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Treatment of severe TMJ clicking with botulinum toxin in the

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Brenda Flores

on 16 October 2013

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Transcript of Treatment of severe TMJ clicking with botulinum toxin in the

Treatment of severe TMJ clicking with botulinum toxin in the lateral pterygoid muscle in two cases of anterior disc displacement
Objectives
A new method is being introduced for the treatment of severe clicking of TMJ associated with anterior disc displacement using Botox in the lateral pterygoid muscle.
The use of this toxin is suggested to block the LP in order to temporarily reduce the action of the muscle and eliminate the cliking.
METHODS
Patients:
Two female 54 and 23 years with longstanding unilateral disc displacement disorder treated with splints and jaw exercises without success.
Displacement of the articular disc (ADD) is one of the most common cause for TMJ sound.
Merete Bakke, DDS, PhD
Eigilid Moller, DDS
Lene Werdelin, MD, DMSc
Torben Dalanger, MD
Noriyuki Kitai, DDS, PhD
Sven Kreiborg, DDS, PhD
Produce lateral movements by unilateral muscle action.
Move disc and condyle in a forward direction by bilateral muscle action.
Stabilize the disc-condyle complex.
No predisposing or precipitating factors in Patient 1.
Patient 2 had a bicycle accident 7 years earlier.
1) EMG guided injection of Botox into the LP
2) Second injection after 6 months.
10U Botox per 0.1ml of sterile saline.
30U were used for the injection.
3) Removed splint 6 months after second Botox injection.
Follow-up
1.5 years after receiving Botox treatment.
Treatment Assessment
1) Verbal reports and clinical recordings of clicking and jaw movements.
2) EMG recordings from LP.
3)MRI of the TMJ.
Results
Patient 1
Clicking and earache ceased after Botox 1, but she had a remaining sensation of blockage.
After Botox 2 blocking feeling diminished.
At control 1 year all symptoms and signs were gone.
Patient 2
Clicking ceased after Botox 1.
No recurrence after Botox 2.
At control 1 year no symptoms and signs were present.
EMG activity of LP showed a systematic decrease of the maximum activity of the injected muscle, which was most marked one month after the Botox application.
-Disc displacement on MRI showed slight but distinct improvement in the disc-condyle relationship in the TMJ with ADDr.
-A slight disc displacement was still present.

Pros
Diverse techniques were used to evaluate the results of the Botox use in LP.
Follow up every 6 months.
Results were as expected.
Improvement of the disc-condyle complex was achieved.
Botox injection is considered safe and efficient local treatment for muscle spasm.
Injection delivery was ensured with EMG guidance.
Cons
Case report is not a significant study, bias included.
Only 2 patients were evaluated.
Contralateral movements of the condyle were diminished for a long period.
Authors could not differenciate if the symptom producing ADDr had changed to a silent ADDr.
Thank
You!
Main Functions of the LP
Full transcript