Martenot Alexis, Devoti Jean-François, Pons Mélanie, Meyer Christophe, Brumpt Eléonore, Louvrier Aurélien, Bertin Eugénie
Université de Franche-Comté, CHU Besançon, Chirurgie maxillo-faciale, stomatologie et odontologie hospitalière, Besançon F-25000, France.
Université de Lorraine, CHU Nancy, Service de Chirurgie Maxillo-Faciale, Plastique, Reconstructrice et Esthétique, Nancy F-54000, France.
J Stomatol Oral Maxillofac Surg. 2024 Oct;125(5):101715. doi: 10.1016/j.jormas.2023.101715. Epub 2023 Nov 25.
Botulinum toxin has proven effective in treating persistent myogenous temporomandibular disorders (M-TMDs) unresponsive to conservative therapies. While the usual injection sites are the masseter and temporalis muscles, the deeper lateral pterygoid muscle (LPM) is often overlooked due to its difficulty of access and the risk of local complications. This study aims to evaluate the effectiveness of botulinum toxin-A injections (BTX-A) in the LPM with MR-guided navigation of patients with persistent M-TMDs.
This retrospective study enrolled 34 patients suffering from M-TMDs despite conservative therapies with a total of 51 injection sessions. All of them were treated by BTX-A injections in the LPM using MR-guided navigation, masseter and temporalis with clinical guidance. The effectiveness of the treatment was evaluated with measures of maximum pain-intensity scores of breakthrough and background pain, maximal interincisal mouth opening (MIO), and the presence of joint sounds. The assessment was conducted before injections, and subsequently, at 1 and 3 months postoperatively. Adverse events and perception of improvement with the treatment were also reported for each injection sessions.
BTX-A injections in the LPM significantly improved pain scores intensity with a reduction of 65 % and 49 % respectively at the 1- and 3-month follow-ups, with peak effectiveness at 1 month. This study showed also a statistically significant improvement in mean MIO at 3 months post-injection and a decrease in joint sounds with persistence in 9,7 % of cases at 3-month follow-up compared to 41,2 % at baseline. No significant adverse events were observed. Patients treated with BTX-A injections in the LPM had a subjective complete improvement in their perception of treatment efficacy in 63 % of cases at the end of the follow-up period.
This study reports clinical experience on the use of MR-guided navigation to perform accurate, reliable, and safe BTX-A injections in the LPM. Although our results appear to be encouraging regarding symptom improvement of patients suffering from persistent M-TMDs, this approach may not be feasible as a primary standard procedure for managing M-TMDs. Further research is necessary to explore potential reproducible, safe, and cost-effective alternatives to enhance the accessibility of the LPM in clinical practice.
肉毒杆菌毒素已被证明可有效治疗对保守治疗无反应的持续性肌源性颞下颌关节紊乱症（M-TMDs）。虽然通常的注射部位是咬肌和颞肌，但由于翼外肌深层（LPM）难以触及且存在局部并发症风险，常被忽视。本研究旨在评估在磁共振引导下对持续性M-TMDs患者的翼外肌深层注射A型肉毒杆菌毒素（BTX-A）的有效性。
本回顾性研究纳入了34例尽管接受了保守治疗但仍患有M-TMDs的患者，共进行了51次注射。所有患者均在磁共振引导下对翼外肌深层进行BTX-A注射，并在临床指导下对咬肌和颞肌进行注射。通过测量突破性疼痛和背景疼痛的最大疼痛强度评分、最大切牙间开口度（MIO）以及关节弹响情况来评估治疗效果。在注射前以及术后1个月和3个月进行评估。还报告了每次注射的不良事件和对治疗改善的感知情况。
对翼外肌深层注射BTX-A后，疼痛评分强度显著改善，在1个月和3个月随访时分别降低了65%和49%，在1个月时达到最大疗效。本研究还显示，注射后3个月平均MIO有统计学意义的改善，关节弹响减少，在3个月随访时9.7%的病例持续存在弹响，而基线时为41.2%。未观察到明显不良事件。在随访期结束时，63%在翼外肌深层注射BTX-A的患者主观上认为治疗效果完全改善。
本研究报告了在磁共振引导下对翼外肌深层进行准确、可靠和安全的BTX-A注射的临床经验。尽管我们的结果在改善持续性M-TMDs患者症状方面似乎令人鼓舞，但这种方法作为管理M-TMDs的主要标准程序可能不可行。有必要进一步研究探索潜在的可重复、安全且具有成本效益的替代方法，以提高临床实践中翼外肌深层的可及性。
