika D V, Lyan D V, Drobyshev A Yu
Moscow State University of Medicine and Dentistry, Moscow, Russia.
Stomatologiia (Mosk). 2021;100(1):44-51. doi: 10.17116/stomat202110001144.
Assessment of the effectiveness of botulinum toxin A in the treatment of temporomandibular joint pain dysfunction syndrome.
In accordance with the diagnostic and treatment guidelines for TMJPDS, 20 patients with TMJPDS with pronounced pain on palpation of the chewing muscles, discoordination of the chewing muscles according to the EMG, and degenerative changes in the temporomandibular joint according to the MRI were examined. The patients had no contraindications to the use of botulinum toxin. : 1) age under 21 years, 2) somatic pathology, 3) refusal of the steps of the proposed diagnostic and treatment algorithm. Methods used: clinical, psychometric (visual analogue scale (VAS) - for pain assessment), X-ray, electromyographic and statistical methods.
An objective reduction in the tone of the chewing muscles was observed after treatment In both groups. However, 30 days after the injection of BtA the IMPACT indicator in the first group was reduced by 403.5 µV or more (38.5%, <0.05), while in the second group it decreased by 201.5 µV or more (25%, <0.05). A correlation was identified between the VAS index (mean 7 points, severe pain level) and IMPACT (<0.05). The onset of a significant pain reduction was observed one week after BtA injection, the most pronounced effect was achieved after 2 weeks and lasted for about 3 months.
The use of BtA as part of the temporomandibular joint pain dysfunction syndrome treatment algorithm contributes to the creation of a «therapeutic window» for comprehensive rehabilitation of patients in this group. It increases the efficacy of the conducted treatment and contributes to a significant prolongation of the TMJPDS remission.
评估A型肉毒杆菌毒素治疗颞下颌关节疼痛功能障碍综合征的有效性。
根据颞下颌关节疼痛功能障碍综合征的诊断和治疗指南，对20例颞下颌关节疼痛功能障碍综合征患者进行检查，这些患者咀嚼肌触诊时有明显疼痛，肌电图显示咀嚼肌不协调，磁共振成像显示颞下颌关节有退行性改变。患者无使用肉毒杆菌毒素的禁忌证：1）年龄在21岁以下；2）躯体疾病；3）拒绝所提议的诊断和治疗算法步骤。使用的方法：临床、心理测量（视觉模拟量表（VAS）——用于疼痛评估）、X线、肌电图和统计方法。
两组治疗后均观察到咀嚼肌张力客观降低。然而，注射肉毒杆菌毒素A后30天，第一组的IMPACT指标降低了403.5微伏或更多（38.5%，<0.05），而第二组降低了201.5微伏或更多（25%，<0.05）。VAS指数（平均7分，重度疼痛水平）与IMPACT之间存在相关性（<0.05）。注射肉毒杆菌毒素A后1周观察到疼痛显著减轻，2周后达到最明显效果，并持续约3个月。
在颞下颌关节疼痛功能障碍综合征治疗算法中使用肉毒杆菌毒素A有助于为该组患者的综合康复创造一个“治疗窗口”。它提高了所进行治疗的疗效，并有助于显著延长颞下颌关节疼痛功能障碍综合征的缓解期。
