Abstract
ObjectiveTreatment of temporomandibular disc displacement with reduction is controversial. This study assesses the use of an anterior positioning splint with botulinum toxin in the lateral pterygoid muscle (BTX) for such cases.MethodsTwelve joints were included; groups I and II received BTX injection while group II also received an anterior positioning splint. Pain scores and clicking status were recorded at regular intervals then a postoperative MRI was done after 4 months.ResultsClinical improvement was noted in both groups. Mean pain scores dropped significantly and clicks in the twelve joints disappeared in 83% of group I and 33% of group II. MRIs showed significant disc position improvement with the higher mean change (1.33 ± 0.76) in group I.Group I showed better improvement of discal position and only one joint regained a click. Patients of group II reported discomfort from the splint which may have caused psychological distress and so worst pain scores.ConclusionsGroup I showed slightly better results but the cost of BTX injections and the complications of the splint should be kept in mind and the decision of treatment selection made according to each condition.
Highlights
Temporomandibular disorders (TMDs) are considered the second most common musculoskeletal condition causing pain and functional disability [1]
Emara et al used the same technique on a larger sample size and concluded that Botulinum toxin (BTX) injection in the lateral pterygoid muscle led to the disappearance of the joint clicking clinically and a significant improvement in the disc position when viewed on the magnetic resonance imaging (MRI) [8]
A published literature review concluded that BTX injection in the lateral pterygoid muscle reduced joint clicking and other TMD symptoms but added that blinded clinical trials assessing the effect of the BTX injection in the lateral pterygoid muscle are necessary [9]
Summary
Temporomandibular disorders (TMDs) are considered the second most common musculoskeletal condition causing pain and functional disability [1]. Emara et al used the same technique on a larger sample size and concluded that BTX injection in the lateral pterygoid muscle led to the disappearance of the joint clicking clinically and a significant improvement in the disc position when viewed on the magnetic resonance imaging (MRI) [8]. This supported the theory proposing the lateral pterygoid muscle’s responsibility for anterior TMJ disc displacement. This study aims to evaluate the efficacy of botulinum toxin type A injection into the lateral pterygoid muscle, with and without an anterior positioning splint in patients with anterior disc displacement with reduction
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