Alvesalo Elina, Kemppainen Pentti, Teronen Olli, Kämppi Antti, Sitnikova Victoria
Department of Oral and Maxillofacial Diseases Faculty of Medicine, University of Helsinki, Haartmaninkatu 1 (PL41), 00014, Helsinki, Finland.
Private Practice Plusterveys, 02240, Espoo, Finland.
J Med Case Rep. 2025 Jul 1;19(1):298. doi: 10.1186/s13256-025-05278-z.
Botulinum toxin A is an increasingly used drug in the treatment of temporomandibular disorders and chronic myofascial pain. Although the treatment is safe, and the procedure is fairly simple, adverse effects can occur. In this case report, we discuss a 37 -year-old, Finnish female patient in whom m. Risorius was temporarily paralyzed by botulinum toxin A injections. According to the study protocol the injections were applied bilaterally to the masseter and temporalis muscles. Represented adverse effects of botulinum toxin A injections are rare according to current literature and therefore it is important to bring this matter up especially from an educational point of view.
This case report describes a case of a 37 -year-old, Finnish female patient who participated in a randomized clinical trial of botulinum toxin A in patients suffering from temporomandibular disorders, more detailed myalgia and headache attributed to temporomandibular disorders conducted in Helsinki University. The patient reported pain in the face area every day for the last 6 months (Diagnostic Criteria for Temporomandibular Disorders Axis II survey) before entering the study. She had had a night splint, more detailed a Michigan splint in the upper jaw, for 1 year and 3 months and had tried selfcare instructions, such as massage and movement therapies, as well as physical therapy with moderate success. Treatment modalities provided only temporary relief for the existing problem.
Even though the patient experienced adverse effects (temporary paralysis of the m.Risorius) after the botulinum toxin A injections she also experienced a noticeable reduction in muscle pain and headache attributed to temporomandibular disorders after the injections and after 6 months still reported reduced pain in the head and neck area. (characteristic pain intensity and graded chronic pain scale values were lower than before the study). Although the paper indicates possible positive outcomes of botulinum toxin A injections for patients suffering from myalgia in mastication muscles and temporomandibular disorders associated headache, there are also adverse effects to consider before making any decision on botulinum toxin A injections.
A型肉毒毒素在颞下颌关节紊乱病和慢性肌筋膜疼痛的治疗中应用日益广泛。尽管该治疗方法安全，操作也相对简单，但仍可能出现不良反应。在本病例报告中，我们讨论了一名37岁的芬兰女性患者，其笑肌因注射A型肉毒毒素而暂时麻痹。根据研究方案，双侧咬肌和颞肌均接受了注射。根据当前文献，A型肉毒毒素注射的不良反应较为罕见，因此，尤其从教育角度而言，提出此问题很重要。
本病例报告描述了一名37岁的芬兰女性患者，她参与了在赫尔辛基大学进行的一项针对颞下颌关节紊乱病、更严重的肌痛以及由颞下颌关节紊乱病引起的头痛患者的A型肉毒毒素随机临床试验。在进入研究前，该患者在过去6个月中每天都有面部疼痛（颞下颌关节紊乱病轴II调查诊断标准）。她佩戴上颌的夜间咬合板（更确切地说是密歇根咬合板）已有1年零3个月，并尝试过自我护理指导，如按摩和运动疗法以及物理治疗，但效果一般。这些治疗方式仅能暂时缓解现有问题。
尽管该患者在注射A型肉毒毒素后出现了不良反应（笑肌暂时麻痹），但她在注射后以及6个月后，颞下颌关节紊乱病引起的肌肉疼痛和头痛明显减轻，仍报告头颈部疼痛减轻。（特征性疼痛强度和分级慢性疼痛量表值低于研究前）。尽管本文表明A型肉毒毒素注射对咀嚼肌肌痛和与颞下颌关节紊乱病相关的头痛患者可能有积极效果，但在决定是否注射A型肉毒毒素之前，也需考虑其不良反应。
